Improving triage accuracy through a modified nurse-administered emergency department assessment of chest pain score on patients with chest pain at triage (EDACT): A prospective observational study

BackgroundChest pain triage in our emergency department (ED) prioritize patients for consultation based on unstructured nursing gestalt. The Emergency Department Assessment of Chest Pain Score (EDACS) identifies patients at low-risk for major adverse cardiac events and may provide standardization for chest pain triage in ED.MethodsWe conducted a prospective observational study, including adult patients with chief complaint of chest pain who were self-conveyed. We aimed to evaluate the overall diagnostic performance of a modified EDACS in triaging these patients.ResultsData was collected over 6 weeks, with 284 patients included in the final analysis. Nursing gestalt had higher sensitivity (97.6%, 95% confidence interval [CI] 87.4% to 99.9% versus EDACS 45.2%, 95% CI 29.8% to 61.3%), while modified EDACS provided higher specificity (76.4%, 95% CI 70.6% to 81.6%, versus nursing gestalt 29.8%, 95% CI 24.1% to 35.9%). EDACS with electrocardiogram had significantly better area under the receiver operating characteristic curve statistic (0.712; 95% CI 0.631 to 0.793) than EDACS alone (0.608; 95% CI 0.528 to 0.689) and nursing gestalt (0.637; 95% CI 0.600 to 0.674) (p = 0.0324).ConclusionsFurther studies should explore if modified EDACS, together with nursing gestalt, can improve triage accuracy for ED patients with chest pain.     

The impact of covid-19 on psychosocial well-being and learning for australian nursing and midwifery undergraduate students: a cross-sectional survey

AimTo explore the impact of COVID-19 on psychosocial well-being and learning for nursing and midwifery undergraduate students in an Australian university.BackgroundThe World Health Organization has reported a substantial psychological impact of COVID-19 on healthcare professionals to date. Evidence is lacking, however, regarding university nursing and midwifery students of the pandemic and its impact on their educational preparation and/or clinical placement during the COVID-19 pandemic.DesignCross-sectional survey of nursing and midwifery undergraduate students enrolled in the Bachelor of Nursing suite of courses from the study institution in August- September 2020.MethodsA cross-sectional self-administered anonymous online survey was distributed to current nursing and midwifery undergraduate students. The survey included three open-ended questions; responses were thematically analysed.ResultsOf 2907 students invited, 637 (22%) responded with 288 of the respondents (45%) providing a response to at least one of the three open-ended questions. Three major themes associated with the impact of the pandemic on psychosocial well-being and learning were identified: psychosocial impact of the pandemic, adjustment to new modes of teaching and learning, and concerns about course progression and career. These themes were underpinned by lack of motivation to study, feeling isolated, and experiencing stress and anxiety that impacted on students’ well-being and their ability to learn and study.ConclusionsStudents were appreciative of different and flexible teaching modes that allowed them to balance their study, family, and employment responsibilities. Support from academic staff and clinical facilitators/mentors combined with clear and timely communication of risk management related to personal protective equipment (PPE) in a healthcare facility, were reported to reduce students’ stress and anxiety. Ways to support and maintain motivation among undergraduate nursing and midwifery students are needed.     

Recreational runners with Achilles tendinopathy have clinically detectable impairments: A case-control study

ObjectivesTo confirm what impairments are present in runners with Achilles tendinopathy (AT) and explore the variance of AT severity in an adequately powered study.DesignCase-control study.SettingTwo private physiotherapy clinics in Australia and Spain.ParticipantsForty-four recreational male runners with AT and 44 healthy controls matched by age, height, and weight.Main outcome measuresDemographics, activity (IPAQ-SF), pain and function (VISA-A), pain during hopping (Hop pain VAS), hopping duration, psychological factors (TSK-11, PASS20), and physical tests regarding lower-limb maximal strength and endurance.ResultsBody mass index (BMI), activity, VISA-A, pain, and duration of hopping, TSK-11, PASS20, standing heel raise to failure, seated heel raise and leg extension 6RM, hip extension and abduction isometric torque were significantly different between groups (P < 0.05) with varied effect sizes (V = 0.22, d range = 0.05–4.18). 46% of AT severity variance was explained by higher BMI (β = −0.41; p = 0.001), weaker leg curl 6RM (β = 0.32; p = 0.009), and higher pain during hopping (β = −0.43; p = 0.001).ConclusionRunners with AT had lower activity levels, lower soleus strength, and were less tall. BMI, pain during hopping, and leg curl strength explained condition severity. This information, identified with clinically applicable tools, may guide clinical assessment, and inform intervention development.     

护士应用体外膜肺氧合技术核心能力评价指标的构建

目的 构建一套科学、系统的护士应用体外膜肺氧合（extracorporeal membrane oxygenation,ECMO）技术的核心能力评价指标,为护士的培养、考核和能力评价提供参考依据。 方法 通过文献回顾、半结构式访谈形成护士应用ECMO技术核心能力评价指标初稿,2021年2月—4月,采用德尔菲法对6个省份的25名专家进行问卷函询,运用层次分析法确定各级指标权重。 结果 共开展2轮函询,问卷有效回收率分别为90.00%、92.59%,第2轮函询专家的权威系数为0.886,肯德尔和谐系数为0.205（P<0.001）。最终构建的评价指标包括临床专业知识、临床实践技能、评判性思维能力、专业发展能力、沟通协调能力、管理能力、个人特质7个一级指标、19个二级指标、70个三级指标。 结论 构建的护士应用ECMO技术核心能力评价指标具有较高的科学性和可靠性,对护士的培养、考核和能力评价具有指导意义。     

Return to Work Self-Efficacy (RTWSE-19) Assessment for Patients with Acute Work-Related Low Back Pain

Nurse practitioners (NPs) often see patients with occupational back pain. Research indicates that hesitation to return to work (RTW) is largely due to perceptions of being unable to resume job tasks or meet expectations. This pilot study evaluates whether the Return-to-Work Self-Efficacy–19 (RTWSE-19) questionnaire, which has been used for injuries at other anatomical sites, is appropriate for lower back pain. The RTWSE-19 was administered to 30 patients who presented with a complaint of an acute work-related back pain; however, it was found to be nonpredictive of RTW, suggesting that NPs should identify other tools to assess their patients’ ability to RTW.