Integrating Nurse Practitioner–Led Mental Health Care in Emergency Departments

Responding to the growing number of people presenting to emergency departments (EDs) with mental health, substance use, and behavioral concerns is a significant clinical challenge. Traditionally, EDs have relied on segregated and in-reach models, usually funded by mental health services and focused primarily on providing EDs with “mental health assessments.” This is no longer adequate for facilitating prompt therapeutic care, reducing ED length of stay, and supporting ED staff. This brief report summarizes key findings from a multisite study conducted in New South Wales, Australia, implementing and evaluating a nurse practitioner–led mental health liaison nurse service based in the ED.     

Nurses’ provision of spiritual care in the Emergency Setting – An Irish Perspective

BackgroundThe researcher’s interest in spiritual care arose during clinical experience in an emergency department. Over a 10-year period, I have observed, that in midst of a busy and increasingly overcrowded setting, nurses find time to provide spiritual care. Although this dimension of nursing practice is not explicitly labelled as spiritual care, it is apparent that interventions such as active listening, touch and ultimately connecting with the patient has, on most occasions, positive effects on the patient’s spiritual dimension. Subsequently, this has provided the momentum to carry out a study on how nurses provide spiritual care, in an emergency setting. The findings revealed that participants regarded spiritual care to be an integral component of their role. In addition, participants reported that they derived positive personal outcomes from providing this aspect of nursing care. Nevertheless, although most participants would argue that spiritual care is central to nursing practice, concerns were expressed with regard to its provision, in the emergency setting.     

Nurse Practitioner–Led Retrograde Ejaculation Management Can Help Optimize Integration of Care

Retrograde ejaculation of semen is a physiological disorder induced by a range of health conditions, many commonly prescribed medications, and acute or chronic stress. Its increasing frequency and its impact on the fertility and the psychosexual health of couples may easily be missed because of its subtle and very personal and difficult to discuss nature. Nurse practitioners, with their frequent contact with both partners and their knowledge of the couple’s history, have the clinical acumen and empathic counseling skills necessary to facilitate this diagnosis and play a vital role in the integrated long-term management of this distressing condition.     

Using the lens of enablement to explore patients’ experiences of Nurse Practitioner care in the Primary Health Care setting

Background

Patient enablement is a patient-centred concept reflecting a patient’s ability to cope, understand and manage their own health. It can be used as a measure of the quality of care and has been linked with improved patient outcomes. While there have been studies into patient enablement following consultations with General Practitioners (GPs) and practice nurses, Nurse Practitioners’ (NPs) role in enabling patients remains unexplored.

Patient-Centered Homes and Integrated Behavioral Health Care: Reclaiming the Role of “Consultant” for Psychiatric-Mental Health Nurse Practitioner

The notion of patient-centered care has long been linked with nursing practice since Florence Nightingale. The discipline of nursing is focused on the holistic care of individuals, families, and communities in times of sickness and/or health. However, in psychiatric-mental health nursing, the concepts of mental health and psychiatric illness still remain marginalized in our health care delivery systems, as well as in nursing education, knowledge development, and practice. Even with the concept of patient-centered homes, acute and primary care providers are reluctant to embrace care of those with psychiatric illness in their respective settings. Psychiatric illness was and continues to be in the shadows, hidden and often ignored by the larger community as well as by health care providers. This paper describes a Health Resources Services Administration (HRSA) Advanced Nursing Education (ANE) training grant's objective of reintegrating psychiatric-mental health practice into ALL health care delivery systems using the concept of patient-centered nursing care as a foundation for, and promotion of, the Psychiatric-Mental Health Nurse Practitioner (PMH-NP) as the “navigator” for not only the patients and their families, but also for their acute and primary care colleagues using an Interprofessional Education Model. The major barriers and lessons learned from this project as well as the need for psychiatric-mental health nurses to reclaim their role as a consultant/liaison in acute, primary, and long-term care settings will be discussed. The PMHNP as a consultant/liaison is being revitalized as an innovative advanced practice nursing health care model in North Carolina.     

Evaluation of an Emergency Medical Services–Based Social Services Referral Program for Elderly Patients

Objective. To describe the preliminary experience of an emergency medical services (EMS)-based follow-up program providing elderly patients access to community-based social services. Methods: This was a retrospective, case series report. Inclusion criteria were adults aged 60 years and older requesting EMS for fall or lift assist; against medical advice (AMA) refusal of transport for a medical complaint; any social service or home care needs; request for nonmedical transportation; multiple prior EMS visits; or cases of elder abuse or neglect. Patients were identified either by paramedics at the time of the call or an EMS physician during routine chart review of “no-transport” calls. Patients were then contacted and offered referral follow-up with a social services worker. Data were collected for age, gender, presence of established social services, referral strategy, complaint type, referral acceptance rate, and follow-up plan. Results: Seventy patients were referred over eight months. Paramedics provided 33% of referrals (23/70) as well as a significantly higher number of social service–related complaints (48% vs. 15%, p = 0.005). Follow-up from a fall occurred more often after EMS physician chart review (53% vs. 30%, p = 0.07). Rates of established social services were similar for patients who accepted and those who declined follow-up (89% vs. 90%, p = 0.95) and between patients who were referred by paramedics and those who were referred by EMS physicians (93% vs. 90%, p = 0.72). Paramedic referral was associated with a significantly higher rate of acceptance (94% vs. 28%, p < 0.001). Conclusion: EMS provides an invaluable opportunity to connect the elderly with social services at the time of contact. In this study, paramedics appeared to refer more social service–related complaints compared with other categories such as fall assistance. This highlights a difference in perception of social service needs among paramedics and represents an area for further training and education.     

Posttraumatic stress disorder in close Relatives of Intensive Care unit patients’ Evaluation (PRICE) study

BackgroundThere is a high risk of post-traumatic stress disorder (PTSD) in relatives of intensive care unit (ICU) patients.AimsTo determine the prevalence and predictors of symptoms of PTSD in relatives of an Australian critically ill population.Methods108 consecutive patients staying >48 h in a mixed, level three ICU were identified. On day three of admission, their next-of-kin were contacted and consent obtained for a telephonic questionnaire to be done at 90 days after ICU discharge. This consisted of the Hospital Anxiety and Depression Scale and the Impact of Event Scale-Revised (IES-R) questionnaires administered to relatives at 90 days post-discharge from the ICU. An IES-R score of >26 was used to define PTSD symptoms.ResultsEight subjects were excluded because the next-of-kin details were unavailable. 37 other subjects refused to participate. Out of a total of 108, 63 family members were included, including 49 next-of-kin of patients who survived. The prevalence of PTSD symptoms was 41.2% (26/63, 95% CI 29.0–54.4%). The anxiety score was found to be a predictor of PTSD symptoms (relative risk = 1.07; 95% CI 1.00–1.14, p = 0.05).ConclusionThere is a high prevalence of PTSD symptoms in next-of-kin of Australian patients admitted to the ICU. High anxiety scores were a predictor for developing PTSD symptoms.     

Evaluation of new antiemetic agents and definition of antineoplastic agent emetogenicity—an update

Development of effective antiemetic therapy depends upon an understanding of both the antiemetic agents and the emetogenic challenges these agents are designed to address. New potential antiemetic agents should be studied in an orderly manner, proceeding from phase I to phase II open-label trials and then to randomized double-blind phase III trials comparing new agents and regimens to best standard therapy. Use of placebos in place of antiemetic therapy against highly or moderately emetogenic chemotherapy is unacceptable. Nausea and vomiting should be evaluated separately and for both the acute and delayed periods. Defining the emetogenicity of new antineoplastic agents is a challenge, since such data are often not reliably recorded during early drug development. A four-level classification system is proposed for emetogenicity of intravenous antineoplastic agents. A separate four-level classification system for emetogenicity of oral antineoplastic agents, which are often given over an extended period of time, is also proposed.     

Evaluation and management of decompression illness—an intensivist’s perspective

Decompression illness (DCI) is becoming more prevalent as more people engage in activities involving extreme pressure environments such as recreational scuba-diving. Rapid diagnosis and treatment offer these patients the best chance of survival with minimal sequelae. It is thus important that critical care physicians are able to evaluate and diagnose the signs and symptoms of DCI. The cornerstones of current treatment include the administration of hyperbaric oxygen and adjunctive therapies such as hydration and medications. However, managing patients in a hyperbaric environment does present additional challenges with respect to the particular demands of critical care medicine in an altered pressure environment. This article reviews the underlying pathophysiology, clinical presentation and therapeutic options available to treat DCI, from the intensivists perspective.     

Capnocytophaga canimorsus: An Emerging Pathogen in Immunocompetent Patients—Experience from an Emergency Department

Background

Capnocytophaga canimorsus is a bacterium of the normal oral flora of dogs and cats. Human infection is caused by animal bite but is rarely observed, mainly in immunocompromised patients. We present 2 cases of C. canimorsus infection that occurred in immunocompetent patients and caused multiorgan failure and in both cases severe neurologic involvement.

Evaluation of an Acetic Acid—Sulphuric Acid Method for Quantitative Determination of Cholesterol in Serum

Abstract

Background: Cutaneous carbon dioxide tension (PcCO₂) is a promising non-invasive surrogate measure of arterial partial pressure of carbon dioxide (PaCO₂). Objectives: To compare values of PcCO₂ and oxygen saturation (SpO₂) with arterial blood gas (ABG) analysis. Methods: SpO₂ and PcCO₂ were measured with a v-Sign?-sensor (Sentec AG, Therwil, Switzerland) and the values compared with simultaneously obtained SaO₂ and PaCO₂ obtained from ABG analysis (ABL 725, Radiometer, Copenhagen, Denmark) in 275 adult patients referred to the lung function laboratory. Results: Median of the PcCO₂ was 4.7 kPa (interquartile range [IQR] 0.9 kPa). Median of the SpO₂ was 97% (IQR 3%). Bland-Altman analysis for comparison of PcCO₂ with PaCO₂ showed a bias of ?0.1 kPa with a precision of ± 0.9 kPa with 3.7% outlying values. Bland-Altman analysis for the comparison of SpO₂ and SaO₂ showed a bias of 20.1 % with a precision of ± 3.5%. There were no complications. Conclusion: There is a good agreement between combined cutaneous capnography and oximetry values with ABG analysis. Due to the excellent safety profile and the short time to get a continuous measurement, this technique should be examined in settings where it can complement repeated ABG analysis when ventilatory disturbances are suspected or non-invasive monitoring of ventilation is needed.     

Prevalence of QTc Prolongation in Patients With Advanced Cancer Receiving Palliative Care—A Cause for Concern?

ContextMedications commonly used for symptom control along with other known risk factors have the potential to prolong ventricular repolarization as measured by the QT interval (the time from the start of the Q wave to the end of the T wave) on a standard electrocardiogram (ECG).ObjectivesTo document the prevalence of a prolonged QT interval corrected for heart rate (QTc) interval in the palliative/oncology setting, compare automatic ECG QTc measurements with manual readings and identify any correlation between QTc prolongation and the use of drugs or other risk factors.MethodsA convenience sample of consecutive patients with cancer, admitted under or known to the palliative/supportive care teams in two metropolitan hospitals, and willing to provide an ECG recording and basic demographic information including QTc risk factors were included. Both automated and manually calculated QTc intervals were recorded. Multivariable analysis was used to determine risk factors independently associated with prolonged QTc intervals.ResultsOf the 389 participants, there was a significant difference in mean QTc between sites using automated but not manual calculations. Manual readings were therefore used with predetermined cutoffs of 0.44 seconds (males) and 0.46 seconds (females). Seventy-two (18.5%) of the participants had a prolonged QTc with six (1.5%) having a prolongation of >0.50 seconds. At-risk drugs were being taken by 218 participants (56.0% of total cohort). Factors shown to be associated with QTc prolongation included age, gender, performance status, and hypocalcemia. No specific medication was associated with increased risk.ConclusionAlthough almost 20% of patients receiving palliative care had prolongation of QTc, the possibility of serious consequences appeared to be low despite the frequent occurrence of risk factors.