Page 641 - ACCCN's Critical Care Nursing

618 S P E C I A LT Y P R A C T I C E I N C R I T I C A L C A R E

Research vignette, Continued
number in this group or whether consideration should be given to of supervision, diagnostic accuracy, quality of documentation,
refining the role model and scope of practice. The role was also appropriateness of investigations, medications required and an
evaluated using a peer audit process of TENP documentation for area for comments. The TENPs were rated 6–9 for supervision
appropriateness and adherence to policy and guidelines. The requirements and 7–9 for diagnostic accuracy, documentation
audits examined components of history, examination, investiga- quality, medications required and investigations and pathology
tion, diagnostic interpretation, management plans, patient dis- ordered. Once again the exact number of surveys conducted was
position and patient referral. Audit scores ranged from 22–25 not reported and validation of the survey tool was not described.
(maximum possible audit score was 25). The number of documen- Unfortunately, patient satisfaction of the role, and representation
tation audits conducted was not stated, and an in-depth descrip- rates of patients treated by the TENPs, were not studied.
tion or validity testing of the audit tool were not discussed. The Overall, this paper detailed a framework and scope of practice for
latter is another topic of potential research.
the successful implementation of a TENP role. Other emergency
Evaluation also included a survey of the TENP work performance departments wishing to implement extended nursing practice
by 5 senior emergency physicians, using a 10-point scale (10 = roles could consider the implementation described here. The
minimal supervision required and/or patient management perfor- paper also supports the benefits, safety and success of the
mance by the TENP was appropriate). The survey examined levels extended nursing practice roles.

Learning activities

1. Review your department’s plan for the management of a 7. Are there specific antidotes for organophosphate poisoning?
potentially chemical-contaminated patient. Explain your answer.
2. Outline what PPE your department has available for staff use. 8. Outline the effects of atropine administration in the context of
3. Describe the routes by which organophosphates can be this poisoning. What are the endpoints for atropine therapy?
absorbed. 9. How does pralidoxime work?
4. In the case study, why did Maria have her clothing removed 10. Outline the preparation for the safe transport of critically
and then washed with soapy water before entering the ED? unwell patients. Consider in your response the patient’s condi-
5. Given the symptoms described for Maria, outline the musca- tion, the personnel required and the equipment.
rinic and nicotinic effects displayed with the poisoning in this 11. Maria’s family members requested to visit her during the initial
case study. management in the ED. How would you handle this request?
6. List the common acronyms outlining the muscarinic and nico-
tinic effects displayed with organophosphate poisoning.

ONLINE RESOURCES REFERENCES

American Emergency Nurses Association, http://www.ena.org 1. Pink N. Triage in the accident and emergency department. Aust Nurs J 1977;
Australasian College of Emergency Medicine, http://www.acem.org.au 6(9): 35–6.
Australian College of Emergency Nursing (ACEN), http://www.acenl.org.au 2. Australasian College for Emergency Medicine. National Triage Scale. Emerg
Australian Institute of Health and Welfare, http://www.aihw.gov.au Med 1994; 6(2): 245–6.
Australian Venom Research Unit, http://www.avru.org 3. Manchester Triage Group. Emergency triage. London: BMJ Publishing; 1997.
Clinical Toxinology Resources, Women’s and Children’s Hospital, Adelaide, http:// 4. Australasian College for Emergency Medicine. Australasian triage scale.
www.toxinology.com Emerg Med 2002; 14 (3): 335–6.
College of Emergency Nursing Australasia (CENA), http://www.cena.org.au 5. Whitby S. Australian Department of Health and Family Services, Liverpool
College of Emergency Nursing New Zealand (CENNZ), http://www. Health Service. Analysis of the process of triage: the use and outcome of the
emergencynurse.co.nz national triage. Canberra: Department of Health and Family Services; 1997.
Commonwealth Serum Laboratories (CSL) Antivenom Handbook eMedicine, 6. Kelly A, Richardson D. Training for the role of triage in Australasia. Emerg
http://www.emedicine.com Med 2001; 13 (2): 230–32.
Emergency Nursing World, http://enw.org 7. Commonwealth Department of Health and Family Services (CDHFS) and
National Asthma Council of Australia, http://www.nationalasthma.org.au the Australian College of Emergency Medicine. Australian national triage scale:
National Institute of Clinical Studies, Emergency Care Community of Practice a user’s manual. Canberra: CDHFS; 1997.
Project, http://www.nicsl.com.au 8. Kitt S. Emergency nursing: a physiological and clinical perspective, 2nd edn.
New Zealand Health Information Service, http://www.nzhis.govt.nz Philadelphia: WB Saunders; 1995.
New Zealand Ministry of Health, http://www.moh.govt.nz 9. McMahon M. ED triage: is a five level triage system the best? Am J Nurs 2003;
Poisons Information Australia, Phone: 131126. 103(3): 61–3.
Poisons Information New Zealand, Phone: 0800 POISON or 0800 764766. 10. College of Emergency Nursing Australasia. Position Statement Triage Nurse.
The Cochrane Library, http://acc.cochrane.org/ 2009. [Cited September 2010]. Available from: http://www.cena.org.au/
Best Bets, http://www.bestbets.org/ 11. Australian College of Emergency Medicine. Guidelines for implementation of
the Australasian Triage Scale in Emergency Departments. 2005. [Cited September
FURTHER READING 2010]. Available from: http://www.acem.org.au/media/policies_and_
guidelines/G24_Implementation_ATS.pdf
Greenland P, Hutchinson D, Park T. Irukandji syndrome: what nurses need to 12. Department of Health and Ageing (DHA). Emergency triage education kit.
know. Nurs Health Sci 2006; 8(1): 66–70. Canberra: DHA; 2007.