Article Summary 1

Jenna Horgan

St Thomas University

NUR 416

Professor Henriquez

January 17, 2022

Article 1 Summary

Article: Kelen, G. D., Wolfe, R., D’Onofrio, G., Mills, A. M., Diercks, D., Stern, S. A., Wadman, M. C., & Sokolove, P. E. (2021). Emergency department crowding: the canary in the health care system. NEJM Catalyst.

Eight certified medical practitioners from assorted medical centers across the US wrote this peer-reviewed article. It describes the dangers posed by overcrowding in the countless emergency room departments across the country. Based on their research findings, this problem has grown increasingly dismal due to the pandemic. The article reveals that different factors cause emergency room crowding. These include health system concerns, emergency room factors, hospital-related factors, and output factors.

The health system-related factors contributing to emergency room problems include the reduced inpatient capacity in hospitals and the lack of access to inpatient and outpatient psychiatric services. Many citizens also lack access to underinsurance, which increases preventable visits to emergency room departments. Emergency-room-related factors that cause overcrowding include the lack of flexible schedules, which enable the medical practitioners to create time slots for different patients. Overcrowding is also caused by the tendency to use emergency rooms as stations to process ‘elective’ admission patients.

Hospital-related factors that cause hospitals’ overcrowding include the lack of adequate structures to deal with demand. For instance, many hospitals are not equipped to handle the type of 24/7 demand that the pandemic has occasioned. This demand also causes crisis fatigue in emergency room medical practitioners, who then slow down when processing patients. Output factors that facilitate overcrowding include the lack of adequate facilities which provide end-of-life healthcare services and the lack of training for emergency room workers.

Based on this article, institutional leaders have to work alongside elected officials and insurers to ratify disaster protocols that cater to the needs of emergency areas. Politicians have to mandate regulations that allocate financial incentives to meet training needs and fund the construction of new healthcare facilities.

Reference

Kelen, G. D., Wolfe, R., D’Onofrio, G., Mills, A. M., Diercks, D., Stern, S. A., Wadman, M. C., & Sokolove, P. E. (2021). Emergency department crowding: the canary in the health care system. The New England Journal of Medicine– NEJM Catalyst.

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Article Summary 2

Jenna Horgan

St Thomas University

NUR 416

Professor Henriquez

January 24, 2022

Article Summary

There have been several research studies carried out on emergency medicine. These studies aim to discuss the effectiveness, implications, or the use of emergency medicine in healthcare. One of the research studies on emergency medicine is the article "augmented reality in emergency medicine." This essay aims to discuss the study type of this study, its purpose, research questions, and its summary.

Munzer et al. (2019) conducted a literature review of 24 articles related to augmented reality in emergency medication. The articles that the authors used were obtained from Scopus, MEDLINE, and Embase databases. The author determined that augmented reality has utility and feasibility as an emergency medication that can be used to deliver care to patients. The authors also determined that it can also be used in education and the training of emergency care providers. According to Munzer et al. (2019), augmented reality can also be used in telehealth because it is feasible to offer care over distances. The type of study used in the article by Munzer et al. (2019) is a systematic review where the authors carried out a literature review of medical and non-medical journals on augmented reality. Systematic reviews entail the evaluation and assessment of research studies carried out on a particular issue (Munn et al., 2018). In this case, the authors reviewed 24 articles that are related to the use of augmented reality in emergency medicine. The purpose of the study by Munzer et al. (2019) was to carry out a review of current literature on the application of augmented reality in emergency medicine. The study's research question was; what is the applicability of augmented reality to training and delivery of care in the context of emergency medicine?

The article which was selected for this assignment is augmented reality in emergency medicine. The purpose of the research was to determine the applicability of augmented reality in emergency medicine. The authors used a systematic review where 24 articles were literature reviewed.

References

Munzer, B. W., Khan, M. M., Shipman, B., & Mahajan, P. (2019). Augmented reality in emergency medicine: a scoping review. Journal of medical Internet research, 21(4), e12368.

Munn, Z., Peters, M. D., Stern, C., Tufanaru, C., McArthur, A., & Aromataris, E. (2018). Systematic review or scoping review? Guidance for authors when choosing between a systematic or scoping review approach. BMC medical research methodology, 18(1), 1-7.

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Emergency Care Article Summary 3

Jenna Horgan

Professor Henriquez

St Thomas University

January 31, 2022

Recommendations for emergency department caring for persons with opioid use and opioid use disorders aim at providing utmost clinical guidance for healthcare nurses dealing with the undertreated and stigmatized population. This is achieved by integrated research that focuses on treating adults using opioid agonist-antagonist medicines in the emergency department (Munn, 2018). The process of Opioid care starts by identifying the risks associated with opioid use, implementing the applied strategies, and then conducting a possible follow-up to monitor the opioid use (Bell, 2020).

The recommendations provided are helpful for nurses to facilitate changes in healthcare systems and manage proper care of individuals with opioid use, withdrawal, and the risks of opioid overdose (Bell, 2020). For instance, individuals with a high risk for opioids do not qualify for opioid use disorder. Thus, determining the treatment resources available in the emergency department is essential. The responsibility of emergency nurses is to advocate for the establishment of treatment and facility partnership programs for efficient care linkage and coordination. They also engage in discussions and problem-solving processes with other care professionals and patients to identify and remove referral acceptance barriers.

Notably, emergency departments are ideal settings purposely to address opioid crises. Therefore, emergency care departments play a significant role in providing suitable treatment and interventions for individuals suspected of using opioids. Although most individuals use opioid medicines related to community-based approaches, they need a referral to emergency care. Many emergency care departments utilize the screening brief method and referral treatment approach to provide opioid treatment hence acting as an example to other related departments (Munn, 2018). As a result, their approach is widely adopted to save more lives in other departments.

References

Bell, C. A. F., & McCurry, M. (2020). Opioid use disorder education for acute care nurses: An integrative review. Journal of Clinical Nursing, 29(17-18), 3122-3135.

Munn, Z., Peters, M. D., Stern, C., Tufanaru, C., McArthur, A., & Aromataris, E. (2018). Systematic review or scoping review? Guidance for authors when choosing between a systematic or scoping review approach. BMC medical research methodology, 18(1), 1-7.

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Running head: NURSING ARTICLE REVIEW 2

NURSING ARTICLE REVIEW 2

Nursing Article Review

Jenna Horgan

St Thomas University

NUR 416

Professor Henriquez

February 2, 2022

The area of clinical practice is family nursing, and it involves the assessment of the family members’ physical; and psychological health and well-being. It assesses the ability of the family to offer care and support to the client where appropriate. One of the major concerns while working in this area has been the growth of the childhood obesity rate. As a family nurse, it is a personal responsibility to ensure that parents and children are assisted in preventing the risk of exposure to childhood obesity and early screening process (Lloyd et al., 2018). The family members must also be educated on managing children who are already diagnosed with obesity by watching their diet and involvement in physical exercises, among other interventions.

Lidgate et al. (2018) collected data on human behavior to help in understanding why and how decisions are made. This was qualitative research that involved four in-depth focus groups using 14 participants, i.e., seven informal caregivers and seven parents. The authors explored experiences of both parents and the informal caregivers when it comes to giving and receiving the informal childcare for British children of age 0-5 years, their apparent reasons of the connections between obesity amongst children and the informal; childcare. and the favored solution thoughts and delivery approaches for the prevention of childhood obesity under the informal care. Based on the outcome of this study, there was a perception that informal care leads to childhood obesity through cross-generation conflict; the reduction in the energy ability of the cares; and the increase in snacking (Lidgate & Lindenmeyer, 2018). Therefore, the authors highlighted the need to ensure that there is the use of the present primary care platforms like the health visits and check-ups to help in reaching and delivering the cheaper information-based solution to children of age between 0 to 5 years who are receiving the informal care.

References

Lidgate, E. D., & Lindenmeyer, A. (2018). Qualitative insight into informal childcare and childhood obesity in children aged 0–5 years in the UK. BMC Public Health, 18, 1229. https://doi.org/10.1186/s12889-018-6131-0

Lloyd, J., CStat, C. S., Logan, S., Green, C., Dean, S., Hillsdon, M., Abraham, C., Tomlinson, R., Pearson, V., Taylor, R., Ryan, E., Price, L., Streeter, A., Wyatt, K., & Wyatt, K. (2018). Effectiveness of the Healthy Lifestyles Programme (HeLP) to prevent obesity in UK primary-school children: a cluster randomized controlled trial. The Lancet Child & Adolescent Health, 2(1), 35-45. https://doi.org/10.1016/S2352-4642(17)30151-7

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Module 5 Article Summary

Jenna Horgan

St Thomas University

NUR 416

Professor Henriquez

February 20, 2022

Module 5 Article Summary

Background of the study

The quality of healthcare services is crucial in gynecological laparoscopic surgery. Multimodal rehabilitation permits optimal recovery in surgery patients by lowering hospital stays. Prevention procedures after surgery curb wound infections. Pre-surgical education and reeducation play a significant role in alleviating doubts over the introduction of surgery protocols. Various guidelines for gynecological surgery have been published based on retrospective studies (Boitano et al., 2018). Thus there was a need for investigating enhanced recovery after surgery protocol (ERAS) using a prospective approach.

Study Type

A prospective cohort study was used and involved 90 participants in the hospital setting between 2017 and 2019. The inclusion criteria include patients scheduled for laparoscopic hysterectomy from non-recurrent causes (Jimenez et al., 2021). The exclusion criteria were for patient with an ASA score of > II. The data collection involved a multidisciplinary team such as nurses, anesthesiologists and gynecologists.

Purpose

The study aim was to assess the implementation of enhanced recovery after surgery protocol (ERAS) for laparoscopic hysterectomy patients. Other goals were to assess the influence of ERAS protocol on postoperative stay, readmission, and morbidity and to evaluate adherence to ERAS protocols (Jimenez et al., 2021).

Research questions

The research questions include:

· Does the implementation of ERAS protocols in gynecological laparoscopic surgery reduce hospital stays with increasing complications associated with surgery?

· What are the challenges associated with the ERAS implementation protocols?

· How does patient adherence to ERAS protocol affect the readmission rates in patients who have undergone gynecological laparoscopic surgery?

Conclusion

The study revealed that the ERAS protocol implementation was feasible in gynecological laparoscopic surgery. It was an option that reduced the hospital stays devoid of increasing the readmission rates and after surgery complications.

References

Jimenez, J. C. V., Serrano, B. T., Muñoz, E. V., Pérez, B. S., & Jimenez Lopez, J. S. (2021). New surgical realities: implementation of an enhanced recovery after surgery protocol for gynecological laparoscopy—a prospective study. Perioperative Medicine, 10(1), 1-6. https://perioperativemedicinejournal.biomedcentral.com/articles/10.1186/s13741-021-00221-4

Boitano, T. K., Smith, H. J., Rushton, T., Johnston, M. C., Lawson, P., Leath III, C. A., … & Straughn Jr, J. M. (2018). Impact of enhanced recovery after surgery (ERAS) protocol on gastrointestinal function in gynecologic oncology patients undergoing laparotomy. Gynecologic Oncology, 151(2), 282-286. https://www.sciencedirect.com/science/article/abs/pii/S0090825818312204

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Module 6 Article Summary

Jenna Horgan

St Thomas University

NUR 416

Professor Henriquez

February 27, 2022

Study Background

The routine use of opioids during anesthesia in laparoscopy is contributing to the opioid crisis. In recent years opioid-free anesthesia (OFA) has been embraced using dexmedetomidine for surgeries like laparoscopic cholecystectomy (Mulier, 2019). Risks of operative pain and nausea are high when using OFA, posing risks of delayed recovery. The quality of Recovery -40 (QoR-40) questionnaires assesses recovery from anesthesia, and many studies have used it to investigate recovery. However, no study exists about using QoR-40to to determine better effects of OFA than general anesthesia (Song et al., 2021).

Study Type

A prospective clinical controlled trial was used, and it involved patients who received OFA (either lidocaine or dexmedetomidine). The participants were patients between 20-65 years planned for gynecological laparoscopy and received patient-controlled analgesia (Song et al., 2021). The exclusion criteria include patients with pregnancy, hypotension, emergency surgery and refusal of study participation. The participants randomly received standard general anesthesia for the control group or OFA at a 1.1 ratio allocation, and the nurses in the care unit were unaware of the group allocation. The laparoscopy was performed with video guidance, and the patient was constantly monitored for pain.

Purpose

The study aim was to examine the effects of opioid-free anesthesia using lidocaine and dexmedetomidine on recovery from gynecological laparoscopy. The other objective was to determine the feasibility of opioid-free anesthesia (OFA) for gynecological laparoscopy (Song et al., 2021).

Research Questions

The research questions include:

· Does OFA during the postoperative period improve clinical outcomes like shivering and postoperative pain, which might contribute to better recovery?

· What are the effects of a combination of lidocaine and dexmedetomidine on the recovery quality after gynecological laparoscopy compared to standard general anesthesia?

Conclusion

The study provides clinical and scientific evidence on the feasibility of opioid-free anesthesia in gynecological laparoscopy. The information is suitable for nurses, anesthetists and surgeons doing gynecological laparoscopy, as the need for OFA to deal with the opioid crisis keep increasing.

References

Mulier, J. P. (2019). Is opioid-free general anesthesia for breast and gynecological surgery a viable option?. Current Opinion in Anesthesiology, 32(3), 257-262. https://journals.lww.com/co-anesthesiology/Abstract/2019/06000/Is_opioid_free_general_anesthesia_for_breast_and.2.aspx

Song, J. Y., Choi, H., Chae, M., Ko, J., & Moon, Y. E. (2021). The effect of opioid-free anesthesia on the quality of recovery after gynecological laparoscopy: study protocol for a prospective randomized controlled trial. Trials, 22(1), 1-8. https://trialsjournal.biomedcentral.com/articles/10.1186/s13063-021-05166-z

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