Fall 2002 - NENA.ca

Volume 25, Number 2, Fall 2002

In This Issue:Conference watch . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2President’s message . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4Certification report . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4Were you aware? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 52002 annual report submitted to CNA . . . . . . . . . . . . . . . . . 5National trauma committee report . . . . . . . . . . . . . . . . . . . 6NENA 2000-2001 year-end financial report . . . . . . . . . . . . . 6Did you know? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7NENA biography . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7Letters to the editor . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7The Ontario report: FYI across the country. . . . . . . . . . . . . . 8Confessions from theCommunication Officer - the NENA website. . . . . . . . . . . 8New Brunswick report- the 2002 regional conference. . . . . . . . . . . . . . . . . . . . . . 9NENA’s “Win a trip to thenational conference” contest rules . . . . . . . . . . . . . . . . . . 9Bouquets . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10Position statement - Family presence duringresuscitation and invasive procedures. . . . . . . . . . . . . . . 11Outlook guidelines for submission . . . . . . . . . . . . . . . . . . . . 11Position statement - Use of non-registered nurses ashealth care providers in the emergency department. . 12Websites of interest . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12The NENA Bursary. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13The NENA Awards of Excellence . . . . . . . . . . . . . . . . . . . . . 15Pediatrics: Changing how we care for kids:Research in a pediatric ED. . . . . . . . . . . . . . . . . . . . . . . . . . 18Research Corner: Evidence-based nursing:Blending the art and science . . . . . . . . . . . . . . . . . . . . . . . 19Trauma Corner: Injury is no accident . . . . . . . . . . . . . . . . . 23Canadian Triage and Acuity Scale- Rural implementation . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24CTAS level five protocol . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25The Best That I Can Be . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26Advocacy and the mental health client . . . . . . . . . . . . . . 26

Outlook 2 • 25-2 • Fall 2002

Emergency Nursing ConferenceSponsored by The Emergency Nurses Interest Group of AlbertaOctober 4-6, 2002, Delta Lodge at Kananaskis, Kananaskis Country in the Rocky Mountains.For more information contact: Shelly Anderson: [email protected] or Pam Little: [email protected]

Resolving Conflict in Health CareAn intensive, interactive conflict resolution workshop presented by mediate.calmOctober 15-17, 2002, The University Club, Dalhousie University, Halifax, Nova Scotia. The full three-day workshop thatwas so successful in Toronto earlier this year is presented immediately prior to the three-day Medical Error Symposiumat Dalhousie University. For more information visit and register on-line: www.mediatecalm.ca

Mind, Body and Soul - Supporting rejuvenation of all health care providersOctober 17, 2002, 0900-1600 hours. Presented by NBENA Saint John Chapter, NBENA. Cost $30.00For further information, contact: Lois Moore or Rose McKenna at (506) 648-6900 or [email protected]

10th annual EMS Development Symposium - EMS- Past, Present and FutureOctober 17-19, 2002, Saint John Regional Hospital, Saint John, NBFor further information contact: website: www.ahsc.health.nb.ca/ems, voice mail: (506) 642-3688 or fax: (506) 652-6430

The Second Halifax Symposium on Health Care ErrorOctober 18-20, 2002, The University Club, Dalhousie University, Halifax, Nova Scotia. Sponsored and organized byCapital Health. For more information contact: Sherri Lamont, Symposium Coordinator: [email protected]

Pediatric Emergency Care 2002A two-day conference for Atlantic Canadian front line health care providers: physicians, nurses, crisis/social workers,house staff and paramedics, sponsored by the Emergency Department Education Committee, IWK Health Care CentreOctober 24-25, 2002, OE Smith Auditorium, IWK Health Centre, Halifax, NS. For more information contact: EricaThomas (902) 470-8823, fax: (902) 470-7248, or e-mail: [email protected]

2003 Nursing Leadership ConferenceFebruary 10-11, 2003, Crowne Plaza, Ottawa, OntarioThe Academy of Canadian Executive Nurses, the Canadian Association of University Schools of Nursing, the CanadianCollege of Health Service Executives, the Canadian Healthcare Association, the Canadian Nurses Association and theCanadian Public Health Association are pleased to issue this Call for Abstracts for the 2003 Nursing LeadershipConference. Nursing requires strong, consistent and knowledgeable leaders who can inspire others, are visible, haveorganizational awareness and can support professional nursing practice. Leadership plays a pivotal role in the lives ofregistered nurses and is essential to ensure quality professional practice environments and quality client outcomes, basedon evidence. This two-day conference is organized into the following three streams and will provide the opportunities tohear, learn and share how nurse leaders are:• Building Professional Practice Environments• Building Primary Health Care• Promoting Evidence-based PracticeSecretariat Contact Information:2003 Nursing Leadership Conference, 50 Driveway, Ottawa ON K2P 1E2,e-mail: [email protected],(800) 361-8404 (x219) or (613) 237-2133 (x219)

Emergency Nursing – “A Kaleidoscope”National Emergency Nurses Conference, sponsored by Saskatchewan Emergency Nurses GroupMay 3-4, 2003, Regina, SaskatchewanFor more information or to request a brochure contact: National Conference Publicity Chairperson, EmergencyDepartment, Pasqua Hospital, 4101 Dewdney Ave., Regina, SK S4T 1A5

Conference watch

Fall 2002 • 25-2 • Outlook 3

NENA elected executivePresidentAnne Cessford, 12555 19th AvenueSurrey, BC, V4A 9P1(H) 604 541-7830;fax: 604 585-5679;e-mail: [email protected] Policicchio, 4712 White Road,Edmonton, AB, T6H 5M3(H) 780 434-5119; (W) 780 472-5116;fax: 780 472-5191; pager 780 445-2083;e-mail: [email protected] Calnan, 1500 Burnside Road West,RR#3, Victoria, BC, V8X 3X1(H) 250 727-2795; (W) 250 727-4181;fax: 250 744-5939;e-mail: [email protected] Bell, 10 Laval DriveRegina, SK S4V 0H1(H) 306 522-6295; (W) 306 766-2238;pager: 306 565-5757; fax: 306 766-2770;e-mail: [email protected] OfficerValerie Eden, 34 Bow StreetDartmouth, NS B2Y 4P6(H) 902 461-1897; (W) 902 465-8340;fax: 902 465-8435;e-mail: [email protected]

Provincial representativesBritish ColumbiaClay Gillrie, 106 West 12th AvenueVancouver, BC V5Y 1T7(H) 604 874-8185; (W) 604 456-8021e-mail: [email protected] Policicchio, 4712 White RoadEdmonton, AB T6H 5M3(H) 780 434-5119; (W) 780 472-5116;fax: 780 472-5191; pager: 780 445-2083;e-mail: [email protected] Lawson, 314 Hansen DriveRegina, SK S4X 3B8(H) 306 543-3623; (W) 306 766-2362;fax: 306 766-2770;e-mail: [email protected]

ManitobaAngela Bachynski, 177 Saul Miller DriveWinnipeg, MB R2V 3W4(H) 204 334-6929; (W) 204 661-7362;fax: 204 661-7232;e-mail: [email protected] Spivey, 112 Old River Road, R.R.#2,Mallorytown, ON K0E 1R0(H) 613 923-5539; (W) 613 548-2333;fax: 613 923-5539;e-mail: [email protected] BrunswickGail Colosimo, 1336 Gorge Rd.Stilesville, NB E1G 1J4(H): 506 384-9708; (W): 506 857-5353;e-mail: [email protected] ScotiaDebbie Cotton, PO Box 34Judique, NS B0E 1P0(H) 902 787-2780; (W) 902 867-4106;fax: 902 863-6455;e-mail: [email protected] Edward IslandCelie Walsh-Gallison, Suffold Road,RR#3, Charlottetown, PEI C1A 7J7e-mail: [email protected] & LabradorCavell Bolger, PO Box 1621, Stn. BHappy Valley, Goose BayLabrador, NFLD A0P 1E0(H) 709 896-2216; (W) 709 897-2361;fax: 709 896-4130;e-mail: [email protected]

Committee chairsCertificationMargaret Pook,319 Linsmore CrescentToronto, ON M4J 4M1(H) 416 425-0832;e-mail: [email protected] PracticeBob Lawson,314 Hansen DriveRegina, SK S4X 3B8(H) 306 543-3623; (W) 306 766-2362;fax: 306 766-2770;e-mail: [email protected] Policicchio,4712 White RoadEdmonton, AB T6H 5M3(H) 780 434-5119; (W) 780 472-5116;fax: 780 472-5191; pager: 780 445-2083;e-mail: [email protected] Walsh-Gallison,Suffold Road,RR#3, Charlottetown, PEI C1A 7J7e-mail: [email protected] Trauma CommitteePatricia Walsh,20 Power StreetGrand Falls/Windsor, NFLD A2A 2E1(W) 709 292-2482; (H) 709 489-4164;e-mail: [email protected]

Volume 25, Number 2, Fall 2002

Outlook is the official publicationof the National Emergency Nurses’Affiliation Inc., published twiceannually by Pappin Communications,84 Isabella Street, Pembroke, Ontario.

ISSN 1499-3627Copyright, NENA, 2002

Editorial staff:Editor: Valerie Eden,[email protected]

Ideas@Work: Pediatrics:Allyson Sheppard,[email protected]

Trauma Corner: Susan PhillipsResearch: Cathy [email protected]

4NSICS RN: Sheila [email protected]

Editorial board:Donna Arsenault, NSChristine Hartley, ON

No part of this journal may bereproduced in any manner withoutwritten permission from NENA.The editors, association and thepublisher do not guarantee, warrant orendorse any product or servicementioned in this publication.

For information on advertising,contact Heather Coughlin, AdvertisingManager, Pappin Communications,The Victoria Centre, 84 Isabella St.,Pembroke, Ontario, K8A 5S5,telephone (613) 735-0952,fax (613) 735-7983,e-mail [email protected] card available at www.pappin.com

Send manuscript enquiries orsubmissions to: Valerie Eden, RN,ENC(C), Outlook Editor, 34 Bow St.,Dartmouth, Nova Scotia, B2Y 4P6e-mail: [email protected]

Outlook is the official publication of the National Emergency Nurses’ Affiliation.Articles, news items and illustrations relating to emergency nursing are welcome.Outlook is published two times per year.Opinions expressed are not necessarily those of NENA, or of the editor. NENAreserves the right to edit information submitted for publication.The use by any means of an article, or part thereof, published in Outlook, is aninfringement of copyright law. Requests for written consent prior to reprinting of anyarticle, or part thereof, should be addressed to the editor.

Outlook 4 • 25-2 • Fall 2002

The theme of this year’s CNA Bienniumwas diversity, with one of the focusesbeing that of achieving a qualityprofessional practice environment or, insimpler terms, a healthy workenvironment for one and all. Needless tosay, such an environment will not appearon its own. It will take work, effort, andcommitment by all to bring it to fruition.

As emergency nurses, we are all tooaware of the stresses in emergencydepartments across the country –overcrowding, gridlock, ambulancediversions and the nursing shortage, justto name a few. Some days, it is so veryoverwhelming, and just too much to copewith. The atmosphere is one ofnegativity, with burn-out, exhaustion,and illness being the end results.

Emergency nurses can make a differenceto our own work environment. Thequestion is, though, how important is ahealthy work environment to emergencynurses in Canada, and are we willing totake up the challenge?

Emergency nurses pride ourselves inbeing diverse. We are often the entrypoint for many to the health care system,the foundation of our institutions. If thisis the case, then we must take up thechallenge ahead of us. We cannot expectothers to solve our problems if we do notaccept responsibility, initiate change, andfocus on the quality of our own workenvironment. We need to start fromwithin and make the necessary changesthat we can.

We need to focus on the problem oneaspect at a time. It is really rather simple,as straightforward as the ABCs that wedeal with each time we assess a patient.Here, however, our ABCs are Attitude,Belief and Commitment.

Attitude requires a positive outlook.Dwelling on the negative is so verydraining. It wears and tears on us and, ifallowed to, will spread and fester in amoment’s notice. We must build on thepositive, give a pat on the back for workwell done by our peers and ourselves. Itis surprising that positive recognition canbe so very rewarding.

Belief is in knowing and believing thatwe can make a difference by changingour attitudes. Give it a try, focus on thepositives and I am sure you, too, will seeand experience a change for the better inyour surroundings.

Commitment is ensuring that we cometo work with a healthy, positive attitude.Make the commitment to yourself then,as an entire department, make thecommitment to each other.

Emergency nurses are a dynamic group!Let’s build on our strengths and togetherwe can begin to make necessary changesto our own health and environment.Focus on one aspect at a time. When wesucceed with this step, we will be readyto take the next step to ensure a qualityprofessional practice environment and, atthe same time, meet the numerouschallenges we do every shift that wework.

Anne CessfordRN, BA, BScN, ENC(C)

President’s message

StatisticsNumber of nurses who have writtenthe emergency certificationexamination (% difference betweenyears)

1994 3011995 233 (-23%)1996 249 (+7%)1997 273 (+10%)1998 165 (-40%)1999 162 (-2%)2000 116 (-28%)2001 192 (+65%)2002 171*(* applied to write)

Total 1,691

Total ENC(C)The total currently certified ENC(C)nurses is 1,193 as of 2001.

Due to Renewalrecertify Recertified rate

1999 244 159 65%2000 217 112 52%2001 237 106 55%2002 240 103 (number applied

to recertify)

Examination informationNext year’s examination date is April 5,2003.

Preparation guideThe Preparation Guide is now availableand included in the cost of registering forthe examination. The guide is alsoavailable through CNA publicationsdepartment at [email protected] or1-800-385-5881. The cost is $34.95(CNA member) or $43.75 (non-member).

Committee structureThe committee is composed ofemergency nurses from the followingareas and with the followingbackgrounds:Administration: Louanne Kinsella, NFHelen Grimm, SKEducation: Meg McDonagh, ABCatherine McDonald, BCClinical: Darlene Cogswell, NBAudrey Dabreo, QCMargaret Pook, ON

A committee meeting was not held inOttawa this year, however, questionswere reviewed and submitted to SuzanneMaize.

SummaryIt has been an honour to work on thiscommittee on behalf of NENA.

Marg Pook, RN, ENC(C)

Certification report

Fall 2002 • 25-2 • Outlook 5

Were you aware?• That Health Canada, followingreports of suffocation andstrangulation of young childrenfrom entanglement in IV tubing ormonitor leads while they werepatients in hospital, has issued thefollowing recommendations:1. All hospitalized children couldpossibly become entangled in amonitor lead or tubing and shouldbe continuously observed by anadult or placed on a monitor.2. Consider treating hospitalizedchildren with oral therapy or aheparin-locked needle if possible.3. Coil excess tubing when thechild is unattended to prevent theinfant/child from becomingentangled.4. Inform hospital staff, parents andother caregivers that young childrenare at risk of entanglement andstrangulation by IV tubing,electronic leads, or cords of any sort.Health Canada asks that therecommendations be posted in aprominent spot for staff and that theybe implemented in the interest ofpatient safety (http://www.hc-sc.ca).

• That a recent study done in Sarasota,Florida revealed that fabricstethoscope covers represent apotential infection control problembecause they are used for longperiods of time, are infrequentlylaundered, and are contaminatedwith pathogenic bacteria known tocause nosocomial infection (Milam,M.W. et al., 2001. Bacterialcontamination of fabric stethoscopecovers: the velveteen rabbit ofhealth care? Infection Control andHospital Epidemiology, 22, 653-655.).

Historical PerspectiveThe National Emergency Nurses’Affiliation Inc. was formed in 1981.

General structureThere are nine active provincial groupsalong with independent members fromQuebec.

The NENA board of directors meetstwice a year, in the spring and fall. Thespring board of directors meeting is heldin conjunction with the AGM and aneducational conference. Odd years are inconjunction with the national conferenceand even years with a regionalconference.

ObjectivesThe mission of NENA is: “To representthe Canadian emergency nursingspecialty”.

The values of NENA are:• All individuals have the right to qualityhealth care• Essential components of emergencynursing practice are wellness promotionand injury prevention• Continuing education and professionaldevelopment are fundamental toemergency practice• Research guides emergency nursingpractice.

The goals of NENA are:• Strengthen the communication network• Provide direction for clinical practice ofemergency nurses• Promote research-based practice• Support and disseminate education.

MembershipAs of February 13, 2002, there are 1,282members of NENA.

Present specialprojects and activities(publications, research,conferences,certification, etc.)NENA and Canadian Association ofEmergency Physicians (CAEP) boards of

directors met in November 2001 todiscuss common issues and prioritize theissues identified. Priorities for actionwere identified under three categories:Improved communications• web page links• sharing of board minutes

Present projects to continue• Canadian Triage Acuity Scale (CTAS)• emphasis on the pediatric component• Canadian Emergency DepartmentInformation System (CEDIS)

New projects• pediatric CTAS education project• violence in the workplace• re-look at the overcrowding positionstatement

The policy and procedures have beenreviewed and revised along with theposition statements. There has been theaddition of three new positionstatements, which are:• Use of non-registered nurses as healthcare providers in the emergencydepartment• Family presence during resuscitationand invasive procedures• Procedural sedation in adults andchildren in emergency departments.

The core competencies for emergencynursing have been developed andpublished and will soon be distributed toall NENA members.

In May 2002, the NENAAGM was heldin conjunction with a regionalconference in Moncton, New Brunswick.The theme of the conference was“Caring for Others, Caring forOurselves”.

Issues of concern• New untrained RN staff; • Vacancies;• Retention; • Nurse:patient ratios;• Non-RNs in the emergency department,skill mix; • Overcrowding; • Emergencydepartment vs. systems problems;• Potential violence/security risks

Date: April 1, 2002

The 2002 annual report submittedto the CNA - National EmergencyNurses’ Affiliation Inc. (NENA)

Celebrate Emergency NursesWeek, October 6-12, 2002,and Emergency Nurses DayWednesday, October 9, 2002

“Caring, Healing,Educating…

one life at a time”

Outlook 6 • 25-2 • Fall 2002

Well, it’s hard to believe fall is upon usand, for some of you it means busy workand course planning, whereas for othersit means structure and process.Whichever emergency nurse you happento be, the national trauma committeewishes you all a safe and happy fall!

The Trauma Nursing Core Course(TNCC) is well on target for this yearwith 1,700 nurses signed up to date. Weexpect to exceed, or at least match, lastyear’s numbers of 1,845 participants.The Emergency Nursing PediatricCourse (ENPC) is also on target with 522nurses registered to date, almost meetinglast year’s number of 645. The Course inAdvanced Trauma Nursing (CATN) isslightly down with no upcoming coursesscheduled to date.

Thank you to the instructors who believein offering educational opportunities toall emergency nurses.

A reminder to all instructor trainers fromcentral and eastern Canada that the nationaltrauma committee is accepting applicationsup until October 15 for four vacantpositions that currently exist, two positionsfrom the east (NFLD, NS, NB, PEI) andtwo positions from central (Ontario,Quebec). The appointments would bemade at the November meeting of theNENA board and the first meeting of thecommittee would be late November orearly December. It is important thatinstructor trainers know of the commitmentneeded to assume these positions on behalfof your provinces, however, the reward ofnetworking within this committee istremendous. Please consider submittingyour names! All submissions should bedirected to the NTC chair. Address and e-mail address are below.

The NTC has developed a process tomanage complaints regarding coursesand we welcome feedback from allemergency nurses who have taken one ofthe trauma courses and who have positivesuggestions re improvement, or who havea concern over quality of teaching.

New administrative manuals will be sentto all instructors by the end ofSeptember. If you do not receive your

copy, please contact the NTC committeemember for your area, or the currentchair. To this end, we request allinstructors of any NENA program toresubmit their full mailing address, e-mail if available and home number eitherby e-mail or letter to the NTC Chair, 20Power Street, Grand Falls-Windsor, NFA2A 2T6, or e-mail: [email protected]

This will help update the database andmake communications more effective.

Contract negotiations have also begunwith the US for the trauma programsfor 2003 so feedback from anyemergency nurse, but particularlyinstructors, would be extremely helpfulin ensuring we negotiate on yourbehalf.

Pat Walsh, Chair,National Trauma Committee,NENA

NENA 2000-2001 year-end financial report

INCOME Actual Budget Variance

Fundraising $814.00 $100.00 $714.00Advertising $113.06 $100.00 $13.06Grants $1,000.00 $2,400.00 ($1,400.00)Sponsors $2,000.00 $0.00 $2,000.00Indirect Fees: ENPC $12,250.00 $8,520.00 $3,730.00Indirect Fees: TNCC $48,889.41 $17,880.00 $31,009.41Indirect Fees: CATN $3,000.00 $1,200.00 $1,800.00Interest Income $3.57 $0.00 $3.57Investment Income $470.45 $0.00 $470.45Member Fees $21,160.00 $23,140.00 ($1,980.00)Misc. Income $21,678.48 $0.00 $21,678.48TOTAL INCOME : $111,378.97 $53,340.00 $58,038.97

EXPENSES: Actual Budget Variance

Awards $0.00 $0.00Advertising $1,198.41 $0.00 ($1,198.41)Bank Charges $241.83 $100.00 ($141.83)Board Meetings $22,393.31 $17,700.00 ($4,693.31)Bursaries $2,750.00 $3,500.00 $750.00CNA Fees $200.00 $214.00 $14.00Committee Meetings $9,438.41 $5,500.00 ($3,938.41)Gifts $242.60 $100.00 ($142.60)Interest Paid $0.00 $0.00 $0.00Legal $391.84 $100.00 ($291.84)Liaison Meetings $1,672.06 $0.00 ($1,672.06)Office Expense $11,798.09 $5,450.00 ($6,348.09)Programs $12,052.00 $12,052.00Promotions $1,481.30 $3,075.00 $1,593.70Public Relations $7,777.92 $3,600.00 ($4,177.92)Reimbursements: ENPC $4,370.00 $3,000.00 ($1,370.00)Reimbursements: TNCC $16,749.41 $5,960.00 ($10,789.41)Reimbursements: CATN $750.00 $400.00 ($350.00)Misc $0.00

TOTAL EXPENSES: $81,455.18 $60,751.00 ($20,704.18)

INCOME/LOSS POSITION: $29,923.79

National trauma committee report

Fall 2002 • 25-2 • Outlook 7

This will be a new feature for Outlook. Iwould encourage all of you to send inyour letters, questions, tips, ideas. Manyof our issues and the problems that weface daily are the same, whether you workin Victoria, BC or Grand Falls, NFLD.

The sharing of information is powerful.Trying to develop a new policy, lookingfor a new form? Request it here. This isyour journal. It is a vehicle forcommunication for all of us. Use it.

Please send your letters, etc., to:Valerie Eden, 34 Bow Street,Dartmouth, NS B2Y 4P6, or e-mail at:[email protected]

Further to your article in the Spring2002 copy of Outlook, I would like tosend a bouquet to my daughter, AllysonShephard. She has accomplished muchin her short career. Graduating fromOttawa University in 1996, she beganworking at the emergency department atChildrens’ Hospital of Eastern Ontario(CHEO). Following two years ofworking in emergency, she wasinstrumental in developing andimplementing the new trauma programin CHEO, which she now manages.

Allyson is a member of ENAO and hasmade a number of presentations atENAO conferences. She is an instructor

for TNCC and provides lectures in theemergency program at AlgonquinCollege. At present, she is completingher Masters degree in nursing.

Allyson has been an inspiration to me.She encouraged me to accept a teamleader position that I am finding verychallenging after working 24 years inemergency at the Queensway-CarletonHospital.

Allyson is a great asset to nursing andshe will continue to advance the verybest of what it means to be aprofessional nurse.

Wendy Shephard

Letters to the editor

Revised Position Statements,Standards and new CoreCompetencies are available forpurchase by non-NENAmembers for$20.00 per document. For orders of20 copies or more, 15% will bereduced from the total cost. Justmake sure that you note this whenyou place your order. Send orders toJerry Bell, 10 Laval Drive, Regina,SK S4V 0H1

Anne Cessford, RN,BA, BScN, ENC(C)

Anne Cessford is a registered nurse witha BA in psychology and a BScN from theUniversity of Windsor, Ontario (1979).She has been involved in the specialty ofemergency nursing since 1988 and hasheld numerous positions in emergencynursing as a staff nurse, clinical educator,triage nurse, manager, and patient servicecoordinator. Anne is presently a clinicalresource nurse in the emergencydepartment of Surrey Memorial Hospitalin Surrey, BC where she also works as asexual assault nurse examiner.

From 1997 to 2000, Anne waspresident of the Emergency Nurses

Group of BC (ENGBC) and chair ofthe Canadian Nurses AssociationNational Emergency NursingCertification Examination Committee.She has been president of the NationalEmergency Nurses’ Affiliation, Inc.since July 2000.

In her role as president of NENA,Anne’s main goal has been to supportand promote the specialty andprofession of emergency nursing withthe focus on communicating with themembership and our partners in healthcare.

As involved as Anne may be withNENA, her number one priority andpassion in life is her husband, Jamie, andtheir three fantastic, teenage children.

Did you know?• That work has started on developing a national orientation and preceptorprogram

• That position statements on ambulance diversions and the responsibility ofpatients on stretchers waiting placement in the ED are currently being drafted

• That core competencies are complete and are being sent out to all members• That NENA standards, core competencies and position statements with anaccompanying letter have been sent to federal and provincial health ministers,CNA, CAUSN, ACEN, Federal Chief Nursing Officer and all provincialregulatory bodies

• That the Peds CTAS educational program has been developed and will roll outthis fall

NENA biography

Outlook 8 • 25-2 • Fall 2002

The Registered Nurses Association ofOntario predicts that by 2011, Ontariowill need to recruit 60,000 to 90,000nurses. With current trends continuing,Ontario can only expect 40,000 to50,000.

The College of Nurses of Ontariostatistics indicate the following:57.5% RNs work in hospitals13.4% RNs work in the community12.6% RNs work in long-term care16.1% work in assorted other fields.

The average age of an Ontario RN is 44in spring 2002.

51.6% RNs work full-time.36.2% RNs work part-time.11.7% work casual.

There are currently 106,305 RNslicensed to practice in Ontario, only82,788 of them are working in nursing.

The Ontario Hospital AssociationPresident, David MacKinnon, wasquoted as saying, “ Fewer Ontario nursesare handling sicker patients who needlonger hospital stays, in fewer acute carebeds!”

A recent study done by The TorontoStar produced no surprises. “Weekendscan be Hell in the ER”, was the headline.Public holidays continue to top the listfor high-volume days. The seven-year,province-wide study concludes what ERnurses have always known; demandpeaks on weekends and holidays whendoctors’ offices are closed. The year’sbusiest week is always betweenChristmas and New Year. The study alsowent on to say: “The emergencydepartment is the barometer of how thewhole health-care system is functioning.If things aren’t working well elsewhere,the pressure is felt in the ER.” No newsto emergency nurses!

Tidbits, trivia, & truisms• I have learned that sometimes what mypatient needs most is a hand to hold anda heart to care.• The Fugu fish, also known as theBlowfish or Puffer fish, is a delicacy inJapan. A pinch of tetrodoxin (fugu fishpoison) is 1,250 times more deadly than

cyanide and is enough to kill 30 people.Chefs must take intensive courses andpass exams to be licensed to prepareFugu dishes.• You don’t stop laughing because yougrow old, you grow old because you stoplaughing.• Confidence never comes from havingall the answers, it comes from being opento all the questions.• Sterilize: what you do to your firstbaby’s pacifier by boiling it and to yourlast baby’s pacifier by blowing on it.• If four out of five people suffer fromdiarrhea, does the other one enjoy it?• Whatever happened to Preparations Athrough G?• If we say something is “out of whack”,what’s a whack?• If it’s true that emergency nurses arehere to help others, then what exactly arethe others here for?

Remember...Emergency nurses are always there forothers, providing the best of care.You reassure and comfort with the manynursing skills you share.You make a major difference ineverything you do.All of us are thankful for that specialperson, “You”.

From an emergency patient.• Caring is such a large part of being anemergency nurse. In order to keep ondoing what you do for others, neverforget to care for yourself !!!

Submitted by Janice L. Spivey, RN,ENCC, CEN, ENAO President

Confessions from theCommunication Officer -the NENA websiteAs you are aware, NENA has a website that, for several months recently, has beeninactive and then disappeared altogether due to a combination of unfortunatefactors. Just prior to my appointment to the role of communication officer, theboard of directors had approved a recommendation to have the website redesignedin an effort to make it more visually pleasing and user-friendly. The person whohad been asked to redesign the website had agreed to do the work. In themeantime, the company that held the domain name for the website had sent out arenewal notice by e-mail. However, no one received this renewal notice and thewebsite disappeared. The IT people at the Ottawa Hospital were unsure of whathad happened to the site and so, after several weeks of e-mails and phone calls,the confusion over the site was sorted out.

The domain name has been reinstated. Unfortunately, the person who had agreedto redesign the website was unable to do the job in the end and we have had tofind another company to do the redesign. We have found a company that is willingto take on the job. At the time of writing, the company is doing a mock-up of anew web page.

I wanted to update you and I also wanted to apologize for any inconvenience thatthe disappearance of the website has caused for any members.

Valerie EdenCommunication Officer

The Ontario report: FYI across the country

Fall 2002 • 25-2 • Outlook 9

The regional conference of 2002 washeld in Moncton, NB, hosted by the NewBrunswick Emergency NursesAssociation. The title was “Caring forOthers, Caring for Ourselves.”Emergency nurses most often are the firstcontact people have with the health caresystem. It is often a critical event forthem, whether perceived or actual. Wemust be prepared to meet their needs,both physical and emotional, and to

support the family and loved ones.Today’s environment of staffingshortages, overcrowding and generallack of resources has compounded thestress on the ER nurse. In order to carefor others, we must take care ofourselves. Our goal was to acknowledgesome of the issues and offer somestrategies that might help in theworkplace.

The conference opened with a smash hit,“Survive!!!ER”, presented by SheilaEarly and Ruth Ringland. It was asometimes comic and other timesthought-provoking look at situationscommon to ER departments and copingstrategies that might be used. Othertopics were: “Critical Incident StressDebriefing” by Rev. R. Maund,“Pediatric CTAS” by Carla Policicchio,“Telecare and Emergency Services,Partners in Quality Care” by Lois Scott,“ATV Trauma” by Heather Oakley,“Adolescent Behavioral Disorders” byDr. S. Sadiq, “Sexual Assault NurseExaminers” by Janet Calnan and SheilaEarly, and “Staff/Manager Relations” byCarla Policicchio. These topics on Fridaywere followed by the NENA AnnualGeneral Meeting. It was a full andrewarding day.

Saturday began with a presentation byJoan Lutes, “Multidisciplinary Roles inthe ER”, a look at the changes thenursing profession has seen over theyears and now, and the inclusion of otherhealth care providers such aspharmacists, discharge planning,psychiatric nurses, and volunteers. Otherpresentations were: “Non-urgentpatients: Why do they seek ER care?” byL. Scott, “Family Presence DuringResuscitation” by Dr. M. Allen, and“Legal Issues in ER” by Joan Allain, all

NENA’s “Win a trip to the nationalconference” contest rulesNENA Inc. will biannually sponsor a NENAmember’s attendance at the nationalconference/AGM, for an article published in Outlook. The winner will be chosenby lottery.

1. Contest will be advertised in Outlook2. Provincial representatives are encouraged to publish the contest among theirmembership.3. Articles must be submitted directly from the author. Provincial newslettersforwarded to the communication officer for selection of items to include inOutlook will not be considered in the lottery. Please refer to the submissionguidelines included with this issue.4. Primary author’s name will be entered into the draw (in the event of multipleauthors).5. Names will be entered into the draw beginning with the winter 2001 edition ofOutlook and ending with the winter edition of 2003.6. The communication officer will maintain a record of names entered into thelottery.7. The NENA president will randomly draw the name of the winner.8. The NENApresident (or delegate) will notify the winner and will communicatewith the winner to ensure conference registration, hotel booking at the conventionrate, and travel arrangements are made at the most economical rate to themaximum value of $2,000.00.9. The draw will occur in January prior to the national NENA conference to allowthe winner to arrange their time off to attend. In addition, this allows time toobtain the best fares and booking of a hotel room at conference rates.10. The winner of the lottery will have three weeks in which to accept their prize.In the event the winner is unable to claim their prize, a second name will bedrawn. The prize is non-transferable.11. The winner will make his or her own travel arrangements.12. The winner’s name will be published in Outlook.13. The winner must be a NENAmember at the time of submission.14. NENA board of directors and Outlook section editors are exempt.15. Articles are published at the discretion of the communication officer16. NENA board of directors has approved the contest rules.

The next National Emergency Nurses Conference is in Saskatchewan in 2003.

New Brunswick report- the 2002 regional conference

Outlook 10 • 25-2 • Fall 2002

followed by another superb session,“Stress” by Mrs. A. Lepage, a familytherapist who kept her audiencecaptivated with her humorous reflectionson human behaviour.

Thank you to all those who attended andmade our conference the success it was.One of the comments on an evaluationform said it very well, “Excellentconference, great opportunity to networkwith excellent, motivated, dedicatedemergency nurses!!”

Thank you to all the presenters. Weappreciate the time and the effort yougave. Comments, again received with theevaluations, say it well, “Excellentspeakers! Great topics! Great reminders!”and, “Excellent. All the speakers wereincredible. I have not been to a conferencewhere every session was led by dynamicspeakers. All very informative.”

We would also like to thank theconference’s major sponsor, Hoffman-LaRoche, as well as other corporatesponsors whose support and recognitionare so important.

As president of the New BrunswickEmergency Nurses Association andchairperson of the planning committee, Iwish to thank those who put so muchthought and effort into the planning ofthis conference. There were many hoursdevoted to the preparation of this eventand your dedication is very muchappreciated! Thank you to NancyAshley,Alison Bulmer, Patti Davis, NancyDouthwaite, Carol Frizzell, KarenGallup, Nadine LeClair, and JeannineMichaud.

One comment was especially appreciatedby the conference planning committeeand might encourage anyone who iscontemplating a conference in the nearfuture, “This was my first NBENAconference. I wish to compliment the

committee on their hard work. You’vedone an excellent job. The conferencewas interesting and informative. Theopportunity to choose topics of personalinterest showed insight into yourdiversified membership.…”

� Eileen Denomy, for her appointment to the Certification Advisory Committee� Lucy Rebello, for being a strong patient advocate� Retiring NENA Board Directors, for their work, their time and their energy� Marg Pook, for her work on the Certification Committee� The Planning Committee of the NB Emergency Nurses Conference� Members of Saint John Chapter NBENA - Sue Benjamin, Haidee Goldie, Lynn Thom and Nicki Hamburg for

achieving certification in emergency nursing

“Bouquets” is dedicated to celebrating the achievements of NENA members. If you would like to send a bouquet to a NENAmember, contact the communication officer, Valerie Eden, 34 Bow Street, Dartmouth, NS B2Y 4P6(H) 902 461-1897; (W) 902 465-8340; fax: 902 465-8435; e-mail: [email protected].

Bouquets

Fall 2002 • 25-2 • Outlook 11

IssueIn most cases, the family is the patient’s primary supportsystem. Family members are frequently not given theopportunity to remain with the patient during invasiveprocedures, including resuscitation efforts. Families andpatients may be separated for reasons such as the perception ofbeing overwhelmed and/or intimidated with the situation andconcern on the part of the individuals performing the procedurein the presence of non-medically oriented individuals.

NENA positionNENAsupports the option of family presence during invasiveprocedures and/or resuscitation efforts.

NENAacknowledges that a support system, (i.e.) social workerand/or pastoral care, must be in place for the family member(s)during invasive procedures and/or resuscitation efforts.

NENA supports further research related to the presenceof family members during invasive procedures and/orresuscitation and the impact it has on family members,patients, and health care professionals.

RationaleEvery emergency patient is a member of a family system withthe family being defined as a person(s) who has anestablished mutual relationship with the patient.

The family system is the major source of support for the

individual during times of stress and crisis. Studies haveindicated that the most important needs identified by familymembers of critically ill patients are:• To be with the patient• To be helpful to the patient• To be informed of the patient’s condition• To be comforted and supported by family• To be accepted, comforted, and supported by health carepersonnel

• To feel that the patient was receiving the best possible care

Family presence during resuscitation efforts allows the patientand the family to support each other and facilitate the grievingprocess by bringing a sense of reality to the treatment effortsand the patient’s clinical status.

ReferencesEichhorn, Dezra J. et al. (2001). Family presence during

invasive procedures and resuscitation: hearing the voice of thepatient. American Journal of Nursing, 101, (5), 48-54.

Emergency Nurses Association. (1998). PositionStatement: Family Presence at the Bedside during invasiveprocedures and/or resuscitation.

Lester, J.S. (1986). Needs of relatives of critically illpatients: a follow-up. Heart and Lung, 15, (2), 189-193.

Meyers, T.A. et al. (2000). Family presence duringinvasive procedures and resuscitation. American Journal ofNursing, 100, (20), 32-43.

Molter, N. (1979). Needs of relatives of critically illpatients: a descriptive study. Heart and Lung, 8, 332-339.

Position statementFamily presence during resuscitationand invasive procedures

Editorial Policy1.Outlook welcomes the submission ofclinical and research articles, casestudies, and book reviews relating to thefield of emergency nursing.2. Statements or opinions expressed inthe articles and communications arethose of the authors and not necessarilythose of the editor, publisher or NENA.The foregoing disclaim anyresponsibility or liability for suchmaterial and do not guarantee, warrant orendorse a product or service advertisedin this publication, neither do theyguarantee any claim made by themanufacturer of such product or service.3. Authors are encouraged to have theirarticles read by others for style andcontent before submission.

Preparationof Manuscripts1. The original copy of manuscripts andsupporting material should be submittedto the NENA Outlook editor. Theauthor should retain one complete copy.2. Manuscripts must be typed, double-spaced (including references), on 8 1/2”x 11” paper with adequate margins.Manuscripts longer than one page mustbe submitted in a disk format in WordPerfect or Word. Submissions areaccepted via e-mail to thecommunication officer.3. Author’s name(s) and province oforigin must be included4. Clinical articles should be limited tosix pages.

5. Direct quotations, tables andillustrations that have appeared incopyrighted material mustbeaccompanied by written permissionfor their use from the copyright ownerand original author and complete sourceinformation cited.6. Photographs of identifiable persons,whether patients or staff, must beaccompanied by signed releases, such asthe following: “I hereby give (author’sname) to use the photograph of(subject’s name) in the NENAOutlook.

Please submit articles to:NENA Outlook Editor, 34 Bow StreetDartmouth, NS B2Y [email protected]

Deadline dates:

February 20 and August 16

Guidelines for submission

Outlook 12 • 25-2 • Fall 2002

IssueNationally, emergency departments have begun to implementalternative staffing options to include the use of non-RNhealth care providers. Non-RN health care providers mayinclude: licensed practical nurses (LPNs), nursing assistants,emergency department technicians, emergency medicaltechnicians (EMTs), and paramedics. The inclusion of non-RN health care providers within the staffing mix of anemergency department does not promote comprehensiveemergency care. There is evidence which supports that ahigher ratio of RN staffing is directly related to improvedpatient outcomes, lower mortality rates, and reduced costs.The impact of the use of non-RN personnel within emergencydepartments can influence the quality of care, patients’perceptions of satisfaction with care, pain management,preventable complications, patient education, and length ofstay. Since research does not exist identifying reliable staffingratios or staffing formulas which would ensure optimalquality of care, the promotion of alternative staffing optionscould therefore negatively impact patients in the emergencydepartment.

NENA positionEmergency departments are increasingly challenged withhigh complexity, high acuity, high volume of patients withina dynamic environment, which necessitates rapid assessmentand intervention by an emergency nurse. All patients seen inthe emergency department should be assessed, care initiatedand evaluated, and be appropriately educated by a registeredemergency nurse.

NENA believes that the provision of emergency care requiresthe knowledge, expertise, and advanced preparation ofregistered nurses to ensure optimal quality of patient care.Patients are entitled to receive specialized nursing careincluding ongoing assessment and treatment by nurses

educated in emergency management. Increasing pressureswithin emergency departments require appropriately skilledregistered nurses. The scope of practice and education of theemergency nurse is directly related to patient outcomes.

NENA believes that budgetary constraints and, at times,limited supply of emergency nurses, should not be used asrationale for inappropriate delegation to non-RN health careproviders or substitution of registered professional nurses inthe emergency setting.

NENA believes that registered professional nurses areaccountable for the quality of care in the emergencydepartment and the delegation of care activities to non-nursing personnel. Patient outcomes and safety arecompromised as the number of non-RN health care providersincreases.

NENA believes that all patients seen in the emergencydepartment deserve comprehensive, professional care byeducated and trained registered nurses. Patients’ statuschange quickly and require the knowledge and skill of aregistered emergency nurse to quickly and appropriatelyassess and intervene.

ReferencesEmergency Nurses Association (1999). The use of non-

registered nurse (non-RN) caregivers in emergency care. DesPlaines, IL: Author.

Gerber-Zimmermann, P. (2000). The use of unlicensedassistive personnel: An update and skeptical look at a role thatmay present more problems than solutions. Journal ofEmergency Nursing, 26(4), 312-317.

Gerber-Zimmermann, P. (2001). The emergencydepartment of the future – The challenge is in changing how weoperate. Journal of Emergency Nursing, 25(6), 480-488.

Pisarcik Lenehan, G. (1999). ED short staffing: It is time totake a hard look at a growing problem and strategies such as standardnurse-patient ratios. Journal of Emergency Nursing, 25: 77-78.

Position statementUse of non-registered nurses as health careproviders in the emergency department

• www.nursesreconnected.com - a popular site with a large database that assists nurses in locating lost classmates and friends• http://nursezone.com/ - the largest community website that is exclusively dedicated to nurses. It is an online communitywith articles, columns written by experts, international news, updates on the latest in nursing and health care innovations,continuing education, contact hours and links to other sites.

• www.nurses.com/nurse-zine/ - a site that offers the latest news, product offerings and industry updates. Sign up for the freenewsletter that is delivered to your inbox twice per week.

• www.healthcarecommission.ca - a series of discussion papers that have been prepared by independent health researchers,experts, and academics with different ideological and philosophical perspectives. Four papers were released on August 2,2002 with other releases planned for later this year. The results of the commission’s research agenda, along with informationgathered through the commission’s far-reaching and comprehensive program, will provide the groundwork for thecommission’s final report and recommendations.

Websites of interest

Fall 2002 • 25-2 • Outlook 13

NENA recognizes the need to promoteexcellence in emergency care, and, tothis end, financial aid to its members.NENA will set aside a predeterminedamount of monies annually with themandate of providing a high standard ofemergency care throughout Canada. Allsections of the emergency nursing teamare eligible for consideration includingstaff nurses, managers and educators.

Applications must be submitted prior tothe spring board of directors meeting ofNENA for review by the standingcommittee for bursary disbursements.On April 1 of each year the number ofbursaries awarded will be determined bythe number of registered members perprovince for that NENA fiscal year i.e.:

1-99 members - 1 bursary100-199 members - 2 bursaries200-299 members - 3 bursaries300-399 members - 4 bursaries400-499 members - 5 bursaries500-599 members - 6 bursaries600 + members - 7 bursaries

One bursary is to be available to NENAboard of directors members and onecollectively to an independent memberper year.

Successful candidates can only receive abursary once every three years.

NENA Bursaryapplication processEach candidate will be reviewed on anindividual basis and awarded a numberof points as set out below:

1. Number of years as a NENA memberin good standing• 2 years....................................1 point• 3-5 years ................................2 points• 6-9 years ................................3 points• 10 + years ..............................5 points2. Involvement in emergency nursingassociations/groups/committees:• Provincial member.................1 point

• Provincial chairperson ...........2 points• Special projects/committee- provincial executive ............3 points

• National executive/chairperson.............................5 points

Candidates with certification inemergency nursing and/or involved innursing research will receive anadditional five points.

If two candidates receive an equal numberof points, the committee will choose thesuccessful candidate. All decisions of thebursary committee are final.

Each application will be reviewed onceper spring board meeting.

Preference will be given to activelyinvolved members of NENA and thoseactively pursuing a career in emergencynursing. Those members requestingassistance for emergency nursingcertification, TNCC, ENPC, CATN, aswell as undergraduate or post-graduatestudies that would enhance emergencycare will also receive preference.

Candidates must have completed FormsA, B and C. (Outlook page 14) Theprovincial director may forwardapplications at the spring board meetings.

Any incomplete forms will be returned tothe provincial director for correction ifpossible.

Eligibility• Current RN status in respectiveprovince or territory. (Proof ofregistration required.)

• Active member in NENA Inc. for atleast two consecutive years. (Proof ofmembership required.)

• Presently working in an emergencysetting which may include:- Emergency department- Nursing station- Pre-hospital- Outpost nursing- Flight nursing

Application processCandidates must complete and submitthe following:

a. NENA Bursary application form “A”b. Bursary reference form “B”c. 200 word essayd. Photocopies of provincial registerednurse status and NENA registration

Provincial representativeresponsibilities:

a. Completes bursary candidate’srecommendation form “C”

b. Ensures application forms arecomplete before submission

c. Brings to board of directors meetingall completed applications

Selection processThe standing committee for bursarydisbursements will:

1. Review all applications submitted byprovincial representatives and awardbursaries based on selection criteria.2. Forward names of successfulcandidates to the board of directors forpresentation.

The NENA Bursary

The NENA bursary

NENABursaryWinnersCongratulations to the followingmembers who were awarded $250.00bursaries at this year’s AGM:

• Ruth Ringland, British Columbia• Tracie Jones, British Columbia• Helen Grimm, Saskatchewan• Selina Godfrey, Ontario• Doris Splinter, Ontario• Janice Gilmour, Ontario• Gabrielle Ross, Ontario• Therese Lauziere, Nova Scotia• Margaret Colbourne,NFLD/Labrador

• Celie Walsh-Gallison,Board of Directors

Outlook 14 • 25-2 • Fall 2002

NENA Bursary application form “A”Name: ______________________________________________ Date of Application: __________________________________

Address: _______________________________________________________________________________________________

Phone numbers: work (_____) _____ - __________; home (_____) _____ - __________; fax (_____) _____ - __________

E-mail: ________________________________________

Place of employment: _____________________________________________________________________________________

Name of course/workshop: _________________________________________________________________________________

Date: ___________________________ Time:___________________________ Length of course: _______________________

Course sponsor: ____________________________________________________Cost of course: _________________________

Purpose of course: ________________________________________________________________________________________

Credits/CEU’s: ______________________ ENC(C) Certified: � Yes � No

Previous NENA Bursary: � Yes � No Date: ________________________

Please submit a proposal of approximately 200 words stating how this educational session will assist youand your colleagues to provide an improved outcome for the emergency care user: Attached?: � Yes � No

Ensure photocopies of provincial RN registration and provincial Emergency Nurses Associationare included with your application: Attached?: � Yes � No

NENA Bursary application form “B”I acknowledge that _______________________________________ (name of applicant) is currently employed in an emergency

care setting. This applicant should receive monies for _______________________________________ (name of course).

Reason: ________________________________________________________________________________________________

Other comments: _________________________________________________________________________________________

_______________________________________________________________________________________________________

Signed: _______________________________________ Position:_______________________________________

Address: _______________________________________________________________________________________________

NENA Bursary applicationprovincial directors’ recommendation form “C”Name of bursary applicant: _________________________________________________ Province: ______________________

Length of membership with provincial emergency nurses group: _______________

Association activities: _____________________________________________________________________________________

_______________________________________________________________________________________________________

Do you recommend that this applicant receive a bursary? � Yes � No

Reason: ________________________________________________________________________________________________

Provincial director signature: _______________________________________ Date: __________________________________

Fall 2002 • 25-2 • Outlook 15

Annual awards ofexcellence in: emergencynursing practice,emergency nursingresearch, emergencynursing administration,and emergency nursingeducationExcellence in nursing and health caredeserves recognition. By celebratingnurses’ achievements in the four domainsof practice, the understanding of nursingis expanded and a positive image isreinforced. The NENA Awards ofExcellence program enables nurses tohonour colleagues for their outstandingcontributions and for demonstratingexcellence in relation to the standards ofnursing practice.

Following is the criteria and nominationprocess for NENAAwards of Excellence.

Selection processAn awards committee of NENA isappointed by the board and reviews allthe nominations to determine that thecriterion for each award has been met.Based on this review, the committeemakes recommendations to the NENAboard of directors. Awards are given tosuccessful candidates in each category atthe NENA annual general meeting.

The NENA awards committee bases itsreview of nominations for awards solelyon the documentation submitted for eachcandidate. Candidates stand the bestpossible chance of recommendation tothe board of directors for an award if thesupporting materials clearly showoutstanding contributions as specified.

All nominations must be submitted to aprovincial representative on the NENAboard of directors by January 31 in theyear of the annual general meeting. Therepresentative will forward thisinformation to the awards committeechairperson.

Preparing anomination package1. Review a copy of the candidate’sresume or curricula vitae (CV). Use it asa guide in putting together thenomination.A current copy of the resumeor CV should be included as part of thesubmission. Information on the resumeshould include, but not be limited to:professional association involvement,professional development, education,posters, presentations, etc.

2. There must be a minimum of twoletters of support from colleagues orassociates of the candidate that willstrongly support the nomination. Selectpeople who have knowledge of thecandidate’s exceptional achievementsand/or people who provide varyingperspectives about the candidate’soutstanding qualities (e.g. peers,employers, students, patients, otherhealth professionals, otherorganizations).

3. Provide the contacts with a copy of theappropriate award criteria and ask themto: indicate why they support thecandidate and how the candidate isexceptional; give specific examplesindicating how the candidate meets thevarious criteria for the award; indicatetheir positions, professional relationship(etc.) with the candidate.

4. Develop a summary. Using thecandidate’s resume and letters of support,prepare a summary of the candidate’sachievement and highlight how thecandidate meets the award criteria.

5. Complete and submit a nominationform with the package.

6. Forward all submissions to theprovincial director by January 31 ofeach year. Incomplete or lateapplications will not be eligible forconsideration. Successful candidateswill be presented with awards at theannual general meeting. In order to

facilitate the process of the applications,the nominator will involve the nomineein the submission and verification ofinformation.

Award of Excellencein Emergency Nursing PracticeThis award recognizes NENA memberswho excel in clinical care/nursingpractice. The nurse must be providingdirect care for the clients in anemergency-type setting.

I. The candidate must excel in all majorcategories of practice:1. Nursing knowledge2. Clinical decision-making3. Professional accountability andresponsibility4. Application of research5. Interpersonal relationship andcommunication skills

II. Supportive documentation mustdemonstrate outstanding performance inrelation to the majority of the standardsof nursing practice:1. Specialized body of knowledge2. Competent application ofknowledge3. Provision of a service to the public4. Code of ethics5. Self-regulation6. Responsibility and accountability

III. Important considerations:1. Consistently demonstratesexcellence as a professional nurse2. Consistently demonstratesresponsibility for professionaldevelopment3. Participates in the activities ofprofessional organization4. Actively demonstrates innovativeand progressive ideas in nursing5. Acts as a role model and mentor6. Contributes directly or indirectlyto improving the quality ofemergency nursing care in one’sprovince/nation

Award of Excellencein Emergency Nursing EducationThis award recognizes a NENA memberwho excels in emergency nursingeducation. The candidate must beproviding nursing education in anemergency care setting.

The NENA Awards of Excellence

The NENA Awards of Excellence

Outlook 16 • 25-2 • Fall 2002

I. The candidate must show outstandingperformance in a majority of thefollowing areas:1. Lecture, demonstration,discussion, clinical or lab instructionDemonstrates and utilizes theprinciples of adult learning2. Consultation, including tutoring,advising and thesis supervision3. Program, curriculum or coursedesign and development4. Innovative teaching methods5. Educational planning and policy-making6. Production of educational material(study guides, instructional materialsand resources, audiovisual, text books.)


III. The candidate must also meet all ofthe following general criteria:1. Consistently demonstratesexcellence as a professional nurse2. Consistently demonstratesresponsibility for professionaldevelopment3. Participates in the activities ofprofessional organization4. Actively demonstrates innovativeand progressive ideas in nursing5. Acts as a role model and mentor6. Contributes directly or indirectly toimproving the quality of emergencynursing care in one’s province/nation7. Encourages and supports life-longlearning8. Demonstrates goodcommunication skills

Award of Excellencein Emergency Nursing ResearchThis award recognizes a registered nursewho excels in nursing research. In aneffort to encourage nursing research, thiscategory is not restricted to emergencynurses, nor is the research restricted toemergency nursing, but the findings maybe transferable to the advancement ofemergency nursing.

I. The candidate must show outstandingperformance in a majority of thefollowing areas and competentperformance in the remaining areas ofnursing research.1. Research with a clinical focus anddemonstrated practical application2. Contribution to the development ofnursing research as a principalinvestigator or research assistant, ora member of a committee receivinggrant proposals, or as a member of anursing research committee3. Acts as a role model, mentor and aconsultant to foster the developmentof beginning researchers4. Evidence of external peer reviewevaluating the outcomes ofcompleted research5. Contributor to the communicationof nursing research findings throughpresentations at conferences, publicspeaking engagements, consultationsand publications6. Obtains funding for nursingresearch based on peer review


III. The candidate must also meet all ofthe following general criteria:1. Consistently demonstratesexcellence as a professional nurse2. Consistently demonstratesresponsibility for professionaldevelopment3. Participates in the activities ofprofessional organization4. Actively demonstrates innovativeand progressive ideas in nursing5. Acts as a role model and mentor6. Contributes directly or indirectlyto improving the quality ofemergency nursing care in one’sprovince/nation

Award of Excellence inEmergency Nursing AdministrationThis award recognizes a NENA memberwho excels in the administration ofemergency nursing. The candidate must

be in a management position in anemergency setting.I. The candidate must excel in a majorityof the following areas and show competentor better performance in the remainder.1. Planning and implementingeffective and efficient delivery ofnursing services2. Participating in the setting andcarrying out of organizational goals,priorities and strategies3. Providing for allocation, optimumuse of, and evaluation of resourcessuch that the standards of nursingpractice can be met4. Maintaining information systemsappropriate for planning, budgeting,implementing, and monitoring thequality of nursing services5. Promoting the advancement ofnursing knowledge and theutilization of research findings6. Providing leadership that is visibleand proactive7. Evaluating the effectiveness andefficiency of nursing services8. Empowering staff throughparticipatory management


III. The candidate must also meet all ofthe following general criteria:1. Consistently demonstratesexcellence as a professional nurse2. Consistently demonstrates respon-sibility for professional development3. Participates in the activities ofprofessional organization4. Actively demonstrates innovativeand progressive ideas in nursing5. Acts as a role model and mentor6. Contributes directly or indirectlyto improving the quality ofemergency nursing care in one’sprovince/nation7. Recognizes contributions andcelebrates successes8. Promotes emergency nursingstandards

Fall 2002 • 25-2 • Outlook 17

NENA Award of Excellence application formForward all submissions to the provincial representatives by January 31 of each year. Incomplete or late applications will not beeligible for consideration. Successful candidates will be presented with awards at the annual general meeting. In order to facilitatethe process of the applications, the nominator will involve the nominee in the submission and verification of information.

Award of Excellence in: ___________________________________________________________________________________

Nominee: _______________________________________ Address: _______________________________________________

_____________________________________________________________________________ Postal Code: _______________

Phone: work (_____) _____ - __________; home (_____) _____ - __________; fax (_____) _____ - __________

E-mail: ________________________________________

Employer: ________________________________________ Current position: _______________________________________

Nominator: _______________________________________ Address: ______________________________________________

_____________________________________________________________________________ Postal code: _______________

Phone: work (_____) _____ - __________; home (_____) _____ - __________; fax (_____) _____ - __________

Letter of support (1) from: _______________________________________________

Letter of support (2) from: _______________________________________________

Signature of nominee: _______________________________________________

Signature of nominator: _______________________________________________ Date: ______________________________

Awards of ExcellenceDo you have an idol? Someone who helped you through that long day, evening, or night shift in ER? Well, NENA wantsto hear about them! NENA is looking for nominations for Awards of Excellence in emergency nursing. There is no limit tothe number of awards that are awarded in four categories: Emergency Nursing Practice, Emergency Nursing Research,Emergency Nursing Administration, and Emergency Nursing Education.

Outlook 18 • 25-2 • Fall 2002

pediatrics

By Rhonda Correll, RN, HBScNEmergency Medicine Clinical

Research CoordinatorChildren’s Hospital of Eastern

Ontario, Ottawa, Ontario

Many years ago, before I would everhave dreamed that I would end upspecializing in research within theemergency department (ED), I worked ona general medicine ward of a pediatrichospital. I received a call one night froma nurse working on a nearby surgicalward. Due to a shortage of beds, they hadbeen required to accept an admission ofan infant with croup who was not doingvery well. The nurse asked if one of ournurses who was more experiencedworking with croup could come and lookat this patient. I went over and sureenough the child was quite distressed. Wecalled the physician responsible for thatpatient and, after examining the child, hewrote an order for IM dexamethasone. Ihad never heard of giving decadron forcroup and questioned him about it. Hereplied that this was a new treatment andhe had just read about some research thathad been done which showed it washighly effective. We administered themedication and I was really impressed bythe dramatic improvement in the child.When I think back, this was the first timeI made a connection between researchand how it changes the way we care forkids. Soon after that, I transferred to theED where I became involved withresearch, working as a research assistantfor several years, and then moving intomy present role as the emergencymedicine clinical research coordinator.

Over the past 10 years, the amount ofresearch within our ED and certainly EDsall across Canada has escalated, bringingabout many changes in practice. In ourhospital, ED-based studies have looked at

respiratory conditions such as asthma,croup and bronchiolitis. These studies areresponsible for many changes in practice,including the use of inhaled budesonideand oral decadron in the treatment ofcroup (Klassen, Craig, Moher, Osmond,Pastercamp, Sutcliffe, Waters & Rowe,1998) and the increased use of inhaledracemic epinephrine in infants withbronchiolitis (Menon, Sutcliffe &Klassen, 1995). Complex care of childrenwith asthma in the ED has beensignificantly impacted and improved byresearch findings over the years (Sung,Osmond & Klassen, 1998; Plint, Osmond& Klassen, 2000). The suturing oflacerations in small children was often atraumatic event involving needles andpainful freezing. Studies looking at theuse of glue to replace sutures in facelacerations of children (Osmond, Quinn,Sutcliffe, Jarmuske & Klassen, 1999)have eliminated the need for sutures onsimple facial lacerations. As a triagenurse, it is a great satisfaction to be ableto tell an anxious child with a simple chinlaceration, “We should be able to justglue that back together...no needles!”

Recently, a study examining the use ofcool mist in the treatment of croupshowed that it was not effective inresolving croup symptoms (Neto,Kentab, Klassen & Osmond, 2002). Thisparticular study is a perfect example ofthe value of evidence-based practice. Wealways assumed that treating childrenwith cool mist within the ED improvedtheir croup symptoms despite the fact thatthere was no evidence to support thispractice. This study resulted in thecessation of the use of mist sticks withinour ED. While mist sticks are in no wayinvasive, they were time-consuming toset up and instruct families how to useand, generally, the child with croup whois already feeling anxious disliked havingthe cool mist blowing into their face.

This kind of care-altering research iscontinuing in our ED. Presently, there area number of studies underway within ourED which, when completed, will provideevidence that will undoubtedly alter ourtreatments and improve the already greatcare we give to our patients with commonED ailments such as gastroenteritis, ottitismedia, wrist fractures, and pain resultingfrom musculoskeletal injuries. It is anexciting time for emergency department-based research and it is great to see somany emergency department nursesbecoming involved in research whichchanges how we care for kids!

ReferencesKlassen, T., Craig, W., Moher, D.,

Osmond, M., Pastercamp, H., Sutcliffe, T.,Waters, L., & Rowe, P. (1998). Nebulizedbudesonide and oral dexamethasone for thetreatment of croup. JAMA, 279(20), 1629-1632.

Menon, K., Sutcliffe, T., & Klassen,T. (1995). A randomized trial comparingthe efficacy of epinephrine with salbutamolin the treatment of acute bronchiolitis. TheJournal of Pediatrics, 126(6), 1004-1007.

Neto, G., Kentab, O., Klassen, T., &Osmond, M. (2002). A randomizedcontrolled trial of mist in the acute treatmentof moderate croup (abstract). AcademicEmergency Medicine, 9(5), 488.

Osmond, M., Quinn, J., Sutcliffe, T.,Jarmuske, M., & Klassen, T. (1999). Arandomized, clinical trial comparingbutylcyanoacrylate with octylycyanocrylatein the management of selected pediatricfacial lacerations. Academic EmergencyMedicine, 6(3), 171-177.

Plint, A., Osmond, M., & Klassen, T.(2000). The efficacy of nebulized racemicepinephrine in the children with acuteasthma: A randomized, double-blind trial.Academic Emergency Medicine, 7(10),1097-1103.

Sung, L., Osmond, M., & Klassen,T. (1998). Randomized, controlled trial ofinhaled budesonide as an adjunct to oralprednisone in acute asthma. AcademicEmergency Medicine, 5(3), 209-213.

Changing how we care for kids:Research in a pediatric ED

Fall 2002 • 25-2 • Outlook 19

Research Corner

By Cathy Carter-Snell,RN, MN, ENC(C),

Mount Royal College,Calgary, Alberta

AbstractIn this introductory article in theresearch section, an overview is providedof evidence-based practice and itspotential value to emergency nurses.Nursing has been described as consistingof both art and science. This definition ofscience in nursing has caused somecontroversy in relation to evidence-basedpractice. Some view science in thetraditional natural science view in whichonly randomized controlled trials countas evidence. This leaves out a substantialportion of research findings in nursingwhich contribute significantly to healthcare and best practices. In this article,the concept of evidence-based practice isexplored and related to the art andscience of nursing. Strategies to increaseevidence-based practice are thensuggested.

In the past decade, there has been anoticeable increase in literatureconcerning evidence-based practice andresearch utilization by nurses. There isinconsistency in the use of the terms“evidence” and “research utilization”.To the medical community, “evidence-based practice” has generally beenlimited to implementing results ofrandomized controlled trials, also calledRCTs. The Health Information ResearchUnit (HIRU) at McMaster University,which is closely linked to a largeinternational research network knownas the Cochrane Collaboration, hasdefined evidence-based practice morenarrowly. It defines evidence-basedhealth care as “the explicit,conscientious and judiciousconsideration and use of the best, most

up-to-date research evidence to guidehealth care decisions”. This is arestrictive definition which should beused cautiously in health care.Randomized controlled trials are limitedin nursing, mainly due to the types ofquestions we ask, as well as the limitson some aspects of our autonomy. Mostof our research is correlational or quasi-experimental, or uses qualitativemethods. Restriction to evidence fromRCTs would exclude an increasinglyrich base of evidence nurses haveamassed.

Health care professionals require awider definition of evidence-basedpractice, one which includes not onlyquantitative data, but also qualitativeand non-research-based evidence.While qualitative research data hasbeen excluded by many medicalevidence-based practice definitions, itis an extremely important source ofinformation and evidence for healthcare professionals. In the past, researchusing qualitative methods was seen as a“stepping stone” leading to quantitativeresearch methods. This is nowunfounded, as many research questionsare suited only to qualitative researchand the findings can stand on their own.Examples may include studies of whatthe experience of loss has meant tofamilies of trauma patients, what itfeels like to be unable to breathe forpatients with lung disorders, and whatis involved in providing comfort inemergency. There have been concernswith the ability to generalize qualitativefindings to other settings orpopulations, including issues ofreliability and validity. It is nowrecognized that qualitative research canalso be rigorous, considering aspectssuch as credibility, fittingness,applicability, confirmability, and

auditability. The utility of qualitativeresearch findings beyond the studysetting may also be enhanced ifsupported by other similar findings insimilar studies. This can be donethrough a process called“metasynthesis” for qualitative data, or“meta-analysis” in quantitative studies.Groups of health care researchers haveformed into specialty groups to performsystematic reviews of related researchin various specialty groups. The mostwell-known of these is the CochraneCollaboration group. They have, untilnow, exclusively conducted systematicreviews of randomized controlled trials,but are currently exploring ways toinclude systematic reviews ofqualitative research findings as well.

Other non-research-based forms ofevidence may also be important. Wemay also have evidence of theeffectiveness of our interventionsthrough sources such as experience,quality assurance data, descriptivereports, patient satisfactionquestionnaires or individualobservations/critical thinking by thepractitioner. Evidence has also beencritical in the development of clinicalpractice guidelines. It is important toremember that the guidelines must beflexible enough to allow for diversity ofevidence. A guideline must be able to beadapted in relation to clients’ uniqueneeds and the nurse’s observations. Thenurse must also be able to explain thebasis of the evidence used to change theguideline. We all recognize that no onepatient presents in the same manner asanother and all respond somewhatdifferently to the same treatment. It hasbeen argued that a more flexibledefinition of evidence is also requireddue to the fluid/changing nature ofknowledge. Even if an RCT is the

Evidence-based nursing:Blending the art and science

Outlook 20 • 25-2 • Fall 2002

appropriate research design for aquestion, it takes time to develop andimplement, and the findings do notstand on their own. As knowledgechanges, it is not possible to keep pacewith an equal amount of generalizableRCT findings. Furthermore, RCTs onlyreflect one aspect of our science and notour art.

The art andscience of nursingArt is described as consisting of learnedskills which have become creative andbeautiful, whereas science is knowledgewhich has been systematically obtainedand formulated. Watching an expertnurse weave measures into their carewhile attending to physiologic andsocial alterations in the client’scondition is truly an art. Understandingand explaining this art, or generalizing itto broader contexts for more consistentor effective care, requires scientificobservation and exploration.Traditionally, science has been seen asconsisting of quantitative empiricalknowledge (positivism), although otherforms of systematic investigation arealso important. Examples includeinterpretive science in which scientistsseek to understand phenomena, andcritical science in which the phenomenaare explained and theories are developedto support change toward or away fromthe outcome. At least four different typesof knowledge have been described, all ofwhich are interrelated andinterdependent. The four include:empiric knowledge, observing theactions of the nurse on the client(aesthetics or the art), knowledge of self(personal), and morality (ethics). Thisimplies that empirical science istherefore only one way of gainingknowledge, and that science and artcannot be separated.

We need to be able to explain not onlythe quantitative aspects of ourpractice, but also the qualitative orsocial aspects of our clientinteractions. How can we argue formore time with clients outside tasks ifwe cannot demonstrate the importanceof our interactions with them? If wehave not explored their perceptions ofour touch, our tone of voice, our

efforts to comfort, how do we knowthe effectiveness of our care? This isevaluated on a daily basis by eachnurse with individual clients. Anunderstanding of these aspectsfacilitates the development of the artin novice practitioners, provides aframework for theory developmentand practice guidelines, andjustification for both our art and ourscience. So how do we increase theevidence base for our practice?

Increasing evidence-basednursing practiceIn order to increase evidence-basedpractice (EBP), we need to know aboutcurrent research findings andobservations, understand our ownpractices and contributions, and tocommunicate with each other aboutthese. Two key aspects which willincrease EBP include increasedutilization of existing research andformation of partnerships to promotefurther research and documentation.

Research utilization is only a piece ofEBP, but is critical. Much research goesunnoticed and practices do not change,even if published or presented atconferences. Nursing practice has beendescribed as based on “tradition, rituals,or hunches rather than scientificknowledge or research”. In a study ofpractices in one US state, it was foundthat while the majority of protocols werereferenced, very few were research-based. It is unlikely that this state isatypical of other North Americanhospitals. In studies of nurses’knowledge of published research-basedchanges in practice, up to 70% wereeither unaware of the changes or hadimplemented six or more in theirpractice.

Research utilization has been defined as“the use of research findings to changeor validate practice” (Fitzimmons et al.,1995). In this context, we are includingqualitative and quantitative findings.How the prevalence of researchutilization is measured is quite variable,however. Some only measure changesmade to practice as a result of researchfindings. It may be argued that thereview of research is equally important.

Many times, we review and interpretdata and find it not suitable for practicechanges, or for a particular patientcircumstance. If changes are not madedue to lack of sufficient evidence orgeneralizability of results, it is arguedthat this is an important aspect ofresearch utilization.

Major reported barriers to researchutilization by nurses include: (Carroll etal., 1997; Pettengill et al., 1994; Funk,Champagne, Wiese, & Tornquist, 1991;LeMay, Alexander, & Mulhall, 1998;Kajermo, Nordstrom, Krusebrant, &Bjorvell, 1998; Walsh, 1997; Kajermo,Nordstrom, Krusebrant, & Bjorvell,2000; Walsh & Walsh, 1998):• aspects of the organization - inadequatetime to implement the new ideas, lack ofauthority to make the changes, inadequatefacilities to implement, lack of supportfrom administration, lack of support fromother disciplines; workload; alreadyexperiencing too much change; lack of aculture which supports or understandsresearch culture; and dominance ofmedical research and practice.• aspects of the presentation - use ofresearch jargon, unclear statisticalexplanations• aspects of the research - accessibility ofresearch findings, publications orcomputer databases, small sample sizesand/or lack of replication of studies,findings not generalizable or applicableto user’s setting;• aspects of the nurse – attitudes towardresearch, inconsistency between practicebeliefs and research findings, inadequatetime to locate or read the research,limited skills in critiquing researchreports, inflexibility to change, lack ofsupport from other nurses, limitedprofessional relationships withcolleagues/team members to supporttheir research searches orimplementation.

A large study of factors affecting Albertanurses’ research utilization revealed thatexperience and nursing school were thetwo most frequently used knowledgesources. These knowledge sources maybe dated and potentially non-evidencebased. Literature (texts and journals)was ranked in the bottom five sources ofknowledge. The role of experience issupported by a qualitative study in the

Fall 2002 • 25-2 • Outlook 21

area of decision-making by nurses.Experience may either be a positiveinfluence predicting information use, orbe negative in terms of increasing bias orpotential for disbelief of researchfindings. If a particular method hasworked for many years, why should thenurse believe it has to now be changed?

It has been shown that education is animportant component of increasedresearch utilization, but not just formaleducation. Inservice education wasfound to increase awareness of researchfindings and was found to influenceutilization. This may be linked to theimmediacy of our needs as adult learnersto apply findings to clinical practice. It isalso important for us to increase thebreadth of our research methods andrange of inquiry to reflect the diversity ofour practice. Much of our work is notquantifiable with a randomizedcontrolled trial, but we see the clinicallysignificant impact our work has on ourpatients. We need to also document andcommunicate our findings withcolleagues. Clinical practitioners areurged to publish and communicate theirobservations, questions, and nursingwisdom and to facilitate research. Withthe reality of cutbacks and “doing morewith less”, however, this seems like adaunting task. At one time, there was areal push in nursing to educate staff onhow to conduct their own research. Thisis no longer a reasonable expectation insuch times of workload issues. What ispossible, however, is ensuring that theresearch which is conducted is relevantto practice and that you find out theresults. This suggests formingpartnerships with nurses with specializedskills or additional resources in research,clinical skills or access to additionalresources.

Nurses with additional training inresearch methods, philosophy and theorydevelopment may include nursespecialists, nurse practitioners, or thosein academic institutions. These nurseshave much to contribute to exploring,observing, and documenting the art andscience. They also usually have access toresources and often have dedicated timeto teach or conduct research.Unfortunately, often we see them asliving in an “ivory tower” and producing

seemingly irrelevant work that is of noimmediate clinical utility, or is not easilyinterpreted by the clinical staff.Partnerships between these nurses andclinical staff are critical bridges to buildto increase our evidence base. Academicstaff need to be aware of relevant issuesand how to communicate their results ina format that is more immediatelyapplicable. Academic researchers gaintenure in part by publishing inprestigious research journals rarely readby practitioners, using technical jargon.They are now being challenged topublish a second publication in thepractice journals in a format that directlyhighlights the applicability of the resultsto practice. Some universities in Canada,such as University of Alberta, areseeking to establish “chair” positions forspecialty clinical areas, such asneuroscience, emergency, critical care ormedical/surgical nursing. The chairwould be responsible for furtheringresearch, theory, and practice in thespecialty area and would have at leasttwo scholars working with them – aresearch scholar and a clinical scholar.The research scholar would workpredominantly on research and theorydevelopment with some responsibilitiesin the clinical specialty area. In a parallelmanner, there would also be a clinicalscholar who would work predominantlyin the clinical area, with some research orteaching responsibilities. These positionsare aimed at understanding andexplaining nursing practice in theseareas, and conducting research which isrelevant to the practice. It is also avehicle to communicate the findings in atimely manner to clinical staff and thecommunity. These nurses can also seeksupport from funding and politicalagencies to further promote change.

The clinical nurse has equally importantresponsibilities. People who practise theart and science directly with the clientsneed to identify their information needsand questions and communicate these tothe academic nurses and fundingagencies. Much of what nurses do istaken for granted or is not explored dueto time and energy constraints. We speakof the essential nature of nurses inemergency practice, but many areas haveparamedics and aides working in

emergency. How do we identify ourunique contributions and establish ourprofessional identity? A patient knowswhen they have “good nursing”, but havewe shown it or defined it? Currentnursing workload measures tend to relyon observable tasks and measurableoutcomes. So how do you define thequestion? One of the most valuablesources this writer has found is the stafflounge! When staff complain of theimpact of a change on their care, or thepoor function of a piece of equipmentimposed due to budget cuts, these arepotential research questions. When theyshare “tricks of the trade” with newgraduates, these are wonderful examplesof the art of nursing wisdom which needto be shared and established in theevidence-based literature. A commonexample is exploring what it is thatnurses notice when they identify a clientis “going sour” despite a lack ofsignificant changes in physiologicindicators. Independent interventionssuch as distraction techniques for pain, oreffectiveness of comfort measures withgrieving family, also need exploration.We also need to question our practice“standards”. What is the reason behindhaving every patient take off theirunderwear for surgery, even for throatsurgery? Why do we insist on steriletechnique for endotracheal suctioningwhen there is no evidence linking poortechnique to nosocomial pneumonia, andwe use clean technique for tracheostomysuctioning (entering the same lungs)?Using staff as a base for questionsunderscores the vital need to have linksbetween researchers and clinical areas.Partnerships can also be formed betweenclinical staff, with or without academicstaff, to share research findings. Journalclubs are one way in which nurses canshare findings. A number of relevantjournals are monitored monthly, one pernurse, and nurses meet monthly topresent, critique and discuss articles theyfeel are relevant to their practice.

ConclusionNursing consists of both science and art.These are interdependent and both arenecessary to expert practice. Anydefinition of EBP we accept in nursinghas to reflect both aspects of our practice,and seek to explain both the empirical

Outlook 22 • 25-2 • Fall 2002

aspects of nursing as well as our essence.Clinical practice guidelines need toreflect evidence from both natural andsocial science. Limiting ourselves toempiric evidence will only limit ourvalue and diminish the important effectswe know we have daily with our clients.Our challenge is to raise questions, seekliterature, stimulate research andcommunicate our wisdom and researchfindings with each other. This is bestachieved through partnerships andresearch utilization.

This column is devoted to the researchutilization aspect of EBP. We will use abroad definition of evidence andhopefully serve to facilitate increasedawareness of issues in critical appraisalof research findings using examples inthe emergency literature. Future topicsinclude discussions of research methods(qualitative and quantitative), statisticalmethods, systematic reviews, researchfunding and resources available. It is alsohoped that the columns will stimulatediscussion in your area and generate ameans to compile our collective wisdomand research questions. The author ofthis column welcomes e-mails, calls andquestions at the contact informationprovided. When possible, some of thesewill appear (hopefully with answers) inthe subsequent issues of the journal. It isthe hope that, through increasedcommunication about research methodsand findings in this column, we can beginsome discussion of research questions,research priorities and begin to formnetworks of people with similar interestsand diverse skills. Through thesepartnerships we may begin to blend theart with science in a culture of evidence-based practice.

About the authorCathy Carter-Snell is pleased to join theOutlook team as a research editor. She isa certified emergency nurse, currentlycoordinating two distance educationprograms at Mount Royal College,Calgary (the Advanced ACCNEmergency Nursing program and theForensic Studies program). She is also asexual assault nurse specialist, workingwith two teams in Alberta. Cathy is alsocompleting her PhD studies at Universityof Alberta, focusing on post-traumatic

stress and acute stress disorders. Herdissertation work is on early detection inemergency of physiologic variables andevent variables which increase risk forlater development of these stressdisorders in sexually assaulted women.Cathy encourages other nurses tocommunicate with her to share researchor practice questions, information orcontacts. She hopes to help build ourcapacity for research, networks andknowledge in emergency nursing. Shecan be reached by [email protected] or at work(403)240-6679.

ReferencesBrett, J.L. (1987). Use of nursing

practice research findings. NursingResearch, 36(6), 344-349.

Carper, B. (1978). Patterns ofknowing. Advances in Nursing Science,1(1), 13-23.

Carroll, D.L., Greenwood, R.,Lynch, K.E., Sullivan, J.K., Ready, C.H., &Fitzmaurice, J.B. (1997). Barriers andfacilitators to the utilization of nursingresearch. Clinical Nurse Specialist, 11(5),207-212.

Coyle, L.A., & Sokop, A.G. (1990).Innovation adoption behaviour amongnurses. Nursing Research, 393, 176-180.

Estabrooks, C.A. (1998). Willevidence-based nursing practice makepractice perfect? Canadian Journal ofNursing Research, 30(1), 15-36.

Estabrooks, C.A. (1999). Modellingthe individual determinants of researchutilization. Western Journal of NursingResearch, 21(6), 758-772.

Estabrooks, C.A., Field, P.A., &Morse, J.M. (1994). Aggregatingqualitative findings: An approach to theorydevelopment. Qualitative HealthResearch, 4(4), 503-511.

Fitzsimmons, L., Shively, M., &Verderber, A. (1995). Focus on researchutilization. Journal of CardiovascularNursing, 9(2), 87-94.

Funk, S.G., Champagne, M.T.,Wiese, R.A., & Tornquist, E.M. (1991).Barriers to using research findings inpractice: the clinician’s perspective.Applied Nursing Research, 4(2), 90-95.

Health Information Research Unit(HIRU). (2001). Definition of EvidenceBased Practice.

Kajermo, K.N., Nordstrom, G.,Krusebrant, A., & Bjorvell, H. (1998).Barriers to and facilitators of researchutilization, as perceived by a group ofregistered nurses in Sweden. Journal ofAdvanced Nursing, 27(4), 798-807.

Kajermo, K.N., Nordstrom, G.,Krusebrant, A., & Bjorvell, H. (2000).Perceptions of research utilization:comparisons between health careprofessionals, nursing students and areference group of nurse clinicians.Journal of Advanced Nursing, 31(1), 99-109.

Kitson, A. (1997). Using evidence todemonstrate the value of nursing. NursingStandard, 11(28), 34-39.

LeMay, A., Alexander, C., &Mulhall, A. (1998). Research utilization innursing: barriers and opportunities.Journal of Clinical Effectiveness, 3(2),59-63.

McWilliam, C.L., Desai, K., &Greig, B. (1997). Bridging town and gown:building research partnerships betweencommunity-based professional providersand academia. Journal of ProfessionalNursing, 13(5), 307-315.

Morin, K.H., Bucher, L., Plowfield,L., Hayes, E., Mahoney, P., & Armiger, L.(1999). Using research to establishprotocols for practice: a statewide study ofacute care agencies. Clinical NurseSpecialist, 13(2), 77-84.

Onyskiw, J. (1996). The meta-analytic approach to research integration.Canadian Journal of Nursing Research,28(3), 69-85.

Pettengill, M.M., Gillies, D.A., &Clark, C.C. (1994). Factors encouragingand discouraging the use of nursingresearch findings. Image - the Journal ofNursing Scholarship, 26(2), 143-147.

Rose, P., & Parker, D. (1994).Nursing: An integration of art and sciencewithin the experience of the practitioner.Journal of Advanced Nursing, 20, 1004-1010.

Sandelowski, M. (1986). Theproblem of rigor in qualitative research.Advances in Nursing Science, 8(3), 27-37.

Thompson, C. (1999). Qualitativeresearch into nurse decision making:Factors for consideration in theoreticalsampling. Qualitative Health Research,9, 815-828.

Tibbles, L., & Sanford, R. (1994).The research journal club: a mechanism forresearch utilization. Clinical NurseSpecialist, 8(1), 23-26.

Walsh, M. (1997). Perceptions ofbarriers to implementing research. NursingStandard, 11, 34-39.

Walsh, M., & Walsh, A. (1998).Evidence-based practice: is patientsatisfaction evidence? Nursing Standard,12(49), 38-42.

Winter, J.C. (1990). Relationshipbetween sources of knowledge and use ofresearch findings. Journal of ContinuingEducation in Nursing, 21(3), 138-140.

Fall 2002 • 25-2 • Outlook 23

Trauma Corner

Injury is no accidentBy Julian B. Young, BA, CRIM, MPA

Program Manager, Nova ScotiaTrauma Program, Department of

Health, Emergency Health Services,Halifax, Nova Scotia

As is evident from the injury statisticspresented by Dr. Tallon, injury causesincalculable human suffering eachday in Nova Scotia. But, did youknow that 95% of all injuries and theevents that lead to their occurrenceare caused by predictablecircumstances? This suggests that weneed to change how we view theproblem of injury. One way we canaccomplish this is to stop callinginjuries “accidents”.The British Journal of Medicinestates that “an accident is oftenunderstood to be unpredictable — achance occurrence or as an act of God— and therefore unavoidable” (Vol322, pp. 1320, June 2001). Bycontinuing to refer to injury-causingevents as accidents, we perpetuate the

myth that injuries just happen and thereis nothing that can be done to preventor control them.

The Nova Scotia Trauma Program hasbegun a campaign to encourage people,particularly the media, health careprofessionals, emergency servicespersonnel, injury preventionorganizations, and academic researchersto stop referring to events such as thosedescribed in the box, as accidents!

Furthermore, we believe that thesegroups have a professional obligation tostop perpetuating the myth that trauma isan accident. By removing the termaccident from our injury vocabulary, wewill be able to shift our focus to thefactors that cause injuries and thestrategies we can adopt to prevent themfrom happening in the first place.

Where can you start? Try not to use theword “accident” when describinginjury-causing events in patient charts,case presentations, research papers, orprevention programs. Instead, useterms such as motor vehicle collision(MVC), industrial injury, car-pedestrian collision, and unintentionalfall. Although this request may soundstrange, the Nova Scotia TraumaProgram is one of a growing number oforganizations seeking to ban the “A”word.

Injury is no accident:An awareness campaignDuring the past year, the Nova ScotiaTrauma Program, along with many ofour partners has been actively engagedin a campaign to educate the media,public, trauma stakeholders regardinginappropriate usage of the word“accident”. Why, you might ask? Anaccident is an event which takes placewithout one’s foresight or expectation;an event which proceeds from an

unknown cause; an event without anapparent cause; is unexpected; isunexplained; is an act of God or theresult of fate or bad luck.

When it comes to describing injuries,the facts make it clear that the wordaccident is misleading and not anappropriate description. Indeed, 95% ofall injuries result from predictable andpreventable circumstances. A goodexample of this is motor vehiclecollisions. It is not an accident whensomeone who has been drinkingcrashes head-on into another vehicle. Itis not an accident when someonedecides to drive too fast for road orweather conditions and hits a tree. It isnot an accident when someone isejected from a vehicle because theywere not wearing a seatbelt.

On the surface, this debate may seemtrivial and may appear to be just anotherargument about political correctness.However, the Nova Scotia TraumaProgram along with many othersbelieves that without a change in the useof language around injury, efforts toprevent it will continue to be hampered.As long as people believe that injuriescannot be controlled (as implied by theword “accident”), they won’t stop tothink about the risks in their lives andthe ways they can mitigate them. Webelieve that over time, changing the waypeople perceive injuries will have apositive impact on our collective effortsto prevent them.

The Nova Scotia Trauma Program asksthat you consider striking the word“accident” from your vocabulary ofinjury. For suggestions regardingalternative language, please visit thetrauma program’s website:www.gov.ns.ca/health/ehs

Reprinted with permission by NovaScotia Trauma Program.

Tragic, but no accident...• When an impaired driver crashesher car and is ejected from thevehicle, her resulting death is noaccident!

• When a young child, who is notwearing a helmet, smashes hisATV into a tree, the debilitatingbrain injury he sustains is noaccident!

• When an elderly man trips on acrack in a poorly maintainedsidewalk, the broken hip hereceives is no accident!

• When a worker, who fails to secureherself with a safety harness, falls30 feet from scaffolding at aconstruction site and sustainssevere spinal cord injury, it is noaccident!

Outlook 24 • 25-2 • Fall 2002

IntroductionThe Canadian Triage and Acuity Scale(CTAS) was developed by the CanadianAssociation of Emergency Physicians(CAEP) in 1998 and published asImplementation Guidelines for theCanadian ED Triage andAcuity Scale.The objectives of the CTAS scale wereto “more accurately define patients’needs for timely care and to allowemergency departments to evaluate theiracuity level, resource needs andperformance against certain operatingobjectives.”

The CTAS national working groupbelieves that Canadians living in ruralcommunities are entitled to the samelevel of emergency medical care as urbanresidents.

Since the publication of the document,many Canadian emergency departments,both urban and rural, have adopted itsrecommendations. Patient flow has beenaltered so patients are seen by a triagenurse upon first entering the department.Nursing staffs have been trained in itsapplication.

Triage by nursing staff, when applied asper the CTAS document, can be veryhelpful in sorting and prioritizingpatients waiting for care.

Problems have arisen in sparsely staffedrural emergency rooms (ERs) whentrying to implement this system. Someinstitutions have provided inadequatetraining to their nursing staff for properimplementation. Physician resourceshave been strained trying toaccommodate the timeframes suggestedin the document for non-urgentproblems. This has led to frictionbetween physicians and ER nursingstaff, and increased job dissatisfactionamong rural physicians, many of whombalance ER work with family practice,hospital inpatient care, obstetricaldeliveries, etc. In some communities,the demand for strict adherence to quickresponse times could result in a loss ofmedical services, i.e. physicians mayleave town. The CTAS document states,“The time responses are ideals(objectives) not established care

standards.” However, hospitaladministrators in many ruralcommunities have demanded physicianresponse within the timeframesindicated by the document, despite thelack of evidence to support any ‘time tophysician’ recommendations. Hopefullyresearch will uncover such data.

In order to address these issues, thefollowing recommendations are intendedto assist in the implementation of theCTAS guidelines in rural health carefacilities.

Recommendations1. The CTAS definitions anddescriptions of triage levels one to fivebe accepted by rural as well as urbanER. See part 6 of the CTAS: “Triage inRural Emergency Health CareFacility.”2a. Nursing staff should be trained in theuse of the CTAS.2b. Nursing staff should be involved inthe implementation and monitoring ofprotocols and medical directives.2c. Rural hospitals must have adequateRN staffing to ensure timely triage for allpatients.3. ER nursing staff should be trainedto provide initial resuscitationincluding CPR, starting IVs anddefibrillation and be familiar withACLS standards. A pediatricassessment course such as ENPC isdesirable.4a. Ambulance services and emergencydepartments should use a common triagescale to reduce the risk ofmisunderstandings leading to inadequatemobilization of personnel.4b. Ambulance services should notifyreceiving hospitals of CTAS levelone and two patients as early aspossible.4c. ER staff should then notify on-call physicians promptly of all CTASlevel one and two patients coming byambulance, prior to their arrival inthe ER.5. On-call physicians should beaccessible at all times (by phone, pager,etc.), both so they can be called in asrequired, and so they can give directionto ER nurses prior to their arrival.

6. The timeframes recommended by theCTAS document are reasonable times tophysician-directed care (in the absenceof evidence). Physician-directed carecould include:• Care provided directly by the physicianin person• Telephone advice• Care provided by nursing staff inaccordance with medical directivesagreed to in advance by the physician.See below for more information.7. The CTAS makes no reference toobstetrics. Because of the wide variationin obstetrical preparedness betweenrural ERs, each institution may wish toprepare guidelines for such emergencies.There are very few examples of suchprotocols available to this committee;hospitals with such protocols areencouraged to submit them forpublication on the Society of RuralPhysicians of Canada (SRPC) website.

ProtocolsThe SRPC-ER committee hasdeveloped a protocol (medicaldirective) for CTAS level five patientspresenting to the ER. Implementingthis medical directive should allowrural and remote ERs to continue toprovide a high standard of care to theirpatients while reducing the number ofuntimely visits to the ER by ruralphysicians. This is not intended to be avehicle to solve overcrowding in urbanERs.

An example of an acceptable medicaldirective for CTAS level four patients inrural and remote hospitals is underdevelopment.

A number of rural hospitals havealready developed a variety of medicaldirectives so that physician-directedcare can be initiated by nursing staffprior to the arrival of the physician.These vary in their detail and in therange of problems addressed. In somerural communities, it may be necessaryto implement more detailed or lessdetailed protocols than the one in thisdocument. Examples of these areavailable on the SRPC website:http://www.srpc.ca/. They can be

Canadian Triage and AcuityScale - Rural implementation

Fall 2002 • 25-2 • Outlook 25

CTAS level five includes conditionsthat may be acute, but non-urgent, aswell as conditions which may be part ofa chronic problem with or withoutevidence of deterioration. Theinvestigation or interventions for someof these illnesses or injuries could bedelayed or referred to other areas of thehospital or health care system.

CTAS level five patients may be triagedby the registered nurse to receive care ata more appropriate time or place if allthe following criteria are met, i.e.criteria (a) to (e) inclusive, withoutcontacting the on-call physician:

a) The patient is six months of age orolder.b) Vital signs are deemed satisfactoryby the nurse, and temperature is 35-38.5°C (38.3°C for age > 60 years)c) The patient is assessed as CTAS levelfive.d) After the nursing assessment, there isno clinical indication that the patientmay require urgent physician attention.e) In borderline cases, or where thenurse is unsure, telephone consultationbetween the nurse and physician hasdetermined that the problem is non-urgent.

When a “non-urgent” patient meets allof the criteria specified above, thepatient will be advised that they havebeen assessed using a set of approvedguidelines to determine the urgency ofneed for medical care and that theirproblem has been assessed as non-urgent at this time.

The nurse may carry out nursingintervention if appropriate, or advise thepatient to seek health care services later,e.g. family physician’s office, walk-in

clinic, make an appointment, or returnwhen the physician will be present inthe ER.Always advise the patient that ifs/he has further problems or if thecondition worsens, to call the hospitalor return to the emergency department.May use “patient letter” - see attached.

Facilities may develop standardizedtreatment protocols for nursing care andsymptom relief. For examples go tohttp://www.srpc.ca/

Documentation/reportingDocumentation should follow the sameprocess as all other ER visits, andshould include the CTAS level, nursingassessment, any nursing interventions,and discharge instructions. Theseshould be reviewed by the on-callphysician early the next day and anysuggested changes be initiated by thephysician and communicated to thenurse involved. Follow-up by thephysician would be documented on thesame outpatient form.

Evaluation/monitoring/auditOngoing monitoring is essential toensure that the directives are effectiveand safe. Keeping a log of the patientstriaged to receive care at a later time orin another location, and any changes incare initiated by the physician, willallow hospitals to monitor theeffectiveness of the protocol andinstitute any necessary changes toimprove the process. Monitoring,auditing, and ensuring the protocols arekept up-to-date is the jointresponsibility of the physicians andhospitals.

Responsibility for careCare provided by nursing staff under amedical directive remains theresponsibility of the on-call physician.It is the responsibility of the physiciansproviding on-call services to thecommunity to ensure that protocols andmedical directives constitute goodmedical care and that they remain up-to-date. It is the responsibility of thehospital to ensure that nurses haveadequate training to implement themedical directives and to monitor thatthey are being followed.

Patient letter:Insert facility name, mailing addressand phone number

Dear Patient:The emergency department is intendedfor those patients who require medicalattention on an emergent or urgentbasis. You have been assessed by anurse who uses a set of approvedguidelines to determine the urgency ofneed for medical care. Your problemhas been assessed as non-urgent at thistime.

We recommend that you take thefollowing action:

• Make an appointment to see yourfamily doctor.

• Return to the hospital at_____________ AM/PM.

If you have any further problems or ifyour condition worsens, please call thehospital or return to the emergencydepartment.

Dr. _____ ; time; ER medicaldirector; date; ER physician on-call

downloaded and modified toaccommodate local circumstances.

Communities with functioningprotocols are invited to submitthem to the SRPC-ER committee sothey can be shared with others.Over time, it is expected that thesewill form a comprehensiverepository of well thought-out andproduced medical directives from

across the country, and perhapsbeyond.

The CTAS is currently undergoingreview. The SRPC is now representedon the CTAS working group. Pleasesend comments or suggestions forimprovement to your SRPCrepresentative on the CTAS workinggroup.

SRPC-ER workinggroup members

Dale DewarChristine ThorntonSylvain DuchainePierre-Michel TremblayKarl Stobbe

CTAS level five protocol

Outlook 26 • 25-2 • Fall 2002

By Lucy Rebelo, RN,Staff Nurse, Emergency Department,

Kingston General Hospital,Kingston, Ontario

Before nurses can encourage clientadvocacy, it is important tounderstand what it means to advocate.According to the Oxford Dictionary(1998), an advocate is defined as: “aperson who pleads for another,” and“a person who supports or speaks infavour” (p.18). In order for theemergency nurse to plead for andsupport the mental health client incrisis, she must possess theknowledge regarding mental healthissues and skills necessary to identifythe client in crisis.

Emergency nurses are front linehealth care providers and an essentialpart of their role includes maintainingnursing skills and knowledge. Byseeking opportunities to enhanceskills and knowledge through the useof observation, exposure, experienceand education, nursing can progressto a higher level. An advancedclinical fellowship awarded by theRegistered Nurses Association ofOntario (RNAO) became the vehiclefor enhancing my role as clientadvocate. I recently completed thisfellowship experience, generouslysupported by my nurse manager anddirector.

A re-evaluation of my nursing roleand the challenges faced by nursesworking in a busy emergencydepartment, in the context of thisfellowship experience, prompted therealization that providing the bestcare possible involves taking on anactive role of client advocate. Nursesare in a position to be advocates. Thenurse as an advocate must not onlyconsider the client, but the other teammembers as well. The dilemma is, arewe as nurses ready to take thechallenge? I believe the only answerto this is yes!

As a result of the severity of mostmental health disorders, it is oftendifficult for the client to process theinformation given to them. Thisbecomes problematic for nurses,“many of whom perceive themselvesas lacking the skills and expertise toprovide appropriate care and treatmentto this client group” (Wand & Happell,2001, p. 166). Mental health clientsand their illnesses are multifaceted.Unlike the patient with abdominal painor a broken limb whose care andtreatment is clear, the mental healthpatient often presents with a litany ofconcerns. It has become theresponsibility of the healthprofessional to decipher theseconcerns. For nurses to assist with thecare of clients in crisis, however,familiarity with clients’ concerns is

Advocacyand thementalhealth client

The BestThat I Can BeIf I could be the very best,the best that I could be,There are very special qualitiesthat you would see in me.

I’d be the nurse that othersWould feel free to call upon,When my patients or my colleaguesfind it hard to carry on.

So let me care and let me shareMy knowledge and my skill,and I will stand beside youas this will be my will.

I can also take a step backso you may have your turn.Through skill and observation,I know we both can learn.

And as I “nurse” my patients,I know that you will see,care and understanding,the qualities in me.

I will be the very bestThat I can be,As I stand beside the bedsideand anticipate their needs.

You will see the warmest smile,and hear the softest voice.You will feel me truly present,as this will be my choice.

A gentle touch, a silent tear,to let you know I care,or just to be beside you,the unspoken word we share.

If you feel the need to talk,you know that I will hear,Your accomplishments, contentmentsyour failures or your fears.

May your choices be the best for you,and if you need a hand,Let my expertise andjudgment guide you,

as this I know they can.

May I be the nurse remembered,the best that I could beWhen I stood beside your bedside,you saw the best in me.

By Karen Johnson, RN, BHScN,BTSN (ER/CC), ENC(C), MEd

May 2002

Fall 2002 • 25-2 • Outlook 27

crucial. Knowledge of these concernsprovides an opportunity to educate andthis, in turn, allows for informeddecision-making by clients.

Learning is a critical element ofmental health nursing. Nurses whotake advantage of learningopportunities and take steps toincrease their exposure to mentalhealth clients develop a greaterunderstanding and a more positiveattitude toward this particular clientpopulation (Brinn, 2000, p. 32).Developing a better understanding ofclient issues, concerns, andchallenges will only serve to enhancethe advocacy role that nursesinherently practise on an ongoingbasis.

Nurses are not alone in their efforts tobe advocates. They can refer to theNursing Code of Ethics and NursingPractice Standards for guidance intheir everyday practice. The

Canadian Standards of Psychiatricand Mental Health Nursing (1998)states that, “the nurse uses soundjudgment in advocating for safe,competent and ethical care for clientsand colleagues even when there aresystem barriers to enacting anadvocacy function (Standard VI, 9).System barriers can consist of feelingsof helplessness, frustration anddisrespect towards the client by thenurse. The Canadian Code ofNursing Ethics (2002) under “values”suggests, “Nurses respect the inherentworth of each person they serve andadvocate for respectful treatment of allpeople.”

By acknowledging our uneasinesstowards mental health clients, wetake the first step in developing anunderstanding of our limitations.Recognizing those limitations is aprerequisite to seeking out learningopportunities. According to Brearley(as cited by Duxbury, 1996), “if

skills in communication, empathy,information-giving and relationship-building are developed and used bynurses, clients will benefit by feelingmore in control of their owndestiny” (p. 36).

In conclusion, nurses play a vital rolein providing client support andeducation. In this way, weacknowledge that it is necessary topromote ourselves as advocates. Foradvocacy to be effective, however,nurses need to possess the skills andknowledge required to care formental health clients in crisis.Continuing educational experiencesthrough participation in nursingfellowships, or through readingarticles in professional literature,should stimulate discussion of theneeds of mental health clients and thespecial role of nurses as clientadvocates.

References

Barber, K. (Ed.). (1998). Canadian Oxford Dictionary.Toronto: Oxford University Press.

Brinn, F. (2000). Patients with mental illness: generalnurses attitudes and expectations. Nursing Standard, 14(27),32-36.

Canadian Nurses Association. (2002). Code of Ethics forRegistered Nurses. Ottawa: Author.

Canadian Nurses Association. (1998). StandardsCommittee of the Canadian Federation of the Mental HealthNurses (Associate Member). The Canadian Standards ofPsychiatric and Mental Health Nursing Practice (2nd Ed.).[On-line]. Retrieved May 29, 2002 fromhttp://www.cfmhn.org/standards/standards.htm

College of Nurses of Ontario. (2000). Compendium ofStandards of Practice for Nurses in Ontario. Toronto: Author

Duxbury, J. (1996). The nurse’s role as patient advocatefor mentally ill people. Nursing Standard, 10(20), 36-29.

Hubert, J. (1993). Speaking Up: Advocacy, Code ofConduct. Nursing Times, 89(44), 59-61.

Odom, J. (2002). The nurse as patient advocate. Journal ofPeriAnesthesia Nursing, 17(2). [On-line]. Retrieved May 31,2002 from http://www2.us.elsevierhealth.com/scripts/om.dll/serve

Wand, T., & Happell, B. (2001). The mental health nurse:contributing to improved outcomes for patients in the emergencydepartment. Accident and Emergency Nursing, 9, 166-176.

Westwood, B., & Westwood, G. (2001). Multi-presentermental health patients in the emergency department-a review ofmodels of care. Australian Health Review, 24(4), 202-213.

Documents

Fall 2002 - NENA.ca