Article 1
Nurse-Sensitive Indicators as Predictors of Trauma Patient Discharge Disposition. Silverstein LA, Moser DK, Rayens MK. J Trauma Nurs. 2024 Jul-Aug;31(4):189-195.
This large-scale study (N=29,642) used the 2021 National Trauma Data Bank to examine how nurse-sensitive indicators predict trauma patient discharge disposition. The researchers found that hospital-acquired pressure injuries (HAPIs) doubled the odds of requiring post-discharge care (OR=2.1), while catheter-associated urinary tract infections (CAUTIs) increased these odds by 1.4 times. Though central line-associated bloodstream infections (CLABSIs) did not significantly predict discharge disposition, this may reflect their low occurrence rate rather than lack of impact. These relationships persisted even after controlling for variables like injury severity, demographics, and preexisting conditions, highlighting the influence of nursing care quality on trauma outcomes.
This study is a step forward in trauma research by shifting focus from traditional outcome measures to examine the impact of nurse-sensitive indicators - an area historically overlooked in trauma literature. While the large national dataset enhances generalizability, inconsistent data collection methods across participating hospitals and significant missing data for some variables (such as length of stay) may affect the findings' reliability. The study's focus on nurse-sensitive indicators as quality measures is innovative, but the binary categorization of discharge disposition (further care vs. no further care) may oversimplify the complexity of post-trauma care needs. Nevertheless, the findings underscore the need for more research examining how nursing care affects trauma outcomes, including investigating longer-term outcomes and evaluating the effectiveness of prevention bundles, specifically in trauma populations.
Article 2
Impact of Bedside Laparotomy Simulation and Microlearning on Trauma Nurse Role Clarity, Knowledge, and Confidence. Messing JA, Russell-Babin K, Baker D, D'Aoust R. J Trauma Nurs. 2024 May-Jun;31(3):129-135.
The critical care environment is one of increasing complexity. As patient acuity rises so does the potential for emergency bedside surgical procedures performed in the intensive care unit (ICU) setting. Preparing nurses to assist with emergency bedside surgical procedures has added challenges. This article evaluated the impact of simulation and microlearning on role clarity, knowledge, and confidence among ICU nurses assisting with emergency bedside laparotomies at a large academic Level I trauma center. Bedside nurses who volunteered to participate in the prospective study completed a pre-test before participating in an in-situ simulation and a post-test immediately after. Short microlearning modules to reinforce bedside laparotomy concepts were completed weekly for three weeks after the simulation. A repeat post-test was completed 30 days after the simulation.
A statistically significant improvement in role clarity, knowledge, and confidence from the pre-test to the post-test and from the pre-test to the 30-day post-test was noted, with the improvement in role clarity and knowledge being highly significant (p < .001). The authors acknowledge the limitations of the small sample size (28 nurses completed the initial pre-test, simulation, and post-test; 16 completed the 30-day post-test) and single-unit study environment (18-bed surgical trauma ICU). The Confidence in Managing Situations (CMCS) scale and the Role Ambiguity Scale used are standardized tools with limitations in feasibility and applicability for this study. The pre-test and post-test knowledge assessment, while not validated, was developed by subject matter experts. Despite the limitations noted, the study findings emphasize the benefits of utilizing in-situ simulations and microlearning modules for education among bedside nurses. These findings are similar to other studies on the value of simulation and microlearning in providing education to healthcare providers. Additionally, multidisciplinary simulations, as a way to increase fidelity when training nurses on surgical procedures, is a noted valued approach to education reinforcement.
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