2018 ENA Today Daily

Attendees in Wonderland

Neon Nights rakes in $23k for ENA Foundation

Emergency nurses let their passion shine through Thursday night at the annual conference welcome party – Neon Nights.

Draped in neon or black light-friendly white, attendees danced the night away to the new-wave stylings of party cover band The Spazmatics, all while raising money for the ENA Foundation. Glowing lounge areas, light tables filled with candy, streamers, balloons and tall Dr. Seuss-like lamps offered a party atmosphere akin to childhood dreams.

Hundreds of party-goers purchased blinking, white and brightly colored hats, suspenders, wands, wigs and jewelry to get into the spirit and give to the cause. The Foundation raised more than $23,000 from product sales, drink purchases and ticket sales. The money goes toward ENA Foundation scholarships and research grants in 2019.

The Spazmatics filled the large room with the ’80s top pop hits intermittently for nearly three hours. But it wasn’t enough. Attendees groaned as the lights came up, and they begrudgingly left the convention center in search of an after party – the sign of a good ENA conference kick-off celebration.

Innovative Fast-Track Format a Hit

The fast-track sessions returned to Emergency Nursing 2018 with a value-add – attendees could select their own adventure from their session-room chairs.

At each designated start time, three presenters delivered talks simultaneously, while attendees listened along through headsets, toggling between each as desired with the press of a button.

Four sets of speakers presented, for a total of 12 presentations in a two-hour session. The new format provided more information in a shorter amount of time than in previous years.

Some attendees came for a specific session, while others clicked around until they found the session most interesting to them.

“The cool thing was that if you started listening and it wasn’t exactly what you thought it would be, you could switch to something different without leaving your seat,” said Carol Tulley of Winfield, Illinois. “I thought it was a really great setup.”

Her colleague Zankhana Desai, also of Winfield, echoed Tulley’s response, noting it was a more effective learning environment than she expected.

“I thought I’d be distracted by the other screens and presenters, but once I got into it and focused on the person, it wasn’t distracting at all,” she said.

Highlights of the fast-track sessions included:

“But It’s Healthier than Smoking: Vaping Emergencies”

There is a common misconception that smoking e-cigarettes, known as vaping, is not as dangerous as smoking conventional cigarettes. In fact, vaping comes with its own set of dangers according to presenter Justin Milici. He said it can present to the emergency department in a variety of ways, including “popcorn lung,” which can lead to respiratory failure, pneumonia or pneumothorax; ingestion of liquid nicotine, often by small children; and burns from exploding lithium batteries.

“Electronic cigarettes are not without their risks, so it is very important to educate patients, caregivers and the community on the long-term health consequences of e-cigarette use and the consequences that can lead to an emergent situation resulting in a patient being admitted to the emergency department,” Milici said.

“Management of Posterior Stroke: When FAST and NIHSS Fail You”

Posterior stroke accounts for approximately 20 percent of stroke patients, but their treatment rate is just 3 to 4 percent. This session presenter demonstrated the use of the BEFAST screening tool, which adds balance and eye evaluation to the assessment, and reviewed the “D’s”—dizziness, dysequilibrium, dystaxia, dysmetria, diplopia, dysarthria, and dysphagia—which can provide structure to an assessment.

“Screening for acute onset and sustained difficulties with balance and vision is both sensitive and specific for posterior stroke,” speaker Wanda Pritts said of the extended screening. “Adding the assessment of balance and vision, the effectiveness of screening for stroke rises to 85 percent.”

“Peds Needs: Tips and Tricks for Caring for our Pediatric Patients”

This session was full of tips and tricks and guidelines to make caring for small patients and their parents as easy as possible.

“When you understand the concept that play is the work of the child, it becomes easier to integrate that concept into daily care,” said presenter Joyce Foresman-Capuzzi. “This clearly helps with establishing trust, performing assessment, collecting specimens, providing treatment and administering medication. Most of these can incorporate playful activities so the child is more cooperative, the family comforted and the nurse less stressed.”

Treating Transgender Patients in the ED

Open-mindedness, professionalism and tact can go a long way when caring for transgender patients or, really, any identified group within society.

“Being educated, nonjudgmental and having some idea of how to ask appropriate questions will help with any culture we are unfamiliar with,” said Christine Marshall, an emergency nurse at St. Joseph Emergency Care Center in Orange, California. 

Transgender Patients in the Hospital

1:30 – 2:30 p.m.

Saturday

Room 413, 414, 415

Marshall will speak on the subject in her presentation, “Transgender Patients in the Hospital,” which will introduce attendees to the lesbian, gay, bisexual, transgender and queer/questioning culture. Specifically, and for starters, she will define terms to describe gender and sexuality and explain the distinct differences between the two. 

“My session is an introduction to the care of transgender patients, and attendees will leave with a greater sense of how they feel about caring for this vulnerable population,” she said. 

Marshall will explore different medical treatments available for transgender patients and related complications. Transgender patients are often on hormones, she said, which can cause many complications, including sterility, blood clots, hypertension, weight gain and other blood and cardiac disorders.

Sex reassignment surgery can also cause complications including infections, strictures and ischemia, she added. 

The discussion will touch on behavioral health issues common in LGBTQ patients and the many barriers they might encounter while in the ED. Marshall explained that members of the LGBTQ population are often at a higher risk for anxiety, depression, suicide, substance use and homelessness.

“LGBTQ people are twice as likely to use drugs and alcohol as well as engage in high-risk sexual behaviors and self-harm,” she said. “About 60 percent of this population has considered suicide, while as much as 41 percent may have attempted suicide.”

Barriers the LGBTQ population encounter in an ED setting include lack of knowledge on the part of staff, discrimination and the feeling of being judged for their appearance, Marshall said. She added that emergency nurses can feel more comfortable communicating with this population if they respect these patients’ preferences and apologize for any mistakes or misunderstandings rather than ignoring them.

“Nurses can overcome the barriers to treating LGBTQ patients by remembering that we don’t have to understand their lifestyle, we just need to respect it and value all differences,” Marshall said. 

LGBTQ Defined

Sex – a matter of the body genetically and phenotypically

Gender – an internal sense of being male, female or other

L – Lesbian: female-identified person attracted to other females

G – Gay: male-identified person attracted to other males

B – Bisexual: person of any gender identity who is attracted to people of the same sex and of various genders

T – Transgender: person whose gender identity does not coincide with the sex or gender they were identified as at birth

Q – Queer: umbrella term for non-heterosexual gender identity

I – Intersex: person born with genitalia, chromosomes or reproductive organs that don’t fit the typical definitions for males or females at birth

A – Asexual: person who doesn’t experience sexual attraction

Human Trafficking: ED Nurses on the Front Line

With human trafficking remaining a nationwide, multibillion-dollar criminal industry, the ED is one of the few places where the lives of trafficking victims intersect with the general population. As such, emergency nurses have a unique opportunity to help victims. 

“Survivor-led statistics are making it obvious that trafficked persons are being seen in the emergency department setting, but we are not equipped as a profession to adequately identify and help these disadvantaged people,” said Steven Donahue, co-leader of a deep-dive session at 10:15 a.m. today. “This session is about giving emergency nurses much-needed educational training in order to recognize and treat human trafficking victims.”

Steven Donahue

Donahue said victims rarely receive preventive care for medical needs and are typically brought to the ED when their conditions begin to hurt their economic value to their traffickers.

“One recent study surveyed hundreds of trafficking victims and found that 88 percent reported they received medical care during their captivity. Of those, 63 percent had been seen and treated in a hospital emergency department,” he said. “We have been lucky enough to meet trafficking survivors and hear their stories. When survivors speak about their interaction with health care workers, they often discuss that they wish their doctor or hospital had done more — or anything — to help them. We want to change this.”  

Human Trafficking Emergency: A Comprehensive Training for Emergency Department Personnel

10:15 a.m. – 12:45 p.m.

Saturday

Room 304

The session will be led by Donahue and Michael Schwien, emergency nurses at Main Line Health outside of Philadelphia. Topics will include statistics, myths and misconceptions, health implications and presentation characteristics, vulnerable populations, red flags and clinical markers for identifying possible victims, trauma-informed care and discussing the human trafficking hotline.

“Health care professionals must understand that the lack of education in health care creates a disparity for victims of trafficking,” Schwien said. “This disparity leads to trafficking victims not receiving the appropriate resources and referrals they need. Hospitals can be a place to empower the individual in making steps toward getting them safe.”

Donahue and Schwien will be joined by Diane Horn, assistant district attorney from Delaware County, Pennsylvania, with the special victims unit. She will discuss current legislation and legal definitions regarding trafficking, reporting requirements for ED personnel, recommendations for charting in order to assist law enforcement, prosecution process for traffickers, legal process for survivors and an example of trafficking within Pennsylvania.

Victim advocate Joy Medori will lead the “In Her Shoes” experience. This interactive activity provides participants the opportunity to place themselves in the shoes of a trafficked person and make decisions based on what the participant would do if they were placed in similar situations.

Donahue and Schwien will provide details on how they successfully implemented a human trafficking protocol within their health system.

“We hope that at the end of this training session, not only will participants be able to better identify and treat victims, but they will be supplied with the tools necessary to distribute education to their coworkers and become change agents at their own hospitals,” Donahue said.

Austin to Host ENA in 2019

It’s never too early to start planning for Emergency Nursing 2019, and ENA is helping attendees do just that.

Next year’s conference – Sept. 29 to Oct. 2 – in Austin, Texas, will provide everything attendees have come to expect from the premier emergency nursing educational and networking event, on top of all that Austin has to offer.

“ENA is excited to host the annual conference in Austin,” said ENA President-elect Patricia Kunz Howard. “Emergency Nursing 2019 will feature exceptional educational opportunities, networking and social events in a city filled with great entertainment. Emergency nurses should plan now to attend this event next September.”

And it’s not just ENA that is excited about next year’s conference; the “live music capital of the world” is ready to welcome the event and its more than 3,000 attendees and exhibitors with open arms.

“We are thrilled to have ENA’s annual conference in Austin next year,” said Bridget Portier, Austin’s Assistant director of Convention Services. “Whether you are interested in history, music, outdoor adventures or shopping, Austin offers something for everyone. ENA attendees can definitely expect to enjoy great food, live music and southern hospitality at its best.” 

Attendees in Pittsburgh ready to register for Austin at the lowest possible cost can visit the designated booth near registration in the main foyer of the David L. Lawrence Convention Center any time this week. And those equally excited to present their research next year in ePosters will have the chance to do so shortly after Emergency Nursing 2018 concludes. ENA is slated to put out a call for abstracts for Emergency Nursing 2019 on Monday.  

For those who can’t wait for next year to enjoy more ENA educational programming and networking opportunities, head down to Orlando Nov. 8 and 9 for the ENA Fall Regional Symposium.

We Are Human, After All

“The No. 1 rule in nursing school is don’t make a mistake. But we are human, after all. We make mistakes,” said Al Duke, who presented “If ‘To Err Is Human,’ Why Am I in Trouble?”

In the Friday session, Duke shared wisdom about organizational culture gleaned from malpractice claims he has reviewed.

The challenge for emergency room nurses is that they must think fast and act quickly, he said. These two requirements demand efficiency over thoroughness. In a world where there are two types of thinking—System 1 and System 2 thinking—nurses often have to act by rote.

System 1 thinking is recognizing patterns or symptoms and then moving to the best known solution. “It doesn’t take a lot of brain power. You could do it in your sleep,” he said.

System 2 thinking, on the other hand, is more analytical and takes processing power.

He likened it to when he first learned to drive. “My first time behind the wheel, I was conscious of how hard I pressed the accelerator and all of the other factors needed to drive. However, now, I hardly even think about it.”

Duke maintains that systems and organizational culture break down when mistakes happen and need to be fixed with new processes, workarounds and checklists, not judgment.

“We need to fix the system, not necessarily the human. Nurses pursue this profession because they want to help; they do not want to do harm.”

Making Sense of the Mistakes

Even the most seasoned emergency nurse will sometimes encounter an unexpected outcome. But emergency nurses can increase patient safety by openly debriefing and problem-solving when patient care does not go as planned.

“Historically, we have been afraid of retribution or disappointment from our peers, so many nurses have kept their ‘mistakes’ to themselves,” said Teri Campbell, a flight nurse who presented “Trials and Tribulations of Terrible Tot Transports and Take-Away Tidbits” on Friday. “If we do not have a brave enough voice to debrief and learn with our peers, then we are setting ourselves and our patients up for future mistakes.”

Campbell’s case-based lecture focused on pediatrics, highlighted transports that did not go as planned and detailed how nurses can learn from mistakes. With humor and empathy, she explained what went wrong. She reviewed questions that keep her up at night and explained the lessons she learned from each case.

She said missteps can happen for a variety of reasons.

“Sometimes, it is because we receive patients who were mismanaged prior to our arrival,” she said. “Sometimes, it is because the patient deteriorated and we did not recognize it right away.  Sometimes, it is because something deleterious occurred that was out of our control and we needed to recognize and immediately intervene to mitigate or prevent poor outcomes.”

Campbell said it is up to emergency nurses to make sense of the mistakes so they aren’t repeated in the future.

Authors Shine Through Posters

Emergency nurses create ePosters for ENA’s annual conference to share what they learned on the job in their emergency departments. The posters at Emergency Nursing 2018 showcased the breadth of that knowledge, covering everything from violence in the workplace to HIV.

First-time presenters Melissa del Mauro and Pamala Sodden from Livingston, New Jersey, said they enjoyed the experience of talking with peers about their workplace violence poster.

“It’s amazing that we’re able to share our experiences with others,” del Mauro said. “We’re proud of our accomplishments, and we’ve learned from our failures. It’s fun to be able to have conversations with nurses from around the country who know exactly what we’ve gone through.”

Sodden and del Mauro were among a strong field of ePoster candidates, but two rose to the top to be judged as this year’s winners:

Evidence-based Practice

“Empowering Emergency Department Nurses to Obtain Earlier Palliative Care Consults”

Susan Boyle and Sidneia Sharif

Boyle and Sharif’s poster highlighted an ED initiative that sought to empower nurses to screen patients for palliative care needs and use their assessment to trigger a palliative consult.

“There are times when aggressive life-sustaining or life-saving care given to a patient may not be the best option or may not be the optimum means of meeting a patient’s goals of care,” said Boyle. “This initiative aimed to provide staff with the confidence to initiate a conversation or plant the seed, and for patients and their families to have an opportunity to make their wishes known to staff before aggressive measures are taken.”

Boyle said she and Sharif, both of Morristown Medical Center in Morristown, New Jersey, read a significant amount of research on other programs around the country to find a suitable screening tool. In their ED, Boyle said the average number of palliative consults requested has increased from an average of eight to 32 per month.

Research Category

“Using Information Technology to Promote Patient Handoff, Safety and Throughput”

Meredith Carr, Nicholas Popowycz, Emily Bowen, Liset Denis, Ann White and Judy Prewitt

The authors, who work at Duke University Hospital in Durham, North Carolina, discovered they could use their electronic medical records system to streamline reports between emergency nurses and inpatient nurses. They created an electronic template that used the software’s auto-population feature to save time. Among their measurements, were the number of patient transfers that needed to take place after the patient was moved upstairs, meaning the patient’s condition had deteriorated or rapid response had to be called.

“We were most pleased the number of rapid responses needing to be called on these patients after they were transferred from the ED went to zero,” White said. “It just reflects better communication between the emergency nurse and the inpatient nurse.”

Opening Session Wows Audience

Opening a conference like Emergency Nursing 2018 is no small task, but planners were up to the challenge.

A dramatic video traced the yearlong journey of ENA lanterns across the United States, and around the world, before arriving in Pittsburgh. Nurses carried their lanterns to the stage and encircled the ENA President Jeff Solheim to complete the trek.

Master of Ceremonies Todd Thomas returned with boundless energy which he used to shake up the early morning crowd. He encouraged audience members stand up and dance to get their blood pumping.

The heart of the session included speakers and live debates on stage. ED Talk subjects included, “I’m a Millennial and It’s Time You Took Me Seriously,” “I Might Be Retired but Don’t Put Me Out to Pasture” and “It’s Better to Burn Out than to Fade Away.”

Two debates focused on nurse staffing ratios and specialty emergency departments, respectively. The audience partcipated using the conference app to vote on the topics before and after the speakers presented their arguments to gauge how many minds were persuaded by the conversation.

Those in the audience appreciated the live debates.

“I found it really interesting and dynamic,” said Molly Davisson of Reno, Nevada. “To pull the audience in and see what they thought in real time was a great idea.”

Her colleague Dustin Bass, also of Reno, agreed. “It was great to hear both sides of topics that we really do struggle with in emergency nursing.”

Solheim, ENA Foundation Chairperson Steven Jewell and ENA Executive Director Nancy MacRae gave a rapid-fire update on many of ENA’s exciting accomplishments this year, including the unveiling of the organization’s new logo.

Finally, keynote speaker Allison Massari, who capped off the event, offered her story of recovery from a near-fatal car accident in which she received second- and third-degree burns over 50 percent of her body. Her personal tale served to inspire and motivate the audience. Her words flowed between the story of her physical recovery and her realizations about the importance of kindness and love.

“Everything we do makes a difference. Every act of kindness counts,” she said. “And, oh, do I remember the kindness of my nurses.”

Massari told stories about the small gestures and great kindnesses her nurses offered, including a seven-second interlude where, as Massari lay in despair and unimaginable pain, a nurse looked her in the eyes and ran her fingers through her hair. She said those memories have never left her.

“You have such an awesome responsibility to help someone heal,” she said softly, adding not every patient has the chance to share their gratitude. “So, on behalf of all of those people, I say thank you.”

Many attendees were emotionally moved by Massari’s story. Others took what she said to heart.

“She was phenomenal,” said Misty Holland of Winter Haven, Florida. “It’s always good to come to a conference like this to refill your cup, and I’d say for a lot of us that’s what she did.”

 

In the Trenches of the Opioid Crisis

There’s often more to drug addiction than just bad choices.

Understanding the pathophysiology and the neurobiology of adverse childhood events and drug addiction can help emergency nurses be more empathetic to patients caught in the opioid epidemic that has gripped the country.

In the Trenches of the Opioid Crisis

2:30 – 3:30 p.m.

Friday

Room 319, 320, 321

While emergency nurses understand the pathophysiology of many diseases and conditions, some might understand less about addiction. To alleviate such knowledge gaps, Darris Bohman and Jennifer Williams of Cincinnati-based TriHealth will lead a session today to highlight staff education that helped increase awareness of the changes that happen in the brains of patients with addiction.

“We understand the pathophysiology of diabetes and heart disease very well, and we are not judgmental when these patients have recurrent issues. But we understand very little about how adverse childhood events change the way people are wired,” Bohman said. 

Darris Bohman

“The opioid crisis has taken its toll on first responders, and our department is no exception,” she continued. “We, however, have started to give training on trauma-informed care, which seems to be helping our staff have more empathy and decrease compassion fatigue.” 

Making the connection from tragedy and trauma to a patient’s drug use was a breakthrough for Bohman in her efforts to understand the grip opioids have on so many patients. 

“It helps to understand that our patients may have lived through incredible tragedy or trauma in their lives and that this is the coping skill they use,” she said. “It does not in any way condone drug use, but to understand that their brains may be hardwired differently than mine, helps me to have empathy.” 

The federal Substance Abuse and Mental Health Services Administration suggests health care workers should treat patients as a “whole person,” recognizing significant past events and the subsequent coping mechanisms. 

“It changes the question, ‘What is wrong with you?’ to ‘What happened to you?’” Bohman said of the trauma-informed care concept. “And while we do not want to delve into their nuanced childhood in the ED, just understanding there is probably a story behind their behaviors increases empathy.” 

Bohman said the trauma-informed care approach helps build trusting relationships with patients.

“Care is all about trust,” she said. “Patients should think, ‘I trust that if I tell you the truth about what brought me to the ED you won’t judge me. I trust that you want what is best for me and will treat me with all the science and art of nursing you know. I trust that I will get good care.’” 

ED nurses should have authentic healing relationships with their patients and understand how to help them be successful, Bohman explained, suggesting if the patients trust the nurses, they will get the treatment they need when the nurses suggest it.

“This is a great opportunity to reframe the way we think about the patient who is an opioid user and make our work less frustrating so we can start to really care again,” she concluded. 

More Opioid Sessions

This week, there are plenty of opportunities to learn more about opioids and the opioid crisis. The session “My Patient Is in Pain and on Buprenorphine … Now What?” scheduled for today and Saturday afternoon, will delve into the drug buprenorphine, which can be an effective alternative to pain management and in some situations, treat opioid addiction. 

Saturday morning will feature “Opioid Crisis: Implement a Team-Based Naloxone Saturation Campaign,” in which a team of presenters will facilitate a discussion on how existing Screening, Brief Intervention, and Referral to Treatment protocols in emergency medicine served as the foundation for launching a system-level Naloxone Saturation Campaign. 

In addition, there are several sessions throughout the conference that discuss ketamine, a drug that has been making a resurgence in EDs as an opioid alternative.

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