1. Chu, Julie MSN
  2. Singh Joy, Subhashni D.

Article Content


According to this article:


* Patients disclose abuse more often when providers probe for it, ask open-ended questions, and respond appropriately to patients' verbal clues.



When ED providers' questions about domestic violence are brief or offhand, victims may not reveal the abuse. Providers can elicit disclosures more successfully if they ask the right questions, give patients a chance to talk, and respond sensitively and appropriately.


During a randomized, controlled trial of a computerized self-administered health risk assessment tool, researchers audiotaped 871 ED encounters at two hospitals. They transcribed and coded 293 audible discussions of domestic violence. The trial involved 40 attending physicians, 46 residents, and four NPs, all of whom knew that they were being audiotaped and that the intervention's goal was to increase domestic violence detection.


Providers usually asked, "Are you a victim of domestic violence?" or a similar question during the social history. In 45% of cases, this was done in a perfunctory way. Some questions were posed in the negative, such as "He's never hit you?" Patients disclosed domestic violence in only 26% of discussions. Most patients whose computerized assessments indicated a risk of abuse didn't tell the provider. Abuse was documented in the charts of only 31% of those who disclosed it. Only 25% of domestic violence disclosures prompted discussion of specific referrals. Patients were more likely to disclose abuse when providers asked open-ended questions such as "Can you tell me what happened?"; asked at least one follow-up question; and responded with empathy.


Providers need further education and practice to improve communication skills and respond better to disclosures of abuse. The study authors suggest that providers reduce the situation's stressfulness by explaining that everyone is asked specific questions about domestic violence. They also suggest responding with sensitivity and asking follow-up questions, as needed.-JC


Rhodes KV, et al. Ann Intern Med 2007;147(9);620-7.



According to this study:


* The risk of fatal pulmonary embolism after discontinuing anticoagulant therapy for venous thromboembolism is relatively low but may be higher depending on the patient's initial presentation and the etiology of the venous thromboembolism.



Clinical decision making often requires clinicians and patients to weigh the risks and benefits associated with various therapies. A new study about discontinuing anticoagulant therapy for venous thromboembolism describes the annual risk of fatal pulmonary embolism and the case-fatality rate of disease recurrence. (That is, "the risk that recurrent disease will be fatal" if anticoagulant therapy is discontinued.)


The study included 2,052 patients who had had a first episode of symptomatic venous thromboembolism and had been receiving anticoagulant therapy for at least three months. Patients were followed for nonfatal deep vein thrombosis, nonfatal pulmonary embolism, definite or probable fatal pulmonary embolism, or possible fatal pulmonary embolism (defined as sudden death of unknown cause). Patients were subcategorized by initial presentation (deep vein thrombosis or pulmonary embolism alone, or both) and by etiology of venous thromboembolism (secondary or idiopathic).


After an average 4.5 years of follow-up, the annual risk of definite or probable fatal pulmonary embolism was 0.19 events per 100 person-years. The annual risk of any fatal pulmonary embolism (definite, probable, or possible) was 0.49 events per 100 person-years. The case-fatality rate of recurrent venous thromboembolism ranged from 4% to 9%. Patients who initially presented with pulmonary embolism had a higher case-fatality rate than those who initially presented with deep vein thrombosis.


Patients with idiopathic venous thromboembolism had triple the risk of any fatal pulmonary embolism after discontinuing anticoagulant therapy, compared with patients with secondary venous thromboembolism. Analysis also showed that increasing age and idiopathic venous thromboembolism were both associated with twice the risk of any fatal pulmonary embolism.


These data may help patients and clinicians decide whether or not to discontinue anticoagulant therapy for venous thromboembolism.-JC


Douketis JD, et al. Ann Intern Med 2007,147(11):766-74.



According to this study:


* RNs at Magnet hospitals report many personal benefits and professional advantages; however, nurses working at hospitals in the process of attaining Magnet status rate several other components of the workplace higher.



Researchers surveyed 3,500 randomly selected RNs for their views on the nursing shortage and their workplace environment. Of the 1,783 respondents, 735 reported the Magnet status of their institutions: 25% indicated Magnet recognition had been attained, 34.6% indicated an application was in process, and 40.4% indicated neither.


There were several significant differences in how nurses employed at Magnet hospitals, in-process hospitals, and non-Magnet hospitals viewed their workplace environments. For example, while 45% of nurses employed at Magnet or in-process hospitals indicated that the care provided to patients is a priority at their facilities, only 26% of those at non-Magnet hospitals did. Nurses employed at Magnet hospitals also reported greater job satisfaction and willingness to recommend nursing as a career than did those employed at in-process and non-Magnet hospitals.


Interestingly, a greater percentage of nurses employed at in-process hospitals rated certain components of the workplace excellent or very good, compared with those employed at Magnet hospitals. These included "opportunities for professional development" (31% and 23%, respectively); "opportunities to influence decisions taken on workplace organization" (23% and 19%, respectively); and the relationship between nurses and management (28% and 20%, respectively). The findings suggest that the process of applying for Magnet status is itself beneficial and that the incorporation of characteristics associated with it can improve the quality of the workplace.-JC


Ulrich BT, et al. J Nurs Adm 2007;37(5):212-20.



According to this study:


* A rapid response team of ICU specialists and a nursing supervisor can help decrease hospital-wide mortality.



In 2005, a rapid response team-including an ICU physician, a pediatric or cardiovascular ICU nurse, an ICU respiratory therapist, and a nursing supervisor-was organized at a children's hospital. The team was called using an emergency paging system for specific reasons: a staff member's worry about a patient or an acute change in a patient's respiratory rate, oxygen saturation, heart rate, blood pressure, or consciousness. The team responded (within five minutes of the call) by implementing diagnostic and therapeutic interventions, discussing the case with the primary physician, and deciding on the best location for care.


Mortality rates and code rates (respiratory or cardiopulmonary arrest) outside of the ICU were examined for almost five years before and just over 1.5 years after the rapid response team was introduced. The team was called 143 times, most often for respiratory distress. With the team in place, hospital-wide mortality rates decreased by 18% and code rates outside the ICU decreased by 71.2%. The team intervention saved approximately 33 lives.


The authors state that the data support the widespread use of rapid response teams to decrease mortality rates in hospitals. Implementing a rapid response team at this hospital didn't require increased funding for staff, but the cost-effectiveness of the team should be examined further, the authors say. They also recommend similar studies in other clinical settings to determine "efficient methods for implementing" rapid response teams. -SDSJ


Sharek PJ, et al. JAMA. 2007;298(19):2267-74.