Accident and Emergency Nursing (2007) 15, 240–242

Accident and

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EmergencyNursing

RESEARCH REVIEW

Henry F.P., Purcell E.M. & Eadie P.A. (2007) emergency nurses, dealing as it does with a cate-

‘‘The human bite injury: a clinical audit and dis-cussion regarding the management of this alco-hol fuelled phenomenon.’’ Emergency MedicalJournal, 24, 455–458.

This three-year retrospective audit was undertakenon the charts of all patients referred to the plasticsurgery unit of a major Dublin inner-city hospitalfrom January 2003 to December 2005. A total of92 patients with 96 human bite wounds were identi-fied. 92% were male and alcohol consumption wasdocumented in 86% of cases. 70% occurred overthe weekend or on a public holiday. Facial injurieswere the most common type of injury (70%), withthe ear being the most common target. The rest ofthe injuries were to the upper limb. One of twotypes of injury was sustained, the occlusive bitewith-or-without tissue loss and the more common‘fight bite’ or closed fist injury. There are certainhigh-risk environments associated with these typeof injuries, such as an increased incidence in institu-tionalised patients, those likely to be bitten as a re-sult of occupational risk and, most commonly, in thecontext of late-night, alcohol-fuelled aggression.

Infection was documented in 18 cases (20%),with bite injuries to the upper limb and those pre-senting late (>12 h) having a higher incidence ofinfection. Current guidelines advocate the man-agement of these wounds as any contaminated sur-gical wound. This involves adequate irrigation,debridement and direct closure where possible.Delayed closure should only be performed if thewound has been inadequately cleansed or remainsvisibly contaminated or infected. Prophylacticantibiotics are advised in the management of thesewounds, despite the lack of research trials to advo-cate their use. The authors advise referral to a spe-cialist centre for complex hand injuries and injuriesto aesthetically-significant areas.

Comment: This is a well-structured, straightfor-ward, clear and useful paper which should interest

0965-2302/$ - see front matter �c 2007 Published by Elsevier Ltd.doi:10.1016/j.aaen.2007.07.005

gory of injury which is regularly seen in most emer-gency departments. The diagrams and photographsare a welcome adjunct to the text. It is worth not-ing that, as the authors identify, human bite inju-ries are both deceptive and challenging in theirpresentation and management. Underestimationof the complexity and potential sequelae of thesewounds may result in a potentially distressing com-plication involving function, infection or cosmeticappearance.

Hughes F., Fritsch K., Grigg M. & Calder S. (2007)‘‘Psychosocial response in emergency situations– the nurse’s role.’’ International Nursing Re-view, 54(1), 19–27.

This paper features an in-depth review of the liter-ature on mental health and psychosocial recovery inworld-wide emergency/catastrophic situations andincludes the World Health Organisation’s (WHO)policies and guidelines. The aim was to describethe nursing contribution to the psychosocial recov-ery of survivors of emergencies during the emer-gency awareness and planning stage and inpromoting recovery over the longer term. Exposureto an emergency situation of any kind has a devas-tating effect on the psychological and social well-being of people who experience them. Nurses forma large component of the emergency response teamand it is essential that they are provided with clearinformation about psychosocial responses in emer-gency situations. This article provides guidance tonurses regarding their involvement in emergencyplanning, both in responding in the acute phase ofan emergency, as well as responding over the longerterm. It also discusses the devastating effects ofdisasters on individuals and communities.

Comment: This is a thought-provoking andabsorbing paper. While natural or man-made disas-ters are thankfully rare in first world countries, theyare a reality for over 16% of the world’s population

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and affect 60 million people worldwide every year.Moreover, with increasing globalisation, immigra-tion and emigration, many emergency nurses mayhave to deal with the devastation caused by disas-ters such as tsunami, earthquake or volcano, or ter-rorist attacks and outbreaks of pandemics.Although this paper was written by senior advisorsand researchers in the Antipodes and the Philli-pines, it has resonance for emergency nurseseverywhere.

McCloskey R. & van den Hoonaard D. (2007)‘‘Nursing home residents in emergency depart-ments: a Foucauldian analysis.’’ Journal of Ad-vanced Nursing, 59(2), 186–194.

This paper is a literature review on the use ofemergency departments by nursing home resi-dents, written by two senior Canadian researchers.Fourteen papers met the selection criteria andwere used in this review. The majority were re-search-based and written by physician researchersfrom the USA, UK or Canada, with a few by nursesand allied healthcare professionals. The majoritywere published in international and/or interdisci-plinary journals. The geographical origins and dis-tribution of these journals suggest that thesubject of nursing home residents in EDs is an inter-national issue, while the interdisciplinary reader-ship implies that the information contained withinthese articles crosses disciplinary boundaries.

Much of the literature reviewed focused on thechallenges presented by older adults in acute careenvironments. Nursing home residents who weretransferred to emergency departments, wereviewed as being particularly problematic, becauseit was believed that they used considerable re-sources and that their needs were not always ame-nable to acute interventions. The aim of thispaper was to challenge current views about theneeds of nursing home residents, moving themaway from being stigmatised, towards a greaterawareness of their unique needs and to providingsome insights into how these needs might be ad-dressed. Foucault’s concept of subjectivity wasused to demonstrate how power derived frommedical knowledge is used by emergency depart-ment personnel to construct nursing home resi-dents as being problematic. The authorsconcluded that current understanding of the careof nursing home residents in emergency depart-ments is embedded in a complex web of social,historical and political factors. Research is neededthat considers multiple perspectives, includingthose of both emergency department staff as wellas nursing home residents and staff.

Comment: This is a comprehensive and scholarlypaper which should interest clinicians and academ-ics alike. Foucault’s approach is explained in a clearand succinct manner. Tellingly, the primary focus ofthe studies reviewed was the effect of residents onemergency departments, rather than how residentsthemselves were affected. Knowledge about the useof emergency departments by nursing home resi-dentswas derivedmainly from retrospective patientrecords’ reviews, while the events in nursing homesthat lead to transfers have been virtually ignored.Clearly, emergency departments and nursing homesdiffer greatly in their organisation, practices andculture and it appears that there is little understand-ing of the other’s roles and functions. However, theassertion that ‘‘unless nursing home staff overcometheir oppressed position within the healthcare sys-tem, residents will continue to be viewed asproblematic’’ (p. 191) is somewhat sweeping. How-ever, Foucault’s approach does tend to lend itselfto some polarisation of positions. Overall, this is aworthwhile and interesting piece of writing.

Evans K., Warner J. & Jackson E. (2007) ‘‘Howmuch do emergency healthcare workers knowabout capacity and consent?’’ Emergency Medi-cine Journal, 24, 391–393.

This short paper describes a cross-sectional surveywith a structured questionnaire which involvedstaff from a large emergency department (ED) inBirmingham. The aim of the study was to assessknowledge of capacity and consent among emer-gency healthcare workers. 86 questionnaires weredistributed and completed by 42 ED doctors, 21ED nurses and 23 emergency ambulance staff. Cor-rect answers on assessing capacity to consent to orrefuse treatment were given by 67% of the doctors,10% of the nurses and by none of the ambulanceworkers. 15% of all respondents wrongly believedthat an adult who is found to have capacity canlawfully be treated against his or her will.

Doctors and nurses have to make daily decisionsregarding their patients’ competency to consent toinvestigations and treatments. Ambulance workershave to make similar decisions when patients refuseto travel to hospital. Clinicians face the possibilitythat some of their decisions will be examined criti-cally in a court-of-law, either from the perspectiveof forcing a competent adult to have treatment theydo not want or for omitting necessary treatment of aperson lacking capacity.With the introduction of theMental Capacity Act of 2005, it is even more impor-tant that clinicians understand the steps to be takenin assessing capacity and treating incompetentadults. The results of this study indicate that many

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ED professionals do not have adequate knowledge onhow to assess capacity and treat people who eitherrefuse treatment or lack capacity. It shows a press-ing need for further education of doctors, nursesand ambulance staff working in the emergencysetting.

Comment: This is a most interesting and rele-vant study for all ED staff. Emergency nurses andambulance staff are usually the first people tosee and to assess a patient, either when an ambu-lance is called or when patients present to the EDand are seen in triage. It is essential that these

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members of staff know how to assess capacity,otherwise they will not know how to proceed whena patient refuses either to come to hospital or tostay for treatment. Currently, there are a numberof diverse independent groups trying to developappropriate training courses, but there is no con-certed government strategy in place to achievethis.

Felicity JohnsonLecturerDublin

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