Wright ER, Linde B, Rau L, et al. The effect of organizational climate on the clinical care of patients with mental health problems. J Emerg Nurs 2003; 29:314-321.

ED nurses who feel their working conditions are positive have more frequent contact and provide a greater variety of interventions to psychiatric patients, says this study from Indiana University-Purdue University Indianapolis.

The researchers surveyed 109 emergency nurses and other clinical staff in a midwestern ED about their organizational climate, including job satisfaction, growth and advancement, and role ambiguity and conflict. The study found that respondents had more empathy and more clinical interaction with mental health patients if they felt their work environment was fair and equitable.

"Both this study and our ethnographic observations of the same facility suggest that negative attitudes are quite prominent among ED staff," wrote the researchers. "Our findings, however, suggest that improving the work climates may improve the quality of care that emergency nurses and others provide to psychiatric patients in an emergency department."

Palchak MJ, Holmes JF, Vance CW, et al. A decision rule for identifying children at low risk for brain injuries after blunt head trauma. Ann Emerg Med 2003; 42:492-506.

Children at low risk for traumatic brain injuries after blunt head trauma can be identified by assessing for clinical symptoms including the absence of abnormal mental status, clinical signs of skull fracture, a history of vomiting, scalp hematoma in children ages 2 and younger, and headache, says this study from University-Davis (CA) School of Medicine and Oregon Health Sciences University in Portland.

Researchers studied 2,043 children with blunt head trauma who presented at a pediatric ED of a Level I trauma center from 1998 to 2001. Children with the above symptoms constituted 99% of children with traumatic brain injuries on computed tomography (CT) scan. Of the 304 children who had CT scans with none of these symptoms, only one had traumatic brain injury on CT, and the patient was discharged from the ED without complications. The researchers note that although CT scan is routinely used to assess children with head trauma, fewer than 10% of these CT scans diagnose traumatic brain injuries. They hypothesized that a set of clinical signs and symptoms accurately can identify children at very low risk. A clinical decision tree, using the above clinical symptoms, was developed to identify children without traumatic brain injuries after blunt head trauma.

"Use of this rule may decrease CT use in patients without an appreciable risk of traumatic brain injury," they wrote.

Sources

For more information about meeting employee needs in your disaster plan, contact:

Mary Casey-Lockyer, RN, BSN, CCRN, Emergency Response Coordinator, Northwest Community Healthcare, 800 W. Central Road, Arlington Heights, IL 60005. Telephone: (847) 618-4665. Fax: (847) 618-5259. E-mail: mcasey-loc@nch.org.

Your Family Disaster Plan is a four-page color brochure published by the American Red Cross addressing disaster safety. Printed copies are available in packages of 25 for a nominal fee plus shipping costs. Ask for number A4466 for the English version or A4466S for the Spanish version. To order, contact your local American Red Cross chapter. Or the brochure can be accessed on-line at no cost in Chinese, English, Korean, Spanish, and Tagalog. Go to www.redcross.org. Click on "Publications," "Community Disaster Education Materials," "General Disaster Preparedness," "Family Disaster Preparedness."