Review
Advanced Trauma Life Support/Advanced Trauma Care for Nurses: A systematic review concerning the knowledge and skills of emergency nurse related to trauma triage in a community

https://doi.org/10.1016/j.ienj.2021.100994Get rights and content

Highlights

  • Trauma triage in low-income countries is often lacking in the health care system.

  • Trauma triage training can enhance knowledge and skills of the emergency nurses.

  • None of the intervention studies reviewed included an experimental or control group.

Abstract

Background

In the trauma triage procedure, nurses with good knowledge and skills can start initial treatment immediately pending doctors availability, and before a final diagnosis is made. The Advanced Trauma Life Support/ Advanced Trauma Care for Nurses is one of the most important trauma education programmes to enhance the knowledge and skills of emergency nurses. This systematic review of the literature attempts to investigate the implications of introducing an Advanced Trauma Life Support/Advanced Trauma Care for Nurses’ knowledge and skills related to trauma triage.

Methods

A systematic review was carried out using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). The included sites and databases are Web of Science, Scopus, PubMed, ScienceDirect, Cochrane Library, and Bielefeld Academic Search Engine (BASE) from 1994 to 2019. The quality of the selected studies was evaluated using a standard quality rating tool (SQRT). The quality of the criteria for inclusion and exclusion was independently reviewed by three researchers.

Results

This study evaluated 5266 records in the identification stage. In the included stage, only four studies were included in this review. In the standard quality assessment, none of the included studies were evaluated as being a strong study, none used an experimental design at three points in time (pre, post and follow-up), and all showed a moderate to high risk of bias. There is a lack of knowledge and skills related to trauma triage among emergency nurses in the included studies.

Conclusion

A lack of knowledge and skills concerning trauma triage among emergency nurses could potentially have an adverse effect on the outcomes of the patients in trauma cases.

Introduction

Emergency nursing is one of professional nursing’s most challenging and short-staffed areas [1]. In the development of trauma care systems, emergency nurses are considered vital in the successful care and treatment of trauma patients [2]. Furthermore, nurses can start initial treatment immediately while patients are still waiting for a doctor and before a final diagnosis is made [3]. However, in low-income countries, trauma triage during an emergency is often one of the weakest parts of the health care system [4].

Internationally, trauma is listed as the sixth major cause of mortality and the fifth leading cause of mild and severe disability [5]. The proportion of trauma patients arriving in the emergency department has increased from 1.3 million in 2015 to 5 million in 2017, and is predicted to exceed 8 million by 2020 [6], [7], [8], [9]. In addition, 90% of trauma happens in low- and middle-income nations [10]. Accordingly, the weak level of the trauma triage system together with the increased percentage of trauma patients in emergency, leads to faulty or incomplete trauma triage among emergency nurses [3].

Emergency nurses with adequate knowledge and skills for the timely evaluation and correct determination of a patient’s level of diagnosis are an essential requirement for efficient triage [11]. However, the knowledge and triage skills among nurses are the significant variables in the emergency department’s purview [12], and, furthermore, previous studies showed that emergency nurses have a poor or moderate level of knowledge and skills concerning trauma triage [3], [13], [14], [15], [16]. Moreover, if the knowledge and skills among emergency nurses are not consistent or of the required standard, the patient care and the effectiveness of the emergency department will be jeopardized [12]. Previous studies indicated that emergency nurses had poor knowledge and skills which affect waiting time for patients’ triage categorization, prioritization, assessment, and allocation [3], [12], [13].

The Advanced Trauma Care for Nurses (ATCN) is the nursing version of Advanced Trauma Life Support (ATLS), which is supported by the Society of Trauma Nurses (STN) [17]. ATLS is supported by the American College of Surgeons Committee on Trauma (ACS COT), and is available internationally [18]. STN contributes to the establishment of the term “teamwork” between nurses and doctors through the use of the ATLS/ATCN programme for the treatment of the trauma patient [18]. The content of the ATLS/ATCN includes early assessment, management of airways, stabilization, and transport of multiple trauma patients [18], [19]. The advantage of the ATLS/ATCN includes a learning, teamwork, cooperative, and synchronized approach to trauma treatment as trauma nurses exchange knowledge and skill with doctors on trauma triage [19], [20], [21], [22].

In previous research, nurses who finished the ATCN or ATLS are able to enhance their knowledge and skills for immediate response compared to those who did not finish the training courses [18], [23], [24]. The ATLS/ATCN determines the nurse’s responsibility to meet the different needs of traumatic patients [22]. However, due to the limited previous research, there is a lack of outcomes on the knowledge and skill of the emergency nurses about the ATLS/ATCN programme [21], [24]. Lacking knowledge and skills concerning the ATLS/ATCN among emergency nurses could potentially and adversely affect the outcomes of the patients in trauma cases [12]. Previous research results showed that nurses need to participate and train in the ATLS/ATCN programme to gain sufficient knowledge and skills to treat trauma patients, and not simply to be an observer in trauma triage programmes [20], [21], [24], [25].

This systematic review of the literature aims to examine the implications of introducing the ATLS/ATCN on the knowledge and skills related to trauma triage among emergency nurses.

Section snippets

Methods

The review method consisted of two important search steps; the first step consisted of searches of the database, while the second step consisted of all the relevant articles being retrieved and screened. This review was reported on the basis of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) criteria to ensure high-quality reporting [26]. This systematic review of the literature was registered at PROSPERO in April /2020 with reference number (CRD42020154164).

Search results

A total of 5266 studies from the expanded search were found. Based on the PRISMA protocol, Fig. 1 shows Identification: the keywords used to classify a total of 5266 papers from online data collection. For Screening: Redundant articles (n = 570) and non-relevant articles (n = 4300) were omitted. Therefore, Eligibility: Filtration was carried out following the requirements for the inclusion/exclusion criteria and the studies (n = 392) were removed from the studies (n = 396) that were tested. The

Discussion

The literature review shows few studies related to nurse’s knowledge and skills of trauma triage. Most previous reviews related to trauma triage focus on trauma patient’s mortality and/or trauma patients transfer [35], [36], [37]. The required criteria for successful triage are the knowledge and skills of emergency nurses for a quick assessment and the proper determination of the quality of diagnosis of trauma patients [11].

The research design in the included studies, found a one-group

Limitations

The limitation of this study is the small number of studies that have been reported using the ATLS/ATCN in response to trauma triage among emergency nurses. In this review of the exclusion criteria including non-English studies, qualitative studies, paramedics, other emergency triage intervention, and unpublished studies may have influenced this review in that the papers included may not be representative of all the research carried out in this field.

The quality of the assessment part used the

Future research

To validate long term training, examine techniques of teaching effectiveness, and, most crucially, explain the progressive enhancement in the overall quality of emergency nurses in practice, ongoing education research should be required on the ATLS/ATCN. Future research should try to control the confounders and bias among participants. This could be done through large-sample randomized control trials.

Conclusion

The findings of the current review show that the location of the majority of the included studies was in the UK and that they did not show the drop-out among the participants. Also, they were of small size and the statistical power was not shown. The quality assessment part shows that the included studies have a weak level of study design and management of the study methodology. Thus, systematic errors in study design and biases in the included study’s methodology will be high.

The ATLS/ATCN is

Registration

The review is registered in PROSPERO (CRD42020154164).

Acknowledgements

I want to thank my supervisors for the guidance that they have provided throughout the writing of my typescript.

Declaration of interest and ethics in publishing

(1) Funding Source: Not applicable.

(2) Conflict of Interest: Not applicable.

(3) Ethical Approval: Not applicable.

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