Guest post by Jillian Thurlow.
I was fortunate enough to attend the 10th International Conference for Emergency Nurses (ICEN) in Hobart last week. Along with the fantastic social events, the opportunities to network with nurses from around the world, the knowledge gained and ideas challenged were phenomenal.
The conference facilitated discussion in the form of concurrent sessions, allowing nurses to attend short sessions relevant to their areas of interest.
These covered the deteriorating patient, paediatrics, older people, triage, trauma and transport, advanced practice and ED systems of care, workforce challenges, ED performance, education, clinical issues, communication and behavioural management.
Beautiful Hobart docks on the conference doorstep.
Presenters discussed changes or challenges faced in their hospital, completed research as well as research in progress. Invited speakers challenged our practice, based on new evidence-based research.
The conference held a moderated discussion, as well as pre-conference workshops accrediting nurses in suturing, x-ray interpretation, toxicology, non-invasive ventilation, advanced wound care and toxicology for the emergency nurse. During meal breaks, we were able to view and test medical equipment, with many medical suppliers coming to demonstrate the latest techniques and tools of the trade.
The conference slogan, ‘new frontiers – reaching great heights’, was evident in speakers who challenged our regular nursing actions and knowledge, showing that in order to have an opinion we must be able to back it up – and research is the key.
My practice was directly challenged when presenter Julie Considine asked nurses to raise their hands if they would apply oxygen to a patient who presented with chest pain who was not hypoxaemic.
Dutifully, I raised my hand, having been taught this during my university studies, being familiar with our hospital’s chest pain pathway and having seen oxygen applied as common practice in this scenario.
I was dumbfounded to see only another two nurses raise their hands, with well over a hundred hands remaining firmly down.
The presenter went on to demonstrate that, while more research needed to be done on the benefits of oxygen for patients with chest pain and normal sP02, oxygen so far had been proven to be detrimental in these cases.
I was shocked to find that support for this came from Guidelines for the Management for Acute Coronary Syndrome from the Heart Foundation of Australia, the Cardiac Society of Australia, clinical care manuals from Queensland Health, along with the Australian Resuscitation Council (ARC). Literature extracted from the Cochrane Library again acknowledged that the use of oxygen with patients who present with chest pain should be limited to those who have oxygen levels less than 93% or an increased work of breathing.
As a Registered Nurse Year 4, I wondered how I had become out of touch with the latest practice so quickly!
The literature says that patients with chest pain and normal oxygen levels do
not have reduced oxygen in their blood, they have reduced oxygen delivery at the myocardial level. Oxygen in high plasma concentration is known to act as a vasoconstrictor of both coronary and cerebral vessels, meaning that oxygen applied to a patient with normal oxygen levels will end up in the plasma as the haemoglobin is already saturated, only adding to the problem.
Often we continue doing what we do only because we have always done it!
Afterwards, when I began to look through the research, the take-home messages from the conference were apparent to me: be open to new findings, keep patient safety and best practice at the centre of everything and most of all, research is the key to the future.