Mercer County Community College



Concepts of Emergency/Trauma Nursing and Emergency/Disaster Preparedness

Simulation Scenario

Utilizing the QSEN Knowledge, Skills and Attitudes for Pre-Licensure Nurses

Level of Scenario:

Beginning _____ Intermediate _____ Complex __X__

Estimated time to complete:

6 to 8 hours

Simulation Learning Objectives:

At the completion of this simulation, the student will:

1) Recognize the patient or designee as the source of control and full partner in providing compassionate and coordinated care based on respect for patient’s preferences, values and needs.

a. Be able to teach the importance of blood glucose monitoring to the patient with diabetes.

b. Knowledge

• Integrate understanding of multiple dimensions of patient centered care

- Coordination and integration of care

- Information, communication, and education

- Physical comfort and emotional support

- Involvement of family and friends

- Transition and continuity

• Demonstrate comprehension understanding of the concepts of pain and suffering, including physiologic models of pain and comfort

• Describe the limits and boundaries of therapeutic patient-centered care

• Discuss principles of effective communication

• Examine nursing roles in assuring coordination, integration, and continuity of care

c. Skills

• Elicit patient values, preferences and expressed needs as part of clinical interview, implementation of care plan and evaluation of care

• Communicate patient values, preferences and expressed needs to other members of health care team

• Provide patient-centered care with sensitivity and respect for the diversity of the human experience

• Assess presence and extent of pain and suffering

• Asses levels of physical and emotional comfort

• Elicit expectations of patient and family for relief of pain, discomfort, or suffering

• Initiate effective treatments to relieve pain and suffering in light of patient values, preferences and expressed needs

• Remove barriers to presence of families and other designated surrogates based on patient preferences

• Assess level of patient’s decisional conflict and provide access to resources

• Engage patients or designated surrogates in active partnerships that promote health, safety and well-being, and self-care management

• Facilitate informed patient consent for care

• Assess own level of communication skill in encounters with patients and families

• Participate in building consensus or resolving conflict in the context of patient care

• Communicate care provided and needed at each transition in care

d. Attitudes

• Values seeing health care situations “through patients’ eyes”

• Value the patient’s expertise with own health and symptoms

• Appreciate the role of the nurse in relief of all types and sources of pain or suffering

• Recognize that patient expectations influence outcomes in management of pain or suffering

• Value active partnership with patients or designated surrogates in planning, implementation, and evaluation of care

• Respect patient preferences for degree of active engagement in care process

• Appreciate shared decision-making with empowered patients and families, even when conflicts occur

• Value continuous improvements of own communication and conflict resolution skills

2) Function effectively within nursing and inter-professional teams, fostering open communication, mutual respect, and shared decision-making to achieve quality patient care.

a. Provide SBAR report to the OR nurse.

b. Successfully triage victims of a mass casualty event as evidenced by correct triage tag designations.

c. Apply, administer and perform all necessary nursing interventions to a patient with traumatic injuries.

d. Knowledge

• Describe own strengths, limitations, and values in functioning as a member of a team

• Describe scopes of practice and roles of health care team members

• Describe strategies for identifying and managing overlaps in team member roles and accountabilities

• Recognize contributions of other individuals and groups in helping patient/family achieve health goals

• Describe impact of own communication style on others

• Discuss effective strategies for communicating and resolving conflict

• Describe examples of the impact of team functioning on safety and quality of care

• Examine strategies for improving systems to support team functioning

e. Skills

• Demonstrate awareness of own strengths and limitations as a team member

• Initiate plan for self-development as a team member

• Function competently within own scope of practice as a member of the health care team

• Assume role of team member or leader based on the situation

• Initiate requests for help when appropriate to situation

• Clarify roles and accountabilities under conditions of potential overlap in team member functioning

• Integrate the contributions of others who play a role in helping patient/family achieve health goals

• Communicate with team members, adapting own style of communicating to needs of the team and situation

• Solicit input from other team members to improve individual, as well as team, performance

• Follow communication practices that minimize risks associated with handoffs among providers and across transitions in care

• Assert own position/perspective in discussions about patient care

• Participate in designing systems that support effective teamwork

f. Attitudes

• Acknowledge own potential to contribute to effective team functioning

• Appreciate importance of intra- and inter-professional collaboration

• Value the perspectives and expertise of all health team members

• Respect the centrality of the patient/family as core members of any health care team

• Respect the unique attributes that members bring to a team, including variations in professional orientations and accountabilities

• Value teamwork and the relationships upon which it is based

• Appreciate the risks associated with handoffs among providers and across transitions in care

3) Integrate best current evidence with clinical expertise and patient/family preferences and values for delivery of optimal health care.

a. Perform a rapid trauma assessment on patients with traumatic injuries.

b. Knowledge

• Describe reliable sources for locating evidence reports and clinical practice guidelines

• Explain the role of evidence in determining best clinical practice

• Describe how the strength and relevance of available evidence influences the choice of interventions in provision of patient-centered care

c. Skills

• Locate evidence reports related to clinical practice topics and guidelines

d. Attitudes

• Value the concept of EBP as integral to determining best clinical practice

• Appreciate the importance of regularly reading relevant professional journals

• Value the need for continuous improvement in clinical practice based on new knowledge

4) Use data to monitor the outcomes of care processes and use improvement methods to design and test changes to continuously improve the quality and safety of health care systems.

a. Be able to use lab data and clinical manifestations to determine the effectiveness of treatment.

b. Knowledge

• Describe strategies for learning about the outcomes of care in the setting in which one is engaged in clinical practice

• Recognize that nursing and other health professions students are parts of systems of care and care processes that affect outcomes for patients and families

c. Skills

• Use measures to evaluate the effect of change

d. Attitudes

• Value own and others’ contributions to outcomes of care in local care settings

• Appreciate the value of what individuals and teams can do to improve care

5) Minimizes risk of harm to patients and providers through both system effectiveness and individual performance.

a. Knowledge

• Examine human factors and other basic safety design principles as well as commonly used unsafe practices (such as, work-arounds and dangerous abbreviations)

• Describe the benefits and limitations of selected safety-enhancing technologies (such as, barcodes, Computer Provider Order Entry, medication pumps, and automatic alerts/alarms)

• Discuss effective strategies to reduce reliance on memory

• Delineate general categories of errors and hazards in care

• Discuss potential and actual impact of national patient safety resources, initiatives and regulations

b. Skills

• Demonstrate effective use of technology and standardized practices that support safety and quality

• Demonstrate effective use of strategies to reduce risk of harm to self or others

• Use appropriate strategies to reduce reliance on memory (such as, forcing functions, checklists)

c. Attitudes

• Value the contributions of standardization/reliability to safety

• Appreciate the cognitive and physical limits of human performance

• Value own role in preventing errors

6) Uses information and technology to communicate, manage knowledge, mitigate error, and support decision making.

a. Knowledge

• Explain why information and technology skills are essential for safe patient care

• Describe examples of how technology and information management are related to the quality and safety of patient care

b. Skills

• Apply technology and information management tools to support safe processes of care

• Document and plan patient care in an electronic health record

• Employ communication technologies to coordinate care for patients

• Respond appropriately to clinical decision-making supports and alerts

• Use high quality electronic sources of healthcare information

c. Attitudes

• Appreciate the necessity for all health professionals to seek lifelong, continuous learning of information technology skills

• Protect confidentiality of protected health information in electronic health records

Room Set-up:

Adult patient in one hospital bed. Pediatric patient in the other hospital bed. Have a medication room/cart and a computer for charting available. Scatter 15 stuffed animals around the room with one patient scenario and triage tag attached to each stuffed animal. Two of the stuffed animals will “turn into” our patients in the Emergency Department: Patient 9 and Patient 11.

Brief overview of Scenario:

A school bus was on its way to a farm for a class trip when the driver lost control, drove off the highway onto a downward-sloped grass median, causing the bus to turn on its side. The bus contained 1 bus driver, 2 teachers, 2 parents, and 10 preschoolers. Several witnesses called 911 and reported the accident. The fire department and EMS are dispatched to the scene.

A car containing 4 nurses carpooling to a nursing convention came upon the accident about 30 seconds after the fire department arrived. The nurses decided to pull over and offer assistance until EMS arrived. The nurses triage the patients as the fire fighters extricate them from the bus.

Cody is a 4-year-old white male brought in by EMTs (Basic Life Support) via ambulance with a yellow triage tag after being involved in the school bus accident. When the school bus tipped over Cody was thrown from his seat and fell onto the corner of a seat on the opposite side of the bus, causing blunt trauma to the abdomen. Cody is diagnosed with active internal bleeding in the abdomen and needs to go to the operating room as soon as possible.

Eve is a 61-year-old black female brought in by EMTs (Basic Life Support) via ambulance with a yellow triage tag after being involved in the school bus accident. Eve was a restrained driver, had no apparent injuries, but was believed to be hypoglycemic. Eve is diagnosed with an altered mental status related to hypoglycemia. Once stabilized, she is discharged to home.

Educator will assign 2-4 students to triage the 15 patients. Have the students place a paperclip over the color on the triage tag for each patient. Time the students. Once the students have completed triage, collect the stuffed animals with the patient scenarios and triage tags attached. Discuss each patient scenario with the class and decide if each patient was triaged appropriately.

Transition the clinical group to the Emergency Department. The student nurses will assume the care of Patient 9 and Patient 11.

Date of creation: 02/19/2012

Review/revisions: 05/04/2012, 10/05/2012, __________, __________, __________

|Brief Description of Patient 9: |Psychomotor skills required prior to simulation: |

| |Foley catheter insertion |

|Name: Cody Gull |IV set up |

|Gender: male |Medication administration |

|Age: 4 |NG tube insertion |

|Weight: 40 pounds |Blood specimen collection |

|Height: 37 inches |Computer documentation |

|Religion: none | |

|Major Support: mother and father |Cognitive skills required prior to simulation: (i.e. independent |

|Allergies: none |reading, video review, computer simulations, lecture): |

|Medications: none |IV fluid calculations |

|Immunizations: Childhood |Lecture/lab on concepts of Emergency/Trauma Nursing and |

|PMH: none |Emergency/Disaster Preparedness |

| |Required readings per course outline |

|Last oral intake: 1 egg and 2 slices of bacon at 7am | |

| |Concepts needed for review: |

|History of Presenting Illness: Patient involved in a school bus |Patient-centered care |

|accident. Bruising over abdomen. Complains of belly pain. |Teamwork and collaboration |

| |Evidence-based practice |

|Social History: none |Quality Improvement |

| |Safety |

|Primary Diagnosis: abdominal bleeding related to blunt trauma |Informatics |

| |Medical asepsis |

|Surgeries/Procedures: exploratory abdominal surgery and repair of |Fluid resuscitation |

|bleeding site | |

| |Medications and fluids: |

|Setting/Environment: emergency department |IV fluids: 0.9% NS |

| |IVPB: Zosyn (tazobactam) 12.5mg/kg in 50mL 0.9% NS |

|Simulator Manikin/s Needed: pediatric male |IV Push: Morphine |

| | |

|Props: |Diagnostics available: |

|Gloves |Labs |

|Patient identification bracelet |X-rays |

|Pediatric non-rebreather mask |CT Scan |

|ECG leads and wires |MRI |

|Cardiac monitor |ECG |

|Intravenous catheter | |

|IV start kit |Student information needed prior to scenario: |

|IV tubing with primary line isontonic crystalloid running |Has been oriented to simulator |

|Urinary catheter |Understands guidelines/expectations for scenario |

|NG tube |Has accomplished all pre-simulation requirements |

|Suction canister |All participants understand their assigned roles |

|Blood pressure cuff |Has been given time frame expectations |

|Pulse-oximeter | |

|Blood tubes |Report students will receive prior to starting the simulation (report |

|Blood transfusion |from EMS responders): |

|Cervical collar | |

|Computer |Cody is a 4 y/o white male brought in by EMTs (Basic Life Support) via|

|Medication cart/room |ambulance with a yellow triage tag after being involved in a school |

| |bus accident. When the school bus tipped over Cody was thrown from his|

|Assignment of Roles: |seat, and fell onto the corner of a seat on the opposite side of the |

|S = student |bus. A cervical collar was placed as a precaution and he was placed on|

|E = educator |a back board. Cody was on scene for approximately 20 minutes waiting |

| |for an available ambulance. He is complaining of abdominal pain and |

|_S_ Primary Nurse |bruising to the left abdomen and left retroperitoneal area has been |

|_S_ Secondary Nurse |noted. No other injuries have been noted. Oxygen is being administered|

|_S_ Family Member #1 |via non-rebreather mask. Parents are on their way to the hospital, but|

|_S_ Family Member #2 |have not yet arrived. |

|_S_ Observer | |

|_E_ Physician/Advanced Practice Nurse |VS on scene: BP 78/46, HR 120, RR 32. |

|_S_ Imaging | |

|_S_ Unlicensed Assistive Personnel |VS in ambulance: BP 76/46, HR 126, RR 28 |

| | |

|Identify educator roles needed: | |

|Educator will give patient responses to any/all actions performed by | |

|students. | |

| | |

|Important information related to roles: | |

|At least one observer should be noting what is being done correctly, | |

|wrong, and what is questionable. | |

| | |

|Critical Lab Values: Hgb 11, Hct 45%, RBC 4.0 | |

| | |

|Medication Calculations: Fluid resuscitation using Pediatric Advanced | |

|Life Support (2010) recommendations 20mLs/Kg isontonic crystalloid for| |

|treatment of hemorrhagic shock in the pediatric patient. | |

| | |

|Zosyn (tazobactam) 12.5mg/kg in 50mL 0.9% NS | |

| | |

|Morphine 0.05 mg/kg (up to 15 mg) | |

| | |

|Blood pressure calculation in pediatric patients SBP 70 + (2 x age in | |

|years) | |

Scenario Progression Outline: Patient 9

|Timing |Programming Data |Expected Interventions |Teaching Points for Debriefing |

|Initial Stage: |Program VS |Wash hands |Initial care of the trauma patient |

|VS: BP 70/40, HR 130, RR 28, temp | | |in the emergency department |

|98.1 |Have manikin moan with pain |Don personal protective equipment | |

| | | |ABCDEFGHI of rapid trauma |

|Resp: Maintaining own airway, lungs|Lung sounds clear |Confirm patient identity |assessment |

|clear, cervical collar in place | | | |

| |Muffled bowel sounds |Collaborate with healthcare team |SAMPLE history |

|CV: Sinus tachycardia, weak pulses | | | |

|all 4 extremities | |Continue O2 100% NRB |Facilitating family presence |

| | | | |

|Neuro: AAO, PERRLA, able to move | |Place patient on ECG monitor |Fluid resuscitation |

|all extremities, GCS 15 | | | |

| | |Obtain vital signs |Labs anticipated |

|GI/GU: muffled bowel sounds | | | |

| | |IV access x 2, large bore |Physical comfort and emotional |

|Skin: bruising to the left abdomen | | |support |

|and left retroperitoneal area | |Obtain blood specimens: CBC, BMP, | |

| | |T&C, blood glucose |Communication with the team |

|Pain: Points to crying face on | | | |

|Faces Scale | |Determine IV fluid dose (364 mLs |Minimizing harm to patient and |

| | |0.9% NS) |providers |

| | | | |

| | |GCS should be done | |

| | | | |

| | |Remove clothing, cover with warm | |

| | |blanket | |

| | | | |

| | |Insertion of foley catheter | |

| | | | |

| | |Check urine for blood | |

| | | | |

| | |Consider insertion of NG tube | |

| | | | |

| | |Bring family in for SAMPLE history,| |

| | |inform family of patient status, | |

| | |allow family to remain with patient| |

| | | | |

| | |Medication for pain and sedation | |

| | |for diagnostic testing | |

| | | | |

| | |Remove from backboard | |

| | | | |

| | |Send for CT head, neck, chest, | |

| | |abdomen, and pelvis | |

| | | | |

| | |Chart assessment and interventions | |

|Stage 1: Worsening Condition |Program new vital signs |Adjust head position to maintain |Patient prep for surgery |

|VS: BP 65/palp, HR 160, RR 20 | |airway | |

| |Give results of procedures: | |Communication with the team |

|Resp: snoring respirations at 20 |Hgb 11, Hct 45%, RBC 4.0, all other|Insert advanced airway (nasal) and | |

|BPM |labs normal |use bag, valve, mask ventilation |Minimizing harm to patient and |

| |X-ray cervical spine negative | |providers |

|CV: Sinus tachycardia, weak central|CT abdomen, positive bleeding from |Obtain consent for emergency blood | |

|pulses, unable to palpate |spleen |transfusion |Informed consent for care |

|peripheral pulses | | | |

| |Give assessment information in |Begin emergency blood transfusion |Core Measures: Surgical Care |

|Neuro: losing consciousness, GCS 10|response to student questions of | |Improvement Project |

| |that system. |Begin antibiotics | |

|Skin: cold, clammy, diaphoretic | | | |

| | |Obtain consent for surgery | |

| | | | |

| | |Utilize pre-surgical checklist | |

| | | | |

| | |Give SBAR report to OR nurse | |

| | | | |

| | |Chart assessment and interventions | |

|Brief Description of Patient 11: |Psychomotor skills required prior to simulation: |

| |IV set up |

|Name: Eve Breslin |Medication administration |

|Gender: female |Blood specimen collection |

|Age: 61 |Use of glucometer |

|Weight: 185 pounds |Computer documentation |

|Height: 63 inches | |

|Religion: Baptist |Cognitive skills required prior to simulation: (i.e. independent |

|Major Support: Husband |reading, video review, computer simulations, lecture) |

|Allergies: none |Lecture/lab on concepts of Emergency/Trauma Nursing and |

|Medications: none (prefers not to take) |Emergency/Disaster Preparedness |

|Immunizations: childhood |Required readings per course outline |

|PMH: Type 2 diabetes, hypertension | |

| |Concepts needed for review: |

|Last oral intake: half bottle of water just before accident |Patient-centered care |

| |Teamwork and collaboration |

|History of Presenting Illness: Patient was the driver of a school bus |Evidence-based practice |

|when she drove off the highway onto a downward-sloped grass median, |Quality Improvement |

|causing the bus to turn on its side. She was wearing her seatbelt. |Safety |

| |Informatics |

|Social History: smokes cigarettes, 1 pack per day | |

| |Medications and fluids: |

|Primary Diagnosis: altered mental status related to hypoglycemia |Dextrose 50% 25g/50mL prefilled syringe IV push |

| | |

|Surgeries/Procedures: none |Diagnostics available: |

| |Labs |

|Setting/Environment: emergency department |X-rays |

| |CT Scan |

|Simulator Manikin/s Needed: Adult female |ECG |

| | |

|Props: |Student information needed prior to scenario: |

|Gloves |Has been oriented to simulator |

|Patient identification bracelet |Understands guidelines/expectations for scenario |

|Adult non-rebreather mask |Has accomplished all pre-simulation requirements |

|ECG leads and wires |All participants understand their assigned roles |

|Cardiac monitor |Has been given time frame expectations |

|Intravenous catheter | |

|IV start kit |Report students will receive prior to starting the simulation (report |

|Blood pressure cuff |from EMS responders): |

|Pulse-oximeter | |

|Blood tubes |Eve is a 61 y/o black female brought in by EMTs (Basic Life Support) |

|Cervical collar |via ambulance with a yellow triage tag after being involved in a |

|Computer |school bus accident. Eve was wearing her seatbelt and firefighters had|

| |to cut the restraint to remove her from her driver’s seat. A cervical |

|Assignment of Roles: |collar was placed as a precaution and she was placed on a back board. |

|S = student |Eve told the EMTS that she was feeling shaky before she lost control |

|E = educator |of the bus. She believed her sugar was low due to skipping breakfast |

| |this morning. She was cold, clammy and diaphoretic on scene and waited|

|_S_ Primary Nurse |approximately 25 minutes for an available ambulance. During the wait, |

|_S_ Secondary Nurse |Eve developed an altered mental status. EMTs attempted to administer |

|_S_ Family Member #1 |oral glucose, but Eve became combative and spit it out. |

|_S_ Observer | |

|_E_ Physician/Advanced Practice Nurse |In route to the hospital, oxygen is being administered via |

|_S_ Imaging |non-rebreather mask. Her husband is on his way to the hospital, but |

|_S_ Unlicensed Assistive Personnel |has not yet arrived. |

| | |

|Identify educator roles needed: |VS on scene: BP 146/78, HR 112, RR 24. |

|Educator will give patient responses to any/all actions performed by | |

|students. |VS in ambulance: BP 140/76, HR 120, RR 22 |

| | |

|Important information related to roles: | |

|At least one observer should be noting what is being done correctly, | |

|wrong, and what is questionable. | |

| | |

|Critical Lab Values: blood glucose 31 | |

Scenario Progression Outline: Patient 11

|Timing |Programming Data |Expected Interventions |Teaching Points for Debriefing |

|Initial Stage: |Program VS |Wash hands |Initial care of the trauma patient |

|VS: BP 140/78, HR 120, RR 22, temp | | |in the emergency department |

|97.6 |Lung sounds diminished |Don personal protective equipment | |

| | | |ABCDEFGHI of rapid trauma |

|Resp: lungs diminished bilaterally,|Normal bowel sounds |Confirm patient identity |assessment |

|cervical collar in place | | | |

| |Give result of blood glucose: 31 |Collaborate with healthcare team |SAMPLE history |

|CV: Sinus tachycardia, pulses all 4| | | |

|extremities | |Continue O2 100% NRB |Facilitating family presence |

| | | | |

|Neuro: responsive to verbal | |Place patient on ECG monitor |Labs anticipated |

|stimuli, pupils 4, equal and | | | |

|reactive, GCS 13 | |Obtain vital signs |Hypoglycemia treatment |

| | | | |

|GI/GU: positive bowel sounds | |IV access |Communication with the team |

| | | | |

|Skin: cold, clammy, diaphoretic | |Attempt to feed patient |Minimizing harm to patients and |

| | | |providers |

| | |Obtain blood specimen: CBC, BMP, | |

| | |T&C, blood glucose | |

| | | | |

| | |Give dextrose | |

| | | | |

| | |GCS should be done | |

| | | | |

| | |Remove clothing, cover with warm | |

| | |blanket | |

| | | | |

| | |Bring family in for SAMPLE history,| |

| | |inform family of patient status, | |

| | |allow family to remain with patient| |

| | | | |

| | |Remove from backboard | |

| | | | |

| | |CT scan head, neck | |

| | | | |

| | |Chart assessment and interventions | |

|Stage 2: |Program new vital signs |Remove cervical collar |Patient-centered care |

|VS: BP 150/80, HR 106, RR 16 | | | |

| |Give results of procedures: |Feed patient protein and |Discharge instructions |

|CV: Sinus tachycardia, pulses all 4|Repeat blood glucose 82, all other|carbohydrates | |

|extremities |labs normal | | |

| |X-ray cervical spine negative |Diabetic education | |

|Neuro: AAO, PEERLA, able to move | | | |

|all extremities, GCS 15 |Give assessment information in |Chart assessment and interventions | |

| |response to student questions of | | |

|GI/GU: positive bowel sounds |that system. | | |

| | | | |

|Skin: warm and dry | | | |

Debriefing/Guided Reflection Questions for this Simulation

How do you feel you performed triaging at the multiple casualty event?

What could be improved with your triaging?

Did you obtain consent to treat the pediatric patient? How?

How do you feel you performed your rapid trauma assessment?

What could be improved with your rapid trauma assessment?

Did you remember to implement all nursing interventions for your patients in the emergency department?

Did you assess for pain and comfort?

How did you collaborate with other healthcare providers to assure that your patients were comfortable?

How did you coordinate care in the emergency department to provide patient-centered care?

How did you feel about having the family stay in the room with your patient?

Do you feel that you communicated your needs and the needs of the patient clearly to the healthcare team?

Why was it important for you to conduct a pre-surgical checklist and provide an SBAR report to the OR nurse?

Recognizing that the patient is source of control and full partner in care, were you able to educate Eve on the importance of diabetes management?

How will you improve your triage, rapid trauma assessment and nursing intervention skills?

Do you feel ready to participate in a drill or a disaster after this week? Why or why not?

References

Emergency Nurses Association (2007). Disaster management. In Trauma nursing core course

provider manual (6th ed.) (pp. 249-272). Des Plaines, IL: Emergency Nurses Association.

Ignatavicius, D. & Workman, M.L. (2010). Concepts of emergency and disaster preparedness. In

Medical-surgical nursing: Patient-centered collaborative care (6th ed.) (pp. 159-168). St.

Louise, MO: Saunders Elsevier.

Ignatavicius, D. & Workman, M.L. (2010). Concepts of emergency and trauma nursing. In

Medical-surgical nursing: Patient-centered collaborative care (6th ed.) (pp. 126-140). St.

Louise, MO: Saunders Elsevier.

Quality and Safety Education for Nurses (2012). Competency KSAs pre-licensure. Retrieved from



The Joint Commission (2012). Surgical care improvement project. Retrieved from



Laskowski-Jones, L. (2010). Concepts of emergency and disaster preparedness. In Ignatavicius,

D. & Workman, M.L. (Eds.), Medical surgical nursing: Patient-centered collaborative care (pp. 159-168). St. Louis, MO: Saunders Elsevier.

Laskowski-Jones, L. & Toulson, K. (2010). Concepts of emergency and trauma nursing. In

Ignatavicius, D. & Workman, M.L. (Eds.), Medical surgical nursing: Patient-centered collaborative care (pp. 126-140). St. Louis, MO: Saunders Elsevier.

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