Date of this Version

11-16-2023

Document Type

DNP Project

Abstract

Sickle Cell Disease (SCD) is common genetic blood disorder that predominantly affects African Americans. In the United States, this disease accounts for a large amount of Emergency Department (ED) visits annually, with pain being identified as the chief complaint upon arrival. Such high ED utilization could signify lack of proper outpatient care or poor quality of care in the ED. A complication of SCD is known as sickle cell crisis or vaso-occlusive crises (VOC). A VOC is caused by deoxygenation which results in red blood cells (RBCs) to become sickle-shaped and adhere to each other in the blood vessel walls. As the RBCs adhere to the vessel walls, there is blockage of blood flow and decreased circulation throughout the body. As a consequence, individuals can develop irreversible organ damage and further health complications due to systemic inflammation and pain.

In order to improve SCD care provision, it is imperative to understand and identify factors causing a delay in medication administration for this target population. VOC episodes presenting to the ED remain inadequately managed. Patients report negative hospital experiences, delay in pain control, stigmatization, negligent care, and lack of empathy from health care providers. A crucial factor contributing to pain relief in the ED is lack of provider SCD knowledge. Patients commonly report that nurses do not fully understand the disease pathology, complications, and management; contributing to analgesic delay, lack of empathy, and pain disbelief. Nurses’ lack of knowledge has potential to impose personal beliefs and attitudes which often do not reflect the patient’s current condition. It is crucial to understand that patients with SCD crisis often arrive with specific requests to the ED as they are the content experts and are actively involved in self-care for their pain management. Nurses must work with patients to understand the reason for their behaviors in order to provide optimal patient care. To help address the educational gap seen in nurses caring for patients arriving with sickle cell crisis to the ED, a quality improvement project was implemented at a large county hospital in South Florida. Participants took a pre-test survey, an educational PowerPoint presentation was given, and a post-test survey was completed to assess if knowledge was improved. The results revealed a statistically significant change in knowledge between the pre-test and post-test. In conclusion, an educational intervention regarding timely pain management proved to increase nurses’ knowledge regarding timely pain management for patients arriving with sickle cell crisis to the ED. The findings support the use of an educational intervention for ED nurses in order to improve analgesic administration and help improve clinical outcomes.

Keywords: sickle cell anemia, sickle cell crisis, sickle cell crisis education, emergency department sickle cell.

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