title: Can emergency nurses safely and accurately remove cervical spine collars in low risk adult trauma patients: An integrative review.
abstract: BACKGROUND
  Well validated clinical decision rules exist to facilitate the safe removal of collars in the alert, orientated, low risk adult trauma patient, however this practice is traditionally conducted by medical staff. The aim of this review is to synthesise current evidence to determine the efficacy of emergency nurses in safely and accurately removing cervical spine collars using cervical spine rules, in alert, orientated, low risk trauma adult patients.
  
  
  METHODS
  A multi-method search strategy was used to find primary research studies followed by a rigorous screening and quality appraisal process. Data from included articles were extracted, grouped and synthesised.
  
  
  RESULTS
  Nine quantitative research articles resulted in four key findings: the inter-rater reliability between nurses and doctors clearing the cervical spine was high (kappa range (0.61-0.80)); nurses can safely implement the cervical spine clinical decision rule; use of a cervical spine clinical decision rule decreases the time patients are immobilised and; nurses felt confident applying a cervical spine clinical decision rule.
  
  
  CONCLUSIONS
  Appropriately trained emergency nurses can safely apply cervical spine rules to alert, orientated, low risk adult trauma patients. Implementation of nurses clearing cervical spines should include training and ongoing monitoring.
authors.affiliation: Sydney Nursing School, The University of Sydney, 88 Mallett Street, Camperdown, Sydney, NSW 2050, Australia; Emergency Department, St. Vincents Public Hospital, 390 Victoria Street, Darlinghurst, Sydney 2010, Australia. Electronic address: nicolasmith26@gmail.com.
authors.forename: Nicola
authors.initials: N
authors.lastname: Smith
authors.affiliation: Sydney Nursing School, The University of Sydney, 88 Mallett Street, Camperdown, Sydney, NSW 2050, Australia; Trauma Service, St George Hospital, Gray St, Kogarah 2217, Australia.
authors.forename: Kate
authors.initials: K
authors.lastname: Curtis
mesh_terms: D001915:Braces; D002574:Cervical Vertebrae; D000066491:Clinical Decision-Making; D020878:Device Removal / Q000451:nursing*; D016529:Emergency Nursing / Q000379:methods* / Q000592:standards; D006801:Humans; D063868:Patient Outcome Assessment; D061214:Patient Safety; D020377:Self Efficacy; D013124:Spinal Injuries / Q000451:nursing*
keywords: Clinical decision making; Emergencies; Injury; Nursing; Patient outcome assessment; Spine