title: Protective lung strategies: A cross sectional survey of nurses knowledge and use in the emergency department.
abstract: BACKGROUND
  Mechanical ventilation (MV) is commonly used in emergency departments (EDs). Protective lung strategies (PLS), comprising of low tidal volume (6mL/kg), control of oxygen and plateau pressures, and administration of positive end expiratory pressure (PEEP) has been shown to reduces the risks associated with MV but there is little evidence exists about nurses' knowledge or application of PLS. Our aim was to explore nurses knowledge and application of PLS in Australian EDs.
  
  
  METHODS
  Descriptive, exploratory design utilising an online questionnaire. A convenience sample was recruited via the College of Emergency Nursing Australasia mailing list and secondary snowball sampling was used to optimise response rate.
  
  
  RESULTS
  There were 157 participants. PLS are being used in most EDs (n=104, 75%) and clinical practice guidelines (CPG) are often available (n=86, 62%). Most ED ventilators are capable of implementing PLS, but measurement of plateau pressures was infrequent (n=46%). Participants demonstrate appropriate knowledge, but reported varying levels of confidence and perceived autonomy when implementing PLS in the ED.
  
  
  CONCLUSIONS
  PLS are being used in Australian EDs, aligning with best available evidence. Nursing staff have good levels of PLS knowledge. Development of an evidence-based CPG may improve confidence when implementing PLS and may pave the way for ED nurses to expand their scope of practice.
authors.affiliation: Emergency Department, Sunshine Hospital,Furlong Road, St. Albans Victoria 3021, Australia. Electronic address: sarah.cornish@wh.org.au.
authors.forename: Sarah
authors.initials: S
authors.lastname: Cornish
authors.affiliation: School of Nursing & Midwifery, Deakin University,Gheringhap Street, Geelong, Victoria 3220, Australia.
authors.forename: Rochelle
authors.initials: R
authors.lastname: Wynne
authors.affiliation: Joseph Epstein Centre for Emergency Medicine Research, Western Health,176 Furlong Road, St. Albans Victoria 3021, Australia.
authors.forename: Sharon
authors.initials: S
authors.lastname: Klim
authors.affiliation: Joseph Epstein Centre for Emergency Medicine Research, Western Health,176 Furlong Road, St. Albans Victoria 3021, Australia; Department of Medicine, Melbourne Medical School - Western Precinct, The University of Melbourne, St. Albans, Vic, 3021 Australia.
authors.forename: Ann-Maree
authors.initials: AM
authors.lastname: Kelly
mesh_terms: D000328:Adult; D001315:Australia; D002983:Clinical Competence; D003430:Cross-Sectional Studies; D004636:Emergency Service, Hospital; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D055370:Lung Injury / Q000517:prevention & control*; D008297:Male; D009741:Nursing Staff, Hospital / Q000592:standards*; D057184:Practice Patterns, Nurses'; D012121:Respiration, Artificial / Q000009:adverse effects*; D011795:Surveys and Questionnaires
keywords: Emergency Department; Emergency nursing; Protective lung strategies; Respiration, Artificial; Tidal volume