Background and objectives Early bystander cardiopulmonary resuscitation (CPR) is one of the most important predictors of out-of-hospital cardiac arrests (OHCA) survival. There is a dearth of literature on CPR engagement in countries such as Ghana, where cardiovascular events are increasingly prevalent. In this study, we sought to evaluate Ghanaians’ knowledge of and attitudes towards bystander CPR, in the context of the country’s nascent emergency medicine network. Methods Capitalizing on the growing ubiquity and use of social media across the country, we used a novel social media sampling strategy for this study. We created, pre-tested, and distributed an online survey, using the two most utilized social media platforms in Ghana: WhatsApp and Facebook. An airtime data incentive of 5 US dollars, worth between 5 and 10 GB of cellular data based on mobile phone carrier, was provided as incentive. Inclusion criteria were (1) ≥ 18 years of age, (2) living in Ghana. Survey participants were encouraged to distribute the survey within their own networks to expand its reach. We stratified participants’ responses by healthcare affiliation, and further grouped healthcare workers into ambulance and non-ambulance personnel. We used chi-square (χ2)/Fisher’s Exact tests to compare differences in responses between the groups. Based on the question “have you ever heard of CPR?”, an alpha of 0.05 and a 95% confidence interval, we expected to have 80% power to detect a 15% difference in responses between lay and healthcare providers with an estimated sample size of 246 study participants. Results The survey was launched on 8 July 2019 and closed approximately 51 h post-launch. With a 64% completion rate and 479 unique survey completions, the study was overpowered at 96% power, to detect differences in responses between the groups. There was geographic representation across all 10 historic regions of Ghana. Over half (57.8%, n = 277) of the respondents were non-medically affiliated, and 71.9% were women. Healthcare workers were more aware of CPR than lay respondents (96.5% vs 68.1%; p < 0.001). Eighty-five percent of respondents were aware that CPR involves chest compressions, and almost 70% indicated that “mouth to mouth” is a necessary component of CPR. Fewer than 10% were unwilling to administer CPR. Lack of skills (44.9%) and fear of causing harm (25.5%) were barriers noted by respondents for not administering CPR. Notably, a quarter of ambulance workers reported never having received CPR training. If they were to witness a collapse, 62.0% would call an ambulance, and 32.6% would hail a taxi. Conclusion The majority of participants are willing to perform CPR. Contextualized training that emphasizes hands-only CPR and builds participants’ confidence may increase bystander willingness and engagement.

The World Health Assembly declared 2020 as the ‘Year of the Nurse and the Midwife’ in recognition of the critical contribution of both professions to global health. Nurses globally are having to do more with less and in the already resource deficient African context, significant adaptation and leadership is required in the way emergency nurses work if they are to be effective in reducing mortality and morbidity within emergency populations. In 2011, an emergency nursing group, representing the largest group of nurses in Africa, swiftly engaged with this process by publishing the document ‘Developing a framework for emergency nursing practice in Africa’ (2012). From this document a strategic plan was devised within a tight timeframe, to operationalise the quest for enhanced emergency nursing in Africa. The purpose of this paper is to describe this development of emergency nursing in Africa and to explain the operational challenges and successes, as well as the lessons learnt in order to assist with future planning.

Background Existing evidence suggest the emergence of palliative care (PC) services in the emergency department (ED). To gain insight into the nature of these services and provide direction to future actions, there is a need for a comprehensive review that ascertains the components of these services, integration models, and outcomes. Methods A scoping review design was employed and reported according to the PRISMA extension guidelines for scoping reviews. Extensive searches in peer‐reviewed databases (CINAHL, EMBASE, PubMed, Cochrane Library, and Medline) and gray literature sources (Trove, MedNar, OpenGrey, and the Agency for Healthcare Research and Quality) were undertaken and supplemented with hand searching. Titles, abstracts, and full text were reviewed in duplicate. Studies were eligible for inclusion if they reported on a PC intervention implemented in the ED for adults. Codes were formulated across the included studies, which facilitated the conduct of a narrative synthesis. Results Twenty‐three studies were retained with the majority (n = 15) emerging from the United States. The components of PC interventions in the ED were categorized as: (1) screening, (2) goals of care discussion and communication, (3) managing pain and other distressing symptoms in the ED, (4) transitions across care settings, (5) end‐of‐life (EoL) care, (6) family/caregiver support, and (7) ED staff education. Traditional PC consultations and integrated ED–PC services were the main modes of delivery. PC in the ED can potentially improve patient symptoms, facilitate access to relevant services, reduce length of stay, improve care at the EoL, facilitate bereavement and postbereavement support for family members, and improve ED staff confidence in delivering PC. Conclusions PC implementation in the ED may potentially improve patient and family outcomes. More studies are needed, however, to standardize trigger or screening tools. More prospective studies are also needed to test PC interventions in the ED.

Providing effective emergency nursing is challenging in low- to middle-income countries because of limited resources and an inadequate infrastructure. The role of the emergency nurse is growing throughout sub-Saharan Africa and this will help decrease the burden of acute illness and trauma on both the people and the economies in the area. However, there is a gap in education for emergency nurses in this part of the world which needs to be addressed. This article describes an emergency nursing degree programme in Ghana which was developed in collaboration with a university in the United States and one in Ghana. It also outlines the development and content of the programme and discusses its success and challenges.

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