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Nursing Research and Practice
Volume 2012 (2012), Article ID 596393, 13 pages
Review Article

Advanced Nursing Directives: Integrating Validated Clinical Scoring Systems into Nursing Care in the Pediatric Emergency Department

1Pediatric Emergency Medicine, Alberta Children’s Hospital, Calgary, AB, Canada
2Division of Emergency Medicine, Department of Pediatrics, University of Calgary, Calgary, AB, Canada

Received 9 December 2011; Revised 6 February 2012; Accepted 20 February 2012

Academic Editor: Valerie Wilson

Copyright © 2012 Erin Kate deForest and Graham Cameron Thompson. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


In an effort to improve the quality and flow of care provided to children presenting to the emergency department the implementation of nurse-initiated protocols is on the rise. We review the current literature on nurse-initiated protocols, validated emergency department clinical scoring systems, and the merging of the two to create Advanced Nursing Directives (ANDs). The process of developing a clinical pathway for children presenting to our pediatric emergency department (PED) with suspected appendicitis will be used to demonstrate the successful integration of validated clinical scoring systems into practice through the use of Advanced Nursing Directives. Finally, examples of 2 other Advanced Nursing Directives for common clinical PED presentations will be provided.