International Emergency Nursing最新文献

Determination of the relationship between competencies in disaster nursing management and perceived stress: The intermediary role of resilience 确定灾难护理管理能力与感知压力之间的关系：复原力的中介作用

IF 1.8 4区医学 Q2 NURSING

International Emergency Nursing

Pub Date : 2024-11-25 DOI: 10.1016/j.ienj.2024.101530

Gülnur Akkaya , Yeliz Akkuş , Ayşe Gül Parlak , Yasemin Karacan

Background

Türkiye encounters various natural disasters, foremost earthquakes, and, nurses’ resilience, ability to cope with stress and disaster competence play a significant role in disasters.

Objective

The objective of this study is to establish the intermediary role of resilience in the relation between nurses’ competencies in disaster management and perceived stress.

Method

The sampling of this descriptive and cross-sectional study included 240 nurses from across Türkiye. The socio-demographic characteristics questionnaire, Competencies for Disaster Nursing Management Questionnaire, Brief Resilience Scale, Perceived Stress Scale were utilized in order to collect data. Among the continuous variables of the research, Pearson correlation analysis, linear regression and hierarchical regression analyses regarding the intermediary effect were performed by using PROCESS Model.

Findings

The mean scale scores of nurses were detected to be “CDNMQ” 6.300 ± 2.771 (medium), “BRS” 18.463 ± 4.308 (medium), and “PS” 21.038 ± 6.759 (low), respectively. The relationship between CDNMQ and PS (path c; ß = −0.534) descends in case BRS is added to the model (path c’; ß = −0.429) (p < 0.05). In light of this finding, BRS was determined to be a partial intervening variable between CDNMQ and PS.

Conclusion

In accordance with this study, it is recommended to plan studies to enhance disaster nursing competence, prioritize resilience, and reproduce this study in various nurse groups.

背景土耳其会遇到各种自然灾害，其中最严重的是地震，而护士的抗灾能力、应对压力的能力和应对灾害的能力在灾害中发挥着重要作用。研究目的本研究旨在确定抗灾能力在护士灾害管理能力和感知压力之间的中介作用。研究采用了社会人口学特征问卷、灾害护理管理能力问卷、简明复原力量表和感知压力量表来收集数据。研究结果护士的平均量表得分分别为 "CDNMQ" 6.300 ± 2.771（中）、"BRS" 18.463 ± 4.308（中）和 "PS" 21.038 ± 6.759（低）。如果模型中加入 BRS（路径 c'；ß = -0.429），CDNMQ 与 PS 之间的关系（路径 c；ß = -0.534）会下降（p < 0.05）。根据这一发现，BRS被确定为CDNMQ和PS之间的部分干预变量。结论根据本研究，建议规划提高灾难护理能力的研究，优先考虑抗灾能力，并在不同的护士群体中重复本研究。

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引用次数: 0

Emergency medical service nurses’ experiences and perspectives on a protocol change of pre-hospital preventive immobilization of spinal injuries after trauma: A qualitative study 紧急医疗服务护士对创伤后脊柱损伤院前预防性固定协议变更的经验和观点：定性研究。

IF 1.8 4区医学 Q2 NURSING

International Emergency Nursing

Pub Date : 2024-11-22 DOI: 10.1016/j.ienj.2024.101533

Otto J. van de Breevaart , Nancy E.E. Van Loey , Luke P.H. Leenen , Lisette Schoonhoven , Wietske H.W. Ham

Objective

In 2016, a selective preventive spinal immobilization protocol for emergency medical service (EMS) nurses was introduced in the Netherlands. This protocol leaves more room for autonomous decision-making in the pre-hospital phase regarding preventive spinal immobilization (PSI), compared to the previous strict protocol. In this study, we explored the experiences and perspectives of EMS nurses on decisionmaking about PSI after the change from a strict to a selective PSI protocol. Methods: We used a qualitative design with semi-structured face-to-face interviews. Thematic analysis was applied. The capability-opportunity-motivation-behavior-model was used to interpret the experiences and perspectives. Results: Thirteen EMS nurses from three emergency medical services were interviewed. Respondents appreciated autonomous decision-making as there was more room for patient-centered informed decision-making. However, autonomous decision-making required optimized knowledge and skills and elicited the need to receive feedback on their decision not to apply PSI. When nurses anticipated resistance to selective PSI from receiving hospitals, they were doubtful to apply it. Conclusion: Nurses appreciate the increased autonomy in decision-making, encouraging them to focus on patient-centered care. Increased autonomy also places higher demands on knowledge and skills, calling for training and feedback. Anticipated resistance to receiving hospitals based on mutual protocol discrepancies could lead to PSI application by EMS nurses while not deemed necessary. Recommendations: To enhance PSI procedures, optimizing the knowledge and skills of EMS nurses that facilitate on-scene decision-making may be indicated. A learning loop for feedback between the EMS nurses and the involved hospitals may add to their professional performance. More efforts are needed to create support for the changed Emergency Medical Services strategy in PSI to prevent unnecessary PSI and practice variation.

目的：2016 年，荷兰为急救医疗服务 (EMS) 护士推出了选择性预防性脊柱固定方案。与之前的严格规程相比，该规程在院前阶段为预防性脊柱固定（PSI）的自主决策留出了更多空间。在本研究中，我们探讨了从严格的 PSI 方案转变为选择性 PSI 方案后，急救护士在 PSI 决策方面的经验和观点：方法：我们采用了半结构化面对面访谈的定性设计。采用主题分析法。采用能力-机会-动机-行为模型来解释经验和观点：来自三个紧急医疗服务机构的 13 名急救护士接受了访谈。受访者对自主决策表示赞赏，因为这为以患者为中心的知情决策提供了更大的空间。然而，自主决策需要优化的知识和技能，并需要在决定不使用 PSI 时得到反馈。当护士预料到接收医院对选择性 PSI 的抵制时，她们对应用 PSI 持怀疑态度：结论：护士对决策自主权的增加表示赞赏，这鼓励她们将精力集中在以患者为中心的护理上。自主权的增加也对知识和技能提出了更高的要求，需要培训和反馈。基于双方协议的差异，预计接收医院会有抵触情绪，这可能会导致急救护士在认为没有必要的情况下应用 PSI：建议：为加强 PSI 程序，应优化急救护士的知识和技能，以促进现场决策。在急救护理人员和相关医院之间建立反馈学习回路，可提高他们的专业表现。还需要做出更多努力，为急救医疗服务在 PSI 中改变策略提供支持，以防止不必要的 PSI 和实践差异。

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引用次数: 0

Decreasing hemolysis rates through phlebotomy education 通过抽血疗法教育降低溶血率。

IF 1.8 4区医学 Q2 NURSING

International Emergency Nursing

Pub Date : 2024-11-20 DOI: 10.1016/j.ienj.2024.101534

Mariolina Bartolomeo, Christina Tedesco, LuAnn Etcher

引用次数: 0

What is the optimal outcome for evaluating the triage Systems? Insights from a prospective observational study 评估分流系统的最佳结果是什么？前瞻性观察研究的启示。

IF 1.8 4区医学 Q2 NURSING

International Emergency Nursing

Pub Date : 2024-11-19 DOI: 10.1016/j.ienj.2024.101540

Arian Zaboli , Francesco Brigo , Serena Sibilio , Gloria Brigiari , Magdalena Massar , Marta Parodi , Michael Mian , Norbert Pfeifer , Gianni Turcato

Background

Currently, there is no universally accepted gold standard outcome for assessing the effectiveness of the Triage Systems. This study aimed to comprehensively evaluate and compare various outcomes utilized in triage studies.

Methods

A prospective observational study was conducted at the Emergency Department (ED) of Merano Hospital from June 1 to December 31, 2023. We assessed the predictive capability of the Manchester Triage System (MTS) across multiple outcomes using areas under the receiver operating characteristic curve (AUROC), along with their corresponding 95% confidence intervals (95% CI), and frequency distributions.

Results

The MTS demonstrated strong performance concerning the most objective outcomes, such as mortality (at 72 h: AUROC 0.914; 95 %CI: 0.815–1; at 7 days: 0.845; 95 %CI: 0.729–0.965; at 30 days: 0.794; 95 %CI: 0.706–0.881), admission to the intensive care unit (0.831; 95 %CI: 0.763–0.899), and need for life-saving interventions (0.870; 95 %CI: 0.806–0.934). Additionally, outcomes such as urgency status and clinical priority, as judged by physicians, exhibited excellent performance and optimal frequency distribution.

Conclusions

The performance of the MTS varied significantly depending on the specific outcome under evaluation. Currently, no single outcome appears superior to others, nor does any seem poised to serve as a potential gold standard for the assessment of triage systems. It is advisable for dedicated working groups to convene and reach a consensus on the most effective outcomes for evaluating the performance of MTS and other triage systems. This should be accomplished through a systematic, standardized, and transparent approach, grounded in the best available evidence.

背景：目前，在评估分诊系统的有效性方面还没有公认的金标准结果。本研究旨在全面评估和比较分诊研究中使用的各种结果：一项前瞻性观察研究于 2023 年 6 月 1 日至 12 月 31 日在梅拉诺医院急诊科（ED）进行。我们使用接收者操作特征曲线下面积（AUROC）及其相应的 95% 置信区间（95% CI）和频率分布评估了曼彻斯特分诊系统（MTS）对多种结果的预测能力：结果：MTS 在死亡率等最客观的结果方面表现出色（72 小时内：AUROC 0.914；72 小时后：AUROC 0.914；72 小时后：AUROC 0.914）：AUROC 0.914; 95 %CI: 0.815-1; at 7 days：0.845; 95 %CI: 0.729-0.965; at 30 days：0.794; 95 %CI: 0.706-0.881）、入住重症监护室（0.831; 95 %CI: 0.763-0.899）和救生干预需求（0.870; 95 %CI: 0.806-0.934）。此外，由医生判断的紧急状况和临床优先级等结果也表现出优异的性能和最佳的频率分布：MTS的性能因评估的具体结果不同而有很大差异。目前，没有任何一种结果比其他结果更优越，也没有任何一种结果可以作为评估分流系统的潜在黄金标准。最好由专门的工作组召开会议，就评估 MTS 和其他分流系统性能的最有效结果达成共识。要做到这一点，就必须以现有的最佳证据为基础，采用系统化、标准化和透明的方法。

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引用次数: 0

The Multinational Association for Supportive Care in cancer criteria. An Evaluation and recommendations for the management of neutropenia in the emergency department 多国癌症支持性治疗协会标准。对急诊科中性粒细胞减少症处理的评估和建议。

IF 1.8 4区医学 Q2 NURSING

International Emergency Nursing

Pub Date : 2024-11-19 DOI: 10.1016/j.ienj.2024.101542

Anas Alsharawneh

Objectives

We aimed to evaluate the reproducibility, accuracy, feasibility, and effect of the Multinational Association for Supportive Care in Cancer (MASCC) criteria on emergency clinical decisions, treatment, and health outcomes.

Methods

A retrospective cohort design was used.

Results

The MASCC score was better at correctly detecting the high urgency (70 % of patients with a high urgency were identified as high risk) than the low urgency (only 30 % of patients with a low urgency were identified as low risk). The examination of the MASCC score as a continuous variable could have been more valuable and indicated inferior validity. The likelihood ratios were far from good, which is better for ruling out the high urgency. The observed likelihood ratio of the MASCC range 17 to 20 provided no information for the goodness of the scale (equal to one). The results from multiple linear regression analyses identified that the MASCC original categorization (high vs. low risk) and the investigated new one (multiple ranges of MASCC score) were significantly associated with time to reassessment, time to be seen, time to decide on admission, boarding time until disposition, and length of stay. However, the original categorization nor the new one was predictive of the admission site. Still, both were significantly associated with hospital disposition (mortality) (p < 0.05).

Conclusion

Even though the MASCC score determines the neutropenia treatment pathway, the sensitivity and specificity analysis identified that the scale did not perform well in detecting real clinical urgency.

目的我们旨在评估多国癌症支持性治疗协会（MASCC）标准的可重复性、准确性、可行性以及对急诊临床决策、治疗和健康结果的影响：方法：采用回顾性队列设计：结果：MASCC评分在正确检测高危急症方面（70%的高危急症患者被认定为高危）优于低危急症（仅30%的低危急症患者被认定为低危）。将 MASCC 评分作为一个连续变量进行研究可能更有价值，但其有效性较差。似然比远远不够，这更有利于排除高危急症。观察到的 MASCC 17 至 20 分的似然比没有提供量表好坏的信息（等于 1）。多元线性回归分析结果表明，MASCC 原始分类（高危与低危）和新调查分类（MASCC 评分的多个范围）与重新评估时间、就诊时间、决定入院时间、处置前的住院时间和住院时间有显著相关性。但是，原始分类和新分类都不能预测入院地点。尽管如此，两者都与入院处置（死亡率）有明显相关性（P 结论）：尽管 MASCC 评分决定了中性粒细胞减少症的治疗路径，但敏感性和特异性分析表明，该量表在检测真正的临床紧迫性方面表现不佳。

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引用次数: 0

“It’s about making a difference”: Interplay of professional value formation and sense of coherence in newly graduated Finnish paramedics "与众不同"：新毕业的芬兰辅助医务人员的职业价值观形成与连贯感的相互作用。

IF 1.8 4区医学 Q2 NURSING

International Emergency Nursing

Pub Date : 2024-11-18 DOI: 10.1016/j.ienj.2024.101541

Christoffer R Ericsson , Veronica Lindström , Ann Rudman , Hilla Nordquist

引用次数: 0

Effect of rescue work training in nursing students with a novel device: A quasi-experimental study 使用新型设备对护理专业学生进行抢救工作培训的效果：准实验研究。

IF 1.8 4区医学 Q2 NURSING

International Emergency Nursing

Pub Date : 2024-11-18 DOI: 10.1016/j.ienj.2024.101544

Verónica V. Márquez Hernández , José Miguel Garrido-Molina , Antonio Javier Segura-Fornieles , Mª Carmen Rodríguez-García , Alba García-Viola

Aims

The aim of this study was to analyze the effectiveness of an intervention for the training of nursing students in rescue work of a traumatized patient using the Snaid® device.

Methods

A quasi-experimental one group pretest–posttest study was carried out. A total of 107 nursing students participated. Data on self-efficacy, knowledge, ergonomics and skill were collected. The data were analyzed with SPSS version 29 statistical software.

Results

Statistically significant differences were found between mean self-efficacy score and time of measurement (U = 2090.500; Z = -8.377; p < 0.001). Statistically significant differences were also found between the time of measurement and the knowledge score (U = 373.000; Z = -11.966; p < 0.001). Considering the results on ergonomics, it was found that the mean score given after the intervention was 9.37 (SD = 1.02). Regarding intervention time, the mean time was 47.76 s (SD = 4.74). Finally, considering skill, the mean score was 8.78 (SD = 1.23).

Conclusion

The results of the present study indicate that participants obtained a high level of self-efficacy, knowledge, skill and ergonomics after training in the rescue work of a patient through the Snaid® device. This device may contribute to improve trauma patient care.

目的：本研究旨在分析使用 Snaid® 设备对护理专业学生进行创伤患者抢救工作培训的干预效果：方法：开展了一项前测-后测一组的准实验研究。共有 107 名护理专业学生参加。研究收集了有关自我效能感、知识、人体工程学和技能的数据。数据采用 SPSS 29 版统计软件进行分析：本研究的结果表明，在通过 Snaid® 设备对患者进行抢救工作培训后，参与者获得了较高的自我效能感、知识、技能和人体工程学水平。该设备可能有助于改善创伤患者的护理。

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引用次数: 0

Development of an evidence-based strategy to implement the HIRAID® emergency nursing framework in rural emergency departments using behaviour change theory 利用行为改变理论制定循证战略，在农村急诊科实施 HIRAID® 急诊护理框架。

IF 1.8 4区医学 Q2 NURSING

International Emergency Nursing

Pub Date : 2024-11-14 DOI: 10.1016/j.ienj.2024.101538

Belinda Kennedy , Kate Curtis , Sarah Kourouche , Louise Casey , Dorothy Hughes , Andrea McCloughen

Introduction

Emergency nurses are critical to emergency care delivery, particularly in rural areas with limited medical support. To support nurses, the validated emergency nursing framework, HIRAID®, was to be implemented. Implementing interventions in the emergency context is notoriously difficult and rural areas have added challenges with limited resources across large geographic areas. This study aims to develop an evidence-informed strategy to implement HIRAID® across a large rural/regional health district.

Methods

The behaviour change wheel and Theoretical Domains Framework were used in developing the implementation strategy. The theoretical domains, linked to barriers and enablers to implementing HIRAID®, were mapped to intervention functions. Associated Behaviour Change Techniques were considered to determine suitability to address barriers or enhance enablers, as well as suitability according to and the APEASE criteria.

Results

Seven intervention functions, such as modelling, education, and incentivisation, were deemed suitable for inclusion. The intervention functions were mapped to 20 BCTs and planned to be operationalised through 11 delivery modes, including a flexible education program, documentation templates, and support in the workplace.

Conclusions

This study determined the relevant BCTs and mechanisms of delivery to mediate change in behaviour and support uptake of the HIRAID® emergency nursing framework in a rural health district.

引言急诊护士对提供急诊护理至关重要，尤其是在医疗支持有限的农村地区。为了向护士提供支持，需要实施经过验证的急救护理框架 HIRAID®。在急诊环境中实施干预措施是出了名的困难，而农村地区由于地域广阔，资源有限，面临着更多的挑战。本研究旨在制定一项有实证依据的战略，在一个大型农村/地区卫生区实施 HIRAID®：方法：在制定实施策略时使用了行为改变轮和理论领域框架。与实施 HIRAID® 的障碍和促进因素相关的理论领域被映射到干预功能上。考虑了相关的行为改变技术，以确定是否适合消除障碍或增强促进因素，以及是否符合 APEASE 标准：结果：七个干预功能，如建模、教育和激励，被认为适合纳入其中。这些干预功能被映射到 20 个 BCT 上，并计划通过 11 种交付模式来实施，包括灵活的教育计划、文件模板和工作场所支持：本研究确定了相关的BCT和实施机制，以促进行为的改变，并支持在农村卫生保健区采用HIRAID®急救护理框架。

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引用次数: 0

The accuracy of triage classification using Emergency Severity Index 使用紧急情况严重程度指数进行分流分类的准确性。

IF 1.8 4区医学 Q2 NURSING

International Emergency Nursing

Pub Date : 2024-11-10 DOI: 10.1016/j.ienj.2024.101537

Krisada Suamchaiyaphum , Allison R. Jones , Shea Polancich

Introduction

Accurate emergency triage is essential for timely and appropriate care based on patient acuity. We sought to evaluate triage accuracy among emergency department (ED) nurses and examine potential influencing factors.

Methods

We conducted an observational study using an electronic medical record chart review of 100 patients admitted at one of three EDs in a large academic medical system in the southern United States from December 1 to 7, 2021. Descriptive statistics were used to summarize the data. We compared the nurses’ initial assigned triage acuity level documented in the medical chart with triage acuity assigned using the Emergency Severity Index Version 4 handbook and assessed inter-rater agreement using Cohen’s kappa coefficient.

Results

Overall triage accuracy was 67%, with most patients (62%) triaged as ESI level 3; under- and over-triage occurred in 25% and 8% of cases, respectively. Cohen’s kappa coefficient was 0.437, indicating moderate interrater reliability between the triage nurses and the ESI handbook. Triage accuracy varied across ED locations and patient characteristics of sex (male: 55.6%, female: 72.3%), type of complaint (trauma: 57.1%, non-trauma: 69.4%), shift (day: 63.5%, night: 73.0%), and mode of arrival (ambulance: 80.8%, ambulatory: 65.2%, and private vehicle: 37.5%).

Conclusion

Triage inaccuracy may be attributed to a combination of nursing- and patient-specific factors. Further study of those factors associated with triage accuracy is warranted.

简介准确的急诊分诊对于根据患者的严重程度及时提供适当的护理至关重要。我们试图评估急诊科（ED）护士的分诊准确性，并研究潜在的影响因素：我们使用电子病历对美国南部一家大型学术医疗系统的三个急诊科之一在 2021 年 12 月 1 日至 7 日期间收治的 100 名患者进行了观察研究。我们使用描述性统计来总结数据。我们将病历中记录的护士最初指定的分诊严重程度与使用《急诊严重程度指数第4版手册》指定的分诊严重程度进行了比较，并使用科恩卡帕系数评估了评分者之间的一致性：总体分诊准确率为 67%，大多数患者（62%）被分诊为 ESI 3 级；分诊不足和分诊过度分别占 25% 和 8%。科恩卡帕系数（Cohen's kappa coefficient）为 0.437，表明分诊护士和 ESI 手册之间的互评可靠性处于中等水平。分诊准确率因急诊室地点和患者性别（男性：55.6%，女性：72.3%）、主诉类型（创伤：57.1%，非创伤：69.4%）、轮班（白班：63.5%，夜班：73.0%）和到达方式（救护车：80.8%，门诊：65.2%，私家车：37.5%）而异：结论：分诊不准确可能是由护理因素和患者特定因素共同造成的。结论：分诊不准确可能是由护理人员和患者的特定因素共同造成的，因此有必要对这些与分诊准确性相关的因素进行进一步研究。

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引用次数: 0

Children with medical complexity in the emergency department: Parent experiences and information needs 在急诊科就诊的病情复杂的儿童：家长的经历和信息需求。

IF 1.8 4区医学 Q2 NURSING

International Emergency Nursing

Pub Date : 2024-11-07 DOI: 10.1016/j.ienj.2024.101532

Danielle Lysak , Samina Ali , Susan Neufeld , Shannon Scott

Background

Children with complex medical needs constitute a growing number of pediatric patients that utilize the emergency department, disproportionately more than children outside of this category. Our objective for this qualitative study was to explore information needs and experiences of parents accessing emergency health care for their child with medical complexity.

Methods

Qualitative description guided this study. Parent participants were recruited via purposive sampling and individually interviewed within a pediatric specialty clinic at a Canadian pediatric tertiary care center. Inductive content analysis organized interview data from parents.

Results

Nine, 60–90 min individual interviews were conducted with parents of a child with medical complexity; four content categories emerged: How the emergency department is different for children with medical complexity, parents as key care coordinators, emergency department experience and resilience, and communication and learning preferences.

Conclusion

These families openly shared their experience with pediatric emergency care. Strategies to support transfer of pertinent health information for children with complex medical needs are needed in the emergency department. Interviews with parents of children with complex medical needs provided key insights to inform and improve the care provided in the emergency department for this growing population of children.

背景：在使用急诊科的儿科病人中，有复杂医疗需求的儿童人数越来越多，比其他类别的儿童多得多。我们进行这项定性研究的目的是，探索父母在为病情复杂的儿童提供急诊医疗服务时的信息需求和经验：方法：本研究以定性描述为指导。我们通过有目的的抽样调查招募了参与研究的家长，并在加拿大一家儿科三级医疗中心的儿科专科门诊对他们进行了单独访谈。归纳内容分析整理了来自家长的访谈数据：共进行了 9 次 60-90 分钟的个别访谈，访谈对象为一名病情复杂的儿童的家长；访谈内容分为四类：急诊科对于病情复杂儿童有何不同、家长是关键的护理协调者、急诊科的经验和应变能力以及沟通和学习偏好：这些家庭公开分享了他们在儿科急诊护理方面的经验。急诊科需要为有复杂医疗需求的儿童制定支持相关健康信息传递的策略。对有复杂医疗需求儿童的家长进行的访谈提供了重要的见解，为急诊科为这一日益增长的儿童群体提供信息和改善护理提供了依据。

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引用次数: 0