Pub Date : 2025-10-28DOI: 10.1016/j.ienj.2025.101705
Yao Jiang , Jing Zhao , Hu Juan
Objective
To investigate the application status of machine learning model in the prediction of clinical outcomes in emergency pre-examination and triage, and to analyze its characteristics, advantages and disadvantages, so as to add an objective tool for medical staff to predict the clinical outcome of patients in the process of pre-examination and triage.
Methods
The literature review method was used to search PubMed, Web of Science, Embase, Cochrane Library, China Biomedical Literature Database, CNKI, Wanfang, VIP and other databases, and the literature that met the inclusion criteria was screened and the specific information of the machine learning model in the literature was extracted.
Results
A total of 12 articles that met the criteria were included, including 5 machine learning models, which were mainly used in clinical outcomes such as hospital admission, death, intensive care unit admission, hospital transfer, and home.
Conclusion
The overall sensitivity of the machine learning model is high, but there are few literature studies on the prediction of clinical outcomes for pre-test triage, so relevant large-sample studies should be carried out in clinical practice to achieve the combination of subjective and objective evaluation tools to improve the accuracy of prediction and ensure patient safety.
目的：探讨机器学习模型在急诊预诊分诊临床结果预测中的应用现状，分析其特点、优缺点，为医务人员在预诊分诊过程中预测患者临床结果增加一个客观的工具。方法：采用文献综述法，检索PubMed、Web of Science、Embase、Cochrane Library、中国生物医学文献数据库、CNKI、万方、VIP等数据库，筛选出符合纳入标准的文献，提取文献中机器学习模型的具体信息。结果：共纳入符合标准的文献12篇，包括5个机器学习模型，主要用于住院、死亡、重症监护病房入住、转院、回家等临床结局。结论：机器学习模型整体敏感性较高，但对预试分诊临床结局预测的文献研究较少，在临床实践中应开展相关大样本研究，实现主客观评价工具的结合，提高预测准确性，保障患者安全。
{"title":"The use of machine learning in predicting clinical outcomes in emergency pre-examination triage: A systematic review of the literature","authors":"Yao Jiang , Jing Zhao , Hu Juan","doi":"10.1016/j.ienj.2025.101705","DOIUrl":"10.1016/j.ienj.2025.101705","url":null,"abstract":"<div><h3>Objective</h3><div>To investigate the application status of machine learning model in the prediction of clinical outcomes in emergency pre-examination and triage, and to analyze its characteristics, advantages and disadvantages, so as to add an objective tool for medical staff to predict the clinical outcome of patients in the process of pre-examination and triage.</div></div><div><h3>Methods</h3><div>The literature review method was used to search PubMed, Web of Science, Embase, Cochrane Library, China Biomedical Literature Database, CNKI, Wanfang, VIP and other databases, and the literature that met the inclusion criteria was screened and the specific information of the machine learning model in the literature was extracted.</div></div><div><h3>Results</h3><div>A total of 12 articles that met the criteria were included, including 5 machine learning models, which were mainly used in clinical outcomes such as hospital admission, death, intensive care unit admission, hospital transfer, and home.</div></div><div><h3>Conclusion</h3><div>The overall sensitivity of the machine learning model is high, but there are few literature studies on the prediction of clinical outcomes for pre-test triage, so relevant large-sample studies should be carried out in clinical practice to achieve the combination of subjective and objective evaluation tools to improve the accuracy of prediction and ensure patient safety.</div></div>","PeriodicalId":48914,"journal":{"name":"International Emergency Nursing","volume":"83 ","pages":"Article 101705"},"PeriodicalIF":1.8,"publicationDate":"2025-10-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145393544","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-10-28DOI: 10.1016/j.ienj.2025.101706
Asuman Şener , Tuğba Çınarlı , Dilan Köse
Background
Considering that patient care is provided for 24 h without interruption in the emergency service, the work roles in this service require a state of full wakefulness. Alarm fatigue is defined as the main cause of clinical alarm management problems. Alarm fatigue, that cannot be managed in a full sense, may make desensitize emergency nurses and may endanger patient safety.
Aim
The aim of the study was to determine the effect of sleep quality on alarm fatigue of emergency nurses.
Methods
This research used the descriptive, cross-sectional and correlational study pattern. The study was completed with 183 emergency nurses from May-November 2023. Data were collected using the Descriptive Information Form, Pittsburgh Sleep Quality Index (PSQI) and the Nurses’ Alarm Fatigue Scale. Data were analyzed using IBM SPSS V26 program.
Results
Of nurses, 96.2 % worked shifts and 38.8 % stated their monthly working hours were more than 240 h. Of those working shifts, 77.6 % slept after their shift, 56.8 % experienced sleep problems and 43.3 % stated they required support to be able to easily fall asleep. The mean scores on the Nurses’ Alarm Fatigue Scale were 24.98 ± 6.16, while mean scores for the PSQI were 9.08 ± 3.48. There was a statistically significant, low level positive correlation between PSQI scores and Alarm Fatigue Scale scores (r = 0.178). Additionally, the simple linear regression model created with the aim of investigating the effect of PSQI scores on Alarm Fatigue Scale scores was identified to be statistically significant (F = 5.897; p = 0.016).
Conclusion
With the aim of empowering nurses working irregular night shifts in institutions providing health services, offering education and teaching programs should be considered. In conclusion, our research will help to create a safer, more effective and encouraging hospital environment for both patients and emergency service nurses.
背景：考虑到急诊服务是24小时不间断地提供患者护理，该服务中的工作角色需要处于完全清醒的状态。报警疲劳被定义为临床报警管理问题的主要原因。警报疲劳如果不能得到充分的管理，可能会使急诊护士变得麻木，危及患者安全。目的：研究睡眠质量对急诊护士报警疲劳的影响。方法：本研究采用描述性、横断面和相关性研究模式。这项研究是在2023年5月至11月期间由183名急诊护士完成的。采用描述性信息表、匹兹堡睡眠质量指数（PSQI）和护士报警疲劳量表收集数据。数据分析采用IBM SPSS V26软件。结果：96.2%的护士轮班工作，38.8%的护士每月工作时间超过240小时。在这些轮班的护士中，77.6%的人在轮班后睡觉，56.8%的人有睡眠问题，43.3%的人表示他们需要帮助才能轻松入睡。护士报警疲劳量表平均得分为24.98±6.16分，PSQI平均得分为9.08±3.48分。PSQI评分与报警疲劳量表评分之间有统计学意义的低水平正相关（r = 0.178）。此外，为了研究PSQI评分对报警疲劳量表评分的影响而建立的简单线性回归模型被发现具有统计学意义（F = 5.897; p = 0.016）。结论：在医疗卫生服务机构中，应考虑为夜班护士提供教育和教学方案。总之，我们的研究将有助于为病人和急救护士创造一个更安全、更有效和鼓舞人心的医院环境。
{"title":"Effect of sleep quality on alarm fatigue among emergency nurses","authors":"Asuman Şener , Tuğba Çınarlı , Dilan Köse","doi":"10.1016/j.ienj.2025.101706","DOIUrl":"10.1016/j.ienj.2025.101706","url":null,"abstract":"<div><h3>Background</h3><div>Considering that patient care is provided for 24 h without interruption in the emergency service, the work roles in this service require a state of full wakefulness. Alarm fatigue is defined as the main cause of clinical alarm management problems. Alarm fatigue, that cannot be managed in a full sense, may make desensitize emergency nurses and may endanger patient safety.</div></div><div><h3>Aim</h3><div>The aim of the study was to determine the effect of sleep quality on alarm fatigue of emergency nurses.</div></div><div><h3>Methods</h3><div>This research used the descriptive, cross-sectional and correlational study pattern. The study was completed with 183 emergency nurses from May-November 2023. Data were collected using the Descriptive Information Form, Pittsburgh Sleep Quality Index (PSQI) and the Nurses’ Alarm Fatigue Scale. Data were analyzed using IBM SPSS V26 program.</div></div><div><h3>Results</h3><div>Of nurses, 96.2 % worked shifts and 38.8 % stated their monthly working hours were more than 240 h. Of those working shifts, 77.6 % slept after their shift, 56.8 % experienced sleep problems and 43.3 % stated they required support to be able to easily fall asleep. The mean scores on the Nurses’ Alarm Fatigue Scale were 24.98 ± 6.16, while mean scores for the PSQI were 9.08 ± 3.48. There was a statistically significant, low level positive correlation between PSQI scores and Alarm Fatigue Scale scores (r = 0.178). Additionally, the simple linear regression model created with the aim of investigating the effect of PSQI scores on Alarm Fatigue Scale scores was identified to be statistically significant (F = 5.897; p = 0.016).</div></div><div><h3>Conclusion</h3><div>With the aim of empowering nurses working irregular night shifts in institutions providing health services, offering education and teaching programs should be considered. In conclusion, our research will help to create a safer, more effective and encouraging hospital environment for both patients and emergency service nurses.</div></div>","PeriodicalId":48914,"journal":{"name":"International Emergency Nursing","volume":"83 ","pages":"Article 101706"},"PeriodicalIF":1.8,"publicationDate":"2025-10-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145402520","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-10-27DOI: 10.1016/j.ienj.2025.101704
Ted J. Andrews , Jill Fennell , Brian H. Wrotniak , Heather Territo
Objectives
Phlebotomy is an important source of self-reported pain in the pediatric emergency department. The purpose of this study was to compare the effectiveness of Buzzy®, a vibrating cold device, to vapocoolant and control in reducing child-reported and parent-perceived pain during IV placement in the pediatric emergency department.
Methods
Patients ages 6–18 years who required IV insertion in the emergency department were randomized to Buzzy, vapocoolant or control groups. The Faces Pain Scale – Revised was used to assess both patient pain and parent perceived pain.
Results
171 patients were randomized into the 3 groups: 56 in the Buzzy group, 57 in the vapocoolant group and 58 in the control group. Patient-reported FACES pain scores decreased significantly from pre- to post-intervention in the Buzzy group (5.41 ± 2.90 to 3.58 ± 2.87, p < 0.01) but not in the vapocoolant group (4.54 ± 2.65 to 3.84 ± 3.12, not significant), or the control group (5.03 ± 3.01 to 4.57 ± 3.43, not significant). Guardian-reported pain scores also showed significant reductions in the Buzzy group (3.46 ± 2.88 to 1.69 ± 2.28, p < 0.01) and vapocoolant group (3.06 ± 2.93 to 2.24 ± 2.56, p < 0.05), with no significant change in the control group (2.86 ± 2.85 to 2.79 ± 2.84).
Conclusions
This study supports the utility of Buzzy® as a clinically effective resource in the management of phlebotomy related pain and demonstrates that it is as good or better than vapocoolant in the pediatric emergency department.
{"title":"The effectiveness of a gate channel device on pain in the pediatric emergency department: A randomized controlled trial","authors":"Ted J. Andrews , Jill Fennell , Brian H. Wrotniak , Heather Territo","doi":"10.1016/j.ienj.2025.101704","DOIUrl":"10.1016/j.ienj.2025.101704","url":null,"abstract":"<div><h3>Objectives</h3><div>Phlebotomy is an important source of self-reported pain in the pediatric emergency department. The purpose of this study was to compare the effectiveness of Buzzy®, a vibrating cold device, to vapocoolant and control in reducing child-reported and parent-perceived pain during IV placement in the pediatric emergency department.</div></div><div><h3>Methods</h3><div>Patients ages 6–18 years who required IV insertion in the emergency department were randomized to Buzzy, vapocoolant or control groups. The Faces Pain Scale – Revised was used to assess both patient pain and parent perceived pain.</div></div><div><h3>Results</h3><div>171 patients were randomized into the 3 groups: 56 in the Buzzy group, 57 in the vapocoolant group and 58 in the control group. Patient-reported FACES pain scores decreased significantly from pre- to post-intervention in the Buzzy group (5.41 ± 2.90 to 3.58 ± 2.87, p < 0.01) but not in the vapocoolant group (4.54 ± 2.65 to 3.84 ± 3.12, not significant), or the control group (5.03 ± 3.01 to 4.57 ± 3.43, not significant). Guardian-reported pain scores also showed significant reductions in the Buzzy group (3.46 ± 2.88 to 1.69 ± 2.28, p < 0.01) and vapocoolant group (3.06 ± 2.93 to 2.24 ± 2.56, p < 0.05), with no significant change in the control group (2.86 ± 2.85 to 2.79 ± 2.84).</div></div><div><h3>Conclusions</h3><div>This study supports the utility of Buzzy® as a clinically effective resource in the management of phlebotomy related pain and demonstrates that it is as good or better than vapocoolant in the pediatric emergency department.</div></div>","PeriodicalId":48914,"journal":{"name":"International Emergency Nursing","volume":"83 ","pages":"Article 101704"},"PeriodicalIF":1.8,"publicationDate":"2025-10-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145394626","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-10-21DOI: 10.1016/j.ienj.2025.101702
Belinda Kennedy , Kate Curtis , Sarah Kourouche , Margaret Fry , Andrea McCloughen
Introduction
Evaluation of implementation strategies by end-users provides valuable insights into mechanisms of use and can identify areas for improvement. In February 2021, the HIRAID® emergency nursing framework was implemented in 10 sites across a predominantly rural Australian health district. The aim of this study was to explore the emergency nurses’ experiences of implementation and perceived impact on nursing practice.
Methods
A qualitative descriptive study was conducted using semi-structured interviews October-December 2021. Emergency nurses were recruited during implementation. Interviews were conducted by telephone, recorded and transcribed verbatim. Data were imported to NVivo and an inductive analytic approach was undertaken, guided by Granheim and Lundman’s iterative conventional qualitative content analysis method.
Results
Thirteen experienced emergency nurses participated, from eight implementation sites. Four overarching categories were developed. Two related to the impact of HIRAID® on practice, influencing communication and critical thinking. The remaining categories related to organisational and individual factors that can influence implementation, and the educational program design and delivery for staff training.
Conclusion
Despite identified challenges in implementation in a rural context, participants all perceived some benefit to the HIRAID® intervention. The study highlights areas where modifications should be considered from the end-user’s perspective for future implementation activities.
{"title":"Australian rural nurses’ experiences of the implementation and impact of HIRAID® emergency nursing framework on nursing practice. A qualitative study","authors":"Belinda Kennedy , Kate Curtis , Sarah Kourouche , Margaret Fry , Andrea McCloughen","doi":"10.1016/j.ienj.2025.101702","DOIUrl":"10.1016/j.ienj.2025.101702","url":null,"abstract":"<div><h3>Introduction</h3><div>Evaluation of implementation strategies by end-users provides valuable insights into mechanisms of use and can identify areas for improvement. In February 2021, the HIRAID® emergency nursing framework was implemented in 10 sites across a predominantly rural Australian health district. The aim of this study was to explore the emergency nurses’ experiences of implementation and perceived impact on nursing practice.</div></div><div><h3>Methods</h3><div>A qualitative descriptive study was conducted using semi-structured interviews October-December 2021. Emergency nurses were recruited during implementation. Interviews were conducted by telephone, recorded and transcribed verbatim. Data were imported to NVivo and an inductive analytic approach was undertaken, guided by Granheim and Lundman’s iterative conventional qualitative content analysis method.</div></div><div><h3>Results</h3><div>Thirteen experienced emergency nurses participated, from eight implementation sites. Four overarching categories were developed. Two related to the impact of HIRAID® on practice, influencing communication and critical thinking. The remaining categories related to organisational and individual factors that can influence implementation, and the educational program design and delivery for staff training.</div></div><div><h3>Conclusion</h3><div>Despite identified challenges in implementation in a rural context, participants all perceived some benefit to the HIRAID® intervention. The study highlights areas where modifications should be considered from the end-user’s perspective for future implementation activities.</div></div>","PeriodicalId":48914,"journal":{"name":"International Emergency Nursing","volume":"83 ","pages":"Article 101702"},"PeriodicalIF":1.8,"publicationDate":"2025-10-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145349478","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-10-18DOI: 10.1016/j.ienj.2025.101688
Hamid Karimi kivi , Saeed Nazari , Elham Zamani , Hosein Mahdian
Background
The 2023 Turkey earthquake represented a significant challenge for health and disaster management systems, necessitating a coordinated response to address the urgent needs of affected populations. This paper explores the experiences and insights of foreign relief and health teams deployed during the disaster, highlighting the challenges encountered, strategies employed, and lessons learned.
Methodology
Utilizing a mixed-methods approach, this study incorporates in-depth, semi-structured interviews with health professionals and disaster response workers. Additionally, operational functions and assessments were observed to provide a comprehensive understanding of the response mechanisms employed during the earthquake. Data collection continued until data saturation and collected data were analyzed using the thematic analysis method, and the results were classified into different categories and sub-categories.
Findings
Extracting experiences in the earthquake of Turkey in 2023; after conducting 26 interviews and data saturation, was reached. The obtained data were divided into 8 categories and 47 sub-categories. Categories include; Response operations, international aid, social partnership, disease care system, planning and response to health emergencies, environmental health, communication and cooperation, coordination, leadership, and control in health operations.
Conclusion
The lessons learned from the health and disaster operations during the 2023 Turkey earthquake provide valuable insights for improving disaster response frameworks worldwide. Understanding the complexities of such emergencies is essential for enhancing the resilience of health systems in the face of future disasters. Additionally, Rapid response teams in the healthcare sector must be thoroughly equipped and ready for action, as they often encounter a myriad of challenges during the complex response process of international missions. Their preparedness is critical in effectively addressing emergent health crises, ensuring timely and appropriate interventions in high-pressure situations.
{"title":"Lessons learned from health and disaster operations during the 2023 Turkey earthquake: Perspectives of foreign relief and health teams","authors":"Hamid Karimi kivi , Saeed Nazari , Elham Zamani , Hosein Mahdian","doi":"10.1016/j.ienj.2025.101688","DOIUrl":"10.1016/j.ienj.2025.101688","url":null,"abstract":"<div><h3>Background</h3><div>The 2023 Turkey earthquake represented a significant challenge for health and disaster management systems, necessitating a coordinated response to address the urgent needs of affected populations. This paper explores the experiences and insights of foreign relief and health teams deployed during the disaster, highlighting the challenges encountered, strategies employed, and lessons learned.</div></div><div><h3>Methodology</h3><div>Utilizing a mixed-methods approach, this study incorporates in-depth, semi-structured interviews with health professionals and disaster response workers. Additionally, operational functions and assessments were observed to provide a comprehensive understanding of the response mechanisms employed during the earthquake. Data collection continued until data saturation and collected data were analyzed using the thematic analysis method, and the results were classified into different categories and sub-categories.</div></div><div><h3>Findings</h3><div>Extracting experiences in the earthquake of Turkey in 2023; after conducting 26 interviews and data saturation, was reached. The obtained data were divided into 8 categories and 47 sub-categories. Categories include; Response operations, international aid, social partnership, disease care system, planning and response to health emergencies, environmental health, communication and cooperation, coordination, leadership, and control in health operations.</div></div><div><h3>Conclusion</h3><div>The lessons learned from the health and disaster operations during the 2023 Turkey earthquake provide valuable insights for improving disaster response frameworks worldwide. Understanding the complexities of such emergencies is essential for enhancing the resilience of health systems in the face of future disasters. Additionally, Rapid response teams in the healthcare sector must be thoroughly equipped and ready for action, as they often encounter a myriad of challenges during the complex response process of international missions. Their preparedness is critical in effectively addressing emergent health crises, ensuring timely and appropriate interventions in high-pressure situations.</div></div>","PeriodicalId":48914,"journal":{"name":"International Emergency Nursing","volume":"83 ","pages":"Article 101688"},"PeriodicalIF":1.8,"publicationDate":"2025-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145325128","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-10-16DOI: 10.1016/j.ienj.2025.101693
Baylie Trostian , Kate Curtis , Sameer Dikshit , Simon Binks , Anne Smith , Belinda Munroe , Geoff Hicks , Andrea McCloughen
Background
Women with early pregnancy bleeding experience care variations. We developed a guideline based on best available evidence to guide Emergency Department (ED) management.
Aim
To identify the barriers and enablers to the use of an evidence-based guideline for initial management of women with early pregnancy bleeding in the ED.
Methods
A mixed methods survey was distributed to 476 staff from four EDs and one Urgent Care Centre, across a health district. Quantitative data were analysed using jamovi (version 2.3.28) and qualitative data were coded and grouped into subcategories and categories. Enablers and barriers were identified, and quantitative and qualitative results were integrated.
Findings
One hundred and four staff completed the survey (response rate 21.8%). Two barriers to evidence-based practice were identified: knowledge and training gap; and ED resources and workload. Two enablers: ED clinician belief about appropriateness of care; and women are willing to stay, wait and/or request care. Two functioned as both enablers and barriers: guideline is available, however elements are absent or not applicable; and ED clinicians are confident in some but not all aspects of care.
Conclusion
Multiple enablers and barriers were identified that may affect the implementation of evidence-based practice for the management of early pregnancy bleeding.
{"title":"Barriers and enablers to evidence-based practice for the initial management of women with early pregnancy bleeding in the Emergency Department","authors":"Baylie Trostian , Kate Curtis , Sameer Dikshit , Simon Binks , Anne Smith , Belinda Munroe , Geoff Hicks , Andrea McCloughen","doi":"10.1016/j.ienj.2025.101693","DOIUrl":"10.1016/j.ienj.2025.101693","url":null,"abstract":"<div><h3>Background</h3><div>Women with early pregnancy bleeding experience care variations. We developed a guideline based on best available evidence to guide Emergency Department (ED) management.</div></div><div><h3>Aim</h3><div>To identify the barriers and enablers to the use of an evidence-based guideline for initial management of women with early pregnancy bleeding in the ED.</div></div><div><h3>Methods</h3><div>A mixed methods survey was distributed to 476 staff from four EDs and one Urgent Care Centre, across a health district. Quantitative data were analysed using jamovi (version 2.3.28) and qualitative data were coded and grouped into subcategories and categories. Enablers and barriers were identified, and quantitative and qualitative results were integrated.</div></div><div><h3>Findings</h3><div>One hundred and four staff completed the survey (response rate 21.8%). Two barriers to evidence-based practice were identified: knowledge and training gap; and ED resources and workload. Two enablers: ED clinician belief about appropriateness of care; and women are willing to stay, wait and/or request care. Two functioned as both enablers and barriers: guideline is available, however elements are absent or not applicable; and ED clinicians are confident in some but not all aspects of care.</div></div><div><h3>Conclusion</h3><div>Multiple enablers and barriers were identified that may affect the implementation of evidence-based practice for the management of early pregnancy bleeding.</div></div>","PeriodicalId":48914,"journal":{"name":"International Emergency Nursing","volume":"83 ","pages":"Article 101693"},"PeriodicalIF":1.8,"publicationDate":"2025-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145313921","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Workplace violence (WPV) is a persistent challenge in emergency departments (EDs), exacerbated by complex sociocultural dynamics, institutional shortcomings, and insufficient support systems. Emergency healthcare providers in South Africa work in high-pressure environments, frequently encountering aggression from patients and families who misunderstand the nature of emergency care.
Aim
To explore nurses’ perceptions and experiences of workplace violence in the emergency departments in South Africa.
Methods
This study used a qualitative descriptive design. Five semi-structured focus group discussions with 20 emergency nurses in South Africa. Data were analysed using thematic analysis. The study followed the COREQ guidelines.
Findings
Three themes emerged: contributors to violence, barriers to reporting workplace violence, and environmental and institutional challenges. Contributors to violence were frequently fuelled by public misconceptions about emergency care procedures, particularly unrealistic triage expectations and staff confrontational behaviours. Barriers to reporting were evidenced by unclear reporting protocols, fear of retaliation or futility, and a culture of managerial indifference. The identified environmental and institutional challenges included insufficient security presence, hazardous physical environments, and a lack of structured support mechanisms.
Conclusion
In South African EDs, WPV is exacerbated by socio-cultural misunderstandings, managerial complacency, and structural weaknesses. Addressing these issues will necessitate comprehensive strategies, such as improved institutional leadership, formalised reporting systems, and proactive safety interventions.
{"title":"South African emergency nurses’ perceptions and experiences of workplace violence: A qualitative study","authors":"Khutso Brian MAIMELA , Alhassan Sibdow ABUKARI , Emmanuel Kwame KORSAH , Shelley SCHMOLLGRUBER","doi":"10.1016/j.ienj.2025.101694","DOIUrl":"10.1016/j.ienj.2025.101694","url":null,"abstract":"<div><h3>Background</h3><div>Workplace violence (WPV) is a persistent challenge<!--> <!-->in emergency departments (EDs), exacerbated by complex sociocultural dynamics, institutional shortcomings, and insufficient support systems. Emergency healthcare providers in South Africa work in high-pressure environments, frequently encountering aggression from patients and families who misunderstand the nature of emergency care.</div></div><div><h3>Aim</h3><div>To explore nurses’ perceptions and experiences of workplace violence in the emergency departments in South Africa.</div></div><div><h3>Methods</h3><div>This study used a qualitative descriptive design. Five semi-structured focus group discussions with 20 emergency nurses in South Africa. Data were analysed using thematic analysis. The study followed the COREQ guidelines.</div></div><div><h3>Findings</h3><div>Three themes emerged: contributors to violence, barriers to reporting workplace violence, and environmental and institutional challenges. Contributors to violence were frequently fuelled by public misconceptions about emergency care procedures, particularly unrealistic triage expectations and staff confrontational behaviours. Barriers to reporting were evidenced by unclear reporting protocols, fear of retaliation or futility, and a culture of managerial indifference. The identified environmental and institutional challenges included insufficient security presence, hazardous physical environments, and a lack of structured support mechanisms.</div></div><div><h3>Conclusion</h3><div>In South African EDs, WPV is exacerbated by socio-cultural misunderstandings, managerial complacency, and structural weaknesses. Addressing these issues will necessitate comprehensive strategies, such as improved institutional leadership, formalised reporting systems, and proactive safety interventions.</div></div>","PeriodicalId":48914,"journal":{"name":"International Emergency Nursing","volume":"83 ","pages":"Article 101694"},"PeriodicalIF":1.8,"publicationDate":"2025-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145253299","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-10-07DOI: 10.1016/j.ienj.2025.101698
Kaisa Seppänen , Antti Tanninen , Anu Venesoja
Background
Clinical placements are crucial for paramedic nursing students’ and other healthcare students’ learning. However, students’ experiences of guidance in placements vary. Our aim was to describe paramedic nursing students’ experiences of clinical placement in an ambulance where the teacher was another supervisor.
Methods
This descriptive qualitative study used purposeful sampling to interview 22 paramedic nursing students who completed their ambulance clinical placement with teacher supervision between April and December 2023. Data were analyzed using inductive content analysis.
Findings
One main category “Paramedic nursing students’ professional growth”, and two generic categories “Teachers’ supervising competence” and “Student-centered view” were generated. Students highlighted low threshold to ask questions, different perspective on supervising, and experiences of being safe, as well as time spent on ambulance tasks, learning discussions, learning experiences, and a targeted weekly schedule in a clinical placement where the teacher was their supervisor.
Conclusion
Embedding pedagogically trained teachers as clinical supervisors in ambulance placements enhances paramedic students’ professional growth by fostering a safe, structured, and student-centered learning environment. Familiar teacher-student relationships, low thresholds for questions, and reflective learning discussions contribute to meaningful supervision and highlight the need for pedagogical competence in ambulance settings.
{"title":"Paramedic nursing students’ experiences of clinical placement in an ambulance where the teacher is another clinical supervisor − A qualitative study","authors":"Kaisa Seppänen , Antti Tanninen , Anu Venesoja","doi":"10.1016/j.ienj.2025.101698","DOIUrl":"10.1016/j.ienj.2025.101698","url":null,"abstract":"<div><h3>Background</h3><div>Clinical placements are crucial for paramedic nursing students’ and other healthcare students’ learning. However, students’ experiences of guidance in placements vary. Our aim was to describe paramedic nursing students’ experiences of clinical placement in an ambulance where the teacher was another supervisor.</div></div><div><h3>Methods</h3><div>This descriptive qualitative study used purposeful sampling to interview 22 paramedic nursing students who completed their ambulance clinical placement with teacher supervision between April and December 2023. Data were analyzed using inductive content analysis.</div></div><div><h3>Findings</h3><div>One main category “Paramedic nursing students’ professional growth”, and two generic categories “Teachers’ supervising competence” and “Student-centered view” were generated. Students highlighted low threshold to ask questions, different perspective on supervising, and experiences of being safe, as well as time spent on ambulance tasks, learning discussions, learning experiences, and a targeted weekly schedule in a clinical placement where the teacher was their supervisor.</div></div><div><h3>Conclusion</h3><div>Embedding pedagogically trained teachers as clinical supervisors in ambulance placements enhances paramedic students’ professional growth by fostering a safe, structured, and student-centered learning environment. Familiar teacher-student relationships, low thresholds for questions, and reflective learning discussions contribute to meaningful supervision and highlight the need for pedagogical competence in ambulance settings.</div></div>","PeriodicalId":48914,"journal":{"name":"International Emergency Nursing","volume":"83 ","pages":"Article 101698"},"PeriodicalIF":1.8,"publicationDate":"2025-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145253350","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-10-06DOI: 10.1016/j.ienj.2025.101697
Duygu Akbaş Uysal , Ebru Ekiz
Background
Emergency departments’ red zones are complex clinical environments requiring both emergency interventions and intensive care-level services, representing a critical area of focus in this special issue on emergency critical care. Nurses working in these settings face multifaceted challenges, including role ambiguity, time constraints, and limited resources. However, few studies have explored these experiences through theoretical models.
Objective
This study aims to provide an in-depth exploration of nurses’ experiences delivering intensive care-level care to critically ill patients in the red zones of emergency departments, within a theoretical framework.
Method
Using a phenomenological qualitative approach, semi-structured interviews were conducted with 21 emergency nurses from various regions in Turkey. Data were analyzed using Braun and Clarke’s six-step thematic analysis, and findings were conceptually interpreted through Meleis’s Transition Theory and Tanner’s Clinical Judgment Model.
Findings
Four main themes and eleven subthemes emerged, including challenges in clinical judgment, role incompatibilities, and systemic shortages. Guided by Meleis’s framework, findings indicate that adherence to intensive care standards and clinical education enhances competence, confidence, and reflective practice, informing nursing practice and policy.
Conclusion
Nurses in emergency department red zones face multifaceted challenges, including the demands of multitasking, complexities in decision-making, and structural limitations in providing care for critically ill patients. The study emphasizes that clinical judgment is shaped not only by individual competencies but also by the availability of systemic support. These results underscore the necessity of establishing clear clinical guidelines, implementing structured team-based care models, and developing practice-oriented training programs to facilitate nurses’ transition between emergency and intensive care settings.
{"title":"Emergency nurses’ experiences of caring for critically ill patients requiring intensive care in the emergency department","authors":"Duygu Akbaş Uysal , Ebru Ekiz","doi":"10.1016/j.ienj.2025.101697","DOIUrl":"10.1016/j.ienj.2025.101697","url":null,"abstract":"<div><h3>Background</h3><div>Emergency departments’ red zones are complex clinical environments requiring both emergency interventions and intensive care-level services, representing a critical area of focus in this special issue on emergency critical care. Nurses working in these settings face multifaceted challenges, including role ambiguity, time constraints, and limited resources. However, few studies have explored these experiences through theoretical models.</div></div><div><h3>Objective</h3><div>This study aims to provide an in-depth exploration of nurses’ experiences delivering intensive care-level care to critically ill patients in the red zones of emergency departments, within a theoretical framework.</div></div><div><h3>Method</h3><div>Using a phenomenological qualitative approach, semi-structured interviews were conducted with 21 emergency nurses from various regions in Turkey. Data were analyzed using Braun and Clarke’s six-step thematic analysis, and findings were conceptually interpreted through Meleis’s Transition Theory and Tanner’s Clinical Judgment Model.</div></div><div><h3>Findings</h3><div>Four main themes and eleven subthemes emerged, including challenges in clinical judgment, role incompatibilities, and systemic shortages. Guided by Meleis’s framework, findings indicate that adherence to intensive care standards and clinical education enhances competence, confidence, and reflective practice, informing nursing practice and policy.</div></div><div><h3>Conclusion</h3><div>Nurses in emergency department red zones face multifaceted challenges, including the demands of multitasking, complexities in decision-making, and structural limitations in providing care for critically ill patients. The study emphasizes that clinical judgment is shaped not only by individual competencies but also by the availability of systemic support. These results underscore the necessity of establishing clear clinical guidelines, implementing structured team-based care models, and developing practice-oriented training programs to facilitate nurses’ transition between emergency and intensive care settings.</div></div>","PeriodicalId":48914,"journal":{"name":"International Emergency Nursing","volume":"83 ","pages":"Article 101697"},"PeriodicalIF":1.8,"publicationDate":"2025-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145245614","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-10-06DOI: 10.1016/j.ienj.2025.101696
Francesca Sandroni , Martina Pia Pugliese , Silvia Magagna , Stefano Sebastiani , Boaz Gedaliahu Samolsky Dekel , Guglielmo Imbriaco
Background
Effective pain management is a fundamental aspect of prehospital emergency care. However, numerous barriers, including inconsistent protocols, limited pharmacological options, and documentation gaps, hinder optimal pain relief. Emergency medical services (EMS) nurses play a crucial role in assessing and managing pain, yet their perspectives on prehospital analgesia remain underexplored.
Objective
This study aims to explore the experiences and perceptions of Italian EMS nurses regarding prehospital pain management, identifying key challenges and potential improvements.
Methods
A qualitative study was conducted using an interpretative phenomenological approach. Semi-structured interviews were performed with 14 EMS nurses from various Italian regions. Data was analyzed through thematic analysis, identifying recurring themes related to pain assessment, treatment, and documentation.
Results
Five main themes emerged: (1) variability in analgesia protocols and pharmacological options, (2) inconsistent pain assessment and documentation, (3) challenges in pain management related to specific patient populations or environmental and logistical factors, (4) nurses’ personal experiences shaping their approach to pain management, and (5) interprofessional collaboration challenges. While nurses emphasized the importance of systematic pain evaluation, barriers such as legal restrictions, inconsistent protocols, and limited pharmacological options were frequently reported.
Conclusion
Prehospital pain management by EMS nurses in Italy faces significant challenges. Expanding protocol-approved pharmacological options, improving documentation practices, and enhancing training for pain management in vulnerable populations could improve care. A standardized, evidence-based national framework is needed to optimize pain relief and ensure equitable patient outcomes.
{"title":"Nurses’ perspectives on providing analgesia in the Italian prehospital emergency setting: A phenomenological study","authors":"Francesca Sandroni , Martina Pia Pugliese , Silvia Magagna , Stefano Sebastiani , Boaz Gedaliahu Samolsky Dekel , Guglielmo Imbriaco","doi":"10.1016/j.ienj.2025.101696","DOIUrl":"10.1016/j.ienj.2025.101696","url":null,"abstract":"<div><h3>Background</h3><div>Effective pain management is a fundamental aspect of prehospital emergency care. However, numerous barriers, including inconsistent protocols, limited pharmacological options, and documentation gaps, hinder optimal pain relief. Emergency medical services (EMS) nurses play a crucial role in assessing and managing pain, yet their perspectives on prehospital analgesia remain underexplored.</div></div><div><h3>Objective</h3><div>This study aims to explore the experiences and perceptions of Italian EMS nurses regarding prehospital pain management, identifying key challenges and potential improvements.</div></div><div><h3>Methods</h3><div>A qualitative study was conducted using an interpretative phenomenological approach. Semi-structured interviews were performed with 14 EMS nurses from various Italian regions. Data was analyzed through thematic analysis, identifying recurring themes related to pain assessment, treatment, and documentation.</div></div><div><h3>Results</h3><div>Five main themes emerged: (1) variability in analgesia protocols and pharmacological options, (2) inconsistent pain assessment and documentation, (3) challenges in pain management related to specific patient populations or environmental and logistical factors, (4) nurses’ personal experiences shaping their approach to pain management, and (5) interprofessional collaboration challenges. While nurses emphasized the importance of systematic pain evaluation, barriers such as legal restrictions, inconsistent protocols, and limited pharmacological options were frequently reported.</div></div><div><h3>Conclusion</h3><div>Prehospital pain management by EMS nurses in Italy faces significant challenges. Expanding protocol-approved pharmacological options, improving documentation practices, and enhancing training for pain management in vulnerable populations could improve care. A standardized, evidence-based national framework is needed to optimize pain relief and ensure equitable patient outcomes.</div></div>","PeriodicalId":48914,"journal":{"name":"International Emergency Nursing","volume":"83 ","pages":"Article 101696"},"PeriodicalIF":1.8,"publicationDate":"2025-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145245568","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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