Journal of Emergency Nursing最新文献

Importance: Emergency triage is prone to error, and quality assurance measures to detect errors are mostly retrospective. Undetected triage practice errors may expose patients to unsafe delays in care, contributing to patient deterioration and harm.

Objective: To map the academic and gray literature on the impact of emergency triage practice errors on patient outcomes.

Evidence review: The scoping review will incorporates reports of patient outcomes related to emergency triage practice errors. Studies reporting patient outcomes of triage (case and cohort), patient experience surveys, and reviews will be included. Studies will be excluded if they omit patient outcomes of triage or report only accuracy, reliability, validity, or clinician opinion. The search will include the academic literature databases of Cumulative Index to Nursing and Allied Health literature; PubMed, Scopus, and Web of Science; Australasian Legal Information Institute; British and Irish Legal Information Institute; and the gray literature search engines of Google Advanced, Patient Safety Network, and the Clinical Excellence Commission. Two reviewers will independently screen titles and abstracts, then full-text papers, with a third reviewer resolving any conflicts. Data extraction and summary will be presented in charts, tables, and narrative formats.

Discussion: This protocol details our planned scoping review of the impact of triage practice errors on patient outcomes. Identification of the impact of specific triage practices on patient safety may inform nurses working in and supporting the role of triage.

Introduction: The aim of this study is to gain an in-depth understanding of the psychological experiences and emotions of primary caregivers of adolescent and young adult patients who have non-fatal suicidal behavior by poisoning. The findings will serve as a valuable resource for clinical nurses, enabling them to effectively implement psychological interventions, develop family intervention strategies, and enhance home care services.

Methods: A total of 11 caregivers of adolescent and young adult patients who lived through a suicide attempt by poisoning were deliberately chosen through purposive sampling from the emergency department of a tertiary hospital in Nanjing from October 2023 to April 2024. The study employed qualitative descriptive methodologies to conduct in-depth interviews with the primary caregivers. The data underwent analysis, organization, and the extraction of themes utilizing Colaizzi's 7-step analytical approach.

Results: The psychological experiences and emotions of primary caregivers of adolescent and young adult patients who lived through a suicide attempt by poisoning can be categorized into 4 overarching themes: (1) Intricate cognitive processes and intense emotional distress experienced before and following the patient's revival. (2) Adverse emotional encounters resulting from intense pressure and societal disapproval. (3) Adaptation and strategies for dealing with challenges. (4) The necessity for expert psychological counseling.

Discussion: Nurses should prioritize the psychological well-being of primary caregivers of adolescent and young adult patients who have lived through suicide attempts by poisoning. To enhance the effectiveness of intervention strategies and promote caregivers' psychological well-being, it is essential to use a multidisciplinary strategy encompassing various disciplines and providing guidance on emotional regulation.

Introduction: Heart failure is a progressive disease that affects more than 6.7 million people in the United States and has a 50% mortality rate. A left ventricular assist device provides an option to many patients with heart failure as a bridge to either transplantation or destination therapy. Patients are becoming more prevalent with improved survival rates. Emergency nurses must have a basic understanding and skills to provide high-quality care. The competency program aims to elevate the confidence of emergency nurses caring for left ventricular assist device patients and reduce the reliance on the circulatory support technician through quarterly skills assessment and simulation.

Methods: A quality improvement project was implemented using quarterly assessments of skills and confidence perception surveys.

Results: The competency program resulted in an increased confidence perception for every skill: changing batteries, exchanging controllers, transporting left ventricular assist device patients, and identifying alarms with appropriate intervention. Overall, 35.6% of nurses felt confident caring for left ventricular assist device patients during baseline data collection, 13.3% during the midyear session, and 75.6% during the final education session.

Conclusion: The quality improvement project identified a need to provide additional support to emergency nurses to increase their skills and confidence. Replication is needed to assess further the efficacy of more frequent simulation-based learning and the implementation of readily available resource books and left ventricular assist device nurse champions.

Introduction: Patient fall risk assessment in the emergency department poses a unique challenge as fall risk is often associated with risk factors other than inpatient falls. While there are many inpatient fall risk assessment tools, few have been used or validated in the ED environment. Therefore, this study examined the predictive performance of the KINDER 1 Fall Risk Assessment Tool in 10 emergency departments.

Methods: A retrospective cohort design was used. Data were collected from November 15, 2023, to April 30, 2024, as a part of an electronic pilot of the KINDER 1 Fall Risk Assessment tool. Inclusion criteria encompassed all adult (≥18 years) ED visits during which a KINDER 1 fall risk assessment was completed. Descriptive statistics were used to describe overall sample characteristics. Predictive performance was calculated via multiple accuracy measurements.

Results: KINDER 1 assessments were completed on 64,811 patients, of which 40 patient falls met inclusion criteria for final analysis. The mean age of the patients who fell was 58.46 years (±18.38). Final sensitivity was 77.5%, and the specificity was 75.8%. Fall prevalence was 0.06%.

Discussion: KINDER 1 exhibited a sufficiently high degree of sensitivity and specificity, supporting an acceptable level of predictive performance. Additional research is recommended to compare the reliability and predictive validity of KINDER 1 to the emergency Hester Davis Scale and the Memorial Emergency Department Fall Risk Assessment Tool, as well as to compare the usability of the tools for nurses in a triage setting.

Introduction: Strong evidence demonstrated that working in a healthy environment has been associated with high-quality patient care. However, the mechanism underlying this relationship requires further investigation. This study aimed to examine the role of structural empowerment in mediating the relationship between nursing practice environment and quality of care among emergency nurses.

Methods: A proportional stratified clustered sampling technique was used to recruit staff nurses working in acute care hospitals in Oman. Four standardized instruments were used to assess nurses' sociodemographic characteristics, perception of the practice environment, structural empowerment, and perceived quality of care. Hayes' process for mediation analysis was used to examine whether empowerment mediates the relationship between the practice environment and quality of care.

Results: A total of 160 emergency nurses participated. The majority (78.8%) perceived the quality of care as good/excellent. Having an adequate foundation for quality of care, sufficient staffing, and managerial support were significant predictors of perceived quality of care. Practice environment was directly and indirectly related to the perceived quality of care through structural empowerment.

Discussion: Nurse leaders can enhance care quality in emergency departments by improving the work environment through engaging nurses in quality activities, ensuring adequate staffing and resources, and providing robust leadership support, which collectively empower nurses and improve patient outcomes.

Introduction: The management of patients with major trauma is complex and encompasses the entire clinical pathway. The trauma coordinator role has been introduced to enhance communication and coordination. Despite the clinical benefits of trauma coordinators, their implementation in Italy is currently limited.

Methods: We conducted a national online survey from May to July 2023 consisting of 6 sections: (1) the trauma centers, (2) the knowledge of the trauma coordinator, (3a) trauma coordinator characteristics, (3b) characteristics that the trauma coordinator should have, (4) trauma coordinator's role and duties, (5) trauma coordinator organizational characteristics, and (6) barriers and opportunities. We performed a descriptive statistics and tested the agreement among raters for sections 2 and 6 using Cohen's or Fleiss' kappa.

Results: Fifty-five respondents from 26 trauma centers participated in the survey. Sixty percent of respondents indicated that a trauma coordinator exists in their trauma center, but only 31% reported that the trauma coordinator is formally recognized. Most trauma coordinators had experience in critical care (69%), but 45% of respondents noted that no rewards were provided for their function. The barriers to trauma coordinator implementation were the absence of a job description (40%) and a lack of human resources (45%). For opportunities, enhanced communication among providers was the most reported benefit. Full agreement on the knowledge of trauma coordinators was found in only 3 centers.

Conclusion: This survey highlights the need for a more structured integration of trauma coordinators into trauma care teams. Emphasizing clear role descriptions, formal recognition, and appropriate compensation is essential to maximize the impact of trauma coordinators on patient outcomes.

Introduction: This study aimed to compare the time spent on episodes seen by primary care emergency departments before (2017) and after (2019) the inclusion of an advanced practice nurse in patient classification.

Methods: Records from 3 primary care emergency departments in 2017 (n = 18,663) and 2019 (n = 22,632) were compared using Student t and chi-square tests. Waiting time for classification, classification time, and total time spent in the consultation area were compared for total episodes, levels of priority, reasons for consultation, and previous clinical processes.

Results: Mean waiting time decreased in 2019 for all episodes (P < .001), priorities IV (P < .001) and V (P < .001), respiratory (P < .001) and skin and subcutaneous tissue diseases (P = .015), and previous chronic processes (P = .042). Mean classification time increased in 2019 for all episodes (P < .001); priorities III (P < .001), IV (P < .001), and V (P = .045); several reasons for consultation, and previous processes. Mean total time spent in the consultation area decreased in 2019 for all (P = .002), priority V (P < .001), skin and subcutaneous tissue diseases (P = .010), and fever episodes (P = .021).

Discussion: The inclusion of nurses with advanced nursing practice roles reduces the waiting time and length of stay in the emergency department, but increases the classification time, which could be linked to early interventions.

Introduction: Emergency department encounters include an increasing number of patients with limited English proficiency, yet little is known about the impact of interpreter services on unplanned revisits to the emergency department. This study aims to assess interpreters' utilization and unplanned ED revisits, serving as an indicator of care quality.

Methods: This was a single-center, retrospective chart review of ED visits at an urban academic center between January and April 2019. Inclusion criteria involved patients aged >18, discharged after evaluation, and with at least 1 ED revisit in the study period. Demographic data, interpreter modality, and revisit incidences within 72 hours and 30 days were analyzed using Chi-squared and Wilcoxon rank-sum tests.

Results: Of 786 reviewed charts, 401 limited English proficiency patients and 294 controls matched by gender, race, and ethnicity were included. Among limited English proficiency patients, the majority identified as Hispanic (84.8% vs 36%, P<.01) and showed higher 72-hour unplanned revisit rates (2.8% vs 0.7%, P = .05). Interpreter documentation for limited English proficiency patients was only 49.6%, with in-person modality prevailing (45.8%). Trained interpreters were underutilized (13% in-person vs 7.7% video, P<.0001). Only 78% (P<.01) of patients with limited English proficiency received discharge instructions in their preferred language.

Discussion: This study reveals a higher unplanned ED revisit rate among limited English proficiency patients, potentially linked to varying interpreter modality effectiveness and underutilization of trained interpreters. Emphasizing the critical role of trained interpreters, these findings offer an opportunity to enhance care quality for limited English proficiency patients in the emergency department.

Introduction: Identifying factors that enhance the stages of behavior change and nurses' readiness to evacuate patients during disasters can facilitate the proper management of the patient evacuation process in emergencies. This study aimed to identify the factors related to the stages of behavior change and nurses' readiness to evacuate patients during disasters.

Methods: This qualitative study was conducted as a directed content analysis using the Hsieh and Shannon method and the MAXQDA 2020 software. Data were collected between January and June 2024 among nurses from various hospitals in Iran. The interview guideline was designed based on the transtheoretical model. Twenty nurses who met the inclusion criteria were selected through purposive sampling. Data collection was done through face-to-face, semi-structured interviews.

Results: The study's findings indicated that all nurses were in the first 3 stages of behavior change. The components for enhancing the stages of behavior change in nurses for patient evacuation during disasters included 4 main categories (cognitive processes of change, behavioral processes of change, resource provision, and risk communication) and 15 subcategories. From the nurses' point of view, stimulus control to manage fear, increase awareness, and dramatic relief were important components in promoting the stages of behavior change toward readiness.

Discussion: This study revealed factors that enhance nurses' preparedness for evacuating patients in disasters. Training courses and operational maneuvers based on the stages of behavior change in nurses may effectively increase the process of patient evacuation during disasters.