Journal of Emergency Nursing最新文献

Introduction: Emergency triage nurses frequently experience significant fatigue owing to long shifts, high patient volumes, and rapid decision-making demands. This chronic fatigue not only affects nurses' health and job satisfaction but also compromises patient care through increased risk of errors. This quality improvement project aimed to assess and address triage nurse fatigue by implementing a reduced shift length protocol at a single academic medical center.

Methods: Using the focus, analyze, develop, and execute model, this project compared fatigue levels during traditional 12-hour triage shifts with reduced 6-hour shifts. A Qualtrics-based pre- and postsurveys using the Samn-Perelli fatigue scale assessed self-reported fatigue levels among emergency triage nurses at 6- and 12-hour intervals. Surveys also captured demographic data including gender (man/woman), experience, education, and ethnicity. Preintervention data were collected over 34 days, followed by the implementation of a 6-hour rotational shift model.

Results: Data analysis from 66 responses over 68 days revealed a statistically significant reduction in fatigue after the intervention. The average fatigue level decreased from 4.58 at the 12-hour mark before the intervention to 3.21 after the intervention (P = .02), representing a 29.91% overall reduction. Experienced nurses reported lower fatigue scores than less experienced peers, whereas nurses with bachelor's degrees demonstrated lower fatigue than those with associate degrees.

Discussion: The implementation of shorter, 6-hour triage shifts effectively reduced fatigue among emergency triage nurses, highlighting a feasible strategy to improve nurse well-being, job retention, and patient care quality. Further projects should evaluate long-term outcomes and explore additional strategies to address nurse fatigue comprehensively.

Introduction: Individuals living with sickle cell disease often experience episodes of acute pain, prompting them to seek care in the emergency department. These patients frequently encounter prolonged wait times and invasive procedures before receiving analgesia. This evidence-based quality improvement project aimed to enhance the timely management of sickle cell-related pain by increasing adherence to an existing pain management pathway. The initiative focuses on promoting the use of intranasal fentaNYL as a first-line analgesic.

Methods: To promote consistent use of the established pathway, multiple interventions were implemented. These included a standard operating procedure to promote safe use of intranasal fentaNYL, a best practice advisory in the electronic health record prompting staff to notify a physician for an intranasal fentaNYL order, the development of a quick-reference badge card, and the creation of educational materials for patients and families addressing the safety and benefits of intranasal fentaNYL use.

Results: The amount of time before pain medicine administration for the preintervention group varied from 12 minutes to 244 minutes. Administration of pain medication in the postintervention period showed a narrower spread: values ranged from 9 minutes to 193 minutes. Comparing the 2 groups, the mean time to pain medication administration dropped from 82.2 to 67.7 minutes and the median time to pain medication decreased from 65 to 59. These findings may have clinical implications; however, the change did not reach statistical significance (P = .2201).

Discussion: This quality improvement initiative demonstrated that increased use of a pre-established intranasal fentaNYL protocol yielded a reduction in time to opioid administration for pediatric patients with sickle cell disease in vaso-occlusive crises. These results align with existing literature emphasizing the benefits of standardized pain pathways in improving efficiency and equity in practice.

Certification is an important aspect of nursing practice, contributing to clinical nursing performance, satisfaction, and improved health care outcomes. Emergency, trauma, and transport nurses seek certification to validate and advance their professional practice. Despite its importance, traditional certification preparation interventions can be resource and time intensive. This paper presents an innovative online strategy successfully implemented and replicated to increase trauma certified registered nurse (TCRN) and critical care registered nurse (CCRN®) rates in a regional level 1 trauma center in the mid-Atlantic. Developed by a frontline nurse, with a focus on accessibility and flexibility, an online platform promoted virtual collaboration, facilitated quick communication, and enabled access to numerous resources in one place. Led by local subject matter experts, 1-hour live and recorded study group sessions were held every other week reviewing key examination blueprint content. The content presentation was followed by group study question practice and case study discussions. The certification strategy initially resulted in 12 inpatient nurses earning TCRN and 18 inpatient nurses earning CCRN®. The program was replicated for trauma certified registered nurse certification review across a 6-hospital health system. The program was awarded the Board of Certification for Emergency Nursing National Certification Champion Award - Large Healthcare Organization category in 2023. The success of this approach demonstrates its potential for broader applications across various health care settings. Organizations seeking to enhance their certification rates may benefit from adopting this toolkit, which offers a structured and supportive pathway for nurses to achieve professional growth and improve outcomes.

Introduction: Acute cholecystitis is a common condition requiring prompt diagnosis and management in emergency settings. Traditional diagnostic pathways often involve patient transfer for imaging, potentially increasing anxiety and discomfort. This study aimed to evaluate the impact of bedside ultrasound compared with standard ultrasound on anxiety and pain levels in patients with suspected acute cholecystitis in the emergency department.

Methods: A comparative observational study was conducted enrolling 100 adult patients with suspected acute cholecystitis. Patients were assigned to either bedside ultrasound at point-of-care (bedside ultrasound group, n = 50) or standard ultrasound requiring transport to the radiology department (standard care group, n = 50). Anxiety was assessed using the state-trait anxiety inventory state anxiety subscale, and pain was measured using a visual analog scale. Assessments were performed before and after ultrasound examination.

Results: Baseline characteristics were comparable between groups. After the intervention, the bedside ultrasound group demonstrated significantly lower anxiety levels (mean state-trait anxiety inventory state anxiety subscale, 42.21 vs 48.74; P = .0087) and reduced pain scores (median visual analog scale, 5.00 vs 6.50; P = .0003) compared with the standard care group. The proportion of patients with high anxiety decreased substantially in the bedside ultrasound group (from 60% to 24%), whereas it remained relatively unchanged in the standard care group.

Discussion: Bedside ultrasound in emergency settings significantly reduces anxiety and pain in patients with suspected acute cholecystitis compared with standard ultrasound protocols. Implementation of point-of-care ultrasound may improve patient experience and potentially enhance clinical outcomes in the management of acute cholecystitis.

Stigmatizing language is prevalent in emergency nursing practice and has significant implications for patient care, clinical judgment, and health equity. Labels such as "drug-seeker," "frequent flyer," and "non-compliant" are often applied without comprehensive assessment and can lead to delayed treatment, inadequate pain management, misdiagnosis, and erosion of trust between patients and emergency clinicians. These terms disproportionately affect marginalized populations, including individuals with substance use disorders, individuals with mental health conditions, racialized minorities, and people experiencing homelessness, thereby reinforcing existing inequities in emergency care. This article examines the ethical, clinical, and systemic implications of stigmatizing language in the emergency setting, with a focus on nursing practice. It explores how bias may be introduced during triage, documentation, and interdisciplinary communication and how such language conflicts with core nursing ethical principles of dignity, justice, and patient-centered care. Evidence-informed strategies are presented, including adoption of person-first language, integration of cultural humility and implicit bias education, application of harm reduction principles, and institutional approaches such as documentation audits and peer accountability.

Introduction: The Australian mental health triage scale is widely used in Australia to triage emergency department patients with behavioral health symptoms. The Australian mental health triage scale outperforms the Emergency Severity Index in distinguishing levels of urgency and meeting time-to-evaluation thresholds among adult patients, but its performance among children is not well studied. We aimed to determine the interrater reliability of acuity levels assigned using the Australian mental health triage scale and the Emergency Severity Index for children with behavioral health emergency department presentations.

Methods: A convenience sample of triage-trained emergency nurses at 2 academic United States children's hospitals was surveyed. Nurses completed a brief training module describing behavioral health triage using the Australian mental health triage scale and the Emergency Severity Index. For 30 written case scenarios of emergency department presentations by children for behavioral health symptoms, nurses assigned acuity levels using the Australian mental health triage scale and the Emergency Severity Index. An interrater reliability using intraclass correlation coefficients was calculated.

Results: Thirty participating emergency nurses reported a median of 7 years of experience working in the emergency department. Half of the acuity levels assigned using the Emergency Severity Index were level 2, whereas acuity levels assigned using the Australian mental health triage scale were more evenly distributed across levels. The intraclass correlation coefficient was 0.81 (95% CI, 0.72-0.89) for the Australian mental health triage scale and 0.63 (95% CI, 0.51-0.78) for the Emergency Severity Index.

Discussion: Among triage-trained nurses using written case scenarios, interrater reliability was high for the Australian mental health triage scale and moderate for the Emergency Severity Index, which may inform consistency of care provision. The wider distribution of acuity levels generated by the Australian mental health triage scale may enable greater differentiation of illness severity. Prospective studies are needed to assess the reliability and validity of the Australian mental health triage scale among pediatric patients in the emergency department.

Introduction: Traumatic cardiac arrest represents 1 of the most challenging emergencies in trauma care, historically associated with dismal survival and frequent perceptions of futility. This narrative review synthesizes contemporary evidence on the epidemiology, prognostic determinants, and management strategies for traumatic cardiac arrest, with emphasis on prehospital interventions and trauma system organization.

Methods: This review was reported in accordance with the Scale for the Assessment of Narrative Review Articles to support methodological transparency and reporting quality. PubMed, CINAHL, and Scopus were searched to identify studies addressing the epidemiology, pathophysiology, and management of traumatic cardiac arrest. Eligible sources included registry analyses, observational studies, reviews, consensus documents, and position statements. Evidence was narratively synthesized to identify consistencies, gaps, and operational priorities across emergency medical services systems.

Results: Reported survival after traumatic cardiac arrest remains low, generally <10%, although selected subgroups demonstrate higher survival depending on mechanism of injury, system configuration, and availability of advanced interventions. Prognosis is strongly influenced by early correction of reversible causes such as hemorrhage, hypoxemia, tension pneumothorax, and cardiac tamponade, summarized in the hypovolemia, oxygenation impairment, tension pneumothorax, and tamponade framework. Evidence demonstrates variable effectiveness of conventional chest compressions and vasopressors, while supporting early thoracic decompression, hemostatic resuscitation, and prehospital blood product administration. Physician-staffed helicopter emergency medical services teams may provide additional benefit through early definitive interventions, although substantial heterogeneity persists across trauma systems.

Discussion: Despite persistently high mortality, outcomes may improve when reversible causes are corrected rapidly, hemostatic resuscitation is initiated early, and system-level coordination is optimized. Current evidence remains heterogeneous and predominantly observational; future research should validate cause-first algorithms, refine prognostic tools, and evaluate prehospital strategies and emergency nursing practices for traumatic cardiac arrest management across diverse emergency medical services systems and emergency care settings.

Introduction: Seizures are a common emergency condition associated with significant clinical and logistical burden, particularly in the prehospital setting. Early identification of patients at risk of serious complications remains a challenge. The modified sequential organ failure assessment score, originally developed to predict mortality, may offer a rapid and feasible tool for risk stratification in this context. Its objective is to evaluate the predictive performance of the modified sequential organ failure assessment score for identifying early clinical deterioration in prehospital patients with seizures.

Methods: A multicenter, retrospective study was conducted including 477 adult patients with seizures treated by advanced life support units in 3 Spanish provinces. Early clinical deterioration was defined as a composite outcome including: use of ≥3 anticonvulsants in the prehospital setting, mechanical ventilation (prehospital or in-hospital), intensive care unit admission, or early in-hospital mortality (within 2 days). Clinical, analytical, and outcome data were collected prospectively and analyzed using receiver operating characteristic curves and calibration models. The Youden index was used to determine the optimal modified sequential organ failure assessment threshold.

Results: Early clinical deterioration occurred in 13.2% of patients. The modified sequential organ failure assessment score showed good discriminative ability (area under the curve, 0.790; 95% CI, 0.726-0.853), particularly for ruling out low-risk patients (negative predictive value, 92.5%). At the optimal threshold of 5.5, the score yielded a sensitivity of 71.4% and a specificity of 73.7%.

Discussion: The modified sequential organ failure assessment score demonstrated moderate-to-good performance in predicting early clinical deterioration in patients with seizures in the prehospital setting. Its simplicity, real-time applicability, and high negative predictive value make it a promising tool for early triage and decision making, especially in resource-limited environments.