Journal of Emergency Nursing最新文献

Introduction: Nil per os is a common precautionary practice in emergency departments for patients with suspected need for emergency surgery. However, this practice may lead to prolonged fasting periods, which can negatively affect patient outcomes. This study aimed to evaluate the necessity and appropriateness of nil per os for patients in the emergency department.

Methods: A retrospective quantitative observational study was conducted, analyzing 41,983 patient visits from 2 emergency departments in 2023. The study focused on surgical, orthopedic, and neurological chief complaints, where nil per os was commonly implemented. We assessed the negative predictive value of emergency surgery within specified time intervals (<6 hours and <12 hours after arrival) solely based on time from arrival in combination with surgical priorities, chief complaints, and triage priorities according to the Rapid Emergency Triage and Treatment System.

Results: Among the 41,983 included patients, 6.1% (n = 2561) underwent emergency surgery. The negative predictive value for emergency surgery within the specified time intervals was highest for Rapid Emergency Triage and Treatment System priorities 3, 4, and 5 (>99%), indicating a very low likelihood of emergency surgery within 6 to 12 hours for these patients. Rapid Emergency Triage and Treatment System priority 1 had the lowest negative predictive value, approximately 80% to 90%.

Discussion: The study indicates that the routine practice of nil per os upon arrival at the emergency department is often unwarranted, particularly for those not classified as Rapid Emergency Triage and Treatment System priority 1. These findings highlight the need for updated guidelines to ensure that nil per os protocols are issued based on a clear medical necessity, thereby minimizing unnecessary fasting and its associated risks.

Introduction: Despite advances in echocardiography and biomarkers, the pathophysiological complexities among heart failure categories remain incompletely understood. This study analyzed patients' characteristics across heart failure with reduced ejection fraction, heart failure with midrange ejection fraction, and heart failure with preserved ejection fraction presenting at the emergency department.

Methods: This is a retrospective analysis of 954 patients with acute heart failure (2016-2023) using electronic health records. Data were collected from patient triage and the emergency department and during hospitalization. Survival analysis was performed using Kaplan-Meier estimates, and an elastic net model was used to handle multicollinearity and high dimensionality in predictor variables.

Results: Patients (median age, 71 years) were categorized as heart failure with reduced ejection fraction (n = 363), heart failure with midrange ejection fraction (n = 131), and heart failure with preserved ejection fraction (n = 460). Patients with heart failure with preserved ejection fraction were older (80 vs 77 vs 74 years; P < .001). Heart failure with reduced ejection fraction showed higher prevalence of cardiomegaly, pleural effusion, and orthopnea (34% and 51%; P < .001), elevated diastolic blood pressure (P < .001), creatinine, N-terminal pro-B-type natriuretic peptide (P < .001), and hematocrit differences (P < .05) than heart failure with preserved ejection fraction. Echocardiographic measures differed significantly across subtypes. In-hospital prediction models achieved an area under the curve of 0.84 (91% sensitivity, 50% specificity); 30-day models had an area under the curve of 0.80 (98% sensitivity, 50% specificity).

Discussion: HF subtypes exhibit distinct clinical and biomarker profiles. Emergency nurses' recognition of these differences during initial assessment may enhance risk stratification and tailored interventions (eg, prioritizing diuretics in heart failure with reduced ejection fraction, managing comorbidities in heart failure with preserved ejection fraction), improving outcomes. Integrating subtype-specific data into protocols could optimize emergency department care, particularly during prolonged boarding.

Introduction: Delirium is a frequent and complex condition among elderly patients in emergency departments, often requiring rapid assessment and intervention. Emergency nurses are integral to identifying reversible causes of delirium, such as urinary retention.

Case presentation: Cystocerebral syndrome, a rare but significant condition predominantly observed in males, is characterized by delirium triggered by acute urinary retention and reversible with bladder decompression. This report details the first documented female case: an 80-year-old patient with Alzheimer's disease presenting with hypoactive delirium, marked by reduced speech and mobility. Through comprehensive nursing assessment, bladder distention was identified as the underlying cause. After catheterization, the patient's symptoms resolved within 10 minutes, confirming the diagnosis of cystocerebral syndrome.

Conclusion: This case underscores the critical role of emergency nursing in recognizing atypical presentations of delirium in elderly female patients and ensuring timely, targeted interventions to optimize outcomes.

Introduction: Ultrasound-guided peripheral intravenous access enhances the clinical management of pediatric patients with difficult intravenous access. However, the quality and depth of the training required to master this skill can vary significantly. We instituted a novel curriculum to streamline the training process using a simplified 3-phase approach.

Methods: This prospective observational study included emergency nurses and paramedics trained in ultrasound-guided peripheral intravenous placement from October 2020 to November 2021. Pediatric emergency nurses and paramedics with experience and proficiency in standard peripheral intravenous placement were included. The training curriculum included 3 phases: (1) 3 hours of didactics, machine, and phantom training; (2) at least 10 supervised cannulations; and (3) 10 unsupervised cannulations in patients with difficult intravenous access. Participants were assessed at each phase and 6 months after the initial training.

Results: Thirty participants completed the training. The average years of experience was 6.37 years (standard error of mean 1.17). Likert rating of comfort level with ultrasound machine competency, vascular anatomy, image acquisition, interpretation, and clinical integration respectively increased significantly between the pretraining survey and post-training survey [2.83 (0.29) vs 4.07 (0.12); 2.83 (0.29) vs 4.30 (0.12); 2.33 (0.23) vs 4.22 (0.13); and 3.00 (0.34) vs 4.22 (0.18); P < .05]. This was sustained for more than 6 months after training. We observed a concomitant decrease in peripheral intravenous attempts (standard 2.86 ± 0.22 vs ultrasound-guided peripheral intravenous 1.2 ± 0.08). The training was valuable (4.9 ± 0.05) and changed clinical management (4.5 ± 0.20) of patients with difficult intravenous access.

Discussion: These findings support the integration of ultrasound-guided peripheral intravenous access as part of staff training to enhance pediatric emergency nurses' paramedic cannulation skills and improve patient management.

Introduction: This study aimed to discover the prevalence and risk factors of burnout among physicians and nurses working in intensive care units and emergency departments.

Methods: This systematic review followed the reporting guidance from the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. A literature search was conducted using the following databases: PubMed, MEDLINE, CINAHL, and Embase. The search was conducted in November 2023. English-language studies reporting burnout prevalence and risk factors among intensive care units and emergency physicians and nurses, with primary outcomes, were identified. Quantitative studies with observational designs underwent review, with 2 independent reviewers screening titles, abstracts, and full texts for inclusion. Quality assessment used Joanna Briggs Institute critical appraisal tools. A meta-analysis was conducted if data were sufficient.

Results: This review included 17 studies. The pooled prevalence rates for burnout, high emotional exhaustion, high depersonalization, and low personal accomplishment were 46%, 48%, 30%, and 47%, respectively. Factors such as age, sex, smoking/tobacco use, education level, years of experience, workload, and the impact of coronavirus disease 2019 were identified as significant determinants of burnout in this population.

Discussion: The results assisted in determining preventive strategies and identified areas for future research.

Background: There is a significant gap in the provision of care for transgender or gender-nonconforming patients. This population experiences a multitude of disparate health outcomes. Studies have demonstrated a clear knowledge gap among ED clinicians regarding the care for transgender or gender-nonconforming patients.

Context: A significant number of ED clinicians reported caring for transgender or gender-nonconforming patients during their careers. Currently, many ED clinicians report receiving minimal or no training in the care of transgender or gender-nonconforming patients. This lack of competency contributes to ED care avoidance in this population.

Methods: This quality improvement project aimed to evaluate the effectiveness of improving clinicians' knowledge and skills, openness and support, and oppression awareness in transgender or gender-nonconforming patients through a targeted educational intervention. This study included 4 community hospital-based emergency departments. Performance in the domains of knowledge and skill, openness and support, and oppression awareness was measured using the Ally Identity Measure questionnaire and a paired t test analysis of scored results.

Intervention: The intervention for this quality improvement project was a synchronous, in-person education session delivered once in each of the respective hospital-based emergency departments that addressed key components of understanding transgender or gender-nonconforming patient care. These topics include relevant terminology, assessment recommendations, common gender-affirming therapies, and local resources for follow-up. It also incorporated audio/video testimonies of transgender or gender-nonconforming patients and a case study.

Results: Improvement was demonstrated in all 3 domains when comparing the pre- and postintervention Ally Identity Measure scores. Knowledge and skills demonstrated the most significant increase from pre- (mean, 25.3) to postintervention (mean, 34.6). Openness and support and oppression awareness demonstrated almost equal improvement when comparing pre- (openness and support mean, 27.0; oppression awareness mean, 16.9) and postintervention performance (openness and support mean, 29.2; oppression awareness mean, 18.4).

Conclusion: Transgender or gender-nonconforming patients represent a unique clinical cohort that requires specialized knowledge to provide competent patient care. ED clinicians demonstrated knowledge deficits regarding transgender or gender-nonconforming patient care. These findings support the need for formalized training in the care of transgender or gender-nonconforming patients and its effectiveness in addressing the existing ED clinician education gap.

Introduction: The coronavirus disease 2019 pandemic prompted significant alterations in emergency department accessibility owing to government-imposed health policies. These changes influenced the frequency of return emergency department visits among older adults, but empirical investigations on this topic remain scarce. This study aimed to examine trends in emergency department return visits among older adults in South Korea during the coronavirus disease 2019 pandemic.

Methods: Older adults (n = 11,034) who returned to the emergency department within 30 days of their last visits from 2019 to 2021 were included. Data on age, sex, acuity score, health insurance type, medical transportation type, emergency department boarding time, chief complaints, final diagnosis, coronavirus disease 2019 infection status, and discharge plan were analyzed.

Results: The total number of return visits was highest in 2019 (before the pandemic) and lowest in 2021 (the second year of the pandemic). Although the overall proportion of return visitors declined annually, a consistent subgroup of older adults with lower acuity symptoms continued to present to the emergency department throughout the study period. Concurrently, as the total number of return visits decreased, the proportion of those eligible for ward admission increased. Emergency department boarding times decreased markedly in 2020, with a modest increase observed in 2021. Final diagnoses remained largely consistent over the 3-year period.

Discussion: Despite fears related to the pandemic, older adults continued to return to the emergency department likely owing to restricted access to local clinics and the suspension of home visit nursing services. To enhance health care delivery in future pandemics, the development of accessible, user-friendly online health care platforms for older adults is recommended.

Introduction: Burnout among registered nurses is an ongoing nurse workforce issue, yet there is no quantified evidence on the factors that contribute to burnout among registered nurses in emergency departments. We examined different aspects of the nurse practice environment in hospital-based emergency departments across New Jersey.

Methods: This cross-sectional study included a survey of emergency nurses. Using a publicly available list, an email invitation with a survey link was used to recruit potential study participants. Four self-reported measures were used. Burnout was a single-item measure, and registered nurse staffing was assessed as the number of patients assigned to a nurse on the last day worked. Additional measures included the perceived workload subscale of the Individual Workload Perception Scale and the Practice Environment Scale of the Nursing Work Index. Logistic regression models were used to estimate the odds of burnout.

Results: A total of 188 emergency registered nurses completed the survey. Seventy-two percent of registered nurses reported moderate to complete burnout and 34% reported sustained or complete burnout. Perceptions of high workloads (odds ratio, 2.89; P = .04) and unsupportive practice environments (odds ratio, 8.02; P<.001) were associated with an increase in the odds of high burnout. An unsupportive practice environment significantly mediated the relationship between high perceived workload and high burnout.

Discussion: There's an urgent need to reduce burnout among emergency registered nurses. Study findings point to a pressing need for hospital and emergency department leadership to implement strategies to improve the practice environment and decrease nurse workloads.

Introduction: Patient and visitor violence and aggression against emergency department clinicians is a complex phenomenon requiring a multifaceted approach and recognition that interventions require time to integrate into practice. The purpose of this study was to determine the efficacy of a multimodal intervention on frequency of workplace violence incidents and clinicians' perceptions of safety in one emergency department.

Methods: A quasi-experimental, longitudinal design was used to answer study questions. Environmental changes, an algorithmic response guideline that included a rapid de-escalation program, and improvements in the formal incident reporting system were implemented. Participants completed an online, anonymous survey that included demographic information, the Personal Workplace Safety Instrument for Emergency Nurses, and a violence and aggression frequency checklist prior to and for three quarters following implementation.

Results: Surveys were sent to all 140 emergency department clinicians. Response rate was highest at baseline but decreased over time. There was no significant difference in number of incidents experienced by clinicians during the study. Perceptions of safety decreased from baseline during the course of the study, but there was a significant increase in the number of formal incident reports submitted.

Discussion: Despite significant efforts, it was difficult to decrease violent and aggressive acts committed by patients and visitors and to improve emergency department clinicians' perceptions of safety in the emergency department. Timing and severity of violent and aggressive acts may have influenced results. More work needs to be done using different research, implementation, and evaluation methods to determine best practices for preventing WPV in the emergency department.

Introduction: Patients often seek care for mental health conditions through the emergency department, however, there are many concerns with the provision of mental health care in the emergency department. This includes workflow issues at odds with mental health care needs, a challenging environment, staffing issues, and long waits for definitive mental health care in a practice known as boarding. While there are several articles on emergency nurses' perceptions of caring for mental health patients in general, there is little research on non-mental health aspects of emergency department care for mental health boarders.

Methods: This qualitative descriptive study aimed to explore bedside emergency nurses' perceptions on non-mental health aspects of emergency department care that impact the care of mental health boarders. A purposive sample of current bedside emergency registered nurses in the United States was used. Data collection occurred via 1-on-1 semi-structured interviews with an interview guide informed by the Theory of Planned Behavior.

Results: Eighteen emergency nurses participated in this study. Four themes were discovered: emergency department workflow and overcrowding, emergency department physical environment, activities of daily living, and lack of distractions.

Discussion: Adequate resources including staffing and supportive workflows are needed to provide quality care to mental health boarders. Safe, calming environments are needed to prevent deterioration, which may require structural changes to emergency departments or the use of spaces outside the emergency department.