Journal of Emergency Nursing最新文献

Introduction: Currently, there is uncertainty about which frailty scale is most appropriate and valid for use in the emergency department. The objective of this study was to compare the most commonly used frailty scales in triage and evaluate their performance.

Methods: This prospective, single-center observational study was conducted from June to December 2023. Data collection spanned 80 days, during which the triage nurse recorded frailty scales using the Clinical Frailty Scale, Identification of Seniors at Risk, Program of Research to Integrate the Service for the Maintenance of Autonomy 7 (PRISMA-7), and the Triage Frailty and Comorbidity tool. The Clinical Frailty Scale, Identification of Seniors at Risk, and PRISMA-7 were used for patients aged >65 years, whereas the Triage Frailty and Comorbidity tool was applied to all patients presenting to the emergency department. The scales were compared using the area under the receiver operating characteristic curve for 90-day mortality, 30-day mortality, and hospitalization.

Results: A total of 1270 patients were enrolled during the study period. In comparing the receiver operating characteristic curves, the Triage Frailty and Comorbidity tool demonstrated a receiver operating characteristic curve of 0.894 (95% CI: 0.858-0.929), whereas the Clinical Frailty Scale had 0.826 (95% CI: 0.762-0.890), PRISMA-7 had 0.814 (95% CI: 0.751-0.876), and Identification of Seniors at Risk had 0.821 (95% CI: 0.759-0.882), with a comparison P value of 0.03. The Triage Frailty and Comorbidity tool also significantly outperformed the other scales for 90-day mortality, 30-day mortality, and hospitalization across the overall population. Considering only the population aged >65 years, it identifies frail patients equally well as the other tools.

Discussion: The findings of this study suggest that the Triage Frailty and Comorbidity tool is a valid instrument for assessing frailty in the emergency department. Moreover, among the scales used, it is the only 1 that considers the entire adult population, not just those aged >65 years, making it more inclusive for a setting such as the emergency department.

Introduction: Emergency nursing demands high levels of dedication and resilience. This study reports on the "Driving Forces" within a broader theoretical framework of "Achieving Personal and Professional Sustainability in Emergency Nursing," highlighting the importance of understanding what motivates and retains emergency nurses to improve their performance and longevity.

Methods: To explore how emergency nurses sustain themselves personally and professionally, this research used a constructivist grounded theory approach, involving 29 registered nurses from diverse backgrounds in the Indonesian emergency nursing context. Data were collected via in-depth semistructured interviews, which were recorded, transcribed, and analyzed systematically.

Results: The study revealed 3 subcategories under the "Driving Forces" category: "Inherent Inspiration," "Extrinsic Motivations," and "Professional Expectations." These subcategories highlight the significant impact of both intrinsic and extrinsic motivations, along with professional expectations, on the commitment and sustainability of emergency nurses.

Discussion: This research underscores the impact of intrinsic and extrinsic motivations and professional expectations on emergency nurses' commitment in Indonesia, indicating potential applicability in enhancing nurse dedication and motivation in similar international contexts. Caution is recommended in global generalizations, emphasizing context-specific validations.

Introduction: In recent years, with the frequent occurrence of public health emergencies, various infectious diseases and natural disasters (earthquakes, tsunamis, and fires have placed a burden on global public health and health care systems, especially on health care workers. This study aimed to investigate the current state of psychological capital among disaster care reservists and the factors influencing it.

Methods: Between January and February 2024, a total of 330 members of the disaster nursing reserve team from 4 tertiary general hospitals in Mianyang, China, were surveyed using an online platform named Wenjuanxing to obtain information on general demographics, psychological capital, and job burnout.

Results: The total score of psychological capital was 91.10 ± 16.15. Psychological capital was negatively correlated with emotional depletion dimension and depersonalization dimension scores (P < .01) and positively correlated with personal achievement dimension scores (P < .01). The results of multiple regression analysis revealed that the psychological capital of members in disaster nursing reserve teams was influenced by various factors such as their marital status, having children, work experience in the department, level of public recognition and respect, number of disaster relief trainings, participation in disaster relief activities, types of disaster relief activities, and level of job burnout (P < .05). This accounted for 48.9% of the total variation.

Discussion: The psychological capital of disaster nursing reserve team members is affected by several aspects, which warrant great attention. Relevant management departments should adopt appropriate strategies to effectively mobilize their self-efficacy, improve their professional identity and sense of achievement, and enhance their psychological capital level.

Introduction: Early warning scores serve as valuable tools for predicting adverse events in patients. This study aimed to compare the diagnostic performance of National Early Warning Score, Hamilton Early Warning Score, Standardized Early Warning Score, and Triage Early Warning Score in forecasting intubation and mortality among patients with coronavirus disease 2019.

Methods: This predictive correlation study included 370 patients admitted to the emergency department of 22 Bahman Hospital in Neyshabur, Iran, from December 2021 to March 2022. The aforementioned scores were assessed daily upon patient admission and throughout a 1-month hospitalization period, alongside intubation and mortality occurrences. Data analysis used SPSS 26 and MEDCALC 20.0.13 software. We adhered to the Standards for Reporting of Diagnostic Accuracy Studies guidelines to ensure the accurate reporting of our study.

Results: The patients' mean age was 65.03 ± 18.47 years, with 209 (56.5%) being male. Both Standardized Early Warning Score and Hamilton Early Warning Score demonstrated high diagnostic performance, with area under the curve values of 0.92 and 0.95, respectively. For Standardized Early Warning Score, the positive likelihood ratio was 10.81 for intubation and 17.90 for mortality, whereas for Hamilton Early Warning Score, the positive likelihood ratio was 7.88 for intubation and 10.40 for mortality. The negative likelihood ratio values were 0.23 and 0.17 for Standardized Early Warning Score and 0.21 and 0.18 for Hamilton Early Warning Score, respectively, for the 24-hour period preceding intubation events and mortality.

Discussion: Findings suggest that Standardized Early Warning Score, followed by Hamilton Early Warning Score, has superior diagnostic performance in predicting intubation and mortality in patients with coronavirus disease 2019 within 24 hours before these outcomes. Therefore, serial assessments of Hamilton Early Warning Score or Standardized Early Warning Score may be valuable tools for health care providers in identifying high-risk patients with coronavirus disease 2019 who require intubation or are at increased risk of mortality.

Introduction: Carotid blowout syndrome is a rare but fatal complication often witnessed secondary to treating patients with head and neck cancer. It occurs when damage and necrosis lead to the carotid artery wall rupture. The symptoms encountered in these patients range from asymptomatic to cardiac arrest. Here, we present 5 cases of carotid blowout syndrome in the emergency department.

Case presentations: Patients demonstrated symptoms ranging from subtle bleeding to hemodynamic instability, highlighting the diverse nature of carotid blowout syndrome in this population. Notably, while all patients had a history of radiotherapy, some had additional risk factors for carotid blowout syndrome, including prior surgery (n = 2), malnutrition (n = 3), and tracheostomies (n = 2). Definitive diagnoses were established through clinical evaluation and computed tomography angiography. Immediate interventions included bleeding control, resuscitation, and consultations with relevant specialties. Four patients underwent interventional radiology procedures, and 1 patient received otolaryngology care. While 2 patients recovered completely, 1 died in the emergency department, and 1 in the intensive care unit. One patient's clinical course was complicated by a stroke.

Conclusion: The approach to the carotid blowout syndrome patient includes complex steps that proceed in a multidisciplinary manner, starting from triage until discharge. Emergency nurses play crucial roles at every stage. They should be aware of carotid blowout syndrome when evaluating patients with head and neck cancer presenting with bleeding. When treating these patients, emergency nurses should be ready for airway interventions, bleeding control, and massive transfusion protocol. In this context, the multifaceted approaches made by nurses contribute significantly to carotid blowout syndrome management in the emergency department.

Introduction: Opioid-related events continue to claim lives in the United States at alarming rates. Naloxone-dispensing rates fall dramatically short of national expectations. Emergency registered nurses are uniquely poised to connect at-risk patients with naloxone resources. This study sought to (1) describe the emergency registered nurses' willingness to provide naloxone resources and (2) explore variables that may influence the nurse's willingness to provide resources.

Methods: A cross-sectional, survey-based design was deployed using an online branch logic approach to include a national sample of emergency registered nurses. The Willingness to Provide, a validated questionnaire, measured the registered nurse's willingness to provide naloxone resources for patients at risk of opioid overdose. Eight variables were assessed for potential influence on willingness.

Results: A total of 159 nurses from 32 states and the District of Columbia completed the online survey via the Research Electronic Data Capture platform. The results revealed a mean Willingness to Provide score of 38.64 indicating a willingness to provide naloxone resources. A statistically significant relationship was identified between the nurse's willingness and years of nursing experience (P = .001), knowledge (P = .015), desire (P = .001), and responsibility (P < .001).

Discussion: In this representative sample, emergency nurses are willing to provide naloxone resources; furthermore, results indicate that higher knowledge, desire, and responsibility scores increase the nurse's willingness to provide naloxone resources; with education and clear expectations, emergency nurses may be able to improve the connection of patients at risk of opioid overdose with naloxone, a potentially lifesaving connection.

Introduction: Dyspnea associated with acute respiratory tract infections is a common cause of emergency admissions and can be distressing for children. This study aimed to evaluate the impact of a handheld fan intervention on physiological parameters in pediatric patients with dyspnea.

Methods: A total of 59 children aged 2 to 12 years presenting to an emergency department for upper respiratory tract infection between March 2022 and March 2023 were assigned to the experimental group (n = 32) or control group (n = 27) by urn randomization. Both groups received the hospital's standard care, including 3 doses of inhaled bronchodilator at 20-minute intervals. The fan intervention consisted of parents applying a handheld electric fan to the child's face at a distance of 15 cm for 5 minutes after each inhaler treatment. Oxygen saturation, heart rate, and respiratory rate were recorded before treatment and after the 3 inhaler treatments.

Results: There were no statistical differences in descriptive characteristics between the experimental and control groups (P > .05). Oxygen saturation values were significantly higher in the control group before treatment but showed greater increases in the intervention group after treatment (P < .001). The intervention group also exhibited greater reductions than the control group in both heart rate and respiratory rate after the third treatment than pretreatment values (P < .05).

Discussion: The handheld fan intervention effectively supports inhaler treatment for children with dyspnea. Further studies are recommended to assess its impact across different age groups and clinical conditions.

It is impossible to fully understand why the United States has consistently failed to protect its citizens from firearm violence until one understands some of the key discrepancies that exist at the center of the firearm policy debate. Differences in language, data categorization, and research related to firearms and their impacts in the United States contribute to confusion and debate between firearm policy advocates and opponents, ultimately stalling progress toward some common goals. As frontline health professionals, emergency nurses must be aware of these nuances in order to be informed advocates for the safety of their patients and their communities. Emergency nurses can use the information from this article to help inform screening and education related to firearm safety and injury prevention. They can also use this information to inform nursing research as well as local and national advocacy efforts related to firearm injuries and deaths.

Introduction: Trauma-informed care has been posited as a framework to optimize patient care and engagement, but there is a paucity of data on patient-level outcomes after trauma-informed care training in health care settings. We sought to measure patient-level outcomes after a painful procedure after implementation of trauma-informed care training for ED staff.

Methods: As part of a quality improvement initiative, we trained 110 ED providers in trauma-informed care. Next, we prospectively recruited patients who had undergone a painful procedure to complete a survey to assess several patient-level outcomes, such as anxiety reduction and overall experience of care. We compared differences in patient outcomes for those who were treated by providers in the trauma-informed care intervention group with those who were treated by providers who did not complete the training (usual care).

Results: One-hundred forty-seven adult patients completed survey measures (n = 76 trauma-informed care intervention group; n = 71 usual care group) over a 1-month period. Most patients offered the highest rating for all ED staff-related questions. We found no significant differences in assessment of patient-reported outcomes based on intervention versus usual care.

Discussion: Our trauma-informed care training did not seem to have a significant effect on our selected patient outcomes. This may be caused by the training itself or the challenges in measurement of the patient-level impact of trauma-informed care training owing to the study design, setting, and lack of standardized tools. Recommendations for future study of trauma-informed care training and measuring its direct impact on patients in the ED setting are discussed.