Journal of Emergency Nursing最新文献

Traumatic arteriovenous fistulas, accounting for most cases (approximately 82%-98%), are typically the consequence of penetrating injuries. The ulnar and radial arteries are the most common sites of occurrence, whereas incidents at the distal radial and ulnar arteries are rare. This emphasizes the critical role of systematic clinical reasoning when evaluating patients with unclear or atypical presentations. Emergency nurses play a vital role in recognizing red flags, escalating care, and advocating for further investigation when standard treatments fail. A previously healthy 55-year-old woman presented with a pulsating and painful swelling on the volar aspect of her right hand, which gradually increased in size after a puncture injury from a fishbone. Emergency nurses should recognize that such presentations require immediate vascular assessment, given that the pulsatile nature and progressive enlargement are key clinical indicators that distinguish arteriovenous fistulas from simple soft tissue injuries. On clinical assessment, a pulsatile mass was noted. Duplex ultrasound, along with angiography, confirmed the presence of an arteriovenous fistula. Differential diagnoses, such as pseudoaneurysm or soft tissue hematoma, were considered but ruled out based on imaging and flow characteristics. A successful embolization procedure was performed to treat the arteriovenous fistulas in her right hand, yielding a positive outcome. For emergency nurses, this case emphasizes the importance of thorough neurovascular assessment in all penetrating hand injuries, regardless of apparent severity. Early recognition of pulsatile masses, assessment of distal perfusion, and prompt escalation to vascular specialists are crucial nursing interventions. The diagnosis of arteriovenous fistulas should not be underestimated, given that they can potentially lead to serious complications such as infection, aneurysm, stenosis, congestive heart failure, steal syndrome, ischemic neuropathy, and thrombosis. Emergency nurses play a pivotal role in early detection through systematic assessment and patient education about warning signs, ultimately preventing progression to life-threatening complications through timely intervention.

Introduction: Chest pain is a leading cause of emergency department visits worldwide. At a Midwest urban level 1 trauma center, chest pain accounts for an average of 2530 emergency department visits annually and constitutes the highest number of observation admissions. This quality improvement initiative aimed to educate emergency nurses and implement an evidence-based chest pain pathway to reduce observation admissions and decrease length of stay.

Methods: Emergency nurses completed pre- and post-education surveys. Educational sessions, delivered both online and in-person, were provided based on the results of a pre-survey. An evidence-based chest pain pathway was implemented. Patients' electronic health records were reviewed and analyzed.

Results: Emergency nurses' chest pain knowledge significantly improved after education [χ² (1) = 6.125; P =.008]. The admission rate (observation and inpatient) among patients meeting the inclusion criteria decreased from 31.16% to 28.55%. The emergency department discharges increased from 68.84% to 71.45%. The length of stay did not significantly increase (P = .89). By sustaining the 2.61% increase in discharges, there is a projected annual variable cost savings of $104,544.66.

Conclusion: This quality improvement initiative resulted in increased knowledge among emergency nurses. This was clinically significant given that it enhanced interdisciplinary collaboration, facilitating an increase in discharges among patients with chest pain. Furthermore, this initiative improved transitions of care across different settings. Future work is recommended to assess the applicability of the initiative and the sustainability of results in other organizations.

Introduction: Patients in emergency departments require both effective medical treatment and emotional support. Presently, the humanistic care, empathic abilities, and influencing factors related to nursing students working in emergency departments are not well understood. This study aimed to explore the current state and influencing factors of humanistic care and empathy skills among Chinese nursing students working in emergency departments.

Methods: A multicenter cross-sectional study involving nursing students was conducted. Data were collected on general information, the humanistic caring ability scale for nursing students, and the Jefferson scale of physician empathy for nursing students.

Results: From August 2023 to August 2024, a survey of 400 nursing students was conducted across 9 top-tier Chinese hospitals' emergency departments in China. The average humanistic care ability score was 77.16 ± 11.02, whereas empathy scored 100.64 ± 15.45. Regression analysis indicated several factors influencing humanistic care ability: reasons for choosing the nursing profession, the humanistic education at school, the humanistic care atmosphere in the emergency department, and noninstructing teachers' care during the emergency department internship. In addition, sex was associated with the empathy score.

Discussion: The humanistic care and empathy abilities of Chinese nursing students in emergency departments are at a moderate level (a score between 60 and 80). Factors such as the reasons for choosing the nursing profession, the schools' humanistic education, the humanistic care atmosphere in the emergency department, and noninstructing teachers' care during the emergeny department internship influence the nursing students' humanistic care ability. Sex plays a role as an influencing factor in their empathy.

Introduction: Workplace violence (WPV) is a significant concern in healthcare settings, especially in the Emergency Department (ED). Early identification of patients at risk for violent behavior is critical to WPV prevention and staff safety. The STAMP tool-Staring, Tone, Anxiety, Mumbling, and Pacing-is uniquely designed for the ED and guides clinicians in assessing behavioral cues associated with potential for violence. This project aimed to decrease staff injuries by implementing the STAMP tool at triage.

Methods: The STAMP tool was piloted in the triage of three urban emergency departments in the Southeastern U.S. Project outcomes included WPV-related staff injuries, tracked for two years before and after STAMP implementation. Additional measures included usability and satisfaction evaluated through surveys and focus group interviews with triage nurses, along with documentation rates of STAMP. Descriptive statistics and independent t-tests were used to analyze the data.

Results: Implementation of the STAMP tool was associated with a significant reduction in WPV-related staff injuries (t(46) = 4.45, p < .001, CI 0.66-1.76). The average usability score for STAMP was 81.5 (SD ± 12.3), with 65% of triage nurses rating usability above average (n = 13/20). 90% of nurses (n = 18/20) found the tool helpful, and 65% (n = 13/20) reported feeling safer at work following implementation. Documentation rates for STAMP surpassed 90% by Week 9 and averaged 88.97% throughout the two-year study period.

Discussion: The STAMP tool is an easily adopted and sustainable tool for early detection and prevention of WPV in the ED. With effective implementation into the triage workflow, STAMP is associated with significant harm reduction, improved communication, high usability, and consistent documentation, supporting its potential for effective prevention of WPV in the ED.

Spinal epidural hematoma is a rare but potentially devastating condition that can result in permanent neurologic deficits if not diagnosed promptly. This case report presents a 48-year-old female patient with a medical history of systemic lupus erythematosus, renal transplantation, and hypertension who developed spinal epidural hematoma after chiropractic manipulation, leading to acute quadriplegia. The objective of this report is to highlight the potential for spinal epidural hematoma development in patients with comorbidities or underlying risk factors, such as systemic autoimmune disease, hypertension, or organ transplantation, after chiropractic manipulation and to emphasize the importance of early recognition to prevent serious neurologic sequelae.

Introduction: Despite efforts made within the emergency department, delays in intravenous thrombolytic time via telestroke remain.

Methods: A quality improvement project streamlined stroke care, focusing on workflow optimization, education, improved communication, and real-time feedback, aiming to reduce door-to-needle time.

Results: A retrospective analysis revealed a reduction in door-to-needle time of 18.05 minutes (95% CI, 7.70-28.41; P = .001) was achieved. Achievement of door-to-needle time goals (30, 45, and 60 minutes) was met after implementation (adjusted P < .005). A higher proportion of intravenous thrombolytic rates occurred after implementation (45 [14.0%] vs 79 [8.1%]; adjusted odds ratio, 1.91; 95% CI, 1.29-2.84; P = .001).

Discussion: A telestroke-enabled primary stroke center consistently achieved <30-minute door-to-needle time through a nurse-led workflow emphasizing early stroke alert and computed tomography.

Introduction: The prehospital interventions provided by helicopter emergency medical services are crucial for improving rescue efficiency and success rates. We aimed to assess and describe the literature on prehospital rescue interventions provided by helicopter emergency medical services personnel worldwide.

Methods: A comprehensive search was conducted via PubMed, MEDLINE, Embase, Web of Science, and CINAHL from January 1, 2010, to September 30, 2025, to identify studies for patients of any age involving helicopter prehospital interventions. Two authors independently completed the data extraction and quality assessment.

Results: Among 10,731 records, 80 studies were included with a total sample size of 3,343,377 cases, of whom 963,779 were transported by helicopter emergency medical services. Of the 84 identified prehospital interventions provided by helicopter emergency medical services crews, 18 high-frequency core emergency interventions were extracted and categorized into 4 systems: circulatory, respiratory, locomotor, and other. The most frequent interventions were endotracheal intubation, drug treatment, and cardiopulmonary resuscitation. Subgroup analyses of "trauma patients only," "cardiac arrest only," and "trauma and non-trauma patients" indicated that advanced airway management, hemodynamic stabilization, and supportive drug therapy were consistently critical across all groups.

Discussion: The helicopter emergency medical services teams provided a wide spectrum of intervention services. Evaluating the interventions is important to gain insight into uniform practices, terminology, and documentation. Identifying intervention outcomes and efficacy is crucial for guiding future research and developing evidence-based, standardized helicopter emergency intervention guidelines.