Journal of Emergency Nursing最新文献

Introduction: Emergency nurses often struggle to deliver effective discharge education owing to limited tools that support patient self-management behaviors. These behaviors, particularly confidence in managing pain (self-efficacy), are essential for managing acute low back pain and reducing pain severity and interference. This pilot study aimed to develop and evaluate a digital self-management intervention, guided by the individual and family self-management theory, to improve patient-centered outcomes.

Methods: Conducted over 7 months in 3 emergency departments, adult patients were randomized into 2 groups: (1) standard discharge care or (2) standard care plus the intervention (an educational video and virtual booster sessions at week 2 and week 8). Feasibility and acceptability were assessed using established criteria for pilot studies. Preliminary clinical efficacy (defined as early evidence of clinically meaningful benefits for patients) was evaluated using measures of patient activation, self-efficacy, and pain severity and interference, collected at 1, 6, and 12 weeks after discharge.

Results: Feasibility and acceptability benchmarks were met, with 86% recruitment (n = 30), 80% retention, adherence, study satisfaction, 87% video satisfaction, and 100% engagement and study recommendation. Participants most frequently recalled the actor's demonstrations, which were reinforced during boosters. The intervention group showed consistent improvements across all measures, with minimal clinically important differences in self-efficacy and pain interference at every time point.

Discussion: This study demonstrates that the digital intervention is both feasible and acceptable, with promising early evidence of meaningful clinical benefit. These findings support the need for a larger trial to fully evaluate its impact on patient outcomes.

Introduction: This exploratory study aimed to provide preliminary insights into how trans and gender diverse youth rate their care in emergency departments, which factors they perceive as influencing their experiences, and whether the concept of ED avoidance, identified in research with trans and gender diverse adults, is relevant to trans and gender diverse youth.

Methods: This exploratory cross-sectional survey and online questionnaire was codesigned by a research team that comprised academic members and trans and gender diverse youth. The study was open to youth across Canada and collected both sociodemographic information and experiential data using short-answer and Likert-type scales paired with comment boxes.

Results: The participants (n = 28), aged 16 to 25 years, reported highly variable experiences in the emergency department, ranging from 0 (very poor) to 8.5 of 10 (excellent) with a mean of 4.3. Furthermore, half (n = 14; 50%) avoided seeking needed care out of concern for how they would be treated. The results of this study suggest that there are a number of factors, such as the trans-competence of the provider, the patient's co-occurring positionality, and the type of chief complaint, that may contribute to the poor experiences of trans and gender diverse youth and their subsequent ED avoidance.

Discussion: These findings provide preliminary insights into the experiences of trans and gender diverse youth accessing and receiving care in emergency departments and suggest that ED avoidance is a salient concept for this age/developmental stage.

Introduction: Identifying the factors influencing emergency nurses' adherence to ethical codes is a crucial strategy for enhancing compliance with these standards. This study aimed to examine the determinants affecting emergency nurses' adherence to ethical codes.

Methods: This descriptive cross-sectional study was conducted among 291 nurses working in emergency departments in Iran. Data were collected using the nurses' professional autonomy questionnaire, the perceived organizational support questionnaire, and the adherence to ethical codes questionnaire. Approval for the study was obtained from the ethics committee at the school of nursing. Privacy and confidentiality of the data were ensured, and an informed consent was obtained from all participants before data collection.

Results: The mean scores for adherence to ethical codes, professional autonomy, and perceived organizational support were 53.45 ± 5.62 (above moderate levels), 115.99 ± 10.17 (above moderate levels), and 7.78 ± 5.31 (at weak levels), respectively. Professional autonomy (P<.001) demonstrated a significant positive impact on adherence to ethical codes but perceived organizational supports' predictive role was borderline (P = .06). In addition, the variables of sex (female) (P<.05) and previous experience in ethics workshops (P<.002) had a significant positive effect on adherence to ethical codes.

Discussion: Professional autonomy, sex, and experience in ethics workshops were identified as positive predictors of emergency nurses' adherence to ethical codes. These findings can serve as a guide for nursing managers and policy makers in creating an environment conducive to the implementation of ethical principles in clinical practice. In particular, they highlight the importance of empowerment programs and support strategies aimed at enhancing nurses' professional autonomy and decision making, particularly in emergency department settings.

Introduction: A patient departure against medical advice is an adverse event driven by patient care dissatisfaction and is associated with higher odds of hospital readmissions and death. Given evidence that better hospital nursing resources are associated with improved patient satisfaction, we evaluated whether nurse staffing ratios are associated with rates of emergency department patient departures against medical advice.

Methods: Cross-sectional design using data from 3 sources: 2023 Penn Nurses4All survey, the 2023 Agency for Healthcare Research and Quality Healthcare Cost and Utilization Project State Emergency Department Database of patient emergency department visits in New Jersey and Oregon, and the American Hospital Association Annual Survey. Patient-to-nurse staffing ratios were measured among direct care nurses in emergency departments and medical-surgical units. Logistic regression models were constructed with nurses and patients clustered within hospitals, with adjusted models accounting for patient and hospital characteristics.

Results: The sample included 2,211,244 emergency department patient visits in 74 hospitals. After adjusting for patient and hospital characteristics, each additional patient added to an emergency department and a medical-surgical nurse's workload was associated with 19% and 55% higher odds of an against medical advice departure, respectively (emergency department, adjusted odds ratio, 1.19; 95% CI, 1.09-1.31; P < .001; medical-surgical, adjusted odds ratio, 1.55; 95% CI, 1.33-1.81; P < .001).

Discussion: Increases in nurses' workloads, both in the emergency department and inpatient setting, were associated with more emergency department patients leaving against medical advice. When nurses care for more patients at a time, patients are attended to less frequently, which can result in more self-directed patient departures. Insufficient staffing in medical-surgical units contributes to longer length of stay and lower inpatient bed turnover. Hospital investments in safer staffing may reduce against medical advice departures.

Introduction: Nurses working in emergency departments are frequently exposed to fatigue and impaired sleep quality. This study aimed to evaluate the effect of progressive muscle relaxation exercises on fatigue severity and sleep quality among nurses working in the emergency department.

Methods: This self-controlled quasi-experimental study was conducted with 35 nurses employed in the emergency department of a public hospital in Turkey. Data were collected using the "Nurse Demographic Information Form," the "Fatigue Severity Scale," and the "Pittsburgh Sleep Quality Index." The study adhered to the Strengthening the Reporting of Observational Studies in Epidemiology checklist for reporting.

Results: After the progressive muscle relaxation exercise intervention, the nurses showed significantly lower fatigue severity scores, indicating a meaningful difference and effect (P < .001; partial eta squared = 0.208). Similarly, after the intervention, sleep quality scores were also significantly improved, showing a statistically significant difference and effect (P < .001; partial eta squared = 0.271).

Discussion: This study demonstrates that progressive muscle relaxation exercises are an effective method for reducing fatigue severity and improving sleep quality among emergency nurses.

This is a revision of the previous joint policy statement titled "Pediatric Readiness in the Emergency Department." This is a joint policy statement from the American Academy of Pediatrics, the American College of Emergency Physicians, the American College of Surgeons, and the Emergency Nurses Association. These updated recommendations are intended to serve as a resource for clinical and administrative leadership of emergency departments as they strive to improve their readiness for the emergency care of children of all ages.

Introduction: Discrimination and stigmatization in emergency departments continue to threaten equitable and safe patient care, particularly for individuals with psychiatric disorders and other marginalized groups. This could include people who are homeless or who are discriminated against because of their sexuality or gender or for other reasons. Traditional education focused solely on knowledge transfer has proven insufficient to address these issues. Person-centered practice, grounded in values, beliefs, and authentic relationships, offers a promising framework to foster equity, inclusion, and reflection among health care professionals. This project explored how person-centered, active learning strategies, facilitated by clinical nurse specialists, can promote awareness of bias and discrimination within emergency care teams.

Methods: A practice development project titled "The Year of Education" was implemented in the emergency department of the University Hospital Basel in January 2024. Rooted in McCormack's person-centered practice framework, the initiative integrated active learning, reflection, and person-centered approaches across monthly educational themes. Two immersive learning interventions are described: (1) a self-experience simulation contrasting stigmatizing and inclusive handovers and (2) a reflective listening exercise using audio recordings of former psychiatric patients describing their experiences with coercive interventions. Each session was facilitated by clinical nurse specialists and followed by group discussions and qualitative evaluations using written reflections and team feedback.

Results: Participants showed increased self-awareness of stigmatizing behaviors. The learning interventions fostered empathy and critical reflection, prompting staff to reconsider routine practices such as the presence of too many people during psychiatric crises or giving handovers behind closed curtains. Staff expressed that these experiences deepened their understanding of patient perspectives and strengthened person-centered approaches in daily practice.

Discussion: The interventions demonstrated that person-centered, reflective education can meaningfully shift attitudes and communication patterns within emergency care. Although the project lacked a formal quantitative evaluation, its perceived impact led to its continuing as the emergency department's educational strategy. Embedding advanced practice nurse roles focused on health equity may be a further step toward less stigmatization and more equity in the emergency department.

Introduction: Housing instability increases chronic pain risk and creates care barriers, making emergency departments the primary points of health care for people experiencing housing instability. Although it is clear that housing instability contributes to chronic pain, the patient's experience of pain is less understood. This study examines differences in pain characteristics by housing status.

Methods: This secondary analysis used data from the Decision-Making Factors for Therapeutic Opioid Use after Emergency Care. In the original study, randomly selected eligible participants self-reported housing status, in addition to validated measures of pain interference, pain self-efficacy, pain anxiety, depression, and sleep disturbances. Regression models explored the relationship between housing status and pain-related outcomes adjusting for demographics.

Results: Among participants (N = 496), 47 (9.5%) reported unstable housing. Compared with stably housed patients, those with unstable housing had higher adjusted odds of current (adjusted odds ratio, 2.05; 95% CI, 1.11-3.86) and lifetime chronic pain (adjusted odds ratio, 2.40; 95% CI, 1.28-4.58) and higher pain-related anxiety scores (β = 13.43; 95% CI, 6.51-20.35), depressive symptoms (β = 4.62; 95% CI, 2.83-6.41), and sleep disturbance (β = 2.37; 95% CI, 1.07-3.54). No differences were found in pain self-efficacy (β = -0.78; 95% CI, -6.88 to 3.62).

Discussion: Unstably housed emergency department patients experience higher rates of chronic pain and pain-related anxiety while maintaining similar pain self-efficacy. Systems-level interventions that address social and structural barriers to pain management among unstably housed patients are needed to improve pain management and reduce emergency department burden. The results should be interpreted with caution given the small sample size and large confidence intervals.

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.