Journal of Emergency Nursing最新文献

Objectives: Back pain is a prevalent condition that affects 1 in 6 Australians at any time, with high associated health care costs. To date, there is limited information relating to symptom severity and recovery trajectory in people with back pain who present to the emergency department for care. A digital care pathway (DCP) can track patient outcomes following presentation with back pain. The primary aim of this protocol is to outline the co-development, implementation, and evaluation of a DCP for back pain patients who present to the emergency department.

Methods: The primary aim will be addressed in 3 overlapping phases: Phase 1 (co-design) will include interviews with back pain patients and health care professionals from the Northern Hospital Emergency Department. Interview findings will inform education resources featured on the DCP and establish questionnaire content and frequency acceptability. Phase 2 (implementation) will include the rollout of the DCP and tracking of patient-reported outcome measures, which will be collected over 12 weeks. Phase 3 (evaluation) will include interviews with a subset of back pain patients who have participated in Phase 2 to evaluate the acceptability of the DCP and the barriers and facilitators of using the DCP.

Ethics and dissemination: This project has been approved via the National Health and Medical Research Council of Australia's National Mutual Acceptance Scheme by St Vincent's Hospital Human Ethics Committee (2022/PID06476), La Trobe University Research Governance (HEC#206/22), and Northern Health Research Governance (NH-2023-372687). We plan to publish the findings in a peer-reviewed journal and present them at conferences.

Introduction: Behavioral health visits to emergency departments have increased, increasing the risk of patient violent agitation that may require restraints to control. Our objective was to determine whether using the Behavioral Activity Rating Scale and treatment recommendations matched to patient scores would affect the number of patients who required physical restraints during their stay in the emergency department.

Methods: In this quality improvement project, nursing performed Behavioral Activity Rating Scale assessments on all behavioral health patients who presented to the emergency department, occurring during triage and at regular intervals with vital signs. Data were collected for a period before implementation and compared with data collected after implementing the Behavioral Activity Rating Scale workflow. Patients who required restraints during their stay, patients who required 2 or more restraints during their stay, and timing of restraint application were analyzed.

Results: Results show a decrease in the number of patients who required restraints during their ED stay, decreasing from a rate of 8.7% to 7.0% (P = .02). There was also a decrease in the number of patients who required multiple restraints, from a rate of 82.2% to 27.2% (P < .001). There was no difference in the number of patients who required restraints 1 hour after their arrival before versus after intervention (P = .40).

Discussion: Early recognition of patient agitation is essential in appropriate treatment of that agitation. The Behavioral Activity Rating Scale assessment is an effective tool to quantify a patient's agitation level. When coupled with treatment recommendations or protocols, it may decrease restraint use in the emergency department.

Introduction: Trauma-informed care has been posited as a framework for creating ideal and safe environments for patients to participate in treatment. However, there are limited studies that demonstrate the impact of a focused trauma-informed care training on ED staff. We implemented a 4-hour trauma-informed care training in a general emergency department. We aimed to measure changes in knowledge, opinions, self-rated competency, barriers, and recent practices before and after implementing trauma-informed care training. We hypothesized that the training would result in significant self-reported improvement in all domains.

Methods: We performed a pre/post interventional study with the intervention being a trauma-informed care training adapted for ED clinical care staff. A validated, publicly available survey tool (Center for Pediatric Stress Trauma-Informed Care [TIC] Provider Survey) was used to assess knowledge, opinions, competency, and utilization of and perceived barriers to trauma-informed care. Pre- and post-training surveys were collected. Responses were stratified by role. Continuous variables were compared using analysis of variance; categorical variables compared using Pearson's chi-square.

Results: Participants demonstrated a high level of perceived knowledge and opinions of trauma-informed care before and after training. We observed significant increases in self-reported competence for all ED staff, some increase in utilization of trauma-informed care in recent practice, and significant decreases in perceived barriers to providing trauma-informed care.

Discussion: Trauma-informed care training is an effective means to improving ED staff self-perceived competence and practice of trauma-informed care even among those with high self-perceived knowledge and opinions of trauma-informed care before the training. Future study should explore the patient-level impact of trauma-informed care training, as well as how to continue to reduce barriers to system-wide implementation of trauma-informed care practices.

Introduction: Despite routine screening for intimate partner violence and validated screening tools for lethality, intimate partner violence assessment and linkage to services remain inconsistent in health care settings. This program aimed to implement and evaluate a lethality assessment program, a nurse-led screening and prevention program for intimate partner violence homicide in an emergency department that partnered with a local community agency.

Methods: A single group pre-post design was used to evaluate changes in knowledge of intimate partner violence and the lethality assessment program protocol and confidence in implementing the protocol among 143 registered nurses in the emergency department. Program outcomes were assessed during a 4-month post-implementation period. Focus group interviews were conducted and analyzed to identify barriers and facilitators of implementation.

Results: Significant improvements in the nurses' knowledge and confidence in implementing the protocol (all P< .001) were observed. Fourteen lethality screens were completed during the 4 months, with 13 indicating high intimate partner violence homicide danger. Eight victims received 20 services (1-5/person) from the local community organization: emergency shelter, safety planning, legal aid, and domestic violence protection order. Barriers to implementation included time, privacy, training, and access to screening forms. Facilitators included champions, resources to allow for implementation, and prompts.

Discussion: The lethality assessment program is a feasible protocol in a health care setting to increase intimate partner violence awareness, link high-risk intimate partner violence victims to needed services in real time, and potentially reduce intimate partner violence homicides. Programs like this are essential to address this public health concern.

Introduction: Although the ED triage function is a critical means of ensuring patient safety, core competencies for ED triage are not well defined in the literature. The purpose of the study was to identify and validate emergency triage nursing competencies and to develop a competency verification process.

Methods: A sample of 1181 emergency nurses evenly divided between roles with oversight of triage training and competency assessment (manager-level and staff nurses performing triage) completed an online survey evaluating competency elements that comprised the following in terms of frequency and importance, training modalities, and evaluation methods: expert assessment, clinical judgment, management of medical resources, communication, and timely decisions.

Results: Both manager-level and triage nurses agreed on the importance of the identified competencies. Gaps in training and evaluation were reported by both staff nurses and manager-level nurses. Triage nurses reported less training offered and less competency evaluation compared with manager-level nurses. Triage nurses reported performing all competencies more frequently and at higher level of competency than manager-level nurses reporting on triage nurse performance.

Discussion: This study provides both a standard set of triage competencies and a method by which to evaluate them. Managers and educators might consider this standard to establish initial triage role competency and periodic competency assessment per institutional guidelines. The gap in perceived education and evaluation suggests that standard education and evaluation processes be adopted across emergency departments.

Introduction: Sustained asymptomatic hypertension in ED patients is a powerful predictor of chronic uncontrolled hypertension. In this study, we assess the feasibility of using a storyboard video and communicating real-time cardiovascular imaging results on blood pressure control and primary care engagement.

Methods: This was a prospective observational exploratory sub-study. Following Institutional Review Board approval (#18-00197), 20 English-speaking adults in an urban emergency department with an initial blood pressure ≥160/100 mm Hg and a second blood pressure ≥140/90 mm Hg were enrolled. Patients watched a 60-second storyboard video about uncontrolled hypertension in the ED setting, featuring racially and ethnically diverse avatars. They then received a real-time bedside echocardiogram. Emergency nurses communicated the echocardiogram results using a standard script and advised follow-up within 2 weeks after discharge. Patient characteristics, blood pressure control, primary care engagement, and acceptability of the intervention were assessed at baseline, 12 weeks, and 24 weeks post-discharge.

Results: All 20 enrolled patients (mean age 55, 70% female, and 95% from underrepresented groups [30% Black, 50% Hispanic, and 15% Black and Hispanic]) exhibited subclinical heart disease on echocardiograms. Blood pressure control improved from baseline (systolic 166 mm Hg, diastolic 97 mm Hg) to 24 weeks (systolic 137 mm Hg, diastolic 78 mm Hg). Seventy percent of patients engaged with primary care post-discharge, and the intervention had high acceptability (94.8% approval).

Discussion: The Brief Risk Communication for ED patientswith sustained asymptomatic hypertension study demonstrates the feasibility and acceptability of using a brief video and real-time cardiovascular imaging for risk communication in the emergency department. Future research will build on these findings with a larger, more comprehensive study.

Introduction: Distal radius fractures are common injuries managed frequently in emergency departments. While numerous studies focus on the surgical treatment of distal radius fractures, there is a lack of research about non-surgically treated patients' early experiences post-injury. The objective of this study was to explore adult patients' initial experiences following closed reduction treatment of distal radius fracture in the emergency department.

Methods: This qualitative study involved semi-structured telephone interviews with 21 patients who underwent closed-reduction treatment at 2 hospitals in Southern Denmark. Interviews were conducted within the first week following ED treatment and analyzed thematically.

Results: Patients were aged 42 to 91, and 3 were men. Three major themes emerged: (1) Pain Management: Patients reported significant pain during waiting periods and treatment, indicating a need for improved pain management strategies; (2) Information Dissemination: Participants expressed a need for clearer, continuous communication about their treatment and recovery expectations; and (3) Beyond the fracture: Patients were anxious about future functional abilities, especially those with dominant hand fractures, underscoring the need for holistic patient care that addresses psychological and social dimensions.

Discussion: Effective pain management, both pharmacological and non-pharmacological, as well as comprehensive, clear communication, is crucial in the initial treatment phase of distal radius fracture. Acknowledging patients' broader concerns can enhance the quality of care and support improved recovery outcomes. These findings imply that future emergency nursing practice should prioritize swift and effective pain management, clear and empathetic communication, and a holistic approach to patient care to optimize recovery outcomes.

Introduction: Over the past 15 years, the emergency nurse practitioner has been recognized as a nursing specialty role with dedicated scope and standards of practice. However, a paucity of objective data exists to validate the actual practice of emergency nurse practitioners in the emergency care setting. The purpose of this pilot study was to describe the initial acuity of patients assigned to emergency nurse practitioners, actions, decisional complexity, and disposition decisions of advanced practice nurses as they function in emergency departments in a single system.

Methods: This descriptive exploratory study used retrospective chart data to gain understanding.

Results: The most common Emergency Severity Index level seen by emergency nurse practitioners was Emergency Severity Index 3. Of 8513 encounters with Emergency Severity Index level data, 21% were triaged at Emergency Severity Index 2, 56% at Emergency Severity Index 3, 21% at Emergency Severity Index 4, and only 2% at Emergency Severity Index 5. Half of encounters resulted in a Current Procedural Terminology code of 99825 or higher and 94% were coded at 99824 or higher. There were a high percentage of admissions including intensive care unit admissions.

Discussion: Although descriptive, this study is highly illustrative of the broad scope of complex skills and clinical decision making required to perform as an advanced practice nurse in the emergency department. Further examination of education and training is warranted.