Journal of Emergency Nursing最新文献

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: Implementing family presence during resuscitation poses many challenges in developing countries, especially in developing countries like Iran, where cultural and contextual factors play significant roles. This study examined the attitudes and barriers of Muslim emergency nurses and physicians toward family presence during resuscitation in Iran.

Methods: A cross-sectional study included 300 physicians and 500 nurses. Data were analyzed using descriptive and analytic statistics.

Results: The overall score of physicians' attitudes toward family presence during resuscitation was higher than nurses' (P = .001). Female nurses had a higher attitude score than male nurses (P = .001). Other demographic variables were not significant with nurses' attitudes toward family presence during resuscitation. The most significant barriers to family presence during resuscitation included increased stress on staff and unwanted events during cardiopulmonary resuscitation. The attitude of Iranian physicians and nurses toward family presence during resuscitation is becoming more positive, with more than half of them agreeing with both the concept and the practice.

Discussion: The findings suggest that hospitals should develop and adopt policies to ensure consistent performance when implementing family presence during resuscitation and that the procedure is safe and effective.

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.

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: Frequent and long-term exposure to clinical alarms can cause emergency nurses to lose their trust in alarms, delay their response, and even disable or mute these alarms.

Methods: A cross-sectional study was conducted to assess emergency nurses' knowledge, perceptions, and practices toward clinical alarm fatigue and investigate the perceived obstacles they face when managing clinical alarms.

Results: Less than half of emergency nurses were unfamiliar with the term "alarm fatigue" (40.8%), lacked knowledge of the causes of alarm fatigue (42.3%), and were unaware of how to prevent alarm fatigue (45.7%). Emergency nurses' knowledge of clinical alarms was found to have a significant negative correlation with their perceived obstacles to the management of these alarms (r = -6.855; P < .001) and a significant positive correlation with their practice in the management of clinical alarms (r = 2.576; P = .010). In contrast, perceived obstacles to the effective management of clinical alarms were found to have a significant positive correlation with emergency nurses' negative perception of clinical alarms (r = 12.449; P < .001). A significant negative correlation was observed between emergency nurses' negative perception of clinical alarms and their practice in the management of these alarms (r = -2.697; P = .007).

Discussion: Clinical alarms represent an additional burden for emergency nurses where a substantial proportion of nurses have limited familiarity with alarm fatigue, lack knowledge about its causes and prevention strategies, and do not customize patient alarm parameters throughout their shifts.

Introduction: We aimed to determine the inter-rater reliability of ultrasonographic optic nerve sheath diameter measurements performed by emergency nurses.

Methods: Point-of-care ultrasound of the optic nerve sheath diameter measurements were performed in B-mode using a 10 MHz linear probe. The emergency nurses had no previous experience in ultrasonography. Emergency nurses performed sonographic measurements on patients in groups of 2. First, 1 emergency nurse measured optic nerve sheath diameter in both the right and left eyes of the patient, and then the other emergency nurse measured optic nerve sheath diameter in the right and left eyes of the same patient. Thus, a total of 4 optic nerve sheath diameter measurements were made by 2 emergency nurses in both eyes of 1 patient. Four emergency nurses measured optic nerve sheath diameter in 25 separate patients. As a result, a total of 600 optic nerve sheath diameter values were obtained in 150 patients. Each emergency nurse recorded their results on data collection forms and was blinded to each other's measurements.

Results: The median optic nerve sheath diameter was 3.6 mm (interquartile range, 0.6). The median optic nerve sheath diameters of males and females were 3.7 mm (interquartile range, 0.6) and 3.5 mm (interquartile range, 0.6), respectively. The intraclass correlation coefficient was 0.89 (95% CI, 0.86-0.91). The intraclass correlation coefficient values for the optic nerve sheath diameter measurements of the right and left eyes were 0.89 (95% CI, 0.85-0.92) and 0.88 (95% CI, 0.83-0.91), respectively.

Discussion: There is good inter-rater reliability among emergency nurses with no previous experience in measuring the optic nerve sheath diameter with point-of-care ultrasound.

Introduction: The conflation of mandated screening question data collection with patient assessment at the initial triage encounter challenges the ability of the emergency nurse to identify patients at risk for deterioration rapidly and accurately. Further, inexperienced triage nurses are generally challenged in differentiating between questions that establish stability and questions that meet other requirements. The aims of the study included exploration of how triage nurses identified critical data elements to facilitate more rapid and accurate patient triage and Emergency Severity Index acuity assignment, perceptions of appropriate location of assessment elements, and identifying common triage processes.

Methods: A quantitative descriptive exploratory study using survey data was used to address study aims.

Results: Participants identified the following elements appropriate to triage as chief complaint, vital signs, allergies (and latex allergy), pain/pain description, weight, history of present illness, suicide risk, preferred language, Glasgow Coma Scale, pregnancy status/last menstrual period, travel history, infectious diseases, arrival method, height, and use of blood thinners. All other screenings were identified as "belonging" during provision of care, at discharge, or never.

Discussion: Emergency nurses identified critical triage data necessary to assign an Emergency Severity Index level. We recommend that future research focus on evaluation of a triage process that removes screening not directly related to the triage decision in terms of nursing accuracy in assigning an Emergency Severity Index level and patient outcomes.

Introduction: Recent literature suggests pain management and sedation in ED patients after rapid sequence intubation are done inconsistently, which impacts patient outcomes negatively. The purpose of this study is to compare rates and timing of post-intubation analgesia and sedation before and after an ED pharmacy practice improvement intervention.

Methods: We conducted a retrospective study of adult ED patients intubated over an 18-month period. The primary study endpoint was the frequency of post-intubation analgesia and sedation administration before and after implementation of the post-intubation guideline and education. Secondary endpoints included time to analgesia and sedation medication after paralytic administration, comparison between paralytic drugs utilized (succinylcholine and rocuronium), and ED length of stay.

Results: Prior to intervention, the mean percentage of post-intubation analgesia and sedation administration was 58.6% and 94.3%, respectively. After paralytic administration, the time to dose of analgesia was 63 minutes (range 0-288) and 47 minutes for sedation medication (range 0-214). The mean length of stay in the emergency department was 298 minutes (range 12-3143). Following the intervention, 35 patients met inclusion criteria, and the mean percentage of analgesia and sedation administration was 77.1% and 91.4%, respectively. The mean time to analgesia administration improved to 22 minutes (range 0-123), and sedation improved to 20 minutes (range 0-284). The mean emergency department length of stay decreased to 204 minutes (range 46-469). When comparing paralytic used, mean time to analgesia and sedation was longer in those who received rocuronium compared to succinylcholine.

Discussion: An educational lecture along with a novel ED post-intubation clinical guideline improved rates and timing to analgesia and sedation. This provides a unique opportunity for emergency nurses to advocate for early analgesia and sedation in mechanically ventilated patients.

Introduction: Emergency departments worldwide are faced with in-hospital crowding and fast-paced admissions, creating an increasingly high workload for health care personnel. In recent years, emergency departments have also experienced an increase in emergency admissions, resulting in burdened workplaces. This has led to debates about nurses' work environment and mental well-being. This study aimed to gain knowledge on the prevalence of depression, anxiety, and stress, as well as insight into the factors influencing the mental well-being of the nursing staff in a Danish emergency department.

Methods: This is a mixed-methods study with an explanatory sequential design. A questionnaire (the Depression, Anxiety, and Stress Scale - 21 Items) was sent to nursing staff (N = 146) in a large emergency department in the Region of Southern Denmark. Afterward, a smaller sample participated in semistructured interviews. The quantitative data were analyzed using descriptive statistics, the Mann-Whitney U test, and the chi-square test. In the qualitative part, a thematic analysis was performed.

Results: Completed surveys were received from 78 nursing staff (53.4%). Overall, the nursing staff reported severe to extremely severe levels of depression (14.1%), anxiety (23.1%), or stress (47.2%) within a week before completing the survey. Higher levels of psychological distress were significantly associated with fewer years of clinical experience and having previously experienced or received treatment for depression, anxiety, or stress. Ten staff members later volunteered to participate in the interviews. The qualitative results formed 3 themes: (1) high work pace and responsibility, (2) professional community and nursing identity, and (3) culture with an increased focus on mental well-being.

Discussion: The nursing staff reported high mental strain, especially in the forms of high stress and anxiety levels. They explained that their mental health was affected by overcrowding, a pressured work environment, and lack of resources.