Pub Date : 2026-01-01DOI: 10.1016/j.jen.2025.08.002
Lisa Wolf PhD, RN, CEN, FAEN, FAAN, Ellen Benjamin PhD, RN, CEN, Paul Clark PhD, RN, FAEN, Michael Callihan PhD, RN, CEN, NRP, FAEN
Introduction
When emergency department staffing is inadequate, patient care may be missed. Information regarding the association between missed care and staffing is lacking in the emergency department setting. This study aimed to explore considerations for and configurations of staffing patterns and their relationship to missed care, missed decompensation, and delays in care.
Methods
This study used an exploratory qualitative approach with data derived from focus groups and analyzed using qualitative content analysis. A total of 39 emergency nurses in varied roles attending a national conference were recruited. The Consolidated Criteria for Reporting Qualitative Research checklist was used to guide the reporting of this study.
Results
Participants reported information grouped into 5 major categories: ratios, staffing patterns, work ethic, role of administration, and missed care. Both staff and charge nurses reported a preference for a 1:3 nurse-to-patient ratio, with higher patient ratios described as leading to missed care, missed decompensation, and delays in care.
Discussion
The individual and institutional elements of staffing decisions may have a significant impact on patient outcomes in the form of missed care, missed diagnoses, and delayed care. Staffing decisions may also affect the psychological health of emergency nurses by fostering burnout. Across roles, nurses perceive a disconnect between the ED environment and staffing plans generated by persons outside the department. Future research should focus quantitatively on relationships between staffing patterns and patient and nursing outcomes.
{"title":"Perceived Relationships Between Emergency Department Staffing Patterns and Missed Care, Missed Decompensation, and Delays in Care","authors":"Lisa Wolf PhD, RN, CEN, FAEN, FAAN, Ellen Benjamin PhD, RN, CEN, Paul Clark PhD, RN, FAEN, Michael Callihan PhD, RN, CEN, NRP, FAEN","doi":"10.1016/j.jen.2025.08.002","DOIUrl":"10.1016/j.jen.2025.08.002","url":null,"abstract":"<div><h3>Introduction</h3><div>When emergency department staffing is inadequate, patient care may be missed. Information regarding the association between missed care and staffing is lacking in the emergency department setting. This study aimed to explore considerations for and configurations of staffing patterns and their relationship to missed care, missed decompensation, and delays in care.</div></div><div><h3>Methods</h3><div>This study used an exploratory qualitative approach with data derived from focus groups and analyzed using qualitative content analysis. A total of 39 emergency nurses in varied roles attending a national conference were recruited. The Consolidated Criteria for Reporting Qualitative Research checklist was used to guide the reporting of this study.</div></div><div><h3>Results</h3><div>Participants reported information grouped into 5 major categories: <em>ratios</em>, <em>staffing patterns</em>, <em>work ethic</em>, <em>role of administration</em>, and <em>missed care</em>. Both staff and charge nurses reported a preference for a 1:3 nurse-to-patient ratio, with higher patient ratios described as leading to missed care, missed decompensation, and delays in care.</div></div><div><h3>Discussion</h3><div>The individual and institutional elements of staffing decisions may have a significant impact on patient outcomes in the form of missed care, missed diagnoses, and delayed care. Staffing decisions may also affect the psychological health of emergency nurses by fostering burnout. Across roles, nurses perceive a disconnect between the ED environment and staffing plans generated by persons outside the department. Future research should focus quantitatively on relationships between staffing patterns and patient and nursing outcomes.</div></div>","PeriodicalId":51082,"journal":{"name":"Journal of Emergency Nursing","volume":"52 1","pages":"Pages 143-157"},"PeriodicalIF":2.3,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145030882","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-01DOI: 10.1016/j.jen.2025.08.014
Filipe Melo MScN, RN, Margarida Reis Santos PhD, RN, Miguel Castelo-Branco Sousa PhD, MD, Cátia Mota MScPsych, Mauro Mota PhD, RN
Introduction
Trauma remains a leading cause of mortality and long-term disability worldwide, often causing significant discomfort during prehospital care. Addressing these discomforts effectively is crucial for improving patient outcomes. This scoping review aimed to identify and categorize the types of discomforts experienced by adult trauma victims in prehospital settings and map the pharmacologic and nonpharmacologic interventions used to mitigate them.
Methods
This scoping review followed the Joanna Briggs Institute framework and Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews guidelines. A comprehensive search was performed in databases including MEDLINE, CINAHL, Scopus, Embase, PsycINFO, Joanna Briggs Institute Evidence Synthesis, Cochrane Database, and relevant gray literature sources. Studies involving adult trauma patients (≥18 years) in prehospital care that reported on discomfort and interventions were included without restrictions on publication date.
Results
Seventeen studies met the inclusion criteria, covering various international contexts. Acute pain was the most frequently reported discomfort, followed by anxiety, fear, cold-induced discomfort, and discomfort caused by immobilization. Pharmacologic interventions predominantly included opioids, nonsteroidal anti-inflammatory drugs, paracetamol, ketamine, and methoxyflurane, whereas nonpharmacologic interventions comprised acupressure, transcutaneous electrical nerve stimulation, cryotherapy, warming measures, communication strategies, and emotional support. Nonpharmacologic interventions, especially acupressure and communication techniques, showed promising results in reducing pain and anxiety.
Discussion
The findings underline the multidimensional nature of discomfort in prehospital trauma care and highlight effective interventions, including pharmacologic and complementary nonpharmacologic strategies. However, significant gaps remain regarding standardized assessment tools for non–pain-related discomforts and combined interventions. This review underscores the necessity for comprehensive management protocols and further research to optimize patient comfort and care outcomes in trauma settings.
创伤仍然是世界范围内死亡和长期残疾的主要原因，经常在院前护理期间引起严重不适。有效地解决这些不适对于改善患者预后至关重要。本综述旨在识别和分类院前环境中成人创伤受害者所经历的不适类型，并绘制用于减轻这些不适的药物和非药物干预措施。方法：该范围评价遵循乔安娜布里格斯研究所框架和系统评价的首选报告项目，以及范围评价指南的元分析扩展。综合检索MEDLINE、CINAHL、Scopus、Embase、PsycINFO、Joanna Briggs Institute Evidence Synthesis、Cochrane Database等数据库及相关灰色文献来源。涉及院前护理的成人创伤患者（≥18岁）的研究报告了不适和干预措施，不受发表日期的限制。结果：17项研究符合纳入标准，涵盖了不同的国际背景。急性疼痛是最常见的不适，其次是焦虑、恐惧、寒冷引起的不适和固定引起的不适。药物干预主要包括阿片类药物、非甾体抗炎药、扑热息痛、氯胺酮和甲氧基氟醚，而非药物干预包括穴位按压、经皮神经电刺激、冷冻疗法、加热措施、沟通策略和情感支持。非药物干预，特别是指压和交流技术，在减轻疼痛和焦虑方面显示出有希望的结果。讨论：研究结果强调了院前创伤护理中不适的多维性，并强调了有效的干预措施，包括药物和补充的非药物策略。然而，在非疼痛相关不适的标准化评估工具和联合干预措施方面仍存在重大差距。这篇综述强调了综合管理方案和进一步研究的必要性，以优化创伤环境中患者的舒适度和护理结果。
{"title":"Sources of Discomfort and Treatment Strategies for Trauma Patients in the Pre-Hospital Setting: A Scoping Review","authors":"Filipe Melo MScN, RN, Margarida Reis Santos PhD, RN, Miguel Castelo-Branco Sousa PhD, MD, Cátia Mota MScPsych, Mauro Mota PhD, RN","doi":"10.1016/j.jen.2025.08.014","DOIUrl":"10.1016/j.jen.2025.08.014","url":null,"abstract":"<div><h3>Introduction</h3><div>Trauma remains a leading cause of mortality and long-term disability worldwide, often causing significant discomfort during prehospital care. Addressing these discomforts effectively is crucial for improving patient outcomes. This scoping review aimed to identify and categorize the types of discomforts experienced by adult trauma victims in prehospital settings and map the pharmacologic and nonpharmacologic interventions used to mitigate them.</div></div><div><h3>Methods</h3><div>This scoping review followed the Joanna Briggs Institute framework and Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews guidelines. A comprehensive search was performed in databases including MEDLINE, CINAHL, Scopus, Embase, PsycINFO, Joanna Briggs Institute Evidence Synthesis, Cochrane Database, and relevant gray literature sources. Studies involving adult trauma patients (≥18 years) in prehospital care that reported on discomfort and interventions were included without restrictions on publication date.</div></div><div><h3>Results</h3><div>Seventeen studies met the inclusion criteria, covering various international contexts. Acute pain was the most frequently reported discomfort, followed by anxiety, fear, cold-induced discomfort, and discomfort caused by immobilization. Pharmacologic interventions predominantly included opioids, nonsteroidal anti-inflammatory drugs, paracetamol, ketamine, and methoxyflurane, whereas nonpharmacologic interventions comprised acupressure, transcutaneous electrical nerve stimulation, cryotherapy, warming measures, communication strategies, and emotional support. Nonpharmacologic interventions, especially acupressure and communication techniques, showed promising results in reducing pain and anxiety.</div></div><div><h3>Discussion</h3><div>The findings underline the multidimensional nature of discomfort in prehospital trauma care and highlight effective interventions, including pharmacologic and complementary nonpharmacologic strategies. However, significant gaps remain regarding standardized assessment tools for non–pain-related discomforts and combined interventions. This review underscores the necessity for comprehensive management protocols and further research to optimize patient comfort and care outcomes in trauma settings.</div></div>","PeriodicalId":51082,"journal":{"name":"Journal of Emergency Nursing","volume":"52 1","pages":"Pages 218-238.e5"},"PeriodicalIF":2.3,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145226307","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-01DOI: 10.1016/j.jen.2025.07.012
Joo Shiang Ang MBBS, Wan San Angeline Tan MN, APN, RN, Wai Jian Lionel Ang RN, Xinyi Lin MBBS
{"title":"Auricular Hematoma and Development of Cauliflower Ear","authors":"Joo Shiang Ang MBBS, Wan San Angeline Tan MN, APN, RN, Wai Jian Lionel Ang RN, Xinyi Lin MBBS","doi":"10.1016/j.jen.2025.07.012","DOIUrl":"10.1016/j.jen.2025.07.012","url":null,"abstract":"","PeriodicalId":51082,"journal":{"name":"Journal of Emergency Nursing","volume":"52 1","pages":"Pages 46-48"},"PeriodicalIF":2.3,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145886353","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-01DOI: 10.1016/j.jen.2025.09.005
John Ramos MMS, PA-C, CAQ-EM
Low-titer type O whole blood has demonstrated survival benefits and improved hemostatic resuscitation compared with component-based transfusion. Although alloimmunization is a concern for women of childbearing potential, more recent evidence suggests that the absolute risk is low compared with the need to preserve maternal life. The administration of whole blood to women of childbearing potential is safer with postexposure Rh immunoprophylaxis and modern advances in the management of fetal anemia.
{"title":"What Would Mother Say? Whole Blood and RhD Alloimmunization in Trauma Resuscitation","authors":"John Ramos MMS, PA-C, CAQ-EM","doi":"10.1016/j.jen.2025.09.005","DOIUrl":"10.1016/j.jen.2025.09.005","url":null,"abstract":"<div><div>Low-titer type O whole blood has demonstrated survival benefits and improved hemostatic resuscitation compared with component-based transfusion. Although alloimmunization is a concern for women of childbearing potential, more recent evidence suggests that the absolute risk is low compared with the need to preserve maternal life. The administration of whole blood to women of childbearing potential is safer with postexposure Rh immunoprophylaxis and modern advances in the management of fetal anemia.</div></div>","PeriodicalId":51082,"journal":{"name":"Journal of Emergency Nursing","volume":"52 1","pages":"Pages 28-33"},"PeriodicalIF":2.3,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145886415","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-01DOI: 10.1016/j.jen.2025.07.013
Lisa Wolf PhD, RN, CEN, FAEN, FAAN
{"title":"Identifying the High-Risk Obstetric Patient at Triage","authors":"Lisa Wolf PhD, RN, CEN, FAEN, FAAN","doi":"10.1016/j.jen.2025.07.013","DOIUrl":"10.1016/j.jen.2025.07.013","url":null,"abstract":"","PeriodicalId":51082,"journal":{"name":"Journal of Emergency Nursing","volume":"52 1","pages":"Pages 24-27"},"PeriodicalIF":2.3,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145886351","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-01DOI: 10.1016/j.jen.2025.07.016
Marlene Porter PhD, RN, CEN, NPD-BC, CCRN
Malignant hyperthermia is a rare, life-threatening hypermetabolic reaction that can strike unexpectedly in the emergency department, demanding swift recognition and intervention to save lives. This syndrome can be fatal if not treated and occurrs in 1 in 100,000 adults and 1 in 30,000 children, with a 3% to 5% mortality rate. Although often associated with perioperative environments, malignant hyperthermia should remain on the radar for emergency nurses, especially when patients exhibit sudden hyperthermia, muscle rigidity, and tachycardia after intubation or procedural sedation. This article emphasizes early recognition, rapid intervention strategies, and preparedness protocols tailored to the ED context to improve outcomes for patients with malignant hyperthermia.
{"title":"Code Malignant Hyperthermia: Malignant Hyperthermia in the Emergency Department—Implications for Nursing","authors":"Marlene Porter PhD, RN, CEN, NPD-BC, CCRN","doi":"10.1016/j.jen.2025.07.016","DOIUrl":"10.1016/j.jen.2025.07.016","url":null,"abstract":"<div><div>Malignant hyperthermia is a rare, life-threatening hypermetabolic reaction that can strike unexpectedly in the emergency department, demanding swift recognition and intervention to save lives. This syndrome can be fatal if not treated and occurrs in 1 in 100,000 adults and 1 in 30,000 children, with a 3% to 5% mortality rate. Although often associated with perioperative environments, malignant hyperthermia should remain on the radar for emergency nurses, especially when patients exhibit sudden hyperthermia, muscle rigidity, and tachycardia after intubation or procedural sedation. This article emphasizes early recognition, rapid intervention strategies, and preparedness protocols tailored to the ED context to improve outcomes for patients with malignant hyperthermia.</div></div>","PeriodicalId":51082,"journal":{"name":"Journal of Emergency Nursing","volume":"52 1","pages":"Pages 49-52"},"PeriodicalIF":2.3,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145030864","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-01DOI: 10.1016/j.jen.2025.08.018
Shirong Wu MSN, Zhipeng Zhong BSN, Huanmei Li BSN, Yurong Xiong BSN, Liying Li BSN, Banghan Ding MD, Qiuying Deng MSN
Introduction
Emergency nurses require strong moral resilience to maintain professional ethics and provide quality care, even when facing challenges and work-related stress. This study sought to investigate the factors influencing moral resilience profiles among emergency nurses and provide recommendations to nursing managers for their enhancement.
Methods
In January to April 2024, a total of 543 emergency nurses from 28 tertiary hospitals in Guangdong Province were surveyed. The measurements included the General Demographic Questionnaire, Rushton Moral Resilience Scale, Simplified Coping Style Questionnaire, and Hospital Ethical Climate Survey. Data analysis was conducted using Mplus 8.3 to examine different moral resilience profiles. Multiple logistic regression was used to explore each profile’s influencing factors.
Results
The participating emergency nurses were categorized into 4 groups: low moral resilience group (25.6%), moral resilience potential group (31.0%), moral adversity challenge group (17.5%), and high moral resilience group (25.9%). Compared with the low moral resilience group, sex, professional title, physical health, hospital’s ethical climate, and negative coping style were common influencing factors for the other 3 groups (P<.05). Supportive friends affected the moral resilience potential group and moral adversity challenge group (P<.05). Monthly income and positive coping style affected the moral adversity challenge group (P<.05). The average monthly night shifts, participation in hospital ethics courses, marital status, and positive coping style affected the high moral resilience group (P<.05).
Discussion
Nursing managers can use the study’s findings to develop targeted strategies to help emergency nurses enhance moral resilience, reduce work pressure, and improve emergency care quality.
{"title":"Moral Resilience and Its Association With Predictors in Emergency Nurses: A Latent Profile Analysis","authors":"Shirong Wu MSN, Zhipeng Zhong BSN, Huanmei Li BSN, Yurong Xiong BSN, Liying Li BSN, Banghan Ding MD, Qiuying Deng MSN","doi":"10.1016/j.jen.2025.08.018","DOIUrl":"10.1016/j.jen.2025.08.018","url":null,"abstract":"<div><h3>Introduction</h3><div>Emergency nurses require strong moral resilience to maintain professional ethics and provide quality care, even when facing challenges and work-related stress. This study sought to investigate the factors influencing moral resilience profiles among emergency nurses and provide recommendations to nursing managers for their enhancement.</div></div><div><h3>Methods</h3><div>In January to April 2024, a total of 543 emergency nurses from 28 tertiary hospitals in Guangdong Province were surveyed. The measurements included the General Demographic Questionnaire, Rushton Moral Resilience Scale, Simplified Coping Style Questionnaire, and Hospital Ethical Climate Survey. Data analysis was conducted using Mplus 8.3 to examine different moral resilience profiles. Multiple logistic regression was used to explore each profile’s influencing factors.</div></div><div><h3>Results</h3><div>The participating emergency nurses were categorized into 4 groups: low moral resilience group (25.6%), moral resilience potential group (31.0%), moral adversity challenge group (17.5%), and high moral resilience group (25.9%). Compared with the low moral resilience group, sex, professional title, physical health, hospital’s ethical climate, and negative coping style were common influencing factors for the other 3 groups (<em>P</em><.05). Supportive friends affected the moral resilience potential group and moral adversity challenge group (<em>P</em><.05). Monthly income and positive coping style affected the moral adversity challenge group (<em>P</em><.05). The average monthly night shifts, participation in hospital ethics courses, marital status, and positive coping style affected the high moral resilience group (<em>P</em><.05).</div></div><div><h3>Discussion</h3><div>Nursing managers can use the study’s findings to develop targeted strategies to help emergency nurses enhance moral resilience, reduce work pressure, and improve emergency care quality.</div></div>","PeriodicalId":51082,"journal":{"name":"Journal of Emergency Nursing","volume":"52 1","pages":"Pages 205-217"},"PeriodicalIF":2.3,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145208270","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-01DOI: 10.1016/j.jen.2025.08.007
Steve Agius PhD, MBA, BSc
{"title":"Author reply to Yu Letter Regarding “Cognitive Task Analysis for Developing a Clinical Decision Support System for Emergency Triage” by Agius et al","authors":"Steve Agius PhD, MBA, BSc","doi":"10.1016/j.jen.2025.08.007","DOIUrl":"10.1016/j.jen.2025.08.007","url":null,"abstract":"","PeriodicalId":51082,"journal":{"name":"Journal of Emergency Nursing","volume":"52 1","pages":"Pages 6-8"},"PeriodicalIF":2.3,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145886423","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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