Journal of Emergency Nursing最新文献

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.

Introduction: Information regarding the factors influencing the intention of family members of patients admitted to the emergency department to commit violence against health care professionals is limited. This study aimed to determine the factors affecting the intention of family members of patients admitted to the emergency department to commit violence against health care professionals.

Methods: This multicenter cross-sectional study, conducted in 3 Turkish hospitals from December 2023 to May 2024, involved 872 family members of emergency department patients. Ethical approval was obtained (approval no: 2023/83). Data were collected through face-to-face surveys using the Intention to Commit Violence Against Healthcare Workers Scale and the Healthcare Access Experience Form. Analysis was performed with SPSS 22.0 using both parametric and nonparametric tests, with significance set at P<.05.

Results: The participants' average age was 35.60 SD = 10.89, with 56.8% male and 61.5% having completed secondary education. Significant factors increasing the intention to commit violence included younger age (P = .001), lower education (P = .001), unemployment (P = .001), and being single (P = .001). Although the overall intention to commit violence was low, negative perceptions regarding health care access, such as lack of information about their relative's condition (P = .001), inability to see their relative during treatment (P = .001), and exclusion from care (P = .001), significantly heightened this intention.

Discussion: This study reveals that the strongest factors influencing the intention to commit violence among family members of patients admitted to the emergency department are the lack of information about their relative and inadequate communication.

Introduction: Health care workers experience settings that can contribute to burnout and post-traumatic stress disorder. Early identification of health care workers at risk for burnout/post-traumatic stress disorder may allow for quicker implementation of mitigation strategies despite limited research. This pilot study explores associations between burnout and post-traumatic stress disorder with demographic and occupational factors in health care workers.

Methods: This quantitative, cross-sectional study on burnout and post-traumatic stress disorder was conducted at a single-site urban academic emergency department from 2022 to 2023. Health care workers were split into provider versus non-provider for confidentiality. Burnout and post-traumatic stress disorder were operationalized using the Oldenburg Burnout Inventory and Post-Traumatic Stress Disorder checklist.

Results: In this cohort (n = 72), many identified as non-Hispanic white (54%) females (74%), and were non-providers (75%) who worked 32 to 40 hours/week (75%). Although not significant, non-providers reported higher disengagement (14.8% vs 0%, P = .19). Females had higher exhaustion (64.2% vs 57.9%, P = .63) while males had higher disengagement (15.8% vs 9.4%, P = .43). Participants <40 had higher disengagement and exhaustion (15.8% vs 5.9%, P = .27; 68.4% vs 55.9%, P = .27), while a previous depression diagnosis led to increased moderate-to-severe disengagement, exhaustion, and burnout (26.7% vs 6.9%, P = .05; 80.0% vs 56.9%, P = .14; and 53.3% vs 37.9%, P = .28, respectively).

Discussion: Though these results are not statistically significant, we demonstrate important associations that are clinically relevant. Non-providers under 40 showed higher disengagement, which may be related to competing responsibilities, while depression increased burnout severity across all domains. Importantly, future research with increased samples will allow relevant sub-group comparisons (ie, nurses vs other non-providers) and continued exploration of factors that influence elevated burnout in health care workers.

Introduction: Prehospital emergency nursing is a critical domain requiring specialized competencies and robust clinical preparation. Nurses in this sector manage high-complexity situations necessitating a broad range of competencies. This study aimed to identify and validate the essential competencies required for specialized ambulance nurses in Italy using a modified Delphi methodology.

Methods: A Delphi study was conducted with a panel of 10 experts, including clinical practitioners and academic professionals. The study involved 2 rounds of questionnaires designed to gather and refine expert opinions on the competencies necessary for ambulance nurses.

Results: The experts identified a comprehensive set of 77 competencies across various domains, emphasizing advanced clinical competencies, decision-making abilities, communication, interpersonal competencies, and leadership. The first round highlighted 31 competencies from clinical experts and 46 from academic experts, with significant overlaps and some divergences. The second round achieved high consensus on many competencies, though some areas, such as holistic and spiritual competencies, showed varied levels of agreement.

Discussion: The identified competencies underscore the complexity and dynamic nature of prehospital emergency nursing. The results provide a framework for developing targeted training programs to prepare nurses for the demands of this field. Continuing education emerged as a crucial element for maintaining and enhancing competencies in the evolving landscape of emergency health care.

Introduction: The family members of patients are an important part of a patient's social support system. The needs of the family members of patients are critical factors that medical staff need to consider when formulating treatment plans. This study aimed to culturally adjust the traditional Chinese version of the Critical Care Family Needs Inventory in the Emergency Department to the simplified Chinese version for use with families in the emergency department of mainland China, test its reliability and validity, understand the needs and factors influencing scores, and to provide a reference for promoting patient and family-centered care.

Methods: A cross-sectional survey was conducted to collect data from family members of a tertiary hospital in northeast China. This study consisted of 2 phases. Phase Ⅰ: 258 questionnaires were collected in the scale revision phase for the assessment of construct validity using exploratory factor analysis. In addition, internal consistency reliability and content validity were used to evaluate the psychometric characteristics. Phase Ⅱ: 297 family members were recruited in the cross-sectional survey phase. The data were collected through the simplified Chinese version of Critical Care Family Needs Inventory in the Emergency Department and analyzed with SPSS 26.0 Statistics software.

Results: In the scale revision phase of the study, the content validity index was 0.92, and the total Cronbach's alpha coefficient was 0.87. In the cross-sectional survey phase, the mean score of family members' needs was 109.2 ± 9.8 (95%CI 108.1, 110.4). Age (P = .019), residential address (P = .001), income (P = .004), and triage category (P = .001) are independent factors influencing total scores.

Discussion: Our findings suggested that the Simplified Chinese version of Critical Care Family Needs Inventory in the Emergency Department is a valid and reliable scale for use within mainland China. The needs of family members are at a high level. Hence, emergency nurses need to acquire more knowledge about family needs to better consider and address their needs.

Introduction: New technologies developed for triage systems can have positive effects on health care professionals. The research was conducted to identify and visualize the studies conducted between 2001 and 2024 on triage and digital triage systems in emergency departments and reveals global trends on this subject.

Methods: The data were obtained from the "Web of Science Core Collection" database on February 8th, 2024. Performance analysis, scientific mapping, and bibliometric analyses were performed using the VOSviewer (1.6.15) software program. Data from 236 publications were analyzed in the study.

Results: The most publications were by Alcock J (n = 3), the most publications by country were published in the USA (n = 114), Harvard University (n = 19) was the institution that published the most, the United States Department of Health Human Services (n = 25) supported publications among the funding institutions, and the most publications were published in the Emergency Medicinal Journal (n = 8).

Discussion: The results obtained from the study reveal the triage and digital triage systems used in emergency services, provide a general perspective on the subject, and guide future research on this subject.