Journal of Emergency Nursing最新文献

Introduction: Evaluation of the intravenous catheterization process in our emergency department revealed that patients with difficult venous access experienced multiple failed peripheral intravenous attempts and treatment delays. This study aimed to improve flagging of patients with difficult venous access and increase first-attempt intravenous catheter insertion in adult emergency department patients.

Methods: The project used a consecutive cohort sampling approach, comparing 2 cohorts of adult patients from the emergency department. The comparator cohort (n = 2016) assessed patient venous access using standard methods, whereas the implementation cohort (n = 2005) used the adult difficult intravenous access scale. Patients flagged as high risk by the scale received ultrasound-guided cannulation from a trained nurse. Analyses compared cohorts on self-reported demographic characteristics, catheter characteristics, difficult venous access flagging, and first-attempt intravenous success.

Results: The adult difficult intravenous access scale significantly improved the flagging of difficult venous access patients between cohorts, from 2% to 10%. Overall, first-attempt intravenous success significantly increased between cohorts from 33% to 41%. In patients with difficult venous access, 97% of the implementation cohort received catheter insertion on the first attempt.

Discussion: Results showed an absolute increase of 8% in both difficult venous access flagging and first-attempt success, a relative 400% improvement in difficult venous access flagging, and a 24% increase in first-attempt intravenous success, demonstrating the effectiveness of combining the adult difficult intravenous access scale with ultrasound-guided cannulation.

Introduction: Acute pancreatitis in pregnancy is a rare but potentially life-threatening cause of acute abdomen for both the pregnant patient and the unborn child. Prompt recognition and multidisciplinary coordination in the emergency department are essential.

Case presentation: A 26-year-old gravida 3, para 0 patient at 39 + 1 weeks' gestation presented to the emergency department with severe upper abdominal pain, nausea, and vomiting. Laboratory testing showed markedly elevated serum amylase and lipase, and ultrasonography identified gallstones consistent with gallstone pancreatitis.

Interventions: Emergency nursing care prioritized rapid triage, maternal assessment and fetal surveillance, intravenous access and fluid resuscitation, symptom-guided analgesia and antiemetics, oxygen supplementation, and early consultation/transfer using a structured situation-background-assessment-recommendation handoff.

Outcomes: After multidisciplinary evaluation, an emergency cesarean section was performed. The neonate required neonatal intensive care unit observation, and the patient received intensive care unit care for pancreatitis. Both were discharged in stable condition 12 days after presentation.

Conclusion: This case highlights the emergency nurse's role in recognizing acute pancreatitis in pregnancy, initiating stabilization, coordinating timely transfer, and supporting patient-family communication in high-risk obstetrical emergencies.

Introduction: Disasters and mass casualty incidents are increasing owing to natural hazards, violence, and public health crises. A disaster-prepared emergency nurse workforce is essential for patient safety and system resilience. At a high-volume level 1 trauma center, a recent mass casualty incident revealed significant gaps in nurse preparedness, including limited knowledge of the emergency operations plan, insufficient training, and low confidence.

Methods: Guided by Rogers' 5-stage change theory and the knowledge-to-action framework, this quality improvement project targeted 31 emergency nurse leaders. Pre- and postintervention outcomes were measured using the emergency preparedness information questionnaire, a disaster preparedness skills questionnaire, and the nursing attitudes regarding disaster preparedness scale. The program included didactic education, hands-on training, tabletop exercises, and the development of an "MCI Playbook." Nurse leaders as "Super Users" and a microlearning series called "Trauma Tuesdays" supported sustainability.

Results: Nurse knowledge increased by 71.6%, confidence by 38.8%, and perceived skills by 9.5%. Post-training scores between experienced and inexperienced nurses were nearly identical, demonstrating the program's effectiveness in closing the knowledge gap.

Discussion: A structured, evidence-based disaster preparedness program improved emergency nurse readiness for mass casualty incidents and provided a replicable model for other health systems. Sustainability was strengthened through institutional backing, nurse leaders as "Super Users," and integration of an "MCI Playbook."

Introduction: Out-of-hospital cardiac arrest is a global health concern, in which bystanders' ability and willingness to perform cardiopulmonary resuscitation determine the survival and neurologic performance of patients. This study aimed to synthesize the available evidence that compares the effects of standard cardiopulmonary resuscitation with chest compression-only cardiopulmonary resuscitation provided by bystanders in terms of survival and neurologic performance at 1 month or later after out-of-hospital cardiac arrest.

Methods: This systematic review with meta-analysis adhered to recognized reporting guidelines. The search strategy was performed in the MEDLINE, Embase, Cochrane Library, and Web of Science databases from inception to February 2025. The DerSimonian and Laird method was used to calculate odds ratios with 95% CIs. Standard cardiopulmonary resuscitation was considered the intervention group, and compression-only cardiopulmonary resuscitation was considered the control group. The risk of bias was assessed using the Newcastle‒Ottawa quality assessment scale. Egger's test and funnel plot symmetry were used to assess publication bias.

Results: Six cohort studies were included. A comparison of standard cardiopulmonary resuscitation and compression-only cardiopulmonary resuscitation performed by bystanders revealed that standard cardiopulmonary resuscitation improved survival at and beyond 30 days after out-of-hospital cardiac arrest (odds ratio, 1.22; 95% CI, 1.00-1.43; I² = 90.9%; P≤.05). However, no significant differences were found in terms of favorable neurologic performance (odds ratio, 1.22; 95% CI, 0.96-1.48; I² = 78.7%; P≤.05).

Discussion: Compared with compression-only cardiopulmonary resuscitation, bystander-provided standard cardiopulmonary resuscitation may increase survival after out-of-hospital cardiac arrest, with a positive (albeit nonsignificant) trend toward better neurologic performance. However, there are not enough studies with randomized controlled designs and longer follow-up periods to establish robust recommendations.

Introduction: Health care professionals show limited competencies regarding intimate partner violence against women, which influences their approach. Professional category seems to be a predictor of detection practices. This study aimed to evaluate the knowledge, preparedness, opinions, and detection practices regarding intimate partner violence against women among health care professionals in hospital emergency departments (n = 178) according to professional category.

Methods: This was a cross-sectional multicenter study using a reduced Spanish version of the Physician Readiness to Manage Intimate Partner Violence Survey questionnaire among emergency nurses and physicians of urban hospital emergency services in the city of Granada, in southern Spain. Binary and multivariate logistic regression models were designed to quantify the magnitude of association between variables and case detection.

Results: Notably, 77% of participants indicated that they had not received previous training in intimate partner violence against women, 26% did not ask questions to identify the abuse, and 65% did not detect any cases in the last 6 months, especially nurses (P = .003). Being an emergency physician (adjusted odds ratio, 2.60; 95% CI, 1.01-5.66), with previous training in gender-based violence (adjusted odds ratio, 4.88; 95% CI, 1.67-14.25) and feeling familiar with the center's policies (adjusted odds ratio, 3.22; 95% CI, 1.30-8.00), was associated with the practice of detecting victims in hospital emergency departments.

Discussion: The low level of preparedness of emergency department health care professionals to identify and respond to intimate partner violence against women is worrying. The findings emphasize the need to evaluate the training programs being offered and the dissemination and monitoring of the protocols in force and to implement standardized detection tools and reinforce the development of emergency nurses' skills and responsibilities.

Introduction: Diagnostic errors in emergency departments significantly affect patient morbidity and mortality. Nurses play a crucial role in the diagnostic process. The Patient-Reported Instrument for Measuring Diagnostic Excellence in Emergency Departments assesses patient perceptions of diagnostic accuracy and communication. This study aimed to identify factors associated with patients' perceptions of diagnostic quality to support nursing efforts in improving patient safety.

Methods: A cross-sectional survey was administered to patients who visited an emergency department within the past 30 days using an electronic health record messaging platform. The 17-item Patient-Reported Instrument for Measuring Diagnostic Excellence in Emergency Departments survey measured perceptions of diagnostic experience, accuracy, and communication, with higher scores indicating more positive perceptions.

Results: Among respondents (n = 454), most participants identified as white (78.7%), non-Hispanic (87%), and female (60.5%). Females reported significantly lower diagnostic experience scores than men (P = .003). Older adults, particularly those aged 70 to 79 years, reported significantly higher Patient-Reported Instrument for Measuring Diagnostic Excellence in Emergency Departments scores than younger participants (P<.03). In addition, longer ED stays correlated with lower perceived diagnostic excellence (P<.05).

Discussion: Despite overall high ratings, disparities in diagnostic perception were evident, especially among females and younger patients, who reported lower satisfaction with diagnostic communication. Extended emergency department stays were linked to reduced perceptions of diagnostic quality. These findings highlight areas where nurses can positively influence patient understanding and safety through enhanced communication.

Introduction: Undertriage of geriatric trauma patients remains a critical concern in emergency care, with rates exceeding 50% in this vulnerable population. Emergency nurses, as frontline decision makers, play a pivotal role in triage outcomes, yet their experiences and decision-making processes when triaging geriatric trauma patients remain largely unexplored. This study aimed to explore emergency nurses' experiences in triaging geriatric trauma patients, focusing on the challenges and strategies influencing their decision making.

Methods: A qualitative descriptive design using inductive content analysis was used. Fifteen emergency triage nurses from a tertiary trauma center in northern China were purposively selected and participated in semistructured interviews between April and June 2025. Data were analyzed using systematic coding and categorization to identify themes and categories.

Results: Three main categories were identified: multidimensional challenges in triage decision making, proactive strategies for managing uncertainty, and professional commitment as the foundation for perseverance. Nurses faced significant challenges owing to atypical presentations, limited information, insufficient support, and moral conflicts in triage decisions. Emergency nurses navigated these challenges by observing subtle cues, rechecking assessments, and seeking peer support. Their professional identity was reinforced by a strong commitment to patient safety despite uncertainty.

Discussion: Emergency nurses navigate geriatric trauma triage within a context of heightened uncertainty, resource constraints, and ethical tensions. Although they demonstrate resilience through proactive coping strategies, persistent cognitive strain highlights the need for geriatric-specific educational interventions, decision-support systems, and psychological support to strengthen decision-making confidence and reduce undertriage risk.

Introduction: Cognitive impairment is common among older patients in emergency departments and is associated with increased hospitalization risks and adverse outcomes. Given the rising prevalence of cognitive impairment among older patients in China, existing cognitive screening tools are often unsuitable for the fast-paced emergency care environment. This study aimed to adapt and validate a Chinese version of the six-item screener for efficient cognitive screening in older adults attending the emergency department.

Methods: Using the Brislin model, we translated and back-translated the English version of the six-item screener and then performed cultural adaptation and expert panel review. By conducting a pilot test with 30 older patients in the emergency department, which informed the development of the Chinese version, we subsequently conducted a cross-sectional validation study with 169 older patients in a tertiary hospital emergency department. We evaluated reliability, validity, factor structure, and cutoff values.

Results: The Chinese version of the six-item screener was restructured into 4 dimensions: immediate recall, temporal orientation, spatial orientation, and memory. Item-level content validity index for the Chinese version of the six-item screener items varied from 0.93 to 1.00, whereas the average scale-level content validity index was 0.98. Exploratory factor analysis identified a 4-factor structure explaining 61.7% of variance. Optimal cutoff scores varied by educational level, and the Cronbach's α coefficient was 0.68, indicating acceptable internal consistency.

Discussion: The validated Chinese version of the six-item screener is a practical, reliable, and culturally appropriate instrument for screening cognitive impairment among older adult patients visiting Chinese emergency departments. Its use may enable emergency nurses to identify at-risk patients promptly, improve patient safety, and support better clinical outcomes.

Introduction: Low back pain is a leading cause of disability worldwide. Despite most cases being nonurgent and best managed in primary care, low back pain remains a common reason for emergency department presentations. Given the potential differences in recovery and management needs in this setting, digital care pathways offer a scalable tool for remote monitoring and targeted research. This study aimed to explore symptom trajectories of people with low back pain presenting to the emergency department over 12 weeks using a digital care pathway.

Methods: Eligible participants were adults presenting to the emergency department with neuromusculoskeletal low back pain who were not admitted for ward care. Participants completed patient-reported outcomes on pain (numerical pain rating scale), quality of life (EuroQol 5-dimension 5-level), function (Oswestry disability index), and psychological state at 3 time points over 12 weeks, with recovery trajectories analyzed using linear mixed-effects models.

Results: A total of 111 people with low back pain registered for the digital care pathway over 6 months. Improvements from baseline to 6 weeks were observed for pain (mean difference, 3.0; 95% CI, 2.1-3.9; P<.001), quality of life (-0.1; -0.2 to 0.0; P = .005), and function (13.6; 7.3-19.9; P<.001), with no improvement between 6 and 12 weeks. Psychological state, inclusive of depression, anxiety, and stress, did not change over the 12-week period.

Discussion: Although people with low back pain in the emergency department show a similar recovery trajectory to those in general practice, they present with higher levels of pain and disability throughout recovery. Given high levels of pain and disability, minimalist care may be inadequate in this setting, highlighting the need for ED-specific low back pain guidelines.

Introduction: Stroke coordinators spend much of their time in the emergency department; many of them are nurses working dual roles as current emergency nurses or trauma coordinators and stroke coordinators. How this hybrid role affects burnout is unknown. This study assessed the impact of this gap on stroke program managers and coordinators through the Texas Stroke Program Survey.

Methods: An electronic survey, with the validated Maslach Burnout Inventory--Human Services Survey instrument to evaluate work-related burnout, was distributed to 181 Texas-designated stroke facilities. They were asked to have 1 stroke coordinator or manager complete the survey anonymously.

Results: Of the 105 approached, 103 responded, and 78 completed the Maslach Burnout Inventory-Human Services Survey, of whom 83.5% (86 of 103) worked at primary or comprehensive stroke centers. Maslach Burnout Inventory-Human Services Survey results showed that 74.4% of the population (58 of 78) exhibited burnout profiles, which were characterized by feelings of ineffectiveness, overextension, or burnout. Turnover among stroke coordinators was high, with 49.5% (51 of 103) reporting 2 or more turnovers over 5 years.

Discussion: The survey results highlight significant variability in role definition and responsibilities among stroke coordinators. Nearly 91.3% of respondents (94 of 103) emphasized the need for standardizing program requirements and providing adequate support for staff development. Implementing a program like those used in trauma centers may reduce variability, enhance support, and mitigate burnout.