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The Effect of Workplace Violence on Emotional Labor and Turnover Intention of Emergency Service Employees: A Model Study 职场暴力对应急服务员工情绪劳动和离职倾向的影响:一个模型研究。
IF 2.3 4区 医学 Q2 EMERGENCY MEDICINE Pub Date : 2026-01-01 DOI: 10.1016/j.jen.2025.07.017
Esra Bekircan PhD, Mustafa Sabak MD, Tufan Alatli MD, Fatma Boğan PhD, Emine Aykol MD, Mustafa Boğan MD

Introduction

Workplace violence against health care workers in emergency services is an important worldwide problem in terms of their occupational health and safety. This study was aimed at investigating the effect of workplace violence experienced by physicians and nurses working in emergency services on their emotional labor and turnover intentions.

Methods

The relational research model, one of the quantitative research methods, was used in the study. The study was conducted with 199 health professionals working in the emergency departments of 3 different tertiary hospitals. The data were collected through face-to-face interviews using the emotional labor scale, the workplace violence scale, and the intention to quit scale.

Results

It was observed that physicians and nurses working in emergency services (hereafter referred to as “participants”) were exposed to verbal violence, physical violence, and sexual violence in the given order. There was a positive correlation between the scores obtained from the intention to quit scale and the workplace violence scale, between the emotional labor scale and the workplace violence scale, and between the emotional labor scale and the intention to quit scale. It was concluded that emotional labor did not mediate the relationship between workplace violence and intention to quit.

Discussion

The study concluded that participants’ exposure to workplace violence was associated with increased levels of both emotional labor and intention to quit. A positive correlation was identified, indicating that higher levels of emotional labor were linked to a greater intention to quit. It is recommended that the public be educated on the effective and appropriate use of emergency services and that psychiatric nurses provide psychological support to emergency service personnel.
导言:在紧急服务中对保健工作者的工作场所暴力是影响其职业健康和安全的一个重要的世界性问题。摘要本研究旨在探讨急诊医师及护士所经历的职场暴力对其情绪劳动及离职意向的影响。方法:采用定量研究方法中的关系研究模型进行研究。研究对象是3所三级医院急诊科的199名卫生专业人员。采用情绪劳动量表、工作场所暴力量表和离职意向量表进行面对面访谈。结果:观察到在急诊服务部门工作的医生和护士(以下简称“参与者”)按给定顺序暴露于语言暴力、身体暴力和性暴力。戒烟意向量表得分与工作场所暴力量表得分、情绪劳动量表得分与工作场所暴力量表得分、情绪劳动量表得分与戒烟意向量表得分均存在正相关。结论:情绪劳动在工作场所暴力与辞职意向之间没有中介作用。讨论:研究得出的结论是,参与者接触职场暴力与情绪劳动和辞职意愿的增加有关。研究发现,两者之间存在正相关关系,表明较高水平的情绪劳动与更大的戒烟意愿有关。建议教育公众如何有效和适当地利用紧急服务,并建议精神病护士向紧急服务人员提供心理支持。
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引用次数: 0
Characteristics of an Urban Emergency Department Callback System for the Treatment of Sexually Transmitted Infections 治疗性传播感染的城市急诊科回呼系统的特点。
IF 2.3 4区 医学 Q2 EMERGENCY MEDICINE Pub Date : 2026-01-01 DOI: 10.1016/j.jen.2025.07.008
Matteo F. Pieri BS, William Huang BS, Aditya Loganathan BS, Ryan Heidish BS, Andrew C. Meltzer MD, MS

Introduction

Patient callbacks after discharge from the emergency department are critical for communicating diagnostic test results, especially for sexually transmitted infections such as gonorrhea and chlamydia. Although these callbacks are essential for timely treatment and patient education, they can be time consuming and administratively burdensome. This quality improvement initiative evaluates the volume, success rate, and primary reasons for emergency department callbacks over 6 years, focusing on patient notification, education, and treatment during their emergency department visit.

Methods

A retrospective analysis was conducted using an administrative data set of 3615 visits that required a callback to patients treated at an urban community emergency department in southeast Washington, DC, between March 2018 and June 2024. Data on callback attempts, reasons for callbacks, and patient follow-ups were extracted and analyzed. Descriptive statistics characterized the frequency and outcomes of these callbacks.

Results

Of the 3615 visits with at least 1 callback attempt, 21.2% of initial attempts failed to reach patients. Chlamydia and gonorrhea were the primary reasons for callbacks, accounting for 46.4% and 45.1% of ED cases requiring a callback, respectively. A notable 9.5% of visits requiring a callback required at least 3 attempts to reach the patient. In addition to gonorrhea and chlamydia, reasons for callbacks included positive results for herpes simplex virus, Trichomonas vaginalis, and various cultures. Limitations included missing data and free-text entries.

Discussion

The high volume of callbacks and the failure rate of initial attempts highlight inefficiencies in the current system. These findings suggest a need for improved technology and workflows to enhance timely treatment and reduce the burden on nursing and physician staff. Future studies should examine the impact of such interventions on treatment outcomes and workflow efficiencies.

Conclusions

Improving callback systems and incorporating rapid sexually transmitted infection testing could streamline ED operations, ensure timely patient treatment, and mitigate the spread of sexually transmitted infections. Further research is needed to validate these approaches and explore their broader implications for public health and clinical practice.
患者从急诊科出院后的回电对沟通诊断测试结果至关重要,特别是对于淋病和衣原体等性传播感染。虽然这些回叫对于及时治疗和患者教育是必不可少的,但它们可能是耗时和行政负担。这项质量改进计划评估了6年来急诊科回访的数量、成功率和主要原因,重点是患者在急诊科就诊期间的通知、教育和治疗。方法:回顾性分析使用2018年3月至2024年6月期间在华盛顿特区东南部城市社区急诊科接受治疗的3615次就诊的行政数据集。提取和分析回调尝试、回调原因和患者随访的数据。描述性统计描述了这些回叫的频率和结果。结果:在3615次就诊中,至少有1次回访尝试,21.2%的初次尝试未能达到患者。衣原体和淋病是回调的主要原因,分别占ED病例的46.4%和45.1%。值得注意的是,9.5%的回访需要至少3次尝试才能联系到患者。除了淋病和衣原体外,召回的原因还包括单纯疱疹病毒、阴道毛滴虫和各种培养的阳性结果。限制包括缺少数据和自由文本条目。讨论:大量的回调和初始尝试的失败率突出了当前系统的低效率。这些发现表明,需要改进技术和工作流程,以加强及时治疗,减轻护理人员和医生的负担。未来的研究应该检查这些干预措施对治疗结果和工作流程效率的影响。结论:完善回访制度和纳入快速性传播感染检测可简化急诊科手术,确保患者及时治疗,并减轻性传播感染的传播。需要进一步的研究来验证这些方法,并探索它们对公共卫生和临床实践的更广泛影响。
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引用次数: 0
Enhancing Patient Care: Venous Thromboembolism Prophylaxis in the Emergency Department 加强病人护理:急诊静脉血栓栓塞预防。
IF 2.3 4区 医学 Q2 EMERGENCY MEDICINE Pub Date : 2026-01-01 DOI: 10.1016/j.jen.2025.08.009
Meredith Scannell PhD, APRN, MSN, MPH, SANE-A, DVNA, OCN, Sandi Mackey MSN, RN, TCRN, Caroline Boudrow MBA, BSN, RN, CNOR, Deborah Sullivan MS, RN, Chaitan K. Narsule MD, FACS
Venous thromboembolism is a serious risk for hospitalized patients, especially those with long emergency department stays, yet preventive measures are often delayed. This review examines effective medication therapies and nursing interventions for venous thromboembolism prophylaxis in the emergency department. Accurate risk assessment, timely medication administration, and patient education are crucial. Medication prophylaxis, primarily with low-molecular-weight heparin, is preferred over mechanical methods. Barriers such as limited knowledge, unclear guidelines, patient refusal, and staffing shortages hinder optimal implementation. Strategies to improve prophylaxis include standardized protocols and nurse-driven initiatives. Emergency nurses are the first to care for patients in the healthcare setting and are in a key position to initiate risk assessments and additional prophylaxis but often lack the knowledge and resources. Healthcare institutions should prioritize education and address systemic barriers. Future research should focus on tailored guidelines for specific patient populations and evaluate prevention strategies. A multidisciplinary approach, incorporating evidence-based practices and patient input, is crucial for optimizing venous thromboembolism prevention and improving patient outcomes.
静脉血栓栓塞是住院患者的严重风险,特别是那些在急诊室长期住院的患者,但预防措施往往被推迟。本文综述了在急诊科预防静脉血栓栓塞的有效药物治疗和护理干预。准确的风险评估、及时的药物管理和患者教育是至关重要的。药物预防,主要是低分子量肝素,比机械方法更可取。知识有限、指南不明确、患者拒绝和人员短缺等障碍阻碍了最佳实施。改善预防的战略包括标准化方案和护士推动的举措。急诊护士是医疗机构中第一个照顾病人的人,在启动风险评估和额外预防方面处于关键地位,但往往缺乏知识和资源。医疗机构应优先考虑教育,解决体制障碍。未来的研究应侧重于针对特定患者群体的量身定制的指导方针,并评估预防策略。结合循证实践和患者输入的多学科方法对于优化静脉血栓栓塞预防和改善患者预后至关重要。
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引用次数: 0
Development and Implementation of the Modified Pediatric Emergency Department Overcrowding Scale in Two Large Academic Pediatric Centers 修订后的儿科急诊科人满为患量表在两个大型学术儿科中心的制定和实施。
IF 2.3 4区 医学 Q2 EMERGENCY MEDICINE Pub Date : 2026-01-01 DOI: 10.1016/j.jen.2025.08.008
Nathan Timm MD, Laura Kemp RN, DNP, Benjamin Kerrey MD, MS, Megan Elam EdD, Kevin M. Overmann MD, MS, Christina Lillich RN, Amanda Thorne DNP, RN, Jennell Collins MSN, RN, Melody Siska MBA, Michael Ponti-Zins MS, Elena Duma MD, Jessica Revet MSN, RN, CEN, Samuel Snell MSN, RN, NEA-BC, CEN, LSSBB, Aralola Ajiboye MSc, PMP, Daniel Imler MD
Emergency department crowding is a chronic problem within health care systems. The consequences of crowding are well documented with negative impacts on patient outcomes, patient/family satisfaction, staff stress, and medical errors. This study describes the implementation of the Pediatric Emergency Department Overcrowding Scale in 2 emergency departments, a 45-bed and a 22-bed, within a large pediatric academic medical center. Initial work revealed the scale worked well at a 45-bed emergency department but significantly underreported crowding at the 22-bed emergency department. A bed capacity correction factor was developed and incorporated in the Pediatric Emergency Department Overcrowding Scale formula, thus standardizing the view of crowding in each emergency department. The modified Pediatric Emergency Department Overcrowding Scale provided real-time visualization of crowding in both emergency departments and health care system capacity management systems. The modified Pediatric Emergency Department Overcrowding Scale was shared with a pediatric emergency department within another large academic pediatric medical center. Implementation of the bed capacity correction factor into their system resulted in a similarly improved demonstration of emergency department crowding through the Pediatric Emergency Department Overcrowding Scale.
急诊拥挤是卫生保健系统中的一个长期问题。拥挤的后果对患者预后、患者/家属满意度、工作人员压力和医疗差错都有负面影响。本研究描述了在一家大型儿科学术医疗中心的两个急诊科,一个45张床位和一个22张床位,实施儿科急诊科过度拥挤量表。最初的工作显示,该量表在45个床位的急诊科效果良好,但在22个床位的急诊科明显低估了拥挤程度。制定了床位容量校正因子,并将其纳入儿科急诊科人满为患量表公式,从而规范了各个急诊科的拥挤情况。修改后的儿科急诊科过度拥挤量表提供了急诊科和卫生保健系统能力管理系统拥挤情况的实时可视化。修改后的儿科急诊科过度拥挤量表与另一个大型学术儿科医疗中心的儿科急诊科共享。在他们的系统中实施床位容量校正因子,通过儿科急诊科过度拥挤量表,同样改善了急诊科拥挤的表现。
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引用次数: 0
Leading With Authenticity: Reducing Workplace Violence in the Emergency Department 真实领导:减少急诊科的工作场所暴力
IF 2.3 4区 医学 Q2 EMERGENCY MEDICINE Pub Date : 2026-01-01 DOI: 10.1016/j.jen.2025.08.010
Patricia Kunz Howard PhD, RN, CEN, CPEN, TCRN, NE-BC, FAEN, FAAN, JoAnn Lazarus MSN, RN, CEN, FAEN, Margaret Spencer BA
Workplace violence is a widespread issue in emergency departments, posing significant physical and emotional risks to health care workers. Authentic leadership, centered on transparency, empathy, and ethical behavior, has emerged as a potential approach to mitigate these risks by fostering trust, collaboration, and a safety culture. By addressing the root causes of violence and empowering teams through open communication, effective role modeling, and comprehensive training, authentic leaders can create supportive environments that reduce violence and improve outcomes for both staff and patients.
工作场所暴力是急诊科普遍存在的问题,对卫生保健工作者造成重大的身心风险。以透明度、同理心和道德行为为中心的真正的领导,已经成为通过培养信任、合作和安全文化来减轻这些风险的潜在方法。通过解决暴力的根本原因,并通过开放的沟通、有效的角色塑造和全面的培训赋予团队权力,真正的领导者可以创造支持性的环境,减少暴力,改善工作人员和患者的结果。
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引用次数: 0
Application of Multistrategy Improvement Gray Wolf Algorithm to Optimize Extreme Gradient Boosting in Emergency Triage 应用多策略改进灰狼算法优化极值梯度增强在急诊分诊中的应用。
IF 2.3 4区 医学 Q2 EMERGENCY MEDICINE Pub Date : 2026-01-01 DOI: 10.1016/j.jen.2025.07.015
Tichen Huang BMgmt, Yuyan Jiang MSc, Rumeijiang Gan MSc, Heping Wang PhD, Fuyu Wang PhD, Yan Li PhD

Introduction

Effective triage in the emergency department (ED) is essential for optimizing resource allocation, improving efficiency, and enhancing patient outcomes. Conventional systems rely heavily on clinical judgment and standardized guidelines, which may be insufficient under growing patient volumes and increasingly complex presentations.

Methods

We developed a machine learning triage model, MIGWO-XGBOOST, which incorporates a Multi-strategy Improved Gray Wolf Optimization (MIGWO) algorithm for parameter tuning. Missing data were processed, and the dataset was randomly split into 80 percent for training and 20 percent for testing. Model performance was evaluated against standard XGBOOST, GWO XGBOOST, AdaBoost, LSTM, and CNN-BiGRU.

Results

MIGWO-XGBOOST improved accuracy by 8.5 percent over unoptimized XGBOOST and reduced optimization time by 9,285 seconds relative to GWO-XGBOOST. Compared with other benchmarks, accuracy gains were 12.5 percent over AdaBoost, 3.3 percent over LSTM, and 1.9 percent over CNN-BiGRU. These results demonstrate both predictive strength and computational efficiency in complex data environments.

Discussion

MIGWO-XGBOOST provides a robust framework for rapid and precise triage decisions in the ED. By enhancing accuracy while substantially reducing computational time, this approach demonstrates the potential of advanced machine learning to support emergency decision-making and optimize patient care pathways.
简介:在急诊科(ED)有效的分诊对于优化资源分配、提高效率和提高患者预后至关重要。传统系统在很大程度上依赖于临床判断和标准化指南,在患者数量不断增加和症状日益复杂的情况下,这可能是不够的。方法:我们开发了一个机器学习分类模型MIGWO- xgboost,该模型采用了多策略改进灰狼优化(MIGWO)算法进行参数调整。缺失的数据被处理,数据集被随机分成80%用于训练,20%用于测试。模型性能根据标准XGBOOST、GWO XGBOOST、AdaBoost、LSTM和CNN-BiGRU进行评估。结果:与未优化的XGBOOST相比,MIGWO-XGBOOST的精度提高了8.5%,优化时间比GWO-XGBOOST减少了9285秒。与其他基准相比,准确度比AdaBoost提高12.5%,比LSTM提高3.3%,比CNN-BiGRU提高1.9%。这些结果证明了在复杂数据环境下的预测强度和计算效率。讨论:MIGWO-XGBOOST为急诊科快速准确的分诊决策提供了一个强大的框架。通过提高准确性,同时大幅减少计算时间,这种方法展示了先进机器学习在支持紧急决策和优化患者护理途径方面的潜力。
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引用次数: 0
Brain Edema After Cosmetic Botulinum Toxin Injection: A Case Report 美容用肉毒毒素注射后脑水肿1例报告。
IF 2.3 4区 医学 Q2 EMERGENCY MEDICINE Pub Date : 2026-01-01 DOI: 10.1016/j.jen.2025.08.013
Lan Lai BSN, RN, Zhongxiang Wang MSN, RN, Yajun Sun MSN, RN
A 26-year-old woman presented to the emergency department with progressive symptoms including fever, pharyngeal pain, dysphagia, bilateral ptosis, and generalized weakness after cosmetic botulinum toxin injections to the neck. This case report aimed to describe an unusual presentation of botulinum neurotoxin-associated central nervous system involvement. This manuscript is a case review describing the clinical course, diagnostic challenges, and management strategies of brain edema after botulinum toxin type A exposure. Key points include the importance of recognizing nontraditional presentations of botulism in emergency settings, the potential for central neurologic complications after cosmetic procedures, and the critical role of emergency nurses in early symptom recognition, airway management, and multidisciplinary coordination for antitoxin administration and intensive care support.
一名26岁女性在颈部注射美容肉毒杆菌毒素后出现进行性症状,包括发烧、咽部疼痛、吞咽困难、双侧上睑下垂和全身无力。本病例报告旨在描述肉毒杆菌神经毒素相关中枢神经系统受累的不寻常表现。这篇手稿是一个病例回顾,描述了a型肉毒杆菌毒素暴露后脑水肿的临床过程、诊断挑战和管理策略。重点包括在紧急情况下识别非传统肉毒杆菌中毒表现的重要性,美容手术后中枢神经并发症的可能性,以及急诊护士在早期症状识别、气道管理、抗毒素给药和重症监护支持的多学科协调方面的关键作用。
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引用次数: 0
Psychosocial Care of Pregnancy Loss in the Emergency Department 急诊科流产妊娠的心理社会护理
IF 2.3 4区 医学 Q2 EMERGENCY MEDICINE Pub Date : 2026-01-01 DOI: 10.1016/j.jen.2025.10.005
Rebecca Mattson PhD, RN, PHN, Shandeigh N. Berry PhD, RN, CNE

Introduction

Emergency departments in the United States manage nearly 900,000 visits annually for early pregnancy loss. Patients frequently report limited emotional support, inadequate provider knowledge, and insufficient communication.

Methods

A pre- and postintervention design was used to assess ED staff knowledge, attitudes, and supportive care skills related to reproductive grief. Demographic data were collected. Paired t tests evaluated changes across 7 educational domains.

Results

The analytic sample (N = 39) consisted of chaplains (7.7%), nurses (61.6%), patient care assistants (7.7%), radiology technicians (5.1%), social workers (5.1%), and ED technicians (12.8%). Postintervention analyses demonstrated increased mean scores across all domains, including emotional support, patient-centered care, discharge planning, bereavement care, community resources, staff support, and communication (P < .0001).

Discussion

The findings suggest that staff education may improve miscarriage care. Additional research is necessary to confirm these results, establish validity, and assess generalizability across settings.
在美国,急诊部门每年处理近90万例早孕流产。患者经常报告情感支持有限,提供者知识不足,沟通不足。方法采用干预前和干预后设计,评估急诊科工作人员对生殖悲伤的知识、态度和支持性护理技能。收集了人口统计数据。配对检验评估了7个教育领域的变化。结果分析样本(N = 39)包括牧师(7.7%)、护士(61.6%)、病人护理助理(7.7%)、放射技师(5.1%)、社工(5.1%)和急诊科技师(12.8%)。干预后分析显示,所有领域的平均得分都有所提高,包括情感支持、以患者为中心的护理、出院计划、丧亲护理、社区资源、员工支持和沟通(P < 0.0001)。讨论本研究结果提示员工教育可改善流产护理。需要进一步的研究来证实这些结果,建立有效性,并评估跨设置的普遍性。
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引用次数: 0
Information for Readers 读者资讯
IF 2.3 4区 医学 Q2 EMERGENCY MEDICINE Pub Date : 2026-01-01 DOI: 10.1016/S0099-1767(25)00502-1
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引用次数: 0
The Power of Positive Self-Affirmation 积极自我肯定的力量
IF 2.3 4区 医学 Q2 EMERGENCY MEDICINE Pub Date : 2026-01-01 DOI: 10.1016/j.jen.2025.10.014
Michael Dustin Bass DNP, MHA, RN, CEN, NEA-BC
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引用次数: 0
期刊
Journal of Emergency Nursing
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