Journal of Emergency Nursing最新文献

Traumatic arteriovenous fistulas, accounting for most cases (approximately 82%-98%), are typically the consequence of penetrating injuries. The ulnar and radial arteries are the most common sites of occurrence, whereas incidents at the distal radial and ulnar arteries are rare. This emphasizes the critical role of systematic clinical reasoning when evaluating patients with unclear or atypical presentations. Emergency nurses play a vital role in recognizing red flags, escalating care, and advocating for further investigation when standard treatments fail. A previously healthy 55-year-old woman presented with a pulsating and painful swelling on the volar aspect of her right hand, which gradually increased in size after a puncture injury from a fishbone. Emergency nurses should recognize that such presentations require immediate vascular assessment, given that the pulsatile nature and progressive enlargement are key clinical indicators that distinguish arteriovenous fistulas from simple soft tissue injuries. On clinical assessment, a pulsatile mass was noted. Duplex ultrasound, along with angiography, confirmed the presence of an arteriovenous fistula. Differential diagnoses, such as pseudoaneurysm or soft tissue hematoma, were considered but ruled out based on imaging and flow characteristics. A successful embolization procedure was performed to treat the arteriovenous fistulas in her right hand, yielding a positive outcome. For emergency nurses, this case emphasizes the importance of thorough neurovascular assessment in all penetrating hand injuries, regardless of apparent severity. Early recognition of pulsatile masses, assessment of distal perfusion, and prompt escalation to vascular specialists are crucial nursing interventions. The diagnosis of arteriovenous fistulas should not be underestimated, given that they can potentially lead to serious complications such as infection, aneurysm, stenosis, congestive heart failure, steal syndrome, ischemic neuropathy, and thrombosis. Emergency nurses play a pivotal role in early detection through systematic assessment and patient education about warning signs, ultimately preventing progression to life-threatening complications through timely intervention.

Introduction: Chest pain is a leading cause of emergency department visits worldwide. At a Midwest urban level 1 trauma center, chest pain accounts for an average of 2530 emergency department visits annually and constitutes the highest number of observation admissions. This quality improvement initiative aimed to educate emergency nurses and implement an evidence-based chest pain pathway to reduce observation admissions and decrease length of stay.

Methods: Emergency nurses completed pre- and post-education surveys. Educational sessions, delivered both online and in-person, were provided based on the results of a pre-survey. An evidence-based chest pain pathway was implemented. Patients' electronic health records were reviewed and analyzed.

Results: Emergency nurses' chest pain knowledge significantly improved after education [χ² (1) = 6.125; P =.008]. The admission rate (observation and inpatient) among patients meeting the inclusion criteria decreased from 31.16% to 28.55%. The emergency department discharges increased from 68.84% to 71.45%. The length of stay did not significantly increase (P = .89). By sustaining the 2.61% increase in discharges, there is a projected annual variable cost savings of $104,544.66.

Conclusion: This quality improvement initiative resulted in increased knowledge among emergency nurses. This was clinically significant given that it enhanced interdisciplinary collaboration, facilitating an increase in discharges among patients with chest pain. Furthermore, this initiative improved transitions of care across different settings. Future work is recommended to assess the applicability of the initiative and the sustainability of results in other organizations.

Pediatric emergency nurses play a central role in mass casualty incident response, yet persistent gaps in readiness remain. This quality improvement project evaluated baseline mass casualty incident readiness among registered nurses in a large pediatric emergency department and assessed the impact of an educational intervention combining didactic review and simulation-based functional exercises. Using a pre-/postintervention design, nurses completed a readiness survey and participated in timed functional tasks to assess knowledge, confidence, and efficiency. The intervention comprised a didactic review of institutional protocols, a practical review of supply locations, and 30-minute functional simulation drills focused on zone leader responsibilities. A total of 63 nurses completed preassessments, and 64 completed postassessments. After the intervention, 92% accurately identified supply locations, 98% described zone leader roles, and 100% reported feeling at least neutral in preparedness. Knowledge gains in this project were statistically significant (P < .001). The results indicate that structured education combined with simulation improved pediatric emergency nurses' readiness for mass casualty incidents within this setting. The intervention's effectiveness was further demonstrated when it was applied successfully during an actual mass casualty incident. Incorporating pediatric-focused mass casualty incident training into ongoing ED education may continue to enhance nurse competence, support team performance, and strengthen institutional disaster preparedness.

Introduction: Patients in emergency departments require both effective medical treatment and emotional support. Presently, the humanistic care, empathic abilities, and influencing factors related to nursing students working in emergency departments are not well understood. This study aimed to explore the current state and influencing factors of humanistic care and empathy skills among Chinese nursing students working in emergency departments.

Methods: A multicenter cross-sectional study involving nursing students was conducted. Data were collected on general information, the humanistic caring ability scale for nursing students, and the Jefferson scale of physician empathy for nursing students.

Results: From August 2023 to August 2024, a survey of 400 nursing students was conducted across 9 top-tier Chinese hospitals' emergency departments in China. The average humanistic care ability score was 77.16 ± 11.02, whereas empathy scored 100.64 ± 15.45. Regression analysis indicated several factors influencing humanistic care ability: reasons for choosing the nursing profession, the humanistic education at school, the humanistic care atmosphere in the emergency department, and noninstructing teachers' care during the emergency department internship. In addition, sex was associated with the empathy score.

Discussion: The humanistic care and empathy abilities of Chinese nursing students in emergency departments are at a moderate level (a score between 60 and 80). Factors such as the reasons for choosing the nursing profession, the schools' humanistic education, the humanistic care atmosphere in the emergency department, and noninstructing teachers' care during the emergeny department internship influence the nursing students' humanistic care ability. Sex plays a role as an influencing factor in their empathy.

Introduction: Workplace violence (WPV) is a significant concern in healthcare settings, especially in the Emergency Department (ED). Early identification of patients at risk for violent behavior is critical to WPV prevention and staff safety. The STAMP tool-Staring, Tone, Anxiety, Mumbling, and Pacing-is uniquely designed for the ED and guides clinicians in assessing behavioral cues associated with potential for violence. This project aimed to decrease staff injuries by implementing the STAMP tool at triage.

Methods: The STAMP tool was piloted in the triage of three urban emergency departments in the Southeastern U.S. Project outcomes included WPV-related staff injuries, tracked for two years before and after STAMP implementation. Additional measures included usability and satisfaction evaluated through surveys and focus group interviews with triage nurses, along with documentation rates of STAMP. Descriptive statistics and independent t-tests were used to analyze the data.

Results: Implementation of the STAMP tool was associated with a significant reduction in WPV-related staff injuries (t(46) = 4.45, p < .001, CI 0.66-1.76). The average usability score for STAMP was 81.5 (SD ± 12.3), with 65% of triage nurses rating usability above average (n = 13/20). 90% of nurses (n = 18/20) found the tool helpful, and 65% (n = 13/20) reported feeling safer at work following implementation. Documentation rates for STAMP surpassed 90% by Week 9 and averaged 88.97% throughout the two-year study period.

Discussion: The STAMP tool is an easily adopted and sustainable tool for early detection and prevention of WPV in the ED. With effective implementation into the triage workflow, STAMP is associated with significant harm reduction, improved communication, high usability, and consistent documentation, supporting its potential for effective prevention of WPV in the ED.

Spinal epidural hematoma is a rare but potentially devastating condition that can result in permanent neurologic deficits if not diagnosed promptly. This case report presents a 48-year-old female patient with a medical history of systemic lupus erythematosus, renal transplantation, and hypertension who developed spinal epidural hematoma after chiropractic manipulation, leading to acute quadriplegia. The objective of this report is to highlight the potential for spinal epidural hematoma development in patients with comorbidities or underlying risk factors, such as systemic autoimmune disease, hypertension, or organ transplantation, after chiropractic manipulation and to emphasize the importance of early recognition to prevent serious neurologic sequelae.

Introduction: Trafficked persons commonly experience adverse health consequences. Despite presenting to hospitals, they often are not appropriately assisted. A health care system and community-based organization partnered to employ a survivor to support patients identified as victims, offering education and community resources.

Methods: The "Survivor Advocate" was available to respond to referral requests from health care professionals, engaging in supportive bedside education with interested patients. For patients confirmed as trafficked persons, the Survivor Advocate offered assistance in accessing specialized community resources. To evaluate the program's impact, descriptive data were collected and analyzed on patients served, including sociodemographic characteristics, presenting complaints, perceived indicators of trafficking, and discharge outcomes. Semistructured interviews were also conducted with stakeholders to explore program operations, successes, and limitations, analyzing text with reflexive thematic analysis.

Results: The advocate served 146 unduplicated patients at 20 hospitals. Nearly half came from 1 hospital at which the advocate was primarily based. Of patients served, 48 (32.9%) were confirmed as trafficked, and 98 (66.1%) were not. Among those confirmed, 42 (87.5%) experienced sex trafficking, 2 (4.2%) experienced labor trafficking, and 4 (8.3%) experienced both. In 17 stakeholder interviews, participants described various ways in which the program was beneficial.

Discussion: The Survivor Advocate program benefited patients, emergency nurses, and other health care professionals. Although most patients served were not confirmed as trafficked, engaging the advocate improved nurses' and social workers' ability to address indicators of violence and trauma and engage compassionately with patients, resulting in referrals to vital resources for numerous individuals.

Introduction: Deaf and hard-of-hearing individuals encounter persistent barriers in emergency departments, where care often relies on rapid, spoken exchanges, auditory dominance, and limited willingness to adapt communication approaches. Without access to signed or visual communication, patient safety is compromised, informed consent becomes uncertain, and equitable care cannot be guaranteed.

Methods: This integrative review critically synthesizes empirical literature on the communication experiences of Deaf and hard-of-hearing patients in emergency settings. A systematic search of peer-reviewed and gray literature was conducted (1970 to March 10, 2025). Identifying 1929 records (967 after duplication), 7 studies met the inclusion criteria. Studies were appraised using the Joanna Briggs Institute and Mixed Methods Appraisal Tool checklists. Thematic synthesis followed the principles of critical interpretive synthesis and the weight of evidence framework.

Results: Five key themes emerged: (1) communication barriers, (2) delays and disparities in care, (3) patient care experiences, (4) systemic exclusion, and (5) strategies for accessible care. Across the literature, interpreter provision was inconsistent, Deaf cultural awareness was limited, and few systems embedded protocols to support language access.

Discussion: Equitable emergency care for Deaf and hard-of-hearing patients requires systemic reform. Key priorities include Deaf awareness training, timely interpreter provision, and the codesign of communication-access protocols led by Deaf communities. These measures are essential for delivering lawful, safe, and patient-centered emergency care.

Introduction: Despite efforts made within the emergency department, delays in intravenous thrombolytic time via telestroke remain.

Methods: A quality improvement project streamlined stroke care, focusing on workflow optimization, education, improved communication, and real-time feedback, aiming to reduce door-to-needle time.

Results: A retrospective analysis revealed a reduction in door-to-needle time of 18.05 minutes (95% CI, 7.70-28.41; P = .001) was achieved. Achievement of door-to-needle time goals (30, 45, and 60 minutes) was met after implementation (adjusted P < .005). A higher proportion of intravenous thrombolytic rates occurred after implementation (45 [14.0%] vs 79 [8.1%]; adjusted odds ratio, 1.91; 95% CI, 1.29-2.84; P = .001).

Discussion: A telestroke-enabled primary stroke center consistently achieved <30-minute door-to-needle time through a nurse-led workflow emphasizing early stroke alert and computed tomography.