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Universal Suicidality Screening in a Pediatric Emergency Department to Improve Mental Health Safety Risk 在儿科急诊室普及自杀筛查,提高心理健康安全风险。
IF 1.7 4区 医学 Q1 Nursing Pub Date : 2024-05-01 DOI: 10.1016/j.jen.2024.01.008
Lauren Do BS, Karen Piper BS, Amanda N. Barczyk PhD, Jeffrey D. Shahidullah PhD, Karla A. Lawson PhD

Introduction

Suicide is the second leading cause of death for youth 12 to 18 years of age. Suicidal ideation can be predictive of suicide attempt, so screening for suicidal ideation by emergency nurses can help identify those at risk and facilitate timely intervention. This study evaluates the use of a universal suicide screening using the Patient Safety Screener 3 and the Columbia Suicide Severity Rating Scale to identify youth ages 12 to 18 years experiencing suicide risk and assess factors predictive of suicide risk level.

Methods

We conducted a retrospective cohort study using data from patients presenting to the emergency department at an acute care hospital that uses a universal screening program for suicide risk. We determined the frequency of positive screens and performed multivariate analyses to identify predictive factors of scoring high on the Columbia Suicide Severity Rating Scale.

Results

Notably, 9.1% of patients were experiencing some level of suicide risk; 10% of those with positive scores had no mental health history and were not presenting for a mental health reason. After controlling for other independent variables, insurance status, mental health presentation, and known mental health history were significantly associated with Columbia Suicide Severity Rating Scale score.

Discussion

Universal screening for suicide risk in pediatric emergency departments by nurses is critical for all patients older than 12 years, given that we identified patients at risk of suicide who presented for non–mental health reasons. These patients may not have been identified or referred to treatment if they were not screened for suicidality increasing risk of future suicide attempt.

导言:自杀是导致 12 至 18 岁青少年死亡的第二大原因。自杀意念可预测自杀企图,因此急诊护士对自杀意念进行筛查有助于识别高危人群并促进及时干预。本研究评估了使用 "患者安全筛查器 3"(Patient Safety Screener 3)和 "哥伦比亚自杀严重程度评定量表"(Columbia Suicide Severity Rating Scale)进行普遍自杀筛查的情况,以识别有自杀风险的 12 至 18 岁青少年,并评估预测自杀风险水平的因素:我们利用一家急诊医院急诊科患者的数据进行了一项回顾性队列研究,该医院采用了一项普遍的自杀风险筛查计划。我们确定了筛查结果呈阳性的频率,并进行了多变量分析,以确定在哥伦比亚自杀严重程度分级表中得分较高的预测因素:值得注意的是,9.1%的患者存在一定程度的自杀风险;10%的阳性患者没有心理健康史,也不是因为心理健康原因就诊。在控制了其他独立变量后,保险状况、精神健康状况和已知的精神健康病史与哥伦比亚自杀严重程度量表的得分有显著关联:考虑到我们发现了非精神疾病原因导致的自杀风险患者,护士在儿科急诊中对所有 12 岁以上患者进行自杀风险普查至关重要。如果不对这些患者进行自杀风险筛查,他们可能就不会被发现或转诊治疗,从而增加未来企图自杀的风险。
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引用次数: 0
Information for Readers 读者信息
IF 1.7 4区 医学 Q1 Nursing Pub Date : 2024-05-01 DOI: 10.1016/S0099-1767(24)00087-4
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引用次数: 0
Polish Perspective: The Influence of National Emergency Severity Index Training on Triage Practitioners’ Knowledge 波兰视角:国家紧急状况严重程度指数培训对分诊医生知识的影响。
IF 1.7 4区 医学 Q1 Nursing Pub Date : 2024-05-01 DOI: 10.1016/j.jen.2023.12.002
Monika Bednarek-Chałuda PhD, Anna Żądło MSc, Natalia Antosz MSc, Patricia Clutter MEd

Introduction

The aim of this study was to assess the impact of the national government initiative Emergency Severity Index version 4.0 validated triage training on triage practitioners’ knowledge and accuracy.

Methods

This pre/post intervention study evaluated the knowledge of triage practitioners, who constituted 30% of employees trained by the national program, in 74 emergency departments across Poland in 2020. Statistical analysis was used to evaluate the impact of the triage training.

Results

No significant differences in triage knowledge were found based on experience, length of ED service, or previous training. Training resulted in increased accuracy (61.3% vs 81.1%) and decreased overtriage and undertriage. Participants significantly reduced errors and improved Emergency Severity Index guideline–based case evaluations, especially for Emergency Severity Index 1-3 cases, with the most notable improvements observed among those without prior triage experience. The training significantly improved interrater reliability.

Discussion

The Emergency Severity Index pilot training demonstrated a significant improvement in the accuracy of triage practitioners. Emergency Severity Index level 4 has been identified as a challenging area to learn, as well as yielding promising results in the acquisition of knowledge across levels 1 and 2, among less experienced practitioners.

导言本研究旨在评估国家政府倡议的急诊严重程度指数 4.0 版验证分诊培训对分诊从业人员的知识和准确性的影响:这项干预前/后研究评估了 2020 年波兰 74 个急诊科分诊从业人员的知识水平,他们中的 30% 接受过国家项目的培训。统计分析用于评估分诊培训的影响:结果:在分诊知识方面,没有发现因经验、急诊室服务时间或之前的培训而产生的明显差异。培训提高了准确率(61.3% 对 81.1%),减少了过度分诊和分诊不足。参与者明显减少了错误,改善了基于急诊严重程度指数指南的病例评估,尤其是急诊严重程度指数 1-3 的病例,没有分诊经验者的改善最为明显。培训大大提高了评分者之间的可靠性:讨论:"急诊严重程度指数 "试点培训显著提高了分诊人员的准确性。急诊严重程度指数第 4 级被认为是一个具有挑战性的学习领域,同时也为经验较少的从业人员获得第 1 级和第 2 级的知识带来了希望。
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引用次数: 0
Evaluating the Oncology-Related Education Needs of Emergency Nurses 评估急诊护士的肿瘤相关教育需求。
IF 1.7 4区 医学 Q1 Nursing Pub Date : 2024-05-01 DOI: 10.1016/j.jen.2023.12.005
Rebecca Lash PHD, RN, MPP, CEN, Sorayah Bourenane MSN, RN, CEN, CNL, Angela Opsahl DNP, RN, CPHQ

Introduction

Treatment for patients with cancer in the emergency department ranges from treating life-threatening emergencies to symptom management or issues unrelated to their cancer, but for which cancer and its treatment may be complicating factors. Nurses are expected to manage the care of this population and be aware of risk factors for complications that may be unique to cancer patients. To date, education for emergency nurses regarding oncologic emergencies and the care for patients with cancer has been limited.

Methods

We conducted a cross-sectional needs assessment to establish emergency nurses’ educational needs (knowledge, skills, and attitudes) related to the care of patients with cancer and to evaluate if there are different educational needs for emergency nurses associated with the care of the cancer patient by practice setting type.

Results

Of 237 nurses surveyed, only 28% of nurse respondents indicated receiving any cancer-specific education or training. Overall, scores on a knowledge assessment were relatively low (mean 53%; range 9.5-85.7%; SD 13%). Nurses reported variable confidence and skills, with the weakest areas being in the triage of complications and oncologic emergencies, assessment of complications related to cancer treatment, and end-of-life conversations. Nearly all of the respondents (97%) indicated a need for oncologic education for emergency nurses with moderate-high priority in relation to other educational needs.

Discussion

Our findings suggest that emergency nurses need a stronger foundation of the knowledge and skills required to care for patients with cancer. Results from this study can inform future curriculum development efforts.

导言:急诊科对癌症患者的治疗范围很广,从治疗危及生命的急症到症状控制或与癌症无关的问题,但癌症及其治疗可能会成为并发症的因素。护士需要对这一人群进行护理管理,并了解癌症患者可能特有的并发症风险因素。迄今为止,针对急诊护士的有关肿瘤急诊和癌症患者护理的教育还很有限:我们进行了一项横断面需求评估,以确定急诊护士在癌症患者护理方面的教育需求(知识、技能和态度),并评估急诊护士在癌症患者护理方面的教育需求是否因执业环境类型而有所不同:在接受调查的 237 名护士中,只有 28% 的受访护士表示接受过任何与癌症相关的教育或培训。总体而言,知识评估得分相对较低(平均 53%;范围 9.5-85.7%;标准差 13%)。护士们的信心和技能参差不齐,最薄弱的领域是并发症和肿瘤急症的分流、癌症治疗相关并发症的评估以及临终对话。几乎所有受访者(97%)都表示急诊护士需要接受肿瘤学教育,与其他教育需求相比,肿瘤学教育的优先级为中高:讨论:我们的研究结果表明,急诊护士需要在护理癌症患者所需的知识和技能方面打下更坚实的基础。本研究的结果可为今后的课程开发工作提供参考。
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引用次数: 0
Emergency Nursing Review Questions: May 2024 急诊护理复习题:2024 年 5 月
IF 1.7 4区 医学 Q1 Nursing Pub Date : 2024-05-01 DOI: 10.1016/j.jen.2024.02.001
Benjamin E. Marett EdD, MSN, CEN, CCRN, COHN, NPD-C, NE-BC, TCRN, FAEN, FAHA, Anne P. Manton PhD, RN, FAEN, FAAN, Schaumburg, IL
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引用次数: 0
Where Is the Humanity for Nurses? A Love Letter to My Fellow Nurse 护士的人性何在?致我的护士同胞的情书
IF 1.7 4区 医学 Q1 Nursing Pub Date : 2024-05-01 DOI: 10.1016/j.jen.2024.02.003
Kaija Freborg DNP, RN, NC-BC
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引用次数: 0
A New Perspective on Missed Nursing Care in the Emergency Department: A Descriptive Cross-Sectional Study 急诊科护理工作缺失的新视角:描述性横断面研究
IF 1.7 4区 医学 Q1 Nursing Pub Date : 2024-05-01 DOI: 10.1016/j.jen.2023.12.006
Maria A. Amritzer PhD, Katarina E. Göransson PhD, Lena M. Berg PhD, Carolin Nymark PhD

Introduction

This descriptive cross-sectional study describes missed nursing care, quality of care, and patient safety rated by nursing staff in emergency departments. Required patient care that is omitted or delayed (missed nursing care) is associated with poorer quality of care and increased risk for adverse events, but studies are scarce in the emergency setting.

Methods

Emergency registered nurses and nursing assistants (N=126) at 2 Swedish emergency departments participated in the study. The MISSCARE surveySwedish version was used for data collection.

Results

Emergency nursing staff assessed that nursing care is frequently missed in the emergency department. More than half of the 24 nursing care items were reported as missed by over 50% of the participants, and registered nurses rated most items significantly higher compared to nursing assistants. Half of the nursing staff perceived quality of care to be good, but nearly the same proportion perceived patient safety as poor. Registered nurses viewed both quality and safety worse than nursing assistants.

Discussion

The present study found very high levels of missed nursing care in most nursing items. Results indicate that nursing staff in emergency departments need to prioritize between the tasks and that some tasks may not be relevant in the context. The emergency setting focuses primarily on identifying signs of urgency, assessing patients, performing interventions, and diagnostics. However, even items that seemed to be prioritized, such as reassessment of vital signs, had a surprisingly high level of missed nursing care in comparison to in-hospital wards.

导言这项描述性横断面研究描述了急诊科护理人员对护理遗漏、护理质量和患者安全的评价。遗漏或延迟对患者的必要护理(遗漏护理)与护理质量下降和不良事件风险增加有关,但在急诊环境中的研究却很少。方法瑞典 2 个急诊科的急诊注册护士和护理助理(126 人)参与了这项研究。结果急诊科护理人员认为,急诊科经常缺少护理服务。在 24 个护理项目中,有一半以上的参与者认为护理工作存在疏漏,其中注册护士对大多数项目的评分明显高于护理助理。半数护理人员认为护理质量良好,但几乎同样比例的护理人员认为患者安全状况不佳。本研究发现,在大多数护理项目中,护理人员的护理遗漏率非常高。结果表明,急诊科的护理人员需要对各项任务进行优先排序,有些任务可能与实际情况无关。急诊环境主要侧重于识别紧急征兆、评估患者、实施干预和诊断。然而,与医院病房相比,即使是重新评估生命体征等看似优先的项目,护理工作的遗漏率也高得惊人。
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引用次数: 0
“I Just Know if I Keep Going, I’ll End Up Hating Nursing.” Lived Experiences of Emergency Nurses Three Years Into the Global COVID-19 Pandemic "我只知道如果我继续下去,我最终会讨厌护理工作"。急诊护士在全球 COVID-19 大流行三年后的生活经历。
IF 1.7 4区 医学 Q1 Nursing Pub Date : 2024-05-01 DOI: 10.1016/j.jen.2024.01.003
Megan R. Simic BN (Hons), RN, Joanne E. Porter PhD, MN, GradDipCC, GradDipHSM, GradCertHeD, BN, RN, Blake Peck PhD, BN (Hons), RN, Christopher Mesagno PhD, MSESS, BS

Introduction

As the coronavirus disease 2019 pandemic continues globally, the personal and professional pressure on health care workers continues to accumulate. Literature suggests that as the pandemic evolves, nurses are experiencing increased levels of anxiety, depression, and post-traumatic stress, ultimately leading them to voice intentions to leave the profession, if they have not done so already.

Methods

Informed by an interpretive hermeneutic phenomenological approach, this longitudinal study was designed to capture how the lived experiences of 9 emergency nurses evolved over the coronavirus disease 2019 pandemic, highlighting their feelings, attitudes, and perceptions toward working in the emergency department at this time in history. Interviews were undertaken in June 2022 and were analyzed using a thematic analysis approach.

Results

Data analysis resulted in a total of 2 major themes and 8 minor themes. The 2 major themes included “exposed wounds” and “Band-Aid solutions.” Levels of burnout increased during the pandemic, with most of the emergency nurse participants dropping their hours, moving roles within the profession, or leaving the profession entirely. Findings elucidate where and how concerns may arise in clinical practice and holistic well-being among emergency nurses, particularly surrounding professional boundaries and protecting work-life balance and professional identity.

Discussion

As the world moves to managing coronavirus disease 2019 as a recognized common respiratory illness, providing time and space for emergency nurses to voice their concerns, design their well-being interventions, set professional boundaries, and reconnect with their professional passion may see lower attrition rates and higher levels of professional satisfaction in emergency nurses globally.

导言:随着 2019 年冠状病毒疾病在全球范围内的持续流行,医护人员所承受的个人和职业压力也在不断累积。文献表明,随着大流行病的发展,护士的焦虑、抑郁和创伤后应激水平正在上升,最终导致他们表达了离开这一职业的意愿,如果他们还没有这样做的话:本纵向研究采用解释学现象学方法,旨在捕捉 9 名急诊护士在 2019 年冠状病毒疾病大流行期间的生活经历,突出他们在这一历史时期对急诊科工作的感受、态度和看法。访谈于 2022 年 6 月进行,采用专题分析方法进行分析:数据分析共产生了 2 个大主题和 8 个小主题。两大主题包括 "暴露的伤口 "和 "创可贴解决方案"。在大流行病期间,职业倦怠程度增加,大多数急诊护士参与者都减少了工作时间,在行业内更换了角色,或完全离开了这一行业。研究结果阐明了急诊护士在临床实践和整体健康中可能出现的问题以及如何出现这些问题,特别是围绕专业界限、保护工作与生活的平衡以及专业身份的问题:讨论:随着全球将2019年冠状病毒疾病作为一种公认的常见呼吸道疾病来管理,为急诊护士提供时间和空间来表达他们的担忧、设计他们的幸福干预措施、设定职业界限并重新与他们的职业激情联系起来,可能会降低全球急诊护士的自然减员率并提高他们的职业满意度。
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引用次数: 0
Ultrasound-Guided Radial Artery Puncture by Nurses in Emergency Department: A Randomized Controlled Study 急诊科护士在超声引导下进行桡动脉穿刺:随机对照研究
IF 1.7 4区 医学 Q1 Nursing Pub Date : 2024-05-01 DOI: 10.1016/j.jen.2024.01.001
Birdal Güllüpınar MD, Caner Sağlam MD, Arif Karagöz MD, Serhat Koran MD, Erden Erol Ünlüer MD

Introduction

Radial artery puncture has been performed by palpation as a standard method in many emergency departments and intensive care units. Nurses play an important role in the care of patients in various settings. Ultrasonography can be performed and interpreted not only by physicians but also by nurses. This study aimed to evaluate whether emergency nurses would be more successful in radial artery puncture procedure by using ultrasonography instead of palpation.

Methods

This single-center, prospective, randomized controlled study was conducted in the emergency department. The patients included in the study were randomized into 2 groups as ultrasonography and palpation groups. Data were recorded on the number of interventions, the duration of the procedure in seconds, total time in seconds, whether the puncture was successfully placed, whether there were complications, the types of complications (hematoma, bleeding, and infection), or whether it was necessary to switch to an alternative technique.

Results

A total of 72 patients, 36 patients in the ultrasonography group and 36 patients in the palpation group, participated in the study. The success rate at the first attempt was statistically significantly higher in the ultrasonography group. Although hematoma formation among the complications occurred in the entire palpation group, it was observed in 72.2% of the ultrasonography group. Puncture time and total time were statistically significantly lower in the ultrasonography group.

Discussion

Our study shows that emergency nurses can use bedside ultrasonography for radial artery puncture successfully.

简介桡动脉穿刺是许多急诊科和重症监护室的标准方法。护士在各种环境下的病人护理中发挥着重要作用。超声波检查不仅可由医生执行和解释,也可由护士执行和解释。本研究旨在评估急诊护士在桡动脉穿刺过程中使用超声波而非触诊是否会更成功:这项单中心、前瞻性、随机对照研究在急诊科进行。方法:这项单中心前瞻性随机对照研究在急诊科进行,研究中的患者被随机分为两组,即超声波组和触诊组。研究记录了干预次数、手术持续时间(秒)、总时间(秒)、穿刺是否成功、是否出现并发症、并发症类型(血肿、出血和感染)或是否需要改用其他技术等数据:共有 72 名患者参与了研究,其中超声波组 36 人,触诊组 36 人。从统计学角度看,超声波组首次尝试的成功率明显更高。虽然在所有触诊组的并发症中都有血肿形成,但在超声波组中有 72.2% 的患者出现了血肿形成。超声波检查组的穿刺时间和总时间在统计学上明显更短:我们的研究表明,急诊护士可以成功使用床旁超声波技术进行桡动脉穿刺。
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引用次数: 0
Emergency Department Discharge Teaching Interventions: A Scoping Review 急诊科出院教学干预:范围审查。
IF 1.7 4区 医学 Q1 Nursing Pub Date : 2024-05-01 DOI: 10.1016/j.jen.2023.12.012
Alexandria Carey MSN, MBA-HC, RN, CNE, CPEN, CEN, Angela Starkweather PhD, ACNP-BC, FAANP, FAAN, Ailiya Bai BSN, RN, Ann Horgas PhD RN FGSA FAAN, Hwayoung Cho PhD, RN, Jason M. Beneciuk PT, DPT, PhD, MPH

Introduction

Emergency department discharge education is intended to provide patients with information to self-manage their condition or injury, identify potential complications, and follow-up or referral. However, most patients cannot recall the discharge information provided, leading to adverse clinical outcomes, return visits, and higher costs. A scoping review was undertaken to explore discharge education interventions that have been studied in the emergency department setting and outcomes that have been used to evaluate the effectiveness of the interventions.

Methods

A literature review was conducted using the databases PubMed/Medline, Cumulative Index to Nursing and Allied Health Literature, and Education Resources Information Center, with search terms focused on emergency nursing and patient discharge education interventions.

Results

Of the publications identified, 18 studies met the inclusion criteria. There was variation among studies on the conditions/injuries and populations of focus for the intervention. The interventions were categorized by learning styles, including auditory (n=10), kinesthetic (n=1), visual (n=15), reading/writing (n=1), and multimodal (n=7). Outcomes evaluated included those that were patient-specific (education, self-management, clinical, and adherence) and metrics of the health system and public health.

Discussion

Multimodal discharge education that addresses various learning styles and levels of health literacy improved patient education, self-management, and clinical outcomes. Additional support and reminders improved patient adherence. Identified gaps included limited kinesthetic interventions and culturally tailored education. Translational science for advancing sustainable interventions in clinical practice is needed to enhance the emergency department discharge process and patient, system, and public health outcomes.

简介:急诊科出院教育旨在为患者提供自我管理病情或损伤、识别潜在并发症以及后续治疗或转诊的信息。然而,大多数患者无法回忆起所提供的出院信息,从而导致不良的临床结果、复诊和更高的费用。我们进行了一次范围性综述,以探讨在急诊科环境下研究过的出院教育干预措施,以及用于评估干预措施有效性的结果:方法:我们使用 PubMed/Medline、护理与专职医疗文献累积索引和教育资源信息中心等数据库进行了文献综述,检索词主要集中在急诊护理和患者出院教育干预:在已确定的出版物中,有 18 项研究符合纳入标准。各研究在干预的病症/损伤和重点人群方面存在差异。干预措施按学习方式分类,包括听觉(10 项)、动觉(1 项)、视觉(15 项)、阅读/书写(1 项)和多模态(7 项)。评估的结果包括针对患者的结果(教育、自我管理、临床和依从性)以及卫生系统和公共卫生的指标:讨论:针对不同学习方式和健康知识水平的多模式出院教育改善了患者教育、自我管理和临床结果。额外的支持和提醒提高了患者的依从性。已发现的差距包括有限的动觉干预和文化定制教育。在临床实践中推进可持续干预措施需要转化科学,以改善急诊科出院流程以及患者、系统和公共卫生结果。
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引用次数: 0
期刊
Journal of Emergency Nursing
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