Australasian Emergency Care最新文献

Background: With emergency departments (EDs) facing growing demand to provide end-of-life care (EOLC), it has become more important to identify the factors that influence the EOLC practices of ED nurses. This study examined the effects of nursing professional values, the nursing work environment, and compassion competence on the EOLC practices of ED nurses.

Methods: This cross-sectional descriptive study was conducted with 136 ED nurses in Korea. Statistical analysis was conducted to examine the relationships among key variables and identify significant predictors of EOLC practices.

Results: EOLC practices exhibited a significant positive correlation with nursing professional values (r = .43), the work environment (r = .42), and compassion competence (r = .60; all p < .001). Compassion competence was the strongest predictor of EOLC practices (β = 0.497, p < .001), explaining 39 % of the variance.

Conclusions: Compassion competence was the most influential factor affecting EOLC practices among ED nurses. These findings highlight the need to incorporate compassion training into ongoing education and create supportive environments that promote emotionally attuned care, even in high-pressure emergency settings.

Background: The COVID-19 pandemic affected frontline Healthcare Workers (HCWs) immensely, subjecting them to extreme psychological distress. The current study assesses the burnout, anxiety, depression, PTSD, and resilience levels among HCWs and analyses the efficacy of institutional mental health interventions.

Methods: A cross-sectional longitudinal study design that combined quantitative surveys and qualitative interviews was employed. There were 500 HCWs from public hospitals, private hospitals, primary healthcare centres, and emergency response teams who took part. Validated measures included the Maslach Burnout Inventory (MBI), Generalized Anxiety Disorder-7 (GAD-7), Patient Health Questionnaire-9 (PHQ-9), PTSD Checklist (PCL-5), and Connor-Davidson Resilience Scale (CD-RISC). Descriptive statistics, chi-square tests, t-tests, and logistic regression were used in data analysis.

Results: Psychological distress was common, with 42.5 % burnout, 35.2 % anxiety, 29.8 % depression, and 21.4 % PTSD. Long hours (OR = 1.85, p < 0.001), high patient volume (OR = 1.67, p < 0.001), and absence of PPE (OR = 1.52, p = 0.002) were major contributors, and robust workplace support (OR = 0.75, p = 0.037) was protective. Qualitative interviews revealed key themes, including persistent sleep disturbances, Mental Health Support, Emotional and Social consequences, Impact on relationships and fear of infecting family members.

Conclusion: HCWs experienced extreme psychological distress throughout the pandemic, which requires additional mental health policies, organizational support, and greater access to digital interventions.

Background: Paediatric mental health crises are an escalating burden in global emergency care, with suicide the second leading cause of death among 10-19-year-olds. Emergency settings often represent the first point of contact for children in psychological distress. However, fragmented implementation, limited use of holistic approaches, and an absence of validated screening tools in paramedicine, contribute to missed opportunities for early intervention.

Methods: This scoping review followed the Joanna Briggs Institute (JBI) methodological framework and PRISMA-ScR guidelines and sourced literature from key databases from 2004 to 2024. Included studies involved validated screening or assessment tools for children aged 0-19 used in emergency care contexts. Data were extracted, charted, and thematically analysed using a biopsychosocial (BPS) lens to evaluate tool design, clinical feasibility, and relevance.

Results: Thirty studies met inclusion criteria, identifying 21 screening and 10 assessment tools, mainly used in hospital-based emergency departments. None were applied in paramedicine. Only five tools aligned with the BPS model. Key barriers included time constraints, training deficits, care discontinuity, and limited inclusivity for culturally and linguistically diverse or neurodivergent populations.

Conclusion: There is an urgent need for BPS-informed, developmentally appropriate tools tailored for paramedic use to improve equitable, child-centred emergency mental health care.

Background: The emergency department (ED) serves as the access point for people requiring treatment during disasters, meaning emergency nurses are typically the first responders in such situations. Tonga's location on the Ring of Fire, has led to the Kingdom experiencing numerous disasters, making it imperative that emergency nurses are well-prepared to respond.

Method: This study utilized a Convergent Parallel Mixed-Method approach. A survey that collected qualitative and quantitative data was conducted among emergency nurses working on the five main islands of Tonga.

Results: A total of 43 emergency nurses responded to the survey with a response rate of 92 %. A key finding of the study is that Tongan emergency nurses are moderately prepared to respond to disasters.

Discussion: Five themes emerged from this study, disaster planning, previous disaster response experience, disaster related training, resourcing, external obligations, and readiness to respond.

Conclusion: To our knowledge this is the first study to explore the preparedness of Tongan emergency nurses to respond to disasters. While the findings of this study may not be generalizable to other settings, they may be beneficial to other Pacific Island Countries and Territories and small island developing nations.

Aims: To synthesise findings from randomised controlled trials (RCTs) on vascular access devices (VADs) in emergency departments (EDs).

Background: VADs play a critical role in EDs, enabling rapid delivery of supportive therapies to address urgent medical needs. This scoping review will map current evidence and determine areas to focus future research priorities.

Methods: Following Arksey and O'Malley's scoping review framework, a comprehensive search was conducted (2012-2024) across four databases. RCTs that focused on peripheral intravenous catheters, central venous catheters, arterial catheters, or intraosseous catheters in an ED setting were included.

Results: 48 RCTs were included, a majority focused on peripheral intravenous catheters (n = 41, 85 %), followed by central venous catheters (n = 4, 8 %), arterial catheters (n = 2, 4 %), and intraosseous catheters (n = 1, 3 %). The findings were categorised by intervention type, including vessel visualisation technology, catheter design, dressing and securement design, distraction techniques, topical anaesthetics, inserter models, and other related techniques. The top three most frequently reported outcomes were insertion success (n = 21), time to successful insertion (n = 20), and catheter-related complications (n = 19).

Conclusion: This review provides ED clinicians with current evidence on VAD technologies and techniques, enabling them to select and implement the most effective options into daily practice reduce costs and improve patient satisfaction.

Background: Rising Emergency Department (ED) demand strains resources to assess and manage frail older adults. Allied health supports comprehensive care, disposition planning and patient safety in the ED but often intervenes late. This study investigated factors affecting allied health referrals and co-designed an early allied health frailty service.

Methods: An explanatory sequential mixed-methods approach was used. Patient journey mapping of low acuity older ED patients was followed by stakeholder focus groups.

Results: From triage, 20 older ED patients waited a mean of 110 minutes (SD 83 minutes) for doctor assessment, 123 minutes (SD 116 minutes) for an ED bed and 355 minutes (SD 297 minutes) for allied health assessment with a mean ED length of stay (LOS) of 685 minutes (SD 444 minutes). Qualitative analysis of focus group discussions identified perceived benefits of an early allied health service including shorter LOS, earlier disposition planning, increased staff confidence and streamlined decision making. Perceived barriers were lack of space, competing assessments with doctors and incomplete investigations. Perceived solutions were refining the inclusion criteria and staff education.

Conclusion: Allied health assessment occurred six hours post presentation, outside national targets. Opportunities and barriers identified supported the development of an earlier allied health frailty service.

Background: Delayed access to treatment in the Emergency Department for patients presenting with time-critical presentations leads to increased morbidity and mortality. This study aimed to determine if the introduction of a novel 'T2 Nurse' nursing role to initiate assessment and treatment for time-critical (category 2) patients reduces time to treatment (TTT).

Methods: This pre/post-implementation pilot study used routinely collected performance data from all category 2 patients presenting to an emergency department in NSW, Australia from January 2023 to July 2024 using regression analysis.

Results: 17,332 pre-implementation records and 16,989 post-implementation records were examined. The mean average TTT pre-implementation was 27 min compared to 12 min during the program, with a mean daily average TTT reduced by 15.4 min post-implementation. After adjusting for seasonal variation, the T2 program significantly reduced average waiting time by approximately 8 min. There was a sustained increase in performance targets with over 80 % of category 2 patients seen within the recommended time post-implementation (a 42 % increase).

Conclusion: The implementation of a T2 nurse role led to statistically and clinically significant sustained improvements in TTT particularly when the T2 Nurse initiates treatment, which may lead to improved health outcomes.

Background: Emergency Medical Services (EMS) are critical for improving survival in out-of-hospital cardiac arrest (OHCA). The expertise of EMS team leaders, such as emergency nurse practitioners (ENPs), may impact patient outcomes. This study aimed to evaluate the role of ENPs and their association with outcomes in OHCA.

Methods: A retrospective analysis was conducted on OHCA cases treated by EMS from 2017 to 2020. Data included ENP presence, number of healthcare personnel, patient demographics, initial rhythm, bystander CPR, physician presence, patient access time, and scene time. Primary outcome was prehospital return of spontaneous circulation (ROSC), with secondary outcome being ROSC at the emergency department (ED).

Results: Among 212 OHCA cases treated by EMS, ENPs were present in 14.6 % of cases. Prehospital ROSC was 11.3 %, while ROSC at the ED was 48.1 %. ENP presence was not associated with increased prehospital ROSC (p = 0.19) but was linked to higher overall ROSC rates at the ED (p = 0.03).

Conclusions: Including ENPs in EMS teams may improve short-term survival outcomes for OHCA patients, particularly at the ED. Further research is needed to explore the broader impact of ENPs in prehospital care.

Background: Triage quality is central to patient safety and the efficient distribution of emergency department resources. Currently, there are no identified quality indicators for application of the Australasian Triage Scale.

Aim: To address a gap in quality indicators specific to triage.

Design: A literature review and modified Delphi technique.

Method: A review of the literature published between 2001 and 2024 was conducted to identify potential indicators and metrics of triage quality, and were categorised across six quality of care domains (patient-centeredness, timeliness, effectiveness, equity, efficiency and safety). Three consecutive online surveys where panellists rated these indicators for perceived appropriateness, validity and feasibility were completed between August and December 2023.

Results: From the review, 17 initial quality indicators across six quality of care domains were developed. Following round 1, 3 indicators were modified and 8 indicators were added. After two further survey rounds, 18 (72 %) indicators met consensus.

Conclusion: An expert panel validated a set of triage quality indicators for measuring Australian triage practice. A continuous quality improvement approach is required to optimise triage practice, develop processes for detecting and reducing patient harm and minimising variation. Further research is needed to test applicability of the indicators.