Emergency nurse : the journal of the RCN Accident and Emergency Nursing Association最新文献

People often express a preference for dying in a home setting rather than in hospital. In emergency departments (EDs), system pressures and the complexity of organising discharges mean that people who are approaching the end of life may be admitted to and die in hospital, even when discharging them to their preferred place may have been indicated and feasible. A rapid discharge checklist can support the process of safely and efficiently discharging patients at the end of life from the ED. It outlines essential steps in the discharge process, including confirming the suitability of discharge, liaising with community services, prescribing anticipatory medicines, and arranging equipment and transport. This article discusses rapid ED discharge checklists for patients at the end of life, outlining the positive outcomes of their implementation in one ED in England. Embedding such checklists into routine ED practice would support emergency nurses to contribute to person-centred and dignified care for patients at the end of life.

Prompt recognition and control of haemorrhage are fundamental responsibilities for the emergency nurse. Nurses are often the first to identify subtle indicators of bleeding and have a central role in activating major haemorrhage protocols, initiating life-saving interventions and communicating with the wider multidisciplinary team. This article explores the pathophysiology of haemorrhage and details assessment methods and evidence-based management strategies. The author also discusses the nurse's role as clinician, advocate and communicator, alongside ethical considerations and human factors.

Asthma affects an estimated 7.2 million people in the UK and is characterised by airway inflammation, bronchoconstriction and variable airflow obstruction. Emergency nurses frequently encounter adults experiencing an acute asthma attack in the emergency department, making a sound understanding of asthma essential for safe and effective care. This article provides an overview of respiratory anatomy and physiology and of asthma pathophysiology, linking it to clinical presentation and severity classification. It outlines key pharmacological and non-pharmacological interventions used during acute asthma attacks, including bronchodilators, corticosteroids, supplemental oxygen, patient positioning and reassurance. The importance of objective measures of respiratory function, such as peak expiratory flow rate, is discussed. The article also highlights the role of emergency nurses in patient education to support self-management and help prevent future exacerbations.

Non-traumatic dental presentations place a significant burden on emergency and urgent care services in England. This article details a critically appraised topic that asked: 'What factors are contributing to non-traumatic dental presentations to emergency and urgent care services?' A systematic literature search covering the period 2010 to 2025 identified four studies: two systematic reviews and two retrospective observational studies. Data extraction focused on sociodemographic, service-related and clinical drivers. Common presenting conditions included untreated caries, abscesses and infections. Socioeconomic deprivation, limited access to NHS dentistry and frequent out-of-hours attendance were consistent drivers. Study quality and geographic scope varied, with one large meta-analysis relying substantially on US data, which limits transferability to the UK. Addressing service availability, prevention and care pathways, plus targeted education for healthcare practitioners, could reduce inappropriate attendances and relieve pressure on emergency and urgent care.

Background: Patients who frequently attend emergency departments (EDs) due to alcohol and substance use often have complex healthcare needs, which can place significant demands on services, particularly in rural areas. Nursing triage notes capture critical information about these presentations.

Aim: To use nursing triage records to provide context which can aid greater understanding of patients who repeatedly attend the ED with alcohol- or substance-related health issues within a wider dataset.

Methods: A retrospective review of triage notes from three rural hospitals in Ireland from October 2020 to February 2023 included 31 patients who had attended more than ten times each, accounting for 623 attendances in total. Data were analysed for substance use, mental and physical health concerns, mode of arrival and referral, including any police involvement.

Results: Alcohol was implicated in 94.7% (n=590) of attendances. Mental health crises occurred in 13.3% (n=83), physical injuries in 38.7% (n=241), and issues surrounding withdrawal or detoxification in 10.6%(n=66). Ambulances transported 49.9% (n=311) of patients, and the police (An Garda Síochána in Ireland) were involved in 8.2% (n=51) of cases.

Conclusion: Nursing triage notes provide essential insight into the complex health needs of frequent attenders seeking emergency care. They can assist nurses in the early identification of patients who would benefit from integrated care pathways and coordinated interventions. This would reduce repeated presentations to the ED and improve patient-centred care and patient outcomes in rural settings.

In UK emergency departments (EDs), crowding, lack of inpatient beds and high patient acuity, compounded by triage 'bottlenecks', inconsistent streaming and fragmented communication between healthcare professionals, can compromise patient care, safety and experience. This article details the evaluation of a service improvement initiative - the First Encounter model - that aimed to address these issues through redesigning the first point of contact for walk-in patients. The initiative involved the co-location of two senior healthcare professionals - a band 6 or 7 senior nurse and the emergency physician in charge (EPIC) - at the ED entrance during peak hours. The aim was to improve the timeliness of patient assessment, strengthen patient experience and support staff's confidence in their clinical decision-making. The findings revealed that the percentage of patients who received clinical engagement within 15 minutes of arrival at the ED more than doubled; the average triage time halved; compliance with the four-hour target improved modestly; waiting-room congestion reduced; and staff felt more confident in their clinical decision-making. The model appears scalable and adaptable to other EDs, although further evaluation is required to establish its sustainability and broader patient outcomes.

In a modern healthcare system, a systems approach to patient safety is essential to learn from incidents and mitigate the risk of avoidable harm to patients. Emergency nurses have an important role in the prevention, identification, reporting, investigation and management of patient safety incidents in the emergency department (ED). This article describes the role of emergency nurses and the ED governance team in patient safety, discusses the interacting work-system factors that contribute to incidents, and introduces the key aspects of the patient safety incident response framework (PSIRF). The author discusses how the PSIRF represents a shift in the way patient safety incidents are managed, with a move away from apportioning blame towards a culture of learning and quality improvement.

The increasing prevalence of mental health crises in Wales has placed significant strain on emergency services, particularly paramedics within the Welsh Ambulance Services NHS Trust. Despite frequently encountering mental health-related cases, paramedics often lack the advanced training necessary to assess and manage these situations effectively. This article explores the urgent need to enhance paramedic mental health training in response to widespread staff shortages and the rising demand for crisis intervention. It outlines the limitations of paramedic education, the effects of inadequate mental health care pathways, and the consequences of reliance on police intervention. The author's proposed solution involves implementing a structured postgraduate training programme for paramedics combining theoretical knowledge, practical experience and ongoing supervision. By empowering paramedics with advanced mental health competencies, healthcare organisations in Wales can improve patient outcomes, reduce pressure on emergency departments and build a more resilient healthcare system.

Anisocoria (unequal pupil size) occurring acutely can be indicative of serious neurological pathology. However, in healthcare professionals who handle nebulised medicines, acute anisocoria is often caused by benign conditions such as mydriasis (abnormal pupil dilation) triggered by exposure to certain drugs and occurring unilaterally. This article reports on the case of an emergency nurse who developed acute anisocoria while on shift. It describes the initial assessment and further investigations, outlines the differential diagnosis, and discusses the implications for emergency nursing practice. Drug-induced mydriasis should be considered in healthcare professionals presenting with acute anisocoria, especially in the absence of red-flag symptoms. Increased awareness of this benign and self-limited condition could promote the safer handling of nebulised medicines and a more nuanced application of 'gloves off' recommendations.

Music festivals, football matches and other sporting events, agricultural shows and state fairs, and religious festivals are large-scale events where people present with medical or care needs in the pre-hospital setting. The author undertook a literature review on patient presentations at large-scale events to provide insight to nurses working at such events about the presentations they are likely to encounter and the skills they need to manage them. This article discusses patient presentations from lower-limb injury to drug intoxication, influenza, heat stroke and cardiac arrest. The author explores the commonalities and differences in patient presentations according to the type of events and makes recommendations for practice.