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

The handover of patients arriving by ambulance at emergency departments (EDs) represents a time-critical event. Having a well understood assessment method supported by responsive operational processes, can improve outcomes for patients and regional safety.

Burnout is a prevalent and escalating issue in emergency nursing, driven by factors such as increased patient demand, overcrowding, staffing shortages, workplace violence and critical incident exposure. This article explores the systemic, environmental and psychological causes of burnout, and examines its detrimental effects on nurses' well-being and patient safety. Strategies for identifying, managing and preventing burnout are discussed, including recognising early symptoms, managing the emotional effect of trauma, supporting personal resilience and the importance of organisational measures such as improved staffing, leadership support and workplace safety initiatives. Practical interventions to develop resilience, enhance emotional regulation and mitigate the effect of shiftwork are explored. The article emphasises that while individual strategies are valuable, systemic changes are essential to address the root causes of burnout. By implementing multilevel approaches, emergency nurses and healthcare organisations can protect staff well-being and sustain the delivery of safe, high-quality care.

Pelvic fractures with haemorrhage are associated with high mortality and morbidity. This article describes the case of a 21-year-old man who was admitted to the emergency department of a hospital in India with a pelvic fracture and haemorrhage following a road traffic accident. It highlights the crucial role of nurses in coordinating the initial assessment, diagnostic investigations and treatment as well as the ongoing management of patients presenting with such injuries. Timely interventions by a multidisciplinary team are critical for preventing hypovolaemic shock, reducing mortality and limiting disability.

People with mental health conditions frequently experience prolonged stays in the emergency department (ED) while awaiting specialist care or an inpatient bed. This article reports the findings of a service evaluation that explored the effectiveness of a daily 'huddle' between ED staff and the liaison psychiatric service (LPS) team in one ED in England in reducing length of stay for this patient population. The evaluation used a convergent mixed-methods design involving the collection and analysis of quantitative data on four key performance indicators (KPIs) (overall length of stay, time to psychiatric assessment, time to psychiatric referral and time to medical assessment) and qualitative data from a focus group discussion with staff. The findings suggest that ED staff should be provided with comprehensive training, including on de-escalation techniques and on recognising and understanding mental health issues, and that a cultural shift is required within EDs to achieve parity of esteem between mental health and physical health.

Ambulance handover between ambulance personnel and emergency department (ED) staff, most often nurses, is a time-critical and complex event that should take place within 15 minutes of the ambulance arriving at the hospital site. However, in recent years there has been an increase in ambulance handover delays, potentially resulting in patient harm. Providing a consistent service to maximise the safety and effectiveness of ambulance handovers is an essential function of all EDs and, increasingly, of acute hospital assessment areas. This article discusses some of the ways in which ambulance handover delays can be addressed, such as using a structured communication tool, and provides an overview of a contemporary standardised approach to initial assessment in the ED that aims to reduce ambulance delays and enhance patient outcomes. The article aims to equip nurses who are responsible for ambulance handovers and initial patient assessments with examples of best practice to support their clinical decision-making and guide clinical practice.

The unpredictability of acute care, rising patient multimorbidity and the under-resourcing of community palliative care services mean that more patients are presenting to emergency services in the final stages of illness, with emergency departments (EDs) increasingly becoming places where people experience end of life. Nurses are often the first to recognise a dying patient and initiate essential care in the ED's high-pressure, intervention-focused environment. This narrative review article explores how emergency nurses can provide high-quality care at the end of life when supported by access to appropriate advanced care planning documentation, integrated records, education and interprofessional collaboration. Given these circumstances, nurses can have a critical role in recognising dying patients, managing their symptoms and supporting their family members. However, the emotional burden and organisational pressures of providing end of life care can also contribute to moral distress among emergency nurses.

Emergency departments (EDs) are increasingly at the front line of care for older adults, a demographic experiencing rapid global growth. This patient group often presents with complex health conditions, polypharmacy, frailty and cognitive impairment, factors which challenge traditional acute care models. This article explores the clinical, organisational and educational challenges in delivering effective, person-centred emergency care for older adults. It presents evidence-based strategies to improve outcomes, drawing on current frameworks such as geriatric EDs and comprehensive geriatric assessment (CGA). Key challenges identified include overcrowding, limited specialist training among staff, suboptimal environmental design, delayed diagnosis and fragmented communication. Evidence-based solutions include the integration of CGA, development of geriatric emergency nursing roles, interdisciplinary collaboration, targeted workforce education and training, and ED environmental adaptations. Enhancing emergency care for older adults requires a system-wide shift towards age-appropriate, interdisciplinary, person-centred models of care. Policy alignment, workforce capacity building and organisational leadership are essential to delivering safe, effective and compassionate emergency care for this population.

Nurses are often first responders to patients in cardiac arrest and therefore have a critical role in delivering cardiopulmonary resuscitation (CPR), which can be physically, emotionally and ethically demanding and highly stressful. The stress of being involved in patient resuscitation is widely acknowledged, but there is limited research on how nurses cope during and after delivering CPR. This qualitative literature review aimed to develop an understanding of the effects of delivering CPR on nurses' mental health and well-being. The thematic synthesis of the 15 studies reviewed identified three main themes: work-related stress, burnout, and psychiatric morbidity. These all adversely affect nurses' mental health and well-being, and potentially the effectiveness of their delivery of CPR, and are implicated in nurse attrition. There is a need for stress-reduction programmes and strategies to enhance nurses' coping skills and for the provision of multidisciplinary training that supports effective teamwork and nurses' delivery of CPR.

The increasing use of healthcare services is leading to issues with hospital overcrowding and this is particularly apparent in emergency departments (EDs). Consequently, patients are being cared for in areas that were not designed for that purpose, such as waiting areas and corridors. This negatively affects nurses' and patients' experiences of care. This article provides a rapid review of the evidence on nurses' and patients' experiences of crowding, corridor care and boarding. The findings highlight three main elements experienced by staff and patients when caring or being cared for in such contexts: stress and frustration; dissatisfaction with care; and safety and coping mechanisms. Enhancing nurse autonomy and improving communication with patients could mitigate some of these negative experiences and thereby improve staff retention, reduce staff-patient conflict and reduce the likelihood of patients leaving the ED without being seen.

Background: Nurses' job satisfaction affects how they feel about their work, their commitment, their relationships with patients and colleagues and ultimately the quality of care they provide. Beyond the many aspects of quality of work life, another factor that is likely to affect nurses' job satisfaction is clinical empathy.

Aim: To investigate the direct and indirect effects of quality of work life on nurses' job satisfaction, with clinical empathy as a mediating factor.

Methods: This was a quantitative cross-sectional study using a descriptive research design along with path analysis. The study population included all nurses working in the emergency departments of hospitals in Sanandaj, Iran. The short form of the Minnesota Satisfaction Questionnaire, the Quality of Work Life questionnaire and the health professional version of the Jefferson Scale of Physician Empathy were used to collect data. A total of 480 nurses were approached, 430 questionnaires were received, and 400 complete questionnaires were included in the data analysis.

Results: The results showed that participants' quality of work life had a direct and significant effect on their job satisfaction. In addition to its direct effect on job satisfaction, quality of work life also affected participants' job satisfaction indirectly through the mediation of clinical empathy.

Conclusion: Paying attention to the factors that affect nurses' quality of work life and promoting high levels of clinical empathy among nurses can increase their job satisfaction and therefore the quality of care they provide.