International Emergency Nursing最新文献

{"title":"Urgent care in Australia: Unblocking nurse practitioner capacity to address systemic access issues","authors":"Natasha Jennings , Vanessa Clothier","doi":"10.1016/j.ienj.2025.101741","DOIUrl":"10.1016/j.ienj.2025.101741","url":null,"abstract":"","PeriodicalId":48914,"journal":{"name":"International Emergency Nursing","volume":"85 ","pages":"Article 101741"},"PeriodicalIF":1.8,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145969392","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Mapping the advanced practice nursing in emergency and intensive care units: A scoping review","authors":"Oscar Fidel Antunez Martinez ,&nbsp;Yoselin Isabel Vallejo Bustamante ,&nbsp;Nelson Orlando Varela Zuniga","doi":"10.1016/j.ienj.2026.101764","DOIUrl":"10.1016/j.ienj.2026.101764","url":null,"abstract":"<div><h3>Background</h3><div>Advanced Practice Nurses (APNs), including Nurse Practitioners and Clinical Nurse Specialists, contribute significantly to quality, efficiency, and leadership in emergency departments (EDs) and intensive care units (ICUs). However, role variability, inconsistent regulation, and limited post-pandemic evidence remain challenges.</div></div><div><h3>Purpose</h3><div>To synthesize recent global evidence on APN roles, competencies, outcomes, and implementation challenges in EDs and ICUs, and identify strategies for effective integration.</div></div><div><h3>Method</h3><div>A scoping review, following Arksey and O’Malley’s framework and PRISMA-ScR guidelines, searched six databases. Eligible sources focused on APNs in EDs or ICUs. Two reviewers independently screened, extracted, and synthesized data descriptively and thematically.</div></div><div><h3>Findings</h3><div>Twenty-five studies were included, showing APNs’ main competences as advanced clinical reasoning, procedural skills, leadership, and evidence-based practice. Challenges involved role ambiguity, regulatory gaps, and limited autonomy. Post-COVID-19 developments expanded APN responsibilities but exposed workforce and educational gaps. Solutions proposed included standardized competencies, policy reform, postgraduate education, and interprofessional collaboration.</div></div><div><h3>Conclusions</h3><div>APNs enhance outcomes and efficiency in EDs and ICUs, but variability in role definitions limits impact. The current body of evidence surrounding APN practice in ICUs and EDs is primarily based on studies with low levels of evidence. Future implementation should be accompanied by rigorous evaluations to generate robust statistical evidence that supports the transferability of APN-led models.</div></div>","PeriodicalId":48914,"journal":{"name":"International Emergency Nursing","volume":"85 ","pages":"Article 101764"},"PeriodicalIF":1.8,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146167383","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Interactive effects of cardiac arrest duration and lactate levels on six-month mortality in patients surviving cardiac arrest and cardiopulmonary resuscitation","authors":"Jianping Lu ,&nbsp;Yuqi Zeng ,&nbsp;Nan Lin ,&nbsp;Qinyong Ye","doi":"10.1016/j.ienj.2026.101765","DOIUrl":"10.1016/j.ienj.2026.101765","url":null,"abstract":"<div><h3>Background</h3><div>The duration of cardiac arrest (CA) and the level of lactate within 24 h of CA are both associated with a poor prognosis in patients who have received cardiopulmonary resuscitation (CPR) but their combined effect remains unclear.</div></div><div><h3>Objectives</h3><div>Assess the independent associations of CA duration and post-resuscitation lactate level with 6-month mortality in patients undergoing CPR.</div></div><div><h3>Hypotheses</h3><div>CA duration and post-resuscitation lactate level have a multiplicative and additive interaction, such that their combined effect on mortality is greater than the sum of their individual effects.</div></div><div><h3>Methods</h3><div>A retrospective cohort study was conducted on patients who underwent CPR and achieved return of spontaneous circulation (ROSC) in the emergency department (ED) of XX Hospital from January 2018 to June 2022. Inclusion criteria included: (1) aged ≥ 18 years; (2) successful CPR with ROSC lasting ≥ 1 h; (3) available CA duration and post-resuscitation lactate level data; (4) 6-month follow-up completed. Exclusion criteria included: (1) systolic blood pressure ≤ 40 mmHg on ED presentation; (2) pre-existing severe liver or kidney dysfunction; (3) missing key data.</div></div><div><h3>Results</h3><div>CA duration and the level of lactate within 24 h of CA were independently associated with the mortality of post-arrest survivors of CPR at six months (odds ratio [OR] = 1.065; 95% confidence interval [CI]: 1.032–1.098; <em>P</em> &lt; 0.001, and OR = 0.323; 95% CI: 0.104–0.997; <em>P =</em> 0.049, respectively). The sensitivity and specificity of CA duration for the prognosis of death were 68.0% and 88.4%, respectively, using a cut-off value of 20.5 min. The area under curve (AUC) was 0.805 (95% CI: 0.745–0.866). Furthermore, these factors were associated, in a multiplicative manner, with death, with an adjusted OR of 1.010 (95% CI: 1.006–1.013). The additive interaction between these factors was associated with death, with a synergy index (SI) of 1.0985 (95%: CI 1.0746–1.1229).</div></div><div><h3>Conclusion</h3><div>CA time and lactate level after CA were associated with the six-month mortality of post-arrest CPR survivors and has both multiplicative and additive interaction.</div></div>","PeriodicalId":48914,"journal":{"name":"International Emergency Nursing","volume":"85 ","pages":"Article 101765"},"PeriodicalIF":1.8,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146174154","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Factors associated with stroke prenotification in emergency medical service among stroke code patients: A retrospective analysis","authors":"Yuan Li ,&nbsp;Sidarrth Prasad ,&nbsp;Suzanne Stone ,&nbsp;Aubrey Day ,&nbsp;Thuy-Tien Ho ,&nbsp;Mehari Gebreyohanns ,&nbsp;Erica Jones ,&nbsp;Nneka Ifejika ,&nbsp;Kim Barker ,&nbsp;Jane A. Anderson ,&nbsp;Sean I. Savitz ,&nbsp;Salvador Cruz-Flores ,&nbsp;Amber Salter ,&nbsp;Yohan Kim ,&nbsp;DaiWai M. Olson","doi":"10.1016/j.ienj.2026.101766","DOIUrl":"10.1016/j.ienj.2026.101766","url":null,"abstract":"<div><h3>Background</h3><div>Emergency medical service stroke prenotification (EMS-SP) and stroke code activation improves stroke process measures for patients transported to the emergency department (ED) with stroke symptoms. We aimed to identify predictors of EMS-SP.</div></div><div><h3>Methods</h3><div>This retrospective analysis includes data collected from an ongoing quality improvement project at a University hospital for all adult stroke code activations for the last 4 months of 2024 and first month of 2025. Multivariable models were used to explore associations between patient demographics, clinical characteristics, and having EMS-SP versus not having EMS-SP.</div></div><div><h3>Results</h3><div>The mean age of the 149 patients in our sample was 67.2 (14.7) years, 85 (57%) were female, 107 (71.8%) were white, 23 (15.4%) were Hispanic, and 95 (63.8%) were determined to be mimics. There were no statistically significant differences in demographics for the 65 (43.6%) patients without EMS-SP versus the 84 (56.4%) patients with EMS-SP. Logistic model shows non-White race was associated with a higher odds of EMS-SP (OR, 2.44; 95%CI = 1.04–5.72); aphasia assessment being performed was associated with a higher odds of EMS-SP (OR, 6.89; 95%CI = 2.82–15.86); a nominally higher odds of EMS-SP was noted for every 5 year increase in age (OR, 1.11; 95%CI = 0.97–1.27); and a higher odds of EMS-SP was noted for every 10 mmHg increase in diastolic blood pressure (OR, 1.24; 95%CI = 1.02–1.47).</div></div><div><h3>Conclusions</h3><div>Patients with aphasia assessment done, who were older, not White, and had higher diastolic blood pressures were more likely to have EMS-SP. Pre-hospital stroke management, including education and feedback for emergency medical service, is warranted.</div></div>","PeriodicalId":48914,"journal":{"name":"International Emergency Nursing","volume":"85 ","pages":"Article 101766"},"PeriodicalIF":1.8,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146158651","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Barriers encountered by walk-in international patients in hospital emergency departments in Japan: A qualitative study","authors":"Shoko Asakawa ,&nbsp;Yuko Takeda ,&nbsp;Richard Henker","doi":"10.1016/j.ienj.2026.101768","DOIUrl":"10.1016/j.ienj.2026.101768","url":null,"abstract":"<div><h3>Introduction</h3><div>The rise in international residents and visitors has increased the number of patients from diverse cultural and linguistic backgrounds in Japanese emergency departments (EDs). However, the challenges encountered by walk-in international patients seeking emergency care remain underexplored, highlighting the need for a better understanding of these barriers and the care provided by ED nurses. This study aimed to investigate the barriers perceived by walk-in international patients visiting EDs in Japan and their perceived experiences of the support provided by ED nurses.</div></div><div><h3>Methods</h3><div>We adopted a qualitative descriptive approach utilizing purposive sampling and the snowball technique. Semi-structured virtual interviews were conducted with 15 international patients to explore their experiences in Japanese EDs. Data were analyzed using reflexive thematic analysis, and the Standards for Reporting Qualitative Research checklist ensured comprehensive reporting.</div></div><div><h3>Results</h3><div>The analysis revealed four major themes: “conflict of culture,” “provider-centered care,” “hesitation to engage in culturally sensitive care,” and “building connections beyond language barriers.”</div></div><div><h3>Conclusion</h3><div>This study highlights the challenges of providing emergency care to international patients in Japan, and stresses the need for culturally competent care to improve patient safety and treatment quality.</div></div>","PeriodicalId":48914,"journal":{"name":"International Emergency Nursing","volume":"85 ","pages":"Article 101768"},"PeriodicalIF":1.8,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146208194","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The application of HFMEA in integrated transport for pediatric emergencies and critical conditions","authors":"Yuru Zhang ,&nbsp;Zhushengying Ma ,&nbsp;Wen Qian ,&nbsp;Huangjia Song ,&nbsp;Xiaohua Ge ,&nbsp;Lili Xu","doi":"10.1016/j.ienj.2026.101748","DOIUrl":"10.1016/j.ienj.2026.101748","url":null,"abstract":"<div><h3>Objective</h3><div>To study the effectiveness of HFMEA in integrated transport for critically ill pediatric patients.</div></div><div><h3>Methods</h3><div>Since January 2024, HFMEA has been implemented in our hospital to facilitate the integrated transport of critically ill children. The study observed and compared the incidence of transport accidents, nursing quality, and satisfaction with medical team cooperation over four months before and after HFMEA implementation.</div></div><div><h3>Results</h3><div>The transport accident rate was 35 % in the control group and 6.7 % in the experimental group, demonstrating a significantly lower incidence of transport accidents (<em>P</em> &lt; 0.001). The nursing quality score in the experimental group was 95.8 %, markedly higher than in the control group. Satisfaction with medical team cooperation in the experimental group was 97.5 %, compared to 88.1 % in the control group, a statistically significant difference (<em>P</em> &lt; 0.001).</div></div><div><h3>Conclusion</h3><div>HFMEA improves the safety of transport for critically ill pediatric patients in emergency settings, thereby enhancing nursing quality.</div><div><strong><em>Implications for Clinical Practice:</em></strong> HFMEA significantly enhances pediatric critical care transport safety, improving nursing quality, efficiency, and multidisciplinary team collaboration.</div></div>","PeriodicalId":48914,"journal":{"name":"International Emergency Nursing","volume":"85 ","pages":"Article 101748"},"PeriodicalIF":1.8,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146079578","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluating a closed-loop tracking and management model in determining aortic dissection diagnosis rates in a selected emergency department in China: A quality improvement project","authors":"Xiaorong Lang ,&nbsp;Shusheng Li ,&nbsp;Jie Xiong ,&nbsp;Jing Cheng ,&nbsp;Danli Zheng ,&nbsp;Yaru Xiao ,&nbsp;Sufang Huang ,&nbsp;Ying Li","doi":"10.1016/j.ienj.2026.101770","DOIUrl":"10.1016/j.ienj.2026.101770","url":null,"abstract":"<div><h3>Objective</h3><div>This study aimed to evaluate the effectiveness of a closed-loop tracking and management model in reducing the rates of missed and misdiagnosed aortic dissection (AD) in the emergency department (ED).</div></div><div><h3>Design</h3><div>Quality improvement report.</div></div><div><h3>Methods</h3><div>Using HIRAID as the guiding framework, a quality improvement program was implemented. The quality improvement team developed a closed-loop tracking and management model for AD, which included symptom-based screening and tracking, blood pressure screening of the limbs as an auxiliary method, and a diagnostic and treatment information tracking platform. The closed-loop tracking and management model for AD was applied in the ED of a tertiary hospital in Wuhan. Blood pressure measurements of the extremities were taken when patients presented with risk symptoms of AD for further screening. Additionally, misdiagnosed cases were continuously tracked.</div></div><div><h3>Results</h3><div>After the application of closed-loop tracking and management model, the rate of misdiagnosed AD decreased from 5.16% in 2019 to 1.23% in 2023.</div></div><div><h3>Conclusion</h3><div>Closed-loop tracking and management model could help reduce the rates of misdiagnosed AD in the ED.</div></div>","PeriodicalId":48914,"journal":{"name":"International Emergency Nursing","volume":"85 ","pages":"Article 101770"},"PeriodicalIF":1.8,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146776835","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A system at risk: Critical gaps in healthcare provider competency and hospital preparedness for CBRNe threats in a geopolitically exposed nation","authors":"Eman S. Qzih ,&nbsp;Muayyad M. Ahmad","doi":"10.1016/j.ienj.2026.101777","DOIUrl":"10.1016/j.ienj.2026.101777","url":null,"abstract":"<div><div><strong><em>Background</em></strong>: Global health security is increasingly threatened by Chemical, Biological, Radiological, Nuclear, and Explosive (CBRNe) incidents. Frontline nurses, as first responders, are critically exposed, yet evidence on their readiness in high-risk regions remains scarce.</div><div><strong><em>Aim</em></strong>: This study aimed to conduct the first dual-level, system-wide evaluation of CBRNe preparedness in Jordan. It specifically sought to benchmark the practical competency of the nursing workforce and hospital-level readiness.</div><div><strong><em>Methods</em></strong>: A mixed-methods cross-sectional study was performed across five major hospitals, involving 298 frontline providers (predominantly nurses, 69.5%, n = 207) and 30 senior administrators. The study utilized a validated provider skills assessment and the Canadian Centre for Emergency Preparedness (CEEP) survey. Data were analyzed using descriptive statistics and the Kruskal-Wallis H-test.</div><div><strong><em>Results</em></strong>: A critical gap between policy and practice was identified, revealing a acute vulnerability among nurses. While all providers were competent in basic (Level D) personal protective equipment (PPE), proficiency plummeted to 14.8% for Level B and 1.7% for Level A. Furthermore, 76.8% of providers had never participated in a CBRNe simulation, and only 20.5% felt capable of performing casualty decontamination, a core nursing responsibility. Hospital-level preparedness varied drastically (p &lt; 0.001), revealing a pronounced military-civilian divide. The top-performing hospital scored 67.7% in biological preparedness, while the lowest scored 16.7% in chemical preparedness.</div><div>Conclusions: This study uncovers a systemic failure in translating CBRNe policy into frontline practice, creating a dangerous vulnerability that disproportionately impacts nurses as first responders. The findings mandate an urgent paradigm shift from fragmented, facility-specific efforts to a standardized, nationally-integrated CBRNe readiness strategy that prioritizes and empowers the nursing workforce.</div></div>","PeriodicalId":48914,"journal":{"name":"International Emergency Nursing","volume":"85 ","pages":"Article 101777"},"PeriodicalIF":1.8,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147286001","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Direct bedding in the emergency department: An underexplored and overutilized model of care","authors":"Lauren Beam,&nbsp;Fabrice I. Mowbray","doi":"10.1016/j.ienj.2026.101754","DOIUrl":"10.1016/j.ienj.2026.101754","url":null,"abstract":"","PeriodicalId":48914,"journal":{"name":"International Emergency Nursing","volume":"85 ","pages":"Article 101754"},"PeriodicalIF":1.8,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147385338","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of early blood testing on emergency department length of stay during overcrowding","authors":"Federica Durando,&nbsp;Jacopo Davide Giamello,&nbsp;Salvatore D’Agnano,&nbsp;Gianpiero Martini,&nbsp;Tania Prinzis,&nbsp;Paola Vietto,&nbsp;Mauro Giraudo,&nbsp;Andrea Sciolla,&nbsp;Giuseppe Lauria","doi":"10.1016/j.ienj.2026.101772","DOIUrl":"10.1016/j.ienj.2026.101772","url":null,"abstract":"<div><h3>Background</h3><div>Emergency Department (ED) overcrowding significantly impacts patient care, increasing wait times and delaying treatment. This study evaluates a quality improvement project involving the implementation of an early nursing care protocol designed to optimize patient management during overcrowding by enabling nurses to initiate blood tests during triage.</div></div><div><h3>Local Problem</h3><div>In our high-volume urban ED in Northern Italy, recurrent overcrowding particularly affected patients with non-urgent triage codes, resulting in prolonged door-to-treatment times and decreased patient satisfaction. Nurses were underutilized in early diagnostic workflows.</div></div><div><h3>Methods</h3><div>The study assessed the effectiveness of a protocol involving a predefined set of blood tests performed during the post-triage waiting period under overcrowding conditions in adult patients presenting with chest or abdominal pain and a triage level 2 to 5 at the ED of Santa Croce e Carle Hospital in Cuneo, Italy, from January 1, 2024, to June 20, 2024. The primary outcome was the reduction in ED treatment time and length-of-stay (LOS) during overcrowding among patients managed with the protocol.</div></div><div><h3>Intervention</h3><div>The intervention consisted of nurse-initiated blood draws using predefined criteria and an electronic lab test panel. The protocol was activated only during predefined periods of severe ED crowding, based on local operational thresholds.</div></div><div><h3>Results</h3><div>3,857 patients were included, with 38% undergoing early blood testing due to overcrowding; patients in the early testing group (i.e. patients managed during overcrowding) experienced a significantly longer waiting time (142 min vs. 48 min, p &lt; 0.001). However, their treatment time was significantly shorter (132 min vs. 162 min, p &lt; 0.001), resulting in a less pronounced increase in total ED LOS. Subgroup analyses confirmed consistent reductions in treatment time across different triage levels and presenting symptoms.</div></div><div><h3>Conclusion</h3><div>Early nursing-led blood testing during ED overcrowding enhances efficiency by reducing treatment times, enabling earlier clinical decision-making, and improving patient monitoring. Despite increased total ED LOS due to overcrowding, this increase appears to be lower than what the prolonged waiting time due to overcrowding itself might have suggested. This quality improvement initiative highlights the potential for advanced nursing roles to optimize emergency care delivery. Further research should assess patient satisfaction and cost-effectiveness.</div></div>","PeriodicalId":48914,"journal":{"name":"International Emergency Nursing","volume":"85 ","pages":"Article 101772"},"PeriodicalIF":1.8,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146167244","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}