Journal of Emergency Nursing最新文献

{"title":"Intentional Coingestion of RisperiDONE and Ethylene Glycol in a 35-Year-Old: A Case Review.","authors":"Robert Asselta","doi":"10.1016/j.jen.2025.06.004","DOIUrl":"https://doi.org/10.1016/j.jen.2025.06.004","url":null,"abstract":"<p><p>This is a complex case of an intentional coingestion involving ethylene glycol, a toxic alcohol, and risperiDONE, an atypical antipsychotic. The patient presented to the emergency department with a myriad of symptoms reflecting the combined toxicities. Ethylene glycol poisoning is characterized by its metabolic conversion to toxic metabolites, leading to severe metabolic acidosis, renal failure, and neurotoxicity. The coingestion of risperiDONE, although less immediately life-threatening, complicates the clinical picture. RisperiDONE is a central nervous system depressant that may contribute to ethylene glycol's neurologic derangements. RisperiDONE has a potential for cardiac complications by prolonging the QT interval reflected in the electrocardiogram. This combination of ingestions can lead to potential lethal cardiac dysrhythmias. This patient presentation highlights the challenges in the diagnosis and management of this combination of overdoses, necessitating a high index of suspicion, rapid identification of the ingested toxins, and aggressive supportive care. This case review underscores the importance of considering the synergistic effects of these 2 coingested substances, which can significantly alter the expected clinical course and prognosis.</p>","PeriodicalId":51082,"journal":{"name":"Journal of Emergency Nursing","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144660953","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":"Utility of Triage Nurses' Quick-Look Assessments of Adults in the Emergency Department for Predicting Hospital Admission.","authors":"Ryuji Suzuki, Toshihiko Takada, Jun Miyashita, Shunichi Fukuhara","doi":"10.1016/j.jen.2025.06.002","DOIUrl":"https://doi.org/10.1016/j.jen.2025.06.002","url":null,"abstract":"<p><strong>Introduction: </strong>Nurses use quick-look assessments, vital signs, and interviews to predict hospital admission, but evidence for the predictive accuracy of quick-look assessments remains limited. This study aimed to evaluate the accuracy of quick-look assessments in predicting hospital admission for adult patients, compare their performance with the National Early Warning Score, and assess the added value of combining quick-look assessments and the National Early Warning Score.</p><p><strong>Methods: </strong>This prospective, single-center, observational study was conducted in the emergency department of an acute care hospital. During triage, nurses predicted admission likelihood based only on quick-look assessments, without any other data such as vital signs or history of illness, with higher quick-look assessment scores indicating greater admission likelihood. The National Early Warning Score was calculated from vital sign data. Three predictive models (quick-look assessment alone, National Early Warning Score alone, and quick-look assessment + National Early Warning Score) were developed using logistic regression modeling. Model performance was assessed using the area under the curve and calibration plots.</p><p><strong>Results: </strong>Of 1588 patients, 144 (9.1%) were admitted. Higher quick-look assessment scores were associated with admission, with odds ratios of 83.8 (95% CI, 26.6-263.8) and 145.2 (95% CI, 21.4-986.4) for quick-look assessment scores of 4 and 5, respectively. The quick-look assessment model had an area under the curve of 0.85 (95% CI, 0.81-0.88), outperforming the National Early Warning Score (area under the curve, 0.67; 95% CI, 0.62-0.73). Adding the National Early Warning Score to quick-look assessments led to minimal improvement (area under the curve, 0.87; 95% CI, 0.83-0.90). Calibration showed that quick-look assessments underestimated moderate-to-high-risk predictions.</p><p><strong>Discussion: </strong>Quick-look assessments allow nurses to make accurate predictions of hospital admissions during ED triage, outperform the National Early Warning Score, and support better patient prioritization.</p>","PeriodicalId":51082,"journal":{"name":"Journal of Emergency Nursing","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144660954","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":"Flail Chest as a Rare Manifestation of Single Rib Fracture: A Case Report.","authors":"Harun Yildirim, Ertan Sonmez, Murtaza Kaya","doi":"10.1016/j.jen.2025.06.005","DOIUrl":"https://doi.org/10.1016/j.jen.2025.06.005","url":null,"abstract":"<p><strong>Introduction: </strong>Flail chest is defined by the fracture of 3 or more ribs at 2 or more sites, resulting in a segment of the chest wall that loses its mechanical integrity, creating a \"floating\" segment. It occurs in 5% to 13% of patients with chest wall injuries. A very rare form of flail chest, sternal flail, refers to the separation of the sternum from the hemithoraxes and is usually associated with multiple anterior cartilage or rib fractures. Contrary to common impression, it has more than 1 form and each varies in severity.</p><p><strong>Case presentation: </strong>A 44-year-old male patient presented to the emergency department with blunt trauma. Imaging studies revealed a third rib fracture with flail chest on the right side, along with multiple rib fractures and a pneumothorax on the left. The lungs showed bilateral contusions. The patient also sustained compression fractures of the third and fifth thoracic vertebrae, a sternal fracture, and a nondisplaced distal radius fracture on the right. The clinical team inserted a chest tube into the left hemithorax to manage the pneumothorax. The patient remained stable and did not require mechanical ventilation. Oxygen therapy was administered via nasal cannula, accompanied by the administration of normal saline and analgesic treatment. Arterial blood gas analysis demonstrated mild lactic acidosis, whereas serial hemogram assessments revealed no clinically significant decline in hemoglobin levels. The patient was subsequently admitted to the department of thoracic surgery for conservative management and close observation, with no immediate indication for surgical intervention. Clinical course remained uneventful, and the patient was discharged on the seventh day in stable condition without complications.</p><p><strong>Conclusion: </strong>Flail chest may result from a single rib fracture in combination with a sternal fracture. Patients presenting with atypical manifestations of flail chest can be discharged without complications within a short period when early diagnosis, appropriate supportive care, and timely treatment are provided.</p>","PeriodicalId":51082,"journal":{"name":"Journal of Emergency Nursing","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144585565","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 Cognitive Task Analysis for Developing a Clinical Decision Support System for Emergency Triage.","authors":"Steve Agius, Caroline Magri, Vincent Cassar","doi":"10.1016/j.jen.2025.05.013","DOIUrl":"https://doi.org/10.1016/j.jen.2025.05.013","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Introduction: &lt;/strong&gt;The Emergency Department (ED) serves as a vital gateway to acute care, where timely and accurate triage decisions are essential to ensure appropriate patient prioritisation and efficient use of limited resources. Triage nurses operate in high-pressure environments and must make rapid decisions, often under conditions of uncertainty, relying on a blend of analytical reasoning and intuitive judgement. However, this complex decision-making process is susceptible to a range of challenges, including cognitive biases, communication breakdowns, procedural inconsistencies, fatigue, and stress, all of which can compromise patient safety and care quality. This study explores the multifaceted nature of triage decision-making, focusing on the influencing factors, cognitive processes, and real-world challenges experienced by nurses. By deepening our understanding of these elements, the paper lays the groundwork for the development of effective Clinical Decision Support Systems (CDSS) that can enhance clinical judgement and support nurses in delivering safe, timely, and efficient emergency care.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;The study used cognitive task analysis through interviews and observations to capture the cognitive strategies used by nurses during triage. This approach provided detailed insights into how nurses assess patient acuity, handle uncertainty, verify decisions, and manage challenges.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;This study identified 26 themes from interviews and observations, illustrating how nurses use experience and protocols such as the Emergency Severity Index to manage patient flow. Key challenges encountered in triage included overcrowding, staff shortages, high patient acuity, communication barriers, frequent interruptions, and multitasking demands. Despite these hurdles, nurses adapted through prioritization and collaboration.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Discussion: &lt;/strong&gt;The findings highlight significant implications for emergency health care, mainly the need for improvements in triage decision making, resource utilization, and patient safety. Data-driven clinical decision support systems can enhance decision making, streamline assessments, reduce delays, and improve safety and equity in triage, particularly in high-stress, resource-constrained environments.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Relevance to clinical practice: &lt;/strong&gt;This study has significant implications for clinical practice, particularly in emergency care settings where effective triage is critical for patient outcomes. By exploring the cognitive processes and challenges faced by triage nurses, the research provides valuable insights into the complexities of decision making under pressure. The findings emphasize the importance of clinical decision support systems to enhance decision accuracy, reduce cognitive load, and mitigate the risk of errors. Implementing data-driven technologies and refining triage protocols can lead to more efficient resource alloc","PeriodicalId":51082,"journal":{"name":"Journal of Emergency Nursing","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144585564","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 Registered Nurse Staffing, Workload, and the Practice Environment on Burnout in Emergency Nurses","authors":"Sharmine Brassington PhD, RN,&nbsp;Charlotte Thomas-Hawkins PhD, RN, FAAN,&nbsp;Mary L. Johansen PhD, RN, NE-BC, FAAN,&nbsp;Pamela B. de Cordova PhD, RN-BC,&nbsp;Jeannie P. Cimiotti PhD, RN, FAAN,&nbsp;Peijia Zha PhD","doi":"10.1016/j.jen.2025.01.007","DOIUrl":"10.1016/j.jen.2025.01.007","url":null,"abstract":"<div><h3>Introduction</h3><div>Burnout among registered nurses is an ongoing nurse workforce issue, yet there is no quantified evidence on the factors that contribute to burnout among registered nurses in emergency departments. We examined different aspects of the nurse practice environment in hospital-based emergency departments across New Jersey.</div></div><div><h3>Methods</h3><div>This cross-sectional study included a survey of emergency nurses. Using a publicly available list, an email invitation with a survey link was used to recruit potential study participants. Four self-reported measures were used. Burnout was a single-item measure, and registered nurse staffing was assessed as the number of patients assigned to a nurse on the last day worked. Additional measures included the perceived workload subscale of the Individual Workload Perception Scale and the Practice Environment Scale of the Nursing Work Index. Logistic regression models were used to estimate the odds of burnout.</div></div><div><h3>Results</h3><div>A total of 188 emergency registered nurses completed the survey. Seventy-two percent of registered nurses reported moderate to complete burnout and 34% reported sustained or complete burnout. Perceptions of high workloads (odds ratio, 2.89; <em>P</em> = .04) and unsupportive practice environments (odds ratio, 8.02; <em>P</em>&lt;.001) were associated with an increase in the odds of high burnout. An unsupportive practice environment significantly mediated the relationship between high perceived workload and high burnout.</div></div><div><h3>Discussion</h3><div>There’s an urgent need to reduce burnout among emergency registered nurses. Study findings point to a pressing need for hospital and emergency department leadership to implement strategies to improve the practice environment and decrease nurse workloads.</div></div>","PeriodicalId":51082,"journal":{"name":"Journal of Emergency Nursing","volume":"51 4","pages":"Pages 684-691"},"PeriodicalIF":1.8,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143588058","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":"From Scholarship to Practice: Supporting Emergency Nurse Authors","authors":"Anna Valdez PhD, RN, PHN, CEN, CFRN, FAEN, FAADN","doi":"10.1016/j.jen.2025.04.015","DOIUrl":"10.1016/j.jen.2025.04.015","url":null,"abstract":"","PeriodicalId":51082,"journal":{"name":"Journal of Emergency Nursing","volume":"51 4","pages":"Pages 509-510.e1"},"PeriodicalIF":1.8,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144517315","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":"ENA Clinical Practice Guideline Synopsis: Interventions to Reduce Needle-Related Pain and Distress in Pediatric Patients","authors":"Andrea Perry MSN, RN, CNL, NPD-BC, CEN, CPEN, TCRN,&nbsp;Carolyn Dixon DNP, RN, FNP-BC, CEN, TCRN,&nbsp;Sheryln Wachtel PhD, RN, CNS-CC, CCRN,&nbsp;Andrea Slivinski DNP, APRN, ACNS-BC, CEN, CPEN, TCRN,&nbsp;Alison Camarda MSN, RN, CEN, CPEN, NPD-BC, SANE,&nbsp;Sharon Coffey DNP, RN, FNP-C, ACNS-BC, CEN, CCRN, FAEN,&nbsp;Joshua Gibson MSN, APRN, CEN, ACCNS-AG, NRP,&nbsp;Janet Kaiser DNP, MSN, RN, CEN, NE-BC,&nbsp;Andrew Slifko DNP, MBA, RN, EMT-B, NEA-BC,&nbsp;Amy Tucker DNP, RN, CCRN, TCRN,&nbsp;Mary Alice Vanhoy MSN, RN, CEN, CPEN, NRP, FAEN,&nbsp;Jessica Bishop-Royse PhD, MS,&nbsp;Altair M. Delao MPH","doi":"10.1016/j.jen.2025.02.006","DOIUrl":"10.1016/j.jen.2025.02.006","url":null,"abstract":"","PeriodicalId":51082,"journal":{"name":"Journal of Emergency Nursing","volume":"51 4","pages":"Pages 519-524"},"PeriodicalIF":1.8,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144517319","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":"Developing and Testing a Multimodal Intervention to Decrease Violence and Increase Perceptions of Safety in the Emergency Department: A Longitudinal Study","authors":"Dianne Maccarone MSN, RN, CEN,&nbsp;Jean M. Boles MSN, RN, CEN,&nbsp;Alexandra Archer MSN, RN,&nbsp;Beverly A. Brown BSN, RN, CEN, TCRN,&nbsp;Nehemiah Weldeab MS,&nbsp;Jesse Chittams MS,&nbsp;James Ballinghoff DNP, MBA, RN, NEA-BC,&nbsp;Leighann Mazzone MSN, RN, CEN, NE-BC,&nbsp;Pamela Z. Cacchione PhD, RN, CRNP, BC, FGSA, FAAN,&nbsp;Christian N. Burchill PhD, MSN, RN, CEN","doi":"10.1016/j.jen.2025.01.011","DOIUrl":"10.1016/j.jen.2025.01.011","url":null,"abstract":"<div><h3>Introduction</h3><div>Patient and visitor violence and aggression against emergency department clinicians is a complex phenomenon requiring a multifaceted approach and recognition that interventions require time to integrate into practice. The purpose of this study was to determine the efficacy of a multimodal intervention on frequency of workplace violence incidents and clinicians’ perceptions of safety in one emergency department.</div></div><div><h3>Methods</h3><div>A quasi-experimental, longitudinal design was used to answer study questions. Environmental changes, an algorithmic response guideline that included a rapid de-escalation program, and improvements in the formal incident reporting system were implemented. Participants completed an online, anonymous survey that included demographic information, the Personal Workplace Safety Instrument for Emergency Nurses, and a violence and aggression frequency checklist prior to and for three quarters following implementation.</div></div><div><h3>Results</h3><div>Surveys were sent to all 140 emergency department clinicians. Response rate was highest at baseline but decreased over time. There was no significant difference in number of incidents experienced by clinicians during the study. Perceptions of safety decreased from baseline during the course of the study, but there was a significant increase in the number of formal incident reports submitted.</div></div><div><h3>Discussion</h3><div>Despite significant efforts, it was difficult to decrease violent and aggressive acts committed by patients and visitors and to improve emergency department clinicians’ perceptions of safety in the emergency department. Timing and severity of violent and aggressive acts may have influenced results. More work needs to be done using different research, implementation, and evaluation methods to determine best practices for preventing WPV in the emergency department.</div></div>","PeriodicalId":51082,"journal":{"name":"Journal of Emergency Nursing","volume":"51 4","pages":"Pages 749-759"},"PeriodicalIF":1.8,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143588055","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 COVID-19 on Selected Nurse and Patient Outcomes in Emergency Units Across South Africa","authors":"Annette L. Pienaar MNSc, RN,&nbsp;Alwiena J. Blignaut PhD, RN,&nbsp;Siedine K. Coetzee PhD, RN, FANSA,&nbsp;Marcel F. Mather MNSc, RN,&nbsp;Erika Fourie PhD","doi":"10.1016/j.jen.2025.02.016","DOIUrl":"10.1016/j.jen.2025.02.016","url":null,"abstract":"<div><h3>Introduction</h3><div>Worldwide, emergency nurses experience worse nurse outcomes (burnout, physical and mental health, compassion fatigue, and job and career satisfaction), further exacerbated by the coronavirus disease 2019 pandemic, although poorly reported in developing countries. Therefore, this study aimed to determine the pandemic’s impact on nurse and patient outcomes in emergency units in South Africa.</div></div><div><h3>Methods</h3><div>A cross-sectional correlational design was used, with data collected from 2 different groups in the public and private sectors after the second and third coronavirus disease 2019 waves using a questionnaire. Purposive sampling of 116 private sector and 27 public sector emergency units (total n = 143) and total population sampling of nurses (n = 332) were used.</div></div><div><h3>Results</h3><div>South African emergency nurses experienced high levels of emotional exhaustion (mean = 28.03; SD = 1.08) and moderate job satisfaction (mean = 2.81; SD = 0.07), being particularly dissatisfied with salary/wages (mean = 2.15; SD = 0.07). More than a quarter (25.30%) planned to quit their jobs. Participants rated patient safety positively (mean = 2.32; SD = 0.09). Nurses responding after the third wave of the pandemic reported higher rates of compassion fatigue (odds ratio, 3.2; 95% CI, 1.01-10.1; <em>P</em> = .047) and dissatisfaction with both professional status (odds ratio, 2.23; 95% CI, 1.13-4.40; <em>P</em> = .02) and independence at work (odds ratio, 2.21; 95% CI, 1.24-3.94; <em>P</em> = .047, <em>P</em> = .01). There were practically significant correlations between job satisfaction and recommending one’s workplace (r = −0.44; <em>P</em> &lt; .001) and emotional exhaustion and confidence in postdischarge care (r = 0.40; <em>P</em> &lt; .001).</div></div><div><h3>Discussion</h3><div>An association between coronavirus disease 2019 and nurse and patient outcomes in South African emergency units exists, highlighting emotional exhaustion, compassion fatigue, and job dissatisfaction concerns. Significant correlations were identified between nurse and nurse-reported patient outcomes. Addressing these concerns is critical to achieving better outcomes and planning for future health emergencies.</div></div>","PeriodicalId":51082,"journal":{"name":"Journal of Emergency Nursing","volume":"51 4","pages":"Pages 644-660"},"PeriodicalIF":1.8,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144043831","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 Role of Structural Empowerment in Mediating the Relationship Between Practice Environment and Quality of Care Among Emergency Nurses: A Multilevel Modeling Approach","authors":"Sulaiman Dawood Al Sabei PhD, RN,&nbsp;Leodoro J. Labrague PhD, RN, DM, CNE","doi":"10.1016/j.jen.2024.12.015","DOIUrl":"10.1016/j.jen.2024.12.015","url":null,"abstract":"<div><h3>Introduction</h3><div>Strong evidence demonstrated that working in a healthy environment has been associated with high-quality patient care. However, the mechanism underlying this relationship requires further investigation. This study aimed to examine the role of structural empowerment in mediating the relationship between nursing practice environment and quality of care among emergency nurses.</div></div><div><h3>Methods</h3><div>A proportional stratified clustered sampling technique was used to recruit staff nurses working in acute care hospitals in Oman. Four standardized instruments were used to assess nurses’ sociodemographic characteristics, perception of the practice environment, structural empowerment, and perceived quality of care. Hayes’ process for mediation analysis was used to examine whether empowerment mediates the relationship between the practice environment and quality of care.</div></div><div><h3>Results</h3><div>A total of 160 emergency nurses participated. The majority (78.8%) perceived the quality of care as good/excellent. Having an adequate foundation for quality of care, sufficient staffing, and managerial support were significant predictors of perceived quality of care. Practice environment was directly and indirectly related to the perceived quality of care through structural empowerment.</div></div><div><h3>Discussion</h3><div>Nurse leaders can enhance care quality in emergency departments by improving the work environment through engaging nurses in quality activities, ensuring adequate staffing and resources, and providing robust leadership support, which collectively empower nurses and improve patient outcomes.</div></div>","PeriodicalId":51082,"journal":{"name":"Journal of Emergency Nursing","volume":"51 4","pages":"Pages 692-701"},"PeriodicalIF":1.8,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143076389","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}