Journal of Emergency Nursing最新文献

{"title":"Stress Responses to Therapy Dog Visits in the Emergency Department: A Nonrandomized Intervention Study.","authors":"Lynn L White, Carla Borchardt, Troy Grovenburg, Katie Kruger, Denise Haisch","doi":"10.1016/j.jen.2026.07.015","DOIUrl":"https://doi.org/10.1016/j.jen.2026.07.015","url":null,"abstract":"<p><strong>Introduction: </strong>Emergency departments are high-stress clinical environments where health care workers are exposed to unpredictable patient acuity, trauma, workplace violence, and rapid decision making. Animal-assisted interventions have demonstrated benefits for patients, with emerging evidence suggesting potential value for reducing health care worker stress and improving emotional well-being. However, objective physiological outcomes and emergency department-specific data remain limited.</p><p><strong>Methods: </strong>This descriptive, interventional study examined the association between therapy dog visits and perceived and physiological stress among emergency department health care workers. Patient- and nonpatient-facing staff completed measures of salivary cortisol, perceived stress, and blood pressure immediately before and after dog interactions. Participants also provided qualitative descriptions of their feelings pre- and postintervention.</p><p><strong>Results: </strong>A total of 76 staff members participated, accounting for 100 therapy dog interactions. Overall, pre- to postintervention changes in salivary cortisol were not statistically significant. Perceived stress decreased significantly for all participants (P < .001), and mean arterial pressure decreased at the α = 0.10 level. Qualitative findings revealed a shift from negative emotional states (stressed and overwhelmed) before dog visits to more positive emotions (calmer, happier, and reenergized) afterward.</p><p><strong>Discussion: </strong>Results of this study suggest that therapy dog visits were associated with lower perceived stress and were well received by staff. Pet therapy may be considered as 1 component of broader organizational strategies to support health care workers in high-stress clinical environments. Therapy dog programs may represent a feasible, low-cost approach for promoting a supportive healing environment.</p>","PeriodicalId":51082,"journal":{"name":"Journal of Emergency Nursing","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2026-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148851957","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":"Decision-Making Frameworks for Vehicle Extrication in Prehospital Trauma Care: A Scoping Review.","authors":"Rachele Gaini, Marta Bianchetta, Domenica Petta, Simone Conte, Flavio Gheri","doi":"10.1016/j.jen.2026.07.009","DOIUrl":"https://doi.org/10.1016/j.jen.2026.07.009","url":null,"abstract":"<p><strong>Introduction: </strong>Vehicle extrication is a critical prehospital phase for patients trapped in motor vehicle collisions. Historically driven by rigid technical protocols, recent evidence suggests a shift toward clinically oriented, multidisciplinary decision-making. This scoping review aims to synthesize current evidence on extrication frameworks and their impact on clinical care.</p><p><strong>Methods: </strong>A scoping review was reported following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews guidelines. Major databases were searched for studies describing decision-making frameworks, algorithms, or clinical pathways for the extrication of trapped trauma patients.</p><p><strong>Results: </strong>Eleven key studies and frameworks were identified. Findings suggest an emerging transition from routine spinal immobilization to selective Spinal Motion Restriction. Biomechanical studies included in the review reported lower spinal movement during guided self-extrication in selected stable scenarios, although this evidence is mainly derived from experimental or simulation-based settings. Contemporary frameworks emphasize the roles of physiological and anatomical assessment, multidisciplinary coordination, and shared decision-making between clinical and technical rescue teams. Emerging themes include mitigating hypothermia risk and managing psychological sequelae following entrapment.</p><p><strong>Discussion: </strong>Extrication is evolving into a dynamic clinical intervention. Transitioning to evidence-based pathways requires integrating clinical triage, selective spinal motion restriction, and thermal protection. For emergency nurses, this implies a leadership role in field triage and patient advocacy, ensuring that technical procedures do not compromise clinical outcomes. Implementing patient-centered extrication frameworks may contribute to reducing scene times and secondary morbidity, although further prospective validation is required. Future research should focus on prospectively validating these algorithms in real-world trauma settings to confirm their impact on long-term survival.</p>","PeriodicalId":51082,"journal":{"name":"Journal of Emergency Nursing","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2026-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148820124","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":"Medication Safety During Transitions of Care From Paramedicine to Emergency Nursing Care: A Scoping Review Protocol.","authors":"Haiying Wang, Clint Moloney, Ashlee Stirling, Sue Morgan, Lori Delaney","doi":"10.1016/j.jen.2026.07.007","DOIUrl":"https://doi.org/10.1016/j.jen.2026.07.007","url":null,"abstract":"<p><strong>Introduction: </strong>Transitions of care in the emergency department are critical points for patient safety, particularly during handovers from emergency medical services (EMS) personnel to emergency department clinicians. This rapid and high-pressure environment often prioritizes urgent clinical care over structured communication, increasing the risk of information loss and medication errors, which can lead to serious patient harm, prolonged hospital stays, preventable complications, and death.</p><p><strong>Objective: </strong>To systematically map academic and gray literature examining medication-related safety risks during transitions of care from EMS personnel to emergency department clinicians.</p><p><strong>Evidence review: </strong>This scoping review will follow the Joanna Briggs Institute guidance to report the outcomes using the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Extension for Scoping Reviews checklist. The database search will be guided by the population, concept, and context framework and will include studies involving EMS personnel and emergency department clinicians. The databases searched will include CINAHL, PubMed, Scopus, Web of Science, APA PsycInfo, Cochrane Library and ProQuest Dissertations & Theses Global and ERIC, alongside gray literature from OpenGrey, World Health Organization Institutional Repository for Information Sharing, Australian Commission on Safety and Quality in Health Care, National Institute for Health and Care Excellence Comission, Proquest Health & Medicine / Health Management, Patient Safety Network, Clinical Excellence Comission, and government health and EMS websites. Two reviewers will independently screen titles, abstracts, and full texts, with a third reviewer resolving discrepancies. The extracted data will be synthesized narratively and displayed in tables and charts to summarize themes and key findings.</p><p><strong>Conclusion: </strong>This review will examine medication safety in the context of the emergency medical services-to-emergency department transition of care. The scoping review will examine the international English-language literature to highlight knowledge gaps and inform future research projects with outcomes that guide strategies that strengthen medication safety, optimize handover communication, and enhance patient outcomes across emergency care transitions.</p>","PeriodicalId":51082,"journal":{"name":"Journal of Emergency Nursing","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2026-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148820135","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":"Association of Non-English Language Preference on ICU Admissions via Emergency Departments: Evidence From a Large United States hospital.","authors":"Dan P Kelleher, Amelia K Barwise, Christopher R Carpenter, Bijan J Borah","doi":"10.1016/j.jen.2026.07.010","DOIUrl":"https://doi.org/10.1016/j.jen.2026.07.010","url":null,"abstract":"<p><strong>Introduction: </strong>Patients with non-English language preference and English-speaking patients may have different critical care outcomes. It is important to examine how both patient groups compare in critical care admissions via the emergency department because patients with non-English language preference can be frequent users of emergency department services. The objective of this study was to examine the association between non-English language preference status and intensive care unit admissions via the emergency department.</p><p><strong>Methods: </strong>This study included hospitalized patients between January 1, 2018, and December 31, 2022, at a large multi-specialty health care organization in the United States Midwest. We used propensity score matching to ensure that patients with non-English language preference and English-speaking patients were comparable across observed characteristics. This study examined the probability of intensive care unit admissions from the emergency department as the primary outcome using logistic regression and examined intensive care unit and hospital length of stay as secondary outcomes using negative binomial models for patients with non-English language preference and English-speaking patients.</p><p><strong>Results: </strong>Patients with non-English language preference had 99% higher odds of being admitted to the intensive care unit via the emergency department compared with similar English-speaking patients (odds ratio = 1.986; 95% CI, 1.627-2.424; P < .001). There were no statistically significant differences between the 2 groups in intensive care unit length of stay and hospital length of stay among the patients who were admitted to the intensive care unit via the emergency department directly.</p><p><strong>Conclusion: </strong>There were differences in how patients with non-English language preference were admitted to the intensive care unit via the emergency department. The results from this study can be used to inform initiatives aimed at improving access to care for patients with non-English language preference.</p>","PeriodicalId":51082,"journal":{"name":"Journal of Emergency Nursing","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2026-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148801425","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":"Enhancing the Use of Home Hospital in the Emergency Department: A Nurse Practitioner-Led Quality Improvement Project.","authors":"Taeseong Kim, Chenjuan Ma, Tara A Cortes, Daniel McWeeney, Christopher G Caspers, Suchismita Datta","doi":"10.1016/j.jen.2026.07.004","DOIUrl":"https://doi.org/10.1016/j.jen.2026.07.004","url":null,"abstract":"<p><strong>Introduction: </strong>Emergency department crowding contributes to adverse patient outcomes and resource strain. Home Hospital, which delivers hospital-level care in a patient's home, can reduce inpatient volume while maintaining quality and safety. Although Home Hospital programs offer a viable solution to these systemic pressures, a recognized gap exists between program availability and actual use by emergency department providers.</p><p><strong>Methods: </strong>This quality improvement project used 3 sequential Plan-Do-Study-Act cycles: (1) a self-paced online learning module on eligibility and referral workflow; (2) point-of-care visual aids at provider workstations; and (3) integration of standardized referral guidance into the emergency department provider manual for sustainability, along with referral data sharing and a QR code link for feedback. The primary outcomes included the proportion of Home Hospital referrals originating in the emergency department and provider confidence with eligibility and referral steps, measured pre- and postintervention using the Home Hospital Clinician Perception Survey and electronic medical record data.</p><p><strong>Results: </strong>During the 3 months before the intervention, 5 of 259 referrals (1.9%) originated in the emergency department. Following the intervention, emergency department--initiated referrals increased significantly to 47 of 266 (17.7%; P < .001), with an odds ratio of 10.9. Provider confidence in identifying eligible patients increased from 41% to 94%, and confidence in completing the referral process increased from 41% to 84%. Provider engagement was high; participation rates reached 94% for the online module and 82% for the visual aids.</p><p><strong>Discussion: </strong>Embedding a low-cost, multi-component strategy into existing workflows was associated with an increase in emergency department--initiated Home Hospital referrals and an increase in provider confidence. This approach is scalable and supports timely, patient-centered alternatives to hospital admission.</p>","PeriodicalId":51082,"journal":{"name":"Journal of Emergency Nursing","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2026-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148801374","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 to Night Shift Wellness in the Emergency Department: A Qualitative Study.","authors":"Sean J Tomberlin, Jacquie M DeMellow","doi":"10.1016/j.jen.2026.07.006","DOIUrl":"10.1016/j.jen.2026.07.006","url":null,"abstract":"<p><strong>Introduction: </strong>Research has demonstrated that night shift nursing and ancillary hospital staff face challenges ranging from sleep disorders to increased medication errors. Night shift work in the emergency department can pose unique wellness barriers worth exploring, given the patient population and the demanding, high-risk setting.</p><p><strong>Methods: </strong>This qualitative descriptive study was conducted via online focus groups in the emergency department of a 355-bed teaching hospital. A total of 18 night-shift staff from clinical and nonclinical roles participated. A reflexive thematic analysis framework was used for coding and theme development. Data saturation was achieved by conducting additional focus groups, and credibility was ensured through reflexive journaling, member checking, deep immersion in the data, and triangulation across separate focus group meetings.</p><p><strong>Results: </strong>Seven themes emerged: \"Sleep as a balancing act,\" \"Night shift workers want a life, too,\" \"Night shift work impacts health,\" \"Impaired professional effectiveness,\" \"Fewer hands make for heavy work, which makes for fewer hands,\" \"Organizational structures and schedules burden night shift,\" and \"Shift vs shift (night shift problems).\" The individual barriers were described as influencing and exacerbating one another.</p><p><strong>Discussion: </strong>Participants identified both personal and work barriers as important to their wellness. Consistent with previous research, sleep, health, and social concerns were priorities. In the current study, participants also identified impaired professional effectiveness as both a measure of and a barrier to their wellness. Understanding these challenges and their impact on staff could inform interventions to improve the quality of life on the night shift.</p>","PeriodicalId":51082,"journal":{"name":"Journal of Emergency Nursing","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2026-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148801356","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":"Clinical Decision Support and the Naloxone Equity Exception: Insights from an Emergency Department.","authors":"Aretha D Miller","doi":"10.1016/j.jen.2026.07.003","DOIUrl":"https://doi.org/10.1016/j.jen.2026.07.003","url":null,"abstract":"<p><strong>Introduction: </strong>Despite rising overdose mortality nationwide, racial and ethnic disparities in naloxone access persist. This study examined whether these disparities remained after adjusting for demographic and clinical risk factors, including an electronic health record-based Clinical Decision Support alert, within an emergency department setting.</p><p><strong>Methods: </strong>A retrospective cross-sectional study of 10,313 emergency department encounters was conducted over a 2-year period. Multivariable logistic regression was used to assess the association between race or ethnicity and naloxone distribution during the emergency department encounter. The model adjusted for age, illness severity, nursing-documented intravenous drug use risk, and daily morphine milligram equivalents.</p><p><strong>Results: </strong>Documented intravenous drug use risk emerged as the strongest predictor, with patients with this risk having significantly higher odds of naloxone distribution (odds ratio, 1.84; 95% confidence interval [CI], 1.67-2.03). Clinical Decision Support alert activation was also associated with increased odds of distribution (odds ratio, 1.14; 95% CI, 1.04-1.25), indicating that the alert contributed modestly when activated. Minor racial and ethnic differences were observed. Black/African American patients had higher odds of naloxone distribution compared with white patients (odds ratio, 1.08; 95% CI, 0.90-1.30). In contrast, increasing age (odds ratio, 0.99; 95% CI, 0.99-0.99) and higher Emergency Severity Index scores (odds ratio, 0.82; 95% CI, 0.77-0.88) were associated with reduced odds of naloxone distribution.</p><p><strong>Discussion: </strong>Integrated Clinical Decision Support may promote more consistent naloxone distribution, though this study could not determine whether the observed patterns reflected equitable access or other clinical and contextual influences. Strengthening early medication reconciliation and embedding reliable risk indicators into triage workflows may improve the reliability of Clinical Decision Support reliability.</p>","PeriodicalId":51082,"journal":{"name":"Journal of Emergency Nursing","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2026-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148801388","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 Lived Experiences of Patients and Health Care Providers During ED Triage in Saudi Arabia.","authors":"Mohammad J Jaber, Hind M AlTmaizy, Yacoub Abuzied, Abdullah Y Kanaan, Eslam K Abusamra","doi":"10.1016/j.jen.2026.07.001","DOIUrl":"10.1016/j.jen.2026.07.001","url":null,"abstract":"<p><strong>Introduction: </strong>Triage in emergency departments is central to matching clinical urgency with timely emergency care, patient safety, and patient experience; yet little is known about how patients and health care providers experience triage in tertiary emergency departments in Saudi Arabia.</p><p><strong>Methods: </strong>This qualitative descriptive study explored triage experiences in a tertiary emergency department in Riyadh, Saudi Arabia. Purposive sampling recruited 42 participants: 21 nurses, 11 physicians, and 10 patients. Data were generated through 35 semistructured individual interviews and 1 nurse focus group with 7 nurses from November 2024 to January 2025, across peak and off-peak periods. Guides were piloted. Data were transcribed verbatim, de-identified, and analyzed inductively using reflexive thematic analysis, emphasizing reflexive bracketing, repeated reading, coding, within- and cross-group comparisons, and consensus-based theme development.</p><p><strong>Results: </strong>Four themes and 12 subthemes described triage as shaped by system conditions: workforce and resource challenges; environmental and infrastructure barriers; organizational and contextual system-level factors; and improvement interventions. Participants linked triage difficulties to staffing and competency gaps, crowding and privacy limitations, workflow and communication failures, and delayed access to diagnostics and beds. Together, the themes showed that triage was experienced as a system-mediated encounter in which care priorities, communication, privacy, and flow were shaped by interactions among people, spaces, resources, and organizational routines.</p><p><strong>Discussion: </strong>Emergency department triage at this tertiary hospital in Saudi Arabia was perceived as a complex process shaped by staffing, communication, infrastructure, and organizational pressures. Patients, nurses, and physicians described how these interconnected factors affected timely care, patient safety, privacy, and the overall triage experience. Improving workforce support, triage training, communication, and emergency department resources may help to strengthen triage quality and enhance emergency care delivery and the patient experience.</p>","PeriodicalId":51082,"journal":{"name":"Journal of Emergency Nursing","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2026-08-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148764132","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 a Staff-Led Vertical Flow Model Policy in a Rural Emergency Department.","authors":"Grace F Winchester, Jennifer Rogers","doi":"10.1016/j.jen.2026.07.005","DOIUrl":"https://doi.org/10.1016/j.jen.2026.07.005","url":null,"abstract":"<p><strong>Introduction: </strong>Emergency department overcrowding contributes to prolonged wait times, increased mortality, and staff burnout. The vertical flow model was developed to improve patient flow and has demonstrated reductions in length of stay, door-to-provider time, and rates of patients who leave without being seen. Although it is adaptable to different emergency department settings, implementation has primarily occurred in large, urban hospitals. This project aimed to develop a staff-led policy for a modified vertical flow model tailored to a small, rural emergency department.</p><p><strong>Methods: </strong>An anonymous survey was distributed to emergency department staff to assess perceptions of the current patient flow and perceived areas for improvement. Survey data were analyzed using descriptive statistics and used to guide the development of a modified vertical flow model policy. The proposed policy was submitted to emergency department leadership for review and was revised based on feedback.</p><p><strong>Results: </strong>Nearly 75% of participants rated the current patient flow as 3 or lower on a 5-point Likert scale. Participants identified reducing door-to-provider time as a key factor in improving patient flow. Major barriers included the increasing patient volume and delays in orders and discharge processes. When comparing emergency department performance metrics 6 months before and 6 months postimplementation, a decrease was found in length of stay and rates of patients who left without being seen.</p><p><strong>Discussion: </strong>A modified vertical flow model policy was developed using the waiting room as the vertical flow area and was revised due to limited provider availability to include protocol orders in triage. The revised policy was accepted by emergency department leadership, demonstrating that the model can be adapted successfully in small, rural emergency departments.</p>","PeriodicalId":51082,"journal":{"name":"Journal of Emergency Nursing","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2026-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148764159","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":"Beyond Necrosis: Early Recognition of Xylazine-Associated Wounds in Emergency Nursing Practice.","authors":"Alexis Skuras","doi":"10.1016/j.jen.2026.07.012","DOIUrl":"https://doi.org/10.1016/j.jen.2026.07.012","url":null,"abstract":"<p><p>Xylazine has emerged as a common adulterant in the illicit drug supply and is increasingly associated with severe skin and soft tissue complications. Existing literature has largely focused on advanced wound presentations characterized by extensive tissue necrosis, hospitalization, and surgical intervention. Although these presentations are clinically significant, they may not reflect the full spectrum of xylazine-associated wounds encountered in emergency nursing practice. Early-stage lesions may present as subtle findings, including superficial ulcerations, papules, pustules, bumps, or multifocal blistering, and may be identified incidentally during clinical encounters. Multiple factors may contribute to underrecognition of these early presentations, including limited clinician familiarity, competing priorities in high-acuity settings, and stigma experienced by individuals with substance use disorders. Delayed recognition may allow progression to more advanced tissue injury requiring intensive treatment. Emergency nurses are uniquely positioned to identify early wound manifestations through routine assessment, trauma-informed communication, and integration of harm reduction principles into care. Increased awareness of early wound characteristics may facilitate earlier recognition, patient education, wound management, and referral to ongoing services. This article reviews current literature on xylazine-associated wounds, highlights distinctions between early and advanced presentations, and discusses implications for emergency nursing practice.</p>","PeriodicalId":51082,"journal":{"name":"Journal of Emergency Nursing","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2026-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148765513","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}