Journal of Emergency Nursing最新文献

{"title":"Emergency Nurses' and Physicians' Attitudes Toward Patients With Chronic Pain and Staff-Patient Relationship Levels.","authors":"Emre Bülbül, Ali Kaplan","doi":"10.1016/j.jen.2025.08.015","DOIUrl":"https://doi.org/10.1016/j.jen.2025.08.015","url":null,"abstract":"<p><strong>Introduction: </strong>Chronic pain often brings patients to emergency departments. Management of chronic pain is influenced by health care providers' attitudes. The first aim of the study was to measure the attitudes of emergency nurses and physicians toward patients with chronic pain in relation to the nurses' and physicians' individual and professional characteristics. The second aim was to measure the differences in attitudes between emergency nurses and physicians at varying levels of interaction with patients.</p><p><strong>Methods: </strong>This descriptive and cross-sectional study was conducted with 201 nurses and 140 physicians employed in the emergency department of public and private hospitals in Turkey. Data were collected using a descriptive characteristics form, the Health Personnel-Patient Relationship Survey, and the Attitudes Toward Patients With Chronic Pain Scale.</p><p><strong>Results: </strong>Nurses demonstrated significantly more positive attitudes toward patients with chronic pain than did physicians. Nurses and physicians who reported job satisfaction in the emergency department had significantly higher scores in both their attitudes toward patients with chronic conditions and the staff-patient relationship levels. Among nurses, sex and willingness to work in the emergency department were significantly associated with attitude scores, whereas, among physicians, weekly working hours were a significant factor. A strong positive correlation was observed between the 2 scales in nurses (r = 0.615) and a moderate correlation in physicians (r = 0.543) (P < .001).</p><p><strong>Discussion: </strong>Emergency nurses and physicians demonstrated attitudes and staff-patient interaction levels that were slightly above average. Positive attitudes of emergency nurses and physicians were associated with better interactions with patients. Factors such as job satisfaction and work conditions influenced the attitudes and interactions of emergency nurses and physicians. Enhancing these attitudes and interactions among providers may improve chronic pain care in emergency settings.</p>","PeriodicalId":51082,"journal":{"name":"Journal of Emergency Nursing","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145202120","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":"Brain Edema After Cosmetic Botulinum Toxin Injection: A Case Report.","authors":"Lan Lai, Zhongxiang Wang, Yajun Sun","doi":"10.1016/j.jen.2025.08.013","DOIUrl":"https://doi.org/10.1016/j.jen.2025.08.013","url":null,"abstract":"<p><p>A 26-year-old woman presented to the emergency department with progressive symptoms including fever, pharyngeal pain, dysphagia, bilateral ptosis, and generalized weakness after cosmetic botulinum toxin injections to the neck. This case report aimed to describe an unusual presentation of botulinum neurotoxin-associated central nervous system involvement. This manuscript is a case review describing the clinical course, diagnostic challenges, and management strategies of brain edema after botulinum toxin type A exposure. Key points include the importance of recognizing nontraditional presentations of botulism in emergency settings, the potential for central neurologic complications after cosmetic procedures, and the critical role of emergency nurses in early symptom recognition, airway management, and multidisciplinary coordination for antitoxin administration and intensive care support.</p>","PeriodicalId":51082,"journal":{"name":"Journal of Emergency Nursing","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145187479","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":"Improving Antibiotic Administration Time in At-Risk Pediatric Populations: A Quality Improvement Project.","authors":"Virginia Elizondo, Nicole Bizzack, Angelica Rodick, Amber Albiar, Amber Dayton, Ashley Collins, Georgina Hernandez, Pauline Chen","doi":"10.1016/j.jen.2025.08.004","DOIUrl":"https://doi.org/10.1016/j.jen.2025.08.004","url":null,"abstract":"<p><strong>Introduction: </strong>Bacterial sepsis is a life-threatening concern for pediatric patients with a history of sickle cell disease, oncological disease, and/or neutropenia who present with fever. Prompt antibiotic administration is critical. However, studies show that many hospitals fail to meet the 60-minute benchmark for high-risk patients, despite its known benefits.</p><p><strong>Methods: </strong>This quality improvement initiative aimed to ensure that at least 80% of the target population received antibiotics within 60 minutes of emergency department registration. The Plan-Do-Study-Act model was used, and data were collected through electronic medical record audits, measuring time to antibiotics from registration to administration. SPSS 27 and a 2-proportion z-test analyzed time to antibiotics improvement.</p><p><strong>Results: </strong>Pre- (n = 137) and postintervention groups (n = 638) were demographically similar. The mean age was 6.5 years before and 7.4 years after intervention, with a balanced sex distribution. Most patients were Black or African American, with clinical presentations including hematology with fever (9.6%), oncology with fever (40.4%), or sickle cell disease with fever (50%). Significant improvement was noted in the proportion of targeted patients receiving antibiotics in <60 minutes between January 2022 and May 2024. The time to antibiotics within goal of patients with oncology improved from 45.2% to 90%, patients with hematology from 42.9% to 81.6%, and patients with sickle cell disease from 44% to 85.1%. Overall time to antibiotics improved from 44.4% to 86.7%.</p><p><strong>Discussion: </strong>The initiative significantly improved timely antibiotic administration. By 2024, 95% of patients received antibiotics within 60 minutes. Enhanced nursing autonomy and team-based strategies were key drivers of success, promoting safer care and sustained quality improvement.</p>","PeriodicalId":51082,"journal":{"name":"Journal of Emergency Nursing","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145092864","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 Mental Health of Emergency Nurses Exposed to Unexpected Death: An Integrative Review.","authors":"Austin DesJardin","doi":"10.1016/j.jen.2025.08.006","DOIUrl":"https://doi.org/10.1016/j.jen.2025.08.006","url":null,"abstract":"<p><strong>Background: </strong>Emergency nurses face high-intensity situations that heighten their risk of mental health concerns, including compassion fatigue and post-traumatic stress symptoms. They report significantly higher levels of depression, anxiety, and secondary stress syndrome than other health care workers, which can negatively affect their well-being and patient care, leading to increased burnout and medical errors. This integrative review aimed to examine the mental health concerns of emergency nurses who care for patients who die unexpectedly.</p><p><strong>Methods: </strong>This integrative review followed Whittemore and Knafl's 5-step framework. A narrative synthesis was then completed, and data were analyzed using the Mixed Methods Appraisal Tool to mitigate biases. Four databases were systematically searched with specified search terms and without date restrictions.</p><p><strong>Results: </strong>Fifteen studies were included, focusing on clinical events such as traumas, gunshot wounds, and motor vehicle accidents. The themes identified throughout the studies included coping mechanisms, end-of-life care education, and peer and managerial support. Symptoms reported by nurses included avoidance, substance abuse, and sleep disturbances.</p><p><strong>Conclusion: </strong>Emergency nurses are vulnerable to the psychological impact of unexpected or traumatic deaths, increasing their risk of mental health concerns that affect their own health and patient outcomes. There is a need for intervention studies to address these issues and improve outcomes for nurses facing unexpected death.</p>","PeriodicalId":51082,"journal":{"name":"Journal of Emergency Nursing","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-09-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145058710","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 Effect of Workplace Violence on Emotional Labor and Turnover Intention of Emergency Service Employees: A Model Study.","authors":"Esra Bekircan, Mustafa Sabak, Tufan Alatli, Fatma Boğan, Emine Aykol, Mustafa Boğan","doi":"10.1016/j.jen.2025.07.017","DOIUrl":"https://doi.org/10.1016/j.jen.2025.07.017","url":null,"abstract":"<p><strong>Introduction: </strong>Workplace violence against health care workers in emergency services is an important worldwide problem in terms of their occupational health and safety. This study was aimed at investigating the effect of workplace violence experienced by physicians and nurses working in emergency services on their emotional labor and turnover intentions.</p><p><strong>Methods: </strong>The relational research model, one of the quantitative research methods, was used in the study. The study was conducted with 199 health professionals working in the emergency departments of 3 different tertiary hospitals. The data were collected through face-to-face interviews using the emotional labor scale, the workplace violence scale, and the intention to quit scale.</p><p><strong>Results: </strong>It was observed that physicians and nurses working in emergency services (hereafter referred to as \"participants\") were exposed to verbal violence, physical violence, and sexual violence in the given order. There was a positive correlation between the scores obtained from the intention to quit scale and the workplace violence scale, between the emotional labor scale and the workplace violence scale, and between the emotional labor scale and the intention to quit scale. It was concluded that emotional labor did not mediate the relationship between workplace violence and intention to quit.</p><p><strong>Discussion: </strong>The study concluded that participants' exposure to workplace violence was associated with increased levels of both emotional labor and intention to quit. A positive correlation was identified, indicating that higher levels of emotional labor were linked to a greater intention to quit. It is recommended that the public be educated on the effective and appropriate use of emergency services and that psychiatric nurses provide psychological support to emergency service personnel.</p>","PeriodicalId":51082,"journal":{"name":"Journal of Emergency Nursing","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145034522","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":"Perceived Relationships Between Emergency Department Staffing Patterns and Missed Care, Missed Decompensation, and Delays in Care.","authors":"Lisa Wolf, Ellen Benjamin, Paul Clark, Michael Callihan","doi":"10.1016/j.jen.2025.08.002","DOIUrl":"https://doi.org/10.1016/j.jen.2025.08.002","url":null,"abstract":"<p><strong>Introduction: </strong>When emergency department staffing is inadequate, patient care may be missed. Information regarding the association between missed care and staffing is lacking in the emergency department setting. This study aimed to explore considerations for and configurations of staffing patterns and their relationship to missed care, missed decompensation, and delays in care.</p><p><strong>Methods: </strong>This study used an exploratory qualitative approach with data derived from focus groups and analyzed using qualitative content analysis. A total of 39 emergency nurses in varied roles attending a national conference were recruited. The Consolidated Criteria for Reporting Qualitative Research checklist was used to guide the reporting of this study.</p><p><strong>Results: </strong>Participants reported information grouped into 5 major categories: ratios, staffing patterns, work ethic, role of administration, and missed care. Both staff and charge nurses reported a preference for a 1:3 nurse-to-patient ratio, with higher patient ratios described as leading to missed care, missed decompensation, and delays in care.</p><p><strong>Discussion: </strong>The individual and institutional elements of staffing decisions may have a significant impact on patient outcomes in the form of missed care, missed diagnoses, and delayed care. Staffing decisions may also affect the psychological health of emergency nurses by fostering burnout. Across roles, nurses perceive a disconnect between the ED environment and staffing plans generated by persons outside the department. Future research should focus quantitatively on relationships between staffing patterns and patient and nursing outcomes.</p>","PeriodicalId":51082,"journal":{"name":"Journal of Emergency Nursing","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145030882","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":"Effect of Distracting Methods on Procedure-Related Fear, Anxiety, and Pain During Intramuscular Injection: A Randomized Controlled Trial.","authors":"Elfidan Gülduran, Gülçin Özalp Gerçeker","doi":"10.1016/j.jen.2025.08.003","DOIUrl":"https://doi.org/10.1016/j.jen.2025.08.003","url":null,"abstract":"<p><strong>Introduction: </strong>Distraction methods such as virtual reality and cold vibration devices (Buzzy) are recommended during vascular access. Few studies focused on distraction during intramuscular injection.</p><p><strong>Methods: </strong>This study evaluated the effect of distraction methods on procedure-related pain, fear, and anxiety during the intramuscular injection in children aged 5 to 12 years in the pediatric emergency department. In the study, children (n = 126) were assigned to 4 groups: virtual reality, manual pressure vibration, Buzzy, and control groups. Heart rate, respiration, blood pressure, and partial oxygen saturation were measured before, during, and after the procedure. Emotional behavior was evaluated using the Children's Emotional Manifestation Scale before the procedure. After the procedure, pain, fear, and anxiety were evaluated using the Child Fear Scale, Child Anxiety Scale-State, Wong-Baker FACES Pain Scale, and Color Analog Scale. The mean scores obtained from the scales were compared using the Kruskal-Wallis analysis (Clinical Trials number: NCT04847934).</p><p><strong>Results: </strong>The diastolic and median blood pressure values were higher, and the partial oxygen value was lower in the control group after the procedure. There was no statistical difference among the groups in terms of emotional behavior before the procedure. There was a statistical difference among the groups in terms of pain scores, but no difference was found in terms of fear and anxiety.</p><p><strong>Discussion: </strong>Virtual reality, manual pressure vibration, and Buzzy distractions were effective on intramuscular injection-related pain. Future studies should also focus on intramuscular injection-related fear and anxiety.</p>","PeriodicalId":51082,"journal":{"name":"Journal of Emergency Nursing","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145024744","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":"Code Malignant Hyperthermia: Malignant Hyperthermia in the Emergency Department-Implications for Nursing.","authors":"Marlene Porter","doi":"10.1016/j.jen.2025.07.016","DOIUrl":"https://doi.org/10.1016/j.jen.2025.07.016","url":null,"abstract":"<p><p>Malignant hyperthermia is a rare, life-threatening hypermetabolic reaction that can strike unexpectedly in the emergency department, demanding swift recognition and intervention to save lives. This syndrome can be fatal if not treated and occurrs in 1 in 100,000 adults and 1 in 30,000 children, with a 3% to 5% mortality rate. Although often associated with perioperative environments, malignant hyperthermia should remain on the radar for emergency nurses, especially when patients exhibit sudden hyperthermia, muscle rigidity, and tachycardia after intubation or procedural sedation. This article emphasizes early recognition, rapid intervention strategies, and preparedness protocols tailored to the ED context to improve outcomes for patients with malignant hyperthermia.</p>","PeriodicalId":51082,"journal":{"name":"Journal of Emergency Nursing","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145030864","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 Psychiatric Emergency Department Triage Process to Optimize Patient Care.","authors":"Kristen Edmunds, Michelle Olshan-Perlmutter, Nicholas Archer, Marquita Boggess, Jared Ruggieri, Jason Roberge","doi":"10.1016/j.jen.2025.07.018","DOIUrl":"https://doi.org/10.1016/j.jen.2025.07.018","url":null,"abstract":"<p><strong>Introduction: </strong>Emergency departments have seen a steady increase in patients presenting with mental health and substance use disorders, leading to overcrowding, prolonged length of stay, patients leaving without being seen, and diminished staff satisfaction. To address these issues, a behavioral health psychiatric emergency department redesigned its triage process to include a fast-track protocol for low-complexity patients, eliminate treatment redundancies, and incorporate a provider in triage to improve patient outcomes and staff satisfaction.</p><p><strong>Methods: </strong>Using the Plan-Do-Study-Act methodology, a revised triage process was implemented to streamline workflows and reduce waste. Time metrics from pre- and postintervention periods were compared.</p><p><strong>Results: </strong>Reductions were observed in all phases of the ED encounter. The median total length of stay decreased by 110 minutes (38% reduction; P<.001). Time from rooming to provider was reduced from 98 to 43 minutes (56% reduction; P<.001), and the median time from arrival to provider was halved, from 152 to 76 minutes (52% reduction; P<.001). The leaving without being seen rate dropped from 10.5% to 6.3% (40% reduction; P<.001).</p><p><strong>Discussion: </strong>The findings suggest that a fast-track triage system, combined with provider in triage, can improve length of stay, reduce leaving without being seen, and enhance staff satisfaction. This model could be beneficial for other emergency departments managing patients with behavioral health concerns.</p>","PeriodicalId":51082,"journal":{"name":"Journal of Emergency Nursing","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145024779","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":"Application of Multistrategy Improvement Gray Wolf Algorithm to Optimize Extreme Gradient Boosting in Emergency Triage.","authors":"Tichen Huang, Yuyan Jiang, Rumeijiang Gan, Heping Wang, Fuyu Wang, Yan Li","doi":"10.1016/j.jen.2025.07.015","DOIUrl":"https://doi.org/10.1016/j.jen.2025.07.015","url":null,"abstract":"<p><strong>Introduction: </strong>Effective triage in the emergency department (ED) is essential for optimizing resource allocation, improving efficiency, and enhancing patient outcomes. Conventional systems rely heavily on clinical judgment and standardized guidelines, which may be insufficient under growing patient volumes and increasingly complex presentations.</p><p><strong>Methods: </strong>We developed a machine learning triage model, MIGWO-XGBOOST, which incorporates a Multi-strategy Improved Gray Wolf Optimization (MIGWO) algorithm for parameter tuning. Missing data were processed, and the dataset was randomly split into 80 percent for training and 20 percent for testing. Model performance was evaluated against standard XGBOOST, GWO XGBOOST, AdaBoost, LSTM, and CNN-BiGRU.</p><p><strong>Results: </strong>MIGWO-XGBOOST improved accuracy by 8.5 percent over unoptimized XGBOOST and reduced optimization time by 9,285 seconds relative to GWO-XGBOOST. Compared with other benchmarks, accuracy gains were 12.5 percent over AdaBoost, 3.3 percent over LSTM, and 1.9 percent over CNN-BiGRU. These results demonstrate both predictive strength and computational efficiency in complex data environments.</p><p><strong>Discussion: </strong>MIGWO-XGBOOST provides a robust framework for rapid and precise triage decisions in the ED. By enhancing accuracy while substantially reducing computational time, this approach demonstrates the potential of advanced machine learning to support emergency decision-making and optimize patient care pathways.</p>","PeriodicalId":51082,"journal":{"name":"Journal of Emergency Nursing","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145024790","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}