Journal of Emergency Nursing最新文献

{"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":"Nurse-Initiated X-Ray Requests for Extremity Trauma in the Emergency Department: A Single-Center, Prospective, Before-and-After Cohort Study","authors":"Vincent Garrouste MD,&nbsp;Laury Malcuit MD,&nbsp;Grégoire Muller MD,&nbsp;Romain Jouffroy MD, PhD,&nbsp;Thierry Boulain MD","doi":"10.1016/j.jen.2025.03.019","DOIUrl":"10.1016/j.jen.2025.03.019","url":null,"abstract":"<div><h3>Background</h3><div>Emergency department overcrowding and prolonged stays are critical issues in health care. Nurse-initiated X-ray requests for isolated extremity trauma may streamline patient care.</div></div><div><h3>Objective</h3><div>This study aimed to assess the impact of nurse-initiated X-ray requests on patient care duration and overall management time in the emergency department.</div></div><div><h3>Methods</h3><div>This single-center, prospective, before-and-after cohort study included 400 patients at the University Hospital of Orléans, France, between January and June 2023. During the first period, X-rays were ordered by physicians. In the second period, triage nurses, trained through a comprehensive program, were authorized to order X-rays. The primary outcome was the duration of medical management from initial physician contact to the end of care. Secondary outcomes included overall emergency department management time and additional X-rays ordered after evaluation.</div></div><div><h3>Results</h3><div>Each period included 200 patients. The duration of medical care was significantly shorter in the second period (median, 21 minutes [interquartile rage, 9-56]) than the first period (median, 47 minutes [interquartile rage, 25-106]), with a median difference of –26 minutes (95% CI, –43 to –16; <em>P</em>&lt;.001). The overall duration of patient management did not differ significantly between periods. Exploratory analyses suggested that a higher percentage of included patients on a given day correlated with shorter care durations for all attending patients.</div></div><div><h3>Conclusion</h3><div>The implementation of nurse-initiated X-ray requests was significantly associated with a reduction of approximately half an hour for patients with isolated limb trauma, although it did not affect the total duration of patient management. Further research is needed to evaluate the broader effectiveness of nurse-initiated X-ray requests in reducing emergency department management times.</div></div>","PeriodicalId":51082,"journal":{"name":"Journal of Emergency Nursing","volume":"51 4","pages":"Pages 587-596"},"PeriodicalIF":1.8,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144081837","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}

{"title":"Sudden Loss: The Bereaved Voices of Those Left Behind","authors":"Lori Kokoszka PhD,&nbsp;Meg Hall PhD, RN, CCRN","doi":"10.1016/j.jen.2025.02.012","DOIUrl":"10.1016/j.jen.2025.02.012","url":null,"abstract":"<div><h3>Introduction</h3><div>Death is inevitable, but the sudden loss of a loved one presents additional challenges particularly to those navigating grief. Limited data are available about survivors’ experience when losing a loved one suddenly in a hospital setting. To determine what resources, if any, would be beneficial to individuals who suddenly lose a loved one in a hospital setting, further research is needed to understand previous experiences.</div></div><div><h3>Methods</h3><div>An interpretive descriptive methodology was used to explore the experiences and meaning of being a survivor of sudden loss within the hospital setting. Semistructured interviews were conducted with 8 participants regarding the sudden loss of a loved one in a hospital setting.</div></div><div><h3>Results</h3><div>Potential participants were screened before interviews to identify survivors who had experienced sudden loss at the age of 18 years or older, had lost someone older than 25 years, and were English speaking and whose loss occurred within 24 to 48 hours in the hospital setting. Qualitative data revealed 4 themes and 1 subtheme.</div></div><div><h3>Discussion</h3><div>Surviving the sudden loss of a loved one within a hospital setting is a unique, individualized experience; however, data from this research reveal that commonalities among experiences exist. Themes revealed feelings of imminent doom for the participants, acknowledging the “new reality” of life and leaving the hospital emotionally drained owing to the distant, transactional care received. Understanding the similarities among experiences of sudden loss in a hospital setting may pave the way for the development of educational and practical resources for survivors and staff. Implementing education resources built upon awareness is necessary when providing care to survivors of sudden loss.</div></div>","PeriodicalId":51082,"journal":{"name":"Journal of Emergency Nursing","volume":"51 4","pages":"Pages 733-741"},"PeriodicalIF":1.8,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144052352","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":"Breaking Down Barriers in Non-English-Speaking Patients","authors":"","doi":"10.1016/j.jen.2025.03.013","DOIUrl":"10.1016/j.jen.2025.03.013","url":null,"abstract":"","PeriodicalId":51082,"journal":{"name":"Journal of Emergency Nursing","volume":"51 4","pages":"Page 514"},"PeriodicalIF":1.8,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144517318","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":"Tale of a Misplaced Pigtail","authors":"Sophia Gamez MD,&nbsp;Kate Backstrum MD,&nbsp;Alison Bryant MD,&nbsp;Max HoddWells MS, MD,&nbsp;Tania D. Strout PhD, RN, MS,&nbsp;Samir Haydar DO, MPH, FACEP","doi":"10.1016/j.jen.2025.01.012","DOIUrl":"10.1016/j.jen.2025.01.012","url":null,"abstract":"","PeriodicalId":51082,"journal":{"name":"Journal of Emergency Nursing","volume":"51 4","pages":"Pages 575-577"},"PeriodicalIF":1.8,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144517326","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":"Addressing the Environmental Impact of Emergency Department Waste: Challenges and Strategies for Sustainable Nursing Leadership Practices","authors":"Margaret Spencer BA,&nbsp;Patricia Kunz Howard PhD, RN, CEN, CPEN, TCREN, NE-BC, FAEN, FAAN","doi":"10.1016/j.jen.2025.03.006","DOIUrl":"10.1016/j.jen.2025.03.006","url":null,"abstract":"","PeriodicalId":51082,"journal":{"name":"Journal of Emergency Nursing","volume":"51 4","pages":"Pages 548-552"},"PeriodicalIF":1.8,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144517543","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":"Comparison of the Characteristics of Korean Older Adults Who Returned to the Emergency Department Within 30 Days Before and During COVID-19: A Retrospective Study","authors":"JuHee Lee PhD, APRN, RN,&nbsp;Hyun Sim Lee PhD, RN, KANP,&nbsp;Ji Young Choi MSN, RN,&nbsp;Hyun Soo Chung PhD, MD,&nbsp;Somin Sang MSN, RN,&nbsp;Jee-Hye Yoo","doi":"10.1016/j.jen.2025.02.008","DOIUrl":"10.1016/j.jen.2025.02.008","url":null,"abstract":"<div><h3>Introduction</h3><div>The coronavirus disease 2019 pandemic prompted significant alterations in emergency department accessibility owing to government-imposed health policies. These changes influenced the frequency of return emergency department visits among older adults, but empirical investigations on this topic remain scarce. This study aimed to examine trends in emergency department return visits among older adults in South Korea during the coronavirus disease 2019 pandemic.</div></div><div><h3>Methods</h3><div>Older adults (n = 11,034) who returned to the emergency department within 30 days of their last visits from 2019 to 2021 were included. Data on age, sex, acuity score, health insurance type, medical transportation type, emergency department boarding time, chief complaints, final diagnosis, coronavirus disease 2019 infection status, and discharge plan were analyzed.</div></div><div><h3>Results</h3><div>The total number of return visits was highest in 2019 (before the pandemic) and lowest in 2021 (the second year of the pandemic). Although the overall proportion of return visitors declined annually, a consistent subgroup of older adults with lower acuity symptoms continued to present to the emergency department throughout the study period. Concurrently, as the total number of return visits decreased, the proportion of those eligible for ward admission increased. Emergency department boarding times decreased markedly in 2020, with a modest increase observed in 2021. Final diagnoses remained largely consistent over the 3-year period.</div></div><div><h3>Discussion</h3><div>Despite fears related to the pandemic, older adults continued to return to the emergency department likely owing to restricted access to local clinics and the suspension of home visit nursing services. To enhance health care delivery in future pandemics, the development of accessible, user-friendly online health care platforms for older adults is recommended.</div></div>","PeriodicalId":51082,"journal":{"name":"Journal of Emergency Nursing","volume":"51 4","pages":"Pages 721-732"},"PeriodicalIF":1.8,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143588021","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":"Nil Per Os in the Emergency Department: A Quantitative Study on Fasting Before Presumptive Emergency Surgery","authors":"Benjamin Bekele MSc, RN,&nbsp;Ingegerd Hildingsson PhD, RM, RN,&nbsp;André Johansson","doi":"10.1016/j.jen.2025.02.014","DOIUrl":"10.1016/j.jen.2025.02.014","url":null,"abstract":"<div><h3>Introduction</h3><div>Nil per os is a common precautionary practice in emergency departments for patients with suspected need for emergency surgery. However, this practice may lead to prolonged fasting periods, which can negatively affect patient outcomes. This study aimed to evaluate the necessity and appropriateness of nil per os for patients in the emergency department.</div></div><div><h3>Methods</h3><div>A retrospective quantitative observational study was conducted, analyzing 41,983 patient visits from 2 emergency departments in 2023. The study focused on surgical, orthopedic, and neurological chief complaints, where nil per os was commonly implemented. We assessed the negative predictive value of emergency surgery within specified time intervals (&lt;6 hours and &lt;12 hours after arrival) solely based on time from arrival in combination with surgical priorities, chief complaints, and triage priorities according to the Rapid Emergency Triage and Treatment System.</div></div><div><h3>Results</h3><div>Among the 41,983 included patients, 6.1% (n = 2561) underwent emergency surgery. The negative predictive value for emergency surgery within the specified time intervals was highest for Rapid Emergency Triage and Treatment System priorities 3, 4, and 5 (&gt;99%), indicating a very low likelihood of emergency surgery within 6 to 12 hours for these patients. Rapid Emergency Triage and Treatment System priority 1 had the lowest negative predictive value, approximately 80% to 90%.</div></div><div><h3>Discussion</h3><div>The study indicates that the routine practice of nil per os upon arrival at the emergency department is often unwarranted, particularly for those not classified as Rapid Emergency Triage and Treatment System priority 1. These findings highlight the need for updated guidelines to ensure that nil per os protocols are issued based on a clear medical necessity, thereby minimizing unnecessary fasting and its associated risks.</div></div>","PeriodicalId":51082,"journal":{"name":"Journal of Emergency Nursing","volume":"51 4","pages":"Pages 675-683"},"PeriodicalIF":1.8,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143774856","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}