Non-violence-related workplace injuries among emergency nurses in the United States: implications for improving safe practice, safe care.

INTRODUCTION: Health care workers are more likely than most other occupations to experience work-related injuries, and emergency nurses frequently encounter job-related hazards in their daily routine. Risk factors for non-violence-related workplace injuries among nurses include heavy workloads, aging of the nursing workforce, workplace environmental factors, obesity, and non-standard work schedules. These factors impact nurses' decisions regarding whether or not to return to their job or to stay in their field of practice, thereby exacerbating workforce shortages and hindering recruitment and retention efforts. METHODS: To better understand non-violence-related workplace injuries among emergency nurses, ENA conducted a survey of its members in 2009. Of the 2294 nurses who responded to the survey, one in five nurses (n = 440) reported that they experienced a non-violence-related injury while working in their emergency department during the previous year. RESULTS: The logistic regression model found three factors that were related to the occurrence of a non-violence-related workplace injury: (1) hospitals having safe patient handling policies and programs, (2) access to decontamination and post-exposure treatment, and (3) emergency nurses' perception of staffing in their emergency department. DISCUSSION: While these results provide only a preliminary understanding of ED non-violence-related workplace injuries, they form the basis of a fundamental model for prevention of workplace injuries among emergency nurses. The model can be used to help establish a culture of ED workplace safety through the integration of safety policies and programs, access to safety equipment and controls, and optimal staffing levels. Support from hospital administrators for ED workplace safety initiatives that address these three components, along with current best practice recommendations from the field of occupational health and safety, have the potential to improve workplace safety for emergency nurses.

ESI Triage Distribution in U.S. Emergency Departments.

The accurate triage of arriving emergency department (ED) patients is a key component of emergency nursing practice. Overtriage assignment of patients misallocates scarce resources in a time of department overcrowding, whereas patient undertriage can create risks for negative patient outcomes secondary to care delays. Limited evidence is available regarding ED triage accuracy. It is estimated that appropriate adherence to the Emergency Severity Index (ESI) triage tool and assigning triage categories could be as low as 60% (McFarlane, 2019a, 2019b). The purpose of this retrospective observational study was to examine the 2019 triage distribution of 954,847 ED encounters at 25 hospitals. Comparisons were then made with the spreads identified in the ESI Implementation Handbook (Gilboy, Tanabe, Travers, & Rosenau, 2020). Study results reflect the presence of wide variations in distribution when compared with the expected spread published by Gilboy et al. (2020). These variations illustrate the need for further facility-level evaluation. ESI Level 2 percentages varied from as little as 2.6% to as high as 69% of each facility's ED visit population. Examining an individual facility's annualized triage distribution may serve as a swift method in determining whether additional investigation into triage accuracy is warranted. EDs must implement and sustain an ongoing quality control program to achieve and maintain triage inter- and intrarater reliability. Further research is needed on the value of triage inaccuracy with real-time feedback on nurses' clinical decision-making and patient outcomes. It is also imperative that the expected and observed ESI triage distribution in U.S. EDs is updated when established accuracy quality control programs are present.

Phylogenetic analysis of the evolution of a signal of aggressive intent in northern swordtail fishes.

The initiation of a coevolutionary relationship between signal and response can be explained by either the receiver taking advantage of information inadvertently provided by the sender or the sender taking advantage of a perceptual bias in the receiver. In addition, once both signal and response are present, the exchange of information may or may not be cooperative. We examined the evolution of a signal of aggressive intent (expression of vertical bars) across all the northern swordtail fishes (Xiphophorus) in a phylogenetic context. We found that the signal was present before responses evolved, which suggests that this coevolutionary relationship was initiated by the receiver taking advantage of information inadvertently provided by the signaler. In addition, we introduce a novel method for examining the cooperative nature of signaling systems and provide some evidence to suggest that in this signaling system, receivers may be exploiting an honest signal in some species.

Evolutionarily labile responses to a signal of aggressive intent.

Males of many swordtail species possess vertical bar pigment patterns that are used both in courtship and agonistic interactions. Expression of the bars may function as a conventional threat signal during conflicts with rival males; bars intensify at the onset of aggression and fade in the subordinate male at contest's end. We used mirror image stimulation and bar manipulations to compare the aggressive responses of the males of four swordtail species to their barred and barless images. We found that having a response to the bars is tightly linked to having genes for bars, while the nature of the response the bars evoked varied across species. Specifically, we report the first known instance where closely related species exhibited differing and contradictory responses to a signal of aggressive motivation. Demonstrating that a signal conveys the same information across species (aggressive intent) while the response to that information has changed among species suggests that the nature of the responses are more evolutionarily labile than the signal.