Introducing a Digital Occupational Violence Risk Assessment Tool Into an Emergency Department: A Pilot Implementation Study.

INTRODUCTION: Occupational violence in emergency departments is prevalent and detrimental to staff and health services. There is an urgent call for solutions; accordingly, this study describes the implementation and early impacts of the digital Queensland Occupational Violence Patient Risk Assessment Tool (kwov-pro). METHODS: Since December 7, 2021, emergency nurses have been using the Queensland Occupational Violence Patient Risk Assessment Tool to assess 3 occupational violence risk factors in patients: aggression history, behaviors, and clinical presentation. Violence risk then is categorized as low (0 risk factors), moderate (1 risk factor), or high (2-3 risk factors). An important feature of this digital innovation is the alert and flagging system for high-risk patients. Underpinned by the Implementation Strategies for Evidence-Based Practice Guide, from November 2021 to March 2022 we progressively mobilized a range of strategies, including e-learning, implementation drivers, and regular communications. Early impacts measured were the percentage of nurses who completed their e-learning, the proportion of patients assessed using the Queensland Occupational Violence Patient Risk Assessment Tool, and the number of reported violent incidents in the emergency department. RESULTS: Overall, 149 of 195 (76%) of emergency nurses completed their e-learning. Further, adherence to Queensland Occupational Violence Patient Risk Assessment Tool was good, with 65% of patients assessed for risk of violence at least once. Since implementing the Queensland Occupational Violence Patient Risk Assessment Tool, there has been a progressive decrease in violent incidents reported in the emergency department. DISCUSSION: Using a combination of strategies, the Queensland Occupational Violence Patient Risk Assessment Tool was successfully implemented in the emergency department with the indication that it could reduce the number of incidents of occupational violence. The work herein provides a foundation for future translation and robust evaluation of the Queensland Occupational Violence Patient Risk Assessment Tool in emergency departments.

Validity and reliability of the novel three-item occupational violence patient risk assessment tool.

AIM: To develop and psychometrically test an occupational violence (OV) risk assessment tool in the emergency department (ED). DESIGN: Three studies were conducted in phases: content validity, predictive validity and inter-rater reliability from June 2019 to March 2021. METHODS: For content validity, ED end users (mainly nurses) were recruited to rate items that would appropriately assess for OV risk. Subsequently, a risk assessment tool was developed and tested for its predictive validity and inter-rater reliability. For predictive validity, triage notes of ED presentations in a month with the highest OV were assessed for presence of OV risk. Each presentation was then matched with events recorded in the OV incident register. Sensitivity and specificity values were calculated. For inter-rater reliability, two assessors-trained and untrained-independently assessed the triage notes for presence of OV risk. Cohen's kappa was calculated. RESULTS: Two rounds of content validity with a total of N = 81 end users led to the development of a three-domain tool that assesses for OV risk using aggression history, behavioural concerns (i.e., angry, clenched fist, demanding, threatening language or resisting care) and clinical presentation concerns (i.e., alcohol/drug intoxication and erratic cognition). Recommended risk ratings are low (score = 0 risk domain present), moderate (score = 1 risk domain present) and high (score = 2-3 risk domains present), with an area under the curve of 0.77 (95% confidence interval 0.7-0.81, p < .01). Moderate risk rating had a 61% sensitivity and 91% specificity, whereas high risk rating had 37% sensitivity and 97% specificity. Inter-rater reliability ranged from 0.67 to 0.75 (p < .01), suggesting moderate agreement. CONCLUSIONS: The novel three-domain OV risk assessment tool was shown to be appropriate and relevant for application in EDs. The tool, developed through a rigorous content validity process, demonstrates acceptable predictive validity and inter-rater reliability. IMPACT: The developed tool is currently piloted in a single hospital ED, with a view to extend to inpatient settings and other hospitals.

Sensory Devices for Older Adults With Behavioral Disturbance in the Emergency Department: A Descriptive Study.

Nonpharmacological strategies are advocated for the management of behavioral disturbance in older adults due to risk of harm from pharmacological therapy; however, limited evidence supports their use in emergency departments (EDs). The current descriptive study was conducted to investigate the use of sensory devices for nonpharmacological management of behavioral disturbance and their perceived impact. Data were collected from the sensory device registry, electronic medical records, and survey. Patient-level data (N = 33) showed that sensory devices, such as tactile blankets or toys and music, can be used in EDs to alleviate behavioral disturbance among older adults. ED staff (n = 22) expressed an interest to increase device supply. A patient and caregiver (n = 2) suggested that the devices be initiated earlier in ED care. Further research is required to strengthen evidence on the impact of these devices on patient outcomes. [Journal of Gerontological Nursing, 47(4), 22-27.].

Factors influencing variation in investigations after a negative CT brain scan in suspected subarachnoid haemorrhage: a qualitative study.

INTRODUCTION: Variation in the approach to the patient with a possible subarachnoid haemorrhage (SAH) has been previously documented. The purpose of this study was to identify factors that influence emergency physicians' decisions about diagnostic testing after a normal CT brain scan for ED patients with a headache suspicious of a SAH. METHODS: We conducted an interview-based qualitative study informed by social constructionist theory. Fifteen emergency physicians from six EDs across Queensland, Australia, underwent individual face-to-face or telephone interviews. Content analysis was performed whereby transcripts were examined and coded independently by two co-investigators, who then jointly agreed on the influencing factors. RESULTS: Six categories of influencing factors were identified. Patient interaction was at the forefront of the identified factors. This shared decision-making process incorporated 'what the patient wants' but may be biased by how the clinician communicates the benefits and harms of the diagnostic options to the patient. Patient risk profile, practice evidence and guidelines were also important. Other influencing factors included experiential factors of the clinician, consultation with colleagues and external influences where practice location and work processes impose constraints on test ordering external to the preferences of the clinician or patient. The six categories were organised within a conceptual framework comprising four components: the context, the evidence, the experience and the decision. CONCLUSIONS: When clinicians are faced with a diagnostic challenge, such as the workup of a patient with suspected SAH, there are a number of influencing factors that can result in a variation in approach. These need to be considered in approaches to improve the appropriateness and consistency of medical care.

Perceptions of nursing workloads and contributing factors, and their impact on implicit care rationing: A Queensland, Australia study.

AIMS: To explore nurses' perceptions of factors affecting workloads and their impact on patient care. BACKGROUND: Fiscal restraints and unpredictable patient illness trajectories challenge the provision of care. Cost containment affects the number of staff employed and the skill-mix for care provision. While organisations may acknowledge explicit rationing of care, implicit rationing takes place at the point of service as nurses are forced to make decisions about what care they can provide. METHOD: A self-report cross sectional study was conducted using an on-line survey with 2,397 nurses in Queensland, Australia. RESULTS: Twenty to forty per cent reported being unable to provide care in the time available; having insufficient staff; and an inadequate skill-mix. The respondents reported workload and skill-mix issues leading to implicit care rationing. Over 60% believed that the processes to address workload issues were inadequate. CONCLUSIONS: Institutional influences on staffing levels and skill-mix are resulting in implicit care rationing. IMPLICATIONS FOR NURSE MANAGERS: Adequate staffing should be based on patient acuity and the skill-mix required for safe care. Managers should be more assertive about adequate clinical workloads, involve staff in decision-making, and adopt a systematic planning approach. Failure to do so results in implicit care rationing impacting on patient safety.

Medication knowledge and willingness to nurse-initiate medications in an emergency department: a mixed-methods study.

AIMS: To assess the medication knowledge of emergency department nurses and determine the factors affecting their nurse-initiated medication practices. BACKGROUND: Nurse-initiated medications is a vital practice for all nurses in emergency departments which improves pain assessment, provides safe pain management and reduces time-to-analgesia and other meaningful treatments. DESIGN: Mixed methods. Between September 2014-January 2015, data were collected by questionnaire assessing medication knowledge and face-to-face interviews determining factors affecting practice. RESULTS: Nurse-initiated medications frequency of the Registered Nurses ranged from 0-36 times per week dependent on employed hours and emergency department area worked. Medication knowledge was consistent among nurses, but there was an overall deficit in nurses' knowledge of mechanism of action. Four major themes were identified from the 24 interviews: patient-centred care, caution and safety as principles of practice; continuing support and education; improvement of practice over time. All nurses regard the practice positively and to be extremely beneficial to patients. Although apprehensive at the start of their nurse-initiated medications practice, confidence improved with exposure and experience. Nurses sought additional information from colleagues and the available evidence-based resources. CONCLUSION: Medication knowledge is not the sole determinant of nurse-initiated medications practice. The practice is motivated by multiple factors such as patients' needs, safety and nurses' confidence.

Exploring factors affecting registered nurses' pursuit of postgraduate education in Australia.

The aim of this study was to explore the factors influencing registered nurses' pursuit of postgraduate education in specialty nursing practice in Australia. Despite the increased requirement for postgraduate education for advanced practice, little has been reported on the contributory factors involved in the decision to undertake further education. The Nurses' Attitudes Towards Postgraduate Education instrument was administered to 1632 registered nurses from the Nurses and Midwives e-Cohort Study across Australia, with a response rate of 35.9% (n = 568). Data reduction techniques using principal component analysis with varimax rotation were used. The analysis identified a three-factor solution for 14 items, accounting for 52.5% of the variance of the scale: "facilitators," "professional recognition," and "inhibiting factors." Facilitators of postgraduate education accounted for 28.5% of the variance, including: (i) improves knowledge; (ii) increases nurses' confidence in clinical decision-making; (iii) enhances nurses' careers; (iv) improves critical thinking; (v) improves nurses' clinical skill; and (vi) increased job satisfaction. This new instrument has potential clinical and research applications to support registered nurses' pursuit of postgraduate education.

Work and personal well-being of nurses in Queensland: Does rurality make a difference?

OBJECTIVE: This study aims to ascertain if differences exist in the perception of the professional practice environment and personal well-being of nurses across different geographical areas in Queensland. DESIGN: This paper was performed on a prospective, self-report cross-sectional on-line survey. SETTING: The study was conducted among the nurses employed in public and private health care settings: acute hospitals, community health and aged care in Queensland, Australia. PARTICIPANTS: Participants of this study were 1608 registered and enrolled nurses and assistants in nursing, current members of the Queensland Nurses Union in 2013 and who provided a workplace postcode. One thousand eight of these participants worked in major cities, while 382 in rural locations and 238 in remote areas. INTERVENTIONS: None. MAIN OUTCOME MEASURES: Scores of well-being as determined by the following scales: the Depression, Anxiety and Stress Scale, the Professional Quality of Life Scale version 5, the Connor-Davidson Resilience Scale and of the Professional Practice Environment using the Practice Environment Scale - Nursing Work Index Revised. RESULTS: Nurses employed in major cities perceived 'nursing foundations for quality care' more favourably than those from other settings. Remote area nurses had lower levels of secondary traumatic stress than nurses in major cities and rural areas. There was no difference between nurses across their geographical locations for stress, anxiety, depression, compassion satisfaction, burnout, resilience and the four other measures of the Practice Environment Scale. CONCLUSIONS: The study findings provide new data suggesting that, with the exception of secondary traumatic stress, the personal well-being of nurses does not differ across geographical settings. Similarly, with the exception of the subscale of 'nursing foundations for quality care' there was no difference in perceptions of the professional practice environment. As secondary traumatic stress is associated with burnout, this finding needs to be investigated further.

Nursing and the nursing workplace in Queensland, 2001-2010: what the nurses think.

The purpose of the study was to inform policy for reform in nursing. A survey mailed to members of the Queensland Nurses' Union four times between 2001 and 2010 elicited views on their employment and working conditions, professional development and career opportunities. Results across years and sectors of nursing consistently showed dissatisfaction in many aspects of employment, particularly by nurses working in aged care. However, views on staffing numbers, skill mix, workload, work stress, pay and staff morale all showed significant improvements over the decade. For example in 2001, 48.8% of nurses believed that their pay was poor, whereas in 2010, this had reduced to 35.2%. Furthermore, there was a significant rise throughout the decade in the opinion of the value of nursing as a good career. In light of the need to address nurse workforce shortages, the trends are encouraging; however, more improvements are required in order to support recruitment and retention.

Tracking the patient journey by combining multiple hospital database systems.

With new national targets for patient flow in public hospitals designed to increase efficiencies in patient care and resource use, better knowledge of events affecting length of stay will support improved bed management and scheduling of procedures. This paper presents a case study involving the integration of material from each of three databases in operation at one tertiary hospital and demonstrates it is possible to follow patient journeys from admission to discharge.

Modelling a two-stream emergency department segregation and admission system from COVID-19 early rapid antigen testing: A pilot study.

OBJECTIVE: Many factors influence patient flow through an ED, including streaming, treatment spaces and staff resources. This pilot study explored and compared real time patient flow using a single-stream system versus varying configurations of possible two-stream systems using computer simulation. METHODS: Simulation modelling was used to assess the delay in treatment of a rapid-antigen-tested-based, two-stream model for patient flow through ED during the peak phase of the COVID pandemic. RESULTS: Modelling two-stream configuration for all patients (minimum time to be seen for both COVID-positive and COVID-negative patients) showed that in the case study ED, a two-stream system and linked changes in bed configuration for managing the risks of infection can impact delays in treatment. CONCLUSIONS: Data-driven modelling within specific clinical settings can inform the (in)efficiency of patient flow processes and help clinicians and managers make evidence-based decisions about patient transition through EDs. This can assist with reconfiguration of ED patient streaming particularly during periods of unique need, such as the recent COVID-19 pandemic.

Retrospective observational study of aged care facility residents presenting to ED post fall: A case for person-centred shared decision making.

OBJECTIVE: Identify the incidence of intracranial haemorrhage in people from residential aged care facilities following falls who had a CT head performed. The secondary objectives were to identify predictor variables for intracranial haemorrhage to inform person-centred shared decision making. METHODS: Retrospective chart review of aged care residents who presented to ED with a triage of fall. Documented evidence of vomiting, headache, external signs of head injury, deviation from baseline neurology and the presence of anticoagulation or antiplatelet agents was reviewed. The rates of CT head, intracranial haemorrhage, emergent interventions, disposition and mortality were assessed. RESULTS: Of the 2546 presentations, 1732 (68.0%) had a CT head and intracranial haemorrhage was found in 76 (4.4%) patients. External signs of head injury and deviation from neurological baseline have a strong association with intracranial haemorrhage in 26 (22.2%) patients, only 4 (0.61%) patients with intracranial haemorrhage had neither. There was a strong association between these clinical features and identification of intracranial haemorrhage on CT head. Anticoagulation and antiplatelet use had no association with intracranial haemorrhage. A 30-day mortality was increased in patients with deviation from neurological baseline. No neurosurgical intervention was performed, and there was inconsistent advice regarding anticoagulation or antiplatelet agents. CONCLUSIONS: Deviation from neurological baseline or external signs of head injury may be predictors of intracranial haemorrhage. Vomiting, headache, anticoagulation or antiplatelets were not associated with intracranial haemorrhage. A person-centred decision-making approach, that is informed by treatment options could better guide clinicians on when to order a CT head after a fall.

Inter-rater reliability of the occupational violence risk assessment tool for emergency departments.

BACKGROUND: The three-item occupational violence (OV) risk assessment tool was developed and validated for use in emergency departments (EDs). It prompts review of each patient's aggression history, behaviours, and clinical presentation. However, confidence around representativeness and generalisability are needed before widescale adoption; hence we measured the inter-rater reliability of the tool among a large group of emergency nurses. METHODS: A cross-sectional study was conducted between Sep 2021 and Jan 2022. Nurses were directed to a website that hosted an e-learning module about the tool. They were asked to apply the tool to two video scenarios of typical patient presentations. Demographic data, including years of emergency experience, were collected to contextualise their responses. Gwet's Agreement Coefficients (AC1) were calculated to determine inter-rater reliability. RESULTS: There were 135 participants: typically female, under the age of 40 years, with more than 3 years of emergency nursing experience. Overall, there was excellent inter-rater agreement (AC1 =0.752, p = 0.001). This was consistent when years of ED experience was stratified: 0-2 years, AC1 = 0.764, p = 0.002; 3-5 years, AC1 = 0.826, p = 0.001; 6-10 years, AC1 = 0.751, p < 0.001; 11-15 years, AC1 = 0.659, p = 0.004; ≥ 16 years, AC1 = 0.799, p < 0.001. CONCLUSION: The three-item OV risk assessment tool has excellent inter-rater reliability across a large sample of emergency nurses.

Effects of mobile mindfulness on emergency department work stress: A randomised controlled trial.

OBJECTIVE: High-occupational stress among ED staff has a detrimental impact on both staff wellness and patient care. The objective of the study is to determine whether 4 weeks of smartphone app-guided mindfulness practice reduces stress levels of ED staff. METHODS: This two-arm randomised controlled trial was conducted in two Australian EDs in 2019-2020. Eligible participants were randomly assigned (1:1) to either an App group or a Wait to Treat group to practice daily 10 min app-guided mindfulness for 4 weeks. Online surveys were collected for both groups at three time periods: before (T1), immediately after (T2) and 3 months after cessation (T3). Then the Wait to Treat group received the same intervention, followed by surveys immediately after the intervention (T4) and 3 months later (T5). Primary outcome was measured using the Perceived Stress Scale. Secondary outcomes were measured using the Maslach Burnout Inventory (three subscales: emotional exhaustion, depersonalisation and personal accomplishment), Mindfulness Attention Awareness Scale and Warwick-Edinburgh Mental Well-being Scale. Both intention-to-treat and per-protocol analysis were performed. Repeated measurement data were analysed by the linear mixed model. RESULTS: Of 148 enrolled participants 98 completed all the surveys, but only half (48%) reported continuous use of the app. Based on the results of the intention-to-treat analysis, there was a statistically significant improvement of perceived stress levels (F = 15.70, P < 0.001), all three components of burnout (emotional exhaustion [F = 14.22, P < 0.001], depersonalisation [F = 3.62, P = 0.030], personal accomplishment [F = 7.51, P < 0.001]), mindfulness (F = 8.83, P < 0.001) and wellbeing levels (F = 10.71, P < 0.001) from pre-intervention to 3 months later with small effect sizes. CONCLUSION: Results of the present study demonstrate that brief mindfulness training via innovative digital technology had a small positive effect in improving emergency staff stress, burnout, mindfulness and wellbeing.

Effect of computed tomography scanner location on time-to-computed tomography in the emergency department: A before and after study.

OBJECTIVES: To compare time metrics associated with a temporary disruption to ED computed tomography (CT) scanner location from adjacent to the ED with direct access from resuscitation rooms, to a location remote to the ED. METHODS: A retrospective before and after study was conducted in a public metropolitan ED with over 66 000 presentations annually. Time-to-CT metrics, operational time metrics and ED length of stay were extracted and analysed from presentations between October 2020 and January 2021. RESULTS: There were 3031 CT scans during the study period. Overall, the disruption was associated with a significant 27-36 min delay (P < 0.01) in time-to-CT start; these delays were also observed in a subset of trauma patients. In a subset of presumed stroke patients, time-to-brain perfusion was significantly delayed by up to 10 min (P < 0.01). There was a 14% (P < 0.01) greater demand for operational services and a time imposition of up to 8 min (P < 0.01) to transport patients to or from CT scanning when the CT scanner was located away from the ED. ED length of stay was consistent at all time points. CONCLUSION: Although rapid, proximate access to CT scanning is often considered desirable in terms of the management of trauma and other time-critical emergencies, the wider time and resource implications demonstrated in this study suggest a potential broader benefit to co-located CT scanning in ED. Our experience could be considered in future re-design of EDs.

Monthly Identification of High Frequency Emergency Presenters to Improve Care Delivery and Evaluation: A Unique Methodological Approach.

Background: Frequent presenters to emergency departments (EDs) pose many challenges around care delivery and health service management. The aim of this study was to investigate the presentation patterns of people with 5 or more ED visits in any calendar month (5+ frequent presenter [FP5+]) to develop a useful methodological framework on which the real impact of interventions may be assessed. Methods: This study is a retrospective analysis of de-identified frequent ED presentation data using segmented regression analysis of an interrupted time series (ITS). Results: A total of 82 FP5+ to this single ED were identified in a year. Of these presenters, 77% had 10 or more presentations in a year. The total FP5+ presentations in the 12 months preceding and after each participant's ≥5 presentations in 1 month (the trigger month for inclusion in the study) accounted for 1,064 and 1,606 visits, respectively. ITS analysis of frequent ED presentations did not show a significant level change or trend change during the data collection period. Monthly review of people who frequently present to a single ED showed that presentations typically occurred in bouts that may span calendar years. Presentation bouts then typically slow, potentially distorting evaluation of the effects of interventions. Conclusion: Rolling monthly examination of presentation data may facilitate timely case review and care delivery, as well as provide a holistic picture of the impacts of interventions targeting patient care needs. This unique analysis demands a reconsideration of the typical before-and-after analysis of interventions for this vulnerable and high-cost group of patients.

Soft collar for acute cervical spine injury immobilisation -patient experiences and outcomes: A single centre mixed methods study.

BACKGROUND: Cervical collars are used as standard care for neck immobilisation after cervical spine injury. Although evidence for the most effective type of collar is lacking, there is evidence regarding adverse patient outcomes when managed in a semi or rigid collar. In response to the evidence of complications and adverse effects when using a hard collar, a large Australian adult trauma hospital that specializes in spinal care, changed its policy from hard to soft collars when managing acute cervical spine injury. OBJECTIVE: The aim of this study was to investigate patients' experiences and outcomes when wearing a soft collar for acute cervical spine injury management in hospital. METHOD: A single centre mixed method sequential study design was used. RESULTS: Medical records from 136 patients were examined and no adverse events resulting from collar use were recorded. Interviews with 20 patients revealed that they understood the value of wearing a soft collar. The soft collars were considered supportive and well tolerated, with good adherence to recommendations for use. CONCLUSIONS: Understanding the patients' experiences informs better care management. This study suggests that soft collars are well tolerated, do not result in pressure injuries or other adverse events and are suitable for managing acute cervical spine injury.

Personality traits of Australian nurses and doctors: challenging stereotypes?

This study compared temperament and character traits of Australian registered nurses and general practitioners. A cross-sectional quantitative design used the Temperament and Character Inventory. Total sample size was 426. Only main effects were detected. Nurses were higher in the temperament traits of Novelty Seeking and Reward Dependence, lower in the character traits of Self-Directedness and Cooperativeness but higher in Self-Transcendence compared with the sample of doctors. Differences in personality profiles between registered nurses and general practitioners might challenge existing stereotypes between these professions. Further exploration of traits exclusive to and shared among health professions would supplement a broad conceptualization of specialities and support the enhancement of appropriate training and career counselling. Awareness of one's temperament and character can lead to a clearer understanding of how they function in the workplace and might encourage reflection on and insight into the implications of their personality and career plans.

The top eight issues Queensland Australia's aged-care nurses and assistants-in-nursing worried about outside their workplace: a qualitative snapshot.

The attainment of a work-life balance is an important issue for recruitment, retention and workforce planning. This paper aims to report on the free text data provided by the aged-care sector nurses around perceptions of important work-life issues. Data were written responses of aged-care nurses to the open-ended request at the end of a survey, which asked them to list up to five political/social/environmental issues concerning them outside of their work. For aged-care nurses, when asked to list political/social/environmental issues they were concerned about outside of work in late 2007, there emerged considered issues around work and life. Among the top eight themes there is an intriguing balance between the themes work, industrial relations, aged care/elder care and health-care services compared with the themes environment, water, societal values and housing. Qualitative insights into the political/social/environmental issues aged-care nurses are concerned about outside of your work suggest their desire for a labour/life or work/life harmony. Aged-care nurses place an equal importance on the nature of labour and the basics of life. The findings provide information for aged-care sector managers and workforce planners on areas in need of consideration to recruit and retain a workforce within aged care.

A mobile mindfulness intervention for emergency department staff to improve stress and wellbeing: A qualitative study.

BACKGROUND: Occupational stress and burnout in emergency departments (ED) are prominent issues requiring effective solutions. In other health settings use of a smartphone mindfulness app have been shown to be a cost-effective strategy for stress management. AIM: To understand ED staff's experiences of practicing mindfulness using a smartphone app. METHOD: A qualitative study was undertaken with 24 ED staff at two Australian EDs who had used a mindfulness app for 4 weeks. Semi-structured, one-to-one interviews were conducted between late 2019 and early 2020. Interviews were audio recorded and transcribed. Descriptive description was utilised in content analysis. RESULTS: Four main themes were identified: individuality in use of the app, perceived benefits and impacts on life, perceived barriers and enablers to use. Participants reported that mindfulness practice had numerous benefits including better stress and anxiety management, as well as improved general wellbeing. The main barriers to mindfulness practice were poor time management for mindfulness and lack of motivation. Reported enablers included a strong desire for promoting wellbeing and the ability to embed practice into existing routine. CONCLUSION: Practicing mindfulness with a smartphone app is a useful strategy to promote ED staff wellness and manage stress. Healthcare organisations should consider the implementation of a mindfulness app for staff.