Analysis of Risk Factors of Hospital Emergency Nursing Based on Comprehensive Nursing Methods.

In order to improve the comprehensive nursing effect of the hospital emergency treatment, this paper analyzes the process of the hospital emergency treatment. In addition, this paper combines the possible risks to analyze the risk factors of the comprehensive nursing in the hospital emergency treatment and builds an intelligent analysis model based on the actual situation of the hospital emergency treatment. At the same time, this paper conducts a systematic survey of emergency services and gives the composition and structure of the system. In addition, this paper divides the business required by the system into modules, including registration module, doctor workstation, nurse workstation, query statistics module, decision-making module, and maintenance module. Finally, this paper suggests that in the process of the clinical triage, more ideas for improving the existing evaluation model should be proposed, and experience should be transformed into advantages, so as to improve emergency triage skills; establish an objective, quantitative, and scientific concept of emergency classification and triage; and fully realize scientific triage and precise triage.

Crisis Standards of Care.

Nursing considerations during states of emergency.

Effectiveness of Mentorship Program in the Emergency Department.

Nurses transferring to other departments (transitioning registered nurses) can benefit from programs designed to improve their performance and intent to stay. This article describes a mentorship program for nurses who transfer into the emergency department, which included weekly meetings between mentor and mentee participants to share constructive feedback. A qualitative evaluation revealed that the program helped mentees feel more supported and mentors more empowered; it also improved teamwork significantly, created camaraderie, intensified confidence levels, enhanced professionalism, and boosted morale across the emergency department.

Emergency nurses' experiences of the implementation of early goal directed fluid resuscitation therapy in the management of sepsis: a qualitative study.

BACKGROUND: Severe sepsis can lead to organ failure and death if immediate treatment, such as intravenous fluids and antibiotics, are not commenced within the first hour. Time - critical initiation of intravenous fluids which in other words is early goal directed fluid resuscitation has not always been given its clinical priority. This qualitative study aimed at exploring the experiences of emergency nurses initiating early goal directed fluid resuscitation in patients with sepsis. METHODS: Using an exploratory approach, face - to - face semi - structured interviews were conducted with ten registered nurses working in emergency departments across New South Wales, Australia. Thematic analysis was used for data analysis. FINDINGS: Participants described various factors that inhibited the timely initiation of early goal directed fluid resuscitation, some clinical practice challenges, and strategies to improve nursing practice. Most participants, particularly those practicing as Clinical Initiatives Nurses suggested the incorporation of nurse initiated early goal directed fluid resuscitation for patients with sepsis as part of their scope of practice. CONCLUSION: Our findings identified several barriers that inhibit effective nurse - initiated early goal directed fluid resuscitation. It is anticipated that these findings will provide validation for the re-evaluation of the existing protocols and practice guidelines to increase the scope of practice of emergency nurses initiating early goal directed fluid resuscitation.

Understanding nurses perspectives of acuity in the process of emergency mental health triage: a qualitative study.

Background: Post deinstitutionalisation, mental health mainstreaming has led to substantial increases in presentations to Emergency Departments (EDs). The assessment process requires the ED triage nurse to undertake a rapid client assessment, assign a clinically appropriate triage score, and then refer the client to a mental health clinician. The initial assessment is important, and a number of factors influence the process of triage, referral and response including an understanding of mental health presentation acuity. Aim: To understand the factors that influence the ED triage assessment, referral and clinical response of clients with a mental illness. Methods: An ethnographic methodology underpinned the research design. ED triage nurses and mental health triage nurses who worked in a regional hospital provided insights through interviews and observations. The study was also informed by institutional policies and procedures regarding triage. Transcribed in-depth interviews, field notes and memos were analysed using an inductive thematic process. Findings: Mental health triage nurses and ED triage nurses concur that triage is an important part of the assessing process for a person who presents to the ED with a mental health problem. Timely and clinically accurate assessment, followed by referral and response is strongly influenced by the user knowledge of the mental health triage scale, and comprehension of mental health acuity. The conflicting understandings between the two professional nursing groups, called professionally cultured orientations, further impact this process. Conclusion: Professionally cultured orientation to mental health triage and acuity comprehension influence the process of emergency mental health triage and therefore may affect optimal client outcomes. Further research into ED triage design, ED triage education, and a shared understanding of acuity is called for.

The Influence of Patient Safety Culture and Patient Safety Error Experience on Safety Nursing Activities of Emergency Nurses in South Korea.

INTRODUCTION: The unique nature of the space and environment of emergency departments is a threat to patient safety. Enhancing patient safety and minimizing safety-related issues are important tasks for ED health care staff. The purpose of this study was to examine the relationships among patient safety culture, patient safety error, and safety nursing activities of emergency nurses in South Korea. METHODS: A convenience sample of 200 emergency nurses working in 12 general hospitals in South Korea were surveyed for safety nursing activities using the Hospital Survey of Patients' Safety Culture, a 4-item questionnaire for patient safety error and ED safety management items in the Guidelines for Patient Safety (seventh revision). RESULTS: Hierarchical regression analysis revealed that the potential factors associated with safety nursing activities were safety training experience (ß = 0.180, P=.01), organizational learning-continuous improvement (ß = 0.170, P=.04), age (ß = 0.160, P=.02), and implementation of domestic and foreign accreditation (ß = 0.147, P=.03). DISCUSSION: To improve patient safety, it is essential to identify problems in medical institutions, determine areas of improvement, and improve the organization's patient safety activity system on the basis of patient safety error experience reports. After training the emergency nurses for continuous improvement, the effect of patient safety activities must be analyzed.

Prehospital care nurses' self reported competence: A cross-sectional study.

BACKGROUND: The Swedish ambulance service has undergone major changes in recent decades due to advancements being made in medical and technical resources, professional competence, and patient care. Registered and specialist nurses share the same role, accountabilities, and responsibilities in the ambulance service, and their professional competence has not yet been evaluated. OBJECTIVES: The aim of the study was to investigate and compare self-reported professional competence among nurses working in the ambulance service and to explore associations between potentially predictive background factors and self-reported professional competence. METHOD: A cross-sectional study with a digital questionnaire was used for collecting data from 34 registered nurses and 71 specialist nurses. The Ambulance Nurse Competence Scale and the Research Utilization Questionnaire were used for data collection. RESULTS: Significant differences were found among the nursing categories in terms of age, gender, education, and work experience. Prehospital emergency nurses reported the highest professional competence. Nurses with a master's degree did not report significantly higher professional competence than nurses with a bachelor's degree. CONCLUSIONS: The findings indicated that there are differences in the professional competence of registered nurses and specialist nurses. Length of work experience in the ambulance service is an important factor associated with higher professional competence.

Emergency nurses' perceptions of their role in responding to escalations of care for clinical deterioration.

BACKGROUND: Clinical leadership is fundamental to patient safety. The Emergency Department (ED) nurse-in-charge is a key leadership role; however, few studies have explored the management of clinical deterioration from the ED nurse-in-charge perspective. The aim of this study was to explore ED nurses-in-charge' perceptions of their role in responding to episodes of escalation of care for clinical deterioration of ED patients. METHODS: A prospective exploratory descriptive design was used to address the study aims. The study was conducted in an urban ED in Melbourne, Australia. Senior emergency nurses who fulfilled the role of being in charge of the ED were invited to participate. In-depth semi-structured interviews were conducted between December 2015 and March 2016. Interview transcripts were analysed using thematic analysis. RESULTS: Two major themes, each with two subthemes were identified. The first major theme of Clinical Risk Management comprised sub-themes of Clinical Skills and Confidence. The second major theme of Resource Management comprised sub-themes of Human Resource Management and Logistical Resource Management. CONCLUSIONS: Strong collaboration, logistical and clinical risk management roles were perceived as fundamental to the nurse-in-charge's capacity to respond to escalations of care for clinical deterioration within in a complex team environment such as the ED.

Exploring the complex interactions of baseline patient factors to improve nursing triage of acute coronary syndrome.

Emergency department (ED) nurses need to identify patients with potential acute coronary syndrome (ACS) rapidly because treatment delay could impact patient outcomes. Aims of this secondary analysis were to identify key patient factors that could be available at initial ED nurse triage that predict ACS. Consecutive patients with chest pain who called 9-1-1, received a 12-lead electrocardiogram in the prehospital setting, and were transported via emergency medical service were included in the study. A total of 750 patients were recruited. The sample had an average age of 59 years old, was 57% male, and 40% Black. One hundred and fifteen patients were diagnosed with ACS. Older age, non-Caucasian race, and faster respiratory rate were independent predictors of ACS. There was an interaction between heart rate by Type II diabetes receiving insulin in the context of ACS. Type II diabetics requiring insulin for better glycemic control manifested a faster heart rate. By identifying patient factors at ED nurse triage that could be predictive of ACS, accuracy rates of triage may improve, thus impacting patient outcomes.

Understanding Respiratory Rate Assessment by Emergency Nurses: A Health Care Improvement Project.

INTRODUCTION: Respiratory rate is the first sign of patient decline. Monitoring and recording respiratory rate are essential nursing competencies. However, health care system emergency nurses' ability to differentiate normal from abnormal respiratory rates was unknown. We conducted a health care improvement project to assess emergency nurses' accuracy in "spot" and "formal" assessments, understand assessment practices, and determine competency and training needs. METHODS: In an anonymous cross-sectional survey, 78 emergency nurses from 1 health care system viewed 3 "spot" and 3 "formal" mock patient videos and answered questions in REDCap (Vanderbilt University, Nashville, TN). Accuracy (abnormal/normal), systematic error (bias), and random error (imprecision) were assessed. Descriptive statistics, bivariate analyses, and qualitative content analysis of open-ended questions were reported. RESULTS: Most emergency nurses identified respiration as abnormal in spot and formal assessment videos. Accuracy was lowest for the video displaying 6 breaths per minute. Emergency nurses were more likely to identify abnormal breathing in all formal assessment videos (n = 59, 75.7%) than in all spot assessment videos (n = 41, 52.6%) (McNemar χ2 = 10.32, P = 0.001). Most emergency nurses reported a willingness to use formal assessments and thought that respiratory rate was a good indicator of a patient's condition. The barriers to accurate assessment included time limitations, prior training focusing on assessments lasting less than 30 seconds, and monitor and staff errors. DISCUSSION: Respiratory rate assessment may be best assessed formally, particularly for bradypnea, where formal checks may outperform spot checks. The results present areas for improving respiratory rate assessment training and clinical practice.

Reliability and validity of three international triage systems within a private health-care group in the Middle East.

AIM: To measure and compare the reliability and validity of three international triage systems (CTAS, MTS and ESI) when applied to patient presentations in the emergency centres of a private health-care group in the United Arab Emirates. BACKGROUND: The ability of triage systems to sort patients into categories based on the urgency of their need and time to physician is a key indicator. Three international triage systems are being used for this purpose in private emergency centre settings. METHOD: Bespoke reference scenarios, 50 vignettes (10 per severity level) were created and validated by a local expert panel. Nurses performing triage at four emergency centres in the Emirate of Dubai completed online surveys to categorise the vignettes based on the triage system they used in their emergency centre. RESULTS: Overall inter-rater reliability per triage category was substantial for allocations in category one, moderate for those in categories two and five, and fair for those in categories three and four. Agreement between raters and the reference standard was consistent throughout all four emergency centres. The accuracy of triaging allocations into categories one, two and five were good, whereas allocations in categories three and four were less accurate. CONCLUSION: International triage systems focus on the identification of more urgent cases and perform poorly in discriminating between those that are less serious, which is less ideal in a setting where less-serious cases are more prevalent.

Emergency nurses' activity levels across rotating shifts.

BACKGROUND: Emergency nurses work consecutive, rotating shift patterns. However, how their occupational physical activity levels are associated between these shifts is unknown. This study aimed to examine the associations between emergency nurses' time spent in different activity levels across one shift and the following day's shift. METHODS: Fifty emergency nurses (45 female, five male) wore an ActiGraph accelerometer and completed work and sleep diaries across four weeks in 2018. A sub-sample (n = 42) also wore an activPAL inclinometer. Time spent sedentary, physically active, and in postural positions was determined. Multi-level analyses examined associations between one shift and the following day's shift. RESULTS: Additional time spent sedentary and in light-intensity physical activity during the first shift was associated with more time spent being physically active in the following day's shift for all rotations except back-to-back night shifts. However, additional time spent engaged in moderate- to vigorous-intensity physical activity during the first shift was associated with less time spent physically active in the following day's shift for afternoon-morning and morning-afternoon rotations. CONCLUSION: These findings demonstrate that shift sequences may impact emergency nurses' physical activity across shifts. Future research should identify the strategies emergency nurses use to maintain activity levels between shifts.

Gaining perspective into the term 'safety culture'; how emergency nurses view its meaning in their everyday practice: a focus group study in an Australian setting.

BACKGROUND: The creation of the safety culture coordinator role within an Australian Local Health District followed a critical incident in one of its emergency departments. As part of the role, it was important to have an understanding of how nurses viewed the term safety culture in order to support them in implementing any changes that would influence their everyday practice. METHODS: A descriptive qualitative design was chosen for the study. Focus groups allowed the perspectives of nurses to be heard and represented. RESULTS: Five themes emerged from the data: defining safety culture, influences of team culture, differences in environmental impact, the reality of reporting incidents and commitment to best practice and patient care. These highlighted the influencing factors that promoted and inhibited a safety culture. CONCLUSION: This study provides a greater understanding of what supports a positive safety culture and the challenges that nurses face. Across the three emergency departments, nurses had similar beliefs about safety culture, with a consensus that safety was everyone's responsibility. This has enabled the safety culture coordinator position to have greater consideration of what initiatives are valued and important in working with nurses to design strategies that influence their safety culture.

Improving Pain Reassessment and Documentation Rates: A Quality Improvement Project in a Teaching Hospital's Emergency Department.

INTRODUCTION: ED pain score reassessment and documentation rates were drastically low according to sampled data from the St. Margaret Hospital Emergency Department, leading to difficult pain management encounters for clinicians. The purpose of this project was to improve pain score reassessment rates in ED patients who were discharged with extremity pain. METHODS: This project was an 8-month, pre-postinterventional (preintervention: September-November 2018, intervention: December 2018-January 2019, and postintervention: February-April 2019) quality improvement project that took place in a community hospital emergency department. Emergency nurses participated in 6 focus groups, allowing for the creation of focus group-themed interventions at the request of the nursing staff. Daily audits of pain reassessment and documentation rates for individual nurses took place during the month of January 2019. In addition, a weekly newsletter was created and reported the ED pain reassessment and documentation rates. RESULTS: All patient encounters (581) were reviewed over the 8-month period. Baseline pain score reassessment and documentation rates were 36.2% (confidence interval, 30.3%-42.3%) in the emergency department. Pain reassessment and documentation rates increased to 62.3% (confidence interval, 56.8%-67.6%) during the 3-month postintervention period. DISCUSSION: Implementing daily audits and weekly newsletters that created transparency of individual and group performances increased pain score reassessment and documentation rates.

Emergency nurses' knowledge about ventilator-associated pneumonia.

INTRODUCTION: Given the increasing number of patients requiring mechanical ventilation in emergency departments in recent years, prevention of ventilator-associated pneumonia is very important. Nurses play a significant role in prevention of ventilator-associated pneumonia. This study aimed to determine the emergency nurses knowledge about prevention of ventilator-associated pneumonia. METHODS: The present descriptive study was conducted in Iran, from July to October 2018. All the nurses with at least a bachelor degree, who are working in two emergency departments of two teaching hospitals, were asked to participate in this study. The "knowledge about ventilator-associated pneumonia" questionnaire consisting of 9 items was used to assess the knowledge of nurses. The results were analyzed using SPSS-16. RESULTS: In total, 53 nurses participated in this study. The mean score of correct answers of nurses to these 9 items was 4.4 ±â€¯1.6. Nurses give the most correct answer to the item about patient's position on the bed so as to reduce the risk of pneumonia with a correct answer of 72.9%. The least correct answer was also given to the item about how humidifier was changed with a correct answer of 1.9%. None of the nurses participating in the study were able to answer all the items correctly. The mean score of knowledge of nurses who had participated in workshops about taking care of patients on mechanical ventilation was significantly higher than those who had not participated in such workshops (4.8 vs. 3.8) (p = 0.045). The mean score of knowledge in nurses who were familiar with the international guidelines for ventilator-associated pneumonia prevention was significantly higher than those who were not familiar with such guidelines (5.1 vs. 4.1) (p = 0.045). CONCLUSION: Emergency nurses participated in this study had inadequate knowledge about the prevention of ventilator-associated pneumonia. Nurse's knowledge affected by participation in related workshop and familiarity with ventilator-associated pneumonia guidelines. Considering the importance of this issue, it is necessary to improve the knowledge of the emergency nurses in this matter by holding training courses.

Code Critical: Improving Care Delivery for Critically Ill Patients in the Emergency Department.

PROBLEM: Although certain critically ill patients in emergency departments-such as those experiencing trauma, stroke, and myocardial infarction-often receive care through coordinated team responses, resource allocation and care delivery can vary widely for other high-acuity patients. The absence of a well-defined response process for these patients may result in delays in care, suboptimal outcomes, and staff dissatisfaction. The purpose of this quality improvement project was to develop, implement, and evaluate an ED-specific alert team response for critically ill medical adult and pediatric patients not meeting criteria for other medical alerts. METHODS: Lean (Lean Enterprise Institute, Boston, MA) principles and processes were used to develop, implement, and evaluate an ED-specific response team and process for critically ill medical patients. Approximately 300 emergency nurses, providers, technicians, unit secretaries/nursing assistants, and ancillary team members were trained on the code critical process. Turnaround and throughput data was collected during the first 12 weeks of code critical activations (n = 153) and compared with historical controls (n = 168). RESULTS: After implementing the code critical process, the door-to-provider time decreased by 62%, door to laboratory draw by 76%, door-to-diagnostic imaging by 46%, and door-to-admission by 19%. A year later, data comparison demonstrated sustained improvement in all measures. DISCUSSION: Emergency nurses and providers see the value of coordinated team response in the delivery of patient care. Team responses to critical medical alerts can improve care delivery substantially and sustainably.

Developing an integrated career and competence framework for a whole systems approach to urgent and emergency care delivery.

BACKGROUND: The impact of crowding in emergency departments on patient safety, staff wellbeing, residents' education and performance of the wider healthcare systems is a global concern. Attention to whole systems healthcare strategies to improve service efficiency is growing, but staff are not well prepared to deliver care across organizational boundaries. Our study aimed to develop an integrated career and competence framework for whole systems urgent and emergency care. METHODS: We used mixed methods underpinned by a sequential exploratory design to collect data from a purposive sample. The sample included participants with clinical and mentoring or supervisory expertise in urgent and emergency care settings (n = 27) and university lecturers in emergency care programs (n = 7). RESULTS: The integrated career and competence framework provides a broad pathway for urgent and emergency care across contributing contexts. The framework illustrates what to expect of staff in urgent and emergency care contexts, irrespective of discipline. CONCLUSION: The integrated career and competence framework highlights the capacity of care contexts to support informed navigation of the healthcare system in pursuit for urgent care. This initiative benchmarks a step toward whole systems urgent and emergency care to relieve the pressure on emergency departments and to grow staff across the system toward integrated working.

Frontline barriers to effective paramedic and emergency nursing STEMI management: clinician perspectives.

BACKGROUND: Factors that hinder the pivotal role frontline clinicians play in STEMI management are under-reported. We aimed to explore perceived barriers to effective STEMI management by addressing the following questions: 1. What are the most commonly occurring barriers to timely STEMI management for paramedics and emergency nurses? 2. Are there differences in barriers experienced by paramedics and emergency nurses? 3. Are there differences in barriers experienced by frontline clinicians in rural and metropolitan settings? METHODS: A 79-item online survey was offered to paramedics and emergency nurses. Descriptive statistics and exploratory factor analysis identified the most frequently experienced types of barriers. Professional groups and geographical locations were compared. RESULTS: There were 333 respondents. Response rates for paramedics was 10% and 9% for members of an emergency nursing association. Most commonly occurring barriers across all respondents were: 'lack of skills development'; 'lack of feedback'; 'untimely support'; 'distance to scene/hospital facilities'; 'hospital-related delays'. Statistically significant differences were found by professional group and geographical location. CONCLUSION: Barriers to timely management were present, but not frequently experienced. Survey responses indicate a need for improved continuing professional development opportunity, clearer feedback mechanisms, streamlined facilitation of STEMI processes in hospitals, and enhanced access to expert advice/resources for all frontline clinicians.

How safe staffing can improve emergency nursing: time to cut the Gordian knot.

The phrase 'cut the Gordian knot' describes a bold and direct solution to a complicated problem. Nursing presence has been defined as nurses' ability to pay attention to patients and make them feel that their needs have been considered. In the emergency department (ED), nursing presence can be adversely affected by factors such as fatigue, workplace bullying, moral distress and inadequate staffing levels, which could lead to suboptimal patient outcomes and compromise the goals of nursing. Nursing presence is also important for nurses' job satisfaction and therefore for staff retention. This article explores the combined effects of fatigue, workplace bullying, moral distress and inadequate staffing levels on emergency nurses. To cut the Gordian knot it also provides recommendations for mitigating these issues in EDs through safe staffing decisions that consider patient acuity and skill mix.