[Advanced practice: students' opinions on the future emergency medicine specialisation]. / Pratique avancée : points de vue d'étudiants sur la future mention Urgences.

In the context of the rebuilding of the emergency services a new health care provider has been identified to reorganize emergency medicine in order to meet the expectations of the population, institutions and professionals. The nurse in advanced practice with extended skills must be able to fit into a pre-existing organization, in collaboration with the actors already present, but also represent an innovative care offer with regard to intra-hospital and pre-hospital needs as well as in terms of regulation. Student proposals.

Modeling emergency department nursing workload in real time: An exploratory study.

Study of emergency department (ED) nursing workload has been largely subsumed under the related but separate phenomenon of ED crowding. Nursing workload is difficult to quantify directly. This observational study explored modeling ED nursing workload indirectly, in real time, from quantitative data available from the patient tracking computer system (PTCS). METHODS: Data on 2793 patient visits plus departmental statistics were collected during 167 60-minute survey periods (SP) in a 25-bed hospital ED in the United States. The charge nurse assessed a perceived workload score (WLS) according to pre-determined criteria following each SP as a validation measure. DATA ANALYSIS: Correlations were calculated between the data and WLS, and strongly correlating variables were incorporated into linear regression models that sought to approximate WLS. RESULTS: A measure of aggregate patient acuity derived from the Emergency Severity Index (ESI) was the strongest predictor of WLS (r = 0.7991). The best-performing model agreed with WLS in 64% of SPs. CONCLUSIONS: Good agreement between model output and WLS suggests that ED nursing workload can be estimated indirectly in real time using data from a PTCS. Strong correlation between the ESI derivative and WLS further validates ESI and suggests a new application for the ESI score.

Nursing: Addressing substance use in the 21st century.

Over the past two decades, there has shift from focusing on the most severe end of the substance use continuum to earlier detection of persons who are at risk given the consequences associated with alcohol and other drug use. In 2017, the Association for Multidisciplinary Education and Research in Substance Use and Addiction (AMERSA) undertook the development of core competencies for specific disciplines addressing substance use in the 21st century. This article presents the core competencies for nursing in accord with the 16 standards of practice and performance for nursing. The competencies for the registered nurse and the advanced practice nurse are intended to inform and guide nursing practice with a focus on prevention, intervention, treatment, and recovery supports for persons who are affected by substance.

Ethical, legal and professional accountability in emergency nursing practice: An ethnographic observational study.

INTRODUCTION: Accountability in nursing practice is a concept that influences quality care, decision-making, safety standards and staff values. Therefore, understanding accountability and how it affects nursing practice could improve patient care and nurses' working conditions. AIM: The aim of this study was to find factors that influenced ethical, legal and professional accountability in emergency nursing practice. METHODS: A qualitative ethnographic approach using participant observation through convenience sampling was employed as the data collection method, while ethnographic content analysis was used for data analysis. RESULTS: The factors linked to nursing accountability found were classified into four main themes: daily dynamics, work environment evolution, customs and routines and bioethics principles' application. DISCUSSION: The long-term effect of chronic high workload and crowding, which affects nursing accountability, could promote burnout in a junior ED workforce. Changes in the nurses' working conditions need to be implemented to limit the workload to which an ED nurse is subjected to. CONCLUSION: ED nurses have to manage their accountability in difficult situations regularly, which followed patterns of four main themes across the majority of situations. Nonetheless, all those factors were influenced by nursing workload, an ever-present factor that was always considered by ED nurses during decision-making.

Emergency clinician perceptions of occupational stressors and coping strategies: A multi-site study.

BACKGROUND: Research exploring multi-disciplinary emergency department (ED) clinicians' perceptions of their working environment is limited, although exposure to occupational stressors is frequent. This study describes ED clinicians' perceptions of their working environment, occupational stressors and their use of coping strategies. METHODS: A cross-sectional descriptive study was conducted in 2017 at two Australian public hospital EDs. Nursing and medical staff completed a print-based survey of 100 items, which included three scales and a demographic questionnaire. Responses were analysed using descriptive statistics and regression analysis. RESULTS: Doctors and nurses (n = 241) completed the survey (response rate 45%). Workload featured as a major factor in perception of the working environment and was a frequently occurring stressor. Death or sexual abuse of a child was the highest rated stressor, despite relative infrequency of exposure. When coping strategies were adjusted for sex, female respondents were more likely to use negative strategies such as blaming themselves (Odds Ratio, OR 4 [1.6-9.7]; p < 0.01) and less likely to use positive strategies such as exercise (OR 0.2 [0.1-0.6]; p < 0.01). CONCLUSIONS: While stressors were similarly rated among the diverse group of clinicians, the ways in which they reported coping varied. Further research is required to facilitate design of staff support strategies.

The impact of introducing the Modified Early Warning Score 'MEWS' on emergency nurses' perceived role and self-efficacy: A quasi-experimental study.

BACKGROUND: Early warning Score is a bedside track and trigger system used to facilitate early detection and management of deteriorating patients. Although emergency department nurses are the key to implement this task, their interaction and contribution to provide an estimate of patients' severities is still suboptimal and neglected. AIM: This study aimed to introduce an educational programme using the Modified Early Warning Score (MEWS) to nurses working in the emergency departments and to assess the programme impact on nurses' self-efficacy and perceived role. METHODS: This non-equivalent, multi-centre, quasi-experimental study, assigned two groups of emergency nurses into intervention and control. The intervention group received three interactive educational sessions totalling 12 h relevant to the application of MEWS in emergency situations using a validated programme called 'COMPASs'. The other group received no intervention. Both groups were assessed for self-efficacy and perceived role in the pre-test, immediate post-test, and three months later follow-up phase. RESULTS: A total of 232 participants were divided into intervention and control groups (118 and 114, respectively), having no variations in age, gender, or experience as registered nurses. The intervention group showed a significant improvement in the self-efficacy scores for the nurses (F: 152.21, df: 2, p < 0.001). Similarly, the intervention nurses exhibited a significant improvement in the perceived role scores after the intervention (F: 121.20, df: 2, p < 0.001). The control group showed no changes in either variable across the three phases. While older nurses with longer experience showed higher self-efficacy after the programme, the perceived role explained an additional 57.0% of the variance in self-efficacy after controlling these two demographics (Beta: 0.743, p < 0.001, CI: 1.18-1.66). CONCLUSION: The existence of an early warning system in the emergency department is able to enhance nurses' self-efficacy and perceived role coinciding with nursing interactions with the multidisciplinary team.

Future Emergency Nursing Workforce: What the Evidence Is Telling Us.

INTRODUCTION: In Australia, on any given day, there are more than 300 advertised emergency nursing positions, and this situation can be replicated in nearly every country internationally. The nursing shortage globally is known. The importance of not only why nurses specialize in the field of emergency nursing but also why they remain in the field requires an understanding of the evidence and research into nursing recruitment and retention. Leadership within the emergency department has a strong correlation to staff retention. It is hoped that, by gaining a greater understanding of the elements that influence staff retention, we will be able to lay down a strong foundation for the future of emergency nursing. METHODS: This literature review used a bibliographic search as well as the author's own experience. RESULTS: This article presents the key factors that have impact on emergency nursing retention: workplace environment, demands on emergency nurses, resilience, and education and training. DISCUSSION: Emergency nursing recruitment and retention is a multifaceted issue that requires urgent attention to develop tools and strategies to support organizations to build a sustainable workforce. This literature review has highlighted the need for further studies to understand why emergency nurses lack the knowledge or capability for a long-term career in emergency nursing.

[ABCDE, a new approach to patient management in emergency departments]. / ABCDE, une nouvelle approche de prise en charge aux urgences.

The ABCDE method constitutes an effective method of patient management in an emergency department. It is structured, systematic and universal. Many patients are able to benefit from it, in traumatology as well as in other sectors. It requires specific training.

[The emergency department triage nurse, a constantly evolving role]. / L'infirmier organisateur de l'accueil aux urgences, un poste en constante évolution.

The number of patients attending emergency departments is constantly growing. They are fast becoming a place of primary care. Early assessment of patients must guarantee the safety of their care. The triage nurse uses a clinical examination and a triage chart to classify the patients. The reception of the patients by the triage nurse is professional. With tension often high in emergency departments, triage nurses play a role in defusing situations, which could constitute the next area of focus of their professionalization.

Innovations in Emergency Nursing: Transforming Emergency Care Through a Novel Nurse-Driven ED Telehealth Express Care Service.

PROBLEM: Emergency department overcrowding and acuity are significant challenges to patients and staff. Low-acuity patients have extended wait times, and decreased satisfaction can have a negative effect on patient flow. METHODS: A multidisciplinary ED team developed and launched the first ED-based Telehealth Express Care Service, where patients who present to the emergency department with minor complaints are offered a "virtual visit" with a board-certified emergency physician located remotely. RESULTS: More than 6 months into the program, more than 1,300 patients have been treated. These patients experienced decreased length of stay (2.5 hours to 38 minutes) and increased satisfaction. The program is very well received by staff members who appreciate its efficiency. DISCUSSION: Telehealth has the potential to optimize ED efficiency, increase patient satisfaction, and promote safe, high-quality provision of care.

Consensus-based clinical research priorities for emergency nursing in Australia.

INTRODUCTION: Research is vital to responding to contemporary challenges of providing safe, high quality emergency nursing care, yet the research priorities for emergency nursing practice in Australia are unknown. This study aimed to establish research priorities for emergency nursing in Australia. METHODS: A two-stage descriptive, exploratory study was conducted. First, research themes were identified through a survey of 232 emergency nurses the Delphi Technique (2 rounds) was used to rank and prioritise the research themes. RESULTS: There were five research themes with a CVI≥0.90: (i) recognising and responding to deteriorating ED patients; (ii) effect of access block on clinical care of admitted ICU patients; (iii) effects of ED overcrowding on clinical care; (iv) scope of practice of specialist emergency nurses; and (v) effect of access block on clinical care of admitted ward patients. These are reflected in four broad research priority areas: professional issues, patient safety, emergency care of vulnerable populations, and healthcare system issues. CONCLUSION: Future research should focus on these priority areas in partnership with other emergency disciplines to enable safe, high quality emergency care, and, to inform the practice of emergency nursing in Australia.

A pilot study examining the speed and accuracy of triage for simulated disaster patients in an emergency department setting: Comparison of a computerized version of Canadian Triage Acuity Scale (CTAS) and Simple Triage and Rapid Treatment (START) methods.

OBJECTIVE: To compare emergency department triage nurses' time to triage and accuracy of a simulated mass casualty incident (MCI) population using a computerized version of CTAS or START systems. METHODS: This pilot study was a prospective trial using a convenience sample. A total of 20 ED triage nurses, 10 in each arm of the study, were recruited. The paper-based questionnaire contained nine simulated MCI vignettes. An expert panel arrived at consensuses on the wording of the vignettes and created a standard triage score from which to compare the study participants. Linear regression and chi-squared test were used to examine the time to triage and accuracy of triage, respectively. RESULTS: The mean triage time for computerized CTAS (cCTAS) and START were 138 seconds/patient and 33 seconds/patient, respectively. The effect size due to triage method was 108 seconds/patient (95% CI 83-134 seconds/patient). The cumulative triage accuracy for the cCTAS and START tools were 70/90 (77.8%) and 65/90 (72.2%), respectively. The percent difference between cumulative triage was 6% (95% CI -19-8%). CONCLUSIONS: Triage nurses completed START triage 105 seconds/patient faster when compared to cCTAS triage and a similar level of accuracy between the two methods was achieved. However, when the typing time is taken into consideration cCTAS took 45 seconds/patient longer. The use of either CTAS or START in the ED during a MCI may be reasonable but choosing one method over another is not justified from this investigation.

Demand for emergency care growing at more than 50,000 patients a month.

Relentless demand for services is driving up waiting times and exacerbating financial pressures in the NHS according to the latest monitoring report from The King's Fund.