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1.
J Adv Nurs ; 2025 Jan 16.
Artigo em Inglês | MEDLINE | ID: mdl-39817707

RESUMO

AIM: To explore the experiences of emergency nurses providing end-of-life care during the COVID-19 pandemic. DESIGN: A qualitative descriptive study. METHODS: Data were collected between May and August 2023. Individual, semi-structured interviews were conducted face to face or by videoconferencing with a purposive and snowballed sample of 11 emergency nurses. Data were analysed using thematic analysis. RESULTS: There were four main themes identified: (1) Isolation and loneliness that emergency nurses felt when providing end-of-life care throughout COVID-19. (2) Comparison of Care Relating to Communication; whereby emergency nurses compared the provision of end-of-life care before COVID-19 to end-of-life care provided during the pandemic. (3) Frustration and guilt: emergency nurses felt when providing end-of-life care. (4) Teamwork: participants interviewed explored the meaning of having a supportive team when providing end-of-life care. CONCLUSIONS: This study explores in-depth experiences of emergency nurses providing care to those who were dying during the COVID-19 pandemic. This study identified that emergency nurses were impacted emotionally by providing end-of-life care during the pandemic, and ongoing support is likely to be needed. This study also reinforced the strength of teamwork amongst emergency nurses. PATIENT OR PUBLIC CONTRIBUTION: No patient or public contribution.

2.
J Adv Nurs ; 2025 Feb 02.
Artigo em Inglês | MEDLINE | ID: mdl-39894453

RESUMO

BACKGROUND: School nurses are sometimes the sole healthcare professionals in schools, highlighting their significant role in delivering emergency care and the vital necessity of their competence in emergency nursing care. The scope of practice and ongoing professional development are hypothesized to play significant roles in enhancing these competencies. AIM: Investigate the direct and indirect effects of the scope of current practice and the importance of training on the emergency nursing care competency of school nurses, with career growth serving as a potential mediator. METHODS: A multi-center cross-sectional study was conducted with a convenient sample of 219 school nurses. Data were collected using the career growth of nurses' scale, the emergency nursing care competency scale for school nurses and the scope of school nursing practice tool. Mediation analysis was used to explore the direct and indirect effects of studied variables. RESULTS: Mediation analysis indicated that the scope of current practice had a significant direct effect on career growth (ß = 0.179) and emergency nursing care competency (ß = 0.389). The importance of practice also had significant direct effects on career growth (ß = 0.164) and emergency nursing care competency (ß = 0.220). Additionally, career growth significantly mediated the relationship between both the scope of current practice (ß = 0.110) and the importance of practice (ß = 0.120) with emergency nursing care competency. CONCLUSIONS: The findings emphasis the critical role of career growth as a mediator between the scope and importance of practice and emergency nursing care competency among school nurses. Expanding the scope of practice and emphasising the importance of professional activities can enhance career growth and improve emergency nursing care competencies. IMPLICATIONS: Nurses scope of practice and clear career advancement through mentorship, advanced certifications, further education and enforcing policies mandating regular emergency care is crucial. Establishing a regulatory framework to define and expand the scope of practice for school nurses is also important. PATIENT OR PUBLIC CONTRIBUTION: No patient or public contribution.

3.
BMC Nurs ; 24(1): 35, 2025 Jan 09.
Artigo em Inglês | MEDLINE | ID: mdl-39789557

RESUMO

BACKGROUND: Emergency departments (ED) are characterized by highly dynamic environments. This study aimed to identify determinants of resilience and mental stress among ED nurses. METHODS: A cross-sectional, analytical design was employed to assess 316 emergency nurses in Kermanshah hospitals using a convenience sampling method. The Connor-Davidson Resilience Scale and the Perceived Stress Scale measured resilience and mental stress, respectively. Data were analyzed using independent t-tests, ANOVA, chi-square tests, and Pearson's correlation in SPSS version 25. RESULTS: The average mental stress score was 26.9, and the average resilience score was 64, indicating moderate levels. Significant relationships were found between employment status, emergency responsibility, economic status, and resilience (P < 0.01). Additionally, place of residence, number of children, education, shift work, social network presence, employment status, emergency responsibility, and economic status were significantly related to psychological stress (P < 0.01). Pearson's correlation showed an inverse relationship between resilience and mental stress (r = -0.123, P = 0.029). Age was inversely related to mental stress (r = -0.408, P < 0.001), while overtime hours per month were directly related to resilience (r = 0.135, P = 0.016) and inversely related to mental stress (r = -0.482, P = 0.029). CONCLUSION: The research highlights the importance of considering demographic variables in managing nurses' resilience and mental pressure, emphasizing the need for hospital officials to focus on work shifts, employment status, and economic conditions.

4.
J Emerg Nurs ; 2025 Jan 13.
Artigo em Inglês | MEDLINE | ID: mdl-39808097

RESUMO

INTRODUCTION: Cognitive impairment in older adults is underrecognized in emergency departments. Despite emergency nurses' central role in facilitating ED screening for clinical and social needs, little is known about their perspectives on implementing delirium and dementia screenings. Nurses can provide insights to promote the uptake of these screenings. METHODS: Using a case study approach, we conducted qualitative interviews with emergency nurses at a public safety net hospital about their perspectives on implementing screening for delirium and dementia. Interview topics were derived from an implementation science framework (Consolidated Framework for Implementation Research). We performed a combined deductive-inductive analysis. RESULTS: Eleven nurses participated in interviews. Four overarching themes were identified. Emergency nurses viewed safety as the core function of screening. Emergency nurses identified adequate staffing, private care spaces, and electronic medical record support as important resources required to support screening implementation. Nurses perceived benefits of screening ED patients for cognitive impairment specifically related to hazards of ED boarding. However, they simultaneously found screenings complex and incompatible with their workflows and available health system resources. DISCUSSION: Emergency nurses conceptualize screenings in terms of patient safety, which may be the best way to frame initiatives to implement screenings for cognitive impairment. In light of ED crowding and boarding's impacts on patient safety, nurses highlighted screening for cognitive impairment as increasingly relevant. However, they found current working conditions of delivering patient care in waiting rooms and hallways not conducive to implementing screenings. Using the Consolidated Framework for Implementation Research framework helped identify workflow limitations that are barriers to ED screening.

5.
J Emerg Nurs ; 2025 Jan 13.
Artigo em Inglês | MEDLINE | ID: mdl-39808096

RESUMO

INTRODUCTION: Documentation templates supported the implementation of HIRAID, a validated framework that supports nurses in assessing and managing patients in emergency departments in rural Australia using a strategy informed by behavior change theory. The study aimed to determine whether the implementation of HIRAID improved the accuracy of nurses' documentation across a large rural health district. METHODS: A Quasi-experimental pre-post study design was conducted across 10 rural emergency departments between November 2020 and November 2021, with HIRAID implemented in February 2021. Retrospective audit of clinical documentation occurred 3 months pre-implementation and repeated at 6-months post. Based on power analysis and a sampling framework, records that met study inclusion were randomized for audit. Documentation accuracy was evaluated, using a modified D-catch instrument, assessing quality and quantity by an experienced research nurse. Data were analyzed with descriptive and inferential statistics. RESULTS: A review of 222 records (110 pre/112 post), demonstrated an improvement in initial ED nursing assessment documentation. Audit scores increased significantly for quantity of documentation across all areas, in particular history (P < .001) and red flags (P < .001), with a 27.1% increase in all red flags recorded. The quality of documentation also significantly improved across all areas, most notably in history (P < .001) and assessment (P < .001). DISCUSSION: Implementation of HIRAID demonstrated a sustained improvement in the quantity and quality of emergency nurse documentation. Improved documentation accuracy is key to informing and evaluating ongoing care and supporting communication and continuity of care, and is essential to patient safety.

6.
J Emerg Nurs ; 2025 Feb 01.
Artigo em Inglês | MEDLINE | ID: mdl-39891624

RESUMO

INTRODUCTION: Patient fall risk assessment in the emergency department poses a unique challenge as fall risk is often associated with risk factors other than inpatient falls. While there are many inpatient fall risk assessment tools, few have been used or validated in the ED environment. Therefore, this study examined the predictive performance of the KINDER 1 Fall Risk Assessment Tool in 10 emergency departments. METHODS: A retrospective cohort design was used. Data were collected from November 15, 2023, to April 30, 2024, as a part of an electronic pilot of the KINDER 1 Fall Risk Assessment tool. Inclusion criteria encompassed all adult (≥18 years) ED visits during which a KINDER 1 fall risk assessment was completed. Descriptive statistics were used to describe overall sample characteristics. Predictive performance was calculated via multiple accuracy measurements. RESULTS: KINDER 1 assessments were completed on 64,811 patients, of which 40 patient falls met inclusion criteria for final analysis. The mean age of the patients who fell was 58.46 years (±18.38). Final sensitivity was 77.5%, and the specificity was 75.8%. Fall prevalence was 0.06%. DISCUSSION: KINDER 1 exhibited a sufficiently high degree of sensitivity and specificity, supporting an acceptable level of predictive performance. Additional research is recommended to compare the reliability and predictive validity of KINDER 1 to the emergency Hester Davis Scale and the Memorial Emergency Department Fall Risk Assessment Tool, as well as to compare the usability of the tools for nurses in a triage setting.

7.
Int Nurs Rev ; 72(1): e70002, 2025 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-39912528

RESUMO

AIM: This study assessed nurses' psychological and operational preparedness for mass-casualty events in healthcare settings. BACKGROUND: Nurses are vital responders in mass-casualty events, which demand quick and effective actions. Both psychological and operational preparedness are key to ensuring their ability to manage such high-pressure situations. METHODS: A multicenter, cross-sectional study was conducted among 156 emergency nurses in Saudi Arabia. Data were collected using a structured questionnaire based on the Transactional Model of Stress and Coping and the Hospital Emergency Incident Command System to assess psychological and operational preparedness. Data collection included demographic information, previous training, incident response experience, preparedness priorities for various mass-casualty events, and perceived challenges and barriers to response. The data were analyzed using descriptive and inferential statistics. FINDINGS: Discrepancies were observed between training and response experience for mass-casualty events, with natural disasters showing the highest alignment and priority, while transportation and fire-related incidents had a greater response than training, suggesting reliance on practical experience rather than formal education. War injuries were among the highly prioritized, with training exceeding response, potentially reflecting geopolitical concerns. Psychological and operational preparedness were moderately rated, with a strong correlation between the two, indicating that enhancing psychological resilience could improve overall preparedness. Key perceived barriers included staff shortages, inadequate resources, psychological stress, insufficient training, and unclear protocols or lack of guidelines. CONCLUSION: The study highlights moderate preparedness levels, with a need for more targeted training and systemic improvements to address identified barriers. IMPLICATIONS FOR NURSING AND HEALTH POLICY: Health policies should prioritize comprehensive disaster preparedness programs with mental health support, clear protocols, and adequate training to improve nurse preparedness for mass-casualty events. Addressing perceived barriers will strengthen the healthcare system's emergency response.


Assuntos
Planejamento em Desastres , Incidentes com Feridos em Massa , Humanos , Arábia Saudita , Incidentes com Feridos em Massa/psicologia , Estudos Transversais , Feminino , Adulto , Masculino , Inquéritos e Questionários , Recursos Humanos de Enfermagem Hospitalar/psicologia , Pessoa de Meia-Idade , Enfermagem em Emergência/educação , Atitude do Pessoal de Saúde , Adaptação Psicológica
8.
BMC Health Serv Res ; 24(1): 211, 2024 Feb 15.
Artigo em Inglês | MEDLINE | ID: mdl-38360620

RESUMO

BACKGROUND: Take-home buprenorphine/naloxone is an effective method of initiating opioid agonist therapy in the Emergency Department (ED) that requires ED healthcare worker buy-in for large-scale implementation. We aimed to investigate healthcare workers perceptions of ED take-home buprenorphine/naloxone, as well as barriers and facilitators from an ED healthcare worker perspective. METHODS: In the context of a take-home buprenorphine/naloxone feasibility study at a tertiary care teaching hospital we conducted a descriptive qualitative study. We conducted one-on-one in person or telephone interviews and focus groups with ED healthcare workers who cared for patients given take-home buprenorphine/naloxone in the feasibility study at Vancouver General Hospital from July 2019 to March 2020. We conducted 37 healthcare worker interviews from December 2019 to July 2020. We audio recorded interviews and focus groups and transcribed them verbatim. We completed interviews until we reached thematic saturation. DATA ANALYSIS: We inductively coded a sample of transcripts to generate a provisional coding structure and to identify emerging themes, which were reviewed by our multidisciplinary team. We then used the final coding structure to analyze the transcripts. We present our findings descriptively. RESULTS: Participants identified a number of context-specific facilitators and barriers to take-home buprenorphine/naloxone provision in the ED. Participants highlighted ED conditions having either facilitative or prohibitive effects: provision of buprenorphine/naloxone was feasible when ED volume was low and space was available but became less so as ED volume increased and space decreased. Similarly, participants noted that patient-related factors could have a facilitative or prohibitive effect, such as willingness to wait (willing to stay in the ED for study-related activities and buprenorphine/naloxone initiation activities), receptiveness to buprenorphine/naloxone, and comprehension of the instructions. As for staff-related factors, time was identified as a consistent barrier. Time included time available and time required to initiate buprenorphine/naloxone (including time building rapport). Healthcare worker familiarity with buprenorphine/naloxone was noted as either a facilitating factor or a barrier, and healthcare workers indicated that ongoing training would have been advantageous. Many healthcare workers identified that the ED is an important first point of contact for the target patient population. CONCLUSION: Integrating a buprenorphine/naloxone program into ED care requires organizational supports (e.g., for managing buprenorphine/naloxone within limitations of ED volume, space, and time), and ongoing education of healthcare workers to minimize identified barriers.


Assuntos
Buprenorfina , Transtornos Relacionados ao Uso de Opioides , Humanos , Antagonistas de Entorpecentes/uso terapêutico , Transtornos Relacionados ao Uso de Opioides/epidemiologia , Serviço Hospitalar de Emergência , Pessoal de Saúde , Buprenorfina/uso terapêutico , Naloxona/uso terapêutico
9.
Pain Manag Nurs ; 25(6): e445-e451, 2024 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-38853040

RESUMO

BACKGROUND: Pain and altered hemodynamic variables are among the most common complications in patients undergoing hand laceration repair in an Emergency Department. AIM: This study aimed to evaluate the effects of using virtual reality (VR) technology on pain and hemodynamic variables in patients receiving hand laceration repair in an Emergency Department. METHOD: This nonblinded randomized clinical trial included 160 patients undergoing laceration repair to their hands under local anesthetics from November 2020 to May 2021. The participants were randomly allocated to the experimental and control groups. Patients in the control group received routine care (such as ambient noise reduction, providing explanations about the surgery, and Lidocaine injection before the surgery). In the experimental group, a video containing natural landscapes and sounds was played using a semi-immersive VR headset during the surgery. Pain level and hemodynamic variables were measured immediately before and after the intervention. The pain was measured using the Critical Care Pain Observation Tool and Visual Analog Scale. RESULTS: Immediately after the intervention, systolic blood pressure (BP), respiration rate, and pain intensity were significantly lower in the intervention group compared with the control group (p < .05). There were no significant differences between the intervention and control groups regarding diastolic BP, mean BP, SPO2, heart rate, and muscular tension (p > .05). CONCLUSIONS: Semi-immersive VR is effective in managing pain and hemodynamic variables during hand laceration repair. The nurses could use the semi-immersive VR to better control of pain and hemodynamic variables during hand laceration repair.


Assuntos
Serviço Hospitalar de Emergência , Hemodinâmica , Lacerações , Realidade Virtual , Humanos , Feminino , Masculino , Adulto , Serviço Hospitalar de Emergência/organização & administração , Serviço Hospitalar de Emergência/estatística & dados numéricos , Hemodinâmica/fisiologia , Pessoa de Meia-Idade , Manejo da Dor/métodos , Manejo da Dor/normas , Medição da Dor/métodos , Mãos/fisiopatologia , Traumatismos da Mão/cirurgia
10.
J Adv Nurs ; 80(11): 4725-4735, 2024 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-38825956

RESUMO

AIM: To develop and psychometrically test the triage decision-making instrument, a tool to measure Emergency Department Registered Nurses decision-making. DESIGN: Five phases: (1) defining the concept, (2) item generation, (3) face validity, (4) content validity and (5) pilot testing. METHODS: Concept definition informed by a grounded theory study from which four domains emerged. Items relevant to the four domains were generated and revised. Face validity was established using three focus groups. The target population upon which the reliability and validity of the triage decision-making instrument was explored were triage registered nurses in emergency departments. Three expert judges assessed 89 items for content and domain designation using a 4-point scale. Psychometric properties were assessed by exploratory factor analysis, following which the names of the four domains were modified. RESULTS: The triage decision-making instrument is a 22-item tool with four factors: clinical judgement, managing acuity, professional collaboration and creating space. Focus group data indicated support for the domains. Expert review resulted in 46 items with 100% agreement and 13 with 66% agreement. Fifty-nine items were distributed to a convenience sample of 204 triage nurses from six hospitals in 2019. The Kaiser-Meyer-Olkin measures indicated that the data were sufficient for exploratory factor analysis. Bartlett's test indicated patterned relationships among the items (X 2 (231) = 1156.69). An eigenvalue of >1.0 was used and four factors explained 48.64% of the variance. All factor loadings were ≥0.40. Internal consistency was demonstrated by Cronbach's alphas of .596 factor 1, .690 factor 2, .749 factor 3 and .822 for factor 4. CONCLUSION: The triage decision-making instrument meets the criteria for face validity, content validity and internal consistency. It is suitable for further testing and refinement. IMPACT: The instrument is a first step in quantifying triage decision-making in real-world clinical environments. The triage decision-making instrument can be used for targeted triage interventions aimed at improving throughput and staff education. STATISTICAL SUPPORT: Dr. Tak Fung who is a member of the research team is a statistician. STATISTICAL METHODS: Development, validation and assessment of instruments/scales. Descriptive statistics. REPORTING METHOD: STROBE cross-sectional checklist. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE: The TDI makes the complexity of triage decision-making visible. Identifying the influence of decision-making factors in addition to acuity that affect triage decisions will enable nurse managers and educators to develop targeted interventions and staff development initiatives. By extension, this will enhance patient care and safety.


Assuntos
Tomada de Decisão Clínica , Serviço Hospitalar de Emergência , Enfermeiras e Enfermeiros , Psicometria , Triagem , Triagem/normas , Serviço Hospitalar de Emergência/normas , Psicometria/instrumentação , Psicometria/normas , Reprodutibilidade dos Testes , Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Análise Fatorial
11.
J Adv Nurs ; 80(5): 2027-2037, 2024 May.
Artigo em Inglês | MEDLINE | ID: mdl-37975436

RESUMO

AIM: Work-related violence is a significant problem in healthcare settings and emergency departments are one of the highest at-risk locations. There have been significant challenges in identifying successful risk-mitigation strategies to reduce the incidence and impact of work-related violence in this setting. This research explores the perspectives of clinical staff who routinely use violence risk assessment to provide recommendations for improvements. DESIGN: This qualitative research used interviews of staff who routinely use of the Bröset Violence Checklist in an emergency department. The study was conducted in April 2022. METHOD: Interview transcripts were subjected to Thematic Analysis to explore participants' clinical experiences and judgements about the utility of the Bröset Violence Checklist. RESULTS: Eleven staff participated in semi-structured interviews. Participants described themes about the benefits of routine violence risk assessment and the influence of the subjective opinion of the scorer with respect to the emergency department patient cohort. Four categories of violence risk factors were identified: historical, clinical, behavioural and situational. Situational risks were considered important for tailoring the tool for context-specificity. Limitations of the BVC were identified, with recommendations for context-specific indicators. CONCLUSION: Routine violence risk assessment using the Bröset Violence Checklist was deemed useful for emergency departments, however, it has limitations. IMPACT: This study's findings offer potential solutions to reduce violence affecting front-line workers and practical processes that organizations can apply to increase staff safety. IMPLICATIONS: The findings produced recommendations for future research and development to enhance utility of the Bröset Violence Checklist. REPORTING METHOD: EQUATOR guidelines were adhered to and COREQ was used. PATIENT OR PUBLIC CONTRIBUTION: No patient or public contribution was involved in this study.


Assuntos
Lista de Checagem , Violência no Trabalho , Humanos , Lista de Checagem/métodos , Violência/prevenção & controle , Agressão , Pacientes , Serviço Hospitalar de Emergência , Violência no Trabalho/prevenção & controle
12.
J Adv Nurs ; 2024 Dec 06.
Artigo em Inglês | MEDLINE | ID: mdl-39641515

RESUMO

AIM: The aim of this discussion paper is twofold: (1) To critically examine the challenges related to resuscitations among rural nurses and how these contribute to a sense of professional isolation and (2) To discuss practical solutions and strategies that could be implemented to mitigate the effects of professional isolation. BACKGROUND: Professional isolation is not unique to rural nursing practice. It is a complex issue often observed in low-resourced environments that are geographically distant from larger hospitals, such as small rural emergency departments. With a greater research focus placed on the recruitment and retention challenges associated with professional isolation, studies often overlook the intermediary factors contributing to this issue, such as the effect of resuscitations on rural nurses. In addition, there are few studies that have evaluated interventions or strategies to address professional isolation. DESIGN: A critical discussion paper. METHODS: This discussion paper is based on data drawn from current evidence and is guided by the authors research experience as part of a doctoral study. RESULTS: Professional isolation negatively affects rural nurses' experiences of resuscitation by creating barriers to skill acquisition and professional growth and reducing career intent in rural areas. Strategies such as leadership training, rural mentorship, debriefing and cognitive aids are possible strategies that could address these challenges. CONCLUSIONS: The trajectory of professional isolation is contingent upon the capacity of rural nurses to have access to professional avenues that enhance connection, sharing of knowledge, skills and experiences. Addressing professional isolation is crucial for the well-being of rural nurses and the overall sustainability and growth of the rural healthcare workforce.

13.
J Adv Nurs ; 2024 Aug 06.
Artigo em Inglês | MEDLINE | ID: mdl-39104304

RESUMO

AIM: To explore how emergency nurses experienced caring for brought-in-dead persons and their relatives, and what hindered or facilitated this care in an emergency setting. DESIGN: A qualitative study using Interpretive Description. METHODS: Data were collected as individual interviews with 13 nurses at seven Danish emergency departments from February to June 2023. FINDINGS: Our analysis revealed the overarching theme 'Navigating the complexities of providing holistic care in a constrained environment', covering five sub-themes: (1) An important yet not recognized nursing task; (2) Pending care needs of the living and the dead; (3) No physical or mental room for the brought-in-dead persons; (4) Utilizing personal experiences in the absence of formal education and training and (5) Navigating professionalism and empathy. CONCLUSION: Emergency departments posed unique challenges in providing care to brought-in-dead persons and their relatives. IMPLICATIONS FOR THE PROFESSION: The unrecognized nature of caring for brought-in-dead persons and their relatives suggests a universal undervaluation of this care in emergency departments. IMPACT: Care for brought-in-dead persons and their relatives is neither recognized nor evidence-based. This study initiates a discussion of the circumstances for delivering care for persons brought-in-dead and has an impact on nurses and nursing leaders employed in emergency departments. REPORTING METHOD: The Consolidated Criteria for Reporting Qualitative Research (COREQ). PATIENT OR PUBLIC CONTRIBUTION: None.

14.
J Adv Nurs ; 2024 Sep 15.
Artigo em Inglês | MEDLINE | ID: mdl-39279130

RESUMO

AIM: To develop an evidence-driven, behaviour change focused strategy to maximise implementation and uptake of HIRAID (History including Infection risk, Red flags, Assessment, Interventions, Diagnostics, communication and reassessment) in 30 Australian rural, regional and metropolitan emergency departments. DESIGN: An embedded, mixed-methods study. METHODS: This study is the first phase of a step-wedge cluster randomised control trial of HIRAID involving over 1300 emergency nurses. Concurrent quantitative and qualitative data were collected via an electronic survey sent to all nurses to identify preliminary barriers and enablers to HIRAID implementation. The survey was informed by the Theoretical Domains Framework, which is a synthesis of behavioural change theories that applies the science of intervention implementation in health care to effect change. Quantitative data were analysed using descriptive statistics and qualitative data with inductive content analysis. Data were then integrated to generate barriers and enablers to HIRAID implementation which were mapped to the Theoretical Domains Framework. Corresponding intervention functions and Behaviour Change techniques were selected and an overarching implementation strategy was developed through stakeholder consultation and application of the APEASE criteria (Affordability, Practicability, Effectiveness and cost-effectiveness, Acceptability, Side-effects/safety and Equity). RESULTS: Six barriers to HIRAID implementation were identified by 670 respondents (response rate ~58%) representing all 30 sites: (i) lack of knowledge about HIRAID; (ii) high workload, (iii) lack of belief anything would change; (iv) not suitable for workplace; (v), uncertainty about what to do and (vi) lack of support or time for education. The three enablers were as follows: (i) willingness to learn and adopt something new; (ii) recognition of the need for something new and (iii) wanting to do what is best for patient care. The 10 corresponding domains were mapped to seven intervention functions, 21 behaviour change techniques and 45 mechanisms. The major components of the implementation strategy were a scaffolded education programme, clinical support and environmental modifications. CONCLUSIONS: A systematic process guided by the behaviour change wheel resulted in the generation of a multifaceted implementation strategy to implement HIRAID across rural, regional and metropolitan emergency departments. Implementation fidelity, reach and impact now require evaluation. IMPACT: HIRAID emergency nursing assessment framework reduced clinical deterioration relating to emergency care and improved self-confidence and documentation in emergency departments in pilot studies. Successful implementation of any intervention in the emergency department is notoriously difficult due to workload unpredictability, the undifferentiated nature of patients and high staff turnover. Key barriers and enablers were identified, and a successful implementation strategy was developed. This study uses theoretical frameworks to identify barriers and enablers to develop a data-driven, behavioural-focused implementation strategy to optimise the uptake of HIRAID in geographically diverse emergency departments which can be used to inform future implementation efforts involving emergency nurses. REPORTING METHOD: The CROSS reporting method (Supporting Information S3) was used to adhere to EQUATOR guidelines. PATIENT OR PUBLIC CONTRIBUTION: No Patient or Public Contribution. TRIAL REGISTRATION: Australian New Zealand; Clinical Trials Registry (ANZCTR) number: ACTRN12621001456842, registered 25/10/2021.

15.
Res Nurs Health ; 47(5): 513-521, 2024 10.
Artigo em Inglês | MEDLINE | ID: mdl-38837799

RESUMO

Nurses-with or without prehospital care training-may find themselves delivering immediate care to injured individuals outside a healthcare facility, sometimes even in situations where their own life is at risk. This study explores the experiences of community nurses and midwives who provided immediate care during the Hamas militant movement's attack in southern Israel. The researchers collected and analyzed eight nurse and midwife survivors' testimonies published in digital media to gain a deeper understanding of their perspectives. Through qualitative content analysis, common themes, patterns, and insights were identified. The study aimed to contribute valuable knowledge in this field and followed the Consolidated Criteria for Reporting Qualitative Research (COREQ) checklist for methodological rigor. Two themes emerged from the testimonies, focusing on the nurses' swift realization of necessary action under fire and resilience and ingenuity in practice. Despite lacking training and resources, the nurses professionally assessed the situation and improvised creative solutions to care for the wounded. Although they had no prehospital emergency care background, community nurses and midwives were able to respond effectively, providing lifesaving care. The findings highlight the nurses' resilience, adaptability, and dedication in unprecedented situations. However, the study also emphasizes the importance of providing all nurses with baseline prehospital care training and structured planning of this care to empower them to deliver optimal patient care in uncertain and dangerous conditions, especially in and around conflict and disaster zones.


Assuntos
Pesquisa Qualitativa , Humanos , Israel , Feminino , Adulto , Enfermeiros Obstétricos/psicologia , Pessoa de Meia-Idade , Masculino , Tocologia
16.
J Emerg Med ; 2024 Sep 05.
Artigo em Inglês | MEDLINE | ID: mdl-39894703

RESUMO

BACKGROUND: Emergency departments (ED) must perform patient care at a safe and efficient pace, which requires an effective care team. Communication and workplace practices that foster identification as part of an emergency healthcare team have not been previously demonstrated. OBJECTIVES: To explore the critical role of communication within ED healthcare teams and its impact on team belonging. This study investigates how communication practices between physicians and nurses in the ED influence team dynamics and the sense of belonging to the healthcare team. METHODS: A qualitative approach involving focus groups with 38 participants from nine EDs in Oregon. RESULTS: This study identifies positive influences on team belonging, such as proactivity, openness, less formal name conventions, and relationships outside of work. Conversely, negative influences include resistance to communication, obstacles to communication, and interactions leading to alienation. CONCLUSION: The findings emphasize the importance of fostering positive communication practices to enhance team dynamics, cohesiveness, and overall well-being within ED healthcare teams. Future research may delve into specific aspects like naming conventions and the role of friendships in healthcare communication.

17.
J Clin Nurs ; 33(7): 2525-2543, 2024 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-38476035

RESUMO

AIM: To determine and describe what interventions exist to improve nurse-family communication during the waiting period of an emergency department visit. BACKGROUND: Communication between nurses and families is an area needing improvement. Good communication can improve patient outcomes, satisfaction with care and decrease patient and family anxiety. DESIGN: Scoping Review. METHODS: A scoping review was conducted following the Joanna Briggs Institution methodology: (1) identify the research question, (2) define the inclusion criteria, (3) use a search strategy to identify relevant studies using a three-step approach, (4) select studies using a team approach, (5) data extraction, (6) data analysis, and (7) presentation of results. DATA SOURCES: Medline, CINAHL, EMBASE, PsychInfo and grey literature were searched on 3 August 2022. RESULTS: The search yielded 1771 articles from the databases, of which 20 were included. An additional seven articles were included from the grey literature. Paediatric and adult interventions were found targeting staff and family of which the general recommendations were summarised into communication models. CONCLUSION: Future research should focus on evaluating the effectiveness of interventions using a standardised scale, understanding the specific needs of families, and exploring the communication models developed in this review. IMPLICATIONS FOR CLINICAL PRACTICE: Communication models for triage nurses and all emergency department nurses were developed. These may guide nurses to improve their communication which will contribute to improving family satisfaction. REPORTING METHOD: PRISMA-ScR. TRIAL AND PROTOCOL REGISTRATION: Protocol has been registered with the Open Science Framework, registration number 10.17605/OSF.IO/ETSYB. PATIENT OR PUBLIC CONTRIBUTION: No patient or public contribution.


Assuntos
Comunicação , Serviço Hospitalar de Emergência , Relações Profissional-Família , Humanos , Adulto , Família/psicologia , Recursos Humanos de Enfermagem Hospitalar/psicologia , Feminino , Masculino
18.
J Clin Nurs ; 2024 Dec 08.
Artigo em Inglês | MEDLINE | ID: mdl-39648140

RESUMO

BACKGROUND: Standardised triage systems have been in place for decades with minor modifications, while nurses' skills and knowledge have significantly advanced. AIM: To determine whether nurses' clinical expertise outperforms triage systems in simulated clinical cases. DESIGN: A multicenter simulated observational study. METHODS: The study was conducted from January 1, 2024 to March 31, 2024, in four Italian emergency departments, enrolling triage-performing nurses. Thirty clinical cases, based on real patients representing daily emergency department influx, were reconstructed. The primary outcome was the agreement between the triage code assigned by the Manchester Triage System and the code assigned based on clinical expertise. The secondary outcome compared the predictive ability of the codes assigned by nurses regarding clinical outcomes, such as death within 72 h, the need for hospitalisation, and the need for life-saving intervention. The study was reported in accordance with the STROBE statement. RESULTS: Seventy-seven triage nurses completed the 30 vignettes. The agreement between the MTS-assigned code and the clinical expertise triage reported a Cohen's kappa of 0.576 (95% CI: 0.564-0.598). For death within 72 h, the clinical expertise code reported better results than the Manchester Triage System. For life-saving interventions, the Manchester Triage System reported a lower performance than clinical expertise. The variability in triage code assignment was higher for clinical expertise compared to the Manchester Triage System. CONCLUSIONS: Triage codes assigned by nurses based on clinical expertise perform better in terms of clinical outcomes, suggesting a need to update triage systems to incorporate nurses' knowledge and skills. However, standardised triage systems should be maintained to reduce variability and ensure consistent patient classification. REPORTING METHOD: The study was conducted and reported according to the STROBE statement. PATIENT OR PUBLIC CONTRIBUTION: No patient or public contribution.

19.
J Clin Nurs ; 2024 Dec 22.
Artigo em Inglês | MEDLINE | ID: mdl-39710600

RESUMO

AIM: To identify key aspects of recovery-oriented practice in caring for people with mental ill-health in general emergency departments. DESIGN: A modified Delphi study with three rounds. METHODS: A 24-member expert panel was recruited consisting of people with lived experience of mental ill-health, registered nurses working in emergency care, registered nurses specialised in psychiatric and mental health nursing and mental health recovery researchers. In the initial round, important aspects of recovery-oriented practice were identified through focus group interviews. Thematic analysis generated statements that were then reformulated as a questionnaire for subsequent rounds. The experts rated each statement's perceived importance on a 5-point Likert scale. The consensus level was set at ≥ 80%. Descriptive statistics were used to analyse the data. RESULTS: Consensus was reached on the importance of 39 of 73 statements, with ≥ 80% deemed 'very important' in recovery-oriented practice in general emergency departments. CONCLUSION: The study emphasises the delicate balance between the essential elements of recovery-oriented practice, their practical feasibility and the predominant biomedical perspective in general emergency department care. It proposes strategies to empower nursing staff and managers to adopt recovery-oriented practices that enhance the quality of care for people with mental ill-health. Enabling staff by providing the necessary prerequisites and a care environment that supports reflective practices is crucial. The responsibility for facilitating these changes needs to be a shared commitment between nursing staff and managers. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE: The identified issues can serve as a framework for interventions, education and training to support the integration of recovery-oriented practice in general emergency care. They can also be used to develop tools for evaluating emergency care environments and promoting alignment with recovery-oriented principles. IMPACT: Problem addressed: People with mental ill-health are at risk of being neglected, judged and dismissed in general emergency department care, creating obstacles to their mental health recovery. MAIN RESULTS: The Delphi study identified 39 key aspects of recovery-oriented practice in general emergency departments, emphasising person-centred, strength-based, collaborative and reflective care. IMPACT: The research seeks to establish a foundation for developing training programmes, education and interventions and for the integration of recovery-oriented practices in general emergency care. It thus has the potential to enhance the quality and equality of care for patients with mental ill-health in emergency care. The impact extends to nursing staff and managers as it seeks to empower them to systematically reflect on and reevaluate established emergency department practices to ensure that every person, irrespective of their health condition, is treated with dignity and respect in emergency department settings. REPORTING METHOD: The CREDES guidance on conducting and reporting Delphi studies. PATIENT OR PUBLIC CONTRIBUTION: The authors have nothing to report.

20.
BMC Emerg Med ; 24(1): 240, 2024 Dec 31.
Artigo em Inglês | MEDLINE | ID: mdl-39736523

RESUMO

BACKGROUND: Based on explainable DenseNet model, the therapeutic effects of optimization nursing on patients with acute left heart failure (ALHF) and its application values were discussed. METHOD: In this study, 96 patients with ALHF in the emergency department of the Affiliated Hospital of Xuzhou Medical University were selected. According to different nursing methods, they were divided into conventional group and optimization group. Activity of daily living (ADL) scale was used to evaluate ADL of patients 6 months after discharge. Self-rating anxiety scale (SAS) and self-rating depression scale (SDS) were employed to assess patients' psychological state. 45 min improvement rate, 60 min show efficiency, rescue success rate, and transfer rate were used to assess the effect of first aid. Likert 5-level scoring method was adopted to evaluate nursing satisfaction. RESULTS: The optimization group showed shorter durations for first aid, hospitalization, electrocardiography, vein channel establishment, and blood collection compared to the conventional group. However, their SBP, DBP, and HR were inferior. On the other hand, LVEF and FS were significantly better in the optimization group. After nursing intervention, SAS and SDS scores were lower in the optimization group. Additionally, the optimization group had higher 45-minute improvement rates, 60-minute show efficiency, rescue success, and transfer rates. They also performed better in 6-minute walking distance and ADL scores 6 months post-discharge. The optimization group had better compliance, total effective rates, and satisfaction than the conventional group. CONCLUSION: It was demonstrated that explainable DenseNet model had application values in the diagnosis of ALHF. Optimization emergency method could effectively shorten the duration of first aid, relieve anxiety, and other adverse emotions, and improve rescue success rate and short-term efficacy. Nursing intervention has a positive impact on the total effective efficiency and patient satisfaction.


Assuntos
Enfermagem em Emergência , Insuficiência Cardíaca , Humanos , Insuficiência Cardíaca/terapia , Insuficiência Cardíaca/enfermagem , Masculino , Feminino , Estudos Retrospectivos , Pessoa de Meia-Idade , Idoso , Serviço Hospitalar de Emergência , Atividades Cotidianas , Cooperação e Adesão ao Tratamento , Doença Aguda
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