"I Just Know if I Keep Going, I'll End Up Hating Nursing." Lived Experiences of Emergency Nurses Three Years Into the Global COVID-19 Pandemic.

INTRODUCTION: As the coronavirus disease 2019 pandemic continues globally, the personal and professional pressure on health care workers continues to accumulate. Literature suggests that as the pandemic evolves, nurses are experiencing increased levels of anxiety, depression, and post-traumatic stress, ultimately leading them to voice intentions to leave the profession, if they have not done so already. METHODS: Informed by an interpretive hermeneutic phenomenological approach, this longitudinal study was designed to capture how the lived experiences of 9 emergency nurses evolved over the coronavirus disease 2019 pandemic, highlighting their feelings, attitudes, and perceptions toward working in the emergency department at this time in history. Interviews were undertaken in June 2022 and were analyzed using a thematic analysis approach. RESULTS: Data analysis resulted in a total of 2 major themes and 8 minor themes. The 2 major themes included "exposed wounds" and "Band-Aid solutions." Levels of burnout increased during the pandemic, with most of the emergency nurse participants dropping their hours, moving roles within the profession, or leaving the profession entirely. Findings elucidate where and how concerns may arise in clinical practice and holistic well-being among emergency nurses, particularly surrounding professional boundaries and protecting work-life balance and professional identity. DISCUSSION: As the world moves to managing coronavirus disease 2019 as a recognized common respiratory illness, providing time and space for emergency nurses to voice their concerns, design their well-being interventions, set professional boundaries, and reconnect with their professional passion may see lower attrition rates and higher levels of professional satisfaction in emergency nurses globally.

Impact of Enhanced Emergency Nursing Processes on the Rescue Outcomes of Emergency Patients with Chest Pain.

Background: Chest pain, a sudden and perilous symptom, is frequently encountered in the emergency department. Prompt and efficient first-aid measures and nursing interventions are crucial for effectively rescuing emergency patients experiencing chest pain. Objective: This study aims to investigate the impact of an enhanced emergency nursing process on the rescue outcomes of emergency patients with chest pain. Design: A randomized controlled study was conducted. Setting: The research was conducted at Suzhou Hospital of Integrated Traditional Chinese and Western Medicine. Participants: A total of 90 emergency chest pain patients admitted between December 2021 and June 2022 were selected and divided into two groups, with 45 cases in each group. Interventions: The control group received routine emergency nursing, while the observation group underwent an improved emergency nursing protocol. Primary Outcome Measures: (1) Treatment initiation time, emergency rescue time, recovery time of vital signs, and hospital stay; (2) curative effect; (3) pain scores; (4) incidence of adverse events; and (5) patient satisfaction. Results: Compared to the control group, the observation group exhibited shorter treatment initiation time, emergency rescue time, recovery time of vital signs, and hospital stay (P < .05). The effective rate in the observation group was higher (P < .05), and pain scores were lower at 30 min, 60 min, 120 min, and 240 min post-rescue (P < .05). The occurrence of adverse events was reduced in the observation group (P = .005), and patient satisfaction was higher at discharge (P < .05). Conclusion: The enhanced emergency nursing process effectively reduces the clinical rescue time for emergency patients with chest pain, enhances rescue efficiency, seizes crucial opportunities for saving lives, and improves patient satisfaction. These findings have significant positive implications for clinical applications.

Transcultural Health Practices of Emergency Nurses Working With Indigenous Peoples: A Descriptive Study.

INTRODUCTION: For decades, health inequalities have persisted among Indigenous peoples. As the Indigenous population is growing in the cities, health care delivery in urban areas can be challenging. Emergency nurses are often the first contact in the health system, and they play a key role in the patient's experience. This study aims to describe the transcultural health practices of Canadian emergency nurses working with Indigenous peoples. METHODS: A descriptive study was conducted among 30 emergency nurses. RESULTS: Approximately 90% of the nurses who participated in the study had not received specific training about Indigenous health. The most common type of culturally appropriate nursing care was clinical examination (mean = 7.22), and sexuality care was the least frequent (mean = 5.47). The nurses were less confident in their ability to interview Indigenous peoples about the importance of home remedies and folk medicine (mean = 5.38). DISCUSSION: In summary, emergency nurses had more confidence in their ability to provide technical care than in their knowledge regarding the cultural aspects of providing care. As Indigenous populations face challenges regarding access to health care, specific interventions should be implemented to support better-quality cultural care from emergency nurses.

The Relationship Between Mindfulness, Triage Accuracy, and Patient Satisfaction in the Emergency Department: A Moderation-Mediation Model.

INTRODUCTION: Individual and collective mindfulness attracts growing research attention, yet reports of their impact on health care professionals' work behaviors are scarce, especially in the emergency department. The aim of the current study was to explore whether the association between trait mindfulness and triage accuracy is moderated by the emergency workload environment, and whether this association promotes patient satisfaction subject to levels of collective mindfulness. METHODS: A prospective consecutive nested design was conducted. Data were collected from ED teams (nurses and physicians, N = 96) on individual characteristics and trait mindfulness. Data were also collected on triage accuracy, triage team characteristics, collective mindfulness, workload, and patient satisfaction (N = 960) at a specific patient-ED team encounter. RESULTS: Findings indicated that ED workload environment (b = 0.24, P < 0.01), trait mindfulness (b = 1.80, P < 0.01), and their interaction (b = -0.04, P < 0.05) were associated with triage accuracy. Triage accuracy (b = 1.81, P < 0.001), collective mindfulness (b = 1.29, P < 0.001), and their interaction (b = -0.32, P < 0.001) were associated with patient satisfaction. The moderated-mediation model was significant under high, but not under extreme, levels of ED workload environment and all levels of collective mindfulness. DISCUSSION: Trait and collective mindfulness are relevant to ED triage and patient satisfaction, but their effects are bounded by workload. The beneficial gain of nurses' trait mindfulness on triage accuracy and collective mindfulness on patient satisfaction is demonstrated only under high-workload environments but limited under extreme-workload environments.

[Hyperbaric medicine and emergency medicine, an example of decompression sickness in diving]. / Hyperbarie et médecine d'urgence, exemple de l'accident de désaturation en plongée.

One of the reasons for the emergency use of a hyperbaric chamber concerns a diving-related accident. Decompression sickness is potentially serious; it requires urgent treatment and hyperbaric recompression. It is caused by the formation of nitrogen bubbles in the organism which appear during the diver's ascent and throughout his or her decompression.

[Carbon monoxide poisoning, treatment and orientation]. / Intoxication au monoxyde de carbone, prise en charge et orientation.

Colourless and odourless, each year carbon monoxide is responsible for several thousand cases of poisoning. Often collective, their symptoms are non specific and can result in serious neurological sequelae or even death, if they are not detected in time. The (pre-) hospital emergency nurse plays an important role in the management of these patients, in terms of assessment, treatment and monitoring as well as the organisation of the admittance of victims, categorisation and medical triage. As part of a team, the nurse ensures that the patient enters an adapted, regulated pathway, with the most serious cases being directed towards a hospital equipped with a hyperbaric medicine facility.

A Review of the Management of Loss of Pregnancy in the Emergency Department.

INTRODUCTION: Women frequently seek ED care for complications in early pregnancy, including loss of pregnancy. This review evaluates the current literature and discusses the care of patients experiencing loss of pregnancy in the emergency department. METHODS: A review of pertinent studies identified through multiple database searches was conducted to determine the existing body of knowledge for the care of ED patients diagnosed with loss of pregnancy. Each of the studies was examined for inclusion criteria and a subsequent analysis of the included studies identified themes related to the care of the women. RESULTS: Thirty-two original research articles and systematic reviews published between 1990 and 2016 were included in the review. Eleven articles addressed recommendations for clinical practice, 5 reported statistics related to pregnancy outcome and clinical presentation, 4 discussed the use of speculum examinations, 4 discussed interventions to decrease ED length of stay, and 3 investigated the use of ultrasound in the emergency department. Only 5 of the articles reviewed discussed emotional support and/or experiences of women with loss of pregnancy in the emergency department. CONCLUSION: Although there are multiple recommendations for the clinical management of loss of pregnancy in the emergency department, the psychological and emotional support of women was addressed infrequently. Additional studies investigating holistic care would be beneficial for ED providers in the management of early loss of pregnancy.

Emergency department waiting room nurses in practice: An observational study.

AIMS AND OBJECTIVES: To identify the activities and behaviours of waiting room nurses in emergency department settings. BACKGROUND: Emergency care has expanded into waiting rooms in some emergency departments. Often viewed as an adjunct to triage, the aim of waiting room nurses is to commence care early, reassess patients and improve communication between patients, families and staff. There is however a paucity of literature relating to waiting room nurses, especially in relation to their current activities and behaviours. DESIGN AND METHODS: Part of a larger exploratory sequential mixed methods designed study. This phase used a nonparticipant observer role to observe waiting room nurses in their natural setting undertaking normal care and responsibilities. One observer, using a tool and reflective journal, collected data on participant interactions, processes and practices on eight waiting room nurses over 13 episodes of observation (total 65 hr:50 min) in two emergency departments. Data analysis used descriptive statistics and thematic analysis. RESULTS: Participants were observed to anticipate and prioritise to deliver holistic, patient-centred care in emergency department waiting rooms. Waiting room nurses had a varied and unpredictable workload, including facilitating the flow of patients from the waiting room. They contributed to patient safety in the waiting room, primarily by reassessing and detecting clinical deterioration. CONCLUSION: Further research into this role is required, including linking efficacy with experience of nurses, impact the role has on patient safety, and patient and family perceptions of the role. RELEVANCE TO CLINICAL PRACTICE: Therapeutic engagement allowed waiting room nurses to reassure and calm patients and families, and deliver holistic, patient-centred care. Waiting room nurses contributed to patient safety in the waiting room, by promptly commencing episodes of care in the waiting room and through close monitoring and assessment to detect patient deterioration.

Strategies for Acute and Critical Care Nurses Implementing Complementary Therapies Requested by Patients and Their Families.

As consumer use of complementary and alternative medicine or modalities continues to increase in the United States, requests for these therapies in the acute and critical care setting will probably continue to expand in scope and frequency. Incorporation of complementary therapies in the plan of care is consistent with principles of patient- and family-centered care and collaborative decision-making and may provide a measure of relief for the distress of admission to an acute or critical care setting. An earlier article provided an overview of complementary and alternative therapies that nurses may encounter in their practices, with specific attention to implications for acute and critical care nurses. This article provides key information on the legal, ethical, safety, quality, and financial challenges that acute and critical care nurses should consider when implementing patient and family requests for complementary therapies.

Implementation of a Life-Sustaining Management and Alternative Protocol for Actively Dying Patients in the Emergency Department.

PROBLEM: The aging population and the growing number of home hospice patients have resulted in increased utilization of emergency departments. This situation poses a clinical challenge to the ED staff in determining when lifesaving treatment is indicated and when end of life care begins. METHODS: Through a shared governance model, ED physicians and nursing staff aimed to implement a best practice model for the care of dying patients. An ED interdisciplinary team identified gaps and brainstormed methods to improve palliative measures and comprehensive care for actively dying patients. RESULTS: A best practice initiative called "Life Sustaining Management and Alternatives" was developed and implemented to provide palliative care services and comprehensive care for patients who are actively dying in the emergency department. IMPLICATIONS FOR PRACTICE: The emergency department became better equipped to handle end of life care, providing adequate pain management, optimal comfort measures, and emotional support with respect and dignity for the dying patient and family. The practices implemented resulted in improved patient care, increased patient satisfaction, and reduced overall hospital admissions.

Emergency Nurses' Perspectives: Factors Affecting Caring.

UNLABELLED: Caring is a universal phenomenon. However, as a result of higher patient acuity and staff shortages within the chaotic ED environment, caring behaviors may be in peril. The purpose of this study was to gain insight into the meaning of caring from the perspective of emergency nurses. Exploring nurses' perspectives of caring is central to improving staffing and retention issues in this unique work environment. METHODS: As part of a larger study, a subsample of emergency nurses who work in public hospitals in Manitoba, Canada (n = 17) were interviewed. A qualitative descriptive design was used to gain insight into the caring perspectives of nurses by asking them, "What does caring meaning to you?" and "What affects caring in your practice in the emergency department?" Emerging themes were extracted through analysis of audio tapes and transcripts. RESULTS: Advocacy and holistic care emerged as major themes in the meaning of caring for emergency nurses. Caring was affected by a number of factors, including workload, lack of time, staffing issues, shift work, and lack of self-care. However, lack of management support was the most consistent hindrance to caring identified by study participants. DISCUSSION: Caring continues to be a unifying concept in nursing; however, influencing factors continue to undermine caring for emergency nurses. Caring is not subsidiary to nursing; it is the central core of nursing. Therefore, fostering a caring working environment is essential for nurses to practice holistic nursing care. It is also imperative to job satisfaction and the retention of emergency nurses.

Opportunistic immunisation in the emergency department: a survey of staff knowledge, opinion and practices.

OBJECTIVE: The aim of this study was to identify (a) emergency department staff knowledge, opinion and practices in relation to childhood vaccines and opportunistic immunisation in the emergency department and (b) differences between nursing and medical staff knowledge, opinion and self reported practices. METHODS: A self-administered, cross-sectional survey was offered to a convenience sample of medical and nursing staff (n=86) working in a tertiary paediatric emergency department. Variables of interest were described using frequencies and odds ratios to report differences between medical and nursing staff responses. RESULTS: An 87% survey response was achieved. The majority of staff agreed that childhood vaccines were safe (96%), effective (99%) and necessary (97%). Less than half (45%) of the staff correctly identified that there is no association between measles, mumps and rubella (MMR) vaccine and autism. Medical staff were more likely than nurses to disagree that giving multiple vaccines overloads the immune system (p<0.01), or that complementary therapies reduced the need for a child to be vaccinated (p<0.006). These knowledge deficits exist despite a reported awareness of immunisation resources. The majority (96%) of those surveyed reported that the Australian Immunisation Handbook was as a useful resource. CONCLUSION: Overall, the majority of staff agreed vaccines are safe, effective and necessary. This study highlighted that staff knowledge deficits and misconceptions about vaccines and vaccine management may be barriers to promoting opportunistic immunisation practices in ED.

Health promotion: healing through loss.

For many women, miscarriage constitutes an often sudden, unexpected physically as well as psychologically traumatic event. A large percentage of women having miscarriage must present to an outpatient setting, primarily the emergency department, for care during this time. Studies indicate that health care professionals are failing to meet the needs of women and their families during and after miscarriage and that greater emphasis should be placed on psychosocial and interpersonal skills. The problem has been identified as how to assist or prepare emergency nurses to better care for the physical and psychological needs of women having early, unanticipated loss of pregnancy. At 1 rural Midwest medical center, it was the women's health staff who took the initiative to address this problem. They recognized the need for a holistic approach to care for women experiencing pregnancy loss. This would be accomplished through bridging the gap between outpatient services and primary care. This resulted in creating a support group called Ended Beginnings, which was organized to help women convalesce through the physical, emotional, and spiritual hardships associated with pregnancy and infant loss. Positive feedback has been received from both patients and staff with regard to the extent to which collaborative services provide a positive impact for both the patient and staff assisting the patient during a time of sudden, unanticipated loss.

Nursing: the skill and art of being in a society of multitasking.

Multitasking, a media-driven bias toward dramatic scenarios, and an emphasis on meeting institutional goals in the form of documentation have led to a culture of action-based practice, which interferes with nurses' ability to simply be with patients. In order for nurses to be fully present with their patients, the cultural norm of multitasking and the emphasis on doing must be reexamined within the context of patient care.

Emergency nurses' provision of spiritual care: a literature review.

The emergency setting has undergone significant changes in recent years. Notably, the throughput and acuity of patients has increased, with a concomitant improvement in the clinical and technical management of these patients (Dolan, 1998; Coughlan and Corry, 2007). However, there is evidence to suggest that the increase in workload and proliferation of technology, at such a fast pace, has potentially threatened the caring component of nursing, including spiritual care (Wilkin and Selvin, 2004). During hospitalization, the majority of patients tend to become anxious because of the fear of the unknown, an uncertain future, and possible resultant complications of their respective illnesses. In this regard, patients being treated in emergency departments are at vulnerable periods of their lives. Consequently, while the emergency department can be physically demanding, nurses spend considerable time in intense interactions with patients. In spite of this, changes have brought associated pressures on both nurses and patients (Bailie, 2005). Therefore, although advances in technology can enable nurses to objectively measure responses to care; conversely, it can supersede the premise of holistic health care. Nonetheless, it has been empirically shown that caring and the provision of spiritual care is not only possible within the technological world of emergency nursing, but it can be positively enhanced by the mastery of the technological environment (Locin, 1995; Little, 2000).