Improving New Graduate Nurse Retention With a Transition to Emergency Nursing Practice Program.

INTRODUCTION: Emergency department turnover rates increased at Sentara Northern Virginia Medical Center. Most applicants were new graduate registered nurses. A strength, weakness, opportunity, threat analysis revealed 3 weaknesses regarding new graduate registered nurses in emergency departments. Transition to practice program was necessary, new graduate registered nurse competency needed to progress rapidly, and retention rates needed improvement. METHODS: The emergency department registered nurse transition to practice pathway was created to address these challenges. Retention statistics were garnered through new graduate registered nurses length of employment. Improving retention rates at Sentara Northern Virginia Medical Center led to expansion of the program to the other 11 hospitals in the system. Self-report surveys were created later to evaluate the new graduate registered nursess' satisfaction with the program and perception of clinical confidence. RESULTS: Using the emergency department registered nurse transition to practice pathway, turnover rates at Sentara Northern Virginia Medical Center dropped from 46% to 5.1%. Post expansion, the overall program retention rates were 96% at 6 months, and 86% at 1 year. The 2-year retention rate prior to COVID-19 was 82%, afterward, it dropped to 65%. Most surveyed new graduate registered nurses had a confidence level of 25% or less on the first day. After their 17-week orientation, 54% reported confidence levels had risen to 75%. Within 6 months, 81% reported 75% confidence, at 1 year, 87% reported levels between 75% and 100%, and at 2 years, 100% reported a confidence level between 75% and 100%. DISCUSSION: This development of the emergency department registered nurse transition to practice pathway resulted in improved emergency department registered nurse retention and confidence. Savings from reduced turnover and reduced temporary labor staffing were achieved with this program. Implementation takes careful resource management, ongoing analysis, and research to validate return on investment.

Cognitive mental workload of emergency nursing: A scoping review.

AIM: Emergency nurses work in an environment of high cognitive mental workload. Excessive cognitive mental workload may result in patient harm and nurses' burnout. Therefore, it is necessary to understand nurses' subjective experience of cognitive workload. This scoping review aimed to curate literature about the subjective experience of cognitive mental workload reported by nurses and psychometric measures of the phenomenon. DESIGN: The scoping review was conducted in accordance with JBI methodology and reported using PRISMA extension for scoping review checklist. METHODS: A priori protocol was created with Peer Review of Electronic Search Strategies checklist and registered in the OSF registry. Databases including PubMed, CINAHL, ProQuest, Scopus, Science Direct, Web of Science and Google Scholar were searched. Published reports were reviewed against the eligibility criteria by performing Title and Abstract screening, followed by Full-text screening. The initial search yielded 1373 studies. Of these, 57 studies met the criteria for inclusion in this study. RESULTS: The search revealed five general measures of cognitive mental workload and their variations. Only one customised measure specifically for medical-surgical nurses was found in the study. Identified measures were collated and categorised into a framework for conceptual clarity. NASA Task Load Index and its variations were the most popular subjective measure of cognitive mental workload in nursing. However, no measure or self-report scale customised for emergency nurses was identified. PATIENT OR PUBLIC CONTRIBUTION: The findings of this scoping review can inform future research into the cognitive mental workload of nurses. The findings have implications for workplace health and safety for nurses and patients.

Ultrasound-guided peripheral intravenous canulation by emergency nurses: A systematic review and meta-analysis.

BACKGROUND: Peripheral intravenous cannulation is a common procedure in the emergency department. Nevertheless, failure rates during the first attempt are as high as 40% in adults and 65% in children. Evidence suggests that physician performed ultrasound-guided peripheral intravenous cannulation (USG-PIVC) is an effective alternative to the traditional method; however, there is insufficient data on the efficacy of the technique performed by nurses. OBJECTIVE: To examine the efficacy of the USG-PIVC technique performed by emergency department nurses. METHODS: A literature review with meta-analysis was performed. The databases used were PubMed, Scopus and CINAHL. The search was conducted in March 2023. Two meta-analysis one of clinical trials about the effectiveness and one about the succession rate were performed. RESULTS: 20 studies were selected and analysed. The studies showed that USGPIVC performed by emergency nurses increased the probability of both the overall success and a successful first attempt compared to the standard technique. In addition, patients showed high satisfaction and lower complication rates. However, the procedure had no significant effect on the time or number of attempts required. A lower probability of success was obtained as regards peripheral intravenous cannulation when the standard technique was used, OR = 0.42 (95 %CI 0.25-0.70p < 0,05). CONCLUSIONS: Ultrasound-guided peripheral intravenous cannulation performed by emergency nurses is a safe and effective technique.

Evaluating the Reliability of a Remote Acuity Prediction Tool in a Canadian Academic Emergency Department.

STUDY OBJECTIVE: There is increasing interest in harnessing artificial intelligence to virtually triage patients seeking care. The objective was to examine the reliability of a virtual machine learning algorithm to remotely predict acuity scores for patients seeking emergency department (ED) care by applying the algorithm to retrospective ED data. METHODS: This was a retrospective review of adult patients conducted at an academic tertiary care ED (annual census 65,000) from January 2021 to August 2022. Data including ED visit date and time, patient age, sex, reason for visit, presenting complaint and patient-reported pain score were used by the machine learning algorithm to predict acuity scores. The algorithm was designed to up-triage high-risk complaints to promote safety for remote use. The predicted scores were then compared to nurse-led triage scores previously derived in real time using the electronic Canadian Triage and Acuity Scale (eCTAS), an electronic triage decision-support tool used in the ED. Interrater reliability was estimated using kappa statistics with 95% confidence intervals (CIs). RESULTS: In total, 21,469 unique ED patient encounters were included. Exact modal agreement was achieved for 10,396 (48.4%) patient encounters. Interrater reliability ranged from poor to fair, as estimated using unweighted kappa (0.18, 95% CI 0.17 to 0.19), linear-weighted kappa (0.25, 95% CI 0.24 to 0.26), and quadratic-weighted kappa (0.36, 95% CI 0.35 to 0.37) statistics. Using the nurse-led eCTAS score as the reference, the machine learning algorithm overtriaged 9,897 (46.1%) and undertriaged 1,176 (5.5%) cases. Some of the presenting complaints under-triaged were conditions generally requiring further probing to delineate their nature, including abnormal lab/imaging results, visual disturbance, and fever. CONCLUSION: This machine learning algorithm needs further refinement before being safely implemented for patient use.

Occupational Stress of Pediatric Emergency Nurses in Greece During the COVID-19 Pandemic.

During the COVID-19 pandemic, numerous studies have shown the high prevalence of occupational stress (OS) of health workers, affecting the quality of health care provided. To date, there is no study regarding OS of emergency care pediatric nurses working in Greece. This study aimed to examine the pediatric nurses' OS working in tertiary public hospitals in Greece. In this cross-sectional study, a total of 104 pediatric nurses were recruited randomly from summer 2020 to summer 2021. The Expanded Nursing Stress Scale (ENSS), which consists of 59 items grouped into nine categories, was used to assess nurses OS. The overall OS mean score was 141.04 (SD = 33.48), indicating mild stress. Among nine categories, pediatric nurses were more stressed about patients and families (mean = 22.83, SD = 5.71), as well as death and dying (mean = 19.33, SD = 5.22), whereas they were less stressed about discrimination (mean = 4.21, SD = 4.09) and problems with peer support (mean = 12.11, SD = 4.58). Sex, age, and shifts did not correlate with OS. Borderline correlation was present between age and inadequate emotional preparation for less experienced nurses (p = 0.047), while higher educated pediatric nurses were more stressed because of workload than lower educated pediatric nurses (p = 0.044). Greek pediatric nurses suffered mild OS during the COVID-19 pandemic. There is a great need for further research and implementation of supportive sustainable programs aimed to the minimization of OS and the optimization of health care provided during and after the COVID-19 pandemic.

Enhancing triage accuracy in emergency nurses: The impact of a game-based triage educational app.

INTRODUCTION: Digital technology has enabled gamification methods to enhance triage education, reflecting an evolving healthcare landscape. OBJECTIVE: To evaluate the effectiveness of a Gamification Triage Education App (GTEA) as a learning tool for emergency nurses, with a focus on creating an engaging and educationally effective platform for triage training. METHOD: The GTEA was developed using no-code based software and expanded upon previous iterations, with added features such as points, rankings, instant feedback, and quest-based stories. From December 2021 to March 2022, 27 emergency room nurses from three hospitals in Korea were instructed to use GTEA for 100 min over the course of a week. The effects were measured before and after the intervention. RESULTS: The results demonstrated a significant increase in triage accuracy from 4.3 ± 2.00 to 5.33 ± 1.47 (t = -2.18, p = 0.039), along with a substantial reduction in overtriage (t = 3.11, p = 0.004). Additionally, increases in critical thinking disposition, triage competency, and triage knowledge were observed (t = -3.11, p = 0.004; t = -2.72, p = 0.011; t = -3.14, p = 0.004, respectively). CONCLUSIONS: The findings provide robust evidence for the effectiveness of gamification in triage training within emergency nursing.

Defining Research Funding Priorities: Emergency Nurses Association Foundation.

INTRODUCTION: Establishing research priorities provides focus and direction for limited resources among organizations and increasing impact in a focused area. The Emergency Nurses Association (ENA) Foundation sought to identify research priorities to guide funding decisions in its extramural grants program. METHODS: A modified Delphi research strategy was used to build consensus among ENA members and key leaders to determine research focus areas. Two Delphi rounds were conducted. In the first round, 81 emergency nurses participated in providing a list of potential research foci. In the second round, 221 emergency nurse leaders recommended which research topics should be prioritized. Descriptive statistics (frequencies, percentages) were calculated for each research topic. The topics were clustered together and rank ordered by frequency/percentage. RESULTS: Eight research priorities were identified: emergency department overcrowding, workplace violence, nurse well-being, appropriate use of the emergency department, new graduate training, mental health care, disaster training, and diversity, equity, and inclusion research. DISCUSSION: These identified research priorities offer direction for determining ENA Foundation funding priorities. In addition, the research priorities provide strategic direction to emergency nurse researchers to promote a rich depth of research that can make a meaningful impact to science and emergency nursing practice.

Application Effect Evaluation of Optimizing Emergency Nursing Process Before Emergency Coronary Intervention in Patients with AMI and Hypertension.

Objective: The study aimed to assess the impact of optimizing the emergency nursing process on certain outcomes in AMI patients with hypertension undergoing coronary intervention therapy. Methods: This is a retrospective cohort study, a total of 90 patients with AMI complicated with hypertension admitted from October 2020 to March 2022 to observe the effect and safety of two different nursing methods in patients with AMI complicated with hypertension. According to the different nursing process, the subjects were divided into the optimization and conventional groups, with 45 cases in each group. Then, the rescue efficiency, success rate, recurrence rate, re-PCI rate, negative emotions, and adverse reactions of the two groups were observed. Results: The results showed that the first aid time (39.23±6.28 vs 49.78±9.14), PCI time (45.13±8.60 vs 60.40±8.16) and ECG time (4.18±0.69 vs 6.87±1.00), success rate (93.33% vs 66.67%) and recurrence rate (8.89% vs 22.22%) of the study subjects undergoing the optimized emergency nursing process were significantly better than those undergoing the general emergency nursing process (P < .05), and their negative emotions (7.51±1.77 vs 14.07±1.93) and adverse reactions (3 vs 9) were significantly lower than those of the conventional group (P < .05). Conclusions: It is suggested that optimizing the emergency nursing process before PCI for patients with AMI complicated with hypertension positively impacts the clinical efficacy and prognosis. Optimizing the emergency nursing process may potential benefits for patient health, healthcare resource utilization, or the quality of care, which should be consider in clinical practice.

Development of a Competency-Based Triage Education Application and Usability Testing for Triage Training Based on the Korean Triage and Acuity Scale.

BACKGROUND: Improving the quality of emergency nursing care requires enhancing triage competency through education programs that integrate the content of the Korean Triage and Acuity Scale, a triage system specifically developed for the Korean context. Thus, this study developed a competency-based triage education application (CTEA), based on the Korean Triage and Acuity Scale, and evaluated its effectiveness through usability testing. METHOD: The CTEA used various teaching methods and game mechanisms, including lectures, case studies, and video-based scenarios, to improve triage competency. RESULTS: In the usability testing phase, the CTEA was refined through expert heuristic evaluation and user interviews conducted with the think-aloud method. Six themes were derived from the interviews, highlighting the need for a well-structured program with realistic scenarios, easy accessibility, gamification, functional improvements, and future triage educational applications. CONCLUSION: These findings suggest that the CTEA is effective and satisfactory for users and can contribute to improving the triage competency of emergency nurses. [J Contin Educ Nurs. 2024;55(1):33-41.].

The Effect of Mandatory Triage Questions on Triage Processes: A Qualitative Exploratory Study.

INTRODUCTION: The study purpose was to obtain an understanding of both the types of questions mandated for the triage encounter in emergency departments across the United States and how emergency nurses perceive the relevance of these questions to the triage process. METHODS: A qualitative descriptive exploratory study using focus group data was used. Data were collected at an in-person emergency nursing conference held in September 2022. Data were analyzed using Mayring's 8-step process. RESULTS: Participants (n = 35) voiced concerns about a lack of expertise at all points in the triage process. The overarching problem is reported as data required by regulatory agencies are conflated with triage assessment information. Participants in this study reported that the conflation of the triage assessment with regulatory compliance is causing significant issues in the ability of emergency nurses to appropriately evaluate patient presentations. Thematic categories were identified as who's assessing the patients? assessment or compliance? important questions, situationally important questions, questions asked before discharge, and the lack of emergency nurse input. DISCUSSION: The conflation of regulatory data collection with patient assessment at the initial triage encounter challenges the ability of the emergency nurse to rapidly and accurately identify patients at risk of deterioration. We recommend that initial triage processes encompass questions that focus on establishing the stability of the patient and the safety of the waiting room and include inquiry relevant to the patient presentation.

The Impact of Coronavirus Disease 2019 Visitor Restrictions on the Attitudes of Emergency Department Staff.

INTRODUCTION: During the first 2 years of the pandemic, visitors for patients with COVID-19 were prohibited from emergency departments in the United States with few exceptions, leaving patients without their caregivers and advocates. Little is known about emergency nurses and nursing assistive personnel beliefs regarding this issue. Therefore, this study's purpose was to describe and assess relationships among emergency nursing and assistive personnel attitudes and perceptions regarding emergency department "no-visitor policies" for patients with COVID-19. METHODS: This institutional review board-approved observational study was conducted in a health care system in the Southwestern United States. Nursing personnel (n = 180; 21.74% response rate) working in 11 emergency departments completed the survey during the fall of 2021. Bivariate correlations and multivariable linear regression modeling were performed to explore relationships among survey questions. RESULTS: Most participants (61%) strongly/very strongly believed that restriction of visitors for patients with COVID-19 was necessary for the protection of staff and patients. In addition, 65% reported strongly/very strongly agreeing that it was unethical and 75% felt upset when these patients died alone. Most (81%) strongly/very strongly agreed that exemptions to the policy should be made in some cases, including imminent death. Respondents' recognition of patients' displeasure with visitor policy, recognition that a lack of visitors affected efficiency, and feeling upset when these patients died alone negatively predicted agreement that restriction was necessary. CONCLUSION: Although most participants favored visitation restrictions for patients with coronavirus disease 2019, their beliefs were complex. Navigating stringent visitation policies and vulnerable patients' needs can result in moral distress for ED personnel.

Construção e validação de cartilha educativa sobre suporte básico de vida para estudantes do ensino médio / Construction and validation of an educational booklet on basic life support for high school students / Construcción y validación de carpeta educativa sobre soporte vital básico para estudiantes de secundaria

O objetivo deste estudo é construir e validar uma cartilha educativa para estudantes do ensino médio sobre Suporte Básico de Vida nas escolas. Trata-se de uma pesquisa metodológica, realizada em três etapas. Na primeira etapa foi realizada revisão bibliográfica, na segunda etapa procedeu-se a elaboração da cartilha educativa e por fim, a validação do material por especialistas. Entre os resultados destaca-se que a cartilha aborda as principais recomendações acerca da segurança do socorrista e suporte básico de vida no adulto e possui 14 páginas. Conclui-se que todos os itens da cartilha educativa obtiveram índice de validade de conteúdo maior que 0,82 conseguindo a validação.

The objective of this study is to build and validate an educational booklet for high school students about Basic Life Support in schools. This is a methodological research, carried out in three stages. In the first stage, a bibliographic review was carried out, in the second stage, the educational booklet was elaborated and, finally, the material was validated by specialists in the subject. Among the results, it is highlighted that the booklet addresses the main recommendations regarding rescuer safety and basic adult life support and has 14 pages. It was concluded that all items in the educational booklet had a content validity index greater than 0.82, achieving validation.

El objetivo de este estudio es construir y validar una cartilla educativa para estudiantes de secundaria sobre Soporte Vital Básico en las escuelas. Se trata de una investigación metodológica, realizada en tres etapas. En la primera etapa se realizó una revisión bibliográfica, en la segunda etapa se elaboró la cartilla educativa y, finalmente, el material fue validado por especialistas en el tema. Entre los resultados, se destaca que la cartilla aborda las principales recomendaciones sobre seguridad del reanimador y soporte vital básico del adulto y tiene 14 páginas. Se concluyó que todos los ítems de la cartilla educativa tuvieron un índice de validez de contenido superior a 0,82, lográndose la validación.

[Construction and application of virtual simulation teaching platform for in-hospital emergency nursing of craniofacial injury patients].

PURPOSE: To construct a virtual simulation teaching platform for in-hospital emergency nursing of craniofacial injury patients by virtual simulation technology, and to evaluate its application effect. METHODS: Through virtual reality, animation, human-computer interaction and other technologies, a 3D experiment scene based on high simulation virtual human was constructed to reproduce the virtual rescue scenes of craniofacial injury patients, such as emergency reception, first-aid cooperation, massive hemorrhage rescue cooperation, and tracheotomy cooperation in emergency rescue of sudden airway obstruction, and exercise modules and assessment modules were set. In the virtual simulation platform, the students used the holistic nursing theory and the PDCA cycle method to observe, evaluate and care for craniofacial injury patients. Preliminary evaluation of the platform was carried out in the training of 62 dental nurses. RESULTS: The virtual simulation platform could improve students' comprehensive first-aid ability for craniofacial injury patients. The item with the highest satisfaction rate for the virtual simulation platform was the consistency between the content of the virtual simulation platform and the theoretical course (the satisfaction rate was 91.9%), and the lowest satisfaction rate was the convenience of the virtual simulation platform operation and the page setting (the satisfaction rate was 80.6%). The evaluation module of the virtual simulation platform showed that the highest score of the comprehensive evaluation was 97, the lowest score was 56, and the average score was 80.2. CONCLUSIONS: The virtual simulation teaching platform for in-hospital first aid of craniofacial injury patients can create an immersive learning mode, provide an intuitive rescue experience to the students, and improve their comprehensive first-aid ability.

(Des)construção dos sentidos do trabalho: vivências de sofrimento em enfermarias de emergência hospitalar / (De)construction of the meanings of work: experiences of suffering in hospital emergency wards

Objetivo: Investigar as vivências de sofrimento no trabalho de enfermeiras em um serviço de emergência hospitalar. Métodos: Estudo qualitativo, com 15 enfermeiras de uma unidade de emergência hospitalar pública de um município da Bahia, Brasil. Os dados foram obtidos por meio de entrevistas em profundidade, analisados pelo Discurso do Sujeito Coletivo e ancorados no referencial teórico da Psicodinâmica do Trabalho. Resultados: Há sofrimento profissional no trabalho de enfermeiras em Unidade de Emergência Hospitalar e está permeado pela (des)construção dos sentidos do trabalho, do modo como este se organiza, do reconhecimento profissional, do adoecimento psíquico e das estratégias de enfrentamento desenvolvidas e que lhes estão disponíveis. Considerações finais: O sofrimento que emerge das relações do trabalho apresenta especificidades da organização e do fazer profissional em enfermagem no setor da emergência, o que compõe o contexto, as causas e as consequências do fenômeno e impacta nas distintas dimensões da vida. Descritores: Enfermagem em Emergência; Adaptação Psicológica; Saúde Mental; Saúde do Trabalhador; Serviço Hospitalar de Emergência.

Objective: To investigate the experiences of suffering in the work of nurses in a hospital emergency service. Methods: Qualitative study with 15 nurses from a public hospital emergency unit in a municipality in Bahia, Brazil. Data were obtained through in-depth interviews, analyzed by the Collective Subject Discourse and anchored in the theoretical framework of Work Psychodynamics. Results: There is professional suffering in the work of nurses in the Hospital Emergency Unit and it is permeated by the (de)construction of the meanings of work, the way work is organized, professional recognition, psychological illness, and the coping strategies developed and available to them. Final considerations: The suffering that emerges from work relationships presents specificities of the organization and professional practice in nursing in the emergency sector, which makes up the context, causes and consequences of the phenomenon and impacts on the different dimensions of life. Descriptors: Emergency Nursing; Psychological Adaptation; Mental Health; Worker's Health; Emergency Hospital Service.

Emergency nurses' perceptions of the utility, adaptability and feasibility of the emergency nursing framework HIRAIDTM for practice change in US: An exploratory study.

BACKGROUND: Patient assessment is a core component of nursing practice and underpins safe, high-quality patient care. HIRAIDTM, an evidence-informed emergency nursing framework, provides nurses with a structured approach to patient assessment and management post triage. In Australia, HIRAIDTM resulted in significant improvements to nurse-led communication and reduced adverse patient events. OBJECTIVES: First, to explore United States (US) emergency nurses' perceptions of the evidence-informed emergency nursing framework, HIRAIDTM; second, to determine factors that would influence the feasibility and adaptability of HIRAIDTM into nursing clinical practice in EDs within the US. METHODS: A cross-sectional cohort study using a survey method with a convenience sample was conducted. A 4-hour workshop introduced the HIRAIDTM framework and supporting evidence at the Emergency Nurses Association's (ENA) conference, Emergency Nursing 2022. Surveys were tested for face validity and collected information on nurse-nurse communication, self-efficacy, the practice environment and feedback on the HIRAIDTM framework. RESULTS: The workshop was attended by 48 emergency nurses from 17 US States and four countries. Most respondents reported that all emergency nurses should use the same standardised approach in the assessment of patients. However, the greatest barriers to change were a lack of staff and support from management. The most likely interventions reported to enable change were face-to-face education, the opportunity to ask questions and support in the clinical environment. CONCLUSION: HIRAIDTM is an acceptable and suitable emergency nursing framework for consideration in the US. Successful uptake will depend on training methods and organizational support. HIRAIDTM training should incorporate face-to-face interactive workshops.

Nursing Sensitive Outcomes evaluation in the Emergency Department: An Umbrella Review / Evaluación de resultados sensibles de Enfermería en el Servicio de urgencias. Revisión de alcance / Avaliação de resultados de enfermagem sensíveis no pronto-socorro. Revisão do escopo

Objective. The aim of this review was to identify reported nursing-sensitive outcomes in the Emergency Department to date. Methods. An Umbrella review was conducted. Four databases, CINAHL, Pubmed, Web of Science and Scopus, were searched from inception until October 2022. MeSH terms were: "nursing", "sensitivity and specificity", "emergency service, hospital", "nursing care". Two reviewers independently screened studies against the inclusion criteria for eligibility, extracted data and assessed study quality with the SIGN tool. Results of the included studies were summarized and described in themes for narrative analysis. The study was enrolled in the PROSPERO registry (CRD42022376941) and PRISMA guidelines were followed. Results. The search strategy yielded 2289 records. After duplicate removal, title, abstract and full-text eligibility screening, nine systematicInvest Educ Enferm. 2023; 41(3): e03Nursing Sensitive Outcomes evaluation in the Emergency Department:An Umbrella Reviewreviews were included in the review. A total of 35 nursing-sensitive outcomes were reported. The most described outcomes were waiting times, patient satisfaction and time to treatment. The less measured were mortality, left without being seen and physical function. Synthesizing nursing-sensitive outcomes in themes for reporting, the most measured outcomes were within the safety domain (n=20), followed by the clinical (n=9), perceptual (n=5) and the least explored functional domain (n=1). Conclusion. Nursing sensitive outcomes research in emergency nursing practice is a conceptual challenge still in its early stage. Several nursing-sensitive outcomes were identified in this review that can evaluate the contribution of emergency department nursing care to patient outcomes. Further research is required to explore patient outcomes sensitive to emergency nursing care.

Objetivo. Identificar los resultados sensibles de enfermería reportados en los Servicios de Urgencias. Métodos. Se realizó una revisión general. Se hicieron búsquedas en cuatro bases de datos, CINAHL, Pubmed, Web of Science y Scopus, desde su inicio hasta octubre de 2022. Los términos MeSH empleados fueron: "nursing", "sensitivity and specificity", "emergency service, hospital", "nursing care". Dos revisores examinaron de forma independiente los estudios en función de los criterios de inclusión para determinar su elegibilidad, extrajeron los datos y evaluaron la calidad de los estudios con la herramienta SIGN. Los resultados de los estudios incluidos se resumieron y describieron en temas para el análisis narrativo. El estudio se inscribió en el registro PROSPERO (CRD42022376941) y se siguieron las directrices PRISMA. Resultados. La estrategia de búsqueda produjo 2289 registros. Tras la eliminación de duplicados y el cribado de elegibilidad de título, resumen y texto completo, se incluyeron en la revisión nueve revisiones sistemáticas. Se informó de un total de 35 resultados sensibles a la enfermería. Los resultados más descritos fueron los: tiempos de espera, la satisfacción del paciente y el tiempo hasta el tratamiento. Los menos medidos fueron la mortalidad, el tiempo sin ser evaluado y la función física. Sintetizando los resultados sensibles a la enfermería en temas para la notificación, los resultados más medidos estaban dentro del dominio de la seguridad (n=20), seguidos por el clínico (n=9), el perceptivo (n=5) y el dominio funcional menos explorado (n=1). Conclusión. En esta revisión se identificaron varios resultados sensibles a la enfermería que pueden evaluar la contribución de los cuidados de enfermería en los servicios de urgencias a los resultados de los pacientes. La investigación de resultados sensibles a la enfermería en la práctica de la enfermería de urgencias es un reto conceptual que aún se encuentra en su fase inicial.

Objetivo. Identificar resultados de enfermagem sensíveis notificados em Serviços de Emergência. Métodos. Foi realizada uma revisão geral. Foram pesquisadas quatro bases de dados: CINAHL, Pubmed, Web of Science e Scopus, desde a sua criação até outubro de 2022. Os termos MeSH utilizados foram: "enfermagem", "sensibilidade e especificidade", "serviço de emergência, hospital", "cuidados de enfermagem". Dois revisores selecionaram independentemente os estudos em relação aos critérios de inclusão para determinar a elegibilidade, extraíram os dados e avaliaram a qualidade do estudo com a ferramenta SIGN. Os resultados dos estudos incluídos foram resumidos e descritos em temas para análise narrativa. O estudo foi registrado no registro PROSPERO (CRD42022376941) e as diretrizes PRISMA foram seguidas. Resultados. A estratégia de busca produziu 2.289 registros. Após remoção das duplicatas e triagem do título, resumo e texto completo para elegibilidade, nove revisões sistemáticas foram incluídas neste estudo. Foram relatados 35 resultados de enfermagem sensíveis, sendo os mais descritos: tempo de espera, satisfação do paciente e tempo para tratamento. Os menos frequentes foram: mortalidade, tempo sem avaliação e função física. Sintetizando os resultados sensíveis à enfermagem por meio de tópicos de relato, os mais mensurados foram dentro do domínio segurança (n=20), seguido do domínio clínico (n=9), do perceptual (n=5) e do funcional. menos explorados (n=1). Conclusão. Esta revisão identificou vários resultados sensíveis à enfermagem que podem avaliar a contribuição dos cuidados de enfermagem nos serviços de urgências para os resultados dos pacientes. A investigação de resultados sensíveis na prática de enfermagem em emergências é um desafio conceitual que ainda está em fase inicial.

'Corridor care' in the emergency department: managing patient care in non-clinical areas safely and efficiently.

Overcrowding in the emergency department (ED) is a significant issue and often leads to nursing care being delivered in areas not intended for clinical use, a practice commonly referred to as 'corridor care'. Delivering care in non-clinical areas negatively affects patient safety and poses unique professional challenges for emergency nurses while also reducing their well-being. To end - or at least reduce - corridor care, system-level interventions are needed. In the meantime, there are practical solutions that can be implemented at an individual and departmental level to mitigate some of the risks associated with it. This article discusses a pragmatic approach to patient care, and explores opportunities for nurses to mitigate risks and enhance safety and efficiency, in overcrowded EDs.

Equipa de emergência médica intra hospitalar: a realidade de quem ativa / Intra-hospital medical emergency team: the reality of who is active

O Estágio de Natureza Profissional (ENP) é uma etapa importante pois visa complementar a formação académica da componente de especialização do ciclo de estudos, onde o estudante, integrado num contexto profissional com profissionais experientes e situações clínicas complexas, desenvolve atividades que lhe permitem adquirir e aperfeiçoar competências comuns e específicas do Enfermeiro Especialista em Enfermagem Médico-Cirúrgica (EEEMC), incluindo também a componente de investigação. O presente relatório reflete, desta forma, as oportunidades de aprendizagem e atividades construídas ao longo deste percurso, no Serviço de Urgência (SU) de um hospital do norte do país, percebendo a importância da intervenção do Enfermeiro Especialista em Enfermagem Médico-Cirúrgica na área da Pessoa em Situação Crítica (EEEMCPSC) e a sua capacidade de prestar cuidados altamente qualificados ao doente e família. O estudo de investigação que integra este relatório assenta num paradigma qualitativo, de carater exploratório-descritivo, e teve como foco a Equipa de Emergência Médica Intra- Hospitalar (EEMI), com o objetivo de compreender a perspetiva dos enfermeiros dos serviços de internamento de adultos acerca da EEMI e do seu funcionamento. O instrumento de recolha de dados utilizado foi a entrevista semiestruturada e participaram no estudo doze enfermeiros dos serviços de internamento de um hospital onde realizamos o ENP, com recolha de dados entre dezembro de 2022 e janeiro de 2023. Os resultados evidenciaram a existência de duas vias orientadoras, paralelas e complementares, que em uníssono permitem a garantia de um atendimento de qualidade e segurança à Pessoa em Situação Crítica (PSC): uma via aferente (contexto de internamento), na deteção precoce de sinais de instabilidade, e uma via eferente na intervenção de equipas diferenciadas (EEMI). Ficaram evidentes os contributos da EEMI para a qualidade e segurança dos cuidados prestados. Fatores relacionados com défice de formação e inexperiência das equipas da via aferente, bem como o desconhecimento dos critérios de ativação da equipa de emergência, impuseram-se como dificultadores da dinâmica da EEMI. De entre as sugestões de melhoria, destacam-se a necessidade de investimento na formação contínua das equipas, centrada em estratégias interativas e em contexto de cuidados, e o desenvolvimento de canais eficazes de comunicação, no sentido da divulgação junto das equipas, dos procedimentos e normativos associados à ativação da EEMI. Releva a necessidade de criação de ambientes favoráveis ao desenvolvimento das práticas, nomeadamente no cumprimento das dotações seguras e no funcionamento da EEMI durante as 24 horas. Desta experiência formativa, realçamos a importância da intervenção diferenciadora do EEEMC na melhoria contínua da qualidade de cuidados, num contexto tão complexo como um SU. A nível pessoal, destacamos o desenvolvimento de competências especializadas comuns e específicas, na interação com o ambiente clínico envolvente.

The professional nature internship is an important stage, as it aims to complement the academic training of the specialization component of the study cycle, where the student, integrated into a professional context with experienced professionals and complex clinical situations, develops activities that allow them to acquire and improve common and specific skills of the specialist nurse in medical-surgical nursing, including the research component. This report reflects the learning opportunities and activities built throughout this journey in the Emergency Department of a hospital in the northern region of the country, understanding the importance of the intervention of the Specialist Nurse in Medical- Surgical Nursing in the area of Critical Condition Individuals and their ability to provide highly qualified care to the patient and their family. The research study included in this report, based on a qualitative and exploratory- descriptive paradigm, focused on the Intra-Hospital Medical Emergency Team with the objective of understanding the perspective of nurses in adult inpatient services regarding intra-hospital emergencies and their functioning. The data collection instrument used was the semi-structured interview and twelve nurses from the inpatient services of a hospital where we performed the professional nature internship participated in the study, with data collection between December 2022 and January 2023. The results showed the existence of two guiding and complementary pathways that, together, ensure the provision of quality and safe care to Critical Condition Individuals: an afferent pathway (hospitalization context), in the early detection of signs of instability, and an efferent pathway in the intervention of differentiated teams (Intra-Hospital Medical Emergency Team). The contributions of the Intra-Hospital Medical Emergency Team to the quality and safety of care provided were evident. Factors related to the lack of training and inexperience of the afferent pathway, as well as the lack of knowledge about the activation criteria for the emergency team, emerged as obstacles to the dynamics of Intra-Hospital Emergency. Among the suggestions for improvement, the need for investment in continuous team training centered on interactive strategies and in a care context, and the development of effective communication channels to disseminate the procedures and regulations associated with the activation of the Intra-Hospital Medical Emergency Team are highlighted. It is important to create favorable environments for the development of practices, particularly in terms of complying with safe staffing levels and the functioning of the Intra-Hospital Emergency throughout the 24 hours. From this formative experience, we highlight the importance of the differentiating intervention of the nurse specialist in medical and surgical nursing in the continuous improvement of the quality of care, in a context as complex as an Emergency Department. On a personal level, we highlight the development of common and specific specialized skills, in interaction with the surrounding clinical environment.