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

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

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

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

Nursing: Addressing substance use in the 21st century.

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

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

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

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

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

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

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

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

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

Evaluación de la satisfacción profesional de Enfermería en unidades de urgencias en Brasil / Evaluation of professional satisfaction among Emergency Unit Nurses in Brazil

OBJETIVO: describir la satisfacción en el trabajo, así como de sus componentes incluidos en el Index of Work Satisfaction (IWS), en el equipo de Enfermería de los servicios de urgencias en una ciudad del interior del estado de São Paulo en Brasil. MÉTODO: estudio descriptivo transversal, desarrollado en cinco unidades de urgencias de una ciudad del interior de São Paulo (Brasil), sobre 208 trabajadores del equipo de Enfermería. Se utilizó el instrumento IWS, que recorre seis componentes: autonomía, interacción, estatus profesional, requisitos del trabajo, normas organizacionales y remuneración, y oscila entre 0,9 (menos satisfacción) y 37,1(más satisfacción). RESULTADOS: los componentes con más y menos satisfacción profesional son, respectivamente, remuneración y estatus profesional, tanto para enfermeros/as como para auxiliares de Enfermería. La puntuación de satisfacción global evaluada por el IWS fue de 9,5 para enfermeros/as y 10,1 en auxiliares. En el caso de los profesionales de Enfermería, y en relación al apartado "importancia asignada", el componente autonomía obtuvo la mayor puntuación. CONCLUSIONES: ante los resultados obtenidos, mediante el análisis de los componentes del IWS, el personal de Enfermería de los servicios de urgencias, de una ciudad del interior de São Paulo (Brasil), presentaron bajo índice de satisfacción profesional. Es importante la concienciación de los gestores relativo a la mejora de las condiciones laborales y la profundización en la investigación de las variables que corroboraron a una puntuación por debajo del mínimo

OBJECTIVE: to describe the satisfaction in work, as well as in the components included in the Index of Work Satisfaction (IWS), among the Nursing Team of the Emergency Units in a city from inner São Paulo, Brazil. METHOD: a descriptive cross-sectional study, conducted in five Emergency Units from a city in inner São Paulo (Brazil), with 208 workers from the Nursing Team. The IWS instrument was used, which covers six components: autonomy, interaction, professional status, work requirements, organization rules and remuneration; it ranges from 0.9 (lower satisfaction) to 37.1 (higher satisfaction). RESULTS: the components with the highest and lowest professional satisfaction were, respectively, remuneration and professional status, both for nurses and for nursing assistants. The overall satisfaction score assessed by the IWS was 9.5 for nurses and 10.1 for assistants. In the case of Nursing professionals, the Autonomy component obtained the highest score in the section "Importance assigned". CONCLUSIONS: according to the results obtained through the analysis of the IWS components, the Nursing staff from the Emergency Units of a city in inner São Paulo (Brazil) presented a low rate of professional satisfaction. It is important to create awareness in managers regarding the improvement in working conditions, and to conduct a deeper research into the variables that led to a score below the minimum level

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

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

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

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

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

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

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

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

Nurses' perceptions of patient safety in the emergency setting: a qualitative study / Percepción de los enfermeros sobre seguridad del paciente en el servicio de emergencia: un estudio cualitativo / Percepção de enfermeiros sobre a segurança do paciente no ambiente de emergência: um estudo qualitativo

Nurses are in a key position to improve the quality of healthcare through patient safety interventions and strategies. However, there is a general misunderstanding of the effects of the numerous and complex work environment factors on patient safety. This qualitative study aims to explore nurses’ perceptions of patient safety aspects in an emergency setting. Semi-structured interviews were conducted with 13 Registered Nurses from an emergency ward in a large general hospital located in north-eastern Brazil. Conventional content analysis in which analysis is gained without imposing preconceived categories was used to analyze the collected data. The findings were clustered in three main categories: Barriers and facilitators for the adoption of patient safety practices, Training on patient safety issues, and Nursing role on the quality of patient safety. Nurses reported that the factors influencing patient safety include: lack of resources, hospi tal overcrowding, excessive workload, lack of training, and ineffective communication. Our results suggest that patient safety in the emergency wards could be improved by developing and reinforcing a safety culture and by providing the necessary infrastructure and support mechanisms (AU)

Las enfermeras están en una posición clave en la mejora de la calidad de la atención a través de intervenciones y estrategias para la seguridad del paciente. En general, percepciones sobre el impacto de los factores del entorno de trabajo sobre seguridad de los pacientes son engañosas. Este estudio cualitativo tuvo como objetivo explorar la percepción de enfermeras sobre seguridad del paciente. Las entrevistas semiestructuradas se llevaron a cabo con 13 enfermeras en una sala de emergencia en un hospital del noreste de Brasil. Un análisis de contenido convencional fue utilizado y el análisis se llevó a cabo sin imponer clases preconcebidas. Los resultados fueron agrupados en tres categorías: Barreras y facilitadores para la adopción de prácticas de seguridad del paciente, Problemas en la formación en seguridad del paciente y Papel de la enfermera en la calidad de las prácticas de seguridad del paciente. Las enfermeras informaron que los factores que afectan la seguridad del paciente incluyen: deficiencia de recursos, hacinamiento, sobrecarga de trabajo, mala formación y comunicación ineficaz. Los resultados sugieren que la seguridad de los pacientes se puede mejorar mediante el desarrollo y fortalecimiento de la cultura de seguridad y la provisión de infraestructura y mecanismos de apoyo (AU)

Enfermeiras ocupam uma posição-chave na melhoria da qualidade da assistência por meio de intervenções e estratégias para a segurança do paciente. Em geral, percepções sobre o impacto dos inúmeros e complexos fatores do ambiente de trabalho sobre a segurança do paciente são equivocadas. Este estudo qualitativo tem por objetivo explorar percepções de enfermeiras sobre a segurança do paciente no cenário de emergência. Entrevistas semiestruturadas foram conduzidas com 13 enfermeiras de uma unidade de emergência em um hospital localizado no nordeste do Brasil. Uma análise de conteúdo convencional, na qual a análise é executada sem impor categorias préconcebidas, foi utilizada na análise dos dados. Os resultados foram agrupados em três categorias: Barreiras e facilitadores para a adoção de práticas de segurança do paciente, Problemas no treinamento em segurança do paciente e Papel da enfermeira na qualidade das práticas de segurança do paciente. Enfermeiras relataram que os fatores que afetam a segurança do paciente incluem: deficiência de recursos, superlotação, sobrecarga de trabalho, treinamento deficiente e comunicação não efetiva. Os resultados sugerem que a segurança do paciente nas unidades de emergência pode ser melhorada pelo desenvolvimento e reforço da cultura de segurança e pela provisão da infraestrutura e dos mecanismos de suporte necessários (AU)