Does moral distress in emergency department nurses contribute to intentions to leave their post, specialisation, or profession: A systematic review.

Background: There is a global shortfall of nurses. Despite national targets to increase nurse training and retention, the numbers leaving the profession continue to rise. Emergency departments (EDs) consistently record above average staff-turnover. Meanwhile descriptions of moral distress amongst emergency nurses are increasing. It is vital to consider the long-term emotional and psychological impact of moral distress on the emergency nursing workforce. However, the events which trigger moral distress in the emergency department may differ from those described in other clinical areas. A clearer understanding of the effects of moral distress on intention to leave could help identify those at risk and inform decisions on interventions designed to mitigate moral distress, aiding nurse retention and the organisational stability of health services. Aim: This systematic review aims to synthesise the available evidence on the association between moral distress and intention to leave in emergency nurses. Methods: A systematic search of studies was performed on MEDLINE, CINAHL, PsychINFO, Web of Science and Cochrane databases (8th -10th June 2022). Results were screened and quality-assessed with cross-checks. The heterogeneity of samples and insufficient data precluded statistical pooling and meta-analysis. Consequently, narrative synthesis was performed. Results: Five studies reported quantitative results eligible for synthesis. Low to moderate levels of moral distress were reported in emergency nurses; contrasting starkly with the significant proportion who reported having left or considered leaving due to moral distress (up to 51%). Sparse, mostly low-quality evidence was identified, highlighting a need for more robust research. Current tools for measuring moral distress appear not to capture the unique pressures which contribute to moral distress in emergency nurses. Conclusions: Emergency nurses cite moral distress as a reason for leaving. Further study is required to determine the levels of moral distress associated with intentions to leave and the strength of that association. This is fundamental to the design of effective retention policies. Future research should also explore the applicability of current moral distress measures to the emergency department, with consideration given to developing emergency department specific tools. PROSPERO Registration number: CRD42022336241 https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=336241.

How does a nursing crisis management intervention impact relatives' experiences in two trauma centres? A time-series study.

Background: Being a relative to a trauma patient may be a dramatic experience. Often, trauma centre nurses do not feel they have the competences needed to meet relatives experiencing a crisis. Therefore, a need exists to enhance their crisis management competencies. Objective: To investigate relatives' experiences of a nursing crisis management intervention on information, inclusion and support, including the importance of these needs in two Danish trauma centres. Design: A prospective intervention study based on interrupted time series. The intervention, conducted in 2020-2021, consisted of a crisis management training programme. Settings: The Trauma Centre of the Aarhus University Hospital and Aalborg University Hospital in Denmark. Participants: Relatives (18+ years) of critically ill or injured patients (n = 293). Methods: Data were collected using a 32-item questionnaire. The primary outcome was relatives' overall experience of the quality of the information, inclusion and support measured on a visual analogue scale (VAS) (0-10). Secondary outcomes were changes in risk ratios and scores between the periods for each of the three main variables. The outcome was measured as weighted and non-weighted scores, taking into account the importance of each variable. Besides use of interrupted time series, predictive and weight-adjusted analyses were performed. Time series comprised a before-period (6 months), an implementation period (3 months) and an after-period (6 months). Due to ceiling effect, the predictive analysis was dichotomized using the median scores for information, inclusion and support. Results: Overall, no differences were observed between the participants' characteristics in each of the three periods. Comparing the implementation period with the after-period revealed a statistically significant positive difference between the relatives' assessment of crisis management [p = 0.009]. Additionally, the probability of scoring >8 from before to after the intervention increased statistically significantly [Risk ratio 1.21, 95 % confidence interval 1.16-1.27]. The secondary outcomes showed that the greatest change over time was inclusion of relatives [Risk ratio, 1.25 95 % confidence interval 1.15-1.35]. Information had the greatest effect on relatives' experience of nurses' provision of crisis management and was also the needs area that relatives considered most important. However, information was also the needs area that evolved least during the study. Conclusions: Based on the selected cut-off levels, the intervention appeared to have a positive effect on relatives' experiences - especially inclusion of relatives. In the weighted analyses, information was considered most important and also had the greatest effect on relatives' overall experience. Nurses' crisis management competencies should be prioritized in trauma centres.

The work of patient flow management: A grounded theory study of emergency nurses.

INTRODUCTION: The current crisis of emergency department overcrowding demands novel approaches. Despite a growing body of patient flow literature, there is little understanding of the work of emergency nurses. This study explored how emergency nurses perform patient flow management. METHODS: Constructivist grounded theory and situational analysis methodologies were used to examine the work of emergency nurses. Twenty-nine focus groups and interviews of 27 participants and 64 hours of participant observation across four emergency departments were conducted between August 2022 and February 2023. Data were analyzed using coding, constant comparative analysis, and memo-writing to identify emergent themes and develop a substantive theory. FINDINGS: Patient flow management is the work of balancing department resources and patient care to promote collective patient safety. Patient safety arises when care is ethical, efficient, and appropriately weighs care timeliness and comprehensiveness. Emergency nurses use numerous patient flow management strategies that can be organized into five tasks: information gathering, continuous triage, resource management, throughput management, and care oversight. CONCLUSION: Patient flow management is complex, cognitively demanding work. The central contribution of this paper is a theoretical model that reflects emergency nurses'conceptualizations, discourse, and priorities. This model lays the foundation for knowledge sharing, training, and practice improvement.

The Impact of Alcohol-Related Presentations to Emergency Departments on Days with a Public Holiday or Sporting Event: A Retrospective Cohort Study.

INTRODUCTION: The consumption of alcohol within the Australian community continues to rise, impacting care delivery in already over-burdened emergency departments (EDs). STUDY OBJECTIVE: This study aimed to examine the impact of alcohol-related presentations (ARPs) to EDs on days with a public holiday or sporting event. METHODS: A retrospective cohort study was undertaken using routinely collected health data pertaining to patient presentations diagnosed with an alcohol-related disorder (ICD-10-AM code F10) to two EDs in Queensland, Australia from January 1, 2016 - December 31, 2020. Descriptive and inferential statistics were used to describe and compare ARPs on event days versus non-event days and uncomplicated versus other ARPs on event days only. RESULTS: Of all 5,792 ARPs, nine percent (n = 529) occurred on public holidays or sporting event days. When compared by day type, type of presentation, mode of arrival, and day of week differed between event and non-event days. On event days, uncomplicated ARPs differed to other ARPs, with uncomplicated ARPs being younger, having shorter median length-of-stay (LOS), and less likely to be admitted to hospital. CONCLUSIONS: In this multi-site study, public holidays and sporting events had a noteworthy impact on ARPs to EDs. Focused refinement on the clinical management of uncomplicated ARPs is warranted to inform future resource allocation, including on event days.

Ensuring Throughput: Development and Validation of Charge Nurse Competencies for United States Emergency Care Settings.

INTRODUCTION: Charge nurses are shift leaders whose role includes managing nursing resources and facilitating appropriate patient care; in emergency departments, the charge nurse role requires both clinical and leadership skills to facilitate the flow of patients, while ensuring patient and staff safety. Literature on orientation and specific training is notably sparse. This study aimed to evaluate the content and process of core competency training and identify evaluation and implementation strategies necessary to improve charge nurse performance in United States emergency departments. METHODS: A modified Delphi technique was used in phase 1 and a qualitative content analysis method was used in phase 2 to address specific aims of the study. RESULTS: In total, 427 emergency nurse managers, directors, educators, and charge nurses responded to the initial survey to identify elements, teaching modalities, and evaluative processes; 22 participated in 1 of 2 focus groups to provide further information about the pedagogical approaches to teaching emergency charge nurse competencies. The top 5 competencies were identified as patient flow management, communication, situational awareness, clinical decision making, and nurse-patient assignment, with understanding that each competency overlapped significantly with the others. Low-fidelity simulation and gamification were identified as a preferred method of both training and evaluation. DISCUSSION: These findings have the potential to support a standardized approach to emergency charge nurse training and evaluation focusing on communication skills, clinical decision making, and situational awareness to facilitate safe and effective nurse-patient assignment and emergency department throughput.

Triage-clinical reasoning on emergency nursing competency: a multiple linear mediation effect.

BACKGROUND: Triage is the first step in providing prompt and appropriate emergency nursing and addressing diagnostic issues. Rapid clinical reasoning skills of emergency nurses are essential for prompt decision-making and emergency care. Nurses experience limitations in emergency nursing that begin with triage. This cross-sectional study explored the mediating effect of perceived triage competency and clinical reasoning skills on the association between Korean Triage and Acuity Scale (KTAS) proficiency and emergency nursing competency. METHODS: A web-based survey was conducted with 157 emergency nurses working in 20 hospitals in South Korea between mid-May and mid-July 2022. Data were collected utilizing self-administered questionnaires to measure KTAS proficiency (48 tasks), perceived triage competency (30 items), clinical reasoning skills (26 items), and emergency nursing competency (78 items). Data were analyzed using the PROCESS macro (Model 6). RESULTS: Perceived triage competency indirectly mediate the relationship between KTAS proficiency and emergency nursing competency. Perceived triage competency and clinical reasoning skills were significant predictors of emergency nursing competency with a multiple linear mediating effect. The model was found have a good fit (F = 8.990, P <.001) with, a statistical power of 15.0% (R² = 0.150). CONCLUSIONS: This study indicates that improving emergency nursing competency requires enhancing triage proficiency as well as perceived triage competency, which should be followed by developing clinical reasoning skills, starting with triage of emergency nurses.

Multicenter evaluation to determine the deficiencies of emergency nurses in forensic case management.

INTRODUCTION: Emergency services are the first places where victims and/or perpetrators of different types of violence are brought for medical treatment. Emergency service nurses are the first health workers who first encounter with the forensic case, first communicate and are in an important position in the rapid and accurate continuation of the forensic process. In this study, it was aimed to determine the level of knowledge of emergency department nurses regarding the management of forensic cases. METHODS: The study was a cross-sectional, descriptive. Ninety-eight emergency nurses working in the emergency departments of three different public hospitals in the same province participated in the study. Study data were collected with the "Nurse Personal Information Form" and the "Knowledge Levels of Nurses related to the Approaches to Forensic Cases Questionnaire". RESULTS: 70.4 % of the nurses participating in the study were women, their mean age was (X ± SD = 27.36 ± 5.21). It is seen that 87.8 % of the nurses have a total working time in the emergency unit between 1 and 5 years and 11.2 % have received training on forensic nursing. "Total Knowledge Score" of undergraduate graduate nurses The mean score was higher and there was a significant difference between the groups (p > 0.05). The nurses who received in-service training and forensically evaluated all cases admitted to the emergency department had a higher mean score in the "Knowledge Score Regarding the Duties of Nurses Regarding Forensic Cases" mean was higher and there was a significant difference between the groups (p > 0.05). CONCLUSION: We recommend the use of institutional guides/protocols together with in-service training for emergency nurses to provide medically and legally correct forensic care and to have sufficient knowledge.

Nursing roles in disaster zones: Experiences and lessons from Turkey's 2023 earthquakes.

BACKGROUND: Disasters affect human health and well-being globally. Nursing plays a vital role in disaster preparedness and response, ensuring efficient early care coordination and delivering effective field treatment. AIM: This study investigates the challenges an Israeli humanitarian delegation encountered during their response to major earthquakes in Turkey in 2023. It explicitly focuses on difficulties in preparation, operations, and collaboration with local teams. The study further analyzes the findings and extracts valuable lessons from the mission. METHODS: Using a qualitative descriptive design, 22 out of 32 nurses involved in delegation participated in three focus group discussions within two months of returning to Israel. The discussions were recorded, transcribed verbatim, and analyzed thematically. The study followed the COREQ guidelines, ensuring comprehensive reporting and methodological rigor in qualitative research. FINDINGS: The study's main findings spanned predeparture preparation, mission challenges in the disaster zone, and postmission lessons, each highlighted by subthemes and participant quotations. A strong sense of mission was evident among the participants, along with frustration at inefficient time management prior to deployment. Many participants noted additional challenges, related to the difficulty of working in multiple languages and across cultures, and the opportunities for resolution. Finally, participants called for better psychological support following the mission. CONCLUSION: Nurses in disaster zones offer valuable insights to enhance preparation, cross-cultural communication, and postmission implementation. NURSING AND HEALTH POLICY IMPLICATIONS: Nurse managers and healthcare policymakers can utilize this study's findings to develop future nursing training programs in disaster-related skills. Additionally, it can help foster collaboration among international healthcare teams.

Development and Implementation of a Pediatric Nursing Emergency Behavioral Health Assessment Tool.

INTRODUCTION: The national pediatric mental and behavioral health crisis dramatically increased emergency department mental and behavioral health visits and changed emergency nursing practice. Acuity assessment determines patient severity level and supports appropriate resources and interventions. There are no established nursing tools that assess pediatric mental or behavioral health acuity in the emergency department setting. Our goal was to develop and implement the novel pediatric emergency nurse Emergency Behavioral Health Acuity Assessment Tool. METHODS: This quality-improvement project used the plan, do, study, act model to design/refine the Emergency Behavioral Health Acuity Assessment Tool and a non-experimental descriptive design to assess outcomes. The setting was a 47-bed urban level 1 pediatric trauma center with more than 60,000 annual visits. The team designed the tool using published evidence, emergency nurse feedback, and expert opinion. The tool objectively captured patient acuity and suggested acuity-specific nursing interventions. Project outcomes included acuity, length-of-stay, restraint use, and patient/staff injuries. Analyses included descriptive statistics and correlations. RESULTS: With over 3000 annual mental/behavioral-related visits, the emergency department had an average daily census of 23 mental and behavioral health patients. Implementation occurred in August 2021. The Emergency Behavioral Health Acuity Assessment Tool dashboard provided the number of patients, patient location, and acuity. Length-of-stay did not change; however, patient restraint use and patient/staff injuries declined. Number of restraints positively correlated with moderate acuity levels (r = 0.472, P = 0.036). DISCUSSION: For emergency nurses, the Emergency Behavioral Health Acuity Assessment Tool provided an objective measure of patient acuity. Targeted interventions can improve the care of this population.

Developing Empathy in Emergency Nurses Using Hearing Voices Simulation.

Background: Many health professionals report feeling uncomfortable talking with patients who hear voices. Patients who hear voices report feeling a lack of support and empathy from emergency nurses. A local emergency department reported a need for training for nurses in the care of behavioral health patients. Objective: The aim of this study is to implement a quality improvement project using a hearing voices simulation. Empathy was measured using the Toronto Empathy Questionnaire, and a post-intervention survey was used to evaluate emergency nurses' perception of the professional development session. Methods: The quality improvement project included the implementation of a hearing voices simulation with emergency nurses. A paired t-test was used to determine the differences in the nurses empathy levels pre-and post-simulation. Qualitative data was collected on the nurses' experience during the simulation debriefing. A Likert-style questionnaire was used to collect data on the nurses' evaluation of the simulation. Results: The results of the hearing voices simulation were a statistically significant increase (p < .00) in empathy from baseline (M = 47.95, SD = 6.55) to post-intervention empathy scores (M = 48.93, SD = 6.89). The results of the post-simulation survey indicated that nurses felt that the hearing voices simulation was useful (n = 100; 98%) and helped them to feel more empathetic toward patients who hear voices (n = 98; 96%). Conclusions: Using a hearing voices simulation may help emergency nurses feel more empathetic toward the behavioral health patients who hear voices. Implications for Nursing: Through the implementation of a hearing voices simulation, clinical staff educators can provide support to staff nurses in the care of behavioral health patients.

Impact of professional nursing interventions on clinical outcomes in patients with acute gastric bleeding: a retrospective analysis.

Acute gastric bleeding (AGB) is a common and potentially serious complication in patients with gastrointestinal disorders. Nursing interventions play a critical role in the management of acute gastric bleeding, but their impact on clinical outcomes is not well understood. The aim of this retrospective analysis was to evaluate the impact of nursing interventions on clinical outcomes in patients with acute gastric bleeding. A retrospective review of medical records was conducted for 220 patients with acute gastric bleeding who were admitted to the hospital between February 2022 and February 2023. Patients were divided into two groups based on whether or not they received nursing interventions during their hospital stay. Clinical outcomes, including length of hospital stay, blood transfusion requirements, and mortality rates, were compared between the two groups using descriptive statistics and logistic regression analysis. Of the 220 patients included in the study, 168 (76.4%) received nursing interventions during their hospital stay. Patients who received nursing interventions had a significantly shorter length of hospital stay (mean = 7.2 days, SD = 2.1) compared to those who did not receive nursing interventions (mean = 10.5 days, SD = 3.4, p < 0.001). Additionally, the 90-day mortality rate was lower in the group receiving professional nursing interventions (4.2% vs. 15.4%, p = 0.010). Fewer patients who received nursing interventions required blood transfusions (33.3% vs. 65.2%, p < 0.001) and mortality rates were lower (6.7% vs. 20.8%, p = 0.04). Multivariate logistic regression analysis suggested that professional nursing intervention was a protective factor for postoperative rebleeding in patients with gastric hemorrhage (OR 0.727, 95% CI 0.497-0.901, P < 0.001). The results of this retrospective analysis suggest that nursing interventions are associated with improved clinical outcomes in patients with acute gastric bleeding. The implementation of nursing interventions, such as individualized care plans, monitoring and evaluation, and patient education, should be encouraged to optimize patient outcomes in this population. Further research is needed to identify the most effective nursing interventions and to evaluate their cost-effectiveness.

Designing a standardised emergency nurse career pathway for use across rural, regional and metropolitan New South Wales, Australia: A consensus process.

BACKGROUND: Emergency nurses are the first clinicians to see patients in the ED; their practice is fundamental to patient safety. To reduce clinical variation and increase the safety and quality of emergency nursing care, we developed a standardised consensus-based emergency nurse career pathway for use across Australian rural, regional, and metropolitan New South Wales (NSW) emergency departments. METHODS: An analysis of career pathways from six health services, the College for Emergency Nursing Australasia, and NSW Ministry of Health was conducted. Using a consensus process, a 15-member expert panel developed the pathway and determined the education needs for pathway progression over six face-to-face meetings from May to August 2023. RESULTS: An eight-step pathway outlining nurse progression through models of care related to different ED clinical areas with a minimum 172 h protected face-to-face and 8 h online education is required to progress from novice to expert. Progression corresponds with increasing levels of complexity, decision making and clinical skills, aligned with Benner's novice to expert theory. CONCLUSION: A standardised career pathway with minimum 180 h would enable a consistent approach to emergency nursing training and enable nurses to work to their full scope of practice. This will facilitate transferability of emergency nursing skills across jurisdictions.

Culturally sensitive emergency care for sexual and gender minority youth: A quality improvement initiative.

BACKGROUND: Despite evidence of the impact of provider implicit bias and overt discrimination experienced by sexual and gender minority youth (SGMY), evidence surrounding sexual and gender minority cultural sensitivity training for pediatric emergency health professionals is limited. No targeted training existed to improve the clinical preparedness of healthcare professionals serving SGMY by increasing providers' knowledge and attitudinal awareness in a pediatric emergency department at a large, urban pediatric hospital in the Southeastern United States. METHODS: The Institute for Healthcare Improvement's [15] Model for Improvement informed the project and was completed in four Plan-Do-Study-Act cycles. A cross-sectional, pre-test post-test design was used to gather demographic data, administer the LGBT-DOCSS questionnaire, and collect participant feedback on the training session. The LGBT-DOCSS results were analyzed using an independent samples t-test. INTERVENTIONS: Evidence-based pedagogical strategies were utilized for a 60-minute staff training session. Staff (n = 25) had six opportunities to attend one of the training sessions over a period of 4 months. RESULTS: Self-selection and voluntary participation contributed to recruiting participants who demonstrated high baseline LGBT-DOCSS scores, particularly on the subscales that measure knowledge and attitudinal awareness. After the sessions, participants showed an increase in LGBT-DOCSS scores with a statistically significant increase in the clinical preparedness subscale. CONCLUSIONS: This project was the first at the institution to focus on culturally sensitive emergency care for sexual and gender minority youth. The content was well received by staff, who demonstrated increased clinical preparedness after the training. Implementing the training as a required component of new nurse orientation and onboarding is the next step in creating a safety culture for SGMY in the PED setting.

Interventions to improve nurse-family communication in the emergency department: A scoping review.

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.

Prevalence of Anxiety, Depression, and Sleep Disturbance Among Emergency Nurses in Oman.

INTRODUCTION: Anxiety, depression, and sleep disturbances among accident and emergency nurses not only harm their well-being but also affect patient care and organizational outcomes. This study examines anxiety, depression, and sleep prevalence and associations among accident and emergency nurses. METHODS: We conducted a cross-sectional correlational survey with 331 accident and emergency nurses in 12 Omani governmental hospitals. RESULTS: Results showed that 28.7% of accident and emergency nurses reported symptoms indicative of anxiety, with 13.6% experiencing symptoms of depression, 16.6% reporting mild sleep disturbances, and 1.5% experiencing moderate disturbance. Those with symptoms of anxiety (r = 0.183, P = .001) or depression (r = 0.152, P = .005) were more likely to experience sleep disturbances. Being single (t [170.7] = 2.5, P = .015), childless (t [169.7] = -2.807, P = .008), Omani (t [215] = 7.201, P < .001), younger (r = -0.375, P < .001) and having less clinical experience (t [329] = 4.6, P < .001) were associated with a higher anxiety score. For depression, being of Omani nationality (t [215] = 7.201, P < .001), having less than 10 years of experience (t [329] = 3.2, P =.002), and being of younger age (r = -0.285, P < .001) were associated with a higher score. DISCUSSION: Accident and emergency nurses commonly experience anxiety, depression, and sleep disturbances. Implementing interventions to promote their mental well-being or manage these issues is crucial. Organizational support is vital for ensuring their mental health, and individual-level interventions may also prove beneficial.

Emergency nurses' preference for tools to identify frailty in major trauma patients: A prospective multi-centre cross-sectional study.

BACKGROUND: Frailty is known to be a predictor of poor recovery following trauma and there is evidence that providing early frailty specific care can improve functional and health outcomes. Accurate assessment of frailty is key to its early identification and subsequent provision of specialist care. The aim of this study was to determine the feasibility and acceptability of different frailty screening tools to nurses administering them in the ED in patients admitted following traumatic injury. METHODS: Patients aged 65 and over attending the Emergency Department of five major trauma centres following injury participated in the study between June 2019 and March 2020. Patients were assessed using the clinical frailty scale (CFS), Program of Research to Integrate Services for the Maintenance of Autonomy 7 (PRIMSA7), and the Trauma Specific Frailty Index (TSFI). Nurses were asked to rank ease of use and to state their preference for each of the tools from best to worst. If the tool was not able to be completed fully then free text responses were enabled to identify reasons. Accuracy of the tool in identifying if the patient was frail or not was determined by comparison with frailty determined by a geriatrician. RESULTS: Data were analysed from 372 patients. Completion rates for each of the tools varied, with highest degree of compliance using the CFS (98.9%). TSFI was least likely to be completed with "lack of available information to complete questions" as the most cited reason. Nurses showed a clear preference for the CFS with 57.3% ranking this as first choice (PRISMA-7 32.16%; TSFI 10.54%). Both PRISMA-7 and CFS were both rated highly as 'extremely easy to complete' (PRISMA-7 58.5%, CFS 59.61%). CONCLUSION: Our results suggest that nurses from five centres preferred to use the CFS to assess frailty in ED major trauma patients.

Family opinions on resuscitation and participation in end-of-life care in the emergency department: A cross-sectional study.

OBJECTIVE: The study looked into emergency department family members' (FMs) views on being present during resuscitation and contributing to end-of-life care. METHODS: A cross-sectional study with 467 FM volunteers of mildly injured or ill patients was conducted at a research hospital between October 2021 and May 2022. Data were collected using a questionnaire administered by a clinical psychologist. The analysis employed SPSS 22.0 with a significance threshold of P < 0.05. The study was conducted according to the STROBE criteria. Statistical significance was set at P < 0.05. RESULTS: The mean FMs' age was 34.3 ± 10.43; 64.2% were male, 62.1% were married, and 76.9% had nuclear families. About 61% wanted the option of being present during resuscitation, with 47.5% desiring participation in both resuscitation and end-of-life care. Significant differences were observed in opinions based on education, work status, and resuscitation training (P = 0.015, P = 0.001, P = 0.002). CONCLUSION: Many FMs sought the choice to be present during resuscitation, and nearly half preferred participation in both resuscitation and end-of-life care.

Emergency Department Discharge Teaching Interventions: A Scoping Review.

INTRODUCTION: Emergency department discharge education is intended to provide patients with information to self-manage their condition or injury, identify potential complications, and follow-up or referral. However, most patients cannot recall the discharge information provided, leading to adverse clinical outcomes, return visits, and higher costs. A scoping review was undertaken to explore discharge education interventions that have been studied in the emergency department setting and outcomes that have been used to evaluate the effectiveness of the interventions. METHODS: A literature review was conducted using the databases PubMed/Medline, Cumulative Index to Nursing and Allied Health Literature, and Education Resources Information Center, with search terms focused on emergency nursing and patient discharge education interventions. RESULTS: Of the publications identified, 18 studies met the inclusion criteria. There was variation among studies on the conditions/injuries and populations of focus for the intervention. The interventions were categorized by learning styles, including auditory (n=10), kinesthetic (n=1), visual (n=15), reading/writing (n=1), and multimodal (n=7). Outcomes evaluated included those that were patient-specific (education, self-management, clinical, and adherence) and metrics of the health system and public health. DISCUSSION: Multimodal discharge education that addresses various learning styles and levels of health literacy improved patient education, self-management, and clinical outcomes. Additional support and reminders improved patient adherence. Identified gaps included limited kinesthetic interventions and culturally tailored education. Translational science for advancing sustainable interventions in clinical practice is needed to enhance the emergency department discharge process and patient, system, and public health outcomes.