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ABSTRACT Aim Design Methods Results Conclusions Implications for the Profession Impact Reporting Method Patient or Public Contributions To elucidate strategies for improving organisational adaptation during public health emergencies from the perspectives of nurse managers.This study utilised a qualitative approach, incorporating complex adaptive system theory within a phenomenological tradition.Semi‐structured interviews were conducted from May 2022 to June 2022. Participants included core members of the Shanghai Public Health Emergency Teams‐Nursing from 12 tertiary hospitals in Shanghai, all of whom had substantial experience as nurse leaders impacting health systems. Data obtained were coded and analysed using interpretative phenomenological analysis.Seventeen frontline nurse managers participated, leading to the emergence of three key themes related to complex organisational adaptation: seeking institutional support for environmental adaptation, building intrateam support for structural adaptation and activating individual support for behavioural adaptation. A conceptual framework of organisational adaptation was proposed, displaying the interconnections among these themes.The study provides valuable insights into managing nursing teams involved in public health emergency preparedness and response as an adaptive system. Identified managerial strategies offer guidance to ensure effective organisational assembly and optimal utilisation of the nursing workforce within the healthcare system.Recognising the crucial role of nurses in managerial positions, who leverage leadership, adaptability and decision‐making skills to coordinate frontline teams, is vital for effective public health emergency response. Their involvement in administrative roles underscores the importance of nursing perspectives in strategic planning, organisational adaptation and enhancing health system resilience during crises.The organisational adaptation strategies effectively adopted by nurse managers provide a reference for international scholars seeking to enhance the function and performance of nursing staff in healthcare system during public health emergencies.Consolidated Criteria for Reporting Qualitative Research (COREQ) checklist.No Patient or Public Contributions. [ABSTRACT FROM AUTHOR]

ABSTRACT Aims Background Design Methods Results Conclusion Relevance of Clinical Practice Patient/Public Contribution To systematically analyse expert perspectives on paediatric‐friendly care in the emergency department and establish specific indicators.With an increasing number of children seeking emergency care, nurses must understand the specific needs of paediatric patients and their families.A two‐round modified Delphi method was used in this study.In this study, experts from clinical practice and academia assessed 56 paediatric‐friendly care criteria in the emergency department. Data were collected to establish a consensus and ensure content validity.Thirty experts completed two survey rounds with response rates of 100% and 93.3%, respectively. In the initial survey, no consensus was reached for eight items. After the items were consolidated, 37 paediatric emergency‐friendly care needs were identified. For each need, the item‐level content validity index exceeded 0.79 for importance and feasibility. The average scale‐level content validity index values were 0.95 and 0.92 for importance and feasibility. These needs were categorised into six dimensions: timely comfort (3 items), emotional care (5 items), frontline safety (11 items), emergency response (10 items), human resources support (5 items) and treatment efficiency (3 items).Paediatric emergency nurses play a vital role in caring for children, improving soft skills through compassion and training and ensuring a well‐equipped, safe environment in the emergency department.This study offers valuable insights for emergency department nurses on the needs of children and their families, emphasising the importance of patient and family education, environmental considerations and the role of certified child life specialists in supporting the emergency healthcare team and ensuring appropriate paediatric care.No direct patient, service user, caregiver or public involvement existed in this study. [ABSTRACT FROM AUTHOR]

ABSTRACT Aim Design Methods Results Conclusions Reporting Method Patient and Public Contribution Although there has been a significant amount of research on nurse workloads in hospital environments, there has been a lack of comprehensive investigation of the workload of triage nurses. This study assesses the workload fluctuations of triage nurses in various emergency departments in the same region and examines how workload varies based on emergency department visit volumes and seasonal fluctuations.The study is a retrospective, multicentre, observational study from January 1, 2019, to December 31, 2023, in seven Italian emergency departments, gathering information on all patients who went through the triage process.We documented the number of nurses present throughout each shift and adjusted the data to account for the number of patients attended to by each triage nurse per shift. The EDs were classified into high‐inflow, medium‐inflow and low‐inflow categories according to the annual number of patients they served.The study included 1,223,331 emergency department triage assessments. During daytime shifts, triage nurses in high‐inflow emergency departments assessed a median of 74 patients, while those in medium‐inflow and low‐inflow emergency departments assessed 63 and 32 patients, respectively. During nighttime shifts, triage nurses in high‐inflow emergency departments assessed 26 patients, compared to 14 in medium‐inflow and 5 in low‐inflow emergency departments. Significant seasonal fluctuations in the workload of triage nurses were observed.This study reveals substantial disparities in the number of patients triage nurses assess, which vary according to emergency department patient inflow volumes and seasonal factors. The findings emphasise the need for more standardised and equitable workload distribution among triage nurses. Future research should aim to establish a systematic nurse staffing model for triage to ensure manageable workloads and maintain patient safety.The Strengthening the Reporting of Observational Studies in Epidemiology was used.No patient or public contribution. [ABSTRACT FROM AUTHOR]

ABSTRACT Background Methods Results Conclusions Death and dying remain taboo subjects in society today and therefore people may come to the end of their life without having thought about what death and dying might be like and what it is to have a good death. The purpose of this qualitative study was to understand the experience of death and dying in a hospital emergency department. Culturally, some individuals are unprepared for death, and when death occurs in an emergency setting it can be particularly shocking.A phenomenological study was undertaken, based on the existential phenomenology of Merleau‐Ponty; and framed by the nurse theorist Hildegard Peplau. Bereaved relatives and registered nurses gave in‐depth interviews describing their experiences and the interviews were analysed using an adaptation of the work of Thomas and Pollio (2002) and Hycner (1985), consistent with Merleau‐Ponty's theories.The study brings new understanding of what it is like to die in an emergency setting through new understanding of what the accompanying relatives/friends of the deceased person experience, aided by new understanding of the experiences of emergency nurses.A nursing model based both on the work of Peplau (Parse et al. 2000) and on the work of the nurse theorists Ruland and Moore (1998) and Zaccara et al. (2017) was devised for use in the emergency department when death occurs. It is hoped that this model will help nurses improve the care given to this group of patients and their loved ones. [ABSTRACT FROM AUTHOR]

AbstractThe purpose of this study was to examine the effect of self-efficacy on the implementation of the adult trauma clinical practice guidelines (ATCPGs) on improving trauma patient outcomes, including missed injuries, and ED LOS. Nurses’ and physicians’ self-efficacy in performing ATCPGs skills were evaluated three months prior to and three months after the intervention’s implementation. Multiple strategies of ATCPGs implementation improved the length of stay (LOS) in the ED for multiple trauma patients. The quasi-experimental design has been implemented in this interventional study. Post-intervention, the self-efficacy of ED healthcare providers in performing ATCPGs skills has increased. Implementation of the ATCPGs has improved the outcomes of patients with multiple traumas. There were 66 patients in this study, and 53 (80.3%) of them were male. The ATCPGs intervention resulted in a statistically significant decrease in the amount of time spent in the ED, as shown by a comparison of the ED LOS in minutes between the two groups (t = 2.56; p = 0.013). Implementing the ATCPGs has improved multiple trauma patients’ outcomes. The results will help decision-makers at hospitals to facilitate interdisciplinary ATCPGs training sessions and establish policies and procedures to introduce adult trauma sheet in the ED to improve multiple trauma patients’ outcomes. [ABSTRACT FROM AUTHOR]

Background: Evaluating emergency room nurses' knowledge of radiation protection, health effects, and decontamination procedures is crucial for preparedness in nuclear and radiological emergencies. This study aims to evaluate the level of knowledge among emergency nurses in Saudi Arabia regarding medical responses to nuclear and radiological emergencies. Methods: A multicenter cross-sectional study was conducted via a self-structured questionnaire with 15 true‒false questions divided into three domains, namely, radiation protection measures, radiation health effects, and decontamination procedures, each with five items and a possible score of 1 point per correct answer. The collected data were analyzed via descriptive and inferential statistics. The study followed the STROBE checklist for methodological rigor. Results: A total of 594 emergency nurses participated in this study, with the majority being young (64.50% aged ≤ 30), female (68.69%), bachelor's degree-holding (67.68%), single (63.64%), having ≤ 4 years of experience (56.06%), working in public health facilities (88.89%), and lacking training in medical response (85.35%). The mean knowledge scores for participants were highest for radiation exposure effects (3.27 ± 0.91), followed by radiation protective measures (2.32 ± 0.99), and lowest for decontamination procedures (1.46 ± 1.07). Overall knowledge was measured at a mean score of 7.06 ± 1.68, with 97.47% of the nurses categorized as having poor knowledge level. Nurses in private hospitals scored higher (7.77 ± 1.82) than those in public hospitals (6.97 ± 1.65) on overall mean knowledge (P = 0.034). Concerning findings include emergency nurses' misconceptions about the protection provided by dense materials, the effectiveness of increasing distance from a radiation source, and prioritizing decontamination of victims over life-saving measures. Additionally, they were unaware of the immediate symptoms following radiation exposure and misunderstood that the primary threat in a radioactive bomb event is the explosion rather than the radiation itself. Conclusion: This study revealed poor knowledge among emergency nurses regarding medical responses to radiation emergencies and highlighted the critical need for enhanced and standardized training in radiation emergency preparedness among nurses. The gaps in knowledge identified in this study could significantly impact the effectiveness of healthcare responses in radiation emergency scenarios. Therefore, targeted educational interventions and policy changes are recommended to address these shortcomings. [ABSTRACT FROM AUTHOR]

Objective: Hand functionality, defined as the ability to perform tasks requiring fine motor skills, is crucial for emergency service nurses as it directly affects their ability to perform tasks requiring fine motor skills, such as administering medication, operating equipment, and providing patient care. This study, therefore, aimed to investigate the effects of an 8‐h work shift on hand functionality and perceived exertion among emergency service nurses. Method: Employing a cross‐sectional design, the study measured manual dexterity, handgrip, and pinch strength, and perceived exertion using the Minnesota Manual Dexterity Test (MMDT), Nine‐Hole Peg Test (9‐HPT), Handgrip Strength Test, Pinch Strength Test, and the Borg Rating of Perceived Exertion (RPE) Scale. Data were collected from 34 emergency service nurses both before and after their shifts. Results: The present findings indicated significant postshift declines in manual dexterity as evidenced by the MMDT and 9‐HPT, with the former demonstrating a large effect size and the latter a small effect size. No significant changes were observed in handgrip and pinch strength. Notably, Borg RPE scores increased significantly postshift, indicating substantial perceived fatigue with a nearly perfect effect size. Correlation analyses revealed significant relationships between increased physical exertion and changes in hand dexterity and strength, underscoring the physical demands placed on nurses during typical work shifts. Conclusions: These findings highlight the need for healthcare institutions to reassess work schedules and ergonomic practices to mitigate fatigue and preserve nurses' hand functionality, thereby enhancing patient care and nurse well‐being. The study calls for further research to explore more comprehensive strategies aimed at reducing the occupational strain on emergency service nurses. [ABSTRACT FROM AUTHOR]

Aim Background Introduction Methods Results Conclusion Implications for nursing policy The study aimed to determine the experiences of Turkish nurses who volunteered in the disaster zone following the 2023 Türkiye–Syria earthquake.The earthquake devastated 11 cities in Türkiye, which required a comprehensive humanitarian response. Despite the crucial role of nurses in crisis management, limited research exists on their experiences in earthquake zones.Nurses experience difficulties in disaster areas, such as physical conditions, lack of disaster plans, and inadequate disaster training before being deployed to earthquake areas.This study used a qualitative research model and case study design. Data were collected through in‐depth qualitative interviews. Nine participants who had worked in earthquake zones for at least 5 days were included in the study. The discussions were recorded, transcribed verbatim, and analyzed thematically. The purposive sampling method was used, and the Consolidated Criteria for Reporting Qualitative Research guidelines were followed.As a result, 4 themes, namely physical conditions, psychosocial conditions, professional conditions, and organization, and their 14 subthemes were determined. This study revealed that nurses encountered difficulties related to physical conditions in earthquake zones. Moreover, the emotional burden expressed by the nurses highlighted the profound psychological impact of disaster response.This study determines that disaster preparedness and support for nurses should be enhanced to improve the arrangement of health services in future calamities.The results of this study can be used by nurse managers and healthcare policymakers to create nursing training programs that focus on disaster‐related competencies. [ABSTRACT FROM AUTHOR]

Introduction: Poor nursing performance is considered a threat to patient safety, affecting the quality of care provided and ultimately impacting patient outcomes. Objectives: The main aim of this study was to identify the predictors of nursing performance. Methods: A cross-sectional predictive design was used. A convenient sampling technique was used to recruit 251 emergency nurses in three health sectors. They were assessed using the secondary traumatic stress scale and the nursing performance scale. Data were collected between June and August 2022. Results: Nurses experienced severe levels of secondary traumatic stress (M = 57.9, SD = 14.94). The nursing performance level was below average (M = 27.48, SD = 9.36), and the mental performance subscale received the lowest rating (M = 5.82, SD = 2.69). There was a strong negative association between the secondary traumatic stress total score and the total score of nursing performance (r = −.77). Additionally, factors such as high body mass index, smoking, the presence of chronic diseases, working overtime, and high levels of secondary traumatic stress were identified as significant predictors of nursing performance. Conclusion: It is recommended that emergency nurses be provided with treatment programs and interventions to reduce their secondary traumatic stress to improve their performance, thereby ensuring high-quality patient care. [ABSTRACT FROM AUTHOR]

The use of haptic simulation for emergency procedures in nursing training presents a viable, versatile and affordable alternative to traditional mannequin environments. In this paper, an evaluation is performed in a virtual environment with a head-mounted display and haptic devices, and also with a mannequin. We focus on a chest decompression, a life-saving invasive procedure used for trauma-associated cardiopulmonary resuscitation (and other causes) that every emergency physician and/or nurse needs to master. Participants' heart rate and blood pressure were monitored to measure their stress level. In addition, the NASA Task Load Index questionnaire was used. The results show the approved usability of the VR environment and that it provides a higher level of immersion compared to the mannequin, with no statistically significant difference in terms of cognitive load, although the use of VR is perceived as a more difficult task. We can conclude that the use of haptic-enabled virtual reality simulators has the potential to provide an experience as stressful as the real one while training in a safe and controlled environment. [ABSTRACT FROM AUTHOR]

OBJECTIVES: Pediatric patients with life-limiting diagnoses frequently seek care in the pediatric emergency department (PED) during times of acute illness, or at end-of-life (EOL) . Although the population of patients with life-limiting diagnoses is heterogenous, clinician expertise in EOL communication is essential to providing family-centered care. In this study, we explored PED physician and nurse experiences with communication when eliciting EOL values, including factors specified to the PED environment, clinician perceptions of family supports and preferences, and clinicians' self-reflection of their skills and challenges in this sphere. METHODS: We performed a prospective qualitative study using semistructured interviews of PED physicians and nurses recruited from a quaternary care center. Thematic content analysis was performed on the transcribed interviews to identify codes and, ultimately, themes. RESULTS: We interviewed 17 emergency department clinicians, including 10 physicians and 7 nurses. Thematic content analysis revealed 6 salient themes. The first theme related to contextual factors of the emergency department environment. Two additional themes related to patient and family characteristics, including unique patient and family factors and clinician interpretation of parental/family needs. Lastly, we found 3 clinician-focused themes including knowledge gaps in EOL communication, communication styles and priorities in EOL conversations with families, and coping with ethical challenges. CONCLUSIONS: PED clinicians report communication-related challenges to providing optimal care for families and patients with life-limiting diagnoses. Participants self-identified gaps in communication skills in this area. Future studies should focus on clinician educational interventions on the basis of this needs assessment and include family perspectives to develop best practice. [ABSTRACT FROM AUTHOR]

Aim: To construct a popularization of an emergency science capacity index system for nurses based on the iceberg model. Design: A mixed‐method research design incorporating quantitative and qualitative components was used. Methods: In this study, the first draft of the questionnaire was developed through literature analysis and semi‐structured interviews. According to the Delphi expert inclusion criteria, 20 experts with rich experience in the field of science popularization were selected, and the system of emergency science popularization ability of nurses was ultimately developed through two rounds of consultation according to the Delphi method. The weights of various indicators were determined through hierarchical analysis. Results: Following two rounds of Delphi surveys, a total of 3 primary, 6 secondary, and 26 tertiary indicators were identified. The indicators were found to be highly significant, with variation coefficients ranging from 0.063 to 0.140. The Kendall's harmonization coefficients for the primary, secondary, and tertiary indicators were 0.350, 0.341, and 0.146, respectively. The popularization of the emergency science capacity system has a certain scientific and practical significance, which is of guidance to the competency of nurses in public health emergencies. Patient or public contribution: No patient or public contribution. This study did not involve patients, service users, caregivers, or members of the public. [ABSTRACT FROM AUTHOR]

Background: The health issues experienced by older people can often be severe and complex, and an increasing number are using residential aged care services to meet their care needs. High-quality nursing care is fundamental to the health and safety of aged care residents and is contingent on nurses' accurate assessment, informed decision-making, and delivery of timely interventions. However, the role of the aged care nurse is often challenging, impeded by factors such as understaffing, high workloads, and a lack of access to clinical infrastructure and resources. When these challenges mount, residents are put at greater risk of adverse outcomes, such as avoidable clinical deterioration and hospital transfers. This study describes the adaptation and implementation of the emergency nursing framework, HIRAID® (History including Infection risk, Red Flags, Assessment, Interventions, Diagnostics, reassessment, communication and plan)—a tool to assist nurses' assessment, decision-making and care in residential aged care. Methods: The HIRAID® framework will be adapted for residential aged care using a real-time Delphi and panel of aged care and nursing experts. The co-designed HIRAID® Aged Care framework will be trialled in 23 residential aged care homes in Sydney, Australia, in a modified stepped-wedge cluster randomised controlled trial design. All homes will be randomised into one of four clusters. Outcomes of interest include the rate of clinical deterioration events resulting from nurses' actions, the rate of hospital transfers determined to be inappropriate, performance against the national mandatory aged care quality indicators, resident satisfaction with care, nurse and medical staff satisfaction with communication, and the quality of nursing documentation. These outcomes will be evaluated using a combination of qualitative and quantitative analysis of routinely collected resident data, expert assessments of facility documentation events against validated criteria, and pre- and post-intervention surveys of residents, family carers, nurses, and medical staff. Discussion: This protocol describes a pragmatic trial that aims to translate an evidence-based framework from the emergency care context into residential aged care. The adapted HIRAID® Aged Care framework will be the first of its kind to standardise and guide holistic nursing assessment, decision-making, and documentation in residential aged care in Australia. Ethics and dissemination: This research has been approved by the Western Sydney Local Health District Human Research Ethics Committee: 2023/ETH00523. A waiver of consent has been approved to access resident health data and nursing documentation at each participating site. Trial registration: Australian and New Zealand Clinical Trial Registry, ACTRN12623000481673. Registered 12 May 2023. Protocol version: Version 1.0 6 February 2024. [ABSTRACT FROM AUTHOR]

Background: Implementing evidence that changes practice in emergency departments (EDs) is notoriously difficult due to well-established barriers including high levels of uncertainty arising from undifferentiated nature of ED patients, resource shortages, workload unpredictability, high staff turnover, and a constantly changing environment. We developed and implemented a behaviour-change informed strategy to mitigate these barriers for a clinical trial to implement the evidence-based emergency nursing framework HIRAID® (History including Infection risk, Red flags, Assessment, Interventions, Diagnostics, communication, and reassessment) to reduce clinical variation, and increase safety and quality of emergency nursing care. Aim: To evaluate the behaviour-change-informed HIRAID® implementation strategy on reach, effectiveness, adoption, quality (dose, fidelity) and maintenance (sustainability). Methods: An effectiveness-implementation hybrid design including a step–wedge cluster randomised control trial (SW-cRCT) was used to implement HIRAID® with 1300 + emergency nurses across 29 Australian rural, regional, and metropolitan EDs. Evaluation of our behaviour-change informed strategy was informed by the RE-AIM Scoring Instrument and measured using data from (i) a post HIRAID® implementation emergency nurse survey, (ii) HIRAID® Instructor surveys, and (iii) twelve-week and 6-month documentation audits. Quantitative data were analysed using descriptive statistics to determine the level of each component of RE-AIM achieved. Qualitative data were analysed using content analysis and used to understand the 'how' and 'why' of quantitative results. Results: HIRAID® was implemented in all 29 EDs, with 145 nurses undertaking instructor training and 1123 (82%) completing all four components of provider training at 12 weeks post-implementation. Modifications to the behaviour-change informed strategy were minimal. The strategy was largely used as intended with 100% dose and very high fidelity. We achieved extremely high individual sustainability (95% use of HIRAID® documentation templates) at 6 months and 100% setting sustainability at 3 years. Conclusion: The behaviour-change informed strategy for the emergency nursing framework HIRAID® in rural, regional, and metropolitan Australia was highly successful with extremely high reach and adoption, dose, fidelity, individual and setting sustainability across substantially variable clinical contexts. Trial registration: ANZCTR, ACTRN12621001456842. Registered 25 October 2021. [ABSTRACT FROM AUTHOR]

Why you should read this article: • To enhance your awareness and understanding of the Columbia-Suicide Severity Risk Scale • To learn about a project to improve suicide risk screening in three emergency departments in the US • To acknowledge the need to provide nurses with adequate training and tools on suicide risk assessment. Suicide is a significant and increasing public health concern. Research has shown that screening for suicide risk is inconsistent in acute care settings and that a variety of different tools are used for that purpose. The Columbia-Suicide Severity Risk Scale (C-SSRS) has emerged as a validated and recognised suicide risk screening tool. This article describes a quality improvement project designed to improve the screening of patients for suicide risk in a large hospital system in the Midwestern US. As part of the project, 97% of nurses working in the organisation’s emergency departments self-completed a 30-minute interactive learning module on the background, relevance and application of the C-SSRS. The C-SSRS enables nurses to classify the severity of suicide risk, which helps to provide interventions commensurate with patients’ level of risk. Following completion of the module, there was a significant increase in the percentage of patients screened for suicide risk. [ABSTRACT FROM AUTHOR]

Aims: The aim of the study was to develop a set of nursing‐sensitive quality indicators for acute poisoning in emergency departments. Design: A two‐round e‐Delphi study was conducted from July to November 2023. Methods: Subject‐matter experts from 19 tertiary hospitals across four provinces of China participated in the survey. Potential indicators identified through a literature review were rated on a 5‐point Likert scale and comments solicited. Descriptive statistics were used to demonstrate convergence of expert opinion, and consensus was reached in two rounds. Weights of each indicator were determined by analytic hierarchy process. There were 20 expert responses in Round 1 and 18 in Round 2. Results: After two rounds, experts reached a consensus on definitions, calculation formulas, and data collection methods for these indicators. Three primary and 11 secondary indicators were included in the final nursing‐sensitive quality indicators for acute poisoning in the emergency department. Conclusion: A set of indicators about acute poisoning care, applicable to the Chinese context, was developed in collaboration with emergency nurse specialists. Implications for the Profession and Patient Care: The lack of supervision of the nursing quality for acute poisoning leads to great variability in clinical practice in different medical institutions. The results can help in their standardization in China and in other countries lacking regulation. Our study also offers nursing managers a concrete and operable evaluation tool for quality supervision. Normative nursing behaviours are conducive to increase safety and enhance patients' experience of medical treatment. Impact: The indicators identified in this study closely approach clinical practice and exhibit the characteristics of sensitivity and practicality. Although developed in the Chinese healthcare system, there is potential for adoption or adaption in other healthcare settings. Reporting Method: This study was reported in line with the Conducting and REporting of DElphi studies (CREDE) guidance on Delphi studies. Patient or Public Contribution: No patient or public contribution in this study. Contribution to the Wider Global Clinical Community: The nursing quality of acute poisoning in emergency departments remains a growing attention, but the relevant assessment tools are lack. This study provides a set of nursing‐sensitive quality indicators for acute poisoning to guide the quality monitoring of nursing managers. Study recommendations have broad applicability to all healthcare professionals who are engaged in emergency nursing. [ABSTRACT FROM AUTHOR]

Aim: To develop and psychometrically test the triage decision‐making instrument, a tool to measure Emergency Department Registered Nurses decision‐making. Design: Five phases: (1) defining the concept, (2) item generation, (3) face validity, (4) content validity and (5) pilot testing. Methods: Concept definition informed by a grounded theory study from which four domains emerged. Items relevant to the four domains were generated and revised. Face validity was established using three focus groups. The target population upon which the reliability and validity of the triage decision‐making instrument was explored were triage registered nurses in emergency departments. Three expert judges assessed 89 items for content and domain designation using a 4‐point scale. Psychometric properties were assessed by exploratory factor analysis, following which the names of the four domains were modified. Results: The triage decision‐making instrument is a 22‐item tool with four factors: clinical judgement, managing acuity, professional collaboration and creating space. Focus group data indicated support for the domains. Expert review resulted in 46 items with 100% agreement and 13 with 66% agreement. Fifty‐nine items were distributed to a convenience sample of 204 triage nurses from six hospitals in 2019. The Kaiser–Meyer–Olkin measures indicated that the data were sufficient for exploratory factor analysis. Bartlett's test indicated patterned relationships among the items (X2 (231) = 1156.69). An eigenvalue of >1.0 was used and four factors explained 48.64% of the variance. All factor loadings were ≥0.40. Internal consistency was demonstrated by Cronbach's alphas of.596 factor 1,.690 factor 2,.749 factor 3 and.822 for factor 4. Conclusion: The triage decision‐making instrument meets the criteria for face validity, content validity and internal consistency. It is suitable for further testing and refinement. Impact: The instrument is a first step in quantifying triage decision‐making in real‐world clinical environments. The triage decision‐making instrument can be used for targeted triage interventions aimed at improving throughput and staff education. Statistical Support: Dr. Tak Fung who is a member of the research team is a statistician. Statistical Methods: Development, validation and assessment of instruments/scales. Descriptive statistics. Reporting Method: STROBE cross‐sectional checklist. Implications for the Profession and/or Patient Care: The TDI makes the complexity of triage decision‐making visible. Identifying the influence of decision‐making factors in addition to acuity that affect triage decisions will enable nurse managers and educators to develop targeted interventions and staff development initiatives. By extension, this will enhance patient care and safety. [ABSTRACT FROM AUTHOR]

Background: Delirium is a state of altered level of consciousness often leading to confusion, inattention, and changes to levels of cognition. Delirium increases average length of stay in the hospital and costs the US health care system approximately $148 billion each year in associated medical costs. Sleep hygiene is an important factor in delirium prevention for all hospitalized patients. Objectives: This quality improvement project was designed to increase implementation of an evidence-based sleep hygiene bundle in the neurocritical care population in order to decrease rates of hospital-acquired delirium. Methods: This project followed the Plan, Do, Study, Act (PDSA) framework to facilitate a continuous quality improvement intervention at amid-Atlantic academicmedical center in the neurocritical care population. The continuous quality improvement included the incorporation of "sleep" as a topic into the daily rounding checklist, thus optimizing the ability to improve adherence to a multicomponent sleep hygiene bundle. The intervention includes the preintervention-postintervention occurrences of delirium and use of the daily rounding checklist. Results: Nursing adherence to documentation of delirium assessments was high at approximately 99%. Following the intervention, there was a 41% decrease in the number of patients who screened positive for hospital-acquired delirium. Discussion: The improvement in cases of hospital-acquired delirium may be attributed to the project intervention. Recommendations for future interventions include analysis of training on sleep plans, focus on nursing education regarding delirium assessment tools, or a measure of staff and/or patient satisfaction related to the intervention. [ABSTRACT FROM AUTHOR]

Background: Trauma population health indicators are worsening in the United States. Nurses working in trauma care settings require specialized training for patient care. Little is known about national enumeration of nurses who hold skill-based trauma certificates. Objective: The purpose of this project was to estimate (1) skill-based certificate status among U.S. nurses who primarily work with emergency or trauma patients, (2) demographic and work characteristic differences between those who report skill-based trauma certificates and those who do not, and (3) continuing education learning needs among nurses who hold skill-based trauma certificates. Methods: This was an applied epidemiologic analysis of the 2022 National Sample Survey of Registered Nurses. Results: The weighted analysis of 239,893 emergency nurses indicated 57% held skill-based trauma certificates with disparities by rural practice, racial identity, age, and marital status. Among those who held skill-based trauma certificates, the greatest need for continuing education was on topics of mental health, quality improvement, and substance use disorders. Approximately 87% of emergency nurses with trauma skill-based certificates only spoke English fluently. Conclusions: Population health management interventions are needed to enhance workforce equity and continuing education opportunities for trauma nurses. Professional nursing organizations, emergency nursing employers, and academic settings should offer continuing education in mental health and quality improvement. These findings also support the need for ongoing activities to enhance language accessibility for non-English speaking patients in the trauma care system. [ABSTRACT FROM AUTHOR]

Objective: Police officers are often the first responders when individuals experience a mental health crisis and typically remain responsible for transport to a psychiatric emergency department. In 2014, a psychiatric ambulance (PA) was introduced in the city of Amsterdam to take over the transport of individuals in a mental health crisis. The purpose of the PA was to use fewer restrictive measures while guaranteeing safety for both patients and personnel. Methods: A preimplementation-postimplementation design was used to assess the feasibility and utility of a single-vehicle PA service compared with police transport. Data on 498 rides were collected in the 4 months before implementation of the PA (pre-PA cohort) and on 655 rides in the 6 months after implementation (PA cohort). Results: After PA implementation, most patients were transported by the PA (82%), and rides by police vehicle were very rare (1%). Individuals in the PA cohort had a greater transportation delay, compared with those in the pre-PA cohort, but the PA reduced use of coercive measures with no increase in the incidence of patient aggression. Among individuals in the PA cohort, hospitalization was more often voluntary than among those in the pre-PA cohort. Conclusions: Transporting emergency psychiatric patients by a special PA rather than by the police reduced the use of coercive measures during transport, kept the occurrence of aggressive incidents stable, and was associated with fewer coercive hospital admissions. [ABSTRACT FROM AUTHOR]

Background: Despite the fact that several triage tools have been implemented globally, emergency care, including the triage system, is often one of the weakest parts of the health system in developing countries, as compared to developed countries. Moreover, emergency centers in African countries are very busy, often flooded by high load of trauma patients, chronic medical conditions, acute medical emergencies, and HIV‐related conditions. These disease conditions precipitate the reasons for the prioritization of patients. In South Africa, studies conducted on the use of triage by nurses revealed that most patients are satisfied with the Nurse‐led triage service provided in emergency departments (EDs). At the same time, some Nurses also see the South African Triage Scale (SATS) as one of the easiest Nurse‐led triage tools. Aim: The study aimed at identifying the factors hindering the effective process of triage during care provision at a selected public hospital in KwaZulu‐Natal (KZN). Methods: This study utilized a cross‐sectional survey, employing a nonprobability convenience sampling to recruit its respondents. The recognition primed decision model formed the framework of the study. Ethical clearance was obtained from the University of KwaZulu‐Natal Ethics Review Board, and ethics principles were carefully observed throughout the study. Results: Out of the 100 respondents, 89% (89) of the respondents perceived that various factors still impede the progress of triage, while 11% (11) of the respondents perceived that no factor impedes the progress of triage. Conclusion: The study indicates that several factors still hinder the effective process of triage. Based on the findings of the study, factors like overcrowding, Nurses waiting for doctors when they know what to do, lack of continuous professional development on triage system, inadequate experience, lack of confidence, and lack of adequate training on triage still impede the efficient triage system. [ABSTRACT FROM AUTHOR]

ABSTRACT Background Aims Methods Results Conclusion Identifying patients with chest pain potentially due to acute coronary syndrome (ACS) early is crucial for triage nurses. They need a reliable, validated screening tool.This study aims to develop an initial screening scale to detect ACS in patients presenting with chest pain in the emergency department.We analyzed electronic medical records of 3131 chest pain patients from 103,041 emergency department visits between January 2018 and December 2019. ACS diagnosis was confirmed by cardiologists through clinical symptoms, electrocardiograms, and cardiac enzyme levels. The study proceeded in four stages: (1) identifying potential ACS predictors through a literature review, (2) validating these predictors with experts, (3) comparing data between ACS and non‐ACS patients and (4) developing a screening scale based on identified predictors. Statistical methods included univariate analysis and binary logistic regression. The scale's accuracy was assessed using ROC curve analysis and compared to existing tools.Eight significant ACS predictors were identified: male sex, age over 49 for males and over 65 for females, typical symptoms, initial pain scale score of 6 or higher, pain duration of at least 10 min, history of ACS, hypertension, and dyslipidemia. Each predictor was scored, with typical symptoms and severe pain receiving higher scores, totaling up to 10 points. A score of 6 or more indicated high ACS risk, demonstrating accuracy comparable to the HEART and TIMI score systems.This study developed a new ACS screening scale for use by triage nurses in emergency departments. This scale can facilitate early detection and intervention for patients at high risk of ACS. [ABSTRACT FROM AUTHOR]

Nursing interruptions occur frequently and often have adverse outcomes, threatening patient safety. Emergency departments have a high incidence of nursing interruptions owing to the concentration of critically ill patients and frequent emergencies. Current research mainly focuses on large hospitals and uses observation and interview methods. Therefore, there is a need to develop tools for measuring emergency nursing interruptions. This study develops a survey questionnaire on emergency nursing interruptions. It tests its validity and reliability by building on the conceptual framework of emergency nursing interruption proposed in the literature. Specifically, we develop a test version of the emergency nursing interruption survey questionnaire using a Delphi expert inquiry and preinvestigation. We selected 1047 emergency nurses in 22 provinces and autonomous regions of China to participate in the survey by completing the questionnaire between June and July 2023 to evaluate the validity and reliability of the questionnaire. The final questionnaire comprised 26 items across 5 dimensions—sources, types, interrupted nursing activities, consequences of interrupted nursing activities, and management of nursing interruptions. The content validity indexes were 0.948 at scale level and 0.842–1.000 at item level. We used exploratory factor analysis (EFA) to extract five common factors with a cumulative variance contribution rate of 66.550%. The results of the confirmatory factor analysis (CFA) demonstrated a good model fit. Cronbach's α coefficient of the questionnaire was 0.912, split‐half reliability was 0.846, and the retest reliability calculated using the intraclass correlation coefficient was 0.915. To ensure the structural validity of the scales, EFA and CFA were conducted using two different datasets. Thus, the questionnaire showed good validity and reliability and can be used to evaluate how nurses understand emergency nursing interruptions. [ABSTRACT FROM AUTHOR]

ABSTRACT Background Aim Methods Results Discussion Conclusions Pre‐hospital emergency nurses, frequently exposed to high‐stress situations, are at risk for burnout and stress‐related issues, affecting their overall well‐being. The Professional Quality of Life (ProQoL) scale, widely used among hospital nurses, remains untested in pre‐hospital emergency settings.To adapt and validate the ProQoL scale for pre‐hospital emergency contexts and explore the protective role of emotional intelligence in professional well‐being.A mixed‐method study was conducted. The qualitative approach involved semi‐structured interviews to inform the modification of items for adapting the ProQoL to the pre‐hospital emergency setting. A quantitative method was applied to assess the relationship between emotional intelligence and professional well‐being through content and face validity measures.Qualitative interviews suggested refining the ProQoL for pre‐hospital emergency settings, emphasising factors such as job satisfaction and professional conduct. The revised 21‐item Pre‐Hospital Emergency‐Professional Quality of Life (PHE‐ProQoL) scale demonstrated strong content validity (I‐CVI: 0.86‐1, S‐CVI: 0.9) and face validity. Significant correlations were observed between emotional intelligence and professional well‐being, with negative correlations between emotional intelligence and both burnout (Pearson's r = −0.859) and post‐traumatic stress (Pearson's r = −0.792), and a positive correlation with compassion satisfaction (Pearson's r = +0.917). Pre‐hospital nurses displayed moderate levels of compassion satisfaction (27.3 ± 9.81), high emotional intelligence (28.0 ± 9.58), especially in empathy, and substantial levels of burnout (22.5 ± 6.09) and stress (21.2 ± 4.3).The study found that pre‐hospital emergency nurses exhibit moderate compassion satisfaction and above‐average emotional intelligence, particularly in perceiving and managing others' emotions. However, they also experience significant levels of burnout and post‐traumatic stress.Burnout and post‐traumatic stress significantly affect pre‐hospital emergency nurses. Enhancing emotional intelligence is crucial for their well‐being. Nursing managers now have access to a validated and reliable tool to assess this. [ABSTRACT FROM AUTHOR]

Objective Methods Results Conclusions To determine the proportion of women presenting to EDs across a regional health district, with early pregnancy bleeding, who received appropriate care.Retrospective cohort review of linked data from five data sets: ED, pathology, radiology, costs and non‐admitted/outpatient. Data collected from five EDs between January 2011 and December 2020, across one health district in NSW, Australia, with 150 000 annual ED presentations. Management received by women of reproductive age, with early pregnancy (<20 weeks gestation) bleeding was compared to seven indicators for recommended care. Indicators included blood tests, psychosocial support, administration of Rhesus D immunoglobulin and US. Indicators were determined by a systematic analysis of published primary research, expert consensus clinical practice guidelines and literature reviews on initial assessment, intervention and diagnostics for women with early pregnancy bleeding.There was no evidence of almost one third of women (n = 3661, 29.4%) receiving any indicators and 54 (0.4%) received five or more indicators of appropriate care. Presentations to rural facility had the lowest number and proportion of indicators being performed (n = 603, 58.0% for no indicators). Cost increased with the number of indicators. Over the study period, the proportion of all indicators being performed increased, and indicator six – psychosocial support referral or care had the biggest growth (almost 500%).Variation in care for women presenting with early pregnancy bleeding to ED was identified. There is an evidence‐practice gap and need for inquiry into barriers and facilitators to prescribed clinical practice for this population. [ABSTRACT FROM AUTHOR]

Objective: To survey the current structure, capability and operational scope of pre‐hospital and retrieval aeromedical teams across Australia. Methods: The medical directors of all Australian civilian adult aeromedical retrieval organisations with pre‐hospital teams and/or doctors for inter‐hospital critical care patient transport were contacted in a survey to qualitatively assess capacity and team structure. Results: All 17 organisations contacted completed the survey. While there is diversity in team structure with the pairing of doctors, paramedics and nurses, capacity for patient care is generally homogenous. A doctor/paramedic model is the more common team structure for rotary‐wing missions, and doctor/nurse for fixed‐wing. Differences are mostly due to state government controlled aspects of their health services. An advanced degree of intensive patient care occurs outside of the hospital. Land and sea rescue is an important aspect of Australian aeromedical work. Conclusion: Aeromedicine in Australia has many consistent elements, but variable contexts have resulted in a diversity of operational models. [ABSTRACT FROM AUTHOR]

Background Methods Results Conclusion and implications for nursing and health policy Nursing competencies in armed conflict situations are critical for effective response and recovery. This study explores nurses’ perceptions regarding their competencies in armed conflict zones to identify areas of proficiency and those requiring further emphasis in training.This cross‐sectional descriptive study adhered to the STROBE reporting guidelines. It used a validated questionnaire examining 47 different competencies for nursing in armed conflict zones, which were subsequently ranked to identify those that were valued most and least.In total, 102 questionnaires were returned (85% response rate). The highest‐ranked competencies focused on immediate life‐saving interventions and personal safety. In contrast, competencies involving broader disaster management, such as understanding organizational disaster plans, post‐death care, and risk identification, ranked lower. This observation may indicate a tendency to prioritize direct clinical care over strategic planning and long‐term recovery in disaster nursing education.This study highlights the critical need to strengthen emergency care competencies among nurses working in armed conflict zones in Yemen. Its findings underscore the importance of targeted training programs, particularly in complex trauma management and psychological first aid, to address nurses’ self‐identified competency gaps. Policy implications include prioritizing resource allocation for emergency care infrastructure, implementing competency‐based deployment strategies, and ensuring access to mental health support for nurses in working conflict zones. These actions are essential for building a resilient nursing workforce capable of providing quality care amidst the unique challenges of armed conflict. [ABSTRACT FROM AUTHOR]

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Purpose: This study aimed to investigate the knowledge, opinions, competence, and barriers of nurses providing trauma-informed care (TIC) to children in hospitals. Methods: Data were collected from 198 nurses nationwide using the TIC Provider Survey developed by the Center for Pediatric Traumatic Stress in July, 2024. Descriptive statistics, t tests, and one-way ANOVA were conducted using the IBM SPSS Statistics software (ver. 23.0, IBM Corp.). Results: Of the 13 items assessing knowledge of TIC, seven had a correct response rate of over 90%. However, the correct response rate for these three items were less than 30%. Regarding opinions on the TIC, more than 90% of participants agreed with five of the seven items. In self-rated competence in providing TIC, they were not competent in responding to a child's (or parent's) questions about whether the child is going to die or understanding how traumatic stress may present differently according to developmental stages. The major barriers to providing TIC were time constraints, lack of training, and organizational support. Items with relatively low performance rates were 'teach parents what to say to their child after a difficult/sick/scary experience, and teach child or parents the specific ways to cope with unpleasant experiences'. Conclusion: This study suggests that it can contribute to the development of specific guidelines for nurses to effectively apply TIC in pediatric and family nursing practice, emphasizing the need for educational programs to support this implementation. [ABSTRACT FROM AUTHOR]

Aims Design Methods Results Conclusion Implications for Patient Care Impact Reporting Method Patient or Public Contribution To identify facilitators and barriers and tailor implementation strategies to optimize emergency clinician's use of adult and paediatric sepsis pathways.A qualitative descriptive study using focus group methodology.Twenty‐two emergency nurses and ten emergency medical officers from four Australian EDs participated in eight virtual focus groups. Participants were asked about their experiences using the New South Wales Clinical Excellence Commission adult and paediatric sepsis pathways using a semi‐structured interview template. Facilitators and barriers to use of the sepsis pathways were categorized using the Theoretical Domains Framework. Tailored interventions were selected to address facilitators and barriers, and a re‐implementation plan was devised guided by the Behaviour Change Wheel.Thirty‐two facilitators and 58 barriers were identified corresponding to 11 Theoretical Domains Framework domains. Tailored strategies were selected to optimize emergency clinicians' use of the sepsis pathways including refinement of existing education and training programmes, modifications to the electronic medical record system, introduction of an audit and feedback system, staffing strategies and additional resources.The implementation of sepsis pathways in the Emergency Department setting is complex, impacted by a multitude of factors requiring tailored strategies to address facilitators and barriers and optimize uptake.This study presents a theory‐informed systematic approach to successfully implement and embed adult and paediatric sepsis pathways into clinical practice in the Emergency Department.Optimizing uptake of sepsis pathways has the potential to improve sepsis recognition and management, subsequently improving the outcome of patients with sepsis.The Consolidated Criteria for REporting Qualitative research guided the preparation of this report.Nil. [ABSTRACT FROM AUTHOR]

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

AbstractPolice officers are increasingly tasked with responding to people in crisis (PIC), often resulting in transfers to emergency departments (EDs) where they can encounter challenges like long wait times, safety concerns, and conflicting perspectives between the medical and legal systems. This qualitative study explores the experiences of police officers during the transfer of PIC to ED nurses and staff. Eleven police officers were recruited and interviewed, providing contextual information about ED transfers in the greater Montreal area. The findings revealed that police officers face varied challenges in transferring PIC to different EDs, influenced by each hospital’s unique characteristics, staffing, security, and organizational issues. Relationships with nurses significantly impact these experiences, ranging from positive interactions to tension and conflict influenced by staff biases and differing perceptions of the PIC. Effective communication between police and ED nurses is critical for accurate clinical evaluation and decision-making, yet often hindered by inconsistent information transfer and procedural gaps. Role confusion, divergent philosophies between police officers and ED nurses, and ‘grey zones’ further complicate transfers, emphasizing the need for clear communication and mutual understanding to ensure safe and effective care. The results underscore the need to ameliorate ED transfers through enhanced joint training for police officers and nurses, establishing hospital-precinct committees, and other intersectoral initiatives to promote collaboration. Such measures are essential to ensure effective and compassionate care of people in crisis while prioritizing safety for all involved. [ABSTRACT FROM AUTHOR]

Introduction Design Methods Results Conclusion Protocol Registration Accurate and rapid triage can reduce undertriage and overtriage, which may improve emergency department flow. This study aimed to identify the effects of a prospective study applying artificial intelligence‐based triage in the clinical field.Systematic review of prospective studies.CINAHL, Cochrane, Embase, PubMed, ProQuest, KISS, and RISS were searched from March 9 to April 18, 2023. All the data were screened independently by three researchers. The review included prospective studies that measured outcomes related to AI‐based triage. Three researchers extracted data and independently assessed the study's quality using the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) protocol.Of 1633 studies, seven met the inclusion criteria for this review. Most studies applied machine learning to triage, and only one was based on fuzzy logic. All studies, except one, utilized a five‐level triage classification system. Regarding model performance, the feed‐forward neural network achieved a precision of 33% in the level 1 classification, whereas the fuzzy clip model achieved a specificity and sensitivity of 99%. The accuracy of the model's triage prediction ranged from 80.5% to 99.1%. Other outcomes included time reduction, overtriage and undertriage checks, mistriage factors, and patient care and prognosis outcomes.Triage nurses in the emergency department can use artificial intelligence as a supportive means for triage. Ultimately, we hope to be a resource that can reduce undertriage and positively affect patient health.We have registered our review in PROSPERO (registration number: CRD 42023415232). [ABSTRACT FROM AUTHOR]

This study determined the level of competencies of the nurses in the emergency room. It tackled their age, civil status, highest educational attainment, position, number of years in service, and number of relevant trainings, and earning average income. It tackled the level of competency along the 11 core competency standards. The study utilized the descriptive research design and utilized a survey questionnaire as the main tool in gathering data. Several statistical tools were used like frequency and percentage, weighted mean, t-test, and ANOVA (Analysis of Variance). The nurse respondents were young adults, married, Bachelor's degree holder, staff nurses, had been in the service for more than 5 years, had undergone few numbers of trainings, and earn an income of below P20,000 a month. The nurses were all competent in the 11 core competencies however the highest in their competency level is along legal responsibility, ethico-moral responsibility, and collaboration and teamwork and lowest on health education and quality improvement. Significant differences were noted along safe and quality nursing practice, quality improvement, record management, communication, and collaboration and teamwork. Significant positive R-values are shown between civil status and number for years in services with clinical competency in health education. This indicates that the longer the length of service of the married emergency room nurse, the higher is their clinical competency in health education. [ABSTRACT FROM AUTHOR]

Background: The relationship between a nurse and a patient is a key part of nursing that can impact how happy the patient is with the care they receive. It appears that the nurse's mental health can also affect this connection. However, there is little research on this topic. So, the aim of the present study was to determine the correlation of nurse's mental health with nurse–patient relational care and nursing care satisfaction. Methods: A total of 532 nurses and 532 patients from 13 Level-III hospitals of Hubei province (China) completed a China Mental Health Survey, general information questionnaire, the Nursing Care Satisfaction Scale, and Relational Care Scale. Results: Age, nurse working years, and night shift last month were correlated with mental health score (r = -0.142, r = -0.150, r = 0.164, p < 0.05). Nurse's mental health was correlated with relational care score and nursing care satisfaction score (r = -0.177, r = -0.325, p < 0.05). Also, relational care score, patients age and gender were correlated with nursing care satisfaction score (r = 0.584 and r = 0.143, x2 = 11.636, p < 0.05). Descriptive information of nurses had a direct impact on nurses' mental health (direct effect = 0.612, 0.419–0.713). Nurses' mental health had a direct effect on relational care score (direct effect = 0.493, 0.298–0.428) and an indirect effect on nursing care satisfaction score (indirect effect = 0.051, 0.032–0.074). Relational care score and patient's descriptive information had also a direct effect on nursing care satisfaction score (direct effect = 0.232, 0.057–0.172 and 0.057, 0.347–0.493). Conclusion: This study showed that the better the mental health of nurses, the more patients feel satisfied with nursing services. [ABSTRACT FROM AUTHOR]

Aim Background Methods Results Discussion Conclusion Implications for nursing and health policy We evaluated Saudi Arabian nurses’ willingness to engage in nuclear and radiological disaster response.In the face of rising nuclear and radiological threats, it is essential that nurses are fully prepared to handle the health consequences of such emergencies. As frontline responders, nurses play a critical role in managing high‐stakes situations, making their readiness a key factor in ensuring public safety during these crises.A cross‐sectional survey was conducted among 612 registered nurses in Saudi Arabia. The survey used a structured questionnaire based on the theory of planned behavior, identifying behavioral intentions as the primary outcome and attitudes toward these behaviors, subjective norms, and perceived behavioral control as influencing factors. The data were analyzed using descriptive and inferential statistics.Most respondents lacked specialized training and reported strong behavioral intentions. Attitude and perceived behavioral control were key drivers of these behavioral intentions, with less impact from subjective norms. Behavioral intentions were also shaped by education, the perceived likelihood of nuclear and radiological emergencies in their region, peer influence, perceived self‐efficacy, and family concerns. Younger and married nurses showed significantly stronger behavioral intentions.Although most nurses lacked specialized training, their strong engagement intentions and positive responses to active learning and training indicate a desire to close this gap through further education. However, inadequate institutional support, trouble communicating with family, and concerns about personal radiation exposure emerged as potential barriers.Targeted educational initiatives and support systems are needed to enhance nurses’ confidence, competence, and willingness to engage in radiological and nuclear emergency scenarios.Policymakers should prioritize the development of specialized training programs and support mechanisms for nurses, ensuring they are adequately prepared to respond effectively to increasing radiological and nuclear threats. [ABSTRACT FROM AUTHOR]

The demands to nurses in the Emergency Room (ER) can lead to stress, potentially causing Burnout Syndrome. This may diminish the effectiveness of the nursing care provided to patients. This study aimed to explore the experience of Burnout Syndrome among nurses in the ER using a descriptive qualitative research design. Ten nurses from the ER participated in the study. All participants provided consistent answers, leading researchers to conclude data saturation through purposive sampling. In-depth interviews with a semi-structured format were conducted for data collection, and the Collaizi technique was employed for analysis. Findings revealed that nurses exhibited signs of Burnout Syndrome, such as physical, emotional, and mental exhaustion, while providing patient care, attributing this to the substantial workload. [ABSTRACT FROM AUTHOR]

The traditional method of monitoring hand hygiene (HH) based on specific indications does not ensure that HH is performed for all required indications during patient care. This study aimed to compare HH performance rates (HHPRs) based on specific indications versus overall patient care among nurses at a university hospital. The study retrospectively analyzed HH monitoring data for 1398 indications from 543 patients and 190 nurses. Observations were conducted continuously, tracking a single healthcare worker from before patient contact until the end of the contact within a 30‐min period. The indication‐based HHPR was found to be 89.1%, while the patient‐based HHPR was 78.1%. In the context of patient‐based HHPR, the lowest rates were observed among nurses in the emergency room (48.3%) and those with less than 1 year of work experience (66.7%). Moreover, the largest discrepancy between indication‐based and patient‐based HHPR was noted among emergency room nurses with less than 1 year of experience. This significant difference underscores the need for patient‐based HH monitoring, particularly for nurses in emergency settings and those with limited experience. [ABSTRACT FROM AUTHOR]

Purpose: To assess the knowledge and confidence level regarding the basic first-aid for treating epistaxis among medical staff, including nurses and physicians across various medical disciplines. The study focused three aspects of first aid management: location of digital pressure, head position and duration of pressure. Methods: The study involved 597 participants, categorized into five groups according to their specialties: emergency medicine, internal medicine, surgery, pediatrics, and community-based healthcare. A paper-based multiple-choice questionnaire assessed knowledge of managing epistaxis. Correct answers were determined from literature review and expert consensus. Results: Most medical staff showed poor knowledge regarding the preferred site for applying digital pressure in epistaxis management. For head position, pediatricians and internal medicine physicians were most accurate (79.4% and 64.8%, respectively, p < 0.01), and nurses from the emergency department outperformed nurses from other disciplines; internal medicine, surgery, pediatrics, and community-based healthcare (61.1%, 41.5%, 43.5%, 60%, 45.6%, respectively, p < 0.05). While most medical staff were unfamiliar with the recommended duration for applying pressure on the nose, pediatricians and community clinic physicians were most accurate (47.1% and 46.0%, respectively, p < 0.01), while ER physicians were least accurate (14.9%, p < 0.01). Interestingly, a negative correlation was found between years of work experience and reported confidence level in managing epistaxis. Conclusions: Our findings indicate a significant lack of knowledge concerning epistaxis first-aid among medical staff, particularly physicians in emergency departments. This finding highlights the pressing need for education and training to enhance healthcare workers' knowledge in managing epistaxis. [ABSTRACT FROM AUTHOR]

Why you should read this article: • To refresh your knowledge of the aims of and processes involved in triage • To enhance your understanding of the strategies you can use to make triage as safe and effective as possible for patients and staff • To contribute towards revalidation as part of your 35 hours of CPD (UK readers) • To contribute towards your professional development and local registration renewal requirements (non-UK readers). Triage is the first stage of a patient’s journey through the emergency department and is used to determine patient acuity. There is no single quantifiable metric for determining acuity, which amalgamates different factors that are more or less relevant depending on the patient’s presentation. This article explains the aim and process of triage and how nurses can ensure the process is effective and safe. The author discusses strategies nurses can use to mitigate uncertainty and to make their acuity assessments rapid, targeted and comprehensive. The author also highlights triage safety considerations, including infection prevention and control and the physical and emotional safety of patients and staff. [ABSTRACT FROM AUTHOR]

Why you should read this article: • To consider the use of body-worn cameras for nurses in EDs in response to increasing violent and aggressive incidents • To read about one hospital’s experience of introducing body-worn cameras for ED nurses • To recognise the importance of testing and evaluating the use of body-worn cameras before full implementation of such equipment. Nurses and other emergency department (ED) staff often experience verbal and physical abuse as part of their everyday work. Body-worn cameras are one tool that ED staff can use to try to reduce workplace violence and abuse and have been shown to be effective in other healthcare environments, such as mental health units. This article describes a pilot service evaluation which used a survey to assess the effectiveness of using body-worn cameras for staff in the author’s ED. Findings suggest that nurses believed the cameras provided support when they were confronted by abusive or aggressive patients or relatives and in some instances diffused potentially violent situations. [ABSTRACT FROM AUTHOR]

Aim: This study was carried out to investigate the perception of the main competencies of disaster management in Iranian emergency department nurses in 2023 in hospitals affiliated with Kermanshah University of Medical Sciences. The present study was conducted to explore the perceived core disaster competencies in nurses of hospitals affiliated with Kermanshah University of Medical Sciences in 2023. Background: Due to the rise in natural disasters, their escalating severity and associated regulatory response necessitate a closer look at the preparedness and core competencies of nursing personnel. The main competencies of nurses are necessary to deal with disasters in unexpected events, and they are expected to use their professional expertise to provide the required nursing services to reduce the risks caused by disasters. Methodology: This descriptive‐analytical study was conducted cross‐sectionally between May and September 2023. In the study, a sample of 384 nurses working in the departments of four hospitals affiliated with Kermanshah University of Medical Sciences was selected through a random stratification. The data collection instrument was a 45‐item scale of nursesʼ perceived core competencies (NPDCC) in handling disasters. The data were analyzed using the Mann–Whitney U‐test, Kruskal–Wallis test, and independent samples t‐test. The significance level was set at 5%. Results: The mean total score of perceived core disaster competencies was 139.11 ± 37.65. The technical skills subscale got the highest score (51.81 ± 11.28) and critical thinking skills received the lowest (9.74 ± 3.92). Also, "technical skills" had the highest average and "critical thinking skills" had the lowest average in all three age groups. The results found a significant difference between the scores of nurses in perceived core disaster competencies in age groups, work environments, education degrees, marital statuses, and experiences of attending disaster workshops (p ≤ 0.05). Conclusions: The results showed that nurses had different levels of core disaster competencies in the department. There are gaps in the core disaster nursing competencies that need to be filled. Nursing managers should consistently evaluate the core nursing competencies to achieve efficacious disaster preparedness. To this aim, it is recommended that authorities implement training courses and programs to enhance the preparedness of nurses in responding to disasters. [ABSTRACT FROM AUTHOR]

Background: Armed conflicts are usually associated with high mortality and morbidity rates, with unpredictable workload, injuries and illnesses. Identifying emergency nurses' views of the core competencies required to enable them to work effectively in hospitals in areas of armed conflict is critical. It is important to inform the requisite standards of care and facilitate the translation of knowledge into safe, quality care. Aim: The aim of this study was to identify emergency nurses' perceptions of core competencies necessary to work in hospitals in the context of armed conflict. Method: A descriptive qualitative phase of a mixed‐method study using semi‐structured interviews with participants was conducted from June to July 2019. The COREQ guideline for reporting qualitative research was followed. Findings: A sample of 15 participants was interviewed. The participant perceptions provided a different perspective of core competencies required for emergency nurses in the context of armed conflict, culminating in four main areas: (i) personal preparedness , (ii) leadership, (iii) communication and (iv) assessment and intervention. Conclusion: This study identified emergency nurses' perceptions of their core competencies. Personal preparedness, leadership, communication, assessment and intervention were identified as contributing to calmness of character, confidence in care and cultural awareness for care in this setting and were essential for them to work effectively when managing victims of armed conflict in emergency departments. Implications for nursing practice and health policy: The findings of this study are important and novel because the researchers sought the perspectives of emergency nurses who have experience in receiving patients from armed conflict firsthand. The findings will inform policymakers in those settings regarding standard of care, education and drills for hospital nurses in optimizing armed conflict care response outcomes. [ABSTRACT FROM AUTHOR]

Doctors and nurses suffer different mental health conditions following traumatic incidents. We systematically synthesized existing evidence on the prevalence of anxiety, depression, and post-traumatic stress disorder (PTSD) and their associated risk factors among doctors and nurses following mass casualty incidents (MCIs). Systematic review. Seven databases were searched (2010–2022) with peer-reviewed articles in English using the predefined keywords. Two reviewers screened the titles, abstracts, and full texts using the eligibility criteria and extracted data independently. We used the National Institutes of Health Quality Assessment Tools (NIH-QAT) and the Critical Appraisal Skills Programme checklist (CASP) to measure the quality appraisal of the included studies. A total of 5170 articles were retrieved, and 2512 articles were assessed by title and abstract (53 were eligible for full-text review). Finally, we included 19 studies. Most were assessed as of fair quality with a considerable risk of bias. PTSD was the highest-reported mental health condition. Nurses reported higher mental conditions, particularly PTSD. Two sets of risk factors (personal and workplace) are associated with anxiety, depression, and PTSD were found. MCIs have a significant impact on the mental health outcomes of emergency health workers. Preventive measures should be designed considering the high-risk group, personal, and organizational risk factors of mental health outcomes. [ABSTRACT FROM AUTHOR]

Background: The pulse oximeter is a simple, cost‐effective and reliable device for estimating arterial blood oxygen saturation. Nurses are required to be knowledgeable in pulse oximeter use. Little is known about nurses' knowledge of pulse oximetry in the Middle East region. Aim: To assess nurses' knowledge of pulse oximetry among emergency and critical care nurses and to explore predictors of nurses' knowledge of pulse oximetry. Study Design: This is the second part of data analysis that was first presented in the 'proficiency in ECG' study conducted in Jordan. The original data used for both parts of analysis included a questionnaire with two tests; a knowledge of pulse oximeter test and an ECG proficiency test. Participants were asked to take, alone without receiving assistance, both tests. In this study, the second part of analysis, the focus is on the pulse oximeter test. The test consisted of 21 items that emphasize knowledge of basic physiological principles as well as device limitations; whether technical or interpretation. The test administration procedure also included asking participants to provide socio‐demographic variables. In the original data collected in both parts of analysis, nurses working in the emergency department, cardiac care units or intensive care units from nine different hospitals (1 governmental, 6 private and 2 educational) and holding a bachelor degree or higher were asked to participate. Results: The total number of participating nurses was 210; out of 247 approached (response rate, 85%). The mean score in the nurses' knowledge of pulse oximetry test was 12.33 out of 21, corresponding to 58.7%. The clinical area currently working in predicted the knowledge of pulse oximetry test score after controlling for all other variables. Emergency department and intensive care unit nurses scored higher than cardiac care unit nurses by 1.86 and 1.63 points respectively (58.2% and 60% respectively). Conclusion: Nurses consistently report inadequate education and training concerning pulse oximeter use and interpretation. A revision to hospital in‐service education seminars and undergraduate nurses' curriculum to assure adequate preparation is needed. Relevance to Clinical Practice: Knowledge of pulse oximetry among emergency and critical care nurses is modest. This is a challenge worldwide. Predictors of nurses' knowledge of pulse oximetery are the clinical area currently working in (ICU and ED nurses are more knowledgeable than CCU nurses), proficiency in electrocardiography and taking an advanced cardiac life support course. [ABSTRACT FROM AUTHOR]

Purpose The fast-paced environment of the emergency department (ED), with frequent admissions, discharges, and transfers, poses a challenge for pharmacy departments to effectively distribute and store medications. The purpose of this study is to propose a unique workflow of patient-specific medication delivery to the ED from a hospital pharmacy to reduce the number of missing medications resulting in medication messages and redispenses. Methods The medication delivery workflow proposed in this study consists of batching the preparation and distribution of patient-specific medications sent from the pharmacy to the ED in the 1 to 2 hours prior to their administration time. Chi-square analysis was completed to compare medication redispenses and "missing medication" messages before and after the intervention, with the significance level set at P < 0.05. Results The percentage of redispensed medications was effectively decreased following implementation of the workflow change from 21.6% to 9.2% (P < 0.001), with unit doses having the greatest reduction (25.8% vs 6.1%, P < 0.001). Benefits of this workflow change were also illustrated through a reduction in the percentage of missing-medication messages sent by nursing staff from 97.7% to 93.9% (P < 0.001). Conclusion This study showed that implementation of standard, hourly batches of medications dispensed from the pharmacy to the ED resulted in a significant reduction in the total percentage of redispensed medications and missing-medication messages. The overall reduction in redispensed medications as a result of this innovative workflow change not only benefited nursing and pharmacy staff but can reduce medication waste and improve patient care through timely administration of medications. [ABSTRACT FROM AUTHOR]

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. 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. 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. 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. [ABSTRACT FROM AUTHOR]

Hospitals frequently introduce new medical devices. However, the process of clinicians adapting to these new vascular access devices has not been well explored. The study aims to explore clinicians' experience with the insertion of a new guidewire peripheral intravenous catheter (PIVC) introduced in the emergency department (ED) setting. The study was conducted at two EDs in Queensland, Australia, utilising a qualitative explorative approach. Interviews were conducted with guidewire PIVC inserters, including ED doctors and nurses, and field notes were recorded by research nurses during insertions. Data analysis was performed using inductive content analysis, from which themes emerged. The study compiled interviews from 10 participants and field notes from 191 observation episodes. Five key themes emerged, including diverse experience, barriers related to the learning process, factors influencing insertion success, and recommendations to enhance clinicians' acceptance. These themes suggest that the key to successful adoption by clinicians lies in designing user-friendly devices that align with familiar insertion techniques, facilitating a smooth transfer of learning. Clinician adaptation to new devices is vital for optimal patient care. Emergency nurses and doctors prefer simplicity, safety, and familiarity when it comes to new devices. Providing comprehensive device training with diverse training resources, hands-on sessions, and continuous expert support, is likely to enhance clinician acceptance and the successful adoption of new devices in ED settings. [ABSTRACT FROM AUTHOR]

Registered nurses report the experience of delivering end of life care in emergency departments as challenging. The study aim was to understand what it is like to be a registered nurse providing end of life care to an older person in the emergency department. A hermeneutic phenomenological study was conducted in 2021, using semi-structured interviews with seven registered nurses across two hospital emergency departments in Queensland, Australia. Thematic analysis of participants' narratives was undertaken. Seven registered nurses were interviewed; six of whom were women. Participant's experience working in the emergency department setting ranged from 2.5–20 years. Two themes were developed through analysis: (i) Presenting the patient as a dying person; and (ii) Mentalising death in the context of the emergency department. Nurses providing end of life care in the emergency department draw upon their personal and aesthetic knowing to present the dying patient as a person. The way death is mentalised suggests the need to develop empirical knowing about ageing and supportive medical care and ethical knowing to assist with the transition from resuscitation to end of life care. Shared clinical reflection on death in the emergency department, facilitated by experts in ageing and end of life care is recommended. [ABSTRACT FROM AUTHOR]