Emergency Department Nurses Research Articles

The role of mental health in the relationship between nursing care satisfaction with nurse-patient relational care in Chinese emergency department nursing.

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. 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. 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). This study showed that the better the mental health of nurses, the more patients feel satisfied with nursing services.

Implementing Triage-Bot: Supporting the Current Practice for Triage Nurses.

In Canada, emergency departments (ED) have 15.1 million unscheduled visits every year; this has been suggested to indicate that patients rely on ED to address the gaps experienced by 6.5 million Canadians who lack a primary care provider. When this large number of visits is coupled with a predicted shortage of 100,000 nurses in Canada by 2030, ED can be expected to face resource limitations, which highlights the importance of triage systems as a source of immediate support. Technology that incorporates innovative analytical methods, automation of routine, and efficient processing can be leveraged to enhance patient outcomes, streamline clinical processes, and improve the overall quality and efficiency of healthcare delivery. This paper aims to highlight how the Triage-Bot, a proposed AI system, can assist ED nurses when triaging patients. The Triage-Bot system is based on the Canadian Triage and Acuity Scale (CTAS), which currently serves as a standardized and highly effective tool for prioritizing patient care in emergency departments across the country. Pre-set and open-ended questions are asked using voice and video, allowing patients to describe their health concerns and conditions. Triage-Bot automatically measures the following vital signs: heart rate (HR), heart rate variability (HRV), oxygen saturation (SpO2), respiratory rate (RR), blood pressure (BP), blood glucose (BG), and stress. The system uses artificial intelligence models, particularly those with a deep learning approach that simultaneously analyzes both the user's facial expression and voice tone. Implementation: A systematic review addressed the implications of AI in nursing and concluded that it could contribute to patient care by providing personalized instructions and/or remotely monitoring patients. The Triage-Bot system can be implemented in healthcare facilities, such as emergency department waiting rooms. The information it collects can then be added to a patient's health records to support nurses in assessing the severity of each patient's condition. Limitations: If the system is accessed without a nurse's guidance, it is imperative that the user receives information regarding when to visit a healthcare provider or ED. Continuous improvements in Triage-Bot's accessibility for patients with varying abilities are required to ensure that the system remains user-friendly during times of illness. The voice and text interaction can also be influenced by a user's understanding of language, culture, and age-related factors.

Correlation between moral distress and compassion fatigue in the emergency department nurses: A cross-sectional study from Ardabil Province, Iran

Correlation between moral distress and compassion fatigue in the emergency department nurses: A cross-sectional study from Ardabil Province, Iran

Assessing triage efficiency in Italy: a comparative study using simulated cases among nurses.

Emergency Departments (EDs) across Italy use different triage systems, which vary from region to region. This study aimed to assess whether nurses working in different EDs assign triage codes in a similar and standardized manner. A multicenter observational simulation study involved the EDs of Bolzano Hospital, Merano Hospital, Pisa University Hospital, and Rovereto Hospital. All participating nurses were given 30 simulated clinical cases (vignettes) and asked to assign triage codes according to the triage systems used in their EDs. Subsequently, we assessed inter-rater agreement and evaluated if code assignment had different performance among hospitals in relation to different clinical outcomes. Eighty-seven nurses participated in this study. There was marked variation in assigned triage codes both across hospitals and among individual operators. The kappa values for inter-rater agreement were 0.632 for Bolzano Hospital, 0.589 for Merano Hospital, 0.464 for Pisa University Hospital, and 0.574 for Rovereto Hospital. Sensitivity and specificity levels varied considerably for the same outcomes when comparing different hospitals. There is a high degree of subjectivity in triage code assignment by ED nurses. In the interest of equitable care for patients, this variability within the same country is hardly acceptable.

A workplace violence prevention program targeting high-risk patients in emergency departments.

Patient violence in emergency departments (EDs) may be prevented with proactive mitigation measures targeting potentially violent patients. We aimed to evaluate the effects of two interventions guided by a validated risk-assessment tool. A prospective interventional study was conducted among patients ≥10 years who visited two EDs in Michigan, USA, from October 2022 to August 2023. During triage, the ED nurses completed the Aggressive Behavior Risk Assessment Tool for EDs (ABRAT-ED) to identify high-risk patients. Following the baseline observational period, interventions were implemented stepwise for the high-risk patients: phase 1 period with signage posting and phase 2 period with a proactive Behavioral Emergency Response Team (BERT) huddle added to the signage posting. Before ED disposition, any violent events and their severities were documented. The data were retrieved retrospectively after the study was completed. Of 77,424 evaluable patients, 546 had ≥1 violent event. The violent event rates were 0.93%, 0.68%, and 0.62% for baseline, phase 1, and phase 2, respectively. The relative risk of violent events for phase 1 compared to the baseline was 0.73 (95% confidence interval [CI]: 0.59‒0.90; p=0.003). The relative risk for phase 2 compared to phase 1 was 0.92 (95% CI: 0.76‒1.12; p=0.418). The use of signage posting as a persistent visual cue for high-risk patients identified by ABRAT-ED appears to be effective in reducing the overall violent event rates. However, adding proactive BERT huddle to signage posting showed no significant reduction in the violent event rates compared to signage posting alone.

Nurse perspectives on the assessment of emergency medicine residents: A qualitative study.

Multisource and 360-degree feedback are emerging methods in the medical education assessment literature. Nursing feedback in particular has been identified as a point of emphasis regarding what medical education leadership would most value for incorporating into their evaluations. There is no currently accepted tool for multisource feedback in the emergency department (ED). To answer this call, we conducted a qualitative study to elucidate nurse perspectives on evaluation of emergency medicine residents. We conducted individual semistructured interviews of ED nurses with experience working alongside residents via volunteer recruitment. Transcripts were coded independently by each author and then reviewed collaboratively to resolve differences. Codes were created by inductive thematic analysis and subsequently underwent constant comparison and classical content analysis. Recruitment continued until analysis of transcripts showed thematic saturation. We organized the interview transcript into chunks of information, arranging 407 quotes from the 10 interview transcripts into 17 codes and six themes regarding observable resident behaviors. Representative quotes and exemplar cases added detailed description to the meaning of these codes. The identified themes for observable resident behaviors included "general communication style," "medical knowledge," "efficiency," "patient communication," "nurse communication," and "professionalism." An additional 13 codes addressed the themes of barriers and catalysts for feedback. The identified themes on observable resident behaviors aligned well with prior literature and with the Accreditation Council for Graduate Medical Education (ACGME) Milestones. The interviews also highlighted nurse perspectives on barriers and catalysts for feedback that would be useful to incorporate into the design of an assessment tool.

Quality of life of emergency department nurses in pediatric and general hospitals in Greece: A cross sectional study

Introduction: The Emergency Department (ED) is a quite stressful workplace for nurses, affecting their quality of life. The existence of factors that affect the quality of life of ED nurses in daily clinical practice, leads to exhausted nurses. Consequently, there is a need to find the factors and the implementation of interventions that will improve the quality of life of nurses. Purpose: To investigate the factors that affect the quality of life of nurses in children's and adult hospitals. Method: The sample of this cross-sectional study consisted of ED nurses in children's and adult hospitals in Greece. To assess the nurses' quality of life, the WHOQOL-BREF questionnaire was used for the ED nurses. Analysis was done with IBM SPSS 26.0. A value of p&lt;0.05 was considered as the level of significance and all statistical tests were two-tailed. Results: Study population included 210 nurses. No statistical significance was found for the relationship between pediatric ED nurses and adult ED nurses regarding their quality of life, sleep, and fatigue. However, a statistically significant relationship was found regarding social relationships tending to a better score in pediatric nurses compared to adults (p=0.011). In all five dimensions of life evaluated by the tool, the quality of life of the nurses in our sample was at moderate levels (Mean-General=69.32, Mean-Physical health=64.70, Mean-Psychological health=67.85, Mean-social relations=69.01 and Mean-Environment =57.60). Conclusion: One or more factors are sufficient to affect or have an impact on the quality of life, sleep completeness and fatigue levels of ED nurses.

Identifying the obstacles facing emergency nurses regarding treating CTAS1 and CTAS2 in Saudi Arabia

BackgroundEmergency nurses play a pivotal role in delivering efficient emergency healthcare, yet they often encounter numerous challenges, especially while managing life-threatening cases, impacting both their well-being and patient satisfaction. This study seeks to identify the prevalent challenges faced by these nurses in Saudi hospitals when handling Canadian Triage and Acuity Scale (CTAS1 and CTAS2) cases, with the aim of mitigating or managing these issues in the future.MethodsThis study incorporated a mixed-method approach to identify obstacles in Emergency Department (ED) nursing treatment of CTAS1 and CTAS2 cases in two major Saudi Arabian hospitals. The research began with qualitative focus group interviews with expert ED nurses, followed by a quantitative survey to measure and explore relationships among the qualitative findings. Data analysis leveraged qualitative thematic analysis and principal component analysis, ensuring rigorous examination and validation of data to drive meaningful conclusions.FindingsFrom expert interviews, key challenges for emergency nurses were identified, including resource management, communication, training compliance, and psychological factors. A survey of 172 nurses further distilled these into five major issues: patient care management, handling critical cases, administration support, patient care delay, and stress from patients’ families.ConclusionThrough a mixed-method approach, this study pinpoints five pivotal challenges confronting emergency nurses in Saudi hospitals. These encompass difficulties in patient care management, the psychological toll of handling critical cases, inadequate administrative support, delays due to extended patient stays, and the stress induced by the presence of patients’ families, all of which significantly impede emergency department efficiency and compromise nurse well-being.

Optimization Automates Emergency Department Nurse Scheduling at Hartford Hospital

A collaboration between Hartford Hospital, MIT, and Dynamic Ideas LLC optimizes nurse staffing in emergency department using a two-phase optimization approach. We developed and implemented robust optimization models and automated scheduling software, reducing staffing costs by 5%–8%, enhancing patient care coverage by 8%–25%. This streamlined process is projected to save approximately $720,000 annually, replacing a labor-intensive scheduling method previously in place.

The accuracy of predicting hospital admission by emergency medical service and emergency department personnel compared to the prehospital MEWS: a prospective multicenter study

IntroductionOvercrowding in the emergency department (ED) is a global problem. Early and accurate recognition of a patient’s disposition could limit time spend at the ED and thus improve throughput and quality of care provided. This study aims to compare the accuracy among healthcare providers and the prehospital Modified Early Warning Score (MEWS) in predicting the requirement for hospital admission.MethodsA prospective, observational, multi-centre study was performed including adult patients brought to the ED by ambulance. Involved Emergency Medical Service (EMS) personnel, ED nurses and physicians were asked to predict the need for hospital admission using a structured questionnaire. Primary endpoint was the comparison between the accuracy of healthcare providers and prehospital MEWS in predicting patients’ need for hospital admission.ResultsIn total 798 patients were included of whom 393 (49.2%) were admitted to the hospital. Sensitivity of predicting hospital admission varied from 80.0 to 91.9%, with physicians predicting hospital admission significantly more accurately than EMS and ED nurses (p < 0.001). Specificity ranged from 56.4 to 67.0%. All healthcare providers outperformed MEWS ≥ 3 score on predicting hospital admission (sensitivity 80.0-91.9% versus 44.0%; all p < 0.001). Predictions for ward admissions specifically were significantly more accurate than MEWS (specificity 94.7–95.9% versus 60.6%, all p < 0.001).ConclusionsHealthcare providers can accurately predict the need for hospital admission, and all providers outperformed the MEWS score.

Investigating perceived core disaster competencies of nurses in Iran: A case study of northwest hospitals.

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. 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. 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 nurses' 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%. 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). 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.

Reducing Blood Culture Contamination in Adult Patients with Cancer Presenting to the Emergency Department

Background: Infection is one of the most common complications of cancer and cancer treatment. Most patients admitted for fever or infection come through the Emergency Department (ED), which is a primary site for blood culture collection. Contamination of blood cultures complicates the diagnoses, compromises quality of care, leads to unnecessary antibiotic exposure and increases financial burdens. It may also lead to unnecessary removal of central venous access devices or delay of critical therapy or procedures. At our institution, the contamination rate of blood cultures drawn in the ED was over twice that of the remainder of the hospital (2.8 versus 0.8), prompting this quality improvement project. Unlike on hospital floors, nurses, instead of phlebotomists, draw most blood cultures due to the urgency of managing suspected sepsis. Our aim was to decrease the ED contamination rate by 20 percent after the first PDSA cycle, and ultimately bring it on par with the remainder of the hospital. Methods: First, we compared ED contamination rates versus other hospital inpatient floors and outpatient centers over a three-month period. We then evaluated the contamination rates of ED nurses versus ED phlebotomists and peripheral versus central line blood draws. Process mapping and fishbone analysis helped identify practices contributing to higher contamination rates. Key drivers of these practices were diagrammed, and potential interventions were ranked on a prioritization matrix. Results: We identified use of alcohol rather than chlorhexidine swabs for peripheral disinfection and inconsistent techniques of blood draw by nurses as critical contributors to increased contamination rates in the ED. Our intervention was creating premade blood culture kits promoting the use of chlorhexidine swabs through availability and easy access in the fast-paced ED environment. Ten cubic centimeter (cc) syringes in the kits encouraged withdrawal of adequate blood samples in compliance with the 7-10 cc guideline. Designated nursing team leaders checked off ED nurses at the bedside, implementing education and adherence in using the blood culture collection kits. The average number of blood cultures in the emergency department was 1,400. A reduction in blood culture contamination from 2.46 percent to 1.89 percent was seen after two months. Conclusions: A guideline-driven, standardized blood culture collection process followed by ED nurses is vital to reducing blood culture contamination. Chlorhexidine is necessary to maintain the lowest contamination rates. Readily available premade blood culture kits improve compliance with materials and techniques associated with best practices.

Just-in-Time Video Using QR Codes: An Approach to Pediatric Trauma Nursing Education.

High acuity trauma and patients in cardiopulmonary arrest are not frequently seen in all pediatric Level I trauma centers. Yet, nurses are required to manage these patients in fast-paced, high-pressure environments. This project aims to develop and evaluate an education program for high-risk, low-volume equipment and skills in the pediatric emergency department setting. This is a pre- and post-quality improvement study conducted in a Northeastern United States pediatric Level I trauma center. Emergency department nurses were invited to view videos detailing high-risk, low-volume equipment use. For the convenience of access, Quick Response (QR) codes linked to the videos were placed on each piece of equipment reviewed. General self-efficacy and levels of self-efficacy in using the equipment were assessed before the intervention and again after 4 weeks from January to February 2023. A total of 43 pediatric emergency nurses participated in the education. The mean aggregate general self-efficacy score was 32.93. Mean scores in all areas (Level 1 rapid infuser, fluid warmer, blood administration, and securing an endotracheal tube) improved after the intervention. Easily accessible, brief refresher videos linked to QR codes in the pediatric emergency department can help empower nurses who need to use high-risk, low-volume equipment.

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

To determine and describe what interventions exist to improve nurse-family communication during the waiting period of an emergency department visit. 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. Scoping Review. 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. Medline, CINAHL, EMBASE, PsychInfo and grey literature were searched on 3 August 2022. 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. 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. 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. PRISMA-ScR. Protocol has been registered with the Open Science Framework, registration number 10.17605/OSF.IO/ETSYB. No patient or public contribution.

Is palliative care a utopia for older patients with organ failure, dementia or frailty? A qualitative study through the prism of emergency department admission

BackgroundNearly three out of four older people will use the emergency department (ED) during their last year of life. However, most of them do not benefit from palliative care. Providing palliative care is a real challenge for ED clinicians who are trained in acute, life-saving medicine. Our aim is to understand the ED’s role in providing palliative care for this population.MethodsWe designed a qualitative study based on 1) interviews – conducted with older patients (≥ 75 years) with a palliative profile and their informal caregivers – and 2) focus groups – conducted with ED and primary care nurses and physicians. Palliative profiles were defined by the Supportive and Palliative Indicators tool (SPICT). Qualitative data was collected in French-speaking Belgium between July 2021 and July 2022. We used a constant inductive and comparative analysis.ResultsFive older patients with a palliative profile, four informal caregivers, 55 primary and ED caregivers participated in this study. A priori, the participants did not perceive any role for the ED in palliative care. In fact, there is widespread discomfort with caring for older patients and providing palliative care. This is explained by multiple areas of tensions. Palliative care is an approach fraught with pitfalls, i.e.: knowledge and know-how gaps, their implementation depends on patients’(co)morbidity profile and professional values, experiences and type of practice. In ED, there are constant tensions between emergency and palliative care requirements, i.e.: performance, clockwork and needs for standardised procedures versus relational care, time and diversity of palliative care projects. However, even though the ED’s role in palliative care is not recognised at first sight, we highlighted four roles assumed by ED caregivers: 1) Investigator, 2) Objectifier, 3) Palliative care provider, and 4) Decision-maker on the intensity of care. A common perception among participants was that ED caregivers can assist in the early identification of patients with a palliative profile.ConclusionsCurrently, there is widespread discomfort regarding ED caregivers caring for older patients and providing palliative care. Nonetheless, ED caregivers play four roles in palliative care for older patients. In the future, ED caregivers might also perform the role of early identifier.

Subjective Study on Pediatric Emergency Department Nurses′ Perceptions of Urgency Using Q Methodology

PurposeIn the emergency department (ED), triage significantly impacts patient safety. Therefore, triage nurses must make decisions accurately and timeously. This study aims to investigate how South Korean pediatric emergency nurses perceive urgency and classify severity using the Q methodology, which examines individuals’ subjectivity. MethodsWe collected 84 statements from a Q population based on a literature review and interviews, and selected 33 Q samples. The P samples included 30 pediatric emergency nurses at a Seoul tertiary-care hospital. The principal component factor analysis method was employed to analyze data using the PC-QUANL program. ResultsFour urgency perception types were identified among pediatric ED nurses. Type 1: “Experiential coping”; Type 2: “Careful reasoning”; Type 3: “Patient-centered thinking”; and Type 4: “Intuitive prediction.” These types appear to be an integrated process of knowledge and clinical experience that considers children’s characteristics and developmental stages. ConclusionsThis study may serve as a basis for future education to improve pediatric ED nurses’ urgency judgment and severity classification skills.

Current state and influencing factors in airbag management among emergency department nurses: A multicenter study

BACKGROUND The emergency department (ED) plays a critical role in establishing artificial airways and implementing mechanical ventilation. Managing airbags in the ED presents a prime opportunity to mitigate the risk of ventilator-associated pneumonia. Nonetheless, existing research has largely overlooked the understanding, beliefs, and practical dimensions of airway airbag management among ED nurses, with a predominant focus on intensive care unit nurses. AIM To investigate the current status of ED nurses' knowledge, beliefs, and practical behaviors in airway airbag management and their influencing factors. METHODS A survey was conducted from July 10th to August 10th, 2023, using convenience sampling on 520 ED nurses from 15 tertiary hospitals and 5 sary hospitals in Shanghai. Pathway analysis was utilized to analyze the influencing factors. RESULTS The scores for ED nurses' airway airbag management knowledge were 60.26 ± 23.00, belief was 88.65 ± 13.36, and behavior was 75.10 ± 19.84. The main influencing factors of airbag management knowledge included participation in specialized nurse or mechanical ventilation training, department, and work experience in the department. Influencing factors of airbag management belief comprised knowledge, department, and participation in specialized nurse or mechanical ventilation training. Primary influencing factors of airbag management behavior included knowledge, belief, department, participation in specialized nurse or mechanical ventilation training, and professional title. The belief in airbag management among ED nurses acted as a partial mediator between knowledge and behavior, with a total effect value of 0.513, and an indirect effect of 0.085, constituting 16.6% of the total effect. CONCLUSION ED nurses exhibit a positive attitude toward airbag management with relatively standardized practices, yet there remains room for improvement in their knowledge levels. Nursing managers should implement interventions tailored to the characteristics of ED nurses' airbag management knowledge, beliefs, and practices to enhance their airbag management proficiency.

Comparison of the correlation between moral sensitivity and clinical competence in emergency and intensive care nurses: A cross-sectional-correlation study

IntroductionNurses’ sensitivity to moral issues, especially in emergency and intensive care units is essential for providing complex nursing care. Therefore, the present study aimed to determine the correlation between moral sensitivity and clinical competence in emergency and intensive care nurses. MethodsThe present multi-center cross-sectional correlational study was conducted in 2022 on 180 nurses in five emergency departments and four intensive care units of general hospitals affiliated to Semnan University of Medical sciences. The study tools include a demographic questionnaire, 25 item Lutzen Moral Sensitivity Questionnaire (MSQ), and a standardized Competency Inventory for Registered Nurses (CIRN). Data were analyzed by mean, standard deviation and MANOVA, Pearson’s correlation coefficient test. ResultsThe two groups did not have significant differences in demographic characteristics (p < 0.05). Majority of two emergency department nurses (83.9%) and Intensive care nurses (81.8%) had a moderate level of moral sensitivity. Also, clinical competence of majority of emergency department nurses (73.3%) and Intensive care nurses (75.8%) were in moderate level. There was significant positive relationship between moral sensitivity with Clinical competence in emergency department nurses (p ≤ 0.01, r = 0.61). No significant relationship was observed between moral sensitivity and the clinical competence of intensive care nurses (p > 0.05, r = 0.15). ConclusionsThere is need for improving the level of knowledge of nurses about moral principles and increasing moral sensitivity which can expand the components of clinical competence, especially in intensive care units.

Barriers and Facilitators of Using Clinical Guidelines for Cardiopulmonary Resuscitation from the Point of View of Emergency Department Nurses

Background: Cardiopulmonary resuscitation (CPR) is an emergency method to restore blood flow and spontaneous breathing in a person who has suffered cardiac arrest. Clinical practice guidelines are recommendations for nurses regarding the care of patients with specific conditions such as cardiac arrest. Accordingly, this study aimed to investigate the experiences of hospital emergency department nurses regarding the implementation of CPR guidelines. Methods: This study was conducted using a qualitative content analysis approach to investigate the experiences of 11 emergency department nurses. The participants were selected using purposive sampling. Data were collected through in-depth semi-structured interviews until saturation was reached. Data were analyzed using the content analysis method proposed by Graneheim and Lundman simultaneously with data collection. Results: Data analysis led to the identification of two main categories and ten subcategories. The categories included "barriers" with five subcategories (lack of knowledge and skills, low motivation, work pressure, lack of facilities, and lack of cooperation among the CPR team) and "facilitators" with five subcategories (facility development, teamwork, conscientiousness, adequate training, and effective supervision). Conclusion: Nursing managers can use nurses’ experiences to find appropriate ways to improve the use of clinical guidelines for CPR.

KNOWLEDGE AND ATTITUDES OF EMERGENCY NURSES REGARDING MEDICATION ERRORS

Medication errors in emergency departments can lead to significant patient harm. Understanding the knowledge and attitudes of healthcare professionals regarding these errors is critical for developing effective prevention strategies. Objective: To assess the knowledge and attitudes of emergency department nurses regarding medication errors. Methods: A descriptive, cross-sectional study was conducted in the Emergency Department of Sheikh Zayed Hospital, Rahim Yar Khan, from March 2023 to March 2024. A total of 150 nurses participated in the study. Data were collected using a 43-item questionnaire available in both Urdu and English. The questionnaire comprised six sections, focusing on knowledge, attitudes, and behaviors regarding medication errors. Responses were recorded on a Likert scale ranging from 1 (totally disagree) to 5 (totally agree). Statistical analysis included descriptive statistics to summarize the responses. Results: The mean age of the nurses was 43.6 ± 16.6 years, with 70% being female and 30% male. A majority of nurses agreed that medication errors can be reduced by calculating drug dosages beforehand (76%), using prepackaged drugs from the pharmacy (62%), and utilizing informative brochures and guidebooks (66%). Attitudes towards error reduction were positive, with recommendations for systematic training of healthcare staff (94%), raising awareness about risk management and prevention (90%), evaluating staff for eligibility (90%), and the importance of reporting and assessing errors (94%). Conclusion: Nurses in the emergency department possess sufficient knowledge and exhibit positive attitudes toward medication errors in the management and administration of IV drugs. However, ongoing training programs and awareness initiatives are essential to update nurses' knowledge and enhance patient safety.