Emergency Department Nurses Research Articles

Emergency department nurses’ intrinsic motivation: A bridge between empowering leadership and thriving at work

BackgroundThe relationship between empowering leadership, intrinsic motivation, and thriving at work among emergency department nurses is unclear. Thriving at work can raise employees’ job satisfaction and lower their tendency to quit. High workloads and unpleasant workplace experiences may result in emergency department nurses thriving less at work. It has been demonstrated that intrinsic motivation and empowering leadership are both linked to thriving at work in employees. AimTo investigate the relationship between empowering leadership and thriving at work among emergency department nurses, as well as the mediating function of intrinsic motivation in this relationship. MethodsThe 337 emergency department nurses were polled using general information questionnaire, Empowering Leadership Scale, Intrinsic Motivation Scale, and Thriving at Work Scale. Structural equation modeling was used for data analysis. ResultsPositive relationships existed between thriving at work and empowering leadership and intrinsic motivation. Intrinsic motivation was a mediator of the relationship between empowering leadership and thriving at work. ConclusionsIntrinsic motivation is one mechanism by which empowering leadership can influence emergency department nurses thriving at work. Nurse managers should adopt an empowering leadership style and take steps to activate the intrinsic motivation of emergency department nurses, thereby increasing nurses’ ability to thrive at work.

Exploring the Variability in Triage Nursing Workload: Insights From a Multicentre Observational Study.

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 Su403: Iterative Simulation to Optimize Mechanical CPR Device Application

Mechanical chest compression devices (MCDs) are commonly used for in-hospital and emergency department (ED) cardiac arrest resuscitation. Manufacturer guidelines and educational materials demonstrate that in the prehospital setting, MCDs can be deployed with an interruption in CPR of less than 15 seconds. No similar materials exist for the in-hospital environment, where observational studies have noted median CPR interruptions of up to 40 seconds for MCD deployment. With the integration of extracorporeal CPR (eCPR) into OHCA systems of care, the need to transfer patients with ongoing CPR to MCDs in the ED is growing. To develop a hospital-specific procedure for receiving a patient in cardiac arrest and deploying the MCD with minimal no-flow time. We used an iterative participatory design process to develop a procedure for receiving patients in cardiac arrest from Emergency Medical Services (EMS). Tasks included transferring a patient, replacing defibrillator pads, and deploying the hospital MCD with minimal no-flow time. Participants including ED physicians, nurses, and respiratory therapists performed a series of simulations using a high-fidelity manikin, resuscitation equipment, and an MCD. Simulations were followed by focused debriefings, participant-directed modification of the working procedure, and repeat simulation until participants expressed satisfaction with the procedure. Participant roles were shuffled after each round. The primary outcome was the duration of CPR interruption required to deploy the MCD; change in this time over successive iterations was assessed using a Wilcoxon signed-rank test. The final procedure described a sequence of steps and responsibilities that participants deemed efficient and reproducible. Through seven simulation-debriefing cycles, CPR interruption associated with MCD deployment decreased from 19 to 10 seconds (p = 0.033). The most common failure modes that participants corrected during modifications involved needed equipment that was out of reach, obstructed provider positioning, and poorly defined roles. On subsequent days, two additional groups of on-shift ED providers deployed the MCD in less than 15 seconds following the developed procedure. Using an iterative design process, we created an MCD deployment procedure that minimized CPR interruptions and was acceptable to hospital staff. This represents an effective, low-cost methodology to design a process for transfer of care during CPR and MCD deployment.

Identifying the Needs of Paediatric-Friendly Care in Emergency Department: A Delphi Study.

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.

Workplace Violence in a Large Urban Emergency Department

Workplace violence (WPV) against health care workers (HCWs) is common and likely underreported. Reliable data on the incidence of WPV and its impact on victims are lacking. To prospectively define the frequency of WPV against HCWs in the emergency department (ED), examine whether HCW demographics are associated with increased risk, and explore the impact of these events on HCWs. This cross-sectional study was conducted over 2 months in 2023 (August 28 to October 22, 2023) in the ED of a large, urban, academic safety net hospital in the US. Participants included ED physicians, nurses, and other HCWs, who were asked to complete a brief so-called shift sheet for every ED shift worked during the study period. WPV as recorded on shift sheets. The primary outcome was the number of events per shift. Events were coded for severity (types 1-5) and gender- or race and ethnicity-related bias. Shift sheets asked for the participant's demographics and whether they experienced verbal or physical abuse during the shift. If so, they were asked to provide a description; rate the impact the event had on them; and indicate whether they felt the event was sexist, racist, or otherwise biased. Perceived impact was recorded, and demographic characteristics associated with the likelihood of experiencing WPV were explored using multivariable logistic regression analysis. Among 72 HCWs who participated in the study, 52 were female (72%). A total of 575 shift sheets were returned of an estimated 1250 possible (46%), with 155 events, including 77 type 1 events (50%; shouting, yelling, or insults), 29 type 2 events (19%; threats of physical or sexual violence, death threats, or use of slurs), and 39 type 3 events (25%; physical violence); there was a mean (SD) of 3.7 (1.9) shifts per 1 event. No type 4 or 5 events, which involve physical violence causing grievous injuries requiring medical attention and, in the case of type 5 events, permanent disability or death, were recorded. Ten events could not be coded. Sexist or racist bias occurred in 38 events (25%) and 11 events (7%), respectively. Participants reported how the event impacted them in 133 events. Of those, moderate or severe impact was reported in 32 (24%) and mild to no effect in 101 (76%). There was no association between self-reported impact and coded severity of events. In a multivariable logistic regression analysis, a higher likelihood of experiencing WPV on any given shift was independently associated with being in the nursing role (odds ratio, 3.1; 95% CI, 1.9-5.0) and being age 40 years or younger (odds ratio, 2.0; 95% CI, 1.2-3.5). In this cross-sectional study of HCWs in the ED, participants experienced WPV once every 3.7 shifts. The nursing role and younger age were associated with increased risk. These results highlight an urgent need to identify interventions to support and protect HCWs.

Assessing Barriers and Facilitators to Participation in a Nurse-Driven, Opt-Out HIV Screening Program in the Emergency Department

Emergency department (ED) HIV screening is a key component of the strategy to end the HIV epidemic, reaching populations with limited access to care for screening and early diagnosis. Many screening programs rely primarily on participation from ED nurses; however, little is known about the factors affecting nurse participation in screening. Guided by the Consolidated Framework for Implementation Research, 20 semi-structured interviews were conducted with ED nurses to explore perceptions of HIV screening, barriers and facilitators to participation, and implementation insights. Nurses were categorized as either high adopters or low adopters based on the number of HIV tests ordered 3 months prior to interviews. The Stanford Lightning Report Method, a rapid qualitative analysis approach, was used to analyze field notes. All participants generally agreed that the ED was an appropriate location for screening and that frequent, multimodal education about screening was needed. Integration of screening into standard workflows, education about the public health impact of screening, and the use of peer champions and mentors were identified as important strategies to increase participation. By incorporating these findings into implementation strategies, EDs may be able to increase nurse participation in screening, addressing important health equity issues in HIV diagnosis.

Knowledge of emergency nurses and related factors toward geriatric: a cross-sectional study.

This study aimed to evaluate the geriatric knowledge of emergency nurses and related factors. This cross-sectional study was conducted on nursing students at Guilan University of Medical Sciences in Iran. The objective was to assess the geriatric knowledge of nurses working in the emergency departments of educational and therapeutic centers in Rasht City. The sample was selected through a census sampling method, including all nurses employed in these departments. Data collection was carried out using a three-part questionnaire, which included sections on 'personal and occupational characteristics' and the 'Questionnaire of Awareness about the Facts of Aging (FAQ)'. A total of 190 emergency department nurses participated in this study. The mean age of the participants was 34.41 years (SD=6.37). The mean score for geriatric knowledge among the nurses was 6.58 (SD=2.24). No statistically significant associations were found between geriatric knowledge and the personal or occupational variables of the nurses. Also, the results showed that changes in nurses' geriatric knowledge are explained to a small extent through personal and occupational characteristics. Overall, these results highlight the urgent need for targeted interventions to improve emergency nurses' understanding of geriatric care. Furthermore, given the lack of significant correlations with demographic and occupational variables, future research should investigate additional factors that may influence emergency nurses' knowledge in this area.

Implementation of Disaster Preparedness in Hospitals by Emergency Department Nurses

Aims: The purpose of this study is to determine the preparedness of emergency room nurses in handling disasters in hospitals. Method: This study employs a qualitative research design, utilizing a single case study that focuses on the implementation of disaster preparedness by emergency room nurses in hospitals. The subjects of this case study are two nurses who meet the inclusion criteria: they have attended disaster preparedness training, work as emergency room nurses, have been part of the hospital disaster team for at least five years, and are considered reliable and competent sources of data related to the research objective. Purposive sampling was used to select the participants, and data was collected through in-depth interviews guided by an interview protocol. Results: Four themes were identified: disaster preparedness, the organizational structure of disaster management functions and tasks, patient grouping, and the communication of clear, effective information along with coordination among medical personnel. Conclusion: The study found that implementing preparedness among emergency room nurses in disaster management is crucial to ensure a prompt and effective response in emergency situations.

Clinical impact of the implementation of monocyte distribution width (MDW) measurement on time to anti-infective administration in sepsis patients in the emergency department: a before/after cohort study

BackgroundTimely recognition of sepsis in emergency department (ED) is challenging. We evaluated the impact of implementing the biomarker monocyte distribution width (MDW) at bedside, on the time to anti-infective administration.MethodsWe conducted a before-and-after cohort study in the ED of an academic hospital in Paris, to compare sepsis patients care and outcomes, before and after the implementation of point of care (POC) MDW measurement in the ED. During post-implementation period (period-2), MDW was measured with complete blood count by ED nurses with results given in 2 min: if above 21.5 units, ED physicians were asked to consider sepsis and to start an anti-infectious as soon as possible. Primary endpoint was time to anti-infectious administration (TTA) from ED arrival, and secondary endpoints were TTA from sepsis onset (TTAS), length of stay, mortality, and hospitalization rates.ResultsIn total, 255 patients (period-1) and 180 patients (period-2) with sepsis were included. The TTA was 5.4 h (3.5–7.7) period-1 and 4.9 h (IQR 2.5–7.1) in period-2 (p = 0.06). MDW implementation significantly reduced the median TTAS from to 3.7 h (IQR 1.5–5.8) in period-1, to 2.2 h (IQR 0.5–4.5) in period-2 (p < 0.001). Mortality rates remained similar between the two periods (18% vs. 16% respectively, p = 0.4), as did hospitalization rates (93% vs. 91%, p = 0.4) and ED length of stay (7.2 h (5.3–9.8) vs 7.0 (5.4–9.4), p = 0.7).ConclusionImplementing POC MDW measurement in the ED protocols enhances the timeliness of anti-infective administration from sepsis onset, meeting current sepsis management guidelines.

Development of an Initial Screening Scale to Detect Patients With Chest Pain From Acute Coronary Syndrome in the Emergency Department.

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.

Emergency nurses' attitude and related factors toward geriatric: A cross-sectional study

Aging and the consequent disabilities are major concerns in contemporary society. The last century has witnessed a significant increase in the elderly population, particularly in developing countries, thereby heightening the need to address the issues this demographic faces. Understanding nurses' attitudes towards geriatric and the factors influencing these attitudes is crucial for predicting and, if necessary, modifying the behavior of emergency department nurses. This study aims to determine the emergency nurses' attitudes and related factors toward geriatric. This cross-sectional analytical study targeted nurses working in the emergency departments of medical training centers in Rasht. A total of 190 nurses were selected using the census sampling method. Data collection involved a two-part questionnaire: one section capturing demographic characteristics and the other utilizing Kogan’s Attitudes Toward Old People scale. The study revealed that the average age of the nurses was 34.41 (standard deviation [SD]=6.37) years. Among the 190 nurses, 171 (90.0%) were women, 105 (70.0%) were married, and 178 (93.7%) held bachelor's degrees. The average length of professional experience among participants was 8.87 (SD=5.24) years, with 7.24 (SD=4.31) years spent in emergency departments. The mean attitude score towards geriatric was 136.24 (SD=10.47), indicating a generally unfavorable attitude. Supervisors exhibited a significantly more positive attitude toward geriatric than regular nurses (P=0.035). No statistically significant relationship was found between the nurses' attitudes and their personal or occupational variables (P&lt;0.05). The findings indicate that nurses generally hold unfavorable attitudes toward geriatric. Given the critical importance of providing high-quality care to this population, developing strategies to improve nurses’ attitudes towards geriatrics is imperative.

Factors influencing the classification accuracy of triage nurses in emergency department: analysis of triage nurses’ characteristics

BackgroundTriage nurses play a vital role in emergency departments (Eds), with the accuracy of the triage nurse significantly impacting patient care and departmental efficiency. However, there is a lack of exploration into whether the time it takes for triage nurses to triage patients affects accuracy.MethodThis study analyzed the electronic medical records of 787 patients and the characteristics of triage nurses, using statistical methods to determine factors affecting classification accuracy. Data were collected from a single general hospital between November 1 and November 30, 2023.ResultsFindings revealed an 84.9% accuracy rate. Longer clinical experience (p = .001, CI = 1.094–2.052), as well as extended classification time (p = .002, CI = 1.338–2.916), significantly improved accuracy. Age and gender had no notable effect.ConclusionEnhancing triage nurse experience and allowing adequate classification time can improve accuracy, optimizing patient care and ED operations.

The Impact of Lifestyle Changes on the Physical and Mental Health of Emergency Medicine Staff and Their Association With Well-Being at a Major Tertiary Hospital.

Introduction The impact of lifestyle changes on the physical and mental health of emergency medicine staff has been a topic of increasing concern due to its effect on healthcare quality. This study aimed to assess the impact of lifestyle changes on emergency medicine staff's physical and mental health and their association with well-being at a major tertiary hospital. Methods A cross-sectional study was conducted in December 2023 using an online questionnaire targeting Emergency Department (ED) staff in Prince Sultan Medical City, Riyadh, Saudi Arabia. The data were analyzed using SPSS software (IBM Corp., Armonk, NY), with a Spearman correlation test and simple linear regression analysis used to determine the relationship between variables. Results The study included 149 participants, primarily male (59.7%) and predominantly within the age group of 30-39 years (59.1%). The sample consisted of ED nurses, residents, consultants, and paramedics, with over half having more than five years of experience in emergency medicine. Lifestyle changes were evident among participants, with 60.4% reporting worsened sleep patterns, 49.7% engaging in less physical activity, and 56.4% reporting poorer eating habits after joining the ED. Well-being assessments revealed moderate well-being scores (mean = 11.7 ± 5.61), with substantial variability in emotional states. Factors such as night sleep quality, physical activity, and nutrition were significantly correlated with well-being, with night sleep quality showing the strongest positive correlation (rho = 0.349, p < 0.001). Night sleep quality, nutritional intake, and physical activity are significant predictors of well-being, with night sleep quality being the strongest predictor (R2 = 0.122, F = 20.39, p < 0.001). Conclusion The study underscores the need for targeted interventions to address lifestyle challenges faced by ED personnel, particularly focusing on improving sleep quality, promoting regular physical activity, and encouraging healthier nutritional habits.

KAP ANALYSIS AND DECISION-MAKING OF NURSES REGARDING SEPSIS ASSESSMENT AND MANAGEMENT IN CRITICALLY ILL PATIENTS

Sepsis is a life-threatening condition that requires prompt identification and management, particularly in critically ill patients. Nurses play a pivotal role in sepsis management, and their knowledge, attitudes, and practices directly impact patient outcomes. However, there is limited data on the awareness and competency of nurses regarding sepsis assessment and management, especially in low-resource settings. Objective: This study aimed to evaluate the knowledge, attitudes, and practices (KAP) of nurses towards the assessment and management of sepsis in critically ill patients. Methods: A cross-sectional study was conducted in the Intensive Care Unit (ICU) and emergency department of DHQ Hospital, Narowal, from July 2023 to July 2024. A total of 100 ICU and CCU nurses were selected using convenience sampling. Data were collected through a 32-item questionnaire that assessed knowledge, attitudes, and practices related to sepsis. Additionally, the 24-item Nursing Decision-Making Instrument (NDMI) was used to evaluate decision-making skills. Descriptive statistics were calculated, and relationships between variables were analyzed using t-tests and ANOVA. Results: The mean knowledge score was 5.1 ± 1.8, with 83% of nurses demonstrating poor awareness of sepsis. The mean attitude score was 2.0 ± 0.9, with 85% of nurses displaying negative attitudes toward sepsis management. The mean practice score was 79 ± 17.8, with 72% of nurses showing poor practice skills. The mean decision-making score on the NDMI was 63.3 ± 19.6. Qualifications (p=0.010, p=0.00) and work experience (p=0.005, p=0.050) significantly influenced knowledge and practice scores. Moreover, knowledge and practice scores varied significantly with different modes of decision-making (p&lt;0.001, p=0.020). Conclusion: The study revealed that ICU and emergency department nurses had insufficient knowledge, negative attitudes, and inadequate practices concerning sepsis assessment and management. Training programs, targeted educational interventions, and policy reforms are urgently required to improve nurses' competency and decision-making skills in sepsis management, ultimately enhancing patient outcomes.

Emergency department nurses' reflective thinking and patient safety competency: The mediating effect of patient safety culture

AimThis study aimed to identify the mediating effect of patient safety culture on the relationship between reflective thinking and patient safety competency in emergency department nurses. BackgroundGiven the complexity and the need for timely assessments and interventions in the emergency department, the patient safety competency of nurses is crucial for preventing safety incidents. MethodsThis study utilized a cross-sectional descriptive correlational design with a convenience sample of 200 emergency department nurses. Participants completed a web-based, self-administered questionnaire that assessed reflective thinking, patient safety culture, and patient safety competency. The percentile bootstrap method for mediation analysis was performed to ascertain the mediating role of patient safety culture in the relationship between reflective thinking and patient safety competency. ResultsBoth reflective thinking and patient safety culture were significant predictors of patient safety competency. Furthermore, patient safety culture was found to mediate the relationship between reflective thinking and patient safety competency among emergency department nurses. ConclusionsThe findings suggest that emergency department nurses could benefit from a competency enhancement program or quality improvement projects that focus on reflective thinking and patient safety culture, which are significant predictors of patient safety competency.

SQuID (subcutaneous insulin in diabetic ketoacidosis): Clinician acceptability.

We previously implemented the SQuID protocol (subcutaneous insulin in diabetic ketoacidosis [DKA]) demonstrating safe, effective treatment of low- to moderate-severity DKA in a non-intensive care unit setting. Since success and sustainability of interventions rely on staff buy-in, we assessed acceptability of SQuID among emergency department (ED) and inpatient clinicians. We conducted a cross-sectional study in an urban academic hospital (March 2023-November 2023), surveying ED nurses (RNs) and physicians (MDs) and floor RNs and MDs treating patients on SQuID via emailed survey links. Clinicians could only take the survey once. We used Sekhon's Theoretical Framework of Acceptability, validated for staff acceptability of a new intervention, assessing eight domains with 5-point Likert responses. Clinicians were asked about prior experience with SQuID, and we assessed ED MD and RN preference (SQuID vs. intravenous [IV] insulin). Surveys included free-text boxes for comments. We present descriptive statistics including proportions with 95% confidence interval and medians with interquartile ranges (IQRs) and conducted thematic analysis of free-text comments. Our overall response rate (107/133) was 80% (34/42 ED RNs, 13/16 floor RNs, 47/57 ED MDs, 13/17 floor MDs), with first-time users of SQuID ranging from 7.7% (hospitalist MDs) to 35.3% (ED RNs) of participants. ED clinicians preferred SQuID over IV insulin (67% vs. 12%, 21% no preference). Acceptability was high across all domains and clinician types (median 4, IQR 4-5). Overall percentage of positive responses (4s and 5s) across domains was 92% (ED RNs [89%], floor RNs [89%], ED MDs [97%], floor MDs [87%]). We identified several themes among participant comments. Acceptability was high across clinician types; 65% of ED clinicians preferred SQuID to IV insulin. Clinicians liked SQuID (affective attitude), found it easy to use (burden), were confident in its use (self-efficacy), felt that it improved outcomes (perceived effectiveness), found that it was fair to patients (ethicality), found that it made sense (intervention coherence), and found that it did not interfere with other activities (opportunity cost).

Impact of Triage Nurse Training on Accuracy and Efficiency: A Systematic Review-Based Study

Background Triage in the emergency department (ED) is a crucial procedure that establishes the urgency of patient care based on symptoms at presentation. Although the efficacy of triage nurse training programs varies, their goal is to increase the precision and efficiency of their decision-making. Aim With a focus on research done between 2019 and 2024, the systematic review attempts to evaluate the effect of training programs on the accuracy and efficiency of triage nurses in emergency departments. Method We conducted a thorough search of the PubMed, EMBASE, and Web of Science databases to find pertinent research. Studies assessing training treatments for triage nurses and reporting accuracy and efficiency-related results were included in the inclusion criteria. Both the quality assessment and data extraction were carried out separately by two reviewers. Result Ten studies that used a range of triage training techniques and covered a variety of geographic areas satisfied the inclusion criteria. Research findings consistently showed that, despite variations in study designs and outcome measures, training programs increased triage accuracy and efficiency. Interventions included clinical decision support system integration, training based on simulation, and conventional classroom-based instruction. Conclusion By increasing decision-making efficiency and accuracy in patient evaluation, training programs greatly improve the performance of triage nurses in emergency departments. To improve comparability and support evidence-based policies, future research must standardize training methodologies and outcome measurements.

Professional competences of emergency department nurses working in the earthquake region on triage management in children and the difficulties experienced by nurses in the decision-making process: A qualitative study

Limited resources in disasters may negatively affect the care of paediatric patients and cause complications to be prevented. The aim of this study was to investigate the professional competence of nurses regarding triage management in children during the Kahramanmaraş earthquake and the difficulties they experienced in the decision-making process. This study used a qualitative exploratory research design with a phenomenological approach. In-depth interviews were conducted with the participants individually and through focus group discussions using a semi-structured interview form. A total of 23 participants working in the emergency department during and after the earthquake were included in this study, which was conducted using a purposive sampling technique. Data were analyzed using content analysis procedures. Max Qualitative Data Analysis (2020) programme was used to code the data. As a result of data analysis, 4 main themes and 15 sub-themes emerged. The four main themes were “Professional Competencies of Nurses During Disasters,” “Triage Decision in the Emergency Department,” “Expectations of Nurses Working in a Disaster Area” and “Participation in Disaster Education”. The results of this study showed that nurses are exposed to difficulties arising from many individuals, psychological, professional, environmental, and educational variables in the early period of disaster. Participants' views revealed a strong relationship between being professionally competent, providing appropriate care to patients and emotional exhaustion.

Exploring Police Officer Experiences During the Transfer of People in Crisis to Emergency Department Nurses and Staff

Police 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.

The Relationship Between Nurses’ Moral Distress, Their Spiritual Well-Being, and Moral Intelligence

Background: Intensive Care Unit (ICU) and Emergency Department (ED) nurses have faced several moral challenges during the COVID-19 pandemic. The factors associated with nurses’ moral distress (MD) can vary depending on the cultural context. Objectives: This study aimed to determine the relationship between MD, spiritual well-being (SWB), and moral intelligence (MQ) of nurses in ICUs and EDs during the COVID-19 pandemic. Methods: This descriptive cross-sectional study was conducted in 2020. The data were collected using self-report questionnaires, including those for personal and professional profiles, Corley’s Moral Distress Scale-Revised, Paloutzian &amp; Ellison’s Spiritual Well-being, and Lennick &amp; Kiel’s Moral Intelligence. Of the 543 nurses working in the ICUs and EDs of hospitals in Zanjan Province (Iran), 370 participants were selected by census sampling. Results: The study results indicated that 90.8% of nurses experienced high MD. The results of the partial correlation test showed no statistically significant relationship between nurses' MD and their SWB or MQ (P &gt; 0.001). Nurses with an associate's degree (P = 0.019) and those working in the EDs (P = 0.001) and the COVID-19 care center hospital (P = 0.001) had higher levels of MD. Religious well-being and the educational level of nurses could predict only 2.5% of the variations in nurses’ MD. Conclusions: This study showed that SWB and MQ of nurses are not related to nurses’ MD, unlike environmental factors. It is recommended that managers provide more support to reduce nurses’ MD in critical situations, such as during the COVID-19 pandemic.