Emergency nursing workload and patient dependency in the ambulance bay: A prospective study

Development and psychometric testing of burn inpatient nursing dependency assessment scale

AIMS

The aim was to develop and psychometrically test the burn inpatient nursing dependency assessment scale (BINDAS).

DESIGN

This was a scale development study.

METHODS

This study was conducted in four phases from November 2019 to November 2021. Items were generated and the initial scale was constructed in phase 1. The preliminary evaluation of items was conducted through expert reviews and a pilot study in phase 2. The scale, including item quality, reliability and validity, was validated with 420 individuals in phase 3. The translation of the scale from Chinese to English was performed in phase 4.

RESULTS

Content validity was satisfactory. Thirteen items were retained after item analysis, and three factors accounting for 73% of the total item variance were extracted through exploratory and confirmatory factor analyses. Predictive validity with nursing time spent with patients during 24 h was also estimated, with r = .66 (p < .01). Receiver operating characteristic analysis was conducted, and an area under the curve of the scale of 0.94 was obtained. Concurrent validity with Barthel index was estimated, with r = -.71 (p < .01). Cronbach's alpha coefficient for scale was .93, and the correlation between raters for total scores was .95.

CONCLUSION

Burn inpatient nursing dependency assessment scale is a psychometrically valid and reliable measurement instrument as well as objective other-rating scale with 12 items for scoring on a four-point scale (0, 1, 2 or 3) and 1 item for scoring on a two-point scale (0 or 2). BINDAS with 13 items was developed in this study. Nurses can give each patient a total score of 0-38. A high score indicates high nursing dependency. The 13-item scale consists of three factors: basic care need, physiological index, and psychology and adaptation.

IMPACT

This scale demonstrated satisfactory psychometric properties and can be used to evaluate patient dependency on nurses in burn units and optimize an individual's care plan to achieve efficient staff allocation.

Barriers to nursing pain management in the emergency department: A qualitative study

BACKGROUND

Although pain is a common complaint among patients presenting to emergency departments (EDs), there is a dearth of nursing literature about barriers to pain management.

PURPOSE

The study aimed to uncover and understand barriers to pain management in the ED from the registered nurse (RN) perspective.

METHODS

Semistructured interviews were conducted with 12 ED nurses in a Jordanian hospital. Data were collected throughout August 2016.

RESULTS

Two broad categories with subcategories emerged. The first category describes the idea of types of patient, which included three particular groups. These were patients who are violent, patients with relatives who are, and patients with expectations of care that nurses view as unrealistic. The second category describes the taxing ED environment, with two subcategories of staff shortages and physician dominance of pain management. Nurses reported feeling as if they are the victims of external factors and perceived that barriers affected teamwork and led to distress which impairs pain management.

CONCLUSIONS

The role of ED nurses in pain management is multifaceted. Therefore, implementing policies to overcome barriers such as violence among ED attenders and the perceived hostility of the ED environment through mandatory security systems, and continuing nursing education including for violence prevention may be beneficial.

Quality and impact of nurse-initiated analgesia in the emergency department: A systematic review

AIM

This paper reports a systematic literature review evaluating the impact and quality of pain management associated with nurse initiated analgesia in patients presenting to the emergency department (ED).

BACKGROUND

Pain is a major presenting complaint for individuals attending the ED. Timely access to effective analgesia continues to be a global concern in the ED setting; emergency nurses are optimally positioned to improve detection and management of pain.

DESIGN

Systematic review.

DATABASES AND DATA TREATMENT

Four databases - CINAHL, EMBASE, Medline, ProQuest - the Cochrane Library and the National Institute of Clinical Excellence were searched from date of inception to December 2017; with no language restrictions applied. Studies were identified using predetermined inclusion criteria. Data were extracted and summarised and underwent evaluation using published valid criteria.

RESULTS

Twelve articles met inclusion, comprising a wide range of analgesics and administration routes to manage mild to severe pain. Overall study quality was high; 7 studies included a form of comparison group. Patient outcome measures included time to analgesia (n = 12; 100%), change in pain score (n = 6; 50.0%); adverse events (n = 6; 50.0%); patient satisfaction (n = 5; 41.7%) and documenting pain assessment (n = 2; 16.7%).

CONCLUSION

Nurse-initiated analgesia was associated with safe, timely and effective pain relief.

Exploring how nurses assess, monitor and manage acute pain for adult critically ill patients in the emergency department: protocol for a mixed methods study

BACKGROUND

Many critically ill patients experience moderate to severe acute pain that is frequently undetected and/or undertreated. Acute pain in this patient cohort not only derives from their injury and/or illness, but also as a consequence of delivering care whilst stabilising the patient. Emergency nurses are increasingly responsible for the safety and wellbeing of critically ill patients, which includes assessing, monitoring and managing acute pain. How emergency nurses manage acute pain in critically ill adult patients is unknown. The objective of this study is to explore how emergency nurses manage acute pain in critically ill patients in the Emergency Department.

METHODS

In this paper, we provide a detailed description of the methods and protocol for a multiphase sequential mixed methods study, exploring how emergency nurses assess, monitor and manage acute pain in critically ill adult patients. The objective, method, data collection and analysis of each phase are explained. Justification of each method and data integration is described.

DISCUSSION

Synthesis of findings will generate a comprehensive picture of how emergency nurses' perceive and manage acute pain in critically ill adult patients. The results of this study will form a knowledge base to expand theory and inform research and practice.