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Kim S, Chang H, Kim T, Cha WC. Patient Anxiety and Communication Experience in the Emergency Department: A Mobile, Web-Based, Mixed-Methods Study on Patient Isolation During the COVID-19 Pandemic. J Korean Med Sci 2023; 38:e303. [PMID: 37821083 PMCID: PMC10562183 DOI: 10.3346/jkms.2023.38.e303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Accepted: 06/08/2023] [Indexed: 10/13/2023] Open
Abstract
BACKGROUND Anxiety and communication difficulties in the emergency department (ED) may increase for various reasons, including isolation due to coronavirus disease 2019 (COVID-19). However, little research on anxiety and communication in EDs exists. This study explored the isolation-related anxiety and communication experiences of ED patients during the COVID-19 pandemic. METHODS A prospective mixed-methods study was conducted from May to August 2021 at the Samsung Medical Center ED, Seoul. There were two patient groups: isolation and control. Patients measured their anxiety using the State-Trait Anxiety Inventory (STAI X1) at two time points, and we surveyed patients at two time points about factors contributing to their anxiety and communication experiences. These were measured through a mobile web-based survey. Researchers interviewed patients after their discharge. RESULTS ED patients were not anxious regardless of isolation, and there was no statistical significance between each group at the two time points. STAI X1 was 48.4 (standard deviation [SD], 8.0) and 47.3 (SD, 10.9) for early follow-up and 46.3 (SD, 13.0) and 46.2 (SD, 13.6) for late follow-up for the isolation and control groups, respectively. The clinical process was the greatest factor contributing to anxiety as opposed to the physical environment or communication. Communication was satisfactory in 71.4% of the isolation group and 66.7% of the control group. The most important aspects of communication were information about the clinical process and patient status. CONCLUSION ED patients were not anxious and were generally satisfied with medical providers' communication regardless of their isolation status. However, patients need clinical process information for anxiety reduction and better communication.
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Affiliation(s)
- Sumin Kim
- Department of Digital Health, Samsung Advanced Institute for Health Science & Technology (SAIHST), Sungkyunkwan University, Seoul, Korea
| | - Hansol Chang
- Department of Digital Health, Samsung Advanced Institute for Health Science & Technology (SAIHST), Sungkyunkwan University, Seoul, Korea
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Taerim Kim
- Department of Digital Health, Samsung Advanced Institute for Health Science & Technology (SAIHST), Sungkyunkwan University, Seoul, Korea
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Won Chul Cha
- Department of Digital Health, Samsung Advanced Institute for Health Science & Technology (SAIHST), Sungkyunkwan University, Seoul, Korea
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
- Digital Innovation Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
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Zolfaghari E, Ridout B, Medlow S, Campbell A, Coggins A, Murphy M, Jani S, Thosar D, Wiederhold BK, Wiederhold M, Steinbeck K. Exploring the use of virtual reality to manage distress in adolescent patients in emergency departments: A feasibility study. Emerg Med Australas 2022; 34:687-693. [PMID: 35238143 PMCID: PMC9790434 DOI: 10.1111/1742-6723.13945] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Revised: 01/31/2022] [Accepted: 02/05/2022] [Indexed: 12/30/2022]
Abstract
OBJECTIVE The present study aimed to explore the feasibility and potential benefits of deploying virtual reality (VR) for adolescents in the ED. METHODS This multi-centre study was undertaken in paediatric and adult EDs in two university teaching hospitals. Twenty-six participants who had voluntarily attended the ED received the VR intervention. Pre- and post-measures assessing changes in state anxiety, stress and affect, and physical biomarkers were obtained. RESULTS The use of VR intervention was associated with significant reductions in distress (Short State Stress Questionnaire - Distress Subscale; t = 4.55, P < 0.001) and negative affect (the International Positive and Negative Affect Scale - Short Form version; t = 4.99, P < 0.001). Most participants chose 'Netflix' as their content of choice. The technology was well received by the participants with subjective reports indicating that receiving VR intervention was 'insanely cool', 'takes you away from what's actually happening' and some participants felt 'privileged to get this experience in a hospital'. CONCLUSIONS VR technology can effectively be used in EDs to assist adolescents and young adults better manage their distress and take steps towards activating more self-control mechanisms that will in turn allow for more meaningful engagements to be established with health clinicians. This technology has broad implications for reducing distress in adolescents in a variety of clinical contexts.
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Affiliation(s)
- Elham Zolfaghari
- Specialty of Child and Adolescent HealthFaculty of Medicine and Health, The University of SydneySydneyNew South WalesAustralia,Academic Department of Adolescent MedicineThe Children's Hospital at WestmeadSydneyNew South WalesAustralia
| | - Brad Ridout
- Discipline of Biomedical Informatics and Digital HealthCyberpsychology Research Group, Faculty of Medicine and Health, The University of SydneySydneyNew South WalesAustralia
| | - Sharon Medlow
- Specialty of Child and Adolescent HealthFaculty of Medicine and Health, The University of SydneySydneyNew South WalesAustralia,Academic Department of Adolescent MedicineThe Children's Hospital at WestmeadSydneyNew South WalesAustralia
| | - Andrew Campbell
- Discipline of Biomedical Informatics and Digital HealthCyberpsychology Research Group, Faculty of Medicine and Health, The University of SydneySydneyNew South WalesAustralia
| | - Andrew Coggins
- Department of Emergency Medicine, Westmead HospitalWestern Sydney Local Health DistrictSydneyNew South WalesAustralia,Discipline of Emergency MedicineSydney Medical School, The University of SydneySydneyNew South WalesAustralia
| | - Margaret Murphy
- Department of Emergency Medicine, Westmead HospitalWestern Sydney Local Health DistrictSydneyNew South WalesAustralia,Discipline of Emergency MedicineSydney Medical School, The University of SydneySydneyNew South WalesAustralia
| | - Shefali Jani
- Specialty of Child and Adolescent HealthFaculty of Medicine and Health, The University of SydneySydneyNew South WalesAustralia,Department of Emergency MedicineThe Children's Hospital at WestmeadSydneyNew South WalesAustralia
| | - Deepali Thosar
- Department of Emergency MedicineThe Children's Hospital at WestmeadSydneyNew South WalesAustralia
| | - Brenda K Wiederhold
- Virtual Reality Medical CenterScripps Memorial HospitalLa JollaCaliforniaUSA
| | - Mark Wiederhold
- Virtual Reality Medical CenterScripps Memorial HospitalLa JollaCaliforniaUSA
| | - Katharine Steinbeck
- Specialty of Child and Adolescent HealthFaculty of Medicine and Health, The University of SydneySydneyNew South WalesAustralia,Academic Department of Adolescent MedicineThe Children's Hospital at WestmeadSydneyNew South WalesAustralia
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Samuel B, Wang H, Shi C, Pan Y, Yu Y, Zhu W, Jing Z. The effects of coloring therapy on patients with generalized anxiety disorder. Animal Model Exp Med 2022; 5:502-512. [PMID: 35794728 PMCID: PMC9773305 DOI: 10.1002/ame2.12256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Accepted: 05/13/2022] [Indexed: 02/05/2023] Open
Abstract
Generalized anxiety disorder (GAD) has harmful effects on physical and mental health and quality of life. Coloring therapy has been reported to have a positive effect on improving patient anxiety and depression. But there are no reported clinical trials examining their effectiveness as a treatment for GAD. This study was planned to evaluate the effectiveness of coloring therapy combined with conventional therapy in improving anxiety, depression, and positive and negative emotions with GAD. This randomized controlled study comprising 88 GAD patients was selected for intervention in different wards. The control group (n = 45) was given conventional antianxiety medication and physical therapy, and the experimental group (n = 43) received coloring therapy combined with conventional therapy. The Self-Rating Depression Scale, Self-Rating Anxiety Scale (SAS), Hamilton Depression Scale, Hamilton Anxiety Scale (HAMA), and Positive and Negative Affect Scale were assessed in both groups before and 3 weeks after the intervention. After the intervention, there were statistical differences in intra- and inter-group comparisons of anxiety, depression, and positive and negative mood scales in the experimental and control groups (p < .05). The minus in anxiety/positive emotions pre- and postintervention in the experimental group was statistically significant compared to that in anxiety/positive emotions pre- and postintervention in the control group (HAMA: d = 1.45, 95% confidence interval [CI] (0.34, 2.57), p = .011; SAS: d = 3.87, 95% CI (1.73,6.00), p = .001; positive: d = 1.76, 95% CI (0.17, 3.34), p = .030). The minus in depressive/negative emotions pre- and postintervention in the experimental group was not statistically significant compared with that in depressive/negative emotions pre- and postintervention in the control group (p > .05). For GAD patients, adding coloring therapy based on conventional drug therapy and physical therapy can not only reduce depression and negative emotions but also have better effects on reducing anxiety and improving positive emotions than conventional therapy.
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Affiliation(s)
- Bosomtwe Samuel
- School of MedicineHuzhou UniversityZhejiangChina,Department of NursingGregory Catholic HospitalBuduburamCentral RegionGhana
| | - Hongmei Wang
- Department of NursingWest China Hospital of Sichuan UniversitySichuanChina
| | - Chengdong Shi
- Department of NursingShenzhen Baoan Maternal and Child Health HospitalGuangdongChina
| | | | - Yuzi Yu
- School of MedicineHuzhou UniversityZhejiangChina
| | - Weiyu Zhu
- Department of Psychosomatic DiseasesHuzhou Third People's HospitalZhejiangChina
| | - Zhou Jing
- School of Teacher EducationHuzhou UniversityZhejiangChina
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Joschko R, Roll S, Willich SN, Berghöfer A. The effect of active visual art therapy on health outcomes: protocol of a systematic review of randomised controlled trials. Syst Rev 2022; 11:96. [PMID: 35578277 PMCID: PMC9109400 DOI: 10.1186/s13643-022-01976-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Accepted: 05/06/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Art therapy is a form of complementary therapy to treat a wide variety of health problems. Existing studies examining the effects of art therapy differ substantially regarding content and setting of the intervention, as well as their included populations, outcomes, and methodology. The aim of this review is to evaluate the overall effectiveness of active visual art therapy, used across different treatment indications and settings, on various patient outcomes. METHODS We will include randomised controlled studies with an active art therapy intervention, defined as any form of creative expression involving a medium (such as paint etc.) to be actively applied or shaped by the patient in an artistic or expressive form, compared to any type of control. Any treatment indication and patient group will be included. A systematic literature search of the Cochrane Library, EMBASE (via Ovid), MEDLINE (via Ovid), CINAHL, ERIC, APA PsycArticles, APA PsycInfo, and PSYNDEX (all via EBSCOHost), ClinicalTrials.gov and the WHO's International Clinical Trials Registry Platform (ICTRP) will be conducted. Psychological, cognitive, somatic and economic outcomes will be used. Based on the number, quality and outcome heterogeneity of the selected studies, a meta-analysis might be conducted, or the data synthesis will be performed narratively only. Heterogeneity will be assessed by calculating the p-value for the chi2 test and the I2 statistic. Subgroup analyses and meta-regressions are planned. DISCUSSION This systematic review will provide a concise overview of current knowledge of the effectiveness of art therapy. Results have the potential to (1) inform existing treatment guidelines and clinical practice decisions, (2) provide insights to the therapy's mechanism of change, and (3) generate hypothesis that can serve as a starting point for future randomised controlled studies. SYSTEMATIC REVIEW REGISTRATION PROSPERO ID CRD42021233272.
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Affiliation(s)
- Ronja Joschko
- Institute for Social Medicine, Epidemiology and Health Economics, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Luisenstr. 57, 10117, Berlin, Germany.
| | - Stephanie Roll
- Institute for Social Medicine, Epidemiology and Health Economics, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Luisenstr. 57, 10117, Berlin, Germany
| | - Stefan N Willich
- Institute for Social Medicine, Epidemiology and Health Economics, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Luisenstr. 57, 10117, Berlin, Germany
| | - Anne Berghöfer
- Institute for Social Medicine, Epidemiology and Health Economics, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Luisenstr. 57, 10117, Berlin, Germany
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Xi J, Gao Y, Lyu N, She Z, Wang X, Zhang XA, Yu X, Ji W, Wei M, Dai W, Qian X. Let’s color: An online coloring game improves subjective well-being and reduces anxiety during the COVID-19 pandemic (Preprint). JMIR Serious Games 2022; 10:e37026. [PMID: 35575761 PMCID: PMC9273045 DOI: 10.2196/37026] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Revised: 04/24/2022] [Accepted: 05/13/2022] [Indexed: 11/27/2022] Open
Abstract
Background COVID-19 has spread worldwide and generated tremendous stress on human beings. Unfortunately, it is often hard for distressed individuals to access mental health services under conditions of restricted movement or even lockdown. Objective The study first aims to develop an online digital intervention package based on a commercially released coloring game. The second aim is to test the effectiveness of difference intervention packages for players to increase subjective well-being (SWB) and reduce anxiety during the pandemic. Methods An evidence-based coloring intervention package was developed and uploaded to an online coloring game covering almost 1.5 million players worldwide in January 2021. Players worldwide participated to color either 4 rounds of images characterized by awe, pink, nature, and blue or 4 rounds of irrelevant images. Participants' SWB and anxiety and the perceived effectiveness of the game in reducing anxiety (subjective effectiveness [SE]) were assessed 1 week before the intervention (T1), after the participants completed pictures in each round (T2-T5), and after the intervention (T6). Independent 2-tailed t tests were conducted to examine the general intervention (GI) effect and the intervention effect of each round. Univariate analysis was used to examine whether these outcome variables were influenced by the number of rounds completed. Results In total, 1390 players worldwide responded and completed at least 1 assessment. Overall, the GI group showed a statistical significantly greater increase in SWB than the general control (GC) group (N=164, t162=3.59, Cohen d=0.59, 95% CI 0.36-1.24, P<.001). Compared to the control group, the best effectiveness of the intervention group was seen in the awe round, in which the increase in SWB was significant (N=171, t169=2.51, Cohen d=0.39, 95% CI 0.10-0.82, P=.01), and players who colored all 4 pictures had nearly significant improvements in SWB (N=171, F4,170=2.34, partial ŋ2=0.053, P=.06) and a significant decrease in anxiety (N=171, F4,170=3.39, partial ŋ2=0.075, P=.01). Conclusions These data indicate the effectiveness of online psychological interventions, such as coloring games, for mental health in the specific period. They also show the feasibility of applying existing commercial games embedded with scientific psychological interventions that can fill the gap in mental crises and services for a wider group of people during the pandemic. The results would inspire innovations to prevent the psychological problems caused by public emergencies and encourage more games, especially the most popular ones, to take more positive action for the common crises of humankind.
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Affiliation(s)
- JuZhe Xi
- Shanghai Key Laboratory of Mental Health and Psychological Crisis Intervention, Affiliated Mental Health Center (ECNU), School of Psychology and Cognitive Science, East China Normal University, Shanghai, China
| | - YuHan Gao
- Shanghai Key Laboratory of Mental Health and Psychological Crisis Intervention, Affiliated Mental Health Center (ECNU), School of Psychology and Cognitive Science, East China Normal University, Shanghai, China
| | - Na Lyu
- Xinhua Hospital, Shanghai Jiao Tong University of Medicine, Shanghai, China
| | - Zhuang She
- Shanghai Key Laboratory of Mental Health and Psychological Crisis Intervention, Affiliated Mental Health Center (ECNU), School of Psychology and Cognitive Science, East China Normal University, Shanghai, China
| | - XinYue Wang
- College of Letters and Science, University of California, Berkeley, CA, United States
| | - Xin-An Zhang
- Antai College of Economics & Management, Shanghai Jiao Tong University, Shanghai, China
| | - XiaoYu Yu
- School of Management, Shanghai University, Shanghai, China
| | - WeiDong Ji
- Affiliated Mental Health Center (ECNU), Shanghai Changning Mental Health Center, Shanghai, China
| | - MengSheng Wei
- School of Management, Fudan University, Shanghai, China
| | - WeiHui Dai
- School of Management, Fudan University, Shanghai, China
| | - Xuesheng Qian
- School of Management, Fudan University, Shanghai, China
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Au TY, Assavarittirong C. The overview of utilizing complementary therapy to relieve stress or anxiety in emergency department patients: animal-assisted therapy, art therapy, and music therapy. Ment Health (Lond) 2021. [DOI: 10.32437/mhgcj.v4i2.125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
The Emergency Department could be a stressful environment for patients. Anxiety and depression may develop due to the atmosphere, in addition to patients’ concerns for their health conditions. The condition could potentially affect the experience of the patient in the Emergency Department and the quality of life after the visit. Pharmacological therapy could be administered to the patients. However, adverse effects may be associated with the treatment. Less aggressive complementary treatment approaches are presented in this article. Controlled clinical trials and randomized pilot studies of different complementary therapies, including animal-assisted therapy, art therapy, and music therapy, were conducted. The complementary therapies discussed in this article showed positive outcomes for patients with hospital-induced anxiety and has no adverse effect reported. Hence, hospitals may consider introducing complementary therapies, such as those mentioned in this study, to improve the patients’ experiences in the Emergency Department
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Yun JY, Kim JW, Myung SJ, Yoon HB, Moon SH, Ryu H, Yim JJ. Impact of COVID-19 on Lifestyle, Personal Attitudes, and Mental Health Among Korean Medical Students: Network Analysis of Associated Patterns. Front Psychiatry 2021; 12:702092. [PMID: 34483994 PMCID: PMC8416342 DOI: 10.3389/fpsyt.2021.702092] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Accepted: 07/16/2021] [Indexed: 12/16/2022] Open
Abstract
The current COVID-19 pandemic have affected our daily lifestyle, pressed us with fear of infection, and thereby changed life satisfaction and mental health. The current study investigated influencing cascade of changes during the COVID-19 among the lifestyle, personal attitudes, and life (dis)satisfaction for medical students, using network-based approaches. This cross-sectional survey used self-reports of 454 medical students during June and July of 2020. Depressive mood, anxiety, and intention to drop out of school were observed in 11.9, 18.5, and 38.3% of medical students, respectively. Directed acyclic graph that estimated directional propagation of the COVID-19 in medical students' daily lives initiated from the perception of unexpected event, propagated to nervous and stressed feeling, trouble relaxing, feeling like a failure, and were followed by trouble concentrating, feeling loss of control for situation, and fear of infecting colleagues. These six features were also principal mediators within the intra-individual covariance networks comprised of changed lifestyle, personal attitude, and mental health at COVID-19 pandemic. Psychosocial supports targeting nervousness, trouble relaxing and concentrating, fear of spreading infection to colleagues, feelings of a failure or loss of situational control are required for better mental health of medical students during the COVID-19 pandemic.
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Affiliation(s)
- Je-Yeon Yun
- Seoul National University Hospital, Seoul, South Korea
- Yeongeon Student Support Center, Seoul National University College of Medicine, Seoul, South Korea
| | - Ju Whi Kim
- Office of Medical Education, Seoul National University College of Medicine, Seoul, South Korea
| | - Sun Jung Myung
- Office of Medical Education, Seoul National University College of Medicine, Seoul, South Korea
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, South Korea
| | - Hyun Bae Yoon
- Office of Medical Education, Seoul National University College of Medicine, Seoul, South Korea
| | - Sang Hui Moon
- Office of Medical Education, Seoul National University College of Medicine, Seoul, South Korea
| | - Hyunjin Ryu
- Office of Medical Education, Seoul National University College of Medicine, Seoul, South Korea
| | - Jae-Joon Yim
- Office of Medical Education, Seoul National University College of Medicine, Seoul, South Korea
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, South Korea
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Considine J, Berry D, Rasmussen B, Hutchinson AM, Rawson H, Jordan P, Street M. Impact of emergency department length of stay on anxiety and comfort in older people. Int Emerg Nurs 2021; 56:100974. [PMID: 33667904 DOI: 10.1016/j.ienj.2021.100974] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Revised: 09/02/2020] [Accepted: 01/28/2021] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Older people are frequent emergency department (ED) users, a vulnerable population and often have long stays in the ED. The aim of this study was to determine whether ED length of stay (LOS) had an impact on older people's (aged ≥65 years) anxiety, comfort and adverse events. METHODS This prospective observational study was conducted in Melbourne, Australia. Patients (n = 301) from three EDs were classified by ED LOS: ≤4-hours (n = 89), 4-8 h (n = 136) and >8-hours (n = 76). Current state and trait anxiety and comfort were measured in ED. Adverse event data were collected from medical records. LOS groups were compared using Chi-Square and Kruskal-Wallis test. RESULTS There was no significant difference in Trait Anxiety Scores. Patients with ED LOS ≤ 4-hours had lower median State Anxiety Scores (p = 0.003), were less likely to require ward admission (p < 0.001), and more likely to require short stay unit admission (p < 0.001). There were no significant differences between groups in comfort or adverse events during ED care or hospitalisation (for admitted patients). CONCLUSION The impact of ED LOS on the anxiety of older ED users appears limited. There was no association identified between ED LOS and comfort during ED care or adverse events during ED care or hospitalisation.
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Affiliation(s)
- Julie Considine
- Deakin University, School of Nursing and Midwifery; Centre for Quality and Patient Safety Research in the Institute for Health Transformation, 1 Geringhap Street, Geelong 3220, Australia; Eastern Health, Centre for Quality and Patient Safety Research - Eastern Health Partnership, Level 2, 5 Arnold Street, Box Hill 3128, Australia.
| | - Debra Berry
- Deakin University, School of Nursing and Midwifery; Centre for Quality and Patient Safety Research in the Institute for Health Transformation, 1 Geringhap Street, Geelong 3220, Australia; Eastern Health, Centre for Quality and Patient Safety Research - Eastern Health Partnership, Level 2, 5 Arnold Street, Box Hill 3128, Australia.
| | - Bodil Rasmussen
- Deakin University, School of Nursing and Midwifery; Centre for Quality and Patient Safety Research in the Institute for Health Transformation, 1 Geringhap Street, Geelong 3220, Australia; Western Health, Centre for Quality and Patient Safety Research - Western Health Partnership, 176 Furlong Road, Sunshine, St Albans 3021, Australia.
| | - Alison M Hutchinson
- Deakin University, School of Nursing and Midwifery; Centre for Quality and Patient Safety Research in the Institute for Health Transformation, 1 Geringhap Street, Geelong 3220, Australia; Monash Health, Centre for Quality and Patient Safety Research - Monash Health Partnership, 246 Clayton Road, Clayton 3168, Australia.
| | - Helen Rawson
- Deakin University, School of Nursing and Midwifery; Centre for Quality and Patient Safety Research in the Institute for Health Transformation, 1 Geringhap Street, Geelong 3220, Australia; Monash Health, Centre for Quality and Patient Safety Research - Monash Health Partnership, 246 Clayton Road, Clayton 3168, Australia.
| | - Peter Jordan
- Eastern Health, Emergency Services, 8 Arnold Street, Box Hill 3128, Australia.
| | - Maryann Street
- Deakin University, School of Nursing and Midwifery; Centre for Quality and Patient Safety Research in the Institute for Health Transformation, 1 Geringhap Street, Geelong 3220, Australia; Eastern Health, Centre for Quality and Patient Safety Research - Eastern Health Partnership, Level 2, 5 Arnold Street, Box Hill 3128, Australia.
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