Nurses' experiences of emergency department triage during the COVID-19 pandemic in Indonesia

Response Time and Influencing Factors Among Emergency Nurses in Indonesian Hospital: A Scoping Review of Current Evidence

Background

The incidence of mass casualty incidents and severe emergencies such as cerebrovascular and motor vehicle accidents in Indonesia is increasing, leading to an increased burden on emergency services. The current literature on response times and associated factors in Indonesian emergency departments (EDs) is extensive yet lacks comprehensive national and regional analysis.

Objective

This study aimed to synthesize existing research on emergency nurse response times in Indonesian hospital settings and identify the factors influencing these times.

Methods

This study was guided by the PRISMA-ScR framework. This study systematically searched the PubMed/MEDLINE, CENTRAL/Cochrane, EBSCOhost, and Google Scholar databases for studies published between 2019 and 2024. The included studies focused on empirical measurements of response times, defined as the time from patient arrival to initial treatment, with a particular interest in examining variations across different hospital levels and regions within Indonesia. A thematic analysis was conducted in this study.

Results

The review included data from 1628 nurses across 13 provinces, highlighting significant variability in response times. Tertiary hospitals generally show faster response times than secondary hospitals. Key factors influencing response times included the demographic aspects of the nursing staff, work environment conditions, and the level of nurse training and education. Specific barriers such as inadequate infrastructure and cultural differences in healthcare-seeking behaviors also play a role.

Conclusion

There is a critical need for targeted improvements in hospital infrastructure and staff training programs to enhance response times across all hospital levels in Indonesia. Future policies should focus on equipping secondary healthcare services to efficiently meet emergency care demands.

'It's only a matter of time' - Lessons learnt and recommendations from COVID-19 to inform emergency nursing for future pandemics: An integrated literature review

PURPOSE

In the recovery phase of COVID-19 disaster management, Emergency Department (ED) nurses are attempting to return to normal workforce operations, despite significant impacts on personal and professional lives. This review aims to examine and synthesise current literature for the learnings and recommendations from the lived experiences of ED nurses during the COVID-19 pandemic.

PROCEDURES

Electronic databases CINAHL Complete, Web of Science, Scopus (Elsevier) and PubMed were utilised using a 5-year timeframe that aligned with COVID-19 in Australia. Final date of accepted papers was 28th February 2024. A JBI Mixed Methods Convergent Integrated Approach was used.

FINDINGS

A total of 15 studies were included in the final review, representing seven countries of origin and included 649 ED nurses. Seven major themes related to learnings and recommendations were generated from data synthesis including (1) professional identity, (2) wellbeing support, (3) camaraderie, (4) effective communication, (5) working conditions and professional boundaries, (6) education and training, and (7) external support.

CONCLUSION

With the likelihood of future epidemic and pandemic events globally, it is vital to explore and collate evidence on the learnings and recommendations from ED during the COVID-19 pandemic to continue to build a sustainable, resilient, and supported workforce.

Linking patient safety, caring behaviours and professional self-efficacy with missed nursing care among Filipino emergency room nurses: A structural equation model study

AIMS

To investigate the interrelationships of patient safety, caring behaviours, professional self-efficacy and missed nursing care among emergency room nurses.

DESIGN

Cross-sectional, correlational study.

METHODS

Filipino emergency room nurses (n = 345) participated via convenience sampling from September 2023 to January 2024. Four validated self-report scales were used to collect data and were analysed using Spearman rho, covariance-based structural equation modelling, mediation and path analyses.

RESULTS

The emerging model of study variables displayed satisfactory fit indices. Patient safety directly influenced caring behaviours and professional self-efficacy, while negatively influencing missed nursing care. Caring behaviours directly and indirectly affected professional self-efficacy and missed nursing care, respectively. Professional self-efficacy negatively influences missed nursing care. Finally, caring behaviours and professional self-efficacy were significant mediators between the association of patient safety and missed nursing care.

CONCLUSION

Caring behaviours and professional self-efficacy of emergency room nurses demonstrated mediating effects that can potentially improve patient safety practices thereby minimizing unfinished or missed nursing care.

IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE

Nurses and healthcare organizations should commit to consistently maintain a workplace culture that fosters patient safety, caring behaviours and professional self-efficacy to minimize avoidable injuries and omitting nursing care tasks.

REPORTING METHOD

STrengthening the Reporting of OBservational studies in Epidemiology (STROBE).

PATIENT OR PUBLIC CONTRIBUTION

No Patient or Public Contribution.

Post-traumatic growth experiences of emergency and critical care nurses after the COVID-19 pandemic: A qualitative meta-synthesis

Objective

The previous coronavirus disease 2019(COVID-19) epidemic inflicted significant psychological trauma on emergency and critical care nurses due to various factors, potentially leading to job burnout. Despite the rise of positive psychology, little is known about the post-traumatic growth experience of these nurses after the pandemic. The aim of this study was to assess the experience of post-traumatic growth among emergency and critical care nurses, in order to provide managerial insights for developing effective strategies and facilitating the transformation of nurses' negative emotions into positive ones.

Design

A qualitative review.

Data sources

PubMed, EBSCO, Medline, Elsvier, Cochrane Library, CINAHL, Web of Science, Embase, and Ovid and Chinese databases include the following: Chinese National Knowledge Infrastructure (CNKI), Wanfang Database (CECDB), VIP Database and China Biomedical Database (CBM).

Review methods

All articles about emergency and critical care nurses' post-traumatic growth after the COVID-19 pandemic were included after searching and screening 13 databases. The meta-synthesis method was used to integrate and evaluate the included literature in qualitative research. The Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) was used as a basis for reporting the review. The literature was selected and evaluated by two researchers, and then meta-integration was used for analysis.

Results

From a total of 11 articles, 90 main results were presented, eight new categories were integrated, and three themes were formed: stress period, adjustment period and growth period. These three themes include eight sub-themes: negative emotion, psychological gap, self adjusting, social support, improvement of personal ability, increased sense of professional belonging, spiritual awakening and extended thinking, look ahead.

Conclusion

Post-traumatic growth in emergency and critical care nurses is dynamic. Managers should monitor the psychological changes experienced by emergency and critical care nurses following traumatic events, offering targeted support at different stages, providing enhanced professional development opportunities, refining management strategies, guiding nurses in self-adjustment and active coping with trauma, and promoting their physical and mental well-being to ensure a positive mindset for effectively addressing future public health crises.

Anxiety and Insomnia Mediate the Association of Fear of Infection and Fatigue: A Cross-Sectional Survey of Nurses Deployed to a COVID-19 Epicenter in China

Background

This study aimed to test the mediating role of anxiety and insomnia in the association between fear of infection and fatigue.

Methods

A cross-sectional questionnaire survey was conducted on the nurses deployed to Heihe. A serial multiple mediation model was established to determine the role of anxiety and insomnia in the association between fear of infection and fatigue.

Findings

Over half (53.0%) of the study participants reported experiencing fear of infection despite stringent personal protection measures. The scores of anxiety (11.87±5.19), insomnia (16.33±5.95), and fatigue (45.94±12.93) were moderately correlated, with a Pearson correlation coefficient ranging from 0.501 to 0.579. Anxiety, either alone or in combination with insomnia, mediated the association between fear of infection and fatigue.

Conclusion

The findings suggest that anxiety and insomnia play a mediating role in the relationship between fear of infection and fatigue. These results emphasize the importance of implementing targeted mental health interventions and work arrangements to address the well-being of healthcare professionals.

Hospital response challenges and strategies during COVID-19 pandemic: a qualitative study

Background

At the beginning of the COVID-19 pandemic, healthcare managers at hospitals did not have sufficient experiences to appropriately respond to the COVID-19 outbreak. Due to a lack of preparedness, many challenges arose in the healthcare system, and each country developed and implemented strategies depending on national policies. This study aimed to understand challenges during the COVID-19 pandemic and strategies used in Iranian hospitals.

Methods

A qualitative research was conducted in four hospitals in an urban area of Iran. In-depth semi-structured interviews were performed with 32 participants including healthcare managers, nurses, and medical doctors. Data underwent qualitative content analysis.

Results

Four categories were developed: 'capacity expansion', 'management affairs', 'diagnostic services," and therapeutic services'. Each category consisted of 2-3 subcategories.

Conclusion

Hospitals should be prepared to intelligently respond to future epidemics. It is necessary to develop a comprehensive epidemic plan for the management of disasters to reduce the impact of the epidemic and minimize the risk to public health and ensure that resources are allocated in an efficient and effective manner.

End of life care during the COVID-19 pandemic: A qualitative study on the perspectives of nurses and nurse assistants

AIM

To explore nurses' and nurse assistants' experiences of providing end-of-life care during the COVID-19 pandemic in Austria, Germany and Northern Italy.

DESIGN

A qualitative explorative interview study.

METHOD

Data were collected between August and December 2020 and analysed using content analysis. Healthcare professionals (nurses (n = 30), nurse coordinators (n = 6) and nurse assistants (n = 5)) from hospitals (n = 32) and long-term care facilities (n = 9) in Austria, Germany and Northern Italy were interviewed for this study.

RESULTS

Five main categories were identified as follows: (i) end-of-life care involves love and duty, (ii) last wishes and dignity of the patient, (iii) communication with the family, (iv) organizational and religious aspects and (v) personal emotions. Results indicate that more training and guidelines are needed to prepare nurses and nurse assistants for end-of-life care during pandemics.

PUBLIC CONTRIBUTION

This research can help prepare nurses and nurse assistants for end-of-life care in pandemics and will be of value for improving the institutional and government health policies. Furthermore, it can be of value in preparing training for healthcare professionals patient-relatives.

Cognitive appraisals and coping strategies of registered nurses in the emergency department combating COVID-19: A scoping review

OBJECTIVE

Explore the relevant evidence about stress-related cognitive appraisal and coping strategies among registered nurses in the emergency department (EDRNs) coping with the COVID-19 pandemic.

METHODS

This scoping review followed the methodological framework of Arksey and O'Malley to map relevant evidence and synthesize the findings. We searched PubMed, EMBASE, CINAHL, Web of Science, and Scopus electronic databases for related studies from inception through February 2, 2022. This review further conducted study selection based on the PRISMA flow diagram and applied Lazarus and Folkman's Psychological Stress and Coping Theory to systematically organize, summarize, and report the findings.

FINDINGS

Sixteen studies were included for synthesis. Most of the studies showed that the majority of EDRNs were overwhelmed by the COVID-19 pandemic. Depression, triaging distress, physical exhaustion, and intention to leave ED nursing were cited as major threats to their wellness. Additionally, comprehensive training, a modified triage system, a safe workplace, psychological support, promotion of resilience, and accepting responsibility may help EDRNs cope with pandemic-related challenges effectively.

CONCLUSION

The long-lasting pandemic has affected the physical and mental health of EDRNs because they have increased their effort to respond to the outbreak with dynamically adjusted strategies. Future research should address a modified triage system, prolonged psychological issues, emergency healthcare quality, and solutions facing EDRNs during the COVID-19 or related future pandemics.

CLINICAL RELEVANCE

EDRNs have experienced physical and psychological challenges during the pandemic. The ED administrators need to take action to ensure EDRNs' safety in the workplace, an up-to-date triage system, and mental health of frontline nurses to provide high-quality emergency care for combating COVID-19.

Emergency nurses' attitudes, perceptions about personal protective equipment and willingness to care for COVID-19 patients: A descriptive, cross-sectional study

Aims

This study investigated emergency nurses' attitudes and perceptions about personal protective equipment and their association with the willingness to care for COVID‐19 patients.

Background

Emergency nurses are at increased risk for COVID‐19 infection as frontline workers and must wear personal protective equipment while attending suspected and confirmed COVID‐19 patients.

Methods

In September 2021, 188 nurses in four emergency departments completed online questionnaires.

Results

Multivariable logistic regression demonstrated that as perceptions of COVID‐19 infection risk increased by 1 point, 26% of nurses were willing to care of COVID‐19 patients. The willingness to care for COVID‐19 patients increased in their attitudes by 1.16 point and perceptions by 1.08 points about PPE.

Conclusions

Perceptions of the risk of infection exposure and confidence in safety of personal protective equipment are associated with nurses' willingness to care for COVID‐19 patients.

Implications for Nursing Management

Nurse managers need to assess nurses' needs for safety and provide a supportive climate to mitigate their concerns regarding infection risk and encourage nurses' willingness to care for patients. Nurse managers should provide precise guidelines on correct personal protective equipment use. Repetitive training on personal protective equipment should be provided to encourage nurses' adaptation to its use.