BACKGROUND:Chest pain is one of the most common reasons for visits to the Emergency Department (ED) worldwide. Effective risk stratification tools are essential for distinguishing between life-threatening cardiac events and non-cardiac causes. The HEART score is a widely used clinical decision tool designed to assist in this process. This review aims to synthesise the evidence on healthcare practitioners' use of the HEART score for risk stratification and management of adults with acute chest pain presenting to the ED. METHODS:A scoping review methodology, based on the Joanne Briggs Institute (JBI) framework, was employed. The review is reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analysis for Scoping Reviews (PRISMA-ScR). The Population - Concept - Context (PCC) framework was used to inform the development of the research question and the inclusion and exclusion criteria. Six electronic databases (CINAHL, Medline, SCOPUS, PubMed, Embase, and GreyLit) were searched from January 2015 to January 2025. Screening was conducted independently by two reviewers against eligibility criteria, with regular meetings held to resolve issues and reach consensus. Data were extracted on study characteristics, use of the HEART score, methodology, patient outcomes and key findings. FINDINGS:Fifteen studies from seven countries were included, encompassing a range of study designs and large variability in sample size. The HEART score demonstrates high inter-operator reliability, with the strongest agreement observed in objective components such as age and troponin levels, and comparatively lower agreement in more subjective elements, particularly patient history. In addition, the HEART score shows strong predictive performance for major adverse cardiac events (MACE), with consistently low event rates (0-2%) among low-risk patients and substantially higher rates observed in intermediate and high-risk groups. High sensitivity supports its safety in identifying patients suitable for early discharge. However, variation in clinician adherence was evident, with low-risk patients frequently admitted despite minimal MACE incidence. Implementation of the HEART pathway was associated with reductions in hospitalisations and diagnostic testing without compromising patient outcomes, highlighting its value in optimising ED utilisation. CONCLUSION:The HEART score is a reliable and effective risk assessment tool for assessing patients with chest pain in the ED. It demonstrates strong predictive accuracy for adverse cardiac events and supports improved patient flow. However, variability in clinician adherence, particularly among less experienced practitioners, may limit its full potential. Enhancing education, supporting clinical decision-making, and integrating the HEART score into clinical structured care pathways may optimise its use and improve patient outcomes.
INTRODUCTION:Maritime mass casualty incidents (MCIs) present significant operational challenges due to environmental instability, geographic isolation, and delayed sea-to-shore evacuation. Despite increasing maritime disaster risks, limited evidence exists on how emergency personnel experience and enact coordinated responses and operational resilience in island settings. METHODS:A qualitative descriptive study was conducted using individual semi-structured interviews with 12 emergency physicians and emergency nurses involved in maritime MCIs coordination in southern Thailand. Data were analysed using reflexive thematic analysis, with the incident command system (ICS) providing a structural lens and adaptive clinical command informing interpretation of adaptive coordination and decision making. FINDINGS:Three interrelated patterns relevant to operational resilience were identified: (1) operational volatility, characterised by environmental instability, delayed evacuation, and fluctuating patient surges; (2) adaptive clinical command, involving flexible triage, dynamic resource allocation, and cross-agency coordination; and (3) community-embedded interoperability, reflecting the contributions of local responders, shared training, and distributed response capacity. Together, these interrelated patterns illustrate how coordinated response is sustained under conditions of uncertainty. CONCLUSIONS:Operational resilience in maritime MCIs emerges from the interaction between structured command systems, adaptive frontline leadership, and distributed response capacity. Adaptive clinical command represents an important capability through which emergency physicians and nurses support situational awareness, coordination, and flexible decision-making during uncertain and resource-constrained maritime emergencies. Strengthening communication interoperability, adaptive leadership, and community-integrated preparedness may enhance disaster readiness in geographically isolated maritime settings.
PURPOSE:Emergency department handovers are vital for patient safety. However, factors influencing nurses' clinical decision-making ability in inbound handovers remain insufficiently understood. We aimed to construct a hypothetical model of factors influencing clinical decision-making ability and handover evaluation among emergency department nurses for inbound patients in the emergency department. METHOD:Structural equation modelling was utilised to verify the goodness-of-fit of the model and the significance of the paths. Data were collected from 223 emergency department nurses using a structured web-based self-report survey conducted from 28 to 29 August 2023. Confirmatory factor analysis and structural equation modelling were performed. RESULTS:The final model showed an improved fit compared with the initial model. Clinical decision-making ability was directly influenced by knowledge-sharing behaviour, autonomy, and critical thinking disposition, and indirectly by work complexity, nursing work environment, knowledge-sharing behaviour, and autonomy. Handover evaluation was directly influenced by nursing work environment, knowledge-sharing behaviour, and clinical decision-making ability, with indirect effects from work complexity, nursing work environment, knowledge-sharing behaviour, and critical thinking disposition. CONCLUSION:We established a structural model that provides a foundation for educational programmes and interventions to enhance emergency department nurses' clinical decision-making and handover performance.
Introduction Traumatic thoracic injuries constitute a major global health burden, associated with high mortality, severe complications, and complex care needs. The acute and unpredictable nature of trauma care often limits early patient involvement despite the importance of person-centred care for safety and recovery. Although nurses provide crucial technical and holistic support, organisational pressures may hinder psychosocial care. Aim This study aimed to explore how patients with traumatic thoracic injuries experience nursing care and participation in a trauma care unit. Methods Sixteen semi-structured individual interviews with patients who had sustained a traumatic thoracic injury were conducted in a level 1 trauma centre. The data were analysed using thematic analysis and an inductive approach. Results The main findings revealed that organisational factors and relational aspects directly influenced the delivery and continuity of nursing care. Organisational factors affected the delivery and continuity of care. Relational aspects, such as attention to individual preferences and basic care needs, and recognition of the patient's capability, influenced perceptions of dignity, participation, trust, and safety. Conclusion Organisational factors and relational aspects shape the quality of trauma nursing, relying not only on adequate resources and professional competence, but equally on the relational integrity of everyday clinical encounters.
Background Bibliometric analysis (BA) is the quantitative analysis of evidence. BAs measure and map research activity by examining publication trends in geographic distribution, journals, authors, institutions, keywords, citations, and collaboration networks. This BA mapped the multidisciplinary evidence informing emergency care (EC). This BA therefore includes the nursing discipline. Methods A retrospective quantitative BA of EC evidence was completed using validated methods. Data were sourced from ClinicalTrials.gov and Clarivate Web of Science. VOSviewer and Microsoft Excel enabled analysis. Results Since 1966, n = 172,714 publications across EC disciplines have been indexed, with n = 76,017 (44%) published since 2016. Annually, an average of n = 2831 publications emerge (R2 = 0.702), with the United States, Germany, and England making the greatest contributions. Annals of Emergency Medicine was the leading journal. The top 1% most-cited publications (n = 92) had a mean citation rate of 291. Original articles accounted for 63.9% (n = 110,501) of publications. Analysis of 137 emergent keywords revealed that management, mortality, care, survival, and outcomes were dominant research themes. As of November 27, 2025, n = 1164 clinical trials were in progress, mostly North American (n = 575; 49.3%), being focused on drug trials (n = 310; 26.6%). Conclusion This BA provides a comprehensive map of the EC multidisciplinary evidence since 1966. Despite substantial growth, investment is needed in EC-focused research, evidence synthesis, and global research capacity. Ongoing BA can inform EC nursing research priorities, funding, and knowledge translation, providing a strategic roadmap to strengthen nursing leadership, education, and translation of evidence into EC practice.
Canada's aging population is a growing challenge for emergency departments (EDs), as older adults require complex, resource-intensive care. Traditional ED models focus on single, acute conditions and often fail to address older patients' multifaceted needs, leading to functional decline, misdiagnosis, and readmission. Nurses are well suited to lead geriatric-focused interventions. This systematic review examined 33 studies since 2014, evaluating nurse-delivered ED care for adults ≥65 years across seven intervention types: multidisciplinary teams, geriatric screening, geriatric assessment, nurse geriatric specialists, ED pathway/process change, and discharge planning.Multidisciplinary teams, nurse geriatric specialists, geriatric screening, and geriatric assessments were associated with improved inpatient admission rates, functional decline, and discharge rates. Combining nurse geriatric specialists with multidisciplinary teams yielded the most consistent benefits. Improvements in ED revisits and hospital length of stay were less consistent, especially in higher-quality studies.Evidence quality was modest, but findings support nurse-delivered strategies in improving care for older adults in the ED. Future research should focus on high-quality, multi-site evaluations to inform practice.
BACKGROUND:The nurse's ability to communicate clinical information effectively can optimise patient safety and is related in part to confidence. Confidence underpins a nurse's capacity and motivation to undertake patient assessment and communication. AIM:To determine the effect of the HIRAID® (History including Infection risk, Red flags, Assessment, Interventions, Diagnostics, reassessment and communication) intervention on emergency nurses' confidence with clinical assessment, professional communication and escalation of care. DESIGN:A modified stepped-wedge cluster randomised control trial across 29 Australian rural, regional and metropolitan emergency departments. METHODS:A theory-informed implementation strategy was used to implement HIRAID® drawing on behaviour change, implementation science and educational pedagogy. Online surveys (pre and post intervention) were distributed to eligible nurses (n = 1377). Multiple regression was used to examine differences in nurses' confidence in patient assessment, communication and escalation of care pre and post HIRAID® implementation, adjusted for nurse years of experience and the practice environment. Qualitative data were analysed using inductive content analysis. RESULTS:Across 29 sites, 671 pre and 534 post intervention respondents completed the survey. Overall, nurses had a median of 5 years of emergency nursing experience. There was a significant difference between pre-and-post HIRAID® implementation in confidence in communication. After adjusting for potential confounding variables, the average communication score significantly increased after HIRAID® implementation. Three themes were generated from qualitative analysis: (i) HIRAID® enables more consistent and high-quality comprehensive assessment and communication; (ii) HIRAID® enables more appropriate prioritisation of care in emergency clinical practice; and (iii) role modelling and expert clinical education support is needed to develop confidence. CONCLUSION:Confidence underpins a nurse's ability to act and influences their capacity and motivation to communicate effectively and acquire and retain clinical information. HIRAID® implementation strengthened nurse confidence in communication and escalation of assessment findings, particularly for emergency nurses with <2 years' experience.
BACKGROUND:Ten Second Triage (TST) is a rapid assessment tool for mass casualty incidents that excludes physiological parameters. The TST was implemented in Pirkanmaa, Finland, in 2024. The Emergency Medical Service (EMS) employees received pre-course material, attended a lecture, and completed one hour of simulation training. The study evaluated whether they could learn and implement the TST after training. METHODS:Data were collected using a questionnaire featuring an imaginary traffic accident, with four case scenarios assessed using TST. The questionnaire evaluated TST learning and the need for additional training. Categorical data were analysed using the Fisher-Freeman-Halton exact test in Case 1 and Pearson Chi-Square test in Cases 2-4. Skewed variables were reported as median and interquartile range. RESULTS:Of 450 (94% of all) EMS employees, 390 (82%) completed the questionnaire. For three of the four cases, correct triage rates were high (88-94%), but for one complex case, the correct rate was 28%. Additionally, 303 (79%) participants felt competent to use the TST post-training, while 61 (16%) indicated a need for further training. CONCLUSIONS:The results show EMS employees can learn the TST method for simple cases, while complex cases with multiple complaints were assessed moderately and require more training.
Background Pain is a common reason for emergency department visits, and patients' pain experiences and beliefs may influence. Objective This study aimed to examine the effects of pain beliefs and experiences on perceived nursing care and patient satisfaction among emergency department. Methods This descriptive study was conducted in the adult emergency department of a university hospital between December 2024 and December 2025 with 475 patients. Data were collected using the Patient Introduction Form, Emergency Department Patient Satisfaction Scale, Care Behavior Scale-24, Brief Pain Inventory, and Pain Beliefs Scale. Results Among participants, 50.5% were female and the mean age was 46.95 ± 18.61 years. It was found that scores for organic pain beliefs were higher than those for psychological beliefs Scores for organic pain beliefs (2.70 ± 0.94) were descriptively higher than those for psychological beliefs (2.20 ± 0.82). Reflecting positive care outcomes, the total CBS-24 mean score was 3.85 ± 1.14 (exceeding the 3.50 midpoint) and the overall EDPSS satisfaction score was 48.32 ± 14.23 out of 72.00. Pain-related variables explained 24.7% of the variance in care behavior scores and 25.2% in patient satisfaction. Pain relief, psychological beliefs, current pain level, general activity, and enjoyment of life emerged as crucial statistical predictors (p < 0.05). Conclusions Pain management efficiency and psychological subdimensions significantly predict emergency nursing care behaviors and patient satisfaction. Rather than relying solely on pain intensity reduction, emergency teams must implement comprehensive care bundles that actively support patients' functional and psychological needs. Clinically, incorporating structured, location-specific pain assessments into pre-registration and continuous professional development is highly recommended to dynamically optimize patient-reported care quality.
BACKGROUND:Emergency nurses are routinely exposed to workplace trauma, placing them at increased risk of secondary traumatic stress. Although body awareness has been proposed as a potential coping resource for stress regulation, its role in relation to secondary traumatic stress remains poorly understood. AIM:To examine the association between body awareness and secondary traumatic stress among emergency nurses and to explore how body awareness is experienced and used as a coping resource to workplace trauma. METHODS:100 emergency nurses completed the Multidimensional Assessment of Interoceptive Awareness and the Secondary Traumatic Stress Scale . Descriptive statistics, correlation analysis, and multiple linear regression were used to examine relationships between body awareness and trauma. Semi-structured interviews were conducted of nine nurses and analyzed using thematic analysis. RESULTS:Most emergency nurses reported moderate levels of body awareness and moderate to high levels of secondary traumatic stress. No statistically significant association was found between body awareness and secondary traumatic stress, and body awareness did not predict trauma levels in regression analysis. Gender emerged as a significant predictor, with male nurses reporting lower secondary traumatic stress scores. Four themes emerged: listening to the body, mind-body disconnection, body awareness as a coping tool and workplace culture and barriers.. CONCLUSION:Body awareness did not demonstrate a direct protective effect against secondary traumatic stress, qualitative findings suggest that it functions as an important situational coping resource . This highlights the need for trauma-informed approaches that integrate individual body-based coping strategies with supportive workplace environments.
Background Artificial intelligence is increasingly explored in prehospital emergency medical services to support clinical and organisational decision-making, yet its real-world application remains unclear. Objective To map the use of artificial intelligence in prehospital emergency medical services, focusing on decision-making processes including dispatch, triage, and transport coordination. Methods A scoping review was conducted following Joanna Briggs Institute methodology and reported according to PRISMA-ScR guidelines. PubMed, CINAHL, Scopus, Engineering Source, and INSPEC were searched (March 2025) without time restrictions. Empirical studies addressing the development, validation, or application of artificial intelligence in prehospital settings were included. Data were synthesised using descriptive analysis and iterative thematic grouping. Results Thirty-seven studies were included, mainly published between 2020 and 2024. Most were observational or proof-of-concept, with machine learning as the predominant approach. Five application domains were identified: time-sensitive conditions, complex emergency management, dispatch and transport coordination, predictive analytics, and organisational efficiency. Artificial intelligence showed potential to improve early diagnosis and operational decision-making; however, most systems lacked external validation and real-world implementation. Conclusions Artificial intelligence represents a promising decision-support tool in prehospital emergency care. Nevertheless, evidence remains preliminary, highlighting the need for rigorous validation, integration into clinical workflows, and training to support safe and effective adoption.
BACKGROUND:Medication-related Missed Nursing Care (MNC) is particularly a risk in short-stay units in ED, increasing the risk of adverse events. This study investigates the prevalence of medication-related MNC in Danish short-stay units, its association with nurse work experience, and the most common reasons for MNC. METHODS:A cross-sectional study was conducted in 16 hospital units using the Danish validated version of MISSCARE Survey. Associations were analyzed using multiple logistic regression adjusted for potential confounders. RESULTS:A total of 319 nurses participated. Overall, 63-73% reported medication-related tasks as frequently missed. Nurses with ≤2 years of experience were less likely to report missed administration of scheduled medications than more experienced nurses. No differences in reporting missed PRN-medication requests or assessing medication effectiveness were associated with work experience. The most commonly cited reason for MNC in Danish ED short-stay units was an "unexpected rise in patient volume and/or acuity." CONCLUSION:Medication-related tasks were frequently missed in short-stay ED units, and nurse experience appears to influence reporting of missed scheduled medication administration. Organizational factors, including staffing adequacy and workload management, were primary contributors. Targeted training combined with supportive work environments may reduce medication-related MNC and improve patient safety in short-stay units.
INTRODUCTION:Paramedics can experience a range of stressful and potentially traumatic events through clinical work, collegial relationships and organisational pressures. This can affect their mental health, including posttraumatic stress symptoms (PTSS). However, paramedics may also experience positive outcomes such as resilience and posttraumatic growth (PTG). This study aimed to examine levels of, and relationships between, paramedics' stress and trauma exposure, resilience, PTSS and PTG. METHODS:A cross-sectional survey was completed by n = 112 paramedics from Australian ambulance services. Data were analysed with descriptive and correlational statistics. RESULTS:Overall, 25.7% of paramedics met the threshold for probable posttraumatic stress disorder, and PTG was low (M = 35.49, SD = 23.84). Resilience was negatively correlated with PTSS (rs = -0.46, p < 0.01). Resilience subfactor Mastering stress was correlated negatively with PTSS (rs = -0.44, p < 0.01), and positively with PTG (rs = 0.24, p < 0.05). Colleague-related stress was related to PTSS (rs = 0.45, p < 0.01), resilience (rs = -0.31, p < 0.01) and PTG (rs = 0.25, p < 0.05). CONCLUSIONS:Paramedics experienced frequent stress and trauma exposure, with high PTSS and low PTG. To support their mental wellbeing, evidence-based resilience interventions are recommended. Wellbeing strategies should include exposure minimisation, targeting avoidable stressors related to colleagues (e.g. bullying, incivility) and organisational processes (e.g. promotion, shift flexibility).
BACKGROUND:Pediatric emergency departments are often fast-paced and high-intensity environments designed to deliver urgent medical care. AIM:To investigate the effects of playing digital games and watching cartoons on pain, fear, and anxiety levels in children during suture removal in a pediatric emergency unit. METHOD:The study was conducted with 90 children aged between 5 and 10 years who presented to a hospital emergency department trauma unit for suture removal between July 2024 and April 2025; the children were allocated to the groups: Group 1, digital games (30 children); Group 2, cartoons (30 children); Group 3, control (30 children). Children in the intervention groups played digital games and watched cartoons immediately before the suture removal procedure. An Introductory Information Form, the Child Fear Scale, Wong Baker Pain Scale, and State-Trait Anxiety Inventory for Children were used to collect data. Analysis of pain change scores indicated significant differences between the groups based on evaluations provided by children, parents, and nurses. RESULTS:Change scores were calculated as post-procedure score minus pre-procedure score; negative values indicate a reduction in the outcome following the procedure. In terms of child pain score change, the change in pain scores of children in the control group (0.717 ± 1.381) was found to be significantly higher than that of children who played digital games (-0.833 ± 1.464) and watched cartoons (-0.483 ± 1.669) (F = 8.700, p < 0.001; the control group had significantly higher post-procedure pain than both intervention groups). In terms of child fear score change, the change scores in the control group (-1.733 ± 2.815) were found to be significantly different from that of children who played digital games (-4.300 ± 2.769) and watched cartoons (-2.000 ± 3.129) (F = 7.061, p = 0.001; the digital game group had significantly lower post-procedure fear than the cartoon and control groups). A similar trend was observed in anxiety change scores. The change in child anxiety in the control group (-1.633 ± 2.526) was significantly different from children playing digital games (-4.700 ± 3.019) and children watching cartoons (-1.833 ± 3.435) (F = 9.708, p < 0.001; the digital game group had significantly lower post-procedure anxiety than the cartoon and control groups). CONCLUSION:Playing digital games was the most effective method for alleviating pain, fear, and anxiety during suture removal. Digital games may be considered a useful non-pharmacological distraction technique for children aged 5-10 years undergoing suture removal in pediatric emergency settings.
Background and problem statement The global population is ageing, and Australia's older population continues to experience the highest growth in emergency department (ED) presentations. Older adults have a higher level of vulnerability and are at greater risk of hospital acquired complications. Local problem The Older Persons Emergency Network Acute Outreach Service (OPEN AOS) provides ED substitution and ambulance co-response to older persons in their home to avoid unnecessary transfers to ED. Since establishment, service demand has grown and cost-effective initiatives to increase service capacity and capability are required to sustain service delivery. Methods A quality improvement project was undertaken to trial and assess mixed reality (MR) goggles in conjunction with video calling software over 90 days, to increase service capacity and capability. Usability, acceptability, enablers, and barriers related to MR use was assessed using the System Usability Scale and open-ended questions. Descriptive statistics summarised the data and content analysis further explained the results. Intervention The intervention involved Registered Nurses or Advanced Practice Nurses performing solo outreaches wearing the MR goggles to liaise remotely with OPEN AOS senior clinicians (Senior Medical Officers or Nurse Practitioners) for medical governance. Results Thirty-two clinicians interacted with MR and completed the survey. Most patients were treated in Residential Aged Care Homes (RACHs) (66%, 21/32) for minor injuries or fractures (25%, 9/32), lacerations (25%, 8/32) or wounds (19%, 6/32). Good usability and acceptability were reported. Nurses found MR easy to use and obtained clear advice from senior clinicians. Senior clinicians found the image quality to be the biggest strength of MR. Half of the staff experienced technical issues mainly due to internet connectivity in RACHs causing call disconnections and distorted images. Discussion These findings provide valuable insight into MR use in the OPEN AOS, enabling service directors to make informed decisions regarding future investment in MR technology. This was a quality improvement project with a small sample size and caution should be exercised when generalising these findings to other healthcare settings. Conclusion MR shows great potential to increase capacity and capability within the OPEN AOS, enabling nurses to carry out solo outreaches safely and competently. Further research is necessary to evaluate clinical and cost effectiveness of MR to support broader adoption in other healthcare settings.
