Ethyl-cyanoacrylate (household super glue) is similar to medical-grade adhesive and is easily found in supermarkets and hardware shops. It can be used to close wounds when medical care is not easy to access and no other form of wound closure is available, for example when travelling or living in remote environments. While it is inexpensive and can be effective, using super glue to close wounds is not without risk and it could cause tissue damage, infection and significant burns if used incorrectly. This article explains when it would be appropriate to use super glue to close a wound, its similarities to medical-grade adhesive and its antimicrobial properties. It includes a step-by-step guide to using super glue to close a wound. The article aims to prepare nurses to reduce harm when super glue is the only option to close wounds in remote areas.
Burnout remains a major issue in nursing, with negative effects on staff well-being, patient outcomes and organisational performance. Burnout is estimated to affect approximately one in ten nurses globally and is associated with higher sickness absence and turnover rates, reduced empathy towards patients, increased risk of errors, and poorer patient outcomes. This article reviews contemporary evidence on the prevalence, causes and effects of burnout among nurses and discusses the potential benefits of integrating the Maslach Burnout Inventory in nurse supervision as part of the solution for addressing burnout. The author outlines the elements of a structured strategy that healthcare organisations would need to put in place to identify staff at risk of (or experiencing) burnout and support them appropriately.
Emergency nurses are frequently the first point of contact for patients presenting to the emergency department (ED) with the symptoms of acute psychosis. Altered perception, fear and disorganised thinking can impair communication and precipitate distress, which may lead to agitation or aggressive behaviour, placing patients and staff at increased risk of harm. In these circumstances, verbal reasoning alone may be ineffective. Evidence indicates that non-verbal communication, such as body posture, eye-level alignment, proximity and tone of voice, can have a pivotal role in these situations by promoting calm and conveying safety, thereby preventing escalation to coercive or restrictive measures. Drawing on research and trauma-informed care principles, this article explores how emergency nurses can adapt Safewards interventions such as soft words, talk down and reassurance into effective non-verbal communication strategies in their practice. The authors provide guidance on embedding non-verbal de-escalation in routine ED nursing practice, highlighting approaches that are transferable to a wide range of mental health-related presentations and have the potential to improve safety, preserve dignity and strengthen therapeutic engagement in emergency care.
Remote patient consultation is a fast-growing area of healthcare in the UK. Clinical decision-making in remote and emergency care involves the processing of information, evaluation of evidence and application of knowledge to select the most appropriate intervention for the patient and reduce the risk of harm. It is important, therefore, that nurses and other healthcare practitioners have an understanding of decision-making processes. In this article, the author explores clinical decision-making in the context of emergency and remote care and considers the importance of effective communication and shared decision-making to support safe and appropriate patient care.
This literature review explores barriers to children's access to routine NHS dental care in the UK and the factors contributing to preventable presentations to emergency and urgent care. Evidence from the seven included studies identified four main themes: socioeconomic deprivation, vulnerable populations, service availability, and parental disengagement and limited oral health education. The findings suggest that poor access to routine dental services is shaped by structural and social inequalities rather than individual factors alone. Children who are looked after, autistic or otherwise vulnerable may experience additional barriers to timely and appropriate dental care. These inequalities contribute to avoidable emergency presentations for conditions that could often be prevented or managed earlier in primary dental settings. The review highlights implications for emergency nursing practice, including recognising unmet need, considering possible safeguarding concerns, communicating sensitively with families, and supporting earlier intervention and signposting to appropriate services.
RATIONALE AND KEY POINTS:Exacerbations of chronic obstructive pulmonary disease (COPD) can result in type 2 respiratory failure, which can be effectively and safely treated with non-invasive ventilation (NIV). NIV involves delivering oxygen to the patient via a mask and ventilator, so it does not require the use of an endotracheal tube. NIV is commonly used in the emergency department for patients presenting with type 2 respiratory failure caused by a COPD exacerbation. It is important that emergency department nurses are confident in the steps required to start patients on NIV. • NIV can feel overwhelming for patients, who are often critically unwell, so nurses must explain NIV to patients and provide reassurance. • NIV constitutes level 2 care, so frequent and careful monitoring is vital for ensuring patient safety and optimal outcomes. • It is important to treat patients holistically, including when monitoring the effectiveness of NIV. REFLECTIVE ACTIVITY: 'How to' articles can help to update your practice and ensure it remains evidence based. Apply this article to your practice. Reflect on and write a short account of: • How the article can improve your practice when starting patients with COPD-associated type 2 respiratory failure on NIV. • How you could use this information to educate nursing students or colleagues on the appropriate technique and evidence base for starting patients presenting with COPD-associated type 2 respiratory failure on NIV.
Neutropenic sepsis is a serious, potentially fatal complication of systemic anticancer therapy. Patients with suspected neutropenic sepsis require treatment with intravenous antibiotics within one hour of presentation to hospital. However, national and local audits suggest that this door-to-needle time target is not always met. This article details a quality improvement project (QIP) undertaken in a medical assessment unit (MAU) that aimed to increase the percentage of patients with suspected neutropenic sepsis receiving antibiotics within the one hour door-to-needle time target by 25%. The QIP comprised several components, including audit of door-to-needle times, staff training and a series of improvement initiatives. The results of the audit showed that 60% ( n =30/50) of patients received antibiotics within one hour of presentation to the MAU, an increase of 30% compared with baseline audit data. Although the QIP did not achieve universal adherence to the target door-to-needle time, there was significant improvement which demonstrates that small changes can enhance patient care.
Emergency departments (EDs) face ongoing challenges such as overcrowding, long waiting times and patient dissatisfaction. Traditional triage-to-bed models of ED care tend to delay diagnostic tests and treatment for moderate-acuity and low-acuity patients. This article describes the redesign of patient flow in one ED in California, in the US, through the creation of portal rooms for early diagnostic tests and QuickPass rooms for low-acuity encounters, with the goal of reducing delays and improving throughput. Early feedback from patients and staff was positive, including improved patient perceptions of receiving timely care. The use of portal rooms and QuickPass rooms represents a practical, low-cost strategy for addressing overcrowding. While formal outcome data are needed, this initiative highlights how lean, resource-conscious ED redesign can meaningfully address long-standing challenges in emergency care. By redefining the use of their physical space and initiating diagnostic tests earlier, EDs can improve patient experience and staff efficiency.
People often express a preference for dying in a home setting rather than in hospital. In emergency departments (EDs), system pressures and the complexity of organising discharges mean that people who are approaching the end of life may be admitted to and die in hospital, even when discharging them to their preferred place may have been indicated and feasible. A rapid discharge checklist can support the process of safely and efficiently discharging patients at the end of life from the ED. It outlines essential steps in the discharge process, including confirming the suitability of discharge, liaising with community services, prescribing anticipatory medicines, and arranging equipment and transport. This article discusses rapid ED discharge checklists for patients at the end of life, outlining the positive outcomes of their implementation in one ED in England. Embedding such checklists into routine ED practice would support emergency nurses to contribute to person-centred and dignified care for patients at the end of life.
Prompt recognition and control of haemorrhage are fundamental responsibilities for the emergency nurse. Nurses are often the first to identify subtle indicators of bleeding and have a central role in activating major haemorrhage protocols, initiating life-saving interventions and communicating with the wider multidisciplinary team. This article explores the pathophysiology of haemorrhage and details assessment methods and evidence-based management strategies. The author also discusses the nurse's role as clinician, advocate and communicator, alongside ethical considerations and human factors.
