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Is there an afterlife? Janice Hudson, who's seen her share of death, ventures an assuring yes in this memoir about her years as a trauma nurse. In May 1987, newlywed intensive-care nurse Hudson was recruited to join a helicopter ambulance service and \"fly out to accidents, scrape up the patients and try to get them to qualified care in that first 'golden hour,' when they'd have the best chance for meaningful survival after traumatic injuries.\" Hudson hits on the usual suspects: barroom brawls, failed suicide attempts, and grisly car wrecks. She also recounts what are likely to be some of the more unusual cases, including a call from a woman who insisted that her mountaintop home was being overrun by an army of mountain lions (which turned out to be a single housecat, amplified thanks to the caller's diet of alcohol and crystal meth). Death is a constant in her pages, but so is Hudson's belief that something interesting awaits us afterward, as a few of her eerie anecdotes attest. -Amazon

This study analyzed outcomes associated with nurse-performed ultrasound (US)–guided intravenous (IV) placement compared to standard of care (SOC) palpation IV technique on poor vascular access patients. This was a randomized, prospective single-site study. Phase 1 involved education/training of a cohort of nurses to perform US-guided IVs. This consisted of a didactic module and hands-on requirement of 10 proctored functional IVs on live subjects. Phase 2 involved patient enrollment. emergency department patients meeting strict criteria of poor access were randomized to US-guided or SOC palpation arm. A functional IV placed by a study nurse was considered successful. Unsuccessful placement implied the study nurse failed, and a rescue IV was attempted. Time to IV placement was the total time required to obtain a functional IV and, if needed, a rescue IV. A total of 124 subjects were enrolled; 63 were randomized to the US-guided arm, and 61 were randomized into the SOC arm; 2 patients were excluded, leaving 59 patients. Success rate was 76% for the US-guided arm and 56% for the SOC arm (P=.02). Compared to the SOC arm, the odds ratio for success for the US-guided arm was 2.52 (95% confidence interval, 1.09-5.92). The mean time to IV placement for the US-guided arm was 15.8 and 20.7 minutes for the SOC arm (P=.75). In difficult access patients, nurses were more successful in obtaining IV access using US guidance than palpation SOC technique. Lengthier placement times were observed more frequently when the SOC IV technique was used.

Emergency departments have high levels of uncertainty, long wait times, resource shortages, overcrowding and a constantly changing environment. Patient experience and patient safety are directly linked, yet levels of patient experience are stagnant. To improve emergency nursing care and patient experience, an emergency nursing framework HIRAID® (History including Infection risk, Red flags, Assessment, Interventions, Diagnostics, communication, and reassessment) was implemented in 29 Australian emergency departments. To evaluate HIRAID® on patient experience in the emergency department. This modified stepped–wedge cluster randomised control trial was conducted in 29 Australian rural, regional and metropolitan emergency departments and involved over 1300 emergency nurses. A total 2704 (1456 control, 1248 intervention) surveys were completed. We hypothesised implementation of HIRAID® would result in an at least 5% increase in patient experience per Schmidt’s Perceptions of Nursing Care Survey and Australian Hospital Patient Experience Question Set. Patients (of all ages) and/or their carers completed a phone interview. Data were analysed using descriptive statistics and Generalized Estimating Equations approaches. Median (IQR) participant age was 54 (31–67) years. The most common presenting problems were abdominal, chest and respiratory issues. Greater than 5% improvement in all categories of the Schmidt’s Perceptions of Nursing Care Survey, and 10 out of 12 Australian Hospital Patient Experience Question Set was achieved. The implementation of the HIRAID® emergency nursing framework in Australian emergency departments significantly improved patient experience with emergency care. Demand for emergency care is increasing. Evaluating what methods work to effectively translate evidence to emergency practice, improve patient experience in the complex emergency setting is crucial. We present how a behaviour change informed implementation strategy enabled maximum, sustained uptake of an intervention that improved patient experience in a variety of emergency settings despite the COVID-19 pandemic and catastrophic flooding. Trial Registration: ANZCTR, ACTRN12621001456842. 25.10.2021.

HIRAID® (History including Infection risk, Red flags, Assessment, Interventions, Diagnostics, communication and reassessment) is an evidence-based framework that supports emergency nurses to optimise safety, quality, and patient experience of care. HIRAID® was the intervention in a modified stepped-wedge cluster randomised controlled trial (SW-cRCT) in a convenience sample of 29 Australian emergency departments (Australian New Zealand Clinical Trials Registry: ACTRN12621001456842). The aim of this paper is to describe the methods and processes used to develop and deliver a theory-informed education program to support behaviour change during HIRAID® implementation. The HIRAID® education program was developed using: i) existing HIRAID® research using the Behaviour Change Wheel and Theoretical Domains Framework to identify enablers and barriers to HIRAID® use; ii) application of educational pedagogical theoretical frameworks (constructive alignment, backwards design, scaffolded learning); Bloom's taxonomy of educational objectives, and active and collaborative learning; iii) Australian standards related to safety, quality, clinical governance, and emergency nursing; and iv) behavioural diagnostic data from study sites (n = 670 nurses). HIRAID® education program consisted of HIRAID® Provider and Instructor Courses and was delivered using a 'train-the-trainer' model. Fifteen HIRAID® Instructor Courses were held from February 2021 to March 2023 with 162 participants, and at November 2023 over 1300 emergency nurses had completed the HIRAID® Provider Course. The theory-informed approach to the HIRAID® education program enabled development of a structured program and delivery in the dynamic and complex emergency department environment. The approach reported in this paper provides a blueprint for other researchers aiming to change behaviours in complex settings.

This study was planned to determine the effect of using Kahoot in pediatric emergency nursing lessons on students' lesson success and motivation levels. Pediatric emergency nursing lessons is considered to be an intensive and rich lesson that includes information about child health and development in addition to the learning outcomes of emergency nursing lessons, blending emergency and pediatric nursing. It was found to be conducted as a randomized controlled study with a total of 60 nursing students, 30 for the experimental group and 30 for the control group, who took pediatric emergency nursing lessons and had never experienced Kahoot before. Data were collected using the Information Form, Exam Success Grade and Motivation Scale for Instructional Material. Mean, percentage calculations, multi-way analysis considered to be of variance and linear regression analysis considered to be were used to analyze the data. When comparing the midterm (t = 1.203, p = 0.002), final exam (t = 1.122, p = 0.001) and end-of-semester (t = 1.126, p = 0.001) scores of the Kahoot group with those of the control group, it was found to be determined that the Kahoot group obtained statis considered to betically significantly higher scores. The effect sizes of the differences between the Kahoot and control groups were 0.4, 0.5 and 0.5, respectively, indicating a large effect. It was found to be determined that there was found to be a statis considered to betically significant difference between the mean scores of the experimental and control groups of nursing students in terms of group, time and group*time interaction. Kahoot application was found to be found to explain 45 % of the increase in exam achievement level and 45 % of the increase in motivation level related to instructional material. Kahoot application was found to be an effective method in increasing the exam achievement and motivation of nursing students taking pediatric emergency nursing lessons.

Documentation templates supported the implementation of HIRAID, a validated framework that supports nurses in assessing and managing patients in emergency departments in rural Australia using a strategy informed by behavior change theory. The study aimed to determine whether the implementation of HIRAID improved the accuracy of nurses' documentation across a large rural health district. A Quasi-experimental pre-post study design was conducted across 10 rural emergency departments between November 2020 and November 2021, with HIRAID implemented in February 2021. Retrospective audit of clinical documentation occurred 3 months pre-implementation and repeated at 6-months post. Based on power analysis and a sampling framework, records that met study inclusion were randomized for audit. Documentation accuracy was evaluated, using a modified D-catch instrument, assessing quality and quantity by an experienced research nurse. Data were analyzed with descriptive and inferential statistics. A review of 222 records (110 pre/112 post), demonstrated an improvement in initial ED nursing assessment documentation. Audit scores increased significantly for quantity of documentation across all areas, in particular history (P < .001) and red flags (P < .001), with a 27.1% increase in all red flags recorded. The quality of documentation also significantly improved across all areas, most notably in history (P < .001) and assessment (P < .001). Implementation of HIRAID demonstrated a sustained improvement in the quantity and quality of emergency nurse documentation. Improved documentation accuracy is key to informing and evaluating ongoing care and supporting communication and continuity of care, and is essential to patient safety.

The objective of this study is to investigate the effects of emergency nursing interventions, specifically those based on the Pediatric Early Warning Score (PEWS), on children diagnosed with acute asthma, to promote the recovery of children with asthma and improve the quality of care for children with asthma. A total of 80 children, Acute asthma attacks under the age of 12, diagnosed with acute asthma and admitted to the Emergency Department of Hebei Children's Hospital between June 2018 and June 2019 were selected as participants for this study. They were randomly assigned to either the control group or the PEWS group. There was no significant statistical difference in age, gender, course of disease, and disease severity between the two groups of children. In the control group, children received standard emergency nursing interventions, while in the PEWS group, children received emergency nursing interventions based on the Pediatric Early Warning Score (PEWS). To evaluate the effectiveness of these interventions, several outcome measures were compared between the two groups. This included assessing the duration for symptoms to disappear, analyzing pulmonary function indicators and respiratory dynamics indicators, measuring scores from the Pediatric Asthma Quality of Life Questionnaire (PAQLQ), and evaluating nursing satisfaction. Following the implementation of the nursing interventions, 1. The average cough disappearance time of children in the PEWS group was 1.97 days shorter than that in the control group, the average wheezing disappearance time was 0.97 days shorter, the average dyspnea disappearance time was 0.64 days shorter, and the average lung wheezing disappearance time was 1.19 days shorter, which indicated that emergency care based on PEWS shortened the duration of symptoms in children with asthma. 2. The average FEV1 of children in the PEWS group was 9.87% higher than the control group, the average FVC was 0.62L higher, the average PEF was 9.84% higher, the average V70 was 0.91% higher, the average V50 was 0.43% higher , and the average V25 was 0.37% higher, when compared with control group. These results indicates that emergency care based on PEWS enhances the lung function of children with asthma. 3. The average respiratory rate of children in the PEWS group was 8.05 times/min lower, and the average dynamic respiratory system compliance was 6.91 mL/cmH2O higher, than that in the control group, which indicated that emergency care based on PEWS improved respiratory dynamics indicators in children with asthma. 4. The average PAQLQ symptom dimension score of children in the PEWS group was 0.84 points higher, the average activity dimension score was 0.34 points higher, and the average emotional dimension score was 0.47 points higher when compared with the control group. This indicated that emergency care based on PEWS improves the quality of life of children with asthma. 5. The nursing satisfaction of children in the PEWS group was 95%, higher than 72.5% in the control group, indicating that emergency care based on PEWS improved the satisfaction of asthma children with the nursing process. The implementation of PEWS based emergency care in pediatric asthma patients has important clinical significance in promoting recovery and improving the quality of care for asthma patients. The implementation of emergency nursing interventions based on the Pediatric Early Warning Score (PEWS) for children with acute asthma has been found to be effective in promoting the recovery of their condition, enhancing their quality of life, and improving nursing satisfaction.

Acute pancreatitis poses a significant threat in the emergency department due to its rapid and dangerous progression. Without timely and effective treatment measures, there is a heightened risk of advancing to multiple organ failure, posing a serious threat to the life safety of patients. This study aims to investigate the impact of graded emergency nursing on patients with acute pancreatitis. A randomized controlled experiment was conducted to assess the effectiveness of graded emergency nursing. The study was conducted in the Emergency Department of Beijing Friendship Hospital, Capital University. A total of 112 patients diagnosed with acute pancreatitis and admitted to our hospital from June 2021 to December 2022 were randomly assigned to either the observation or control group, with 56 patients in each. Patients in the control group received standard emergency nursing care, while those in the observation group underwent graded emergency nursing. The study assessed (1) triage time, waiting time, and treatment time, (2) the correct rate of diagnosis and the success rate of rescue, (3) functional status score, and (4) patient satisfaction with nursing care. Compared to the control group, patients in the observation group experienced significantly shorter triage time, waiting time, and treatment time (P < .05). Additionally, the observation group exhibited higher correct rates of diagnosis and success rates of rescue (P < .05). The functional status score in the observation group showed improvement (P < .05), and patients in the observation group reported higher satisfaction with nursing care (P < .05). Graded emergency nursing proves effective in reducing waiting times for diagnosis and treatment in acute pancreatitis patients, enhancing treatment success rates, and improving overall nursing quality. These findings hold valuable implications for clinical application and promotion.