Point-of-care ultrasound is essential in the initial assessment of polytrauma patients. The E-FAST protocol enables rapid detection of intra-abdominal free fluid, pericardial effusion, and pneumothorax, with particular usefulness in prehospital settings. However, ultrasound training among emergency nursing staff remains limited, especially within Advanced Life Support (ALS) mobile units. To evaluate the effect of a brief, structured training program on the acquisition of competencies for obtaining E-FAST windows in ALS mobile units nurses, assessing knowledge, technical skills, scanning sequence, and perceived confidence. A quasi-experimental pre-post intervention study was conducted with nurses with ≥6 months of experience in emergency or prehospital care. The intervention included baseline assessment, a 2-h theoretical module, high-fidelity simulation with Ultrasound Mentor®, and hands-on practice with human models. Final assessment combined a theoretical test, simulator-based practical evaluation, and scanning with a real ultrasound device. Knowledge, execution times, and confidence levels were recorded. Fourteen nurses participated, most without previous ultrasound training (85.7%). Initial confidence was low and improved significantly after the intervention. Theoretical performance increased in 5 of the 6 evaluated items, reaching up to 92.9% accuracy in key content areas. Practical assessment demonstrated an organized scanning sequence and appropriate times for prehospital care (medians of 118 s [IQR 24.5] in advanced simulation and 237 s [IQR 33.3] using a real ultrasound device). The program enabled the acquisition of essential skills even in professionals without prior ultrasound experience. The combination of theory, simulation, and hands-on practice facilitated rapid competency transfer and protocol standardization. A brief training program improves ALS mobile units nurses' competence and confidence in obtaining E-FAST windows, supporting the safe integration of point-of-care ultrasound into prehospital care.
A nationwide healthcare crisis, characterized by a strained emergency care system and a significant shortage of physicians, has created substantial shifts in the clinical environment and directly affected emergency nurses who serve on the front lines of patient care. This study aimed to explore emergency nurses' experiences during a prolonged healthcare crisis. A descriptive qualitative study was conducted. Data were collected from November 2024 to February 2025. Individual interviews were conducted using semi-structured, open-ended questions. Nurses with at least one year of experience in the emergency department were recruited. Fifteen nurses participated, and the interviews were analysed using conventional content analysis. The study adhered to the Consolidated Criteria for Reporting Qualitative Research. Three themes were identified: (i) Chaos phase: Disruption of emergency department operations (ii) Transitional phase: Nurses' dedicated efforts to fill gaps from physicians' absence, and (iii) Adaptation phase: Stepping into more advanced emergency nursing. Emergency nurses play a pivotal role in safeguarding patients' health through close collaboration with physicians and active participation in clinical decision-making. Even during crises, they maintain core nursing responsibilities while providing compassionate care and delivering patient- and family-centered care as a key aspect of their practice. As nursing roles expand, enhancing nurses' competencies requires policy support, including the development of a practical education system and the institutionalization of standardized competency assessments.
As the global cancer burden rises, adults with advanced cancer face significant physical and psychosocial symptoms requiring early integration of palliative and supportive care. Nurses in oncology, emergency, and community settings are central to symptom assessment, care coordination, communication, and advance care planning, yet their roles in early integration remain underexplored. This scoping review mapped nursing contributions to early palliative and supportive care for adults with advanced cancer and described related patient, caregiver, and system outcomes. A search of PubMed, CINAHL, Scopus, and ScienceDirect was conducted for English-language studies published between January 2016 and November 2025 involving nursing-relevant interventions in early palliative or supportive care. Fourteen studies were included: trials, observational studies, qualitative research, reviews, and a meta-analysis. Six domains emerged. Early integration consistently improved quality of life and reduced symptom burden. Nurse-led interventions increased end-of-life discussions and advance directive completion. Telehealth and telephone follow-up proved feasible for symptom management. Studies noted moderate palliative competence but gaps in communication and structural support. Caregiver-focused interventions enhanced caregiver quality of life and self-efficacy. Conclusions: Nurses are pivotal in early palliative care. Expanding structured nurse-led models, strengthening communication training, and addressing organizational barriers are essential to deliver timely, person-centered care.
Emergency nurses in Palestinian hospitals operate under chronic stress related to political instability, resource constraints, and high trauma exposure. These conditions may affect both psychological resilience and Advanced Life Support (ALS) competency, yet the evidence base remains unclear. This scoping review sought to map the available body of literature about psychological resilience and ALS competency among emergency nurses in Palestine, identify gaps in research, and determine the relationship between psychological resilience and ALS competency, which is the core focus of this review. Following PRISMA-ScR guidelines and JBI scoping review methodology, a comprehensive search of seven electronic databases and grey literature was conducted for studies published between January 2000 and January 2026. Two reviewers independently screened studies and extracted data using a standardized, pilot-tested charting form. Findings were synthesized descriptively using narrative synthesis organized around the review objectives. From 1,292 records identified, 18 studies met inclusion criteria. Most studies were descriptive or correlational (94.4%). Burnout prevalence among emergency nurses ranged from 64% to 72.9%, and substantial gaps in ALS/BLS knowledge were reported, including low accuracy in resuscitation sequence identification (26.6%). Only one intervention study was identified, evaluating simulation-based BLS training. No studies were found that assessed resilience-based or comprehensive programs which address psychological wellbeing and clinical competency issues. There were no studies that specifically analyzed the connection between psychological resilience and competency in ALS. The existing literature on Palestinian emergency nurses is dominated by descriptive studies, with a marked absence of intervention research. Despite documented psychological distress and clinical competency gaps, no studies have evaluated psychological resilience-focused or integrated interventions. This review highlights critical evidence gaps and provides a foundation for future intervention-oriented research.
Integrating research into nursing education is critical for evidence-based practice and professional development. However, nursing students often encounter significant challenges when engaging in research, which may hinder their academic and clinical growth. Understanding these experiences is essential for optimizing research training in nursing curricula. This study explored the lived experiences of nursing students participating in graduation research projects, focusing on their perceived benefits, challenges, and support needs. A descriptive phenomenological approach was employed, and this study adhered to the Consolidated Criteria for Reporting Qualitative Research (COREQ). Thirty-eight nursing students (15 male, 23 female) from a Saudi Arabian university participated in focus group discussions between February and May 2024. Data were collected using semi-structured interviews, supported by demographic surveys and audio recordings. Colaizzi's descriptive phenomenological method was used for the final analysis. Four central themes emerged: (1) Skill Development and Academic Growth, (2) Mentorship and Peer Support, (3) Barriers to Success, and (4) Curricular Recommendations. Students valued the acquisition of research competencies and their practical applications in clinical practice. Mentorship, peer support, faculty guidance, and collaborative learning were pivotal in navigating research challenges. Prominent hurdles included time constraints, methodological difficulties, and stress. To alleviate pressure, participants recommended curricular adjustments, including extended project timelines (6-12 months) and earlier exposure to research. Graduation research projects are transformative yet demanding experiences for nursing students. While they enhance critical thinking and readiness for advanced studies, structural challenges persist. Institutions should implement targeted interventions, such as phased research training and strengthened mentorship, to foster student success. This study provides actionable insights for nursing educators and policymakers to refine research curricula, ensuring students are better prepared for evidence-based practice and future scholarly pursuits.
Intraoperative cardiac arrest (IOCA) is a high-acuity surgical crisis demanding flawless execution of technical and behavioral skills. Traditional crisis management often lacks structured, nursing-specific cognitive tools, leaving teams vulnerable to fixation errors and communication breakdown under stress. The objectives of the study were to determine whether a structured multidisciplinary crisis checklist improves critical resuscitation timelines, nursing performance adherence, behavioral teamwork dynamics, and provider subjective stress mitigation during simulated IOCA events. This prospective, comparative cohort study evaluated 40 operating room teams (N = 120 healthcare professionals: anesthesiologists, scrub nurses, and circulating nurses) sequentially allocated to either the Multidisciplinary Checklist group (MC; n = 20 teams) or the Standard Resuscitation group (SR; n = 20 teams) following traditional Advanced Cardiovascular Life Support (ACLS) guidelines. Teams managed a standardized intraoperative ventricular fibrillation scenario. Outcome parameters included a novel, validated Nursing Performance Adherence Score (NPAS), time-to-critical-interventions, Mayo High Performance Teamwork Scale (MHPTS) scores, and provider subjective stress levels mapped via a 10-point Visual Analog Scale. The team was designated as the primary unit of analysis. Total NPAS was significantly superior in the MC group compared to the SR group (9.25 ± 0.79 vs. 6.4 ± 1.43, p < 0.001), correlating tightly with checklist utilization (R = 0.86, p < 0.001). For critical technical workflows, the MC group achieved an 8.4-fold higher probability of rapid epinephrine delivery, decreasing median administration time by 51 s (143.5 s vs.194.5 s; Hazard Ratio = 8.42, Log-rank, p < 0.001). Teamwork quality was significantly enhanced in the MC group, yielding superior total MHPTS scores (28.60 ± 1.96 vs. 22.30 ± 3.31, p < 0.001). Subjective provider stress levels were significantly reduced via checklist implementation (p < 0.001). Integrating a structured multidisciplinary crisis checklist into simulated IOCA workflows significantly accelerates life-saving interventions, optimizes nursing task execution, alleviates clinician stress, and ensures high-performance team collaboration. These empirical simulation findings strongly support the implementation of specialized emergency manuals in perioperative safety training.
Patients with advanced chronic obstructive pulmonary disease(COPD) endure severe physical and psychological suffering, face heavier socioeconomic burdens, and experience long-term unmet needs for palliative care. This study aims to explore the multidimensional needs of patients at an advanced stage of disease, with the goal of developing customised palliative care services tailored to their specific requirements. Between October 2024 and April 2025, semi-structured interviews were conducted with 38 participants recruited from a tertiary general hospital in Urumqi, Xinjiang Uygur Autonomous Region, China. The participants included patients with advanced COPD, their corresponding family caregivers, and healthcare professionals. Data were analysed using Braun and Clarke's thematic analysis approach. The analysis revealed that the palliative care needs of patients with advanced COPD arise from a dynamic framework comprising two interrelated dimensions, rather than a simple checklist. The first dimension encompasses two core needs that run throughout a patient's entire life journey: the challenges in maintaining identity and the empowerment and support system requirements. The second dimension is the time-based disease progression pillar, representing 'Needs across the disease trajectory', which encompasses needs during stable periods, acute exacerbations and the end-of-life stage. The palliative care needs of patients with advanced COPD must be addressed, as they directly impact quality of life and dignity during the final stages of life. Efforts should focus on developing systematic interventions that are culturally appropriate and policy-driven.
In rural northern Sweden, community hospitals serve as essential first-response centres. During emergencies, general practitioners remotely collaborate on-call with on-site nurses via videoconferencing. This setup of geographically distributed teams enables healthcare delivery across long distances. However, little is known about how healthcare professionals make sense of and negotiate roles and responsibilities in such distributed emergency settings. Hence, the aim of this study was to analyse how healthcare professionals position themselves and others in interprofessional teams when collaborating in distributed emergency settings in rural areas. Interprofessional focus group interviews (n = 17) were conducted with staff (one nursing assistant, one registered nurse and one physician per focus group) at community hospitals in rural northern Sweden, following full-scale, simulated, in-situ team training. The analysis was inspired by Billig's concept of ideological dilemmas and Wetherell's concept of interpretative repertoires. Participants drew on three interpretative repertoires-Involvement, Responsibility and competence, and Control and dependency-to account for teamwork in distributed emergency settings. Across these repertoires, participants accounted for involvement as both enabled and difficult to sustain, responsibility as not readily transferred, and control as limited and dependent on others' accounts. These ways of accounting reflected ongoing dilemmas, as professionals positioned themselves in relation to competing demands when acting under conditions of distance, uncertainty and mediated access to the clinical situation. Distributed teamwork reshapes the conditions for collaboration in emergency care, as roles and responsibilities become continuously negotiated in relation to tensions concerning involvement, responsibility and control. As a result, collaboration is unevenly achieved and cannot be taken for granted. Not applicable.
Seizures are one of the most attended neurological emergencies in the prehospital context. The categorization of the risk of these patients is a great challenge for health professionals, due to the limited information, leading to inaccurate diagnoses. The aim of this study was to explore the development and validation of a long-term mortality predictive score that considers vital signs and biomarkers in seizure patients. A prospective, multicenter study was conducted by emergency medical services (EMS) in Spain, including five advanced life support units, 27 basic life support units and four emergency services. The sample consisted of adults who suffered prehospital seizures, in which vital signs and blood tests were recorded using point-of-care tests (POCTs) to predict long-term all cause 1 year mortality. The sample consisted of 198 patients, in whom 33 mortality events were recorded. Our predictive model identified age, Glasgow Coma Scale (GCS) score, hemoglobin, serum Anion Gap (SAG), international normalized ratio (INR), and Charlson comorbidity index as risk factors, revealing and AUC of the score of 0.743 (95%CI 0.624-0.862). This study has identified hemoglobin, SAG and INR as prehospital biomarkers capable of predicting long-term mortality in patients who have suffered prehospital seizures. The combination of these new biomarkers to age and GCS into a score available for EMS staff could be a practical and effective tool that improves risk stratification and patient management.
The Research to Practice column is intended to improve the research critique skills of the advanced practice registered nurse (APRN) and the emergency nurse (RN) and to assist with the translation of research into practice. A topic and a research study are selected for each column. A patient scenario is presented as a vehicle, in which to review and critique, the findings of the selected research study. In this column, we review the conclusions of Gabet, M., et al. in the article on the Effectiveness of emergency department-based interventions for frequent users with mental health issues: A systematic review.
Nurses are central to trauma care in both peacetime and conflict, where training and expertise directly affect patient outcomes. Cooperative training between healthcare professionals from opposing communities is rare in regions of ongoing violence, yet may be a powerful mechanism for strengthening regional trauma systems and advancing health diplomacy. Operating Together is a binational initiative that brings Palestinian and Israeli trauma providers together for joint training. This study describes the establishment of a regional Advanced Trauma Care for Nurses (ATCN) program serving both Israeli and Palestinian communities, evaluates course effectiveness, and health‑diplomacy attitudes. Between January 1 and December 31, 2025, six ATCN providers and two ATCN instructor courses were conducted. Participants completed anonymous questionnaires assessing satisfaction, perceived clinical relevance, and attitudes toward Palestinian-Israeli health cooperation. Descriptive statistics summarized responses, and comparisons used independent‑samples t tests and Fisher's exact tests (significance p < 0.05). Of 52 participants, 36 completed the study (50% Israeli, 50% Palestinian). Participants reported high course satisfaction (M = 8.44/10) and perceived educational impact (M = 4.39/5). Most (94.4%) expressed interest in maintaining professional contact. The belief that cooperation improves patient care is strongly correlated with positive health‑diplomacy attitudes (rs =.74, p < .001). Palestinian nurses reported significantly higher scores regarding the role of health cooperation in conflict resolution and mutual understanding (both p = .006). Male participants had higher health‑diplomacy index scores than female participants (p = .004). In the context of ongoing conflict, joint ATCN courses for Palestinian and Israeli nurses were associated with high educational satisfaction and strong support for continued professional cooperation. Participants perceived binational training as beneficial for trauma care and contributing to a more positive climate. Joint trauma nursing education may provide a promising platform for strengthening trauma systems and advancing health diplomacy in conflict‑affected settings. Prognostic and epidemiological; Level II-III (educational intervention).
Immunological checkpoint inhibitors (ICIs) have shown promise in treating various malignancies but are understudied in genitourinary cancers among patients with advanced chronic kidney disease (CKD), who are typically excluded from clinical trials. We evaluated the efficacy and safety of ICIs in this high-risk patient group. This retrospective cohort study included patients with CKD diagnosed with renal cell carcinoma and urothelial carcinoma, utilizing data from 63 healthcare organizations in the TriNetX US Collaborative Network database between January 2015 and December 2023. Patients with advanced CKD (aCKD) and early CKD (eCKD) receiving ICIs were compared after 1:1 propensity score matching. Outcomes were assessed using Kaplan-Meier and Cox proportional hazards models. The primary outcome was all-cause mortality, and secondary outcomes included immune-related adverse events (irAEs). The study involved 2213 patients with aCKD and 9784 with eCKD who received ICIs. After matching, 2196 patients remained in each cohort. Patients with aCKD had higher 2-year all-cause mortality than those with eCKD (44.7% vs. 35.5%; HR = 1.372, 95% CI: 1.248-1.507). They also had a modestly higher risk of overall coded irAEs (HR = 1.141, 95% CI: 1.058-1.231), mainly driven by AKI (HR = 1.662, 95% CI: 1.500-1.840). Increased risks of mortality and AKI were evident from 3 months and persisted through 60 months. In this large retrospective database study, aCKD was associated with worse survival and greater renal vulnerability among ICI-treated patients with genitourinary cancers. CKD alone should not automatically preclude ICI use in carefully selected patients, but close renal monitoring and multidisciplinary management are warranted, particularly for patients with aCKD. Not applicable.
Severe accidental hypothermia (core temperature < 28 °C) is an infrequent but resource‑intensive emergency department (ED) presentation that requires altered Advanced Cardiac Life Support (ACLS) management, aggressive rewarming, and timely consideration of veno-arterial extracorporeal membrane oxygenation (VA-ECMO). Prior to this project, our inner‑city academic ED lacked a standardized approach, contributing to variability in care. We designed, implemented, and achieved ≥ 95% real‑time utilization of a bedside pathway for patients with severe accidental hypothermia. In response to issues identified in the review of a case of severe hypothermia, a multidisciplinary team developed and revised a severe hypothermia pathway through eight Plan‑Do‑Study‑Act cycles. Implementation strategies included an in situ simulation, targeted nursing skills sessions, and interdepartmental case debriefings. From January 2025 to April 2025, cases of severe hypothermia were reviewed. Our primary outcome was pathway utilization; secondary outcomes were staff perceptions, including timely access to VA-ECMO. Our severe hypothermia pathway includes a flowchart alongside a set of cue cards. The flowchart prompts management in three key realms: modified ACLS, rewarming techniques, and prognostication/VA-ECMO. The cue cards guide step-by-step management, including how to access mechanical CPR and VA-ECMO. Key themes included: development of a streamlined pathway, clinical provider education, and improved interdepartmental communication. 100% (6/6) of cases utilized the pathway. Interdisciplinary feedback suggests providers find the pathway to be useful and that it facilitates timely access to consideration for VA-ECMO. A pragmatic hypothermia resuscitation pathway was successfully implemented in our ED, supporting access to VA-ECMO. Our work acknowledges these resuscitations are resource intensive and may disrupt care to other patients. Therefore, cases for VA-ECMO should be carefully selected. Future work includes exploring an ED Code ECMO at our site and a city-wide prehospital VA-ECMO referral pathway. RéSUMé: OBJECTIFS: L’hypothermie accidentelle sévère (température centrale > 28 °C) est une présentation rare mais nécessitant beaucoup de ressources au service des urgences (SU), qui nécessite une gestion modifiée du soutien cardiaque avancé (ACLS), un réchauffement agressif et la prise en compte en temps opportun des paramètres veineux.oxygénation extracorporelle artérielle (VA-ECMO). Avant ce projet, notre ED académique du centre-ville manquait d’une approche standardisée, ce qui contribuait à la variabilité des soins. Nous avons conçu, mis en œuvre et atteint ≥ 95 % d’utilisation en temps réel d’un parcours au chevet des patients atteints d’hypothermie accidentelle sévère. MéTHODES: En réponse aux problèmes identifiés lors de l’examen d’un cas d’hypothermie sévère, une équipe multidisciplinaire a mis au point et révisé une voie d’hypothermie sévère à travers huit cycles de planification et d’étude. Les stratégies de mise en œuvre comprenaient une simulation in situ, des séances ciblées sur les compétences infirmières et des débriefings de cas interdépartementaux. De janvier 2024 à avril 2025, les cas d’hypothermie sévère ont été examinés. Notre critère de jugement principal était l’utilisation des voies d’accès ; les critères de jugement secondaires étaient les perceptions du personnel, y compris l’accès en temps opportun à l’AV-ECMO. RéSULTATS: Notre voie d’hypothermie sévère comprend un organigramme ainsi qu’un ensemble de cartes de repère. Le diagramme de flux invite à la gestion dans trois domaines clés : l’ACLS modifié, les techniques de réchauffage et la prévision/VA-ECMO. Les cartes de repère guident la gestion étape par étape, y compris comment accéder à la RCP mécanique et au VA-ECMO. Les thèmes clés comprenaient : le développement d’une voie rationalisée, la formation des prestataires de soins cliniques et l’amélioration de la communication interdépartementale. 100 % (6/6) des cas ont utilisé la voie. Les commentaires interdisciplinaires suggèrent que les prestataires trouvent la voie utile et facilitent l’accès en temps opportun à la prise en compte de la VA-ECMO. CONCLUSION: Une procédure pragmatique de réanimation en cas d’hypothermie a été mise en œuvre avec succès dans notre service des urgences, favorisant l’accès à l’ECMO-VA. Nos travaux reconnaissent que ces réanimations sont gourmandes en ressources et peuvent perturber les soins d’autres patients ; par conséquent, les cas de VA-ECMO doivent être soigneusement sélectionnés. Les travaux futurs incluent l’exploration d’un code ED ECMO sur notre site et d’un parcours de référence VA-ECMO pré-hospitalier à l’échelle de la ville.
The purpose of this narrative review was to review existing literature to determine a consensus of established best practices to mitigate the risks of boarding geriatric and high acuity patients. The PubMed database was searched using the following key terms: quality care, inpatient boarding, emergency department, nursing care, and access block. Fourteen articles were reviewed, identifying quality and safety concerns, organizational imperatives, and potential solutions. The care of boarding patients poses unique challenges for hospitals, physicians, and nurses. Organizational priorities should include strategies to minimize boarding in the ED and interventions to improve the quality and consistency of care when boarding cannot be avoided. Discharge lounges, a popular alternative, fail to demonstrate a return on investment or improved throughput.
Measles is a highly contagious vaccine-preventable disease that was once controlled with measles, mumps, and rubella vaccinations but has reemerged in the United States and globally as a public health emergency. Despite availability of a safe and effective vaccine, declining vaccination rates driven by vaccine hesitancy, access issues, and clustering of unvaccinated individuals have led to measles outbreaks. Since January 2026 in the United States, both the International Vaccine Access Center (IVAC; 1,654 cases) and the Centers for Disease Control (CDC; 1,671 cases) have reported a high number of cases (IVAC, March 27, 2026; CDC, April 3, 2026) that will exceed the reported cases (2,286) in 2025 (CDC, April 3, 2026). The Pan American Health Organization (PAHO) reported an epidemiological alert on measles in the Americas Region (PAHO, February 3, 2026). Emergency Nurse Practitioners must identify, manage, and initiate control measures. This review covers clinical manifestations, vaccination guidelines, management, and complications of measles.
Emergency department (ED) nurses care for patients during critical times: violence, trauma, death, etc. Continuous exposure increases risk for secondary traumatic stress (STS): negative reaction experienced by someone with an indirect exposure to trauma. This impairs their ability to cope, increases levels of anxiety/depression, and increases attrition. Using a phenomenological design, the researcher interviewed 23 bedside ED nurses in Missouri and/or Illinois, USA. Five themes emerged: patient care, relationships at work, life outside the hospital, impacting on a personal level, and residual stress. Three themes emerged related to coping strategies: positive, dysfunctional, and debriefing as a coping strategy. Nurses are impacted by STS in numerous areas of their lives and rely on both positive and negative coping strategies to help mitigate the negative effects. Hospitals should introduce the concept of STS during nursing orientation so nurses may be able to implement coping strategies before negative effects are experienced.
Despite the emergency department (ED) being a primary entry point for acutely ill older adults, delirium in this setting remains poorly characterized. This study aimed to determine ED delirium prevalence, identify associated patient characteristics in a diverse population, describe current ED management practices, and examine hospital utilization outcomes in a large, heterogeneous cohort. This multi-site retrospective cohort study analyzed 2,827 older adult patients (≥ 65 years) across three diverse EDs within a single integrated health system in the New York metropolitan area, identifying delirium via rigorous, validated in-depth chart review requiring evidence of acute change from baseline. Independent risk factors for ED delirium and hospital admission were identified via modified Poisson regression. Management strategies and 30-day hospital utilization outcomes were characterized. All analyses were stratified by control and intervention periods of a parent delirium screening trial. ED delirium prevalence was 16.0% (95% confidence interval: 14.6-17.4%), consistent across study periods and sites. The prevalence of delirium was 27.3% among hospitalized patients; 7.9% of all discharged patients had delirium. Independent risk factors included advanced age (adjusted relative risk, aRR = 1.01), dementia (aRR = 3.10), higher Charlson Comorbidity Index (aRR = 1.06), facility arrival (aRR = 1.28), and higher ED acuity (aRR = 3.85 for highest). Patients with delirium were more likely to receive physical restraints, psychoactive medications, and constant observation, but also safety precautions, family involvement, and palliative care consults (all p < 0.001). Delirium independently predicted hospital admission (aRR = 1.54) and was associated with higher 30-day readmissions (19% vs. 13%; p = 0.002). Approximately 1 in 6 older ED patients had delirium, including 7.9% who were discharged home. ED management involved both restrictive (restraints, psychoactive medications) and supportive (Goals-of-Care discussions, family involvement, safety precautions) strategies, though the latter remained underutilized. These findings underscore the critical need for standardized delirium screening, enhanced recognition, and supportive strategies.
Paramedics in emergency medical services (EMS) work in high-demand environments in which occupational well-being is closely linked to patient safety and workforce sustainability. While transformational leadership has been associated with positive staff outcomes in health care, evidence regarding its associations with work engagement and occupational well-being in prehospital EMS remains limited. This study examines transformational leadership in Finnish EMS in relation to paramedics' work engagement and occupational well-being, including whether the association between transformational leadership and occupational well-being is statistically consistent with an indirect pathway involving work engagement. A cross-sectional online survey was conducted among 322 Finnish paramedics working in EMS at basic or advanced levels. Transformational leadership was assessed using the 43-item Transformational Leadership Scale, work engagement using the Utrecht Work Engagement Scale (UWES-9), and occupational well-being using a single-item self-rated numeric scale (4-10). Descriptive statistics, Pearson correlations, and hierarchical multiple regression analyses were conducted, adjusting for age, gender, education level, professional title, and years of EMS experience. Bootstrap resampling (5,000 samples) was used to examine whether the association between transformational leadership and occupational well-being was statistically consistent with an indirect pathway involving work engagement. Transformational leadership had a mean score of 2.75 (SD = 1.03, range 1-5). Leadership ethics received the highest ratings, whereas feedback and rewards were rated lowest. In multiple regression analyses, transformational leadership was positively associated with work engagement (β = 0.437, p <.001) and occupational well-being (β = 0.501, p <.001) after controlling for demographic factors. Work engagement was positively associated with occupational well-being (p <.001). When work engagement was added to the model, the association between transformational leadership and occupational well-being decreased but remained statistically significant, suggesting that the association was statistically consistent with an indirect pathway involving work engagement. Transformational leadership was positively associated with work engagement and occupational well-being among Finnish paramedics in EMS. The association between transformational leadership and occupational well-being was statistically consistent with an indirect pathway involving work engagement. However, causal or mediational conclusions cannot be drawn due to the cross-sectional design. From a health services perspective, the findings suggest that leadership may represent a key organizational resource for supporting workforce well-being and performance in high-demand EMS systems.
ObjectiveTo evaluate the clinical and cost-effectiveness of SHARE TO CARE (S2C), a complex intervention for hospital-wide, systematic implementation of shared decision making.MethodsWe analyzed clinical effectiveness, health care resource utilization, and implementation costs of S2C from the statutory health insurance perspective using a quasi-experimental difference-in-differences approach with evidence from the Department of Neurology. Clinical outcomes included inpatient hospital admissions, emergency department admissions, and rates of standard and advanced imaging procedures. Implementation costs comprised those related to the conception, development, process integration, ongoing support, and auditing of S2C. Health care utilization data covered inpatient and outpatient care, pharmaceuticals, therapeutic services, assistive devices, and nursing care. We conducted sensitivity analyses to account for uncertainties.FindingsS2C was associated with a reduction in inpatient hospital admissions, emergency department admissions, and imaging rates in the intervention group. The cost analyses aligned with these findings, showing reduced total costs and health care resource utilization in the intervention group. Although none of the estimates reached the predefined thresholds for statistical significance, the primary analysis yielded weak evidence (P < 0.1) of a reduction in emergency department admissions in the intervention group. Overall, savings outweighed the costs of implementing S2C, suggesting cost-effectiveness.ConclusionsS2C has the potential to reduce emergency department admissions and overall health care costs from the statutory health insurance perspective. Further research should investigate generalizability, the timing of the treatment effect, and potential biases introduced by the COVID-19 pandemic. The demonstrated effects of shared decision making (SDM) have encouraged statutory health insurances in Germany to offer additional reimbursement for clinics certified under the S2C program. The S2C model illustrates how payers and providers can collaborate to facilitate the nationwide implementation of SDM.HighlightsThe implementation of SHARE TO CARE (S2C) was associated with a statistically nonsignificant reduction in emergency department admissions after 1 y from the statutory health insurance perspective, based on data from the Department of Neurology.The cost savings from reduced health care utilization outweighed the implementation costs, and despite not reaching statistical significance, the results support the potential cost-effectiveness of S2C.S2C has the potential for nationwide implementation as a systematic form of shared decision making.Future research should investigate the generalizability of the results to other health care settings.
Outpatient settings, including emergency departments, urgent care centers, and primary care clinics in underserved communities, face persistent workforce instability because of high patient volumes, limited resources, and burnout. This qualitative single-site case study explored retention strategies as perceived by Hispanic Generation Z employees working in a rural primary care clinic near the US-Mexico border. Semi-structured interviews were conducted with 12 medical assistants and analyzed using thematic analysis. Four themes influencing retention emerged: feeling appreciated and recognized, psychologically safe workplace relationships, flexibility with opportunities for professional growth, and cultural affirmation and belonging. Although conducted in an outpatient setting, the findings have conceptual relevance to the broader direct patient-care workforce. Results underscore the importance of relational, cultural, and developmental factors often overlooked in retention strategies that emphasize structural or operational solutions. Culturally responsive approaches may enhance workforce well-being, improve team stability, and support sustainable care delivery in underserved communities.