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Editorial Board</text>
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                <text>International Emergency Nursing Vol. 56 May 2021&#13;
Emergency handover of critical patients. A systematic review</text>
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                <text>Background: Emergency handover of critical patients is used to describe the moment of union between prehospital and hospital health team. However, the literature shows several definitions leading to great heterogeneity. &#13;
Purpose: To study the emergency handover of critical patients between two critical-emergency care wards performed by emergency nurses worldwide and to identify the features of these processes.&#13;
Methods: We conducted an integrative review in eleven databases published from 2010 to 2019. Quality criteria and PRISMA checklist were applied. The protocol is registered with PROSPERO (CRD42020182335). &#13;
Results: A total of 22 studies included and the following factors were identified: variability vs standardization, identification, professionals’ behavior, localization, environmental factors, patient participation, clinical records, education/training, responsability, and communication.&#13;
Conclusions: The actual emergency handover occurs under conditions quite contrary to those recommended by experts so that it is neither safe nor effective, leading a serious problem for patient safety and quality care. </text>
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                <text>Ruth Tortosa-Alted , Sílvia Revert ́e-Villarroya , Estrella Martínez-Segura, Carlos Lopez-Pablo, Marta Berenguer-Poblet</text>
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                <text>Sri Wahyuni</text>
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                <text>International Emergency Nursing Vol. 56 May 2021&#13;
Evaluation and treatment of pain in the pre-hospital setting. A comparison&#13;
between patients with a hip injury, chest pain and abdominal pain</text>
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                <text>Background: A large proportion of patients who call 112 in Sweden do so because of pain. The purpose of this study was to compare three of the most common types of pain presented by the patients: chest pain, abdominal pain and hip injury, in terms of initial assessment, intensity, treatment and effect of treatment. The overall rationale was to evaluate whether the early assessment and treatment of pain in the pre-hospital setting is optimal or whether there is room for improvement.&#13;
Methods: Observational study during 2016 including 1234 patients triaged to chest pain, abdominal pain and hip injury by the Emergency Medical Services (EMS) in Gothenburg, Sweden.&#13;
Results: Severe pain on the arrival of the EMS was described by 39% of patients with a hip injury, 27% with abdominal pain and 15% with chest pain. Analgesics were given to 58% of patients with a hip injury, 35% with&#13;
chest pain and 34% with abdominal pain. A lower intensity of pain at re-evaluation was observed in 80% of patients with a hip injury, 57% with chest pain and 43% with abdominal pain. Administration of analgesics&#13;
increased with the duration of pre-hospital care time in all three groups.&#13;
Conclusions: Patients with a hip injury had the most severe pain and they received most pain-relieving medication. Overall, a relatively small proportion of patients with pain received pain-relieving medication and there appears to be an extensive room for improvement.</text>
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                <text>Carl Magnusson, Marie Carlstrom, Nathalie Lidman, Johan Herlitz, Par  ̈ Wennberg, Christer Axelsson</text>
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                <text>Sri Wahyuni</text>
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                <text>International Emergency Nursing Vol. 56 May 2021</text>
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                <text>International Emergency Nursing Vol. 56 May 2021&#13;
Impact of COVID-19 on paramedicine students: A mixed methods study</text>
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                <text>Background: Viral epidemics have negative and sometimes extreme impacts on psychological well-being, particularly in health care workers. Studies have reported higher levels of depression, anxiety, insomnia,&#13;
stress, distress, fear, burnout, and post-traumatic symptoms.&#13;
Objective: This research aimed to explore the psychological impacts of COVID 19 on paramedicine students.&#13;
Methods: A convergent mixed method design study was undertaken using self-reporting instruments and qualitative interviews.&#13;
Results: Responses were received from 151 students (38.3% responses rate). Most students experienced some level of anxiety (62%), although severe levels were only reported by 6% of respondents. Students had significantly greater odds (OR = 2.05, p = 0.045, 95% CI: 1.02, 4.12) of higher anxiety levels if they were female. &#13;
Thematic analysis of the interviews largely supported these results, with themes focused on changing approaches&#13;
to study, financial situation, social support, University adaptation, acceptance and career pathway choice.&#13;
&#13;
Conclusions: This study identified and explored the anxiety and coping strategies in an undergraduate para-&#13;
medicine cohort when faced with a viral epidemic. Although most of the responding paramedic students reported&#13;
&#13;
above normal levels of anxiety in the initial stages of the COVID-19 outbreak, many students, with the help of&#13;
learning, financial and social support, and a range of positive coping strategies, have adapted well to the impact&#13;
of the pandemic and associated lockdown period.</text>
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                <text>Brett Williams, Christine King , Brendan Shannon , Cameron Gosling</text>
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The implementation of an emergency nursing framework (HIRAID) reduces patient deterioration: A multi-centre quasi-experimental study</text>
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                <text>Introduction: Timely recognition and treatment of acutely ill patients at appropriate levels of the health system are fundamental to the quality and safety of healthcare. This study determines if the implementation of an emergency nursing framework HIRAID (History, Identify Red flags, Assessment, Interventions, Diagnostics, communication and reassessment) improves patient safety.&#13;
Methods: A quasi-experimental cohort study was conducted in two emergency departments in [Anonymised], Australia. HIRAID was implemented using a multi-pronged behaviour change intervention. Data of 920 patients (374 pre and 546 post) who deteriorated within 72-hours of ED departure were collected. Statistical tests were conducted as two-sided, with a 95% confidence interval to determine pre/post cohort association.&#13;
Results: Patients in the post group had more comorbidities, but experienced less deterioration associated with care delivered in the ED (27% to 13%). There was a reduction in treatment delays [ 28.3% to 15.1%, p = 0.041, 95% CI (1.1%–25.3%)], and delay or failure to escalate care when abnormal vital signs were identified [20.2% to6.9%, p = 0.014, 95% CI (3.5%–23.1%)]. Isolated nursing-related causal factors decreased from 20 (21%) to 6 (8%).&#13;
Conclusions: Implementing a standardised emergency nursing framework is associated with a reduction in clinical deterioration related to emergency care.</text>
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                <text>International Emergency Nursing Vol. 56 May 2021</text>
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                <text>International Emergency Nursing Vol. 56 May 2021&#13;
The wider implications of the COVID-19 pandemic: Assessing the impact of accident and emergency use for frequent attenders</text>
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                <text>Introduction: Emergency departments have seen altered patterns of attendance since the beginning of the COVID-19 pandemic, with reductions in the number of attendances for non-COVID-19 – patients. We assessed the use of the emergency department by frequent attenders during the height of the COVID-19 pandemic and explored any changes in emergency department attendance by this group.&#13;
Methods: As part of ongoing improvement work, we utilised a cohort design to evaluate the difference in patterns of attendance for the frequent attender group in a single centre. We created a 2019 ‘top attender’ cohort and a similar cohort for 2020. We compared admission patterns between the two time periods in order to understand the impact of the COVID-19 pandemic on this group.&#13;
Results: Both groups were predominately male. Mental health and substance misuse use problems were common across both cohorts. The majority of patients lived in a socioeconomically deprived areas. The median number emergency department visits in 2019, for the top attender cohort was 6 (IQR: 4–9) vs 4 (IQR: 2–7) for the top attender cohort of 2020 (p &lt; .0013).&#13;
Conclusion: This single centre evaluation has shown a significant reduction in emergency department attendances for a frequent attender cohort in a single centre. Future work should investigate the longer-term impact which the COVID-19 pandemic has had on this patient group.</text>
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                <text>David Kyle, Martin Shaw, Donogh Maguire, Donald McMillan, Tara Quasim, Alastair H. Leyland, Joanne McPeake </text>
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                <text>International Emergency Nursing Vol. 56 May 2021</text>
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                <text>International Emergency Nursing Vol. 56 May 2021&#13;
Work experience of triage nurses in emergency departments during the prevalence of COVID-19</text>
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                <text>Objective: In December 2019, the global outbreak of Corona Virus Disease 2019 (COVID 19) was reported. As of March 8, 2020, more than 90,000 cases were reported worldwide, resulting in a shortage of global medical resources. The purpose of this study was to understand the working experience of triage nurses in the emergency department (ED) of a large teaching general hospital in Shenzhen (Guangdong province, China) during the COVID-19 epidemic. This will provide a basis for improving the emergency nursing strategies and the epidemic response capabilities of triage nurse.&#13;
Methods: Ten triage nurses were selected as subjects by objective sampling for in- depth interviews, and the data were analyzed by the Colaizzi seven-step analysis method. &#13;
Results: There were four themes in the working experience of triage nurses, including fear of infection and transmission, job stress, gratitude, and expectations of managers. &#13;
Conclusion: During the COVID-19, the work experience of triage nurses mainly included the fear of infection and transmission, the high work pressure, the sense of team strength and the care of leaders. It was suggested that nursing managers should ensure the human resources of triage nurses, increase training, strengthen emergency drills, improve emergency nursing countermeasures, and improve the response capability of triage nurses during the epidemic.</text>
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                <text>International Emergency Nursing Vol. 56 May 2021</text>
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