ED crowding is a recurring driver of patient-initiated violence against emergency nurses

Key takeaways

• The study reviewed 728 acute-care stroke hospitalizations (429 ischemic, 236 hemorrhagic, and 63 TIA), with 4,136 nursing diagnoses and 27,528 nursing actions recorded.
• Nursing complexity, measured as nursing diagnoses within 24 hours of admission, differed across subtypes (F = 5.81, P = 0.003), with TIA lower than both stroke types and no significant difference between ischemic and hemorrhagic stroke.
• Nursing intensity, measured as nursing actions during the stay, followed a clear gradient (H = 16.73, P less than 0.001): highest in hemorrhagic stroke, intermediate in ischemic stroke, and lowest in TIA.
• Nursing intensity still differed after standardizing by length of stay (H = 12.999, P = 0.002), suggesting the gradient is not just a function of longer admissions.

Nursing implications

• For neuroscience and stroke nurses, the findings reinforce that hemorrhagic stroke patients tend to carry the heaviest hands-on nursing load, while TIA patients generally require the least, which can help teams anticipate workload and advocate for appropriate assignments. Because complexity was similar between ischemic and hemorrhagic stroke while intensity was not, the number of nursing problems on admission may not, on its own, predict how much bedside work a stroke patient will need.

Limitations & cautions

• This was a single-center retrospective study using routinely collected data and ICD-9-CM coding, so its findings depend on local documentation practices and may not generalize to other hospitals or nursing languages. It measured counts of nursing diagnoses and actions rather than patient outcomes, so it does not show whether higher nursing intensity changed how patients fared.
• AI-summarized from the linked source. Review the original article before applying to practice.

Key takeaways

• 610 hospital nurses in the Czech Republic, Poland, and Slovakia reported how often they omit 32 nursing activities using the standardized BERNCA-R scale.
• Nurses' age, marital status, parenthood, education, and years of experience were not significantly associated with the overall level of rationing.
• The type of ward was more strongly associated with rationing, and emergency departments reported the highest frequency of omitted care.
• Activities requiring extended patient communication, assessment, or monitoring were most often rationed, while basic hygiene tasks were rarely omitted.

Nursing implications

• For nurses and nurse leaders, the findings suggest that when care is missed, the more productive response is to examine staffing structures, workload, and workflow, especially in high-intensity units like emergency departments, rather than attributing it to individual nurses. The pattern that communication, assessment, and monitoring are rationed first can help teams watch for exactly the care most likely to slip under pressure.

Limitations & cautions

• This was a cross-sectional survey in three hospitals in three countries, so it captures associations at one point in time and cannot establish cause, and self-reported rationing may differ from care actually missed. The findings from these specific Central European sites may not generalize to other countries or health systems, and the study did not directly measure patient outcomes.
• AI-summarized from the linked source. Review the original article before applying to practice.

Key takeaways

• Among 1076 adults aged 40 or older with acute myocardial infarction, 19.0% presented without any chest-related symptoms.
• Reduced level of consciousness was independently associated with atypical presentation (odds ratio 4.93; 95% CI 2.41 to 10.05; P < .001).
• Greater functional dependence in activities of daily living was also independently associated (odds ratio 1.10; 95% CI 1.06 to 1.15; P < .001).
• Patients with atypical presentations tended to be older with lower body mass index and lower Glasgow Coma Scale scores.

Nursing implications

• For emergency nurses, the findings suggest a heart attack cannot be ruled out on the absence of chest pain alone, especially in older adults or those with reduced consciousness or high dependence in activities of daily living. Folding functional status and Glasgow Coma Scale into the triage picture, and keeping a lower threshold for cardiac workup in impaired patients, may help catch atypical presentations earlier.

Limitations & cautions

• This was a single-center retrospective cohort at one regional teaching hospital in Taiwan, drawing on electronic health record data from 2016 to 2023, so practice and documentation patterns may not generalize elsewhere. The observational design shows association, not causation, and only patients already diagnosed with acute myocardial infarction were included, so the study cannot speak to how often atypical presentations are missed entirely.
• AI-summarized from the linked source. Review the original article before applying to practice.