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Introduction: Patients with chronic pain who frequent emergency departments present a challenge to health care providers. Mental health, substance abuse, and pain issues are difficult to distinguish in fast-paced clinical settings, and significant symptoms may remain unaddressed. This pilot study sought to determine whether electronically delivered screening tools measuring pain and mood could identify areas to target for improving emergency care., Methods: A prospective, descriptive pilot study used repeated measures of validated instruments to investigate the status of patients after their ED encounter. Persons with chronic pain not related to cancer and documented opioid use were recruited by nursing personnel after an ED encounter. Consenting participants (n = 52) were invited to perform an online survey that included self-reported measurements of pain intensity, pain interference, depression, subjective health, and health distress. The survey was repeated after 8 weeks., Results: The baseline survey was completed by 42.3% of 52 patients who provided consent (n = 22, 68.2% female). The mean pain severity score was 5.96 (SD 1.57) and the mean pain interference score was 7.52 (SD 1.81) using 0 to 10 scales of the Brief Pain Inventory. Personal Health Questionnaire Depression Scale ratings indicated that a major depressive disorder should be considered for 54% of the participants., Discussion: Online surveys delivered to patients with chronic pain detected unmet needs for depression and persisting high levels of pain interference after ED encounters. Adding mood-specific screening tools to pain assessments may be necessary in clinical settings to identify depression and refer for appropriate treatment., (Copyright © 2014 Emergency Nurses Association. Published by Mosby, Inc. All rights reserved.)

Introduction: The research literature reveals that the emergency care rendered to elderly patients may be of poor quality. Research examining elderly patients' ED use and their perceptions of their ED experiences was analyzed and synthesized, revealing gaps in the research and identifying areas for future research., Methods: A computerized search was made of 3 databases (medline, HealthSTAR, and CINAHL). Each of the studies was systematically evaluated with use of the Nursing Practice Research Analysis Tool., Results: Despite increased length of stay, more diagnostic tests, and higher expenses, the elderly have a higher rate of recidivism and are dissatisfied with their outcomes upon leaving the emergency department. Several areas that need to be explored further include quality of services rendered from the elderly ED patient's perspective; whether ageism exists within the emergency department; and the consequences of that ageism on the quality of care provided., Discussion: The elderly are being cared for by ED personnel who have limited geriatric education within an environment that is antithetical to their needs. Research and endeavors that concentrate on improving the care of the elderly ED patient must be given top priority.

Objective: To provide clinical practice recommendations for screening and interventions for intimate partner violence (IPV) in ED settings., Setting: Eleven mid-sized community-level hospital emergency departments (20,000 to 40,000 admissions annually) in Pennsylvania and California., Participants: All women (4641) aged 18 years or older who came to the emergency department during 309 selected shifts., Methods: An anonymous survey inquiring about physical, sexual, and emotional IPV was conducted from 1995 through 1997. In addition, medical records were abstracted for every woman (18 years and older) seen in the 11 participating emergency departments during the study period., Results: The vast majority of both abused and nonabused women supported routine screening for IPV; however, fewer than 25% of women said they were asked about IPV by ED staff. ED screening rates for IPV were higher among women who came to the emergency department because of acute trauma from abuse (39%) than for women who reported that they had been abused within the past year (13%). The prevalence of past year and lifetime IPV was significantly higher when the questionnaire was self-administered than when it was administered by a nurse. More than a third of women who had recently been abused and 76% of women who acknowledged experiencing physical or sexual IPV within the past year reported that they did not come to the emergency department for treatment of an injury. Although the majority of women (76% to 90%) agreed with the concept of health care providers reporting IPV to the police, women abused recently were significantly less likely to support this practice., Conclusion: The study provides evidence supporting standard protocols for routine screening for IPV among women who come to emergency departments and chart prompts for both screening and interventions. These actions are acceptable to the majority of both abused and nonabused women seen in the emergency department and should be considered in systematic repeated training of health care professionals in emergency departments. This information is important for health care providers who are seeking to improve their identification of and care for abused women.

Objective: The purposes of this study were to determine the most effective nursing intervention to decrease pain for patients with minor musculoskeletal trauma and moderate pain at triage and to examine patient satisfaction., Methods: Patients were assigned to 1 of 3 intervention groups: (1) standard care (ice, elevation, and immobilization); (2) standard care and ibuprofen; or (3) standard care and music distraction. Patients were monitored for pain ratings for 60 minutes. Patients who sustained minor musculoskeletal trauma within the past 24 hours and presented with pain ratings of 4 or greater were included. Two patient satisfaction questions were asked upon discharge from the emergency department., Results: Seventy-seven patients met the inclusion criteria. No differences in pain ratings between groups were demonstrated. A statistically significant reduction in pain for all patients occurred at 30 minutes (F = 16.18, P <.01) and was maintained at 60 minutes. However, 70% of patients continued to report pain ratings of 4 or greater (on a scale of 1 to 10) at 60 minutes. The reduction in pain was not found to be clinically significant.Eighty-four percent of patients stated that they were more satisfied with their overall care in the emergency department because of the immediate attention to pain relief they received at triage. No differences in satisfaction existed between treatment groups, although patients who reported higher pain ratings expressed statistically significant lower satisfaction with pain management scores (F = 9.375, P =.003)., Conclusion: None of the therapies-standard care (ice, elevation, immobilization), standard care with ibuprofen, or standard care with music distraction-provided clinically significant pain relief to patients who had minor musculoskeletal trauma (ie, sprains and fractures) and moderate pain at triage. Interestingly, satisfaction scores were sometimes positive, even when pain was not relieved.

Objective: Patients' perceptions and satisfaction are areas of growing concern in health care research, but little has been reported from the perspective of elderly persons. The purpose of this study was to describe elderly patients' perceptions of care in the emergency department., Methods: A qualitative, descriptive study design was used. Twelve elderly people were interviewed following a treatment episode in 1 of 3 emergency departments in the western United States and data were submitted to content analysis according to qualitative, interpretive methodology., Findings: The following 5 themes emerged from the analysis: "needs for information," "observations of waiting time," "perceptions of professional competency and caring service," "concerns about process and facility design," and "personal tolerance.", Discussion: Findings support some aspects of existing literature and offer additional information regarding care of elderly persons in the emergency department. Results also support the need for more research in the area of the actual experience of elderly patients in the emergency department.