Experiences and Challenges Faced by Nurses in Traumatic Wound Care in the Emergency Department: A Systematic and Comprehensive Review

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Therefore, our study is anticipated to serve as a source for future research Introduction: This study is a systematic review that compiles recent evidence regarding nurses' experiences and various situations encountered in traumatic wound care in emergency departments. Methods: Data collection was conducted by searching the databases (PubMed, Google Scholar, Science Direct, Cochrane, TurkMedline, and Ulakbim) using the keywords "Traumatic wound care in the emergency department, nurse experience in wound care in the emergency department, challenges experienced in wound care management in the emergency department." The final search was conducted on February 9, 2024 Results: This review included 10 studies. Various recommendations and strategies for traumatic wound care and its aftermath have been outlined. The results of the included studies emphasize the challenging and stressful nature of traumatic wound care, highlighting the need for staff support, specialized preparation for traumatic wound care, necessary equipment, and training to overcome these challenges. Overall, the findings suggest that comprehensive strategies should be developed for both pre- and post-traumatic wound care based on the information provided by these studies. Discussion: While there are numerous studies on wound care in emergency departments, there is a scarcity of guidance on effective strategies specifically tailored to traumatic wound care. Evidence suggests that addressing and prioritizing multifaceted approaches are crucial for both nurses and patients in traumatic wound care. Further research is needed to provide robust evidence for effective interventions aimed at reducing nurses' distress during and after traumatic wound care. Conclusion and Implications for Nursing and Health Policy: Traumatic wound care is a critical issue in emergency departments where nurses face significant challenges. Through this systematic review, the results of many studies have been synthesized to identify necessary actions and provide recommendations Traumatic wound care nurse experience emergency department Figures Figure 1 Introduction Emergency department nurses play a crucial role in caring for trauma patients, critically ill patients, and injured individuals, and their role is vital for ensuring safe and effective patient care. Providing systematic technical skills with continuous care is essential for critically ill patients. Ensuring adequate care for seriously injured patients requires a comprehensive and structured assessment according to guidelines and standards for systematic trauma care. Therefore, nurses can design and utilize a scale that can adequately perform complex care to improve trauma outcomes (Hassankhani et.al. 2018) Trauma patients often remain immobile in the emergency department for extended periods before being admitted to the ward. Nurses in the emergency department may focus on caring for patients with life-threatening conditions and pay less attention to skin care. Healthcare professionals are committed to providing best practices in wound care. Participants identified that effective patient-centered, evidence-based wound care requires having a clear mandate for wound care to be a priority in a healthcare system (Rafiei et. al. 2014) Traumatic wounds and lacerations are common complaints in emergency departments. Despite a broad literature on wound care, many emergency clinicians base wound management on transmitted theories and techniques, leading to controversial, contradictory, and unsubstantiated recommendations. In this issue, evidence-based recommendations for wound care and management are reviewed, including wound cleansing and irrigation, anxiolysis/sedation techniques, closure methods, and post-repair wound care (Danesh et. al. 2022). This systematic and comprehensive review aims to analyze and synthesize definitions, experiences, and challenges encountered in traumatic wound care to understand how experiences are provided and what difficulties are faced. Methods Research strategy: This systematic review was conducted by searching the specified databases (Pubmed, Google Scholar, Science Direct, Cochrane, TurkMedline, and Ulakbim) using the keywords "Traumatic wound care in the emergency department, nurse experience in wound care in the emergency department, challenges in wound care management in the emergency department." The last search was conducted on February 9, 2024. A total of 5550 studies were retrieved; 2000 from Pubmed, 403 from Google Scholar, 1180 from ScienceDirect, 1167 from Cochrane, 390 from TurkMedline, and 410 from Ulakbim. Duplicate articles were identified (n = 470) and excluded. The titles and abstracts of the remaining studies (n = 5080) were reviewed by the researchers, evaluated for compliance with the criteria determined for the study, and ultimately, 10 studies were included in the systematic review. The PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) checklist tool was used to review the literature, summarize the findings, and report the results (Fig. 1). Inclusion criteria: Semi-structured qualitative studies, exploratory-descriptive phenomenological design, qualitative research, and full-text accessible articles published in Turkish and/or English between 2005 and 2024 were included in the systematic review. Exclusion criteria: Review studies, screening studies, studies including wound care experiences in intensive care units and pediatric patients, and articles and thesis studies defined as gray literature were not included in the systematic review. Quality Assessment The Critical Appraisal Skills Programme (CASP) quality assessment tool was used for evaluating the quality of the qualitative studies (Critical Appraisal Skills Programme, 2018 and 2020). Each study was rated from A to D; where A represents a study with no or very few flaws and high reliability in terms of transferability, dependability, and confirmability; B represents a flawed study with low likelihood of affecting its reliability, transferability, dependability, and/or confirmability; C represents a flawed study with a likelihood of affecting its reliability, transferability, dependability, and/or confirmability; and D represents a study with significant flaws that are likely to affect its reliability and transferability. The reliability and/or confirmability of the study. The final report was considered to be of sufficient quality (score of C + and above) for assessing the confidence in the findings as part of the Grading of Recommendations, Assessment, Development, and Evaluation for Qualitative Evidence Synthesis (GRADE-CERQual) approach (Long et al. 2020; Walsh et al. 2006; Lewin et al. 2018a; Lewin et al. 2018b). The full CASP assessment for each study can be found in Table 2 of the reviewed report. Findings After the literature review, it was observed that out of the studies meeting the inclusion criteria, 5 were qualitative research types, 2 were both qualitative and semi-structured studies, and the others were respectively exploratory-descriptive phenomenological design, phenomenological qualitative research, and cross-sectional research types. The studies included in the systematic review were reviewed, summarized, and presented in tabular format by the researcher (Table 1). Table-1 Characteristics of included studies and summary of qualitative findings Authors and year The purpose of the research is Type of research and sample size Quality rating* Findings and conclusions of the study Alisic et al, 2014 Avustralia The research aimed to explore the experiences of emergency room nurses in caring for critically injured children. A semi-structured qualitative study involving 20 nurses working in the emergency department. A + The study highlights the need for providing psychosocial care and support in pediatric emergency departments. It indicates that nurses tend to focus more on physical care, and there is a lack of awareness about traumatic stress in children and widespread practices to promote psychological healing in emergency department settings. There is a call for further research and interventions to address this gap. While nurses are more involved in traumatic wound care, the importance of providing psychosocial care is emphasized. Kriel, K. A. (2020). South Africa The aim is to understand how traumatic events affect emergency room nurses. An exploratory-descriptive phenomenological design involving 6 nurses with over 30 years of experience. A + The findings revealed that emergency room nurses who experienced distressing patient phenomena such as mass casualties and gang-related cases exhibited psychological distress at levels including post-traumatic stress disorder, secondary traumatic stress, compassion fatigue, and symptoms of vicarious trauma. They also found instances of compassion fatigue, psychological distress, and stress disorders following traumatic wound care. Freeman et al., 2014 Canada The study aims to explore the lived experience of being a trauma nurse in a trauma unit. A phenomenological qualitative study involving 7 nurses. B + The study revealed four subsets of themes: being always vigilant, not being caught unprepared, facing challenges, and sharing the journey. While trauma nurses may find meaning and satisfaction in their roles in wound care management, the findings of this research indicate the need for support and ensuring safe working environments due to the potential for trauma nurses to experience violence and aggression in their daily nursing practices. Lee, H. J., & Lee, S. K. (2022). South Korea The study aimed to investigate the effects of job embeddedness and the nursing work environment on turnover intentions among nurses in trauma centers. A cross-sectional study involving 120 nurses. A + The nurses in trauma centers, faced with the mortality of severely injured trauma patients, are found to experience higher psychological burdens and be more sensitive to job stress. If trauma nurses can choose the clinical equipment used and ensure an adequate supply of qualified staff, turnover among nurses can be prevented, ultimately leading to improved quality of nursing care and enhanced patient safety. This study highlights the necessity of equipment selection and trained, competent personnel for ensuring adequate and safe care in trauma wound management. Catlette, M. (2005). ABD The aim is to examine the phenomenon of workplace violence among nurses working in Level I Trauma Centers by interviewing emergency department nurses who have experienced violence during their shifts. It approached a qualitative descriptive study with the perspectives of 8 registered nurses." A + Emergency room nurses identified specific experiences of violence in the workplace. Inadequate security measures and vulnerability were two themes consistently raised throughout the interviews. Similarly, in this study, experiences following traumatic wound care highlighted issues of inadequate security measures and vulnerability. Tunç, H. (2023). Turkey The purpose of this study is to draw insights from the experiences of nurses who volunteered in the earthquake-stricken areas following the devastating earthquakes in Turkey, aiming to understand how nurses can better prepare for disasters and contribute to the exploration of topics related to disaster nursing preparedness. The study employed a qualitative research method, with data collected through semi-structured interviews with 9 nurses. A + In this study, they struggled with a lack of coordination in traumatic care management and inadequate living conditions. The psychological challenges experienced by nurses, communication issues, working with different teams, and the importance of acting professionally were discussed based on experiences. Jabbour, R et al. 2021 Lebanon Nurses' Stories from Beirut: Management of Care for Patients Affected by the Explosive Disaster of 2020, Amidst Pandemic and Economic Crises. The study utilized a qualitative research method, with data collected through semi-structured interviews. Eight nurses participated in the study. B + After the explosion, I worked in the emergency department of a city hospital in Beirut. We were called to duty during a major disaster, and now we are trying to cope with the aftermath. As nurses, we have faced many traumas in our country, which has been plagued by war and terrorism for decades. I can't comprehend how we managed wound care and management in the days and weeks following this tragedy. I don't know how we continued to care for the injured. I don't understand how we could listen to stories of horror, fear, disappointment, and sorrow repeatedly. In this study, they experienced such horror, fear, disappointment, and sorrow that they are not aware of how they provided wound care to trauma patients. Yang, Y. N., et al. 2010 Chinese The aim is to provide insight into the response of Chinese nurses to the 2008 Wenchuan earthquake. This study solely investigated nurses' experiences in disaster site rescue; thus, the knowledge, skills, and qualities required in disaster nurses as revealed in this study may be partial. A qualitative study conducted in collaboration with 10 nurses. A + Their experiences reinforced the necessity for disaster nurses to work without adequate equipment and supplies. In such circumstances, they relied heavily on assessment skills, clinical judgment, and expert knowledge of injuries and infections in disaster settings. They needed to be flexible, take initiative, and be creative when routine practices were not possible. Without formal training, nurses expressed that they were not adequately prepared to function particularly productively, effectively, collaboratively, and with less stress in disaster relief efforts. They noted that routine practices were not feasible in traumatic wound care, and they had to rely on their initiative and expertise to tend to the injured. Scott A, et al 2023 ABD To identify the factors influencing professional staff decisions and the implementation skills of Trauma-Informed Care (TIC) in a Level I Emergency Department trauma center. The qualitative research study consisted of semi-structured interviews and quantitative surveys. There were 4 nurses, 7 doctors, and other participants. A + Although they provided excellent care to patients experiencing acute physical trauma, many shared that they could better attend to patients with a history of trauma, including those often stigmatized such as obesity, substance use disorder, mental health issues, and non-English speakers. Participants identified opportunities to improve care for patients with trauma histories, including staff training, spending more time with patients, and efforts to reduce bias against patients. This study revealed that while they provided excellent care for acute traumatic wound care, they did not provide excellent care for individuals with obesity, substance use disorders, psychological issues, and non-English speakers. Lu, H. J.,et al 2020 Taiwan Researching healthcare professionals' experiences in utilizing comprehensive care to improve outcomes for patients with traumatic injuries. A qualitative study with 28 healthcare professionals A + Some participants mentioned that the majority of their patients expressed concerns about the condition of their wounds and wound healing. Despite providing instructions on wound care to patients in hospitals, patients generally had issues with wound care. Some patients were unable to properly care for their wounds and called the hospital for assistance or returned to the nurse station. Collaboration appears to have a positive impact on post-injury care. Trauma case management indicates the necessity of a coordinated process in providing comprehensive wound care following a traumatic injury. * Score derived from Critical Appraisal Skills Program (CASP) quality assessment tool for qualitative studie Taking into account the examples of studies reviewed, the research included one semi-qualitative, two qualitative, four mixed-methods, one cross-sectional, one phenomenological, one exploratory-descriptive phenomenological, and one semi-structured qualitative study. Discussion In the study conducted by Alisic et al. (2014), aimed at investigating the experiences of emergency department nurses in caring for severely injured children, 20 pediatric emergency nurses were evaluated. The study highlights the importance of providing psychosocial care to patients as well as addressing their traumatic wound care needs. Kriel, K. A. (2020) conducted a study to understand how traumatic events affect emergency department nurses. They interviewed six nurses who had worked for more than thirty years, and the findings indicated that nurses who encounter traumatic cases experience psychological distress such as post-traumatic stress disorder, secondary traumatic stress, compassion fatigue, and symptoms of vicarious trauma. On the other hand, Lee and Lee (2022) conducted a cross-sectional study involving 120 nurses to investigate the effects of the work environment on trauma center nurses' intentions to leave their jobs. They found that nurses reported experiencing higher psychological burden while working and were more sensitive to job stress. Catlette (2005) conducted a study to analyze the phenomenon of workplace violence and incidents of violence experienced by 8 nurses working in Level I Trauma Centers. As a result, nurses who experienced specific incidents of violence in the workplace identified inadequate security measures and vulnerability as significant themes consistently expressed during the interviews. Similarly, Freeman et al. (2014) conducted a phenomenological qualitative study to explore the lived experiences of trauma nurses working in a trauma unit in Canada. Four significant themes emerged from the study. These are expressed as always being vigilant, not being caught unprepared, facing challenges, and sharing the journey. Given that trauma nurses may experience violence and aggression in their daily nursing practices, the findings of this study underscore the need for support and ensuring safe working environments. In a different study by Jabbour et al. (2021), the care management of patients during the pandemic, economic crises, and the 2020 explosion disaster in Lebanon/Beirut was the focus. The results revealed that the nurses experienced such horror, fear, disappointment, and grief that they expressed being unaware of how they provided wound care to trauma patients. Lu et al. (2020) planned a qualitative study to investigate the experiences of 28 healthcare professionals in using comprehensive care to improve outcomes for patients with traumatic injuries. Some participants noted that although they provided instructions on wound care to patients in hospitals, patients generally faced issues with wound care, and some patients were unable to care for their wounds and called the hospital for help. This highlights the need for a coordinated process in healthcare services for traumatic case management and providing comprehensive wound care following a traumatic injury. In a study by Scott et al. (2023), they found that they provided excellent care for acute traumatic wound care in their practice. However, it was revealed that they did not provide excellent care for individuals who were obese, substance abusers, had psychological issues, or did not speak English. In a study by Tunç (2023), interviews were conducted with 9 nurses who volunteered in the earthquake-stricken area following an earthquake in Turkey. The aim was to utilize the nurses' experiences to better prepare for disasters and contribute to the investigation of issues related to disaster nursing preparedness. In this study, it was highlighted that nurses struggled due to coordination deficiencies and inadequate living conditions in managing traumatic care. Additionally, the psychological challenges, communication problems, working with different teams, and the importance of acting professionally were emphasized. In contrast, a study by Yang et al. (2010) revealed that Chinese nurses during the 2008 Wenchuan earthquake had to work without the necessary equipment and supplies. They had to be flexible, use initiative, and be creative in situations where routine practices were not possible. Many nurses who provide trauma care experience stress afterward, leading to feelings of regret about their career choices, contemplating resigning, or leaving their jobs. Nurses may reduce their communication with patients and even feel anger towards them. Nurses often draw upon their previous experiences to cope with post-traumatic stress. Studies in the literature show that emergency department nurses frequently experience stress, anxiety, depression, and burnout symptoms following traumatic wound care (Annagür 2010; Ayrancı et al. 2002; Gökçe and Dündar 2008; McAllister and McKinnon 2009; Scully 2011; Sterud et al. 2006). This study and others indicate that emergency department nurses universally face a situation that negatively affects their mental health during and after traumatic wound care, putting them at risk for psychological trauma. Implications for Nursing and Health Policy Approaching a traumatic patient necessitates the immediate assessment of appropriate safety measures and follow-up care, particularly in unforeseen and complex patient scenarios, to promptly evaluate the correct urgency levels and intervene accordingly. This study integrates existing scientific research on traumatic wound care in the emergency department and defines high-level competencies for nurses in terms of their experiences, challenges, and attitudes. These also guide how nurses approach traumatic patients and lead to coping strategies accordingly. In trauma units, it becomes apparent that nurses' ability to provide appropriate aseptic conditions, procure suitable materials, and maintain a conducive environment significantly impacts wound care. Considering these factors, precautionary measures should be taken into account. Limitations This study has notable limitations to consider. While our findings may represent the experiences of nurses in other urban emergency department settings, they cannot be fully generalized. The rapid review method is ideal for meeting the needs of a specific context, and the knowledge user within our research team's specific needs and context guided the search strategy and eligibility criteria. Given the short timeline of this rapid review, the gray literature search was limited to articles obtained through Google Scholar searches and other databases, and it is not assumed to be comprehensive. The search was also limited to articles published in the last 14 years and only available in English and Turkish, based on guidance from content experts, academic librarians, and the knowledge user, according to the rapid review approach. Recommendations for Emergency Nurses Nurses' experiences in the emergency department (ED) are integral to providing quality patient care and it is the responsibility of nursing leadership to further enhance the environment for nurses to gain more experience and cope with the challenges they face in order to fulfill their professional duties. This rapid review synthesizes current evidence on emergency department nurses' experiences in wound care and the difficulties they encounter. While emergency department nurses' experiences and difficulties in wound care vary, evidence supporting the effectiveness of specific interventions or intervention combinations is limited. Nurses, particularly in traumatic wound care, are encouraged to share their observations and experiences in writing and exchange them with each other. Conclusion This systematic review synthesized the latest evidence on Emergency Department (ED) nurses' experiences and challenges in traumatic wound care. Considering the complexities of traumatic wound care, interventions targeting nurses, staff, patients/visitors, and the ED environment are deemed necessary. There is a need for more rigorous methodologies in further research to evaluate more effective and sustainable interventions in traumatic wound care. Additionally, it is crucial to consider multiple stress factors associated with fear, stress, fatigue, burnout, etc., experienced by nurses providing traumatic wound care and to chart a course accordingly. Finally, interventions addressing systemic inequalities that contribute to aggressive behavior from patients and visitors during traumatic wound care encounters should be designed and implemented. Declarations ACKNOWLEDGMENTS I thank all the authors for their contributions AUTHOR CONTRIBUTIONS : Study design: İsmail ÖZTAŞ. Data collection: İsmail ÖZTAŞ, Ayla YAVA, Sevgi ÖZTAŞ. Data analysis: İsmail Öztaş, AYLA YAVA. Manuscript writing: İsmail ÖZTAŞ, Sevgi ÖZTAŞ . Critical revisions for important intellectual content: İsmail ÖZTAŞ, Sevgi ÖZTAŞ, Ayla YAVA FUNDING INFORMATION No funding was received for the development or writing of this article. AVAİLABİLİTY OF DATA AND MATERİALS The datasets used and/or analyzed in the current study can be made available by the corresponding author upon reasonable request . ETHICS STATEMENT No ethical approval is required for this article Consent for publication Not applicable. Competing interests The authors declare no competing interests. Author details 1 Hakkari University, Vocational School of Health Services, Hakkari, Turkey, 2 Hasan Kalyoncu University, Faculty of Health Sciences, Authors and Affiliations İsmail Öztaş, RN, MSc, Hakkâri University, Vocational School of Health Services, Hakkâri, Turkey Ayla Yava, RN, PhD, Prof., Hasan Kalyoncu University, Faculty of Health Sciences, Department of Nursing, Gaziantep, Turkey Sevgi Öztaş, RN, PhD, Hakkâri University, Vocational School of Health Services, Hakkâri, Turkey References Hassankhani, H., Hasanzadeh, F., Powers, K. A., Zadeh, A. D., & Rajaie, R. (2018). Clinical skills performed by Iranian emergency nurses: Perceived competency levels and attitudes toward expanding professional roles. Journal of Emergency Nursing, 44(2), 156-163. https://doi.org/10.1016/j.jen.2017.06.007 Rafiei, H., Abdar, M. E., Iranmanesh, S., Lalegani, H., Safdari, A., & Dehkordi, A. H. (2014). 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Taking care of staff: a comprehensive model of support for paramedics and emergency medical dispatchers.Traumatology, 17, 35-42. Sterud, T., Ekeberg, Q., & Hem, E. (2006). Health status in the ambulance services: a systematic review. BMC Health Services Research, 6,82-92. Table 2 Table 2 is available in the Supplementary Files section. Additional Declarations No competing interests reported. Supplementary Files Table2.docx Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4609319","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":330004630,"identity":"194137de-69b0-427d-bac5-0daef82637c0","order_by":0,"name":"ismail ÖZTAŞ","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAABEElEQVRIiWNgGAWjYBACNhCRUABmMz4GMg2AdANUHJ8WoDoeBgZmYxQtPHjtgmhhk4ZogRqFSwsf/+nEDw8MbOzt2Y8/qy6oSTPmn324geFD2WEGe+kD2B0mkbtZIsEgjZmHJ8fs9oxjOWYS5xIbGGecO8zAw5eAQwvvBqCWw2w8DDlst3nYKmwYzjA2MPO2AbXgcBkb/9nNP4BaeHj4nz8r5vlXYSMP0vIXnxaG3G0gWyR4JBLMgIbnmBmAtDDi0yKRu80C6BcDnhtvjKV5+9KMDYFaDvacS+fhOYNdi3z/2c03f1TY2LP3pz/8zPMt2XDeGfaHD36UWcux92DXgh0cYCAUk6NgFIyCUTAK8AIAcOdSA0RQDkUAAAAASUVORK5CYII=","orcid":"","institution":"Hakkari University","correspondingAuthor":true,"prefix":"","firstName":"ismail","middleName":"","lastName":"ÖZTAŞ","suffix":""},{"id":330004631,"identity":"612b58f5-8ca3-4b36-a6bf-3f607ea1864a","order_by":1,"name":"ayla yava","email":"","orcid":"","institution":"Hasan Kalyoncu University","correspondingAuthor":false,"prefix":"","firstName":"ayla","middleName":"","lastName":"yava","suffix":""},{"id":330004632,"identity":"0e1d45c0-0c92-4097-b6fa-f6c800622688","order_by":2,"name":"sevgi öztaş","email":"","orcid":"","institution":"Hakkari University","correspondingAuthor":false,"prefix":"","firstName":"sevgi","middleName":"","lastName":"öztaş","suffix":""}],"badges":[],"createdAt":"2024-06-20 05:36:26","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4609319/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4609319/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":62130910,"identity":"e7999034-f8f1-460f-84c4-d05cd8e621e9","added_by":"auto","created_at":"2024-08-09 15:38:58","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":388256,"visible":true,"origin":"","legend":"\u003cp\u003ePRISMA flow diagram. PRISMA, Preferred Reporting Items for Systematic Reviews and Meta-Analysi.\u003csup\u003e18\u003c/sup\u003e\u003c/p\u003e","description":"","filename":"floatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-4609319/v1/f8408163687e82acbf786c06.png"},{"id":65052917,"identity":"bfee6f90-d50b-4463-836b-e717c270d529","added_by":"auto","created_at":"2024-09-23 06:24:11","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":989924,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4609319/v1/1fd8efdb-18b7-45bc-b83b-3286ed5d8565.pdf"},{"id":62130970,"identity":"6e3b1218-f7ba-4b78-b7f0-96dbbf6e9e37","added_by":"auto","created_at":"2024-08-09 15:39:02","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":25373,"visible":true,"origin":"","legend":"","description":"","filename":"Table2.docx","url":"https://assets-eu.researchsquare.com/files/rs-4609319/v1/2136cc4e8dddfd669b69d179.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Experiences and Challenges Faced by Nurses in Traumatic Wound Care in the Emergency Department: A Systematic and Comprehensive Review","fulltext":[{"header":"Introduction","content":"\u003cp\u003eEmergency department nurses play a crucial role in caring for trauma patients, critically ill patients, and injured individuals, and their role is vital for ensuring safe and effective patient care. Providing systematic technical skills with continuous care is essential for critically ill patients. Ensuring adequate care for seriously injured patients requires a comprehensive and structured assessment according to guidelines and standards for systematic trauma care. Therefore, nurses can design and utilize a scale that can adequately perform complex care to improve trauma outcomes (Hassankhani et.al. 2018)\u003c/p\u003e \u003cp\u003eTrauma patients often remain immobile in the emergency department for extended periods before being admitted to the ward. Nurses in the emergency department may focus on caring for patients with life-threatening conditions and pay less attention to skin care. Healthcare professionals are committed to providing best practices in wound care. Participants identified that effective patient-centered, evidence-based wound care requires having a clear mandate for wound care to be a priority in a healthcare system (Rafiei et. al. 2014)\u003c/p\u003e \u003cp\u003eTraumatic wounds and lacerations are common complaints in emergency departments. Despite a broad literature on wound care, many emergency clinicians base wound management on transmitted theories and techniques, leading to controversial, contradictory, and unsubstantiated recommendations. In this issue, evidence-based recommendations for wound care and management are reviewed, including wound cleansing and irrigation, anxiolysis/sedation techniques, closure methods, and post-repair wound care (Danesh et. al. 2022).\u003c/p\u003e \u003cp\u003eThis systematic and comprehensive review aims to analyze and synthesize definitions, experiences, and challenges encountered in traumatic wound care to understand how experiences are provided and what difficulties are faced.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003eResearch strategy: This systematic review was conducted by searching the specified databases (Pubmed, Google Scholar, Science Direct, Cochrane, TurkMedline, and Ulakbim) using the keywords \u0026quot;Traumatic wound care in the emergency department, nurse experience in wound care in the emergency department, challenges in wound care management in the emergency department.\u0026quot; The last search was conducted on February 9, 2024. A total of 5550 studies were retrieved; 2000 from Pubmed, 403 from Google Scholar, 1180 from ScienceDirect, 1167 from Cochrane, 390 from TurkMedline, and 410 from Ulakbim. Duplicate articles were identified (n\u0026thinsp;=\u0026thinsp;470) and excluded. The titles and abstracts of the remaining studies (n\u0026thinsp;=\u0026thinsp;5080) were reviewed by the researchers, evaluated for compliance with the criteria determined for the study, and ultimately, 10 studies were included in the systematic review. The PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) checklist tool was used to review the literature, summarize the findings, and report the results (Fig.\u0026nbsp;1).\u003c/p\u003e\n\u003cp\u003eInclusion criteria: Semi-structured qualitative studies, exploratory-descriptive phenomenological design, qualitative research, and full-text accessible articles published in Turkish and/or English between 2005 and 2024 were included in the systematic review.\u003c/p\u003e\n\u003cp\u003eExclusion criteria: Review studies, screening studies, studies including wound care experiences in intensive care units and pediatric patients, and articles and thesis studies defined as gray literature were not included in the systematic review.\u003c/p\u003e\n\u003cp\u003eQuality Assessment\u003c/p\u003e\n\u003cp\u003eThe Critical Appraisal Skills Programme (CASP) quality assessment tool was used for evaluating the quality of the qualitative studies (Critical Appraisal Skills Programme, 2018 and 2020). Each study was rated from A to D; where A represents a study with no or very few flaws and high reliability in terms of transferability, dependability, and confirmability; B represents a flawed study with low likelihood of affecting its reliability, transferability, dependability, and/or confirmability; C represents a flawed study with a likelihood of affecting its reliability, transferability, dependability, and/or confirmability; and D represents a study with significant flaws that are likely to affect its reliability and transferability. The reliability and/or confirmability of the study. The final report was considered to be of sufficient quality (score of C\u0026thinsp;+\u0026thinsp;and above) for assessing the confidence in the findings as part of the Grading of Recommendations, Assessment, Development, and Evaluation for Qualitative Evidence Synthesis (GRADE-CERQual) approach (Long et al. 2020; Walsh et al. 2006; Lewin et al. 2018a; Lewin et al. 2018b). The full CASP assessment for each study can be found in Table \u003cspan\u003e2\u003c/span\u003e of the reviewed report.\u003c/p\u003e\n"},{"header":"Findings","content":"\u003cp\u003eAfter the literature review, it was observed that out of the studies meeting the inclusion criteria, 5 were qualitative research types, 2 were both qualitative and semi-structured studies, and the others were respectively exploratory-descriptive phenomenological design, phenomenological qualitative research, and cross-sectional research types. The studies included in the systematic review were reviewed, summarized, and presented in tabular format by the researcher (Table\u0026nbsp;1).\u003c/p\u003e \u003cp\u003eTable-1 Characteristics of included studies and summary of qualitative findings\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"No\" id=\"Taba\" border=\"1\"\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAuthors and year\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eThe purpose of the research is\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003eType of research and sample size\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eQuality\u003c/p\u003e \u003cp\u003erating*\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eFindings and conclusions of the study\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAlisic et al, 2014\u003c/p\u003e \u003cp\u003eAvustralia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eThe research aimed to explore the experiences of emergency room nurses in caring for critically injured children.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003eA semi-structured qualitative study involving 20 nurses working in the emergency department.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eA\u003csup\u003e+\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eThe study highlights the need for providing psychosocial care and support in pediatric emergency departments. It indicates that nurses tend to focus more on physical care, and there is a lack of awareness about traumatic stress in children and widespread practices to promote psychological healing in emergency department settings. There is a call for further research and interventions to address this gap. While nurses are more involved in traumatic wound care, the importance of providing psychosocial care is emphasized.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eKriel, K. A. (2020).\u003c/p\u003e \u003cp\u003eSouth Africa\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eThe aim is to understand how traumatic events affect emergency room nurses.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003eAn exploratory-descriptive phenomenological design involving 6 nurses with over 30 years of experience.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eA\u003csup\u003e+\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eThe findings revealed that emergency room nurses who experienced distressing patient phenomena such as mass casualties and gang-related cases exhibited psychological distress at levels including post-traumatic stress disorder, secondary traumatic stress, compassion fatigue, and symptoms of vicarious trauma. They also found instances of compassion fatigue, psychological distress, and stress disorders following traumatic wound care.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFreeman et al., 2014 Canada\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eThe study aims to explore the lived experience of being a trauma nurse in a trauma unit.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003eA phenomenological qualitative study involving 7 nurses.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eB\u003csup\u003e+\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eThe study revealed four subsets of themes: being always vigilant, not being caught unprepared, facing challenges, and sharing the journey. While trauma nurses may find meaning and satisfaction in their roles in wound care management, the findings of this research indicate the need for support and ensuring safe working environments due to the potential for trauma nurses to experience violence and aggression in their daily nursing practices.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLee, H. J., \u0026amp; Lee, S. K. (2022). South Korea\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eThe study aimed to investigate the effects of job embeddedness and the nursing work environment on turnover intentions among nurses in trauma centers.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003eA cross-sectional study involving 120 nurses.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eA\u003csup\u003e+\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eThe nurses in trauma centers, faced with the mortality of severely injured trauma patients, are found to experience higher psychological burdens and be more sensitive to job stress. If trauma nurses can choose the clinical equipment used and ensure an adequate supply of qualified staff, turnover among nurses can be prevented, ultimately leading to improved quality of nursing care and enhanced patient safety. This study highlights the necessity of equipment selection and trained, competent personnel for ensuring adequate and safe care in trauma wound management.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCatlette, M. (2005).\u003c/p\u003e \u003cp\u003eABD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eThe aim is to examine the phenomenon of workplace violence among nurses working in Level I Trauma Centers by interviewing emergency department nurses who have experienced violence during their shifts.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eIt approached a qualitative descriptive study with the perspectives of 8 registered nurses.\"\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003eA\u003csup\u003e+\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eEmergency room nurses identified specific experiences of violence in the workplace. Inadequate security measures and vulnerability were two themes consistently raised throughout the interviews. Similarly, in this study, experiences following traumatic wound care highlighted issues of inadequate security measures and vulnerability.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTun\u0026ccedil;, H. (2023).\u003c/p\u003e \u003cp\u003eTurkey\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eThe purpose of this study is to draw insights from the experiences of nurses who volunteered in the earthquake-stricken areas following the devastating earthquakes in Turkey, aiming to understand how nurses can better prepare for disasters and contribute to the exploration of topics related to disaster nursing preparedness.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eThe study employed a qualitative research method, with data collected through semi-structured interviews with 9 nurses.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003eA\u003csup\u003e+\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eIn this study, they struggled with a lack of coordination in traumatic care management and inadequate living conditions. The psychological challenges experienced by nurses, communication issues, working with different teams, and the importance of acting professionally were discussed based on experiences.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eJabbour, R et al. 2021\u003c/p\u003e \u003cp\u003eLebanon\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNurses' Stories from Beirut: Management of Care for Patients Affected by the Explosive Disaster of 2020, Amidst Pandemic and Economic Crises.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eThe study utilized a qualitative research method, with data collected through semi-structured interviews. Eight nurses participated in the study.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003eB\u003csup\u003e+\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eAfter the explosion, I worked in the emergency department of a city hospital in Beirut. We were called to duty during a major disaster, and now we are trying to cope with the aftermath. As nurses, we have faced many traumas in our country, which has been plagued by war and terrorism for decades. I can't comprehend how we managed wound care and management in the days and weeks following this tragedy. I don't know how we continued to care for the injured. I don't understand how we could listen to stories of horror, fear, disappointment, and sorrow repeatedly.\u003c/p\u003e \u003cp\u003eIn this study, they experienced such horror, fear, disappointment, and sorrow that they are not aware of how they provided wound care to trauma patients.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYang, Y. N., et al. 2010\u003c/p\u003e \u003cp\u003eChinese\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eThe aim is to provide insight into the response of Chinese nurses to the 2008 Wenchuan earthquake. This study solely investigated nurses' experiences in disaster site rescue; thus, the knowledge, skills, and qualities required in disaster nurses as revealed in this study may be partial.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eA qualitative study conducted in collaboration with 10 nurses.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003eA\u003csup\u003e+\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eTheir experiences reinforced the necessity for disaster nurses to work without adequate equipment and supplies. In such circumstances, they relied heavily on assessment skills, clinical judgment, and expert knowledge of injuries and infections in disaster settings. They needed to be flexible, take initiative, and be creative when routine practices were not possible. Without formal training, nurses expressed that they were not adequately prepared to function particularly productively, effectively, collaboratively, and with less stress in disaster relief efforts. They noted that routine practices were not feasible in traumatic wound care, and they had to rely on their initiative and expertise to tend to the injured.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eScott A, et al 2023\u003c/p\u003e \u003cp\u003eABD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTo identify the factors influencing professional staff decisions and the implementation skills of Trauma-Informed Care (TIC) in a Level I Emergency Department trauma center.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eThe qualitative research study consisted of semi-structured interviews and quantitative surveys. There were 4 nurses, 7 doctors, and other participants.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003eA\u003csup\u003e+\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eAlthough they provided excellent care to patients experiencing acute physical trauma, many shared that they could better attend to patients with a history of trauma, including those often stigmatized such as obesity, substance use disorder, mental health issues, and non-English speakers. Participants identified opportunities to improve care for patients with trauma histories, including staff training, spending more time with patients, and efforts to reduce bias against patients. This study revealed that while they provided excellent care for acute traumatic wound care, they did not provide excellent care for individuals with obesity, substance use disorders, psychological issues, and non-English speakers.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLu, H. J.,et al 2020\u003c/p\u003e \u003cp\u003eTaiwan\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eResearching healthcare professionals' experiences in utilizing comprehensive care to improve outcomes for patients with traumatic injuries.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eA qualitative study with 28 healthcare professionals\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003eA\u003csup\u003e+\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eSome participants mentioned that the majority of their patients expressed concerns about the condition of their wounds and wound healing. Despite providing instructions on wound care to patients in hospitals, patients generally had issues with wound care. Some patients were unable to properly care for their wounds and called the hospital for assistance or returned to the nurse station. Collaboration appears to have a positive impact on post-injury care. Trauma case management indicates the necessity of a coordinated process in providing comprehensive wound care following a traumatic injury.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"6\"\u003e* Score derived from Critical Appraisal Skills Program (CASP) quality assessment tool for qualitative studie\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eTaking into account the examples of studies reviewed, the research included one semi-qualitative, two qualitative, four mixed-methods, one cross-sectional, one phenomenological, one exploratory-descriptive phenomenological, and one semi-structured qualitative study.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eIn the study conducted by Alisic et al. (2014), aimed at investigating the experiences of emergency department nurses in caring for severely injured children, 20 pediatric emergency nurses were evaluated. The study highlights the importance of providing psychosocial care to patients as well as addressing their traumatic wound care needs.\u003c/p\u003e \u003cp\u003eKriel, K. A. (2020) conducted a study to understand how traumatic events affect emergency department nurses. They interviewed six nurses who had worked for more than thirty years, and the findings indicated that nurses who encounter traumatic cases experience psychological distress such as post-traumatic stress disorder, secondary traumatic stress, compassion fatigue, and symptoms of vicarious trauma. On the other hand, Lee and Lee (2022) conducted a cross-sectional study involving 120 nurses to investigate the effects of the work environment on trauma center nurses' intentions to leave their jobs. They found that nurses reported experiencing higher psychological burden while working and were more sensitive to job stress.\u003c/p\u003e \u003cp\u003eCatlette (2005) conducted a study to analyze the phenomenon of workplace violence and incidents of violence experienced by 8 nurses working in Level I Trauma Centers. As a result, nurses who experienced specific incidents of violence in the workplace identified inadequate security measures and vulnerability as significant themes consistently expressed during the interviews. Similarly, Freeman et al. (2014) conducted a phenomenological qualitative study to explore the lived experiences of trauma nurses working in a trauma unit in Canada. Four significant themes emerged from the study. These are expressed as always being vigilant, not being caught unprepared, facing challenges, and sharing the journey. Given that trauma nurses may experience violence and aggression in their daily nursing practices, the findings of this study underscore the need for support and ensuring safe working environments.\u003c/p\u003e \u003cp\u003eIn a different study by Jabbour et al. (2021), the care management of patients during the pandemic, economic crises, and the 2020 explosion disaster in Lebanon/Beirut was the focus. The results revealed that the nurses experienced such horror, fear, disappointment, and grief that they expressed being unaware of how they provided wound care to trauma patients.\u003c/p\u003e \u003cp\u003eLu et al. (2020) planned a qualitative study to investigate the experiences of 28 healthcare professionals in using comprehensive care to improve outcomes for patients with traumatic injuries. Some participants noted that although they provided instructions on wound care to patients in hospitals, patients generally faced issues with wound care, and some patients were unable to care for their wounds and called the hospital for help. This highlights the need for a coordinated process in healthcare services for traumatic case management and providing comprehensive wound care following a traumatic injury.\u003c/p\u003e \u003cp\u003eIn a study by Scott et al. (2023), they found that they provided excellent care for acute traumatic wound care in their practice. However, it was revealed that they did not provide excellent care for individuals who were obese, substance abusers, had psychological issues, or did not speak English.\u003c/p\u003e \u003cp\u003eIn a study by Tun\u0026ccedil; (2023), interviews were conducted with 9 nurses who volunteered in the earthquake-stricken area following an earthquake in Turkey. The aim was to utilize the nurses' experiences to better prepare for disasters and contribute to the investigation of issues related to disaster nursing preparedness. In this study, it was highlighted that nurses struggled due to coordination deficiencies and inadequate living conditions in managing traumatic care. Additionally, the psychological challenges, communication problems, working with different teams, and the importance of acting professionally were emphasized.\u003c/p\u003e \u003cp\u003eIn contrast, a study by Yang et al. (2010) revealed that Chinese nurses during the 2008 Wenchuan earthquake had to work without the necessary equipment and supplies. They had to be flexible, use initiative, and be creative in situations where routine practices were not possible.\u003c/p\u003e \u003cp\u003eMany nurses who provide trauma care experience stress afterward, leading to feelings of regret about their career choices, contemplating resigning, or leaving their jobs. Nurses may reduce their communication with patients and even feel anger towards them. Nurses often draw upon their previous experiences to cope with post-traumatic stress. Studies in the literature show that emergency department nurses frequently experience stress, anxiety, depression, and burnout symptoms following traumatic wound care (Annag\u0026uuml;r 2010; Ayrancı et al. 2002; G\u0026ouml;k\u0026ccedil;e and D\u0026uuml;ndar 2008; McAllister and McKinnon 2009; Scully 2011; Sterud et al. 2006). This study and others indicate that emergency department nurses universally face a situation that negatively affects their mental health during and after traumatic wound care, putting them at risk for psychological trauma.\u003c/p\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003eImplications for Nursing and Health Policy\u003c/h2\u003e \u003cp\u003eApproaching a traumatic patient necessitates the immediate assessment of appropriate safety measures and follow-up care, particularly in unforeseen and complex patient scenarios, to promptly evaluate the correct urgency levels and intervene accordingly.\u003c/p\u003e \u003cp\u003eThis study integrates existing scientific research on traumatic wound care in the emergency department and defines high-level competencies for nurses in terms of their experiences, challenges, and attitudes. These also guide how nurses approach traumatic patients and lead to coping strategies accordingly.\u003c/p\u003e \u003cp\u003eIn trauma units, it becomes apparent that nurses' ability to provide appropriate aseptic conditions, procure suitable materials, and maintain a conducive environment significantly impacts wound care. Considering these factors, precautionary measures should be taken into account.\u003c/p\u003e \u003c/div\u003e"},{"header":"Limitations","content":"\u003cp\u003eThis study has notable limitations to consider. While our findings may represent the experiences of nurses in other urban emergency department settings, they cannot be fully generalized. The rapid review method is ideal for meeting the needs of a specific context, and the knowledge user within our research team's specific needs and context guided the search strategy and eligibility criteria. Given the short timeline of this rapid review, the gray literature search was limited to articles obtained through Google Scholar searches and other databases, and it is not assumed to be comprehensive. The search was also limited to articles published in the last 14 years and only available in English and Turkish, based on guidance from content experts, academic librarians, and the knowledge user, according to the rapid review approach.\u003c/p\u003e \u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003eRecommendations for Emergency Nurses\u003c/h2\u003e \u003cp\u003eNurses' experiences in the emergency department (ED) are integral to providing quality patient care and it is the responsibility of nursing leadership to further enhance the environment for nurses to gain more experience and cope with the challenges they face in order to fulfill their professional duties. This rapid review synthesizes current evidence on emergency department nurses' experiences in wound care and the difficulties they encounter. While emergency department nurses' experiences and difficulties in wound care vary, evidence supporting the effectiveness of specific interventions or intervention combinations is limited. Nurses, particularly in traumatic wound care, are encouraged to share their observations and experiences in writing and exchange them with each other.\u003c/p\u003e \u003c/div\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThis systematic review synthesized the latest evidence on Emergency Department (ED) nurses' experiences and challenges in traumatic wound care. Considering the complexities of traumatic wound care, interventions targeting nurses, staff, patients/visitors, and the ED environment are deemed necessary. There is a need for more rigorous methodologies in further research to evaluate more effective and sustainable interventions in traumatic wound care. Additionally, it is crucial to consider multiple stress factors associated with fear, stress, fatigue, burnout, etc., experienced by nurses providing traumatic wound care and to chart a course accordingly. Finally, interventions addressing systemic inequalities that contribute to aggressive behavior from patients and visitors during traumatic wound care encounters should be designed and implemented.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eACKNOWLEDGMENTS\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eI thank all the authors for their contributions\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAUTHOR CONTRIBUTIONS\u003c/strong\u003e: \u003cstrong\u003eStudy design:\u003c/strong\u003e İsmail \u0026Ouml;ZTAŞ. \u003cstrong\u003eData collection:\u003c/strong\u003e İsmail \u0026Ouml;ZTAŞ, Ayla YAVA, Sevgi \u0026Ouml;ZTAŞ. \u003cstrong\u003eData analysis:\u003c/strong\u003e İsmail \u0026Ouml;ztaş, AYLA YAVA. \u003cstrong\u003eManuscript writing:\u003c/strong\u003e İsmail \u0026Ouml;ZTAŞ, Sevgi \u0026Ouml;ZTAŞ\u003cstrong\u003e. Critical revisions for important intellectual content:\u003c/strong\u003e İsmail \u0026Ouml;ZTAŞ, Sevgi \u0026Ouml;ZTAŞ, Ayla YAVA\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFUNDING INFORMATION\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNo funding was received for the development or writing of this article.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAVAİLABİLİTY OF DATA AND MATERİALS\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets used and/or analyzed in the current study can be made available\u003c/p\u003e\n\u003cp\u003eby the corresponding author upon reasonable request\u003cstrong\u003e.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eETHICS STATEMENT\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNo ethical approval is required for this article\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor details\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003csup\u003e1\u003c/sup\u003eHakkari University, Vocational School of Health Services, Hakkari, Turkey,\u0026nbsp;\u003csup\u003e2\u003c/sup\u003eHasan Kalyoncu University, Faculty of Health Sciences,\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eAuthors and Affiliations\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eİsmail \u0026Ouml;ztaş,\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eRN, MSc, Hakk\u0026acirc;ri University, Vocational School of Health Services, Hakk\u0026acirc;ri, Turkey\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAyla Yava,\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eRN, PhD, Prof., Hasan Kalyoncu University, Faculty of Health Sciences, Department of Nursing, Gaziantep, Turkey\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSevgi \u0026Ouml;ztaş,\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eRN, PhD, Hakk\u0026acirc;ri University, Vocational School of Health Services, Hakk\u0026acirc;ri, Turkey\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eHassankhani, H., Hasanzadeh, F., Powers, K. A., Zadeh, A. D., \u0026amp; Rajaie, R. (2018). Clinical skills performed by Iranian emergency nurses: Perceived competency levels and attitudes toward expanding professional roles. Journal of Emergency Nursing, 44(2), 156-163. https://doi.org/10.1016/j.jen.2017.06.007 \u003c/li\u003e\n\u003cli\u003eRafiei, H., Abdar, M. E., Iranmanesh, S., Lalegani, H., Safdari, A., \u0026amp; Dehkordi, A. H. (2014). Knowledge about pressure ulcer prevention, classification and management: A survey of registered nurses working with trauma patients in the emergency department. \u003cem\u003eInternational Journal of Orthopaedic and Trauma Nursing\u003c/em\u003e, \u003cem\u003e18\u003c/em\u003e(3), 135-142. https://doi.org/10.1016/j.ijotn.2014.03.004\u003c/li\u003e\n\u003cli\u003eDanesh, V., Sasangohar, F., Kallberg, A. S., Kean, E. B., Brixey, J. J., \u0026amp; Johnson, K. D. (2022). Systematic review of interruptions in the emergency department work environment. International Emergency Nursing, 63, 101175. https://doi.org/10.1016/j.ienj.2022.101175 \u003c/li\u003e\n\u003cli\u003eLong HA, French DP, Brooks JM. Optimising the value of the critical appraisal skills programme (CASP) tool for quality appraisal in qualitative evidence synthesis. Res Methods Health Sci. 2020;1(1):31-42. \u003cu\u003ehttps:// doi.org/10.1177/2632084320947559 23. \u003c/u\u003e\u003c/li\u003e\n\u003cli\u003eWalsh D, Downe S. Appraising the quality of qualitative research. Midwifery. 2006;22(2):108-119. \u003cu\u003ehttps://doi.org/10.1016/j.midw.2005. 05.004\u003c/u\u003e\u003c/li\u003e\n\u003cli\u003eLewin S, Booth A, Glenton C, et al. Applying GRADE-CERQual to qualitative evidence synthesis findings: introduction to the series. Implement Sci. 2018;13(suppl 1):2. \u003cu\u003ehttps://doi.org/10.1186/s13012-017- 0688-3 24.\u003c/u\u003e \u003c/li\u003e\n\u003cli\u003eLewin S, Bohren M, Rashidian A, et al. Applying GRADE-CERQual to qualitative evidence synthesis findings\u0026mdash;Paper 2: how to make an overall CERQual assessment of confidence and create a Summary of Qualitative Findings table. Implement Sci. 2018;13(suppl 1):10. \u003cu\u003ehttps://doi.org/ 10.1186/s13012-017-0689-2\u003c/u\u003e\u003c/li\u003e\n\u003cli\u003eAlisic, E., Conroy, R., Magyar, J., Babl, F. E., \u0026amp; O\u0026rsquo;Donnell, M. L. Psychosocial care for seriously injured children and their families: A qualitative study among Emergency Department nurses and physicians. Injury 2014. http://dx.doi.org/10.1016/j.injury.2014.02.015\u003c/li\u003e\n\u003cli\u003eKriel, K. A. (2020). A qualitative study on the psychological impacts of patient and workplace trauma on emergency nurses. The IIE.\u003c/li\u003e\n\u003cli\u003eFreeman, L., Fothergill-Bourbonnais, F., \u0026amp; Rashotte, J. (2014). The experience of being a trauma nurse: A phenomenological study. 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T\u0026uuml;rk Sağlık Bilimleri ve Yaşam Dergisi, 6(3), 122-132. https://doi.org/10.56150/tjhsl.1362173\u003c/li\u003e\n\u003cli\u003eJabbour, R., Harakeh, M., Dakessian Sailan, S., Nassar, V., Tashjian, H., Massouh, J., ... \u0026amp; Darwish, H. (2021). Nurses\u0026rsquo; stories from Beirut: The 2020 explosive disaster on top of a pandemic and economic crises. International nursing review, 68(1), 1-8. https://doi.org/10.1111/inr.12675\u003c/li\u003e\n\u003cli\u003eYang, Y. N., Xiao, L. D., Cheng, H. Y., Zhu, J. C., \u0026amp; Arbon, P. (2010). Chinese nurses\u0026apos; experience in the Wenchuan earthquake relief. International nursing review, 57(2), 217-223.\u003c/li\u003e\n\u003cli\u003eScott A. Simpson, Maria Schimpf, Evelyn Fox, Hastane personeli destek programları aracılığıyla travmaya dayalı bakım vaadinin ger\u0026ccedil;ekleştirilmesi , Journal of the American College of Acil Hekimler A\u0026ccedil;ık , 4 , 4 , (2023) .\u003cu\u003e https://doi.org/10.1002/emp2.13001\u003c/u\u003e\u003c/li\u003e\n\u003cli\u003eLu, H. J., Huang, H. M., Hsiao, T. Y., Hung, C. C., Lin, W. T., \u0026amp; Lee, B. O. (2020). Health Professionals\u0026apos; Perspectives on the Efficacy of Using Comprehensive Care to Improve Outcomes in Patients With Traumatic Injury. The journal of nursing research : JNR, 28(6), e126. https://doi.org/10.1097/jnr.0000000000000396\u003c/li\u003e\n\u003cli\u003eMoher D, Liberati A, Tetzlaff J, Altman DG, The PRISMA Group (2009). Preferred Reporting Items for Systematic Reviews and Meta-Analyses: The PRISMA Statement. PLoS Med 6(6): e1000097. \u003cu\u003edoi:10.1371/journal.pmed1000097\u003c/u\u003e\u003c/li\u003e\n\u003cli\u003eAnnag\u0026uuml;r, B. (2010). Sağlık \u0026ccedil;alışanlarına y\u0026ouml;nelik şiddet: risk fakt\u0026ouml;rleri, etkileri, değerlendirilmesi ve \u0026ouml;nlenmesi. Psikiyatride G\u0026uuml;ncel Yaklaşımlar, 2, 161-173.\u003c/li\u003e\n\u003cli\u003eAyrancı, \u0026Uuml;., Yenilmez, \u0026Ccedil;., \u0026amp; G\u0026uuml;nay, Y. (2002). \u0026Ccedil;eşitli sağlık kurumlarında ve sağlık meslek gruplarında şiddete uğrama sıklığı. Anadolu Psikiyatri Dergisi, 3, 147-54. \u003cbr\u003e \u003c/li\u003e\n\u003cli\u003eG\u0026ouml;k\u0026ccedil;e, T., \u0026amp; D\u0026uuml;ndar, C. (2008). Samsun ruh ve sinir hastalıkları hastanesinde \u0026ccedil;alışan hekim ve hemşirelerde şiddete maruziyet sıklığı vekaygı d\u0026uuml;zeylerine etkisi. İn\u0026ouml;n\u0026uuml; \u0026Uuml;niversitesi Tıp Fak\u0026uuml;ltesi Dergisi, 15, 25-28. \u003c/li\u003e\n\u003cli\u003eMcAllister, M., \u0026amp; McKinnon, J. (2009). The importance of teaching and learning resilience in the health disciplines: a critical review of theliterature. Nurse Education Today, 29, 371-379. \u003c/li\u003e\n\u003cli\u003eScully, P. J. (2011). Taking care of staff: a comprehensive model of support for paramedics and emergency medical dispatchers.Traumatology, 17, 35-42. \u003c/li\u003e\n\u003cli\u003eSterud, T., Ekeberg, Q., \u0026amp; Hem, E. (2006). Health status in the ambulance services: a systematic review. BMC Health Services Research, 6,82-92.\u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Table 2","content":"\u003cp\u003eTable 2 is available in the Supplementary Files section.\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Traumatic wound care, nurse experience, emergency department","lastPublishedDoi":"10.21203/rs.3.rs-4609319/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4609319/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eAim:\u003c/strong\u003e In this article, we aimed to contribute to the scientific community by highlighting the challenges and experiences of nurses in wound care in emergency department\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eBackground:\u003c/strong\u003e Although there are many studies related to wound care, a literature review reveals that there is no research similar to our article. Therefore, our study is anticipated to serve as a source for future research\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eIntroduction:\u003c/strong\u003e This study is a systematic review that compiles recent evidence regarding nurses' experiences and various situations encountered in traumatic wound care in emergency departments.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods: \u003c/strong\u003eData collection was conducted by searching the databases (PubMed, Google Scholar, Science Direct, Cochrane, TurkMedline, and Ulakbim) using the keywords \"Traumatic wound care in the emergency department, nurse experience in wound care in the emergency department, challenges experienced in wound care management in the emergency department.\" The final search was conducted on February 9, 2024\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults: \u003c/strong\u003eThis review included 10 studies. Various recommendations and strategies for traumatic wound care and its aftermath have been outlined. The results of the included studies emphasize the challenging and stressful nature of traumatic wound care, highlighting the need for staff support, specialized preparation for traumatic wound care, necessary equipment, and training to overcome these challenges. Overall, the findings suggest that comprehensive strategies should be developed for both pre- and post-traumatic wound care based on the information provided by these studies.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDiscussion:\u003c/strong\u003e While there are numerous studies on wound care in emergency departments, there is a scarcity of guidance on effective strategies specifically tailored to traumatic wound care. Evidence suggests that addressing and prioritizing multifaceted approaches are crucial for both nurses and patients in traumatic wound care. Further research is needed to provide robust evidence for effective interventions aimed at reducing nurses' distress during and after traumatic wound care.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion and Implications for Nursing and Health Policy: \u003c/strong\u003eTraumatic wound care is a critical issue in emergency departments where nurses face significant challenges. Through this systematic review, the results of many studies have been synthesized to identify necessary actions and provide recommendations\u003c/p\u003e","manuscriptTitle":"Experiences and Challenges Faced by Nurses in Traumatic Wound Care in the Emergency Department: A Systematic and Comprehensive Review","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-08-09 15:38:38","doi":"10.21203/rs.3.rs-4609319/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"276333ba-508e-4420-842a-6d9b31d9e9ab","owner":[],"postedDate":"August 9th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2024-09-23T06:16:05+00:00","versionOfRecord":[],"versionCreatedAt":"2024-08-09 15:38:38","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-4609319","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4609319","identity":"rs-4609319","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}