Emergency Nursing
Learning Objectives
The learner will be able to:
- Explain emergency care as a collaborative, holistic approach that includes the patient, the family, and significant others.
- Discuss priority emergency measures instituted for any patient with an emergency condition.
Scope and Practice of Emergency Nursing
The emergency nurse has had specialized education, training, and experience to gain expertise in assessing and identifying patients health care problems in crisis situations.
In addition, the emergency nurse establishes priorities, monitors and continuously assesses acutely ill and injured patients, supports and attends to families, supervises allied health personnel, and teaches patients and families within a time-limited, high-pressured care environment.
The emergency health care staff members work as a team in performing the highly technical, hands-on skills required to care for patients in an emergency situation
The nursing process provides a logical framework for problem solving in this environment. Patients in the ED have a wide variety of actual or potential problems, and their condition may change . Therefore, nursing assessment must be continuous, and nursing diagnoses change with the patient’s condition. Although a patient may have several diagnoses at a given time, the focus is on the most life-threatening ones; required.
Issues in Emergency Nursing Care
Emergency nursing is demanding because of the diversity of conditions and situations that, if not unique to the ED, certainly present a challenge . These issues include :
- Legal issues
- Occupational health and safety risks for ED staff
- Challenge of providing holistic care in the context of a fast- paced,
- Technology-driven environment in which serious illness and death are confronted on a daily basis.
- Another dimension of emergency nursing is nursing in disasters. With the increasing use of weapons of terror, the emergency nurse must expand his or her knowledge including caring for victims of terrorism.
Limiting Exposure to Health Risks
Because of the increasing numbers of people infected with hepatitis B and with human immunodeficiency virus (HIV), health care providers are at an increased risk for exposure to communicable diseases through blood or other body fluids. This risk is further compounded in the ED because of the common use of invasive treatments in addition to the wide range of patient conditions.
All emergency health care providers should adhere strictly to standard precautions for minimizing exposure
Family-Focused Interventions
The family is kept informed about where the patient is, how he or she is doing, and the care that is being given.
Allowing the family to stay with the patient, when possible, also helps allay their anxieties. Additional interventions are based on the assessment of the stage of crisis that the family is experiencing. Measures to help family members cope with sudden death
Anxiety and Denial:
During these stages, family members are encouraged to recognize and talk about their feelings of anxiety.
Asking questions is encouraged. Honest answers given at the level of the family’s understanding must be provided. Although denial is an ego-defense mechanism that protects one from recognizing painful and disturbing aspects of reality, prolonged denial is not
encouraged or supported. The family must be prepared for the reality of what has happened and what may come.
Remorse and Guilt :
Expressions of remorse and guilt may be heard, with family members accusing themselves (or each other)
of negligence or minor omissions. Family members are urged to verbalize their feelings until they realize that there was probably
little that they could have done to prevent the injury or illness.
Anger :
Expressions of anger, common in crisis situations, are away of handling anxiety and fear. Anger is frequently directed at the patient, but it is also often expressed toward the physician, the
nurse, or admitting personnel. The therapeutic approach is to allow the anger to be ventilated, then assist the family to identify their feelings of frustration.
Grief:
Grief is a complex emotional response to anticipated or actual loss. The key nursing intervention is to help family member work through their grief and to support their coping mechanisms letting them know that it is normal and acceptable for them to cry, feel pain, and express loss. The hospital chaplain and social services staff both serve as invaluable members of the team when assisting families to work through their grief
TRIAGE
The word triage comes from the French word trier, meaning “to
sort.” In the daily routine of the ED, triage is used to sort patients
into groups based on the severity of their health problems and the
immediacy with which these problems must be treated. Triage is an advanced skill
A basic and widely used system uses three categories: emergent, urgent, and non-urgent (Berner, 2001)
Emergent patients have the highest priority life threatening condition , and they must be seen immediately.
Urgent patients have serious health problems, but not immediately life threatening ones; they must be seen within 1 hour.
Non-urgent patients have episodic illnesses that can be addressed with 24 hours without increased morbidity (Berner, 2001).
A fourth, increasingly used class is “fast-track.” These patients require simple first aid or basic primary care. They may be treated in the ED or safely referred to a clinic or physician’s office.
Protocols may be followed to initiate laboratory or x-ray studies from the triage area while the patient waits for a bed in the ED.
Also, nurses in the triage area collect crucial initial data: vital signs and history, neurological assessment findings, and diagnostic data if necessary.
The ED staff work collaboratively and follow the ABCD (airway, breathing, circulation, disability) method:
• Establish a patent airway.
• Provide adequate ventilation, employing resuscitation measures when necessary. (Trauma patients must have the cervical spine protected and chest injuries assessed first.)
• Evaluate and restore cardiac output by controlling hemorrhage, preventing and treating shock, and maintaining or restoring effective circulation.