Transcription
The demand for emergency care in the United States is growing rapidly. Emergency departments function as safety nets for communities of all sizes by providing services to both insured and uninsured patients seeking medical care. They are also responsible for public health surveillance and emergency disaster preparedness.
This is part one of a four-part lesson. After this lesson, you will be able to identify the roles and responsibilities of the healthcare team in an emergency, prioritize resuscitation interventions based on the primary survey of the injured patient, and prevent or reduce common risk factors in an emergency that contribute to adverse events.
So, who goes to the ER? Well, everyone does. In the emergency care environment, rapid change is the rule. The typical emergency department is fast-paced, and at the height of activity, might even appear chaotic. Patients seek treatment for a number of physical, psychological, spiritual, and social reasons.
The emergency nurse is one member of the large interdisciplinary team who provides care for patients in the emergency room. A collaborative team approach to emergency care is considered a standard of practice in this setting. The nurse coordinates care with all levels of healthcare team providers, from pre-hospital emergency medical services personnel to physicians, hospital technicians, and professional and ancillary staff.
In the emergency department setting, staff and patient safety are major concerns. Chart 10-1, page 124 of your textbook, provides a few examples for best safety practices. Staff safety concerns center on the potential for transmission of disease and on personal safety when dealing with aggressive, agitated, or violent patients and visitors. The emergency nurse uses standard precautions at all times.
In addition to concerns about staff safety, there are also patient safety guidelines. The most common patient safety issues are patient fall risk, skin breakdown, and high risk for medical errors and adverse events. Hospital emergency rooms have unique factors that can affect patient safety. These factors include the provision of complex emergency care, constant interruptions, and the need to interact with the many providers involved in caring for one patient.
The scope of emergency nursing practice encompasses management of patients across the lifespan, from birth through death, all health conditions that prompt a person of any age to seek emergency care. Emergency nursing practice requires that nurses be skilled in patient assessment, priority setting, multitasking, clinical decision-making, clear communication, solid knowledge base, flexibility, and adaptability.
The waiting room never empties. Work is never caught up. Sometimes there is a lack of bed space. It is very difficult to maintain privacy, which makes it difficult to protect confidentiality. Sometimes they have to use hall beds, which makes it difficult to protect dignity, and at times there are issues with language barriers.
Triaging patients is the process of sorting and classifying patients into priority levels based on their complaints. Emergent is a life- or limb-threatening. Some examples could be respiratory distress, chest pain with diaphoresis, active hemorrhage, or unstable vital signs. Another level would be urgent. The patient needs to be seen quickly, but they're not life-threatening. Examples could be severe abdominal pain, renal colic, displaced or multiple fractures, complex or multiple soft tissue injuries, or new onset respiratory infection, especially pneumonia in older adults. Then we have the non-urgent cases. Patients can wait a few hours to be seen. Some examples are skin rash, strains and sprains, a so-called cold, or just simple fractures.
There are other models used to triage patients. Such models as the Emergency Severity Index or the Canadian Triage Acuity Scale. Regardless of the model used, triage nurses must use a systematic approach, apply solid clinical decision-making skills, and maintain a caring ethic. Be careful of fatigue and burnout. This can lead to jaded and biased preconceptions. They can reflect in your decisions of choosing the appropriate level during triage. It can also hinder your care. Remember to stay objective and compassionate. What if you are coming to the emergency room? Remember, how would you want to be treated?
So, what are we going to do with the ER patient? At the conclusion of the assessment, the physician must make a decision regarding patient disposition. Should the patient be admitted to the hospital, transferred, or be discharged to home? Generally, this decision is made based upon the nurse's initial assessment, the physician's assessment, and any diagnostic reports that were completed. I think for most of the patient's safety, be sure to include adequate patient education if needed. Contact caseworkers for the patient's if you expect the patient should need resources upon discharge.
This concludes part 1 of this lesson. If you have any questions related to the lesson content, contact the instructor.