Emergency Nursing Concept PDF

EMERGENCY NURSING CONCEPT INTRODUCTION AMIE S. PEREZ, RN CLINICAL INSTRUCTOR  OBJECTIVES At the end of this lecture, you will be able to: Define emergency and it’s different types Define emergency nursing and it’s goals. Identify the different members of the ER team. Describe emergen...

EMERGENCY NURSING CONCEPT INTRODUCTION AMIE S. PEREZ, RN CLINICAL INSTRUCTOR  OBJECTIVES At the end of this lecture, you will be able to: Define emergency and it’s different types Define emergency nursing and it’s goals. Identify the different members of the ER team. Describe emergency nurse and it’s functions. Enumerate the general principles of emergency management and care rendered to emergency patients. Recognize the different issues in emergency nursing care and ways to help family cope on sudden death. EMERGENCY  A sudden, urgent, usually unforeseen occurrence requiring immediate action ( Dorland’s Medical Dictionary).  Medical or surgical condition requiring immediate or timely to prevent permanent disability or death.  https://youtu.be/QvB4dyx-rVk EMERGENCY  Care given to patient with urgent and critical needs  A condition is still considered an emergency situation until it is stable or no longer threatened the client’s integrity or well being.  TYPES OF EMERGENCIES 1 3 DANGER TO LIFE DANGER TO PROPERTY emergencies that can cause emergencies that do not threaten an immediate danger to the any people, but do threaten peoples' life of people involved. property. 2 4 DANGER TO HEALTH DANGER TO ENVIRONMENT not immediately threatening to life emergencies that do not immediately might have serious implications for endanger life, health or property, but the continued health and well-being do affect the natural environment and of a person creatures living within it. EMERGENCIES ARE DIVIDED INTO 2 GROUPS MEDICAL TRAUMATIC EMERGENCIES EMERGENCIES All acute psychological Physiological crises that crises that are NOT directly are directly caused by an cause by traumatic impact impact to the body and to the body. generally requires surgical intervention.  EMERGENCY NURSING  A nursing specialty in which nurses care for patients in the emergency or critical phase of their illness or injury.  Skilled in dealing with people in the phase when a diagnosis has not yet been made and the cause of the problem is not known.  Patients may range from birth to geriatric THE FOUR UNIVERSAL GOALS OF EMERGENCY NURSING CARE PROVIDER EDUCATOR MANAGER ADVOCATE  GOALS OF EMERGENCY NURSING 1 2 3 4 To establish a To achieve a level of To enable the To ensure the partnership with the independence in the individual to avoid ill- maximum patient/relatives. patient appropriate health or injury effectiveness of to the illness or through self-care, nursing and medically injury health education, and prescribed treatment environmental safety is observed. SCOPE AND PRACTICE OF EMERGENCY NURSING 1 2 Assessment, analysis, nursing diagnosis, Care that is complicated by the planning, implementation of interventions, limited access to medical history outcome identification, and evaluation of human and the episodic nature of the responses of individuals in all age groups health care. 3 4 Triage and prioritization Emergency operations preparedness  EMERGENCY ROOM TEAM 1 2 3 EMERGENCY TRIAGE TEAM ER RESIDENT RESPONSE TEAM DOCTORS 4 5 ER NURSES NURSING ASSISTANT/ AIDE  OTHER PERSONNEL IN ER 1 2 3 ADMITTING STAFF POST GRADUATE MEDICAL/ INTERNS RESPIRATORY/ NURSING STUDENTS 4 5 RESPIRATORY MEDICAL THERAPIST TECHNOLOGIST/ RADIOLOGY TECHNICIAN  EMERGENCY NURSE FUNCTIONS: Establishes priorities Specialized education, training, Monitors and continuously experience, and expertise in assesses patients who are assessing and identifying acutely ill and injured patients’ health care problems in Supports and attends to crisis situations. families Supervises allied health Focused on giving timely care to personnel their patients Educates patients and families within a time-limited, high pressured care https://youtu.be/msUI-fSoJLQ environment. https://youtu.be/Gr18bvqWSW8 GENERAL PRINCIPLES OF EMERGENCY MANAGEMENT Remain calm and think before acting Identify oneself as a nurse to victim and by stander Do a rapid assessment for priority data ( ABC ) Carry out lifesaving measures as indicated by the priority assessment Do a head-to-toe assessment before initiating first aid measures. Obtain data from the patient ( secure consent) Avoid unnecessary handling or moving of victim, move only if danger is present Do not transport the victim until all first aid measures have been carried out and appropriate transportation is available.  EMERGENCY DEPARTMENT MAJOR GOALS: To preserve life To prevent deterioration before more definitive treatment can be given To restore the patient to useful living To determine the extent of injury or illness To establish priorities for the initiation of treatment DIFFERENT AREAS IN EMERGENCY DEPARTMENT Resuscitation Area Medical Area Pediatric Area Surgical Area OB- GYNE Area Minor OR OPD CARE OF EMERGENCY PATIENT ❖ Main Goal: Recognizing life-threatening illness or injury ❖ Priority: Initiating interventions to reverse or prevent a crisis before making a medical diagnosis. CARE OF EMERGENCY PATIENT ❖ This process begins with your first contact with a patient.  Prompt identification of patients who need immediate treatment and  Determining appropriate interventions are essential nurse competencies. POSITION STATEMENTS OF EMERGENCY NURSES ASSOCIATION ON DIFFERENT ISSUES ACCESS TO HEALTH CARE a. All individuals must have equitable access to comprehensive health care services b. All factors impeding access to quality health care must be removed c. The use of Emergency Departments for primary care and for non-urgent needs be alleviated by expanding primary and preventive health care services  ACCESS TO HEALTH CARE d. the lack of appropriately prepared nurses and nurse educators deepens health disparities, inflates costs, and exacerbates health care outcomes e. emergency nurses must be actively involved in research that contributes to equitable access to health promotion and critical, acute, and chronic health care; and f. emergency nurses must maintain ongoing continuing education to acquire and enhance knowledge and skills related to community and patient needs, institutional efficiencies, and other issues concerning equitable access to health care.  ADVANCED PRACTICE IN EMERGENCY NURSING ENA recognizes the contributions of clinical nurse specialists and nurse practitioners in emergency care settings. Advanced practice registered nurses have a broad depth of knowledge and expertise in their specialty area and manage complex clinical and systems issues.  ALL HAZARDS  All-hazards planning should begin at home.  Response to a mass casualty event should be organized and coordinated as to maximize the number of lives saved.  It is essential to integrate responding entities using a common framework applicable to all-hazards.  All-hazards planning include utilizing a coordinated community- wide plan that links local, state, regional, and national resources.  ALL HAZARDS  The active participation of emergency nurses in hospital and community-wide drills in preparing for, responding to, and recovering from all-hazards incidents is essential.  All-hazards planning must involve care of individuals across all age groups and diverse populations.  Volunteer responders should participate and deploy as a requested individual, group, or team  Situations arise during a disaster when it may become necessary to provide care using altered care standards and/or in an altered or less than ideal environment.  ALL HAZARDS  Development of basic and advanced continuing education courses and training is essential to prepare emergency nurses in the care and treatment of all- hazards patients.  Content of all-hazards disaster medicine and emergency response should be included in core curricula for emergency nurses and other health care professionals.  Emergency nurses should be involved in research related to disaster preparedness topics. HAZARDOUS MATERIAL EXPOSURE  A comprehensive and multidisciplinary approach shall be taken for the prevention of hazardous material exposure;  Efforts toward an all hazards approach to preparedness, mitigation, planning, and response of hazardous material exposure shall be undertaken;  The development of appropriate hazardous material exposure guidelines shall be based on evidence-based practice;  HAZARDOUS MATERIAL EXPOSURE  Emergency care personnel shall be prepared and knowledgeable regarding the recognition and management of patients exposed to or contaminated with hazardous material;  Emergency departments and their associated hospitals shall be prepared to receive and care for contaminated patients;  Emergency departments and their associated hospital’s staff shall use the appropriate personal protective equipment (PPE) for the management of hazardous material exposure;  Best practice is the regionalization and standardization of equipment, supplies, education, and hands-on training as it pertains to the care of contaminated patients;  PATIENT SATISFACTION IN THE EMERGENCY DEPARTMENT  The primary customers of the emergency department are patients, families, and significant others;  Respect for the diversity of patients, families, and significant others are inherent in emergency nursing practice;  PATIENT SATISFACTION IN THE EMERGENCY DEPARTMENT  The actions and interactions of the emergency nurse consistently demonstrate efforts to meet customers' needs for respect, dignity, and quality care;  The emergency department is a unique health care delivery system and that instruments to measure customer service, quality of care, and patient satisfaction must recognize that uniqueness  PATIENT SATISFACTION IN THE EMERGENCY DEPARTMENT  Standardized measurement and monitoring of customer service, quality of care, and patient satisfaction should be an on-going process within the emergency department and at the national level;  The dissemination of accurate information to the public about emergency department services is critical to the perceptions of patients and their families concerning the care they can expect to receive;  PATIENT SATISFACTION IN THE EMERGENCY DEPARTMENT  Continuing education on customer service may improve both patient and staff satisfaction with emergency department care delivery; and  Research is needed to measure patient outcomes related to the quality of care in emergency departments. ISSUES IN EMERGENCY NURSING CARE  ISSUES IN NURSING CARE ETHICO-MORAL ADVANCE DIRECTIVES - documents that indicate what is to be done for a patient in extreme who is no longer able to give or withhold permission for medical treatment - usually written to avoid prolonging an inevitable, often painful or non-sentient dying process.  ISSUES IN NURSING CARE DO NOT RESUSCITATE ORDER - a physician order in the hospital chart informing other medical personnel that they should not institute CPR in the event of cardiopulmonary arrest DUTY TO ACT - duty of a party to take necessary action to prevent harm to another party or the general public - breech of duty to act may make a party liable for damages depending on the circumstances and relationship between the parties CONSENT TO TREATMENT – THRU INFORMED CONSENT  Means that the client is knowledgeable of ALL treatments and procedures and AGREE to these before implementation.  Must be presented in language in cc the client understands the implications of any treatment.  By being informed : clients have the right to refuse any treatment or procedures  HOWEVER CONSENT IS VALID ONLY if client is of adult years and of sound MIND.  But Not all adults can give consent especially if HYPOXIC, INTOXICATED OR ALTERED LEVEL OF CONSCIOUSNESS.  EMERGENCY DOCTRINE  Emergency treatment can be provided under this doctrine  The client would have been able to consent to this IF ABLE because the alternative would have been death or disability.  This removes the need for obtaining informed consent before emergency treatment and care are initiated.  RIGHT TO PRIVACY AND CONFIDENTIALITY  not allowing unauthorized person into the hosp area  not disclosing private facts  MANDATORY REPORTING  Laws require hospitals, nurses and physicians as well to notify appropriate locale, state or agencies when incidents occur.  Ex. Communicable disease: meningitis, meningococcemia, food poisoning PHYSICAL EVIDENCE AND CHAIN CUSTODY  All evidences must be recorded during examination  Should be maintained in its natural condition.  PHYSICAL EVIDENCE AND CHAIN CUSTODY Examples:  Clothings – paper bag to prevent decomposition  Bullets – MD usually marks the bottom of the bullet and referred to the later during investigation or trial. They are placed in a sealed bag, labeled and given to proper authorities.  Gunshot wound- photograph and describe the wound  Specimen are obtained for legal purposes ( ex. Sexual assault victim- tested for alcohol level by proper person must be documented on his clinical records).  TRANSFER LAWS  Nurses should be aware of the hospital transfer policies, guidelines and protocols.  This is done because of lack of facilities or medical expertise  Stabilization, documentation and specific guidelines must be observed.  Receiving institution must accept the transfer  Transfer will not endanger the patient  Qualified personnel in attendance and proper medical equipment should be available REASONS FOR MEDICAL ERRORS 1. Poor training of healthcare staff 2. Patient overcrowding and doctor understaffing 3. Patient medical history is mystery to attending staff /personnel 4. Unsanitary or ill equipped facilities 5. Inefficient or effective record keeping policies 6. Unsafe or negligent medication distribution procedures  ISSUES IN NURSING CARE LEGAL ERRORS  Common Emergency Room Errors that have legal impact are the following: 1. Prescription drug errors or negligent administration of medication 2. Failure to thoroughly assess the patient 3. Performing procedures without securing consent to the patient or relatives  DOCUMENTATION AND PRIVACY  Patients should be provided with a statement of the privacy policy of the health care agency  Access to the medical record, both paper and electronic, are strictly held confidential as to provide privacy to the patient  ISSUES IN NURSING CARE CULTURAL  Sociocultural differences between patient and provider may result in miscommunication, distrust, poor treatment adherence, and worse outcome.  Improperly trained clinicians may resort to stereotyping and even biased or discriminatory treatment of patients based on race, ethnicity, culture, language proficiency, or social status.  ADDITIONAL ISSUES IN EMERGENCY NURSING CARE ISSUES IN EMERGENCY NURSING CARE Documentation of Limiting Exposure to Consent and Privacy Health Risks Violence in the Providing Holistic Emergency Care Department DOCUMENTATION OF CONSENT AND PRIVACY Consent to examine and treat the patient is part of the ED record. The patient needs to give consent for invasive procedures (e.g., angiography, lumbar puncture). Unconscious or in a critical condition and unable to make decisions – DOCUMENTATION DOCUMENTATION OF CONSENT AND PRIVACY THE NURSE MUST DOCUMENT: The patient’s is unconscious and brought to the ED without family or friends Monitoring patient’s condition All instituted treatments and the times at which they were performed Response to the treatment Condition at discharge or transfer About instructions given to the patient and family for follow-up care LIMITING EXPOSURE TO HEALTH RISKS This risk is further compounded in the ED because of the common use of invasive treatments in patients who may have a wide range of conditions and are unable to provide a comprehensive medical history. All emergency health care providers must adhere strictly to standard precautions for minimizing exposure Early identification and strict adherence is crucial. VIOLENCE IN THE EMERGENCY DEPARTMENT CAUSES: The effects of substance abuse, injury, or other emergencies. Emotionally volatile patient and families The environment of the ED, including being subjected to long wait times and crowded conditions, SAFETY IS THE FIRST PRIORITY. VIOLENCE IN THE EMERGENCY DEPARTMENT PHYSICAL THREATS ARE MOST OFTEN ACCOMPANIED BY VERBAL ABUSE, which is the most common type of violence A patient or family member may come to the ED armed To avoid angry confrontations, members of gangs and families who are feuding need to be separated in the ED  VIOLENCE IN THE EMERGENCY DEPARTMENT The Joint Commission has strict standards regarding documentation of the reason, monitoring for safety, and ensuring the dignity of the patient who is restrained (Solheim, 2016). Precautions to be taken to avoid injury include the following situations: For prisoners, the hand or ankle restraint (handcuff) is never released, and a guard is always present in the room. A mask can be placed on the patient to prevent spitting or biting. Non restraint techniques should be tried when possible—e.g., talking with the patient, minimizing environmental stimulation  VIOLENCE IN THE EMERGENCY DEPARTMENT Precautions to be taken to avoid injury include the following situations: Physical restraints are used on any patient who is violent only as needed and, if used, should be humanely and professionally given (ACEP, Distance should be maintained from the patient to avoid grabbing; Staff should not wear items that can be grabbed by the patient, such as dangling jewelry and stethoscopes. Furthermore, distance should be maintained between the patient and the door so that an escape route for the staff member is preserved.  VIOLENCE IN THE EMERGENCY DEPARTMENT Precautions to be taken to avoid injury include the following situations: Objects should not be left within patient reach; even an intravenous (IV) line spike can become a tool of violence if the patient is determined. Courses on safety (de-escalation and physical restraint techniques) assist the staff with preparing for various violent situations In the case of gunfire in the ED, self-protection is a priority. Security officers and police must gain control of the situation first, and then care is provided to the injured PROVIDING HOLISTIC CARE Patients and families are overwhelmed by anxiety because they have not had time to adapt to the crisis They experience real and terrifying fear of death, mutilation, immobilization, and other assaults on their personal identity and body integrity. When confronted with trauma, severe disfigurement, severe illness, or sudden death, the family experiences several stages of crisis.  PROVIDING HOLISTIC CARE The initial goal for the patient and family is anxiety reduction, a prerequisite to effective and appropriate coping. SAFETY is of prime importance. Close observation and preplanning are essential Security personnel are stationed nearby in the event that a patient or family member responds to stress with physical violence.  Assessment of the patient and family’s PROVIDING psychological function includes evaluating HOLISTIC CARE emotional expression, degree of anxiety, and cognitive functioning Possible nursing diagnoses include: Anxiety or death anxiety related to uncertain potential outcomes of the illness or trauma Ineffective coping related to acute situational crisis Possible nursing diagnoses for the family include: Grieving Interrupted family processes Compromised or disabled family coping related to acute situational crisis TWO TYPES OF INTERVENTIONS IN ER PATIENT- FAMILY- FOCUSED FOCUSED INTERVENTION INTERVENTION  PATIENT-FOCUSED INTERVENTION Act confidently and competently to relieve anxiety and promote a sense of security. Explanations should be given that the patient can understand. Human contact and reassuring words reduce the panic of the person who is severely injured or ill and aid in dispelling fear of the unknown The patient who is unconscious should be treated as if conscious  PATIENT-FOCUSED INTERVENTION Ensuring patient safety is a major focus in clinical practice settings. Some of the most common sentinel event in the ED include delays to care and medication errors Common root causes for these sentinel events revolve around:  nurse staffing patterns  patient volume  specialty availability.  PATIENT-FOCUSED INTERVENTION Solutions to patient safety issues in the ED include: ensuring optimal nurse staffing, pharmacy presence, rapid diagnostics turnaround times  to minimize wait time to diagnosis and fostering teamwork and support by leadership  FAMILY-FOCUSED INTERVENTION The family is kept informed about where the patient is, how he or she is doing, and the care that is being given. Encouraging family members to stay with the patient, when possible, also helps allay their anxieties. HELPING FAMILY MEMBERS COPE WITH SUDDEN DEATH 1 2 3 Take the family to a Talk to the family together Reassure the family that private place. so that they can grieve everything possible was together and hear the done; inform them of the information given together treatment rendered. 4 5 6 7 Avoid using Encourage family Avoid giving Encourage the euphemisms members to support each sedation to family family to view the such as ―passed other and to express members. body if they wish. on.‖ emotions freely HELPING FAMILY MEMBERS COPE WITH SUDDEN DEATH 8 9 10 Spend time with the Allow family members to Avoid volunteering family, listening to talk about the deceased unnecessary information them and identifying and what he or she meant any needs that they to them may have for which the nursing staff can be Encourage the family to helpful.. talk about events preceding admission to the emergency department.  https://youtu.be/lcB2wLjAkA4 THANK YOU! Do you have any questions? [email protected] 09778900067 FB: Ae Mii Perez CREDITS: This presentation template was created by Slidesgo, incluiding icons by Flaticon, and infographics & images by Freepik. Please, keep this slide for attribution.