SCHOOL OF NURSING AND ALLIED HEALTH SCIENCES

NBNS 1504 TRAUMA AND EMERGENCY NURSING SEPTEMBER 2013

Title: Critically discuss the Standards of Emergency Nursing Practice applicable in your workplace that supports the provision of effective and efficient care of clients requiring stabilization and/ or resuscitation for a variety of illnesses and injuries.

Name: MAIZATUL AKMAR BT IBRAHIM Matric number: 720618145398001 NRIC: 720618145398 Telephone number: 0123817871 E-mail address: akmar1972@yahoo.com

Tutors name: MISPAN BIN SAMIGON Learning Centre: JOHOR BAHRU MAY 2012 Semester

TABLES OF CONTENT 1.0 INTRODUCTION 1.1 Standard of Emergency Nursing Practice 2.0 EMERGENCY NURSES 2.1 Criterion based job description and performance evaluation 2.2 Policies and procedures 2.3 Standardized Care Plan 3.0 PROFESSIONAL DEVELOPMENT 3.1 Orientation and education programs 3.2 Performances improvement programs 3.3 Research projects 4.0 SUMMARY REFFERENCES

PAGES 2 2-3 4 4-5 6 7-8 9 9 10 10 - 11 11 12

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1.0 INTRODUCTION The Emergency and Trauma Department is one of the entrances to the hospital that is truly different each and every day. It can shift quickly from being the quietest to the most hectic department in the hospital. Emergency nursing is the care of individuals of all ages who have perceived or actual physical or emotional alternations of health. Emergency nursing is sporadic and unpredictable. Unplanned situation and undiagnosed health problem require prompt and accurate assessment and interventions. Motor vehicle crashes, heart attacks, strokes, falls, and hundreds of other emergency situations can happen to anyone. Emergency nurses provide rapid assessment and treatment to patients in the initial phase of illness or trauma and often in lifethreatening situations that requires intervention ranging from minimal care to life support. Emergency nursing is multidimensional, therefore, requiring knowledge of various body system, disease processes and age groups common to other nursing specialties. Emergency nursing comprises three major components: Emergency nursing practice setting Standard of emergency nursing practice Emergency nursing environment

1.1 Standard of Emergency Nursing Practice The Standards of Emergency Nursing Practice are specialty standards that are intended for emergency nurses working in a variety of setting; emergency departments, prehospital and military settings, ambulatory care centers and clinic or other health environments providing emergency care. Standards are written values defining the performance of Emergency Nurses that is predetermined and acceptable to authority. The standards are one of the criteria for Emergency Nursing Practice and, are use to measure by which the public views nursing performances and to which nurses are held accountable. Standards enhance the accountability of the profession to the public by articulating, promoting and ensuring safe nursing for the public. The Standards of Emergency Nursing Practice consisted of the following: Criterion based job description and performances evaluation Policies and procedures
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Standardized care plan Orientation and education programs Performances improvement programs Research projects

Emergency nursing crosses all these specification and includes the provision of care that ranges from birth, death, injury prevention, womens health, disease, and life and limb-saving measures. Unique to emergency nursing practice is the application of the nursing process to patients of all ages requiring stabilization and/ or resuscitation for a variety of illnesses and injuries. The scope of Emergency Nursing includes: Triage and Prioritization Stabilization and resuscitation Assessment, diagnosis, planning and implementation of interventions where limited data may be available and evaluation of patient response. Provisions of care in uncontrolled and/ or unpredictable situations Crisis interventions to meet the needs of unique patient situation Emergency operation preparedness Education of the patient and community to facilitate attainment of an optimal level of wellness Wellness initiatives directed to patient and community, particularly related to disease and injury prevention

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2.0 EMERGENCY NURSES Emergency nurses provide professional nursing care to medically ill and traumatized patients of various criticalities use triage to determine the patients level of severity or priority. The nurses must be able to demonstrate the knowledge and skill necessary to provide care appropriate to the age of the patients served on her assigned unit. Emergency nurses must demonstrate knowledge of the principles of growth and development over the life span. They must possess the ability to assess data reflective of the patients status and interpret the appropriate information needed to identify each patients requirements relative to his or her agespecific needs. They must be able to provide the care needed as described in the departments policies and procedures.

2.1 Criterion based job description and performances evaluation Emergency nurses specialize in assessing, intervening and stabilizing a variety of trauma and illnesses with decisive action. Due to the range of medical conditions that may require urgent treatment and care, they must be knowledgeable about general as well as specific health issues. The most important responsibility for an emergency nurses is understanding triage, which is a method of prioritizing injuries based on medical need. An emergency nurse must have the ability to make quick and accurate assessments about incoming patients, including both physical and mental health conditions. Time management is crucial in this job. Along with triage, emergency nurses must quickly ascertain the information from incoming patients such as, identify the medical problem, document medical history, check for any allergies and current medications, and obtain height, weight, body temperature, heart rate and blood pressure of the patient. An emergency nurses provide direct and individualized nursing care to patients based on the application of scientific nursing principles. In addition to general nursing care, responsibilities of emergency nurses include: Collect current symptoms, as well as a detailed patient history and then consults and coordinates with health care team members to assess, plan, implement and evaluate patient care plans. Perform triage, while considering both physical and psychosocial elements.
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Manages basic life support needs and stabilizes patient until the attending physician is available, based upon nursing standard and protocols. Initiates corrective action whatever information from monitoring equipment show adverse symptomatology. Records patients current vital signs. Works directly under physicians, assisting them during examine patient, diagnostic testing and treatments. Prepare and administers orally, subcutaneously, through an intravenous, and records prescribed medications. Reports any adverse reactions to medications or treatments in accordance with the policy regarding the administration of medications by a licensed registered nurse.

Provide IV therapy Cleans and bandages wounds Provide basic, bedside care Maintains proper supplies and appropriate medical equipment to care for patients Reports any suspected abuse to appropriate agencies Initiates patient education plan, as prescribed by physician. Teaches patients and significant others how to manage their illness or injury, by explaining; post-treatment home care needs, diet/ nutrition/ exercise program, self-administration of medication and rehabilitation, as well as provides referrals to other healthcare professionals for follow-up treatment.

Display professionalism while completing multiple urgent tasks in timely manner Records all care information concisely, accurately and completely, in a timely manner, in the appropriate format and on the appropriate forms.

Emergency nurses collaborate with other professional disciplines to ensure effective patient care delivery and achievement of desired patient outcomes. Nurses effectively interact with patient and significant others, while maintaining the standard of professional nursing.

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2.2 Policies and Procedures Emergency Medicine and Trauma Service (EMTS) is seen as the frontline and a critical service of Ministry of Health (MOH). It is a specialty domain that offers clinical care to a wide range of acute medical infirmities, illness or injury. This involves the provision of emergency critical medical care that includes diagnostic, resuscitation and stabilization components and life saving interventions. The EMTS general scope includes pre-hospital and hospital-based medical care. It advocates client focused care, which is holistic and total in nature which inculcates a corporate culture value of caring, teamwork and professionalism. The construct and function of Emergency and Trauma Department is to discharge roles for the management of: Major trauma patients Pediatrics patients Mental health patients Survivors of victim of domestic violence and sexual assault Contagious patients Victims of chemical, biological or radiological incidents Individuals brought for medical care while under detention Extended observational medicine Pre-hospital care, transport and retrieval services

It is also expected that the Emergency and Trauma Department be in a state of readiness for the management of mass casualty or disaster victims. Objective of the Emergency Medicine and Trauma Service (EMTS) is: To provide a prompt, accurate and definitive emergency medicine and trauma care service. To provide an integrated and comprehensive care and this is seamless and continuous from the pre-hospital care setting through to the hospital service. To provide total quality management in all the critical management inters phases from pre-hospital care to triage service and sorting out to the various dedicated management zone namely: critical (red) zone, semi critical (yellow) zone and none critical (green) zone.
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To provide and efficient and effective resuscitation and stabilization together with an accurate diagnostic service and critical life saving intervention. The management of the critical patient shall be conducted by an efficient team of skillful personnel which include specialists, medical officers, assistant medical officers, staff nurses and other healthcare personnel.

2.3 Standardized Care Plan The emergency nurse demonstrates a concise and timely assessment of the undiagnosed patient. They must identify urgency of presenting symptoms relative to possible differential diagnosis, priorities care, assesses and triages for multiple patients simultaneously. Initiates appropriate timely nursing interventions and coordinates team response based on presenting history and clinical data. Evaluates relevant risk factors such as trauma, violence, age related when determining patient urgency. The emergency nurse should identifies deviation from the expected clinical course, conducts ongoing timely and do appropriate reassessment of the patient. The emergency nurses must incorporate assessment of the social dynamics of family into care of patient. The emergency nurse must triage every patient entering the Emergency and Trauma Department Service and determine priorities of care based on physical, psychosocial and spiritual need, as well as factors influencing patient flow through the system. Triage assessment shall include rapid, systematic collection of data related to the patients chief complaint . The patient is triaged according to the urgency of his or her presenting problem within the categories such as, resuscitative, emergent, urgent, less-urgent and non-urgent. Triage assessment shall be analyzed to determine acity, patient care area, any appropriate interventions based on triage protocol. The emergency nurse shall function independently within cope of practice established for professional nurse by provincial regulatory bodies such as, Malaysia Nurses Board. The emergency nurses should anticipate and instigates appropriate treatment and management strategies for multiple unstable or undiagnosed patients within a dynamic environment. Interpret assessment data to inform treatment and management priorities relevant to patients. Nursing intervention applied according to patient presentations to initiate treatment
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and management. The emergency nurses provide clinical support and expertise to interdisciplinary colleagues as necessary. Anticipates discharge or admission and collaborates to ensure efficient management while maintaining continuity of patient care. The emergency nurse evaluates patient progress against predicted outcomes. The emergency nurse demonstrated effective communication skills and interaction with health care team, patients and families use of appropriate communication strategies. They must provide a timely, comprehensive and appropriate handover of patients to continuing health care teams. The emergency nurses must ensure all patient data written in clear, concise and accurate. Consults with key health professionals to plan, deliver and evaluate care to a diverse patient population. Communicates appropriately to establish rapport and obtain a comprehensive patient and family assessment. The emergency nurses encourage family participation in patient care and management decisions. They should communicate using strategies such as active listening, paraphrasing and non-judgmental approaches in interacting with others. The emergency nurse collaborates with health care team members to provide effective and coordinated care. Teamwork appropriately can manage critical incidents and stressful situations. Allocates and delegates health care team members to team roles such as Trauma team, Disaster team and Resuscitation team. They provide feedback that acknowledges individual performance and fosters team cohesion in the workplace. Support staff with challenging family and personal needs, initiates grief support and crisis intervention when appropriate. The emergency nurses should recognize the potential for cumulative stress and its impact on staff health, well-being and work performance.

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3.0 PROFESSIONAL DEVELOPMENT The Standard of Emergency Nursing Practice provides a unique opportunity for the emergency nurse to serve as a focal point at the intersections of primary, secondary and tertiary care on the disease-wellness continuum. This collaborative role enables the emergency nurse to affect the process and outcomes of concerns such as bioethical issues, humanism, biopsychosocial and spiritual needs of patients, alternative care modalities in the nursesrole as patient advocate. The emergency nurse shall be competent and current, adherence to established Standards Emergency Practice, recognizes the need to develop and train new graduates in the skills and knowledge needed to become specialized as an emergency nurse. They must competence in Basic Cardiac Life Support (BLS) procedures, Advances Cardiac Life Support (ALCS) protocols and Pediatric Advanced Life Support (PALS) protocols.

3.1 Orientation and education programs A written orientation program shall be used to introduce new nurses to the relevant aspects of the facilities. Orientation shall be based on the function which the emergency nurse is expected to assume in the Emergency Setting such as, written policies and procedures, the physical set-up of the emergency facility and the utilization of all client care equipment, and documentation system. Knowledge of the roles and function of other emergency personnel as described according to legal statues, job description, policies and procedures, and knowledge of nursing procedures and psychomotor skill within the emergency situation. The emergency nurse shall facilitate learning experiences for members of the health care team and nursing students with participated in the orientation regarding policies, procedures, roles and responsibilities. The emergency nurse participated in the teaching and supervision of health care team members and nursing students during clinical practice. The emergency nurse should acts as a teacher, preceptor, mentor, and role model to the nursing students. The emergency nurse will participate in public education regarding the Emergency Care System and participate in the dissemination of health information as it is related to identify needs of the patient.

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3.2 Performances Improvement Programs The emergency nurse shall maintain their professional competence based on provincial governing bodies such as, Malaysian Nursing Board. The emergency nurse shall obtain progressive, ongoing education. Determines professional learning needs and identifies short and long-term education goals relevant to practice. They should plans and implements activities to achieve educational goals. The emergency nurse should shares newly gained knowledge from relevant educational programs with peers and colleagues and demonstrates enhanced clinical practice as a result of continuing education. The emergency nurses should have knowledge of and participates in professional group that impact on the practice of Emergency Nursing. The Emergency and Trauma Department shall define the level of knowledge, skills and training requirements for all its personnel. The emergency nurses should have access to appropriate educational programmed used the facilities such as Skill Labs to maintain and augment their professional competency. Their participation shall be documented. The nurses are required to participate in the Ministrys e-CPD programmed. The department shall facilitate staff to attend relevant educational programs conducted by professional group, societies and educational institutes. Equitable, just and nurturing system for recruitment, credentialing, performance management and staff retention are required in the Emergency and Trauma Department

3.3 Research Projects The Standard of Emergency Nursing Practice provides clinical practice that is evidencebased and informed by relevant research. The emergency nurses should have critique practice and use information from research literature to improve practice, possess an awareness of research in Emergency Nursing. Seeks out research relevant to emergency practice and engages in debate on subject matter within appropriate forum. The emergency nurses should participates in research that promote or enhances the speciality of emergency nursing and considers the impact of current research within the context of own workplace. They should participate in research that value adds to clinical outcomes for patients and disseminates result of practice

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improvement and research through conference presentations and publication of results in relevant journals. The emergency nurse shall collaborate with colleagues in other disciplines who are engaged in research the practice setting. They participate in and support interdisciplinary research and assist in identification of research subjects. The emergency nurse in leadership roles shall facilitate research in the practice setting when agency guidelines governing research have been fulfilled. They provide administrative support for research conducted in settings for which they are responsible and should include research activities as a component in performance evaluations. The emergency nurse shall adhere to ethics that govern research. They protect the subjects rights to privacy and confidentiality; protect the subjects rights to voluntary or informed consent without coercion. The emergency nurse should demonstrate knowledge of and participates in the mechanisms available to address violation of the rights.

4.0 SUMMARY Emergency Nursing is practiced in a unique environment which includes unplanned situation requiring intervention, the allocation of limited resources, and the need for emergent care as perceived by many patients arriving in an unscheduled manner, potentially creating a stressful, chaotic environment. The services provided by the emergency nurse must be directed and structured to maximize the available time, space and resources within which the nurse functions. They must utilize theoretical and practical knowledge in terms of pathophysiology, mechanism of injury, pharmacokinetics to determine evaluation criteria. Demonstrate continuing evaluation of patient responses to the effectiveness of interventions in accordance with evidence-based clinical guidelines. As with other health care professionals, emergency nurses are expected to comply with protocols, procedures and safety policies of a health care facility. Emotional stability, communication, leadership, sympathy and attention to detail are traits common among emergency nurses. Word: 2,892

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REFFERENCES 1. Carlson.S., (2010). Professional Practice: Standards of Emergency Nursing Practice (Online) Available: nena.ca/public/b/about/archive/2010/10/professional-practicestandards-of-emergency-nursing-practice.aspx (2013 Nov 3).

2. Manton.A., (2004). Emergency Nursing (Online) Available: www.nsna.org/Portals/o/Skins/NSNA/pdf/Imprint_Jan04_Manton.pdf (2013 Nov 3).

3. Medical Development Division. Ministry of Health Malaysia., (2012). EmergencyMedicine and Trauma Services Policy. National Library of Malaysia Cataloging in Publication Data

4. Practice Standards (for the Emergency Nursing Specialist)., (2007). (Online) Available: cena.org.au/CENA/Documents/Standards.pdf (2013 Nov 5)

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