INTRODUCTION TO EMERGENCY NURSING

GENERAL INFORMATION

• Emergency nursing deals with human responses to any trauma or sudden illness that requires immediate intervention to prevent imminent severe damage or death
• Care is provided in any setting to persons of all ages with actual or perceived alterations in physical or emotional health.
• Initially, patients may not have a medical diagnosis.
• Care is episodic when patients return frequently, primary when it is the initial option for health or preventive care, or acute when patients need immediate and additional interventions.
• Emergency nursing is a specialty area of the nursing profession like no other.
• Emergency nurses must be ready to treat a wide variety of illnesses or injury situations, ranging from a sore throat to a heart attack.

HISTORICAL DEVELOPMENT OF EMERGENCY NURSING

• Florence Nightingale was the first emergency nurse, providing care to the wounded in the Crimean War in 1854.
• The Emergency Department Nurses Association (EDNA) was organized in 1970
• A competency-based examination, first administered in 1980, provides Certification in Emergency Nursing; certification is valid for 4 years
• EDNA developed Standards of Emergency Nursing Practice, published in 1983, to be used as a guideline for excellence and outcome criteria against which performance is measured and evaluated.
• In 1985, the Association name was changed to Emergency Nurses Association (ENA), recognizing the practice of emergency nursing as role-specific rather than site- specific.
• Originally, ENA aimed at teaching and networking, the organization has evolved into an authority, advocate, lobbyist, and voice for emergency nursing. It has 30,000+ members and continues to grow, with members representing over 32 countries around the world.

CONCEPT OF EMERGENCY NURSING

• The term emergency is used for those patients who require immediate action to prevent further deteriorations or stabilizing the condition until the availability of the services close to the patients.
• “Emergency has been defined as a condition determined clinically or considered by the patient or his/her relatives as requiring urgent medical services, failing which, it could result in loss of life or limb”.-WHO
• Medical emergency is a situation when patient requires urgent & high quality medical care to prevent loss of life or limb and/or to initiate action for the restoration of normal healthy life.
• Emergency care can be defined as the episodic and crisis-oriented care provided to patients with conditions ranging from minor to serious or life-threatening injuries or illnesses.
• Emergency management traditionally refers to urgent and critical care needs; however, the ED has increasingly been used for non-urgent problems, and emergency management has broadened to include the concept that an emergency is whatever the patient or family considers it to be
• Emergency nursing is a specialty within the field of professional nursing focusing on the care of patients with medical emergencies, that is, those who require prompt medical attention to avoid long-term disability or death.

PRINCIPLES OF EMERGENCY NURSING

Principles of Emergency Nursing includes –

1.       Guiding principles for emergency care

• Quick assessment of the casualty and situation to institute life saving measures.
• Keep casualty in dorsal position and cover his/her body with whatever cloth is available to prevent heat loss.
• Avoid unnecessary handling except to remove the victim from additional danger.
• Give first aid to the injured part.
• Observed and keep a medical record of the casualty’s initial condition till he reaches the hospital.
• Reassurance should be given to the victim and relatives that he/she is in safe hands.
• Prevent people crowding near the victim; allow fresh air to circulate around the victim.
• Do not give water to drink to the victims with abdominal injuries may requiring immediate surgery.
• Make arrangements for safe transportation to hospital after first aid.
• In few emergencies like unconsciousness, uncontrollable bleeding, respiratory difficulties etc., require coordinated efforts for speedy transportation for medical facilities with simultaneous lifesaving appropriate care is important.

2.       Principles of emergency management

• Maintain patent airway & provide adequate ventilation employing resuscitation measures when necessary
• Control hemorrhage & its consequences
• Evaluate and restore cardiac output
• Prevent and treat shock, maintain or restore effective circulation
• Carry out a rapid initial and ongoing physical examination
• Assess the patient consciousness, whether the patient can follow commands or not, evaluate the size & reactivity of pupils.
• Start ECG monitoring if appropriate
• Apply Splint of suspected fractures sites including cervical spines in patients with head injuries
• Protect wounds with sterile dressings
• Start a flow sheet of patient’s vital sign, neurological state, to guide in decision-making.

SCOPE AND PRACTICE OF EMERGENCY NURSING

• The emergency nurse has had special training, education, experience, and expertise in assessing and identifying health care problems in emergency & crisis situations.
• The emergency nurse establishes priorities, monitors and continuously assesses acutely ill and injured patients, supports and attends to families, supervises allied health personnel, and teach the patients and families within a time-limited, high-pressured care environment.
• Nursing interventions are accomplished interdependently in consultation with or under the direction of a licensed physician.
• Appropriate nursing and medical interventions are anticipated based on assessment data.
• 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.

EMERGENCY NURSES

• Emergency nurses also deal with non­-emergent populations that present with non-life threatening issues as well. Patients that present to the Emergency Department may range from birth to geriatric.

Qualities of Emergency Nurse

• The Nurses working in Emergency or trauma units must have specialized skills in handling emergencies. Some of these skills are:
• Observation and assessment skills
• Quick decision making skills
• Patient care skills in emergency situations.
• Emotional stability
• Self-confidence with ability to lead and control the patients as well as attendants.
• Recording and reporting skills.

Roles of the Emergency Nurse

• Care provider: provides comprehensive direct care to the patient and family.
• Educator: provides patient and family with education based on their learning needs and the severity of the situation and allows the patient to assume more responsibility for meeting health care needs
• Manager: coordinates activities of others in the multidisciplinary team to achieve the specific goal of providing emergency care
• Advocate: ensures protection of the patient’s rights

Functions of the Emergency Nurse

• Uses triage to determine priorities based on assessment and anticipation of the patient’s needs
• Provides direct measures to resuscitate, if necessary
• Provides preliminary care before the patient is transferred to the primary care area
• Provides health education to the patient and family
• Supervises patient care and ancillary personnel
• Provides support and protection for the patient and family

Qualifications of an Emergency Nurse

• An emergency nurse is a registered nurse with specialized education and experience in caring for emergency patients.
• Emergency nurses continually update their education to stay informed of the latest trends, issues, and procedures in medicine today.
• Many take a special examination that proves their level of knowledge. After successful completion of this exam, they are certified in emergency nursing.
• Some emergency nurses also acquire additional certifications in the areas of trauma nursing, pediatric nursing, nurse practitioner, and various areas of injury prevention
• Many emergency nurses acquire additional certifications in the areas of trauma nursing, pediatric nursing, nurse practitioner, and various areas of injury prevention