Learning Plan - Emergency Nursing Practice - Assignment Example

Introduction An emergency nurse, if appropriately educated and knowledgeable may shed the workload in an emergency department very effectively being quite able to provide safe medical care to the patients attending emergency departments. This speacility of nursing is related to episodic and crisis oriented care provided to the patients with serious, potentially life-threatening injuries or illnesses where there are many unknown variables and potentially unpredictable situations (Sbaih, 2001). It is true that many a cases presenting in to the emergency department may be beyond the skill realm of an emergency nurse, and these cases would eventually need intervention of a trained emergency physician, but nurses in these scenarios may at least draw the attention of the doctors the earliest. On the other hand, many patients presenting in to the emergency department may not have that serious a clinical situation. However, an emergency nurse should be equipped with knowledge, expertise, learning, and clinical skills to handle these alone at her level. Type of patients in the emergency department There are several varieties of patients that may attend emergency department seeking care. Of these certain categories of patients may need immediate nursing or physician care since they may be potentially life-threatening. These include airway compromise, cardiac arrest, severe hemodynamic shock or compromise, injury or cases of multiple trauma, or altered level of consciousness. Certain other cases are also emergent, but may wait for some time. These are patients sustaining head injuries, severe trauma, lethargy or agitation, conscious overdose, severe allergic reaction, chest pain, chemical exposure to the eyes, severe back pain, gastrointestinal bleeding with unstable vital signs, cerebrovascular accidents with deficits, severe asthma, abdominal pain, vomiting and diarrhea with dehydration, acute psychotic episodes, fever in children, severe headache, severe acute pain of any origin, neonatal diseases, or sexual assault (Fry, 2008). Nurses may encounter cases of head injury presenting in an alert state but with vomiting, mild to moderate asthma, moderate trauma, cases of abuse or neglect, GI bleeding with stable vital signs, and patients with history of seizure who are alert on presentation. Many other conditions are trivial, which can be really very efficiently treated by the emergency nurses, and these include alert head injury without vomiting, minor trauma, vomiting or diarrhea without dehydration, earache, minor allergic reactions, foreign body in the cornea, and chronic back pain. There may also be cases of sore throat, cases with minor symptoms, or chronic abdominal pain (Schriver et al., 2003). Anticipated Nursing Role To be able to deliver competent care, being a registered nurse, the emergency nurse must be able to assess, plan, implement, and evaluate nursing care alone or in collaboration with the emergency physician in order to achieve the goals of care and health outcomes in such patients. This must be either independent or interdependent care delivery within the framework of accountability and responsibility (Hageness et al., 2002; ANMC, 2004). Where possible, according to competency standards, the emergency nurse would also deliver education in order to promote and maintain health with a preventative approach. The nurse would demonstrate critical thinking and analytic abilities for care decision making and would demonstrate satisfactory knowledge base. She would be able to appraise her own knowledge and learning in order to engage in professional development through a pathway of evidence-based care (ANMC, 2004). From this angle, an emergency nurse has certain roles while delivering care to a patient presenting into the emergency department. The initial action is assessment, and a systematic and methodical assessment process through primary and secondary surveys enable the nurse to identify and prioritize the needs of such patients. The primary assessment consists of a rapid assessment of airway, breathing, circulation, and neurologic disabilities, mainly in order to diagnose preliminarily any life-threatening problem (Rowe, 1994). If a life-threatening condition is anticipated, an interdependent care method is necessary, and the nurse can draw attention of the doctor. In the secondary survey, the nurse must expose the patient and obtain a full set of vital signs. Some patients at this stage would need a pulse oximetry, urinary catheter, or a gastric tube. At this stage, depending on indications and protocol in the department, the nurse may go ahead to draw some preliminary laboratory tests. From the nursing point of view, it is important to assess the family's needs and concerns (Everson, 2005). Nurses are instrumental in providing comfort measures, which may include verbal reassurances and adequate pain management. It is to be remembered that family member may serve as important sources of information regarding the history including medications and other relevant past illnesses which may help the nurse to reach a diagnosis which may help to identify the seriousness of the case. This is important since in many cases, the nurse will need help as soon as possible. She will have to assist with transfer and further assessment of the patient. In specific examination she will undertake a methodical examination of all the systems and record all findings (Castner, 2008). Self-assessment I have evaluated my situation and my learning on the backdrop of my placement as an emergency nurse in the real clinical situation. I had been previously trained in my placements in medical and surgical units. From that experience, I know the basic background pathophysiology of these conditions. As a result, it was easier for me to understand the importance of a physical examination in such patients (Sullivan, 1989). Moreover, from my academic knowledge, it was easier for me to anticipate the consequences of delay in diagnosis and delivery of care in these patients. My other strength was my ability to understand the concerns of the family and the patients. I could understand and accept the basic anxieties of an acute patient. I was fully aware of the patients’ fear of death, mutilation, isolation, and suffering (Mortensen, 2004). Although I was inexperienced in emergency nursing practice and was feeling awkward about doing a nursing assessment due to lack of experience, I think my strength was skills of communication, which is very important in the emergency department. Gaps in Knowledge However, I must admit that my experience in traumatology, respiratory medicine, neuromedicine, and cardiology was inadequate. I was feeling always nervous whether I would miss any serious organ damage in a trauma patient. A detailed neurological examination would be necessary in assessing a patient of stroke, and I would often fail to do that confidently (Marett, 2000). In patients with cardiac presentation, interpretation of findings from cardiac examination and ability to do a cardiopulmonary resuscitation would always be necessary, and I realized I needed a little more practice to do that (Marett, 2000). Learning Needs Need to know in detail neurological examination and interpretation Need to acquire the skills of clinical examination and assessment of the patients presenting in to the emergency department specially patients with transient ischaemic attack (TIA) or cerebrovascular accident (CVA) Relationship with Graduate Qualities The nurse must fulfill duty of care. The competency standards indicate that the nurse must perform nursing interventions in accordance with recognised standards of practice. If my clinical knowledge is deficient, my assessment may be wrong, and there is a high probability that I may cause harm to the patient (Lyneham et al., 2008). I should be able to recognise that I have responsibility to prevent harm. Moreover, the nursing interventions provided by me must be through comprehensive and accurate assessment. If my clinical skills and knowledge is deficient in some areas, there is a high probability that the interventions would be inaccurate. Moreover, I must maintain a current knowledge base. Learning Objective To develop an understanding of the skills of assessment of the patients who presented to the Emergency Department with transient ischaemic attack (TIA) or cerebrovascular accident (CVA) and to develop a fact sheet for undergraduate nursing students before the final submission date. Resources Current academic text books will be utilised to form the baseline knowledge. Apart from that, I will use nursing manuals, guidelines, and electronic journal resources. These serve as important sources of evidence that needs to be utilised through methodical review of them. This could be accomplished through evidence gleaned from current nursing literature on emergency nursing (Keough et al., 2003). The school library may serve as a good source, and I decided to use internet based and printed journal articles to draw evidence for practice. In my view, there would still be some gaps, which must be filled through discussion with the doctors in the emergency department or other specialists who might attend the patient. I also decided to follow the patients who may cross my shift or may be admitted to the hospital following triage by me (Jagim, 2001). Conclusion Emergency nursing practice is currently being shaped by advance knowledge in emergency assessment, advanced resuscitation, advent of technology, recognition that emergency nursing is a speciality practice. Some other factors such as growing client expectations, increased patient load, and changing case mix, combined together has made emergency nursing practice a difficult task. Added to this, the need to maintain the competency standards can be interpreted as the need on the part of these nurses to remain updated in knowledge and clinical skills. This assignment suggests that these nurses must evaluate their knowledge and update them on a regular basis, and self-examination is the best method to accomplish this. Reference List ANMC (2004) Competency Standard. ANMC. Castner, J., (2008). Emergency nursing decisions: a proposed system of nursing diagnosis. J Emerg Nurs; 34(1): 33-6. Everson, F., (2005). Regional emergency nursing program: how one region solved its needs for more efficient orientation education. J Emerg Nurs; 31(4): 398-9. Fry, M., (2008). Overview of emergency nursing in Australasia. Int Emerg Nurs; 16(4): 280-6. Hageness, SM., Kreitzer, MJ., and Kinney, ME., (2002). Complementary, integrative, and holistic care in emergency nursing. Nurs Clin North Am; 37(1): 123-33, viii. Jagim, M., (2001). Emergency nursing around the world. J Emerg Nurs; 27(5): 413-4 Keough, VA., Schlomer, RS., and Bollenberg, BW., (2003). Serendipitous findings from an Illinois ED nursing educational survey reflect a crisis in emergency nursing. J Emerg Nurs; 29(1): 17-22. Lyneham, J., Parkinson, C., and Denholm, C., (2008). Intuition in emergency nursing: a phenomenological study. Int J Nurs Pract; 14(2): 101-8. Marett, BE., (2000). Emergency nursing: promises to keep! J Emerg Nurs; 26(6): 531-4. Marett, BE., (2000). Emergency nursing in perspective: mentoring, sharing, supporting. J Emerg Nurs; 26(5): 401-2. Mortensen, S., (2004). Emergency nursing: ailing or closing in on the cure? Axone; 25(3): 4-8.Proehl, JA., (2002). Developing emergency nursing competence. Nurs Clin North Am; 37(1): 89-96, vii. Rowe, JA., (1994). Emergency nursing assessment and notes. J Emerg Nurs; 20(2): 138-42. Sbaih, LC., (2001). Shaping the future: reforming routine emergency nursing work. Accid Emerg Nurs; 9(4): 266-73. Schriver, JA., Talmadge, R., Chuong, R., and Hedges, JR., (2003). Emergency nursing: historical, current, and future roles. J Emerg Nurs; 29(5): 431-9. Sullivan, R., (1989). Triage: a subspecialty of emergency nursing. Emphasis Nurs; 3(2): 26-33. Read More