Discuss how community nurses can contribute to the alleviation of the A&E crisis.
Carolyn and Clarke state in a DoHC report (2001b) that “all nurses have a contribution tomake to public health”. The purpose of this essay is to examine
how the nursing profession
can help in alleviating the A&E “crisis”
through public health and as members of primarycare teams. In order to achieve this, I will first look at government publications on the A&E
“crisis”. I will examine the causes of the “crisis” in light of the publications and the
ions required to improve the conditions of Irish waiting times in A&E‟s.
Furthermore, I will look government publications specific to the nursing role in public healthalongside research and publications on the subject. Using this I will directly look at methodsthat are been taken and can be taken by the nursing profession to improvement thefunctioning of a primary care team and moving health into a more community level thus
aiding to improve the A&E “crisis”.
The A&E “crisis” has been subject to numerous
discussions and publications outlining areas
in need of attention and methods which will alleviate this “crisis”.
The Department of Healthand Children (DoHC) (2002) stated that
hospital services cannot be evaluated in isolationfrom primary care, community services and specialist care services
. The Department of Health and Children (DoHC) (2001a), recommend that a primary care teams should include
GP‟s, nurses/midwife‟s, occupational therapists,
social workers, physiotherapists, health careassistants and home help.Although primary care has been seen as a way forward in upgrading of the Irish healthservice, much emphasis has been placed on how it can aid in the alleviation of the A&E
“crisis”. In 2005 the
Health Service Executive (HSE) published the A&E Mapping and
Efficiency Review Report. The report stated that they “did not find evidence of an A&E„crisis‟ [but]... dysfunctions and bottlenecks within the wider health system and th
environment as a whole”
. The report showed that numerous actions needed to be taken toease the strain placed
on A&E‟s. The DoHC‟s A&E Ten Point Plan
(2004) as cited by theHSE (2005) identified ten
which should be changed or improved. These included newminor injury, chest pain and respiratory clinics to which a GP can refer a patient to ratherthan to A&E, increasing MRI units, Acute Medical Units and nursing home places for highdependency units, expand home care packages, palliative care and GP out of hours service(however, the
HSE (2007) showed that there is no evidence of G.P.‟s reducing the waitingtimes in A&E‟s as between their working hours i.e. 8am
-8pm is the highest number of self referrals) and improving the security and cleaning of the A&E Department.This was then further discussed by the HSE (2006) when they looked at the need for ensuringpatients is admitted in 24 hours. It also recommended that no more than 10 patients should bewaiting at any one time. It reiterates the need for admission lounges and GP access todiagnostics along with more hours for radiographers and also the need for communityintervention teams and primary care management of chronic illnesses such as asthma anddiabetes
. The briefing states that “
Admission to hospitals can be avoided where flexible caresupports are available on a timely basis to people experiencing a care crisis or a relatively
This illustrates the strong need for a primary care team in the communityand also how it improves the efficiency of the A&E Department.While the report showed that the number waiting on beds in A&E Departments can bereduced through the use of care at a primary level in the community,DoHC
2002) showedthat the number of beds in Ireland had reduced from 17,665 in 1980 to 11,832 in 2000. It also