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Emergency Nursing

Emergency Nursing

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Published by Swapnil Mahapure

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Published by: Swapnil Mahapure on Apr 11, 2012
Copyright:Attribution Non-commercial


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According to the ENA, the definition of
“Emergency nursing involves the assessment, diagnosis, and treatment of 
perceived, actual or potential, sudden or urgent, physical or psychosocial problems thatare primarily episodic or acute. These may require minimal care or life
supportmeasures, education of client and significant others, appropriate referral and knowledge
of legal implications”.
Emergency nursing was officially recognized as a specialty in 1970. The national associationrepresenting these nurses LS the Emergency Nurses Association (ENAI. Its currentmembership comprises more than 25,000 nurses who have chosen this area of professionalnursing. The ENA is recognized internationally and by 1999 had approximately 400 membersfrom 35 different countries. Emergency nurses throughout the world have realized both theirsimilarities and differences through use of the World Wide Web and increasing internationalglobalization.
The ED of the future is being formulated today. Not only is technology changing,but the day-to-day processes that support the ED infrastructure are being challenged andredesigned. These include concepts such as incorporating multiple triage stations and bedsideor back-end client registration; using computerized protocols, guidelines, and electronic medicalrecords; integrating nontraditional health care modalities; initiating wireless communicationtechnolo
gy; and creating “virtual” EDs.
 In addition to the provision of direct client care, other multifaceted roles exist within emergencynursing. The emergency nurse is involved in the initial triaging of clients according to illnessseverity, may perform as a mobile intensive care nurse (MICN) by directing pre-hospital carepersonnel via telecommunication, and frequently provides client care in the pre-hospitalenvironment. Community clinics use ED nurses, and many emergency nurses have becomeactive in injury prevention programs at both national and local levels. Advanced practice rolessuch as clinical nurse specialists and nurse practitioners are integrated into many EDsthroughout the United States. Nurses in these advanced practice roles often have
a master‟s
degree level of education or higher in addition to specialty certification.
The emergency nurse has had specialized education, training, and experience to gain
expertise in assessing and identifying patients‟ health care problems in crisis situations.
In addition, the emergency nurse establishes priorities, monitors and continuouslyassesses acutely ill and injured patients, supports and attends to families, supervises
allied health personnel, and teaches patients and families within a time-limited, high-pressured care environment.
Nursing interventions are accomplished interdependently, in consultation with or underthe direction of a licensed physician or nurse practitioner. The strengths of nursing andmedicine are complementary in an emergency situation. Appropriate nursing andmedical interventions are anticipated based on assessment data.
The emergency health care staff members work as a team in performing the highlytechnical, hands-on skills required to care for patients in an emergency situation.
The nursing process provides a logical framework for problem solving in thisenvironment. Patients in the ED have a wide variety of actual or potential problems, andtheir condition may change constantly. Therefore, nursing assessment must becontinuous,
and nursing diagnoses change with the patient‟s condition. Although a
patient may have several diagnoses at a given time, the focus is on the most life-threatening ones; often, both independent and interdependent nursing interventions arerequired.
Past federal legislation has mandated that any client who presents to an EDseeking treatment must be rendered aid regardless of financial ability to payfor services. Since the mid-1980s, additional specific legislation has beenenacted requiring ED personnel to stabilize the condemn of any clientconsidered medically unstable before transfer to another health care facility
the Consolidated Omnibus Budget Reconciliation Act (COBRA) of 1985 -andthe Omnibus Budget Reconciliation Act (OBRA) of 1990. This stabilization
mtist occur regardless of the client‟s financial ability to pay for services. ED
personnel who transfer clients to another institution without first providing thisinitial stabilization can incur substantial fines and penalties, as can thehospital administration.
Clients have continued to seek health care services in the ED, even with theproliferation of managed health care plans and gatekeeping policies. Thefinancial integrity of the ED has been challenged over the years due to thelegal obligations of the ED to provide service.
Retrospectively, financial reimbursement for rendered services has beendenied to EDs from managed health care plans following a determination that
the client‟s problem did not constitute a true emergency
Additional legislation was enacted (Emergency Medical Treatment and ActiveLabor Act EMTALA in 1988, 1989, 1990, and 1994) requiring that a medicalscreening examination be performed on all ED clients before solicitation ofinformation about ability to pay.3 This medical screening examination must
be inclusive enough to determine whether the client is experiencing anemergency medical condition requiring treatment or, in the case of a pregnantwoman, is experiencing labor contractions. An emergency medical conditionincludes drug abuse, hemodynamic instability, psychiatric illness, intoxication,severe pan, and labor.
If a client has an emergency medical condition, stabilization must berendered. Stabilization is interpreted to mean that deterioration of the client isunlikely during possible transfer or discharge of the client. Continuedinterpretations of this act have expanded the facilities that come underEMTALA. These include not only EDs. but also hospital owned urgent carecenters, anywhere unscheduled clients appear for medical care, and off sitelocations that are within a 250-yard zone of a main hospital that is coveredunder the 2001 outpatient prospective payment system. Violations of thislegislation can again result in fines and penalties.
a. Most adult clients seeking treatment in the ED give voluntary consent to thestandard and usual treatment performed in this setting. In some instances,however, a client is deemed unable to give consent for treatment. This
inability may be due to the critical nature of the client‟s illness or injury or to
other conditions, such as an altered level of consciousness. In theseinstances, emergency care may be rendered to the client under the impliedemergency doctrine. This doctrine assumes that the client would consent totreatment to prevent death or disability if the client were so able.b. Children younger than the age of legal majority must have the consent oftheir parent or legal guardian for medical care to be rendered. Exceptionsinclude (1) emancipated minors, (2) minors seeking treatment forcommunicable diseases, including sexually transmitted diseases, injuriesfrom abuse, and alcohol or drug rehabilitation, and (3) minor-aged femalesrequesting treatment for pregnancy or pregnancy-related concerns. Somestates also allow the adult caregiver with whom the child resides to givetreatment authorization even though that caregiver may not be the parent.c. The issue of informed consent in the ED is the same as in any other healthcare setting. Adult clients must he informed about the necessity of requiredtreatments, expected outcomes, and potential complications. Clients mustalso be mentally competent and understand the information being explained.As in any other setting, a mentally competent adult client always maintainsthe right to refuse treatment or withdraw previously given consent.
a. Restraining a client while he or she is in the ED may at times be necessary.The need for restraints usually arises because the client is becoming agitatedor potentially violent. Hard leather or chemical restraints are used in the ED if

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