GCNM - EMERGENCY NURSING

GCNM EME 501: FOUNDATIONS AND

THEORIES OF EMERGENCY NURSING
FACILITATOR : MRS GLORIA ACHEMPIM- ANSONG
RN, BA, MPHIL, FWACN, FFGCNM,MEMBER, STTI
 MODULE OBJECTIVES

On completing this module, the resident should be able to;

Describe the origin of Emergency nursing
Describe the scope of the practice area of the emergency nurse.
Discuss the various theories of emergency nursing
Describe the triaging of patients/clients
List the various diagnostic investigations carried out on patients /clients
 CONTD

Discuss the physiology and assessment of pain

Demonstrate the techniques of advanced health assessment of patient/client
Identify life-threatening injuries or conditions during a primary survey and
initiate appropriate interventions.
Assess and manage fluid and electrolyte abnormalities in a patient/client
Apply the nursing process in the management of patient/client
 Contents
Emergency Nursing: a historical perspective

INTRODUCTION

CLASS DISCUSSION

HISTORY AND DEVELOPMENT OF NURSING IN GHANA AND

WORLDWIDE

FLORENCE NIGHTINGALE
HISTORY OF EMERGENCY NURSING

The Profession of nursing was transformed by World War II (WWII)Integrating the

concept of tender and caring nursing, with skilled well-trained efficiency.
All branches used enlisted men to care for wounded in the field (a precursor to
modern day paramedics), and the nurses were used to supervise, and provide
specialized care.
Post War Care - Prior to the war, Emergency Rooms (ERs) were staffed on an as
needed basis.
15-30yrs after the war, the ERs changed into a more specialized model, and the
family physician was no longer required to be available 24/7
 CONTD

As more patients arrived at Emergency Departments, hospitals were forced to

assign increasing numbers of nursing staff to provide care, even though the
roll was not clearly defined.
At the same time ERs were becoming more recognized, and transport of
patients to hospitals for care was also gaining attention.
1960s-1970s - As the roots of ER care took hold, several nursing associations
and groups developed to continue the advancement of Emergency nursing as a
specialty .
The Emergency Nurses Association (ENA) published the first Core Curriculum
standards of Emergency Nursing Practice and the Journal of Emergency
Nursing.
 CONTD

In the 2000s and Beyond, The ENA Continue to address concerns with
Emergency Department overcrowding, holding patients, rising costs, safety in
the workplace, and nursing shortage and level triage system implemented in
many ERs around the world.
The Future - As ER nursing becomes more complex, and specialized, the need
for research, and continued growth is vital. We will be forced to continuously
grow and adapt to overcome the challenges we face everyday.
Guiding our profession into the next decade.
 CONTD

Crosscurrents of change in professional role definition, technological

advances, nursing personnel shortages, shift work challenges, job
dissatisfaction, staffing inadequacies, and a decline in those electing nursing
as a profession all contribute to a profession in transition.
The hospital emergency department (ED) is among those professional arenas
in the forefront of this nursing transition, exacerbated by the remarkable
growth in ED patient census in recent years.
 CONTD

Many recently designed or remodelled EDs are becoming rapidly obsolete due
to changing privacy requirements, advances in technology, and the ED
assumption of major diagnostic and resuscitation tasks, all exacerbated by
ongoing patient census increases.
HISTORY OF EMERGENCY NURSING

Historically, patient care was generally provided where the illness or injury
occurred. There were no hospitals and emergency departments (EDS).
Patients were nursed in Monasteries and Churches.
dating back to the middle ages ( Sefrin & Weidringer, 1971)
Although emergency care is common in the world, many parts of the globe
still do not have emergency care systems including departments staffed by
nurses and physicians.
 CONTD

In 2012, the World Health Assembly adopted Resolution 60:22 Titled;

Health Systems: Emergency care systems, establishing a policy tool for
improving emergency care access and providing emergency care globally
(Anderson etal. 2012)
NOTE: In 2012, there were 5,004 emergency departments in US.
 THE ROLE OF FLORENCE NIGHTINGALE (FN)

FN has long been associated with the origin of emergency nursing

She took nurses out to the fields to provide care to wounded soldiers during the Crimean war in
1854.
TYPE OF CARE: Rapid Management of Acute Patients.
She recognized that, nurses play a significant role in the social care of patients, and that this
could not be separated from the patients health care needs.
She worked hard and demonstrated the role of advocacy, an important part of patient care in
emergency nursing practice (Ayers,2014)
FN pressed for the welfare of her nurses, she demanded better working and living conditions by
promoting time off etc.
EMERGENCY NURSING IN THE 20TH
CENTURY
Emergency nursing and emergency medicine continued to develop in quality,
during the 20th century. The medical and nursing care provided to soldiers
during World war II and the Korean and Vietnam wars demonstrated that rapid
and acute care could make a difference in patient outcomes.
Emergency medicine was recognized as a specialty in the 1970s.
It quickly became an integral part of emergency care.
The role of the nurse in world war II and the Korean and Vietnam wars
demonstrated the importance of nursing in the triage process and acute care
of the ill injured patient.
 CONTD

During this time, the American Nurses Association (ANA) began to gain more
members and political power to represent the profession and the work of
nursing.
N/B : 59,000 American Nurses served the Army Nurse cops during World war II
(US Army Centre of Military History, 2003).
4,000 Navy Nurses served shifts hospitals during the Korean war
6,250 nurses served in the Vietnam War.
 CONTD

Initially, most nurses who were either assigned to an emergency room or were
called to see a patient when one presented had to provide and perform any
needed immediate care and then wait for the physician to arrive.
The specialization of Nursing assisted in identifying the unique function,
responsibilities and education needed to provide care in the ED or intensive
care unit.
 CONTD

The concern about the lack of enough physicians in the ER led to the suggestion of training
nurses to perform specific intervention for emergency care Examples;
Obtaining History
Instituting CPR
Stopping haemorrhage
Inserting nasogastric tube
First aid
Remaining well informed in new methods of utilizing emergency communication ( Owen,
1970)
OWEN, 1970 NOTES;

Every nurse involved in emergency care should serve a period of training

and indoctrination in what in necessary for emergency care of the patient at
the site, en route to the hospital via emergency transportation in emergency
department, operating room, recovery room, intensive care and coronary care units.
EMERGENCY NURSES ASSOCIATION (ENA)

Two visionary nurses Anita Dorr and Judith Kelleher took on the challenge of
creating a way for emergency nursing to be recognized as a specialty.
Anita Dorr formed the EMERGENCY ROOM NURSES ORGANIZATION and
developed the 1st Resuscitation Chart.
Judith Kelleher called her association; THE EMERGENCY DEPARTMENT NURSES
ASSOCIATION (EDNA)
On December 1st, 1970, these two nurses combined their organizations to
EMERGENCY DEPT NURSES ASSOCIATION
Judith Kelleher is accredited with Emergency Department nurses Room
 CONTD

EDNA and American College of Emergency Physicians( ACEP) share the same
office
Both associations continue to work to this day collaboratively toward ensuring
that the quality of care provided in the ED is evidence-based and the needs of
all emergency patients are recognized and met
EDNA changed its name in 1985 to the ENA.
ENA has membership of over 40,000 members
 CONTD

In the 2000s and Beyond, The ENA Continue to address concerns with
Emergency Department overcrowding, holding patients, rising costs, safety in
the workplace, and nursing shortage and level triage system implemented in
many ERs around the world.
The Future - As ER nursing becomes more complex, and specialized, the need
for research, and continued growth is vital. We will be forced to continuously
grow and adapt to overcome the challenges we face everyday.
Guiding our profession into the next decade.
STATE OF EMERGENCY MEDICINE IN
GHANA
NATIONAL AMBULANCE SERVICE(NAS)
In 2004 the Ministry of Health (MOH) in collaboration with the Ministry of Interior
established seven (7) pilot ambulance stations.
The mandate of the National Ambulance Service, (NAS), is to provide efficient and
timely pre-hospital
emergency medical care to the sick and the injured and transport them safely to
health facilities.
NAS
NAS has since expanded to cover all regional capitals and targets to cover all districts
as well.
GHANA-MICHIGAN EMERGENCY MEDICINE
COLLABORATION

Collaborators include:
Kwame Nkrumah University of Science and Technology (KNUST)
Komfo Anokye Teaching Hospital (KATH)
Ghana College of Physicians and Surgeons
Ghana Ministry of Health
University of Michigan Department of Emergency Medicine and School of
Nursing
MISSION

The mission of the Collaboration is to

improve the provision of emergency medical care in Ghana through innovative
and sustainable Physician Nursing and Medical student training programs.
 CONTD

The Ghana Emergency Medicine Collaborative is funded

by the Medical Education Partnership Initiative of the National Institutes of
Health Fogarty International Centre, with additional support from the University
of Michigan Department of Emergency Medicine and the University of Michigan
Centre for Global Health
EMERGENCY NURSING

KNUST introduced a degree course in emergency nursing during the 2010-2011

academic year
A 2 year course for diploma holders
A professional diploma in emergency nursing to commence at KNUST
This program will be based in the department at KATH with lectures given by
EN faculty
IMPACT OF EMERGENCY MEDICINE

An established nurse-led triage using SATS

Emergency physician and senior clinicians presence in the
A&E department 24/7
Prompt resuscitation & stabilization of acutely ill and injured persons
Provision of Update courses in emergency medicine
Leading a new approach and attitude in patient care
THE FUTURE

Promotion of the spread and establishment of emergency medicine in Ghana

and across West Africa
Emergency care education and training
Emergency physician training
Emergency nurse training
Emergency Physician assistant training
Systems improvement
In-hospital
Inter facility(REFERRALS)
Collaborations/Partnerships in education, training & research
THE SCOPE OF EMERGENCY NURSING

The dimensions of emergency nursing include the roles, responsibilities,

functions, and skills that involve a specific body of knowledge.
The boundaries of emergency nursing are described as both internal and
external with sufficient flexibility and resilience to change in response to
societal needs and demands.
The task of defining the scope of emergency nursing is complex.
 CONTD

Emergency nurses frequently contact patients in the emergency department

before the patients see physicians. In this situation, the nurse must be skilled
at rapid, accurate physical examination, early recognition of life-threatening
illness or injury, the use of advanced monitoring and treatment equipment,
and in some cases, the ordering of testing and medication according to
"advance treatment guidelines" or "standing orders" set out by the hospital's
emergency physician staff.
 CONTD

Emergency nurses most frequently are employed in hospital emergency

departments, though they may also work in free-standing emergency centres
or urgent care clinics.
Behavioural health of patients have become an increasing concern for
emergency nurses.
 CONTD

The scope of emergency nursing practice involves the assessment, analysis,

nursing diagnosis, outcome identification, planning, implementation of
interventions, and evaluation of human responses to perceived, actual or
potential, sudden or urgent, physical or psychosocial problems that are
primarily episodic or acute and which occur in a variety of settings.
These may require minimal care to life-support measures; patient,
family, and significant other education; appropriate referral and discharge
planning; and knowledge of legal implications.
 CONTD

Emergency patients are people of all ages with diagnosed or undiagnosed

problems of varying complexity.
Emergency nurses also interact with and care for individuals, families, groups
and communities.
Emergency nursing practice is independent and collaborative in nature. The
practice of emergency nursing also includes the delivery of compassionate,
competent care to consumers through education, research and consultation.
 CONTD

Emergency nursing occurs in hospital emergency departments; pre-hospital

and military settings; clinics, health maintenance organizations, and
ambulatory care centers; business, educational, industrial and correctional
institutions; and other health care environments.
Emergency care is also at the point of contact with consumers; where they
live, work, play or go to school.
 CONTD

The scope of emergency nursing practice is bound both externally and

internally.
The external boundaries include legislation/regulations, societal demands for
expedient quality emergency care, economic climate, health care delivery
trends, and resources. Individual state nurse practice acts which define
nursing care are an example of legal boundaries used to provide the basis for
interpretation of the safe practice of nursing.
 CONTD

Rules and regulations which evolve from these acts are used as guidelines by
state boards of nursing to issue licenses and ensure the public safety.
Examples of the legislative/regulatory factors important to emergency
nursing include: the Consolidated Omnibus Reconciliation Act (COBRA); the
Emergency Medical Treatment and Labor Act (EMTALA); the Joint Commission
on Accreditation of Healthcare Organizations (JCAHO)
A NEW SPECIALTY EMERGENCY NURSING
THE SPECIALTY OF EMERGENCY NURSING
Just as the profession of nursing is diverse, so too is the specialty of
emergency nursing. Most specialty nursing groups are identified by their focus
on one of the following:
specific body system
specific disease process/problem
specific age group
specific population, such as women's health care or mental health
 CONTD

Emergency nursing crosses all these specifications 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.
This specialty is extremely fast-paced, which can be either daunting or
energizing, depending on your personality.
DOMAIN OF EMERGENCY NURSING

Stabilize patients experiencing trauma

Minimize pain
Quickly uncover medical conditions
Teach patients about injury prevention

JOB CHARACTERISTICS
Fast-paced
Multifaceted Structured
Patient-facing
 CONTD

The specialty practice of emergency nursing is defined through the

application of a specific body of knowledge and the implementation of
specific role functions
Emergency Nurses treat patients in emergency situations where they are
experiencing trauma or injury.
These nurses quickly recognize life-threatening problems and are trained to
help solve them on the spot.
They can work in hospital emergency rooms, ambulances, helicopters, urgent
care centers, sports arenas, and more.
The Emergency Nurse treats a variety of conditions from sore throats to
heart attacks for patients of all ages and backgrounds.
Characteristics of Emergency nursing
Practice

Characteristics of emergency nursing practice include:

Assessment, analysis, nursing diagnosis, planning, implementation of
interventions,
outcome identification, and evaluation of human responses of individuals in
all age groups whose care is made more difficult by the limited access to past
medical history and the episodic nature of their health care.
Triage and prioritization.
 CONTD

Emergency operations preparedness.

Stabilization and resuscitation.
Crisis intervention for unique patient populations, such as sexual assault
survivors.
Provision of care in uncontrolled or unpredictable environments.
Consistency as much as possible across the continuum of care.
 CONTD

Other characteristics of emergency nursing environments include;

unanticipated situations requiring;
intervention, allocation of limited resources, need for immediate care as
perceived by the patient/others, and contextual factors.
Contextual factors are the variety of geographic settings, unpredictable
numbers of patients, and unknown patient variables which include severity,
urgency, and diagnosis.
 CONTD

Nursing roles include those of patient care, research,

administration/management, education, consultation and advocacy.
NOTE:
From minor injuries to major traumas, from birth to death.
Emergency nursing is for those who enjoy every day being different and who
are risk-takers.
A new nurse in the ED can expect every day to be different. The variety of
patients means you will see diverse diseases or injuries daily. However, the
skills to assess and provide intervention will begin to come into focus. You
build upon each experience to prepare you for your next patient.
 SUMMARY AND CONCLUSION

Emergency nursing 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.
 REFERENCES

Emergency Nurses Association (2009). Sheehys Emergency Nursing; principles

and Practice. 6th ed. Mosby, Elsevier: USA.
Kitt, S.& Kaiser, J. (1999).Emergency Nursing: A physiologic and clinical
perspective. W.B. Saunders: Philadelphia, USA.
Ministry of health/Ghana Health Service(2003). Management of Accidents and
Emergencies; A manual for frontline providers
Nettina, S.M. & Mills, E. (2006). Lippincott Manual of Nursing practice. 8th ed.
Lippincott Williams & Williams, Philadelphia.