Against Medical Advice: A Literature Review

The choice of utilizing this article entitled,” Against Medical Advice: A Survey of ED Clinicians’ Rational for Use,” (Brenner, 2016) is inspired by observing that the Emergency Department (ED) is where we can find a channel of activities surrounding patients who present with differing needs, urgency, and levels of care. The ED is a cesspool of patients seeking emergency care, most often the capacity of the ED is challenged in its need to accommodate every person who presents whether they be non-urgent or emergent. The articles’ utilization of quantitative approach strongly inspires the exploration of the study. As presented in the article, “Patients discharged from an emergency department Against Medical Advice (AMA) represent a population of patients with both medical and legal implications invoked for themselves and the clinician who performs
the discharge.” (Brenner, 2016) The aim of this study is to identify the factors that patients may have in leaving AMA, as well as identifying the clinicians’ and the nurses’ reaction in its implementation. Secondly, the article, “Seeking Status: The Process of Becoming and Remaining an Emergency Nurse,” (Winters, 2016) is chosen as a representation of a Qualitative study for its exhibition of showing nurses’ perception of an extremely contentious topic, acculturation and retention in the Emergency Department. Nurses at the ED, not discounting other units of the hospital, often face the ultimate of patient’s existence. The depersonalization felt by nurses’ in this occurrences is under reported or unexamined. As stated in the article, “Utilization of the ED across the United States is continuing to escalate. Processes and strategies to retain qualified ED nurses are urgently needed.” (Winters, 2016, p. 412) The aim of this study is to highlight the strategies utilized by nurses in remaining in the ED. Their motivations and their guiding mantras. Justification for the Selection of the Articles The reason for reconnoitering about patients’ clearance from an emergency department as an AMA characterizes a cluster of patients with medicinal and legitimate allegations entreated for the decision to leave. The clinician who executes the discharge has an ethical and legal responsibility to present some form where the patient can justify the AMA, without coercion or influence outside his freedom to choose healthcare. “The law dictates that a patient has the right to refuse medical care and that treatment without consent may be considered battery.” (Levy, 2012) Regardless of the vast number of these occurrences, the existence of patient signing out AMA has its repercussions, limited studies have been accomplished on features and influences that effect a clinician’s judgement to release a patient with this disposition. The need to explore this method in its effectivity is depicted in the article. On the other hand, connections between the patient and the nurse can be put together by the patients’ time of stay inside the hospital setting, in different units or even at the hospice unit. Contrariwise, patient- nurse relationship is essentially built within minutes or hours in the ED. The quickness, time-challenged ED often confront the understanding for patients in search of emergency facilities. Nurses in turn are left with a question, “Have I been effective in my delivery of care?”
Emergency nurses in this society are now faced with a rising dilemma of increased dissatisfaction in their work and their role as a caregiver.
As identified by Siller (2016, p. 325), the ED is where we can find a channel of activities surrounding nurses who present with unfavorable work environments, the likelihood of burn-out and stress is high, nurse job dis-satisfaction is abundant, high turnover, and decreased nurse retention is ripe. It is in this article where these factors are explored and identified.
Rationale for the Choice of Journal Where Articles Were Written The articles presented above were obtained from the Journal of Emergency Nursing (JEN). This is the Emergency Nurses ‘Associations (ENA) outlet for peer-reviewed publications. The JEN is abstracted and/or indexed in International Nursing Index (INI), Cumulative Index to Nursing & Allied Health Literature (CINAHL), and MEDLINE. The Journal is recommended for initial purchase in Brandon-Hill study, Selected List of Nursing Books and Journals (March 1994). Frequency is bimonthly. (Emergency Nurses Association, 2016)
A Way to See and Read the Articles
(Links)
The rise of the internet and the globalization of media is both an advantage and a disadvantage. Most publications/ books/articles/sources/ blogs/commentaries are now readily available on-line given that one is a member of the site or the association it represents. The disadvantage presents when the article presented is cited in a different way of which does not readily reflect the exact reference and pages where the quote or words were lifted. The purpose of which is to emphasize its authenticity.