Nursing Scenario Analysis
The emergency department is a fast paced, busy, and vital to the hospital and community. There are patients of all ages coming into the ED. Every patient that comes in has a different diagnosis. Patients have various medical problems, for example, one patient could have the flu and one patient could have just been cut free from a car. When multiple patients are coming in there must be a way to sort through all the ciaos. A triage nurse determines which patient is most important and gets the sent back to a room to begin treatment. While in triage, each patient has vital signs checked. If indicated, they will also have an EKG. In triage at Jackson General ED, the nurse uses a checklist to organize patients, which determines who is priority. The triage algorithm Jackson General ED uses is “ESI”. This chart gives five levels of priority, one being first and five being last. A patient must need lifesaving interventions to be marked a one. To be assigned a two a patient must be high risk of needing lifesaving actions. The next two levels require resources to be implemented. For example, a three requires more than one resource to be used, for
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instance, abnormal vital signs, lab work, and CXR. A four only requires one resource. If a patient comes in with a fracture, he or she would only need an x-ray, that patient would be considered a four. A five is patients that come in requesting refills or simple checkups. Once the nurse determines the level of importance she enters it into the computer and sends the patient to the next waiting room. While in triage, me and the triage nurse saw seven patients. Each category/level of priority was assigned except for #1(red). The hospital saw roughly 90,000 to 100,000 patients in the year of 2016. At that rate, there was 250 to 280 patients seen every day. On some days, there were even 300 patients seen. Emergency department nurses work in emergency situations life-threatening illness, trauma, or injury. ED nurses work quick in the moment. Nurses that work in the ED must have fast and precise assessment skills. Every second counts when it comes to an emergency. Emergency nursing is a specialty. Every nurse must provide quality care for all patients. This includes pediatric, adolescent, adult, and geriatric. ED nurses must be prepared to care for a wide array of medical diagnoses. Emergency medical service or EMS provides the on-site care and all the pre-hospitalization care. Once in the hospital, the EMS waits with the patient until they have an open, assigned room. When the room is prepared, the nurse and EMS take the pt to the room and transfer the patient from the stretcher to the bed. The EMS provides the nurse with the hand-off report and any other information available. One EMS used a SBAR form to provide information to the nurse. Many ethical and legal issues arise in the emergency department.
At many times, patients come in unconscious or with altered mental status. Many patients come in with major injury or trauma. When trauma comes in the nursing staff has little information about the patient. In a lot of cases, the nurse has very little time to gather data about the patient coming into the ED. Nurses have to perform invasive procedures without consent. Some patients require CPR and later the staff find the patient was a DNR. Even though the outcome was not what should have been, the nurse has to reflect beneficence, what is in the best interest of the patient, do good for each patient in their care. Patients need advocates and somebody to promote the patients’ rights. These are just a few of the ethical and legal issues in the emergency
department.
My clinical rotation at Jackson General Hospital Emergency Department was extremely interesting and I was very happy to find I enjoyed the ER. When we first arrived, we went on a tour of the emergency department. The ED was very organized. The ED was overflowing with nurses and doctors. I was following a travel nurse that worked 7A to 7P. He had a lot of experience in the emergency department. I was thankful to get to learn from someone that is so seasoned in the field. Our patients had a variety of diagnoses. The first patient had pneumonia and the second patient depression which was preventing the client from performing activities of daily living. I was able to start IVs, hang fluids and medications, and administer subcutaneous medications. Once those patients were discharged we had two more patients admitted. The first patient had an anaphylactic reaction to nuts. The second patient was post-op with absent sensation in the foot resulting in a pressure ulcer. I also saw an elderly patient have a seizure. I watched as the nurses worked to protect and care for the patient. I also followed three nurses in triage. Multiple patients walked in the doors during the hour I was there. I applied 12-lead EKGs and took vital signs. I saw one patient with an extremely high blood pressure that was immediately sent back to a room. I also saw a patient with debilitating gout and arthritis. The entire clinical group was able to go to the top floor and see the helicopter land on the roof. They were transporting a patient from another hospital. We followed the patient and nurses down and watched as they gave report to the doctors and they began assessing the patient. I enjoyed the clinical rotation at the emergency department. I think it was a great experience and chance to be educated about emergency nursing.
instance, abnormal vital signs, lab work, and CXR. A four only requires one resource. If a patient comes in with a fracture, he or she would only need an x-ray, that patient would be considered a four. A five is patients that come in requesting refills or simple checkups. Once the nurse determines the level of importance she enters it into the computer and sends the patient to the next waiting room. While in triage, me and the triage nurse saw seven patients. Each category/level of priority was assigned except for #1(red). The hospital saw roughly 90,000 to 100,000 patients in the year of 2016. At that rate, there was 250 to 280 patients seen every day. On some days, there were even 300 patients seen. Emergency department nurses work in emergency situations life-threatening illness, trauma, or injury. ED nurses work quick in the moment. Nurses that work in the ED must have fast and precise assessment skills. Every second counts when it comes to an emergency. Emergency nursing is a specialty. Every nurse must provide quality care for all patients. This includes pediatric, adolescent, adult, and geriatric. ED nurses must be prepared to care for a wide array of medical diagnoses. Emergency medical service or EMS provides the on-site care and all the pre-hospitalization care. Once in the hospital, the EMS waits with the patient until they have an open, assigned room. When the room is prepared, the nurse and EMS take the pt to the room and transfer the patient from the stretcher to the bed. The EMS provides the nurse with the hand-off report and any other information available. One EMS used a SBAR form to provide information to the nurse. Many ethical and legal issues arise in the emergency department.
At many times, patients come in unconscious or with altered mental status. Many patients come in with major injury or trauma. When trauma comes in the nursing staff has little information about the patient. In a lot of cases, the nurse has very little time to gather data about the patient coming into the ED. Nurses have to perform invasive procedures without consent. Some patients require CPR and later the staff find the patient was a DNR. Even though the outcome was not what should have been, the nurse has to reflect beneficence, what is in the best interest of the patient, do good for each patient in their care. Patients need advocates and somebody to promote the patients’ rights. These are just a few of the ethical and legal issues in the emergency
department.
My clinical rotation at Jackson General Hospital Emergency Department was extremely interesting and I was very happy to find I enjoyed the ER. When we first arrived, we went on a tour of the emergency department. The ED was very organized. The ED was overflowing with nurses and doctors. I was following a travel nurse that worked 7A to 7P. He had a lot of experience in the emergency department. I was thankful to get to learn from someone that is so seasoned in the field. Our patients had a variety of diagnoses. The first patient had pneumonia and the second patient depression which was preventing the client from performing activities of daily living. I was able to start IVs, hang fluids and medications, and administer subcutaneous medications. Once those patients were discharged we had two more patients admitted. The first patient had an anaphylactic reaction to nuts. The second patient was post-op with absent sensation in the foot resulting in a pressure ulcer. I also saw an elderly patient have a seizure. I watched as the nurses worked to protect and care for the patient. I also followed three nurses in triage. Multiple patients walked in the doors during the hour I was there. I applied 12-lead EKGs and took vital signs. I saw one patient with an extremely high blood pressure that was immediately sent back to a room. I also saw a patient with debilitating gout and arthritis. The entire clinical group was able to go to the top floor and see the helicopter land on the roof. They were transporting a patient from another hospital. We followed the patient and nurses down and watched as they gave report to the doctors and they began assessing the patient. I enjoyed the clinical rotation at the emergency department. I think it was a great experience and chance to be educated about emergency nursing.