Emergency Room Nursing: Prioritizing Patient Care and Interventions

Nursing relies on theory and its constituent concepts, as they underpin every nursing intervention and revolve solely around the patient. Although the practice executed by Registered Nurses in an emergency room mirrors that of an Advanced Practice Nurse Practitioner, it is less intricate.

Upon arrival, emergency room nurses begin the patient assessment process by asking about the chief complaint. This complaint is used to label the patient and determine their triage level, which guides resource allocation for intervention. The nurse's main focus is addressing this chief complaint while considering the patient's need for education and readiness to learn.

These factors contribute to improving the patient's well-being and restoring their health. Figure 1.1 shows how emergency room nurses prioritize care within a framework designed for registered nurses in this setting. Implementing this nursing framework enables nurses to organize and prioritize actions effectively. Knowing the chief complaint is crucial for providing appropriate treatment. It is also important to ask about the reason behind the patient's visit since they may have multiple symptoms related to their illness.

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Prioritizing concerning symptoms prompts nurses to inquire about what bothers patients most, such as headaches or shortness of breathNurses gather relevant data related to the patient's chief complaint, such as oxygen saturation, respiratory rate and effort, lung auscultation, presence of cough, and observation of color. Both subjective and objective data are equally important in this process.

This type of data includes patient symptoms, health history, and social history (such as smoking). The nurse will then implement her plan of care and intervene by providing supplemental oxygen, if necessary, elevating the head of the bed, and encouraging slow breathing if it appears labored or fast.

After each intervention, the nurse must reassess to determine effectiveness; if interventions do not work, the plan of care must be modified. Subsequently, the nurse must consider readiness and ability to learn when providing education. If a patient is not ready to learn, it becomes challenging for the nurse to teach and help achieve overall goal of restoring health. This cycle continues with each illness episode; the nurse always tailors the plan of care to meet needs. For example, if a patient has a mental handicap, education may be directed towards their caregiver for optimal chances of achieving good health. This conceptual framework applies well in emergency room nursing practice as it is an organized cycle focused on the patient's needs. In an emergency room setting, prioritizing and organizing symptoms and data is crucial - forgetting an oxygen saturation measurement can be life-threatening for a breathless patient!

Furthermore, nursing interventions are always tailored around the initial chief complaint and data gathered. It is a cycle that starts over each time a patient presents with an illness. Even though this framework is frequently utilized, there are many areas in which it could improve. What about a patient’s environment, social stability, and body’s response to the illness? In addition, there are no interrelationships noted on this model. There are many ways this framework could improve, be more in depth, and help reach goals by learning about other nursing theories and theorists.

Nursing theorist Myra Estrin Levine provides extensive insight into the relationships between nurses and patients as well as the holistic approach to healthcare. Levine's expertise as a nurse and broad theoretical perspectives contribute to her comprehensive views on nursing. According to Alligood & Tomey (2010), Levine identified three major concepts of the Conservation Model: wholeness, adaptation, and conservation.

The current model shown in Figure 1.1 fails to consider the patient as a whole; it only focuses on specific aspects of the patient's condition or complaints. The existing theory employed by emergency room nurses can greatly benefit from incorporating Levine's major concepts and recognizing how much influence the environment alone can have on patients.

According to Alligood and Tomey (2010, p.228), the metaparadigm of nursing includes the concept of "organismic response," which is often overlooked by nurses in practice despite being taught in anatomy and physiology classes. This response is controlled by the autonomic nervous system and triggers a "fight or flight" reaction in the body. The fight or flight response can be induced by stress, illness, or a patient's awareness of their surroundings. It can affect variables such as heart rate, blood pressure, anxiety, and stress levels. The nature of this response varies among individuals and is influenced by their past experiences and perception of threat. In addition to holistic healthcare, Levine emphasized the significance of the nurse-patient relationship. Both nurses and patients unknowingly apply Levine's conservation models on a regular basis. Nurses conserve energy by using tools like IV trays or kits to streamline tasks and minimize physical exertion. Similarly, patients conserve energy when they are unwell in order to support their body's healing process. Various forms of conservation are essential for both the nurse and the patient.The conservation of both structural integrity and personal integrity is crucial in every nurse-patient interaction. In cases where a patient experiences severe head trauma, the nurse must prioritize their own personal integrity to prevent the patient from experiencing heightened anxiety and stress. This, in turn, would drain the patient's energy and hinder their body's ability to heal.

Nurses may experience strong emotions when encountering a significant amount of blood, but they recognize the importance of controlling their non-verbal cues when interacting with patients. The nurse's personal integrity involves respecting patient requests, following privacy regulations, and educating patients about procedures. To prevent further blood loss in a patient with head trauma, applying pressure to the wound is a life-saving intervention that maintains structural integrity and prevents worsening conditions. Conserving energy, maintaining structural integrity, and upholding personal integrity are crucial in nursing interactions. Nurses also have a responsibility to consider social integrity as social well-being is vital for society. Levine's research supports the idea that "health is socially determined." Educating patients in ways that promote regained independence can increase personal integrity and societal acceptance by improving health outcomes. Society often categorizes individuals based on illnesses such as cancer, obesity, limb amputation or pregnancy.Judging individuals based on their health issues can lead to acceptance or rejection in society (youtube.com, 2011). Nurses play a crucial role in guiding the perception and response of patients' loved ones towards the patient and their illness. The University of the Philippines Open University (UPOU) (2011) emphasizes that nurses should prioritize the social well-being of patients during their hospital stay by providing access to communication tools like magazines, television, newspapers, and telephones. This support can enhance patients' self-esteem and reduce stress related to their illness. Understanding the nurse-patient relationship and conservation models is essential for successful health restoration (UPOU, 2011). However, it is important to note that Figure 1.1 presents simplistic models that overlook personal emotions of both patients and nurses, which significantly influence overall health outcomes.

The Conservation Model in primary care nursing, as utilized by Levine's concepts, is shown in Figure 1.2 (Alligood and Tomey, 2010, p. 227).

Levine’s conservation model (Fig 1.2) provides primary care nurses with guidelines for evaluating patients, taking into account the patient and their family. Figure 1.2 also illustrates the connection between a nursing model and the nursing metaparadigm, encompassing well-being, holistic care, education, and nursing. Additionally, recognizing the patient as a "whole" prompts primary care nurses to consider the patient's overall health. This comprehensive assessment covers clinical issues (body), psychological factors (mind), and spiritual beliefs that may influence the care plan. Understanding how wholeness, adaptation, and the environment interact helps primary care nurses comprehend the broader context and how advanced practice nurses can enhance patient outcomes.

The term "adaptation" refers to variables in patients that can impact them holistically or be influenced by their environment. Factors such as age, smoking cessation, or weight gain/loss can significantly affect both the patient and their treatments. The medical team must understand both internal and external aspects of a patient's environment (Alligood & Tomey, 2010, p.227). This relates to adopting a holistic approach and considering adaptation when developing the care plan. Awareness of the patient's living situation can have an impact on their overall well-being.If the patient lacks full understanding of their terminal illness, explaining the significance of a hospice program can be challenging.

According to Alligood & Tomey (2010, p. 229), Figure 1.3 depicts Levine's "Conservation Principles" and their interconnection within the nurse-client relationship.

Levine recognized the importance of the nurse-patient relationship and its effect on the patient's well-being. Both nurses and patients consider maintaining their integrity during interactions to be significant. For example, Sarah brings her daughter Claire to the emergency room after a seizure at home. Despite having prescribed medication for Claire's seizures, Sarah chooses not to administer it herself in order to preserve her own integrity and gain acceptance within her community. The primary care nurse practitioner also has a responsibility to maintain personal integrity by remaining composed during each visit with this patient. It is their duty to re-educate Sarah on the care plan or make modifications based on her family's needs. This provides an opportunity to discuss alternative medications, educate Sarah on how to administer current medication, and refer her to a neurologist if necessary. Levine's four conservations are crucial when tailoring the care plan. Seizures result in energy expenditure by the patient, which can potentially impact structural integrity through reduced oxygenation to the brain and resulting neurological deficits (Fig 1.3). The nurse aims to educate Claire's family in order to uphold their personal integrity and effectively communicate the care plan. This can have a transformative effect on the family by reducing stress levels. It is important to recognize that nursing models inherently involve assumptions;However, it is crucial to acquire knowledge from these assumptions.

According to Levine's conservation theory, nursing interventions can impact both sick and healthy patients, regardless of illness. Patients often desire acceptance while staying true to themselves. It should be noted that the interpretation of "environment" in Figure 1.2 may lead to misunderstandings, suggesting that learning only happens in stress-free situations. However, stressful situations actually offer valuable learning opportunities for patients, families, and nurses. Additionally, assuming that all individuals behave similarly and use the same processes is incorrect since patients, nurses, and primary care professionals are diverse. Nursing interventions should take into account scientific knowledge as well as each individual's behavioral responses.

Levine's model of advanced practice nursing (Figure 1.2) lacks responsiveness to interventions and the integration of trial and error processes. Advanced practice nurses consistently intervene to improve patient health but may not always achieve success with their interventions. The constant need for advanced nurse practitioners to adapt their care plans highlights the cyclical nature of nursing as a framework.

Levine (2013) argues that holistic nursing emphasizes integrating the nurse's expertise and empathy towards patients, aligning with the goals of advanced practice nurse practitioners.

The text explores how primary care nurse practitioners can enhance their competence, knowledge, and skills as they advance from the role of a registered nurse. This increased knowledge enables them to make better decisions, determine appropriate treatment options, and educate patients throughout their lifespan to help them maintain good health. Nurse practitioners align with Levine's holistic approach to healthcare by emphasizing prevention as the best form of intervention. Therefore, adopting a comprehensive perspective when treating patients and dedicating significant time to listen and educate them can greatly benefit nurse practitioners. It is important to recognize that each patient, medical case, and care plan is unique. Nurse practitioners excel at understanding their patients' specific requirements by spending quality time with them, which enhances patient success and promotes healing. Additionally, nursing theory plays a crucial role in the nurse practitioner's understanding of the interrelationships between a patient's conservation of energy (html tag), social integrity (html tag), structural integrity (html tag), and personal integrity (html tag). Expanding their knowledge base allows nurse practitioners to become well-rounded professionals who acknowledge and address the realities of a patient's environment in order to improve overall health.Nurse practitioners have the responsibility of addressing various factors, both internal and external, that may cause distress for patients. They provide support and education to enhance the well-being of patients. Despite the evolving nature of the nurse-patient relationship and the challenges it may face, nurse practitioners are accountable for applying these theories in practical ways.

References

Alligood, M. R., & Tomey, A. M. (2010). Nursing Theorists and Their Work (7th ed.). Retrieved from Cardwell, S. (2013). Copy of Myra Levine. Retrieved from http://prezi.com/uths961c5swr/copy-of-myra-levine/ Fawcett, J., Schaefer, & Moore, K. (1991). Levine’s conservation model: a framework for nursing practice. Philadelphia: F.A. Davis Co. University of the Philippines Open University. (2011). Nursing Theories. Retrieved from http://nursingtheories.blogspot.com/2011_07_01_archive.html You Tube.( 2011). The Nurse Theorists - Myra Levine Promo.Retrieved from http://www.youtube.com/watch?v=C8tJUjDDKKw