Observation Paper

can you write an observation paper on the emergency department, and follow the rubric for this paper and i will attach my friend work as guide line but please don’t copy her paper, also my clinical day is next Tuesday i will add some information here when i come. and write 8 pages no include the cove and reference page.  using APA format and use  least 2 peer reviewed nursing journal articles less than 5 years and attach the PDF of resource.

Trauma Center Research Paper Objectives

1. Describe Triage Protocol: how are patient’s triaged; what are the numbers or colors used for triage during disaster

2. Identify 5 safety guidelines/practices specific to the Trauma Center. Step beyond standard precautions! What measures/guidelines are observed to protect staff, nurses, doctors, other patients? REFERENCE A TRAUMA CENTER SAFETY POLICY IN YOUR PAPER.

3. Define what “The Critical Hour” means for Trauma Victims. Describe 60 minutes of patient care for a selected patient in the Trauma area in which you are assigned. Choose a patient, (critical, if available) and document 60 minutes of care for that patient. Include Chief Complaint, history of present illness, nursing interventions provided upon patient arrival to ER room (example: O2, EKG, bp, etc) IV’s (site, type (ie 20 g), Medications including fluids (crystalloids & colloids) administered, Oxygen, diagnostics completed (example: labor, testing), differential medical diagnosis considered upon patient arrival, final medical diagnosis, disposition of patient (example: admit, discharged, etc). Provide a care plan inclusive of 1 nursing diagnosis, 2 interventions, 1 outcome and evaluation of your interventions and outcome

4. During your clinical experience, describe an example of autonomy of the Trauma Nurse. Provide details of any ethical and legal dilemmas the Trauma Nurse was confronted with during your clinical experience. Include what the outcome was and if you concur with how it was handled by the nurse. If you did not identify an ethical and legal dilemma that occurred; identify an ethical and legal dilemma that could have occurred in the given situation and how it could be resolved

5. Reflect on your Trauma unit experience. Describe and/or identify an issue new to you and what was gained from your experience in the Trauma Center. This is time for personal reflection of how you felt, what you experienced, etc. Examples could be: what was learned; what would you do different/same as a nurse in this role; what ethical issues did you see; what type of doctor/nurse interactions were observed; was anything observed questionable from an ethics, harassment, bullying, etc, standpoint. This goes well beyond the “I liked what I did. It was fast paced and I learned a lot” response!

6. APA format, typed, double spaced, title page, sentence structure and spelling and grammar accurate. References are required, including at least 2 peer reviewed nursing journal articles. USE YOUR APA REFERENCE BOOK!!!!! Review the Professional Writing Policy in your student handbook

7. Journal Articles used as a reference are provided, and/or links are valid and journal article easily accessed.

8. LENGTH: Minimum 8 pages not including cover and reference pages

SEE SYLLABUS FOR DUE DATE

Grading Criteria – Trauma Center Experience Be sure to read the paper objectives prior to the experience and paper write up!!

Please attach a copy of the grading criteria with your paper. THANK YOU!!!

Content Possible

Points

——————-Comments————– Points

Received

Triage Protocol (how are patient’s triaged; what are the colors used for triage during disaster) 10
5 safety guidelines/practices 10
The Critical Hour Discussion of Focus Client

1 nursing diagnosis, interventions, outcomes and evaluation

45
Discussion of autonomy and ethical and legal dilemmas 12
Reflection on the Overall Experience (examples: what was learned; what would you do different/same as a nurse in this role; what ethical issues did you see; what type of doctor/nurse interactions were observed; was anything observed questionable from an ethics, harassment, bullying, etc, standpoint; etc) 10
APA Format with reference page. Mechanics (Grammar, Sentence Construction, spelling, etc.)

Minimum 8 pages not including cover and reference pages

8
References provided and integrated including minimum 2 peer reviewed nursing journal articles to support paper (2 pts each). Journal Articles provided &/or links are valid and access journal article (1 pt). 5
Total 100

Graded By _______________________________________________

Running head: TRAUMA CENTER PAPER 1

TRAUMA CENTER PAPER 8

Trauma Center Paper

Meghan Inman

Patty Hanks Shelton School of Nursing

Trauma Center Paper

Introduction

The Trauma Center can be a fast paced, exhilarating place for nursing students as well as nurses. However, there are certain guidelines in place along with safety protocols to ensure that nurses provide prudent care and that patients and the nurses are safe. It is important in the trauma center setting to not only be fast but also be safe.

Triage Protocol

The triage protocol is different at Hendrick Medical Center because rather than use a numbering system, they use a color system based on severity of the patient. After a color assignment, the patient will then go the appropriate color location. If the patient is in a life-threatening condition such as a heart attack or stroke, they are given the color red. The next color below red its yellow reflecting conditions like chest pain. With a yellow color, the patient may be having symptoms leading to a life-threatening event that can receive interventions to prevent the life-threatening event. The next color is green which reflects stable patients that may need an intervention such as fluids to treat them. An example of a green patient is someone with gastroenteritis who has been nauseous and vomiting since the previous day.

Safety Guidelines

Safety guidelines are of the upmost importance in any area of the hospital. Not only are there safety measures in place for the patient but also for the physicians, nurses, and other staff. The first safety measure I noted was a badge scanner protects the access to the actual emergency department. One must be an employee of Hendrick or must be accompanied by an employee of Hendrick to come back. I believe this is in place to protect the safety of the staff. This keeps only authorized people and patients back in the exam rooms.

The second safety measure in place is that there is always two to three security guards rounding in the Hendrick trauma center and checking on nurses. This is important for when a patient becomes combative or if a patient comes in feeling unsafe or abused. I think this not only promotes safety but promotes collaboration through all of the disciplines at the hospital.

The third safety guideline noted is the staffing ratio. Throughout the day the charge nurse rounded the unit to ensure that there were enough nurses for the patient load. In On the Threshold of Safety: A Qualitative Exploration of Nurses’ Perceptions of Factors Involved in Safe Staffing Levels in Emergency Departments they discuss the positive and negative factors in safe staffing ratios. This study asked nurses about solutions to better staffing and they stated,

“…having huddles throughout the day to reorganize care, establishing processes for other nurses in the hospital to provide patient care in the emergency department during surges, and engaging staff and administration in understanding the complex interplay between adequate staffing and the provision of high quality, safe, emergency care. … finding ways to cope with the emotional toll and cultivate a supportive work environment” (Wolf, Perhats, Delao, Clark, Moon, 2017).

I agree that all of these things should be implemented into emergency department nursing. They also discussed retaining nurses and having more than one or two experienced nurses working in the trauma center. This can be complicated because many nurses get burnt out in a trauma center setting however, if trauma centers implement what the nurses spoke of above it may decrease the burn out in nurses. Within the Hendrick trauma center I saw many nurses working together and helping each other out and even doctors stepping in to help nurses.

The fourth safety measure implemented was the five medication rights of medications four times before giving medications to patients. They also would check with other nurses if they had to calculate a drip rate or if they were giving a high alert medication. The nurses also talked about the implementation of the medication scanning system that they use on the floors coming in June to help promote more medication safety.

The final safety measure implemented is special trauma rooms in place for large traumas that come in. Within these rooms they have everything needed for any type of trauma. I think this promotes safety because it promotes timely implementation of interventions. Time is crucial in the trauma center and so any measure to minimize time is going to promote better outcomes and safety.

“The Critical Hour”

The “Critical Hour” is a term used to describe the first hour that the patient is in the trauma center. This is the most important time period for the patient because the sooner interventions are done the better the patient outcome is. The patient I will be discussing is a female who came in complaining of a nose bleed lasting since 0200. The patient arrived to the trauma center at 1000. Upon entering the room the patient was not having any active bleeding of the nares. When shining a pen light up the nares there were also no blood clots or signs of trauma to the nose. The nurse questioned the patient asking about medical history and any medications taken. He also asked if she had done anything to stop the nose bleed. Getting a health history from this patient was difficult because she could not remember any of her medications or any history of medical problems. The only thing she stated was that she takes pills for her diabetes. The nurse asked about any use of anticoagulants and the patient denied use of them. After this question the patient stated that she had a mild stroke previously and that her chest was feeling the same way it did when she had the stroke. She showed no signs of residual deficits from the stroke. The nurse then found the doctor and discussed the assessment data with him. Although the patient denied using a blood thinner the doctor believed she may be experiencing a side effect or toxicity of the blood thinner. The nurse asked if she could be moved to a different room and monitored via a five lead electrocardiogram. The doctor said yes. When attached to the five lead the patient was in normal sinus rhythm displaying a P wave, QRS complex, and T wave. Once hooked up to the five lead the patient complained of chest pain at seven out of ten. The nurse informed the doctor and he ordered aspirin 325 mg and nitroglycerin sublingual. While the nurse gathered the medications, I placed an 18 gauge IV in the right antecubital fossa. I then collected “rainbow labs” which consists of a CBC, CMP, PT, PTT, lactic acid, and troponin levels. Vitals were taken and the values were within normal limits besides a slightly elevated blood pressure. Her blood pressure was 135/85 and her oxygen saturation was 100% on room air. Her pulse was 85. Respirations were 18. The labs came back with slightly elevated troponins. Upon seeing the troponin levels, the patient was admitted to Anderson 5, a telemetry observation floor to monitor the chest pain at 1230. One nursing diagnosis for this patient would be ineffective tissue perfusion: myocardial. One intervention we performed was connecting the patient to the 5 lead EKG for monitoring. The other intervention was to keep the patient NPO in case the patient needed to be rushed to the cath lab. We not only did these two interventions. We gave medications, ensured the patient stayed calm, and rested so she did not place extra stress on her heart. One outcome would be to relieve or lessen the chest pain of the patient. To help with this we gave one nitroglycerin tablet. Thirty minutes later, I went back and asked her about her chest pain and she said it remained at a seven. Just before transferring the patient, she stated her chest pain was at a five. I believe our intervention was effective because in the end it did decrease the chest pain along with the other interventions we performed.

Autonomy of the Trauma Center Nurse

Trauma center nurses must be able to think critically, quickly, and be able to ac autonomously. They do many things in anticipation for what may happen such as: starting an IV and fluids, drawing labs, and hooking patients up to a five lead EKG. Another part of nurse autonomy is within the Apollo charting system. They can open up a patients chart, type in their chief complaint and a list of orders will come through and the nurse can implement the appropriate orders for the patient.

Ethical/Legal Dilemma

An ethical dilemma I observed was during our assessment of the patient I discussed during the Critical Hour section. When we would ask her questions about medical conditions or we would name one she would say yes. This made it hard to get to the root of the problem and provide treatment. When we left the room and the nurse asked a more experienced nurse for advice, the experienced nurse told him, “she may just be looking for drugs and saying what she needs to get the medicine.” Although the patient may be looking for drugs we are still obligated to treat everyone the same. In my opinion, we should have waited for a family member to come and ask them more about her medical history.

My Reflection

I enjoyed my time in the trauma center. I was amazed at how the entire team worked together and supported each other. Although there were times when the floor would become very busy, the nurses remained calm and were certain to give patients the time they needed. What I learned from this experience was to be patient when asking a patient questions and what questions to ask to get to the root of the problem. There were many times when I think a question would not be pertinent but it would lead to a question that would help us identify the problem. It was also interesting to see the dynamic between nurses and doctors. They were very collaborative and the doctors respected the nurses recommendations for treatment. I think I would like to maybe work in the trauma center one day. However, I would like to develop my critical thinking skills and confidence in my autonomy before working in that setting.

References

Wolf, L. A., Perhats, C., Delao, A. M., Clark, P. R., & Moon, M. D. (2017). On the threshold of safety: A qualitative exploration of nurses’ perceptions of factors involved in safe staffing levels in emergency departments. Journal of Emergency Nursing, 43(2), 150-157. doi:http://dx.doi.org/10.1016/j.jen.2016.09.003

 
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