Emergency Nursing Practice

Dr. Elsye Maria Rosa, M.Kep

UNIT GAWAT DARURAT

Unit Gawat Darurat (UGD) : adalah unit pelayanan di Rumah sakit yang memberikan pelayanan pertama pada pasien dengan ancaman kematian dan kecacatan secara terpadu dengan melibatkan berbagai multidisiplin

Emergency Nursing

Emergency Nursing is practiced in a unique environment which includes unplanned situations requiring intervention, the allocation of limited resources, and the need for emergent care as perceived by many patients arriving in an unscheduled manner, potentially creating a stressful, chaotic environment.

The services provided by the Emergency Nurse must be directed and structured to maximize the available time, space and resources within which the nurse functions.

Emergency Nursing
The profession of nursing is diverse, so too is the specialty of emergency nursing, focus on one of the following: 1. Specific body system 2. Specific disease process/problem 3. Specific age group 4. Specific population, such as womens health care or mental health

Falsafah

Kecepatan dan ketepatan dalam memberikan pertolongan pada pasien sesuai tingkat kegawatdaruratan, tanpa membedakan sosial, ekonomi, agama dan ras dan akan menurunkan angka kematian dan kecacatan.

Tugas dan Fungsi

Memberikan pelayanan kesehatan pasien gawat darurat selama 24 jam secara terus menerus dan berkesinambungan, meliputi: a. Mengelola pelayanan gawat darurat b. Melakukan pelayanan siaga bencana c. Melaksanakan pendidikan dan pelatihan gawat darurat d. Mengelola fasilitas, peralatan dan obat-obatan life saving e. Mengelola tenaga medis, tenaga keperawatan dan tenaga non-medis f. Mengelola administrasi dan keuangan UGD g. Melaksanakan pengendalian mutu pelayanan gawat darurat h. Melakukan koordinasi dengan unit/RS lain.

Tujuan
a. Mencegah kematian dan kecacatan pada penderita gawat darurat, . b. Menerima rujukan/merujuk penderita gawat darurat. c. Melakukan pertolongan korban musibah massal

d. Mengembangkan dan menyebarluaskan pengetahuan

SIFAT PASIEN GAWAT DARURAT

PERLU PERTOLONGAN SEGERA,

CEPAT, TEPAT DAN AMAN

MEMPUNYAI MASALAH PATOLOGIS, PSIKOSOSIAL, LINGKUNGAN, KELUARGA

TIDAK SABAR MENUNGGU INFORMASI

UNIK

PERAWAT PROFESIONAL

Perawat gawat darurat

Orang terdekat dengan pasien Paling mengetahui perkembangan pasien saat dirawat tanda tanda kegawatan Mampu mengenal gejala dan pertolongan sebelum dokter datang

Bertanggung jawab atas perkembangan dan tindakan yang telah dilakukan pencatatan

Berfikir dan berinisiatif

Melihat gejala pasien syok hipovolemik

Interpretasi data syok ? produk urine, sirkulasi perifer, kehausan,kesadaran atur posisi pasien, berikan oksigen, hangatkan perifer

ER NURSE ROLE
Care

provider: provides comprehensive direct care to the patient and family. Educator: provides patient and family with education based on their learning needs and the severity of the situation and allows the patient to assume more responsibility for meeting health care needs Manager: coordinates activities of others in the multidisciplinary team to achieve the specific goal of providing emergency care Advocate: ensures protection of the patients rights

The Staff Emergency Nurse shall meet specified qualifications for employment.

Minimum TWO years acute care, medicine/surgery experience in an active treatment setting is preferred. Emergency nursing recognizes the need to develop and train new graduates in the skills and knowledge needed to become specialized as an Emergency Nurse. Competence in: Basic Cardiac Life Support (BCLS) procedures Advanced Cardiac Life Support (ACLS) protocols Pediatric Advanced Life Support (PALS) protocols Emergency Nursing Pediatric Course (ENPC), Course on Advanced Trauma Nursing (CATN II),

The Triage Nurse shall meet specified qualifications for employment

Minimum TWO years recent Emergency Nursing Practice Demonstrated competence in Emergency Nursing Practice Displayed acquisition of Advanced Assessment, Interviewing and Interpersonal skills

ER NURSING INTERVENTIONS
INDEPENDENT

Fungsi mandiri berkaitan dengan pemberian asuhan (Care) DEPENDENT Fungsi yang didelegasikan sepenuhnya atau sebagian dari profesi lain INTERDEPENDENT Kerjasama saling membantu dlm program kes.(Perawat sebagai anggota Tim Kes.)

The Clinical Nursing Educator shall meet specified qualifications for Employment

THREE years recent Emergency Nursing Experience Experience in instructional methods Baccalaureate Degree-Nursing is preferred. Demonstrated comprehension of specific needs of the Adult Learner

The Unit Manager shall meet specified qualifications for employment

Minimum of 5 years Emergency Nursing Experience Maintains a working knowledge of and supports the dissemination of same in the work environment: Demonstrate comprehension of Nursing Management Strategies Demonstrated leadership skills Baccalaureate Degree-Nursing is preferred.

The scope of Emergency Nursing

1. Triage and Prioritization 8. Wellness initiatives directed to patient and community, particularly related to disease and injury prevention 9. Research

2. Stabilization and resuscitation

7. Education of the patient and community to facilitate attainment of an optimal level of wellness

10. Forensic Nursing

3. Assessment, Diagnosis, Planning and Implementation of interventions where limited data may be available and evaluation of patient response.

6. Emergency Operations Preparedness

4. Provisions of care in uncontrolled and/or unpredictable situations

5. Crisis interventions to meet the needs of unique patient situations

Sumber: The National Emergency Nurses Affiliation (NENA) Inc

FUNGSI INDEPENDEN DI UGD DIJABARKAN

Sebagai TUAN RUMAH YG BAIK BAGI PASIEN / ANGGOTA TIM KES. LAIN Melaksanakan PENGKAJIAN, Membuat DIAGNOSA,

MerencanakanYAN KEP, Melaksanakan TINDAKAN ASKEP,

Mengevaluasi YANKEP, Mendokumentasik an PROSES KEP.

Melaksanakan KEBIJAKAN DAN PROSEDUR YG BERLAKU DI RS / UGD

SEBAGAI KOMUNIKATOR

MERAWAT & MENJAGA KEUTUHAN ALAT AGAR SIAP PAKAI

SEBAGAI OPERATOR UNTUK ALAT KEDOKTERAN : EKG, DEFIBRILATOR, RESPIRATOR, NEBULIZER, MONITOR JANTUNG, AIR VIVA DLL.

SEBAGAI PEMBERI ASKEP PASIEN GAWAT DARURAT SELAMA 24 JAM TERUS- MENERUS Berkesinambungan, TURUT SERTA DALAM KLB.

KEMAMPUAN MINIMAL PETUGAS UGD Pedoman DepKes 1990

1.

2.

3.

4.

5.

Membuka & Membebaskan JALAN NAFAS (Airway) Memberikan VENTILASI PULMONER OKSIGENISASI (Breathing) Memberikan SIRKULASI ARTIFICIAL dengan jalan MASSAGE JANTUNG LUAR (Circulation) Menghentikan PERDARAHAN, BALUT BIDAI, TRANSPORTASI, Pengenalan & Penggunaan OBAT RESUSITASI, Membuat & Membaca REKAMAN EKG.

Legal issues affecting the provision of emergency nursing

Negligence Malpractice Informed consent Duty to report suspected crimes to the police Duty to gather evidence in criminal investigations; be aware of hospital policy and state laws for evidence collection Advanced directives, including durable power of attorney and living wills

EMERGENCY SERVICES
PREHOSPITAL CARE EMERGENCY TELEPHONE INTRAHOSPITAL CARE

ELECTRONIQUE TECHNOLOGY

STANDARD I: TRIAGE
Assessment
rapid, systematic collection of data related to the patients chief complaint. categories: resuscitative, emergent, urgent, less urgent and non-urgent

Analysis/Plan assessment shall be analyzed to determine acuity, patient care area, and any appropriate interventions based on triage protocol

Intervention
Initiates nursing interventions according to triage protocols

Collaborative Intervention

Evaluation

STANDARD II: ASSESSMENT

2.1 Initial Assessment: Initial assessment shall include systematic and pertinent collection of data based on the chief complaint. 2.2 Ongoing Assessment: Continuing reassessment shall be performed to include systematic and pertinent collection of data that reflect the current health status of the patient.

The Emergency Nurse Assessment of Physical,Psychosocial and Spiritual needs of Patients within the Emergency Care System.

STANDARD III: ANALYSIS/PLANNING

1. Plan of Care

2. Supplies and Equipment

3. Safety

4. Legal Responsibilities

STANDARD IV: INTERVENTION

The Emergency Nurse shall function independently within the scope of Professional Nursing Practice established by their respective regulatory body.

Independent Functions

Collaborative Function

The Emergency Nurse shall function collaboratively with other health care providers to implement the plan of care within the scope of professional nursing practice.

STANDARD V: EVALUATION
Emergency Nursing Care shall be evaluated on a continual basis to determine attainment of patient centered outcomes. Records and uses current patient data to measure progress Utilizes data from the patient, primary care giver, and members of the health care team Documents reassessment of the patient and revises the plan of care accordingly

Evaluation:

Initiatives Development

The Emergency Nurse shall be involved in mechanisms to regularly evaluate and monitor the quality of emergency care. Participates in the development of continuous quality improvement (CQI) plans

STANDARD VI: ETHICS

Code of Ethics for Nursing. Ethics: The Emergency Nurse shall provide care that demonstrates ethical beliefs and respect for the patients rights. Respects the individuality and human worth of the patient regardless of age, sexual orientation, socioeconomic status, cultural or ethnic background or spiritual beliefs Respects the health and well-being, choice, dignity, confidentiality, fairness and privacy of the patient Promotes and utilizes principles of equity and fairness in assisting the patient Takes actions which are consistent with their professional responsibilities and standards of practice

STANDARD VII: COMMUNICATION

Liaison with the Patient and Significant Others
The Emergency Nurse shall provide sufficient information to allow the patients and significant others to participate in the patients care.
The Emergency Nurse shall participate in educational endeavours related to the provision of emergency care within the community.

Liaison with Community

Interdisciplinary Relations

The Emergency Nurse shall effectively communicate, in order to facilitate effective and comprehensive emergency health care
The Emergency Nurse shall interact as team members of the Emergency Medical System, respecting the limits, capabilities, and responsibilities of all members.

Interactions Public Relations

The Emergency Nurse shall demonstrate skill in interacting with the public to foster the provision of respectful patient centered care

EMERGENCY DEPARTMENT (ED) ENVIRONMENT

EXAMINATION ROOMS

ENTRANCES

TRIAGE

WAITING ROOM

ORTHOPEDIC ROOM

X-RAY ROOM

LABORATORY

MINOR SURGERIES

AMBULANCE AREA

OFFICES

CONFERENCE ROOM

Emergency Department (ED)