Nursing and Emergency Specialty
Emergency Health Care
Emergency nursing is multifaceted by its very nature. Emergency patients range from newborns to the "old-old" and the nursing and medical diagnoses for which they seek treatment include common illnesses such as flu symptoms to life-threatening injuries or events. Emergency nursing research, then, has many foci.
The breadth of emergency nursing care enables emergency nurses to apply evidence-based knowledge from other clinical nursing specialties, but emergency nursing presents challenges that are unique to the emergency or urgent care setting.
Emergency As A Specialty
While the exact number is unknown, it is estimated that about 80,000 RNs consider emergency nursing to be their clinical specialty. What is known is that in 2003, Americans made 110.2 million visits to hospital emergency departments (National Hospital Ambulatory Medical Care Survey: 2002 Emergency Department Summary, Centers for Disease Control and Prevention (CDC)).
This represents a
23% increase in emergency department usage in the past decade Of note is that
while usage of the emergency departure has increased, the number of emergency
departments in the US has decreased by approximately 15% (National Center for
Health Statistics, March, 2004).
Emergency Nursing Association
In 1991, the Emergency Nurses Association (ENA) Foundation was established as a means to provide funding (and encouragement) for peer reviewed research. In addition, shortly thereafter, a doctor ally prepared nurse researcher was hired to be the Director of Research at the Emergency Nurses Association's headquarters.
Several multisite studies were developed and conducted by a team
of researchers, using practicing emergency nurses as data collectors. The
convergence of these factors served to aid in the creation of a "research
culture" as a visible component of emergency nursing.
Emergency Nursing Research
As
noted by Bayley, MacLean, Desy , and McMahon (2004), the number of emergency
nursing research articles increased from 49 studies in the years between
1982-1991 to 262 studies published between 1992-2002, representing a fivefold
increase. They found, however, that emergency nursing research was
"scattered across many topics."
Research Initiative
As the major source of funding for emergency nursing research, the ENA Foundation established a list of "research initiatives" that would receive preference in funding decisions.
The current research initiatives are:
(a) mechanisms to assure effective, efficient, and quality emergency nursing care delivery.
(b) effective and efficient outcomes of emergency nursing services and procedures.
(c) factors affecting emergency nursing practice.
(d) influence of health care technologies, facilities, and equipment on emergency nursing practice.
(e) factors affecting health care cost, productivity, and market forces to emergency services.
(f) ways to enhance health promotion and injury prevention.
(g) methods for handling complex ethical issues related to
emergency care; and ( ht mechanisms to ensure quality and cost-effective
educational programs for emergency nurses.
Benefits of Nursing Emergency Research
While these initiatives gave a sense of direction, in many ways they were considered. to be too broad to foster the concerted effort needed to build an emergency nursing knowledge base necessary for evidence-based practice.
Excellent studies that have had important consequences for the care of emergency patients and their families have been the direct result of funding provided by the ENA Foundation.
One such study involved the issue of family presence during
resuscitation. The concept of family members being present at stressful times
has received a good deal of attention, not only by and for emergency nurses,
but this knowledge base has been extended to use in other areas of nursing.
A review of research presentations and posters displayed at the most recent annual meeting of the Emergency Nurses Association can give an overview of topics of interest in emergency nursing research, included in oral presentations were topics focusing on blood drawing techniques, injury prevention, use of the emergency department for nonurgent illnesses, emergency nurse burnout, and aspects of pain management.
Some examples of poster presentations included: triage, trauma care, standardized language usage (NIC, NOC, NANDA), pain management protocols, and pediatric issues. It becomes clear that although the research culture in emergency nursing has consistently increased and excellent studies are being conducted, the issue of the research being scattered rather than focused remains a concern.
The Emergency Nurses Association also has worked closely with the US Coast Guard in research funded by the Coast Guard to examine factors related to boating injuries. This is in keeping with a commitment of the Association to engage in injury prevention activities from a number of different perspectives.
In addition, the Association has also
conducted extensive research funded by the Health Resources and Services
Administration's Maternal and Child Health Bureau (HRSA/MCHB) focused on the
provision of family-centered care in the emergency departure.
Emergency Nursing Association Funds and Supporting
In 2002, Bayley, MacLean, Desy , and McMahon, with funding and support from the Emergency Nurses Association and the ENA Foundation, undertook a Delphi study to identify and prioritize "research questions of greatest value to emergency nurses and of highest importance for health care consumers."
Participants in the study were highly experienced in emergency nursing and most had advanced degrees. After the round I responses were collapsed into 154 research topics, participants in round II were asked to evaluate each of the topics using two questions:
(1) what is the value of research on this question for practicing emergency nurses, and
(2) what is the importance of research on
this question for consumers of emergency nursing services?"
Results demonstrated that the answer to the first question about value of the research question to practicing emergency nurses concerned issues related to staffing, holding patients in the emergency department for long periods of time, and the ongoing educational needs of emergency nurses.
The second question, having to do with the importance of the research to consumers of emergency care, issues of pain management were of most concern.
Other areas of highly ranked research need for emergency nurses included methods of effective patient education, and the provision of sufficient numbers of adequately prepared professional nurses for the care of persons with emergency health problems.
The authors noted the consistency of the findings with ENA's mission and values, especially the value statement "All individuals have a right to quality emergency care delivered with compassion."
They postulated that all of the highly ranked research topics had safety and quality of care as the central organizing principle.
The information derived from this important study will be of immense help to future emergency nurse researchers as well as practicing emergency nurses who seek to provide the most relevant, evidence based practice to their patients.
The results of the study can organize and focus future research endeavors as well as establish funding priorities for the ENA Foundation and others. The future for emergency nursing research is brighter because of the Delphi study.
Now, emergency nursing researchers will be able to develop the knowledge base essential for effective emergency nursing practice.
Give your opinion if have any.