dr. elsye maria rosa, m.kep (emergency_nursing_practice )

7/28/2019 Dr. Elsye Maria Rosa, M.kep (Emergency_Nursing_Practice )

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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 melibatkanberbagai 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 asperceived 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 thespecialty of emergency nursing, focus on one of the

following:

1. Specific body system

2. Specific disease process/problem3. Specific age group

4. Specific population, such as women’s 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 menurunkanangka kematian dan kecacatan.



Tugas dan Fungsi

Memberikan pelayanan kesehatan pasien gawat daruratselama 24 jam secara terus menerus danberkesinambungan, meliputi:

a. Mengelola pelayanan gawat darurat

b. Melakukan pelayanan siaga bencanac. Melaksanakan pendidikan dan pelatihan gawat darurat

d. Mengelola fasilitas, peralatan dan obat-obatan lifesaving

e. Mengelola tenaga medis, tenaga keperawatan dan

tenaga non-medisf. Mengelola administrasi dan keuangan UGD

g. Melaksanakan pengendalian mutu pelayanan gawatdarurat

h. Melakukan koordinasi dengan unit/RS lain.



Tujuan

• a. Mencegahkematian dankecacatan padapenderita gawatdarurat,

.

•b. Menerimarujukan/merujukpenderita gawatdarurat.

•c. Melakukanpertolongankorban musibahmassal

•d. Mengembangkandan menyebarluaskan

pengetahuan



SIFAT PASIEN GAWAT DARURAT

PERLUPERTOLONGAN

SEGERA,

CEPAT, TEPAT DAN

AMAN

MEMPUNYAIMASALAH

PATOLOGIS,

PSIKOSOSIAL,LINGKUNGAN,KELUARGA

TIDAK SABAR

MENUNGGUINFORMASI

UNIK

PERAWAT

PROFESIONAL



Perawat gawat darurat

Orang terdekatdengan pasien

Paling mengetahuiperkembanganpasien saat dirawat

tanda – tandakegawatan

Mampu mengenalgejala danpertolongan

sebelum dokter datang

Bertanggung jawabatas perkembangandan tindakan yang

telah dilakukanpencatatan

Berfikir danberinisiatif

Melihat gejala pasiensyok hipovolemik

Interpretasi data syok ?produk urine, sirkulasi

perifer, kehausan,kesadaranatur posisi pasien, berikan

oksigen, hangatkan perifer



ER NURSE ROLE

Care provider : provides comprehensive direct careto 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 moreresponsibility 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 patient’s rights



The Staff Emergency Nurse shall meet

specified qualifications for employment.

Minimum TWO years acute care, medicine/surgeryexperience in an active treatment setting ispreferred. Emergency nursing recognizes the needto develop and train new graduates in the skills andknowledge 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 NursingPractice

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 andPrioritization

2. Stabilization andresuscitation

3. Assessment, Diagnosis,Planning and Implementation

of interventions wherelimited data may be available

and evaluation of patient

response.

4. Provisions of care inuncontrolled and/or

unpredictable situations

5. Crisis interventions tomeet the needs of

unique patient situations

6. Emergency OperationsPreparedness

7. Education of thepatient and community

to facilitate attainment of

an optimal level of wellness

8. Wellness initiativesdirected to patient andcommunity, particularly

related to disease andinjury prevention

9. Research

10. Forensic Nursing

Sumber: The National Emergency

Nurses’ Affiliation (NENA) Inc



FUNGSI INDEPENDEN DI UGD

DIJABARKAN•Sebagai TUANRUMAH YG BAIKBAGI PASIEN /ANGGOTA TIMKES. LAIN

•MelaksanakanPENGKAJIAN,

•MembuatDIAGNOSA,

•MerencanakanYANKEP,

•MelaksanakanTINDAKAN ASKEP,

•Mengevaluasi YANKEP,

Mendokumentasikan PROSES KEP.

•MelaksanakanKEBIJAKAN DAN

PROSEDUR YGBERLAKU DI RS /UGD



•SEBAGAIKOMUNIKATOR

•MERAWAT &MENJAGA KEUTUHANALAT AGAR SIAP

PAKAI

•SEBAGAI OPERATORUNTUK ALATKEDOKTERAN : EKG,

DEFIBRILATOR,RESPIRATOR,NEBULIZER, MONITORJANTUNG, AIR VIVA DLL.

•SEBAGAI PEMBERI ASKEPPASIENGAWAT DARURAT SELAMA

24 JAM TERUS- MENERUSBerkesinambungan, TURUTSERTA DALAM KLB.



KEMAMPUAN MINIMAL PETUGAS UGD

Pedoman DepKes 1990

1. Membuka & Membebaskan JALAN NAFAS (Airway)

2. Memberikan VENTILASI PULMONER

OKSIGENISASI (Breathing)

3. Memberikan SIRKULASI ARTIFICIALdengan jalan MASSAGE JANTUNG LUAR

(Circulation)

4. Menghentikan PERDARAHAN, BALUT BIDAI,

TRANSPORTASI, Pengenalan & Penggunaan OBATRESUSITASI,

5. 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

• PREHOSPITALCARE

•EMERGENCYTELEPHONE

•INTRAHOSPITALCARE

•ELECTRONIQUE

TECHNOLOGY



STANDARD I: TRIAGE Assessment

• rapid, systematic collection of data related to the patient’schief complaint.

• categories: resuscitative, emergent, urgent, less urgent andnon-urgent

Analysis/Plan

• assessment shall be analyzed to determine acuity,patient care area, and any appropriate interventionsbased on triage protocol

Intervention

•Initiates nursing interventions according to triageprotocols

Collaborative Intervention

Evaluation



STANDARD II: ASSESSMENT

• 2.1 Initial Assessment: Initialassessment shall include systematicand pertinent collection of data basedon the chief complaint.

• 2.2 Ongoing Assessment:Continuing reassessment shall beperformed to include systematic andpertinent collection of data that reflectthe current health status of the

patient.

The Emergency

Nurse Assessment of Physical,Psychosocialand Spiritual needs of

Patients within theEmergency Care

System.



STANDARD III: ANALYSIS/PLANNING

1. Plan of Care2. Supplies

and Equipment

3. Safety4. Legal

Responsibilities



STANDARD IV: INTERVENTION

• The Emergency Nurse shallfunction independently within thescope of Professional NursingPractice established by their

respective regulatory body.

IndependentFunctions

•The Emergency Nurse shall function

collaboratively with other health careproviders to implement the plan of care within the scope of professionalnursing practice.

CollaborativeFunction



STANDARD V: EVALUATION

• Emergency Nursing Care shall be evaluated on acontinual basis to determine attainment of patientcentered outcomes.

• Records and uses current patient data to measureprogress

• Utilizes data from the patient, primary care giver, andmembers of the health care team

• Documents r eassessment of the patient and revises

the plan of care accordingly

Evaluation:

• The Emergency Nurse shall be involved inmechanisms to regularly evaluate and

monitor the quality of emergency care.• Participates in the development of continuous

quality improvement (CQI) plans

InitiativesDevelopment



STANDARD VI: ETHICS

Code of Ethics for Nursing. Ethics: The Emergency Nurse shall provide care that

demonstrates ethical beliefs and respect for the patient’srights.

Respects the individuality and human worth of the patientregardless of age, sexual orientation, socioeconomicstatus, 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 inassisting the patient

Takes actions which are consistent with their professionalresponsibilities and standards of practice



STANDARD VII: COMMUNICATION

• The Emergency Nurse shall provide sufficientinformation to allow the patients and significantothers to participate in the patients care.

Liaison with the Patientand Significant Others

• The Emergency Nurse shall participate ineducational endeavours related to theprovision of emergency care within thecommunity.

Liaison with Community

• The Emergency Nurse shall effectivelycommunicate, in order to facilitateeffective and comprehensive emergencyhealth care

InterdisciplinaryRelations

•The Emergency Nurse shall interact as team members of the

Emergency Medical System, respecting the limits, capabilities, andresponsibilities of all members.Interactions

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

PublicRelations

T T ( )



EMERGENCY DEPARTMENT (ED)

ENVIRONMENT

ENTRANCES TRIAGEWAITING ROOM

EXAMINATIONROOMS

MINORSURGERIES

LABORATORYX-RAY ROOM ORTHOPEDICROOM

AMBULANCEAREA

OFFICESCONFERENCE

ROOM



Emergency Department (ED)