The emergency department has long been an area where primary focus was placed on the chief complaint. The chief complaint was addressed, and the patient was discharged to follow up with their doctor.
Fewer people today have access to a primary care provider, and these individuals rely on EDs to provide all of their healthcare needs.
Healthcare providers are affected by decreasing numbers of hospitals/emergency departments, increasing numbers of patient visits and a longer length of stay in the department. Increased wait times in the ED are directly associated with these increased visits.1 This is especially notable in urban areas.2
There is also the problem of ED nurses caring for admitted patients who must remain in the department due to the decreased availability of acute care beds. The emergency nurse is often in the essential role of care planner and provider.
The increased time in the ED requires the emergency nurse to perform an assessment that encompasses many personal and social aspects of the patient and significant others compared to the single complaint of the past. Nurses frequently are required to provide care as they continue to perform their assessment.
The nurse educator must prepare future nurses for the expanded role that emergency nursing requires. This includes rapid assessment, the use of critical thinking in determining the course of care, health promotion and patient teaching.
When the student first arrives in the classroom, the student should be encouraged to develop their critical thinking and assessment skills. This didactic focus should be on synthesis and application of knowledge within the nursing process.
Students need to be taught to seek clarification, to understand the reasoning/rationale behind what they are learning. They should also be taught to question their personal bias/beliefs in the acquisition of knowledge. This can be accomplished through Socratic questioning conducted in a supportive environment.
Repeated use of this method will stimulate the students to begin raising questions. This requires a commitment by the student to review their course materials prior to their class and a commitment by the instructor to engage the student, while keeping them interested in the material. The resulting development of problem-solving skills will be beneficial in making valid, precise and applicable clinical decisions in the emergency setting.3
The clinical setting offers the opportunity for students to learn rapid assessment skills.
The student should be taught that the initial greeting and touch of a patient’s hand can provide a great deal of information, making this the beginning of the assessment process.
In the first clinical rotation students should be encouraged to introduce themselves to their patients and converse with them for a few minutes. When the students return, ask them to describe as much as they can about their patients from both a physical and psychosocial frame of reference.
Then the student should be asked what they think they neglected to observe or assess during this brief interaction. This exercise will help the students to refine their assessment skills throughout their clinical and learning laboratory experiences.
Each encounter with a patient and family should be used as an opportunity to determine physical, psychosocial and teaching needs.
Throughout our curriculums, we expose our students to the need to educate patients prior to discharge. Students are taught the domains of learning, how to teach using these domains and how to evaluate the learning that has occurred. The student is also taught to provide information and skills at a level that the patient can understand.