Role of Nursing Associate in Emergency Department: A Case Study

This essay explores the role of nursing associate in providing physical and mental patient-centered care in the emergency department. It discusses communication, health promotion, and evidence-based practice. A case study analysis of a patient admitted following a fall is included.

Emergency department
nursing

Contents
INTRODUCTION...........................................................................................................................1
MAIN BODY..................................................................................................................................1
CONCLUSION................................................................................................................................5
REFERENCES................................................................................................................................7

INTRODUCTION
The role of nursing associate (NA) has become a crucial part of the nursing profession
bridging the gap between health care assistants and registered nurses. This essay will explore the
NA's role as part of a multi-professional team and its utilisation to support other professionals'
patients and their families in care delivery. The role will be described explicitly in the context of
a patient admitted to the emergency department following a fall and how the NA uses their
knowledge and skills to work with others in providing physical and mental patient-centred care.
The patient will be referred to as 'Grace', and the trust will remain anonymous to maintain
confidentiality and adhere to the nursing and midwifery councils (NMC) code of practice
(NMC,2018). The essay will also discuss the importance of communication and how the NA
uses different approaches to support families and facilitate patient care. Public health and health
promotion will also be discussed to explore contemporary methods and the significance of the
NA role in health promotion and understanding how illness prevention and behaviour can differ
through the lifespans. Different policies will also be reviewed to examine the influence they have
had on the role of the NA.
NA's are expected to use evidence-based practice (EBP) as a fundamental approach in their
care provision. EBP will be examined to explore how the NA applies it to inform their practice to
provide high-quality care that improves patient outcome.
MAIN BODY
In this essay role of NA is to provide acute care to patient while they are being admitted in
hospital care setting (Jangland and et.al., 2018). The data of patient is kept confidential and a
fictitious name is being given to patient that is Grace. This name will be used in addressing
patient due the confidentiality policy of hospital. Grace was being admitted to hospital as she
unwitnessed a fall, she was suspecting of having a fracture. She is a 75-year-old lady with a
medical history of dementia, she lives in a care home. Patient is also suffering from atrial
fibrillation. Grace has provided the power of attorney to her daughter. Patient was being admitted
to hospital for fracture and also assess for head injury. It was being analysed from the medical
record that patient have GCS at 14/15 (Lenaghan, Cirrincione and Henrich, 2018). The BP was
recorded at 160/90 and HR at the rate of 110. This measurement can give rise to issues related to
heart and also because of this well-being of patient and their quality of life can be affected
severely. From the medical record it was been analysed that patient BP was higher and the heart
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rate of patient is also 110 which is quiet high. It means that because of this patient can face issues
related to other conditions. It has also been analysed from the case study that patient one leg is
shorten and also she has limited mobility. This has made patient’s condition more worsening and
adequate and acute care is being needed so that health outcome of patient can be improved. It has
also been evaluated that these conditions have lower down self-esteem of Grace and there can be
deterioration in her mood swings. Patient also live alone and she had a daughter who lives far
away and only visit sometimes. This means that patient has no family to provide better support
(Pearlmutter and et.al., 2017).
It has been evaluated that in order to analyse situation of patient and to provide support with
her diagnosis adequate skills will be required by nursing associate. In this they need to make use
of better communication skills so that needs and demands of patients can be analysed. It means
that communication is a process through which knowledge can be traded between individuals. In
most of the cases verbal and nonverbal communication can be used. In this NA needs to analyse
their pitch and done which is being used with patient and also they need to be involved in
analysing the ways in which patient will be treated.
The nursing associated (NA) is been introduced to Grace and also NA has explained about
their role and responsibilities (Ridderikhof and et.al., 2017). Patient will be kept under
supervision of RN so that situation can be analysed and also RN will support NA if they face any
type of issue in handling of patients. NA was involved in completing the assessment booklet. In
this booklet he has filled the personal details of patient, risk assessment of mobility, malnutrition,
hydration and elimination. This booklet filling is necessary so that better care and accountability
can be given to patient. This is a form of nonverbal communication so that better and adequate
support can be provided to patient at the time of need (Finnegan and et.al., 2017).
By evaluating the situation of patient, NA realised that the pain level of patient has been
increased. NA assess pain level and he has also followed and suspected the fall and fracture.
Various test was being performed by NA such as ECG, X ray, CT scan, VTE risk assessment.
NA has analysed that there were changes seen in behaviour of patient. Grace seems to be sad,
agitated and restless (Catlin, 2018). NA was involved in analysing the reason for patient being
sad. It was being evaluated by NA that after her falling down, she has lost her confidence and
self-esteem and also her daughter was not there who can support her, so this was the reason
because of which she seems agitated and depressed. It was also being analysed by NA that
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elderly aged people tend to go through this type of behaviour, they feel lonely at times. Better
therapy was advised by NA to patient. NA communicated with Grace so that they can be able to
know about the thoughts, feelings and belief of patient. It was also being analysed that holistic
care was been taken of patient so that patients better health outcome can be maintained. It was
also being analysed that in this approach patients, spiritual, physical and emotional needs are
being taken in consideration. By implementing adequate verbal communication NA was being
able to know about likes and dislikes of patients (Landes, Turk and Wong, 2020).
The medical record of Grace has provided the details that she was suffering from and has a
history of dementia. For this NA has made use of subjective and objective assessment. By this it
was been evaluated that patient has difficulty in reporting due to confusion. It was also being
evaluated that NA has supported patient with dementia plan. In this NA was been engaged in
analysing the risk which can be faced by Grace. He has made sure to display clear signs and
symbols related to any task which needs to be performed by nursing associated. NA has made
sure that no such objects are been placed in front of patient which can lead in harm to themselves
and also to others (Lenaghan, Cirrincione and Henrich, 2018). It was also being analysed that
NA was being able to prioritise his care without any kind of delayed work and he made sure that
effective care was been delivered so that health outcome of patient can be improved. This has
also assisted in assisting NA in enhancing emotional as well as social well-being of patient.
Besides NA needs to look after Grace physical wellbeing too. In this situation NA needs to seek
himself as an important commodity who has significant contact with patient and can also advise
them on how to take care of themselves (Hsiao and et.al., 2017).
The public health England, has implemented guidelines and policies related to role of NA,
TNA and RN which needs to be followed by them if they are been involved in taking care of any
patient who is admitted to emergency department of hospital care setting. Health promotion
needs to be delivered in several different ways by keeping in mind the provision of education,
guidance, maintaining better physical as well as emotional wellbeing. They have a responsibility
of analysing the risk before providing care to any individual. Necessary steps also need to be
taken so that risk can be controlled and health outcome of patient can be improved (Källberg and
et.al., 2017).
Grace physical attribute was that she has one short leg and also had difficulty in walking.
She was suffering from impaired mobility and fracture. NA was being involved in providing
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support to Grace. It was being analysed that patient was unable to even go to toilet because of
her reduced mobility. NA has provided him adequate support so that she can overcome the health
issues which has been faced by her. This has assisted in enhancing health outcome and also
better wellbeing was been maintained. NA made sure that and provided adequate support to
patient in doing their daily tasks (Jangland and et.al., 2018). This has assisted in enhancing
quality of life of patient and this has led to improvement in health outcome of patient. Various
essential task was being performed by NA and RN so that adequate support can be given to
patient. This has assisted them in enhancing health outcome.
NA was involved in providing adequate support to Grace in doing routine task and also
better care decisions was being taken by NA. NA also made sure that personal information of
patient is not been shared by them. This aspect was being included in hospital policies. Due to
impaired mobility and fracture the essential tasks of living was being taken care by NA. In this
NA provides bed pan or commode by taking the preference of Grace and making sure that there
is no delay in providing these type of services. This was being done by NA in order to enhance
health and wellbeing of patient (Sonis and et.al., 2018).
Person centred care was being provided by NA to Grace. In this NA was involved in
analysing the signs and symptoms of various disease which is been faced by patient. In this the
NA has also collaborated with multi-disciplinary team so that adequate care can be provided in
emergency department. The NMC code of conduct (2018) and working within the standard of
proficiency (2018) was been followed. NA was being engaged in providing inpatient fall
prevention care. For this bed rails up was put by NA and also they have put call bells which can
be used by patient (Eriksson and et.al., 2018). This has assisted the care provider in making sure
that no risk of falling is been faced by Grace.
Grace was depressed, lonely and it was being aggravated because of her impaired
mobility and also because her family member does not visit her regularly. For this nursing
associated has contacted a volunteer service which assisted in enhancing mood of Grace. This
has assisted care provider in promoting her health as well as wellbeing. In this NA has accepted
the fact that in order to provide adequate care there must be a collaboration of different skills so
that emotional and physical health can be enhanced (Barbosa and Silva, 2017). Nursing associate
has made sure that care to Grace has been provided with dignity and integrity. They have try to
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make ensure that the cultural sentiments of any individual is not being hurt while providing the
care.
Nursing associate has made sure that while providing care to Grace they have given them
reassurance and has also provided assistance so that patient can be adapted to environment. This
has helped them in making patient appears more settled. NA made sure that Grace was also
involved in treatment plan which was been made by them. By this nursing associate can bring
modification in the plan according to patient. NA has also offered the support to family and care
provider was involved in providing them with feedback given from doctors related to health
status of Grace. Nurses also enquire about best way to support patient. In this care provider has
also made use of adequate opportunities to check and understand the clarity to patient, so that
Grace can be more settled in the environment and their health outcome improves significantly.
Evidence based practice was being used by nursing associate in order to enhance quality of
life of patients and also adequate support is being provided. In this NA has made sure that Grace
adopts healthier life practices and also provided them with information related to risk involved in
not following the better routine (Catlin, 2018). X ray was being done to check upon the fractured
neck or femur. This has assisted in analysing the exact issue which was been faced by Grace.
Evidence based interventions included multi-disciplinary team so that health outcome of patient
can be improved. It was also being analysed that because of this the well-being and quality of life
can be enhanced. This has assisted in enhancing the health outcome of patient (Vafaei and et.al.,
2018).
Grace has suffered from depression but no cognitive impairment. In this NA has also
assisted in providing patient with better therapies so that her thoughts and believes can be
administered. This has assisted in providing adequate care to patient so that their health outcome
can be enhanced. It has also been analysed that Grace was also suffering from ulcer so NA has
asked the hospital staff to put the air mattress so that risk of ulcer can be further reducing down.
CONCLUSION
From the above study it has been summarised that various approaches have been used in order
to improve and enhance health outcome of patient. It has also been analysed that NA has made
use of multi-disciplinary approach in order to enhance health and quality of life of patient. In the
case study provided patient was being suffering from issues like impaired mobility because of
fracture. She was also feeling depressed, sad and anxious. Service user lived alone in a care
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home and she had a daughter who visits her some time. This was making patient depressed. It
has also been analysed from the case study that It has been evaluated that in order to analyse
situation of patient and to provide support with her diagnosis adequate skills will be required by
nursing associate. In this NA has made sure that roles and responsibilities are been followed by
them as given in the guidelines of health policies. Effective communication has been used by NA
so that needs and issues which has been faced by patient. This has assisted them in enhancing
their health outcome and also because of this health and well-being of patient can be improved. It
has also been analysed that in order to enhance health outcome of patient holistic approach is
being used. This has assisted NA in analysing the spiritual, and emotional needs of patients. This
has helped NA in improving the well-being of patients. It has also been analysed that blood
pressure level of patient was also very high and this can lead to facing of potential problem in
future. It has been analysed that effective written and verbal communication is been used by NA
so that they can be able to build up better relationship with patient and this will assist them in
enhancing the wellbeing.
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REFERENCES
Books and Journals
Vafaei, S.M. and et.al., 2018. Improving nursing care documentation in emergency department: a
participatory action research study in Iran. Open access Macedonian journal of medical
sciences, 6(8), p.1527.
Eriksson, J. and et.al., 2018. Registered nurses’ perceptions of safe care in overcrowded
emergency departments. Journal of clinical nursing, 27(5-6), pp.e1061-e1067.
Sonis, J.D. and et.al., 2018. Emergency department patient experience: a systematic review of
the literature. Journal of patient experience, 5(2), pp.101-106.
Källberg, A.S. and et.al., 2017. Physicians’ and nurses’ perceptions of patient safety risks in the
emergency department. International emergency nursing, 33, pp.14-19.
Landes, S.D., Turk, M.A. and Wong, A.W., 2020. COVID-19 outcomes among people with
intellectual and developmental disability in California: The importance of type of
residence and skilled nursing care needs. Disability and Health Journal, p.101051.
Pearlmutter, M.D. and et.al., 2017. Analysis of emergency department length of stay for mental
health patients at ten Massachusetts emergency departments. Annals of emergency
medicine, 70(2), pp.193-202.
Catlin, A., 2018. Interdisciplinary guidelines for care of women presenting to the emergency
department with pregnancy loss. MCN: The American Journal of Maternal/Child
Nursing, 43(1), pp.13-18.
Jangland, E. and et.al., 2018. Inadequate environment, resources and values lead to missed
nursing care: A focused ethnographic study on the surgical ward using the Fundamentals
of Care framework. Journal of Clinical Nursing, 27(11-12), pp.2311-2321.
Hsiao, P.R. and et.al., 2017. Family needs of critically ill patients in the emergency
department. International emergency nursing, 30, pp.3-8.
Ridderikhof, M.L. and et.al., 2017. Emergency department pain management in adult patients
with traumatic injuries before and after implementation of a nurse-initiated pain treatment
protocol utilizing fentanyl for severe pain. The journal of emergency medicine, 52(4),
pp.417-425.
Lenaghan, P.A., Cirrincione, N.M. and Henrich, S., 2018. Preventing emergency department
violence through design. Journal of emergency nursing, 44(1), pp.7-12.
Finnegan, M.A. and et.al., 2017. Emergency department visits following elective total hip and
knee replacement surgery: identifying gaps in continuity of care. JBJS, 99(12), pp.1005-
1012.
Wolf, L.A. and et.al., 2018. Triaging the emergency department, not the patient: United States
emergency nurses’ experience of the triage process. Journal of emergency nursing, 44(3),
pp.258-266.
Jeffery, M.M. and et.al., 2020. Trends in emergency department visits and hospital admissions in
health care systems in 5 states in the first months of the COVID-19 pandemic in the
US. JAMA internal medicine, 180(10), pp.1328-1333.
Barbosa, I.D.A. and Silva, M.J.P.D., 2017. Nursing care by telehealth: what is the influence of
distance on communication?. Revista Brasileira de Enfermagem, 70(5), pp.928-934.
Pich, J.V., Kable, A. and Hazelton, M., 2017. Antecedents and precipitants of patient-related
violence in the emergency department: Results from the Australian VENT Study
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(Violence in Emergency Nursing and Triage). Australasian emergency nursing
journal, 20(3), pp.107-113.
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