Most of the patients the emergency department faces every day are critically ill patients. These patients are characterized by acute onset, serious illness, rapid change, great psychological pressure and high expectations for medical staff. Because patients are often ill and their families are impatient, it is easy to cause disputes in this case, and many disputes are directly or indirectly related to the communication barriers between nurses and patients. In this case, nurses should make full use of communication skills and methods to reduce nurse-patient disputes, improve nursing quality and establish a harmonious nurse-patient relationship in emergency.
First, the importance of emergency triage:
Emergency triage is a process in which emergency nurses evaluate each patient simply and quickly, understand their medical needs and judge the urgency of treatment, so that they can get the right treatment and care at the right time and in the right treatment area. Emergency triage is the first step of emergency nursing procedure. Whether the triage is in place in time can better reflect the level and service attitude of the hospital. This puts higher demands on emergency nurses. In addition to the basic professional knowledge of emergency nursing, emergency nurses also need to master the medical nursing knowledge of various diseases, at the same time, they should have strong ability to analyze and evaluate the condition, have certain coordination and communication skills, be able to actively communicate with patients and their families, use their own work experience wisely and calmly, make a preliminary judgment on the disease according to the severity of the condition, and assign patients to the correct diagnosis and treatment department as soon as possible to win opportunities for patient rescue.
Second, the emergency department work characteristics:
Most patients who come to the emergency department are critically ill and need timely diagnosis and treatment or quick rescue, which involves a wide range of medicine, many diseases, complicated conditions and rapid changes in their conditions. Nurses are required to have keen observation and the ability to analyze and predict the development of diseases. And quickly cooperate with doctors in various departments to carry out timely and effective rescue.
However, the number of non-emergency patients has increased. They think that once they get to the emergency room and hang up the emergency number, they are emergency patients and should give priority to treatment, while doctors and nurses should give priority to the diagnosis and treatment of critically ill patients, which is easy to cause dissatisfaction.
There are also trauma patients and drunken patients on both sides of the accident. They are stimulated by stress conditions, and their mood is unstable, which brings potential risk factors to doctors and nurses.
Third, the scope of emergency triage
1, all kinds of trauma, especially open trauma patients. 2. Severe patients with unstable vital signs, unconsciousness or coma.
3. Patients with severe symptoms (such as high fever, bleeding, severe vomiting, pain, etc.). ) or elderly patients who can't queue up according to the routine workflow of outpatient service, or patients who are difficult to cooperate with flat diagnosis (such as mental disorder, drunkenness, etc. ).
4. Other circumstances that really need urgent treatment.
Attachment: scope of emergency trauma diagnosis and treatment in various specialties
1, Ophthalmology: Eye trauma is under the eyebrow arch and around the orbit.
2. Stomatology: around the mouth and lips
3. Otolaryngology: the rest of the face except 1 and 2;
4. Patients with burns and scalds during the day (normal working hours) shall be treated by the Burn Plastic Surgery Department, and abnormal working hours shall be treated by emergency surgery first. Please consult the Burn Plastic Surgery Department if necessary.
5. Emergency operation: trauma other than 1, 2 and 3.
6, emergency room to deal with severe trauma open specialist consultation scope and secondary outpatient triage scope.
(1), orthopedics: limbs, buttocks, back neck.
(2) General surgery: chest and abdomen, waist and back, anterior neck and perianal region.
(3) Brain Surgery: Head
(4) Urology: genitals and surrounding environment
(5) Burn plastic surgery: burns, scalds and skin defects.
(6) Gynecology: Female perineal trauma
Fourth, the classification of diseases
Class I: critical illness with extremely unstable vital signs. If it is not treated urgently, it will soon be life-threatening, such as cardiac arrest, shock, coma, massive hemorrhage, persistent severe arrhythmia, severe dyspnea, repeated convulsions, acute severe poisoning, fatal trauma, extensive burns and so on.
Class II: acute and severe, with potential danger, and the condition may change rapidly, which requires urgent treatment and close observation, such as chest pain, suspected myocardial infarction, surgical critical acute abdomen, sudden severe headache, severe trauma, burns, severe fractures, high fever, etc.
Grade III: Sub-emergency, general emergency, stable vital signs, no serious complications, such as closed fracture, small area burns, etc.
Class Ⅳ: Non-emergency, you can wait or go to the clinic, such as mild to moderate fever, rash, skin abrasion, etc.
Five, emergency triage skills:
1, a good image of a nurse: Nurses should dress neatly, be full of energy, be calm and confident, be kind to patients, behave steadily, be decisive and orderly, and give people a sense of trust and intimacy. If you feel urgent, you can receive treatment and care safely.
2. Take the initiative to accept patients: For patients who come to the emergency department, nurses should stand up and accept patients enthusiastically, speak kindly and ask about their illness in a caring tone. For elderly patients with mobility difficulties, they should be helped to the reception bed or sit in a chair immediately, and take appropriate lying position or posture according to their illness, and immediately take oxygen, which to a certain extent increases patients' sense of dependence on nurses and their sense of self-belonging.
3. For critically ill patients who arrive at the door of the emergency room, people with mobility difficulties, or patients transferred from ambulances in other hospitals, nurses should immediately push carts to meet patients at the door, make preliminary judgments on different conditions, and help patients take appropriate positions. Dealing with patients can reduce their pain, comfort patients with simple language, let patients better cooperate with nurses and improve the correct rate of triage.
4. Use the inspection, sniffing, questioning and pulse of the four diagnostic methods of traditional Chinese medicine to make triage, judge the severity and type of the disease, and quickly decide which doctor is involved in the rescue.
(1) directly observe the patient's look, shape, posture, head and neck facial features, skin, excrement and secretions with eyes, and infer the changes of the body. The triage nurse must personally check the patient, such as whether the patient is conscious, whether the pupil is narrowed or enlarged, and carefully observe the patient's vital signs to obtain correct information and make triage accurate; Such as whether the patient has traumatic bleeding, pale face, edema, etc. For example, patients with dyspnea are mostly heart and lung diseases. Pay attention to the close relationship between the onset of certain diseases and age.
(2) Hearing diagnosis includes listening to sounds and smelling, which means observing the patient's voice, language, breathing, cough, vomiting, belching, sneezing, bowel sounds and other smells in the patient's body. If the patient's mouth smells of garlic, it means organophosphorus pesticide poisoning, and the smell of rotten apples means diabetic ketoacidosis.
(3) Inquiry is an important part of triage, occupying a major position in the four diagnoses, which plays a great role in correct triage and treatment, including the patient's medical history, self-conscious symptoms, past health status, family history, etc. If you find that the patient's statement is unclear and incomplete, don't ask or hint at the patient with your own subjective assumptions, so as not to make the consultation information inconsistent with the reality and bring bad stimulation or influence to the patient's spirit. 1 For acute abdominal pain, pay attention to ask whether there is diarrhea, overeating or eating spicy food, especially for women, to prevent ectopic pregnancy.
(4) Pulse diagnosis is divided into pulse diagnosis and pulse diagnosis. Pulse diagnosis is based on pulse; Massage is to touch and press the patient's skin, limbs, chest and abdomen; If there is tenderness and rebound pain in the abdomen.
(5) In the daily emergency triage, we should also pay attention to and comprehensively consider some situations: 2.5. 1 Priority triage population: children, the elderly, patients with physical or mental disabilities, patients who frequently see a doctor, patients who see a doctor again, and patients who have seen a doctor in other places. 2.5.2 People needing attention: patients who are easily abused or attacked, and patients who are affected by alcohol.
(6) Precautions: Before the doctor arrives, the nurse can give first aid as appropriate. The condition is complex, so it is difficult to determine the responsibility system for the first diagnosis according to the discipline, and other departments should cooperate closely. In case of patients in urgent need of multi-specialty rescue in batches, the director of nursing department and the personnel on duty should be informed to assist in the deployment of rescue personnel. The triage nurse can accurately triage patients to various departments, which will reduce the delay in treatment time due to various consultations and examinations, and more importantly, avoid life-threatening changes in some patients during the round-trip consultations and examinations.