This essay will reflect on the core initial assessment process of the patient in the Accident & Emergency (A&E) department where I am employed as a staff nurse. The Gibbs model of reflection is used in a rudimentary way to form the structure as it a model I have used previously and is the one with which I am most familiar.
I will explore how the initial nursing assessment is undertaken and compare it to other processes employed by other A&E departments and I aim to highlight strengths or weaknesses and look at the background history and evidence base for why we do the assessment the way that we do.
The reason for doing so is to inform a core duty and process that I undertake with knowledge and solid reasoning, the aim being to improve my skill and expertise to perform the assessment process.
Any names and identifying data have been changed to protect confidentiality in accordance with the Nursing and Midwifery (NMC) Code of Practice (2008).
My role within the A&E department is that of registered staff nurse. The Collins English Dictionary (2009) defines a staff nurse as; “A person who works in a hospital taking care of the ill and injured and whose rank is below that of a sister”.
I work in all areas of the A&E department including Minors, Majors, Paediatrics and the rests room. It is my duty to perform many clinical tasks including; recording vital observations, the preparing and administering of medicines as well as other clinical tests and investigations.
One of the main tasks that I and all other qualified nurses undertake regardless of which area in A&E that they are working in is the initial assessment of patient. This is referred to by most staff as triage. Fitzgerald et al (2010) defines Triage is ‘an essential element of modern medical care as it is necessary to assign relatively scarce resources to unlimited medical needs’.
This refers to nursing or hospital based triage (Williams, 1992) as opposed to the many forms of battlefield triage or emergency triage as employed in times of disaster or mass casualty incidents. (Collins 2009, Iserson & Moskop 2007)
The Mosby's Medical Dictionary (2009) defines a clinical assessment as "an evaluation of a patient's physical condition and prognosis based on information gathered from physical and laboratory examinations and the patient's medical history."
Although accurate, this definition alludes to reaching a complete prognosis with returned laboratory results. The initial assessment performed in the department where I work is in most cases considered complete long before a prognosis is made and results have been returned.
The Initial assessment as it is called on the Casualty Cards used in A&E therefore is just the start of the A&E process and not the end. However, there are occasions where a prognosis, diagnosis, treatment and discharge could conceivably happen within minutes of a patient’s presentation. (See &Treat)
Yet, despite the first page of the Casualty Card (cascard) being titled as ‘Initial Assessment’ I would argue that the real initial assessment has actually been performed by the A&E reception staff. It is they who decided whether to send the patient to minors, paediatrics, majors or resus.
These areas automatically infer an urgency to treat and so a patient who is sent to majors would most likely been seen more urgently than a patient sent to minors. This system employed by the reception staff does more resemble the battlefield triage systems employed across the world, as it is a crude and quick process.
Prior to undertaking the A&E course and this assignment I had always considered this to be a risky process that was both potentially unsafe for the patient and an unfair burden on the receptionist. However there is some…