Post on 03-Apr-2018
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Emergency Nursing Practice
Dr. Elsye Maria Rosa, M.Kep
7/28/2019 Dr. Elsye Maria Rosa, M.kep (Emergency_Nursing_Practice )
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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
7/28/2019 Dr. Elsye Maria Rosa, M.kep (Emergency_Nursing_Practice )
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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.
7/28/2019 Dr. Elsye Maria Rosa, M.kep (Emergency_Nursing_Practice )
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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
7/28/2019 Dr. Elsye Maria Rosa, M.kep (Emergency_Nursing_Practice )
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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.
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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.
7/28/2019 Dr. Elsye Maria Rosa, M.kep (Emergency_Nursing_Practice )
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Tujuan
• a. Mencegahkematian dankecacatan padapenderita gawatdarurat,
.
•b. Menerimarujukan/merujukpenderita gawatdarurat.
•c. Melakukanpertolongankorban musibahmassal
•d. Mengembangkandan menyebarluaskan
pengetahuan
7/28/2019 Dr. Elsye Maria Rosa, M.kep (Emergency_Nursing_Practice )
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SIFAT PASIEN GAWAT DARURAT
PERLUPERTOLONGAN
SEGERA,
CEPAT, TEPAT DAN
AMAN
MEMPUNYAIMASALAH
PATOLOGIS,
PSIKOSOSIAL,LINGKUNGAN,KELUARGA
TIDAK SABAR
MENUNGGUINFORMASI
UNIK
PERAWAT
PROFESIONAL
7/28/2019 Dr. Elsye Maria Rosa, M.kep (Emergency_Nursing_Practice )
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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
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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
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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),
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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
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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.)
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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
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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.
7/28/2019 Dr. Elsye Maria Rosa, M.kep (Emergency_Nursing_Practice )
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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
7/28/2019 Dr. Elsye Maria Rosa, M.kep (Emergency_Nursing_Practice )
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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
7/28/2019 Dr. Elsye Maria Rosa, M.kep (Emergency_Nursing_Practice )
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•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.
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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.
7/28/2019 Dr. Elsye Maria Rosa, M.kep (Emergency_Nursing_Practice )
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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
7/28/2019 Dr. Elsye Maria Rosa, M.kep (Emergency_Nursing_Practice )
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EMERGENCY SERVICES
• PREHOSPITALCARE
•EMERGENCYTELEPHONE
•INTRAHOSPITALCARE
•ELECTRONIQUE
TECHNOLOGY
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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
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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.
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STANDARD III: ANALYSIS/PLANNING
1. Plan of Care2. Supplies
and Equipment
3. Safety4. Legal
Responsibilities
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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
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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
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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
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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 ( )
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EMERGENCY DEPARTMENT (ED)
ENVIRONMENT
ENTRANCES TRIAGEWAITING ROOM
EXAMINATIONROOMS
MINORSURGERIES
LABORATORYX-RAY ROOM ORTHOPEDICROOM
AMBULANCEAREA
OFFICESCONFERENCE
ROOM
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Emergency Department (ED)
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