There are limited data about quality-relatedoutcomes from nursing care in the ED. Re-search needs to be conducted to examine therelationship of ED crowding to important pa-tient outcome measures. To address the is-sue of ED crowding completely, researchersmust examine the consequences, not onlythe causes, of crowding. By examining rela-tionships between ED crowding and nurse-sensitive patient outcomes, researchers canprovide evidence on which to base nurs-ing practice. For example, by examining fac-tors that affect the frequency with which theemergency nurse collects, interprets, and re-sponds to information may be altered dur-ing ED crowding. How nurses respond tochanges in patient status and ways to stream-line communication during periods of crowd-ing are potential foci of future research.Addressing Additional Patient PopulationsResearch has been conducted that examinesthe delays of antibiotics to patients with pneu-monia, thrombolytics to patients with strokeand acute myocardial infarction (MI), electro-cardiogram and aspirin to MI patients, andanalgesics to patients with hip fractures. How-ever, many ED patients are not included inany of these populations. No analysis has beenperformed on patients with abdominal painof unknown etiology, migraine sufferers, non-cardiac chest pain patients, or many other cat-egories of patients who fall into common pre-sentations or lower acuity.RELEVANCE FOR NURSESNurses can advance safe effective care bybuilding an understanding of how ED crowd-ing affects the practice of the emergencynurse and the outcomes of emergency pa-tients. ED nurses need to continue to studythe effects of crowding on ED patients, andevaluate factors and potential barriers to theprocesses of monitoring and intervention asCopyright © 2011 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.
52Advanced Emergency Nursing Journalwell as provide evidence-based knowledge forpractice and education. Determining barri-ers and facilitators to monitoring under var-ious crowding states has great potential tocontribute to consistent, high-quality nurs-ing care. Low-quality or missed nursing caremay cause mortality and contribute to re-turn ED admissions, poor communication be-tween clinicians, and missed opportunities toeducate patients for self-management result-ing in unnecessary suffering, and contributeto patient/family dissatisfaction with an insti-tution or a provider. For example, monitor-ing and surveillance of especially vital signs,level of consciousness, and patient responseto treatment is a common valued nursing in-tervening process priority.A discipline is “characterized by a uniqueperspective, a distinct way of viewing all phe-nomena”(Donaldson & Crowley, 1978). How-ever, much of the crowding research is beinggenerated by physicians and policy makers,both of whom lack the unique perspectivethat nurse researchers provide. Studies con-ducted within the medical profession focuson how to fix the problem of ED crowdingand not on how the problem affects a per-son. Generating knowledge about ED crowd-ing and nurse-sensitive patient outcomes isimportant to nursing practice and education.
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