THE IMPORTANCE OF HEALTH PROFESSIONALS IN CARING FOR PATIENTS IN URGENT AND EMERGENCY SITUATIONS
REGISTRO DOI:10.69849/revistaft/th10247051944
Renan Barros Braga1,Alda Helena dos Santos Carvalho2, Amélia Carla Silva Oliveira Carvalho2, Izabel Cristina Queiroz Malizia2, Luciene Lopes Bohrer3, Nildo Francisco Silva de Arantes3, Thiago Alves Rabelo Campos3, Rubiana Cordeiro e Silva3, Thiago Gomes Zaki Gerges3, Pollyana Patrícia Vasconcelos de Almeida Lopes4, Arlanny Rose Ferreira Lima Amorim4, Clívia Mirelly da Silva4, Habynaara Freitas de Oliveira5, Letícia Teixeira Torres5, Larissa Vanessa Ferreira Memoria6, Márcia Alves Ferreira6, Érika Brito dos Santos7, Rafaela Gomes Santos7, Maria Divina dos Santos Borges Farias7, Daniela Uchoa Pires Lima8, Luciana de Sena Melo Veras8, Julliete dos Santos Holanda da Silva9, Aline Amorim da Silveira9, Aline Márcia Pereira Pinheiro Silva10, Islany Barbosa Soares da Silva10, Ellise Grazielle Mendonça Dantas11, Elisa de Moraes Batista11, Alessandra Pinheiro da Silva12, Jorge Bugary Teles Júnior14, Wanaline Fonsêca15, Alan Jefferson Alves Reis16, Amanda Aparecida Dias17, Gisele Cristina Calixto Tonatto18, Natália Sales Sidrins18, Marília Silveira de Melo18, Larissa Porfirio Carvalho19, Soraia do Socorro Furtado Bastos20, Daniel Verçosa Amorim21
Abstract
The aim of this study was to analyze scientific production on the role of nursing during urgent and emergency procedures, as well as to assess the importance of emergency care provided by the nursing team in emergency situations. The aim was to study how Brazilian scientific production has addressed the role of nursing in these procedures in recent years. Emergencies represent the main entry points for patients into hospitals and, considering the severity of the injuries, care will require coordinated actions from different services and may require a considerable length of hospitalization, resulting in high costs. In this way, the research aimed to better understand the relevance of the role of nursing in this critical context. The methodology used was a literature review, focusing on current literature published between 2014 and 2024. This time frame allowed for an analysis of recent trends and advances in the field. The literature review established a solid basis for understanding the evolution of nursing knowledge and practices in urgencies and emergencies, highlighting the continuing importance of this field of activity for public health.
Keywords: Urgency. Emergency. Nursing practice. Health professional.
1 INTRODUCTION
With the constant increase in urgent and emergency care in the country, there is a growing need for rapid and specialized care to provide first aid in cases of trauma and sudden emergencies, either at the scene of the accident or at the first medical contact. To meet this demand, basic and advanced support ambulances are sent, depending on the victim’s condition, accompanied by highly qualified health teams. This care demonstrates that immediate and appropriate intervention reduces the number of deaths and complications associated with the lack of rapid and effective help (JUNIOR; DE ARAÚJO, 2023).
Pre-hospital care plays a crucial role in the survival of victims of various types of accidents, and it is impossible to deny its significant contribution. This type of care is essential for reducing the time it takes to get to the right hospital, which can make a huge difference to the patient’s prognosis. In addition, the initial interventions carried out by health professionals at the scene of the incident are fundamental to stabilizing and maintaining the victim’s life until they can receive more advanced medical care. These initial actions, when carried out quickly and accurately, significantly increase the chances of recovery and reduce the risk of serious complications (DE OLIVEIRA SENA; DA SILVA OLIVEIRA, 2020).
It is important to emphasize that this type of approach aims to emphasize information for the purpose of planning nursing activities, bearing in mind that serious trauma caused by accidents and violence and clinical ailments are the main types of ailments that require specific attention. According to the Pan American Health Organization, the emergency unit is designed to promote health services required on an emergency and urgent basis to prolong the victim’s life or prevent critical consequences, which must be provided immediately (MOURA et al., 2014).
Initial care for trauma patients takes place in three successive stages, each crucial for the stabilization and effective treatment of the victim. First, at the scene of the accident, emergency professionals perform first aid and assess the severity of the injuries, providing immediate care that can be vital for the patient’s survival. Then, during transport to the hospital, the rescue team continues to monitor and treat the victim, ensuring that they arrive at the medical center in the best possible condition. Finally, in the hospital center, the patient receives more specialized care, with advanced resources and a medical team prepared to deal with complex trauma cases (BRASIL, 2016).
Emergency units are specially designed environments for the care of patients with specific acute conditions. These units are structured to provide highly specialized teamwork and can be classified into three main categories: first aid, emergency room and emergency. Emergency care is geared towards less serious cases that still require rapid and effective assessment. Emergency care is intended for situations of greater urgency, where rapid intervention can be decisive. The emergency department, on the other hand, deals with the most critical and complex cases, requiring an immediate response and advanced resources for stabilizing and treating patients. Each of these areas plays an essential role in the healthcare system, ensuring that victims of trauma and other emergencies receive the appropriate care at each stage of care (DE AZEVEDO, 2019).
In this way, the Brazilian Hospital Services Company (EBSERH) is crucial in the management of federal university hospitals, directly impacting on urgent and emergency care. This research aims to analyze Brazilian scientific production on the role of nursing in these contexts. The studies highlight the importance of continuous and specialized training, effective practices, and integration between health professionals. EBSERH promotes a collaborative environment and invests in team training, improving the quality of care and the training of professionals in the Brazilian health system. The aim of this study was to analyze the scientific production on the role of nursing during urgent and emergency procedures, as well as to assess the importance of emergency care by the nursing team.
The relevance of the research is to help plan nursing activities so that they act correctly in situations that require immediate care. The results obtained will help to evaluate nursing performance during urgent and emergency procedures. The problem of this research is based on the following question: What is the importance of urgent and emergency care by the nursing team in health units within the Brazilian state?
Emergencies are characterized by sudden and threatening situations that require immediate corrective and defensive actions, differing from care in doctors’ offices, basic health units or scheduled treatments. In these emergency contexts, patients can present with a wide variety of problems, which can change by the minute. Therefore, the team needs to make quick decisions, based on systematized and precise care, usually using emergency protocols to establish priorities (ASSUNÇÃO et al., 2021).
2 THEORETICAL FRAMEWORK
2.1 URGENCY AND EMERGENCY: BASIC PROTOCOLS FOR THE ROLE OF NURSES
We’ll start with a basic contextualization of the protocols that guide nursing in urgent and emergency care in health units.
According to Silva (2018), urgency is when there is a situation that cannot be postponed, which must be resolved quickly, because if there is a delay, there is even a risk of death. Emergency is when there is a critical situation, with an occurrence of danger, but it can wait a while.
As nursing professionals, we must understand that urgencies and emergencies require people who are prepared to identify situations, decide on the level of the situation, act quickly and effectively in the event of threats to life, contribute to increasing the quality of care, speed up decision-making and management of resources, theoretical and scientific foundations, leadership skills, work, discernment, initiative, teaching skills, maturity and emotional stability (SILVA, 2018).
According to dos Santos Silva et al (2019), the nursing team in the hospital’s emergency department is made up of a variety of specialized professionals, each playing a crucial role in providing fast and effective care to patients. This team includes clinical-surgical emergency nurses, who have expertise in dealing with urgent medical and surgical conditions; protocol nurses, who are responsible for reception and pre-care, ensuring that patients are triaged and prioritized according to the severity of their conditions; nurse coordinators, who supervise and organize the workflow and integration of the activities of the entire team; nursing technicians, who assist in performing procedures and monitoring patients; and nursing assistants, who provide support in various tasks essential to the care and well-being of patients. Together, these professionals form a dedicated and well-trained team, prepared to respond efficiently and in a coordinated manner to emergencies, ensuring that each patient receives the necessary care quickly and effectively.
The care activities carried out by nurses in urgent and emergency situations follow specific protocols, including: providing patient care in conjunction with the doctor; preparing and administering medication; facilitating the performance of complementary tests necessary for diagnosis; inserting nasogastric, nasoenteral and bladder tubes; changing tracheotomies and performing venipunctures with catheters; performing highly complex dressings; preparing instruments for intubation, aspiration, cardiac monitoring and defibrillation; assisting the medical team in carrying out various procedures; and monitoring and recording patients’ vital signs (CUNHA et al., 2019).
The nurse in the emergency unit plays a multifaceted and vital role that requires attention and competence. Their role includes taking the patient’s medical history, carrying out a detailed physical assessment and implementing the necessary treatment. In addition, the nurse has the responsibility of advising patients on maintaining their health, educating them on preventative measures and essential guidelines for continuing treatment. They also provide vital instructions for aftercare, ensuring that patients and their families are well informed about the next steps in the recovery process and how to prevent future complications. By carrying out these tasks, nurses ensure comprehensive and continuous care, promoting not only immediate recovery, but also the long-term health of patients (SANTANA et al., 2021).
It is important to establish that the nurse assumes the leadership role of the nursing team and develops actions focused on care, management, teaching and research. In terms of care, nurses lead more complex actions, delegating less complex ones to nursing technicians and/or assistants, respecting the ethical and legal aspects of the profession. Therefore, they are responsible for coordinating the nursing team and are a vital and integral part of the emergency team (SILVA; INVENÇÃO, 2018).
Nurses’ working hours vary significantly depending on the hospital or health service in which they work. Some workdays are eight hours a day, others follow the pattern of twelve hours of work followed by thirty-six hours of rest, and still others consist of six hours a day. However, regardless of the official length of the working day, it is widely recognized that nurses are rarely able to keep to the stipulated hours. They often have to extend their working hours, whether by a few minutes or even several hours. Even those who manage to finish their shifts on time are aware that there is often an additional demand that requires their presence beyond the regular hours. This extension of working hours reflects the demanding and unpredictable nature of working in healthcare environments, where the well-being of patients may require extra and immediate attention, regardless of official working hours (PEREIRA, 2017).
3 METHODOLOGY
This study is a literature review. By analyzing the published literature, a theoretical framework and a conceptual structure were drawn up to support the development of the research.
This literature review was conducted by searching the databases of the United States National Library of Medicine (PubMed), Scientific Electronic Library Online (SciELO), Latin American and Caribbean Literature on Health Sciences Information (LILACS) and the Latin American Center for Health Sciences Information (BIREME) using the terms: Urgency, Emergency and Nurse.
In order to provide guidance and support for the production of the work, readings and interpretations were made about the role of nurses in the care of urgent and emergency patients. The articles were filtered using the inclusion and exclusion criteria, and then the titles and abstracts were read to make sure they were appropriate to the topic. After selecting the articles, they were read in full to analyze the research data.
After collecting the data, the material was analyzed based on the relevance of the answers to the problems that prompted the investigation. The data analyzed was tabulated based on its description.
4 RESULTS AND DISCUSSIONS
An emergency is a condition that occurs when certain circumstances change a given situation. Assistance in emergency and urgent situations is necessary when a patient needs to be attended to in an extremely short period of time. Emergency refers to a situation in which care cannot be delayed and must be provided immediately (AZEVEDO, 2016).
The need for nurses to be trained to work in mobile units shows the importance of the theoretical procedures we learn as nurses: help in the moments after an accident, especially the first two hours, are the most important to ensure the recovery or survival of injured people (MOURA et al., 2014).
Emergency cases are characterized by the need for specific treatment, the patient will be referred to the necessary specialty, orthopedics, general surgery, neurology and clinical medicine. In this case, there is little risk to life. Emergency cases are characterized by the assessment of all specialties, as the risk to life is imminent and treatment must be started immediately. There is a Polytrauma room in the sector, which has complete support and a team attuned to the procedures necessary for care. Once the clinical condition has been stabilized, the client is taken to the basic support units, where treatment will continue (LUNA et al., 2022).
Routine cases are cases that can wait until the next day, where they will be followed up by the nearest Basic Health Unit. Basic health units prioritize actions to promote, protect and recover the health of individuals and their families, from newborns to the elderly, whether healthy or ill, in a comprehensive and continuous manner. It represents the population’s first contact with the municipality’s health service, ensuring referral and counter-referral to the different levels of the system. Created in Brazil in the 1990s, it was inspired by experiences from other countries whose public health has reached quality levels, with investment in health promotion, such as Cuba, England and Canada (LUNA et al., 2022).
This service was designed to bring health services closer to the population and fulfill the State’s constitutional principle of guaranteeing citizens their right to receive comprehensive health care, by building a care model based on health promotion, protection, early diagnosis and recovery, allowing those responsible for providing health services, the managers of the Unified Health System (SUS), to deepen their knowledge of those they are supposed to serve. The strategy of these units reaffirms and incorporates the basic principles of the SUS: universalization, decentralization, comprehensiveness and community participation (MULLER, 2018).
4.1 THE TRAINING OF PROFESSIONALS WORKING IN EMERGENCIES
The training required to work in emergency units is important for the practice of nursing in emergency sectors that deal with patients/clients at imminent risk of life. The Standards of Practice for Emergency Nursing of the American Nursing Association (AAE), since 1983, have been defined in three levels of competence: the first requires minimum competence for the nurse to provide care to the traumatized patient; in the second the professional needs specific training in emergency nursing and in the last level the nurse must be a specialist in a well-defined area and act in the pre- and intra-hospital setting (LUNA et al., 2022).
The levels of competence are essential for delimiting and restricting the work of non-specialized nurses in emergency units, given that the reality experienced in Brazil’s hospital units is that staff are hired on a temporary basis and do not follow the technical criteria for placing professionals in these critical care units (CARVALHO, 2019).
The practices involved in clientelist schemes are very strong and will not disappear quickly from national life. Hence the importance of demanding movements and the development of permanent mechanisms for democratic participation, in the form of partisan and deliberative decision-making collegiate bodies between the state and civil society (LUNA et al., 2022).
There are democratic hiring mechanisms that obey levels of competence and are at odds with clientelist practices, which are through competitions and selection processes with strict hiring criteria and pre-defined requirements, while still requiring professional qualifications in the form of specialization and/or courses in the area of emergency nursing. This way, you can have care with professionals who are trained in the area (SILVA et al., 2014).
However, well-trained nurses, with available resources and a team that is in tune with their activities and working in harmony, are able to perform their role efficiently and with solutions, improving the quality of life of the population they assist. They are professionals who have value and importance in practicing in emergencies (MOURA et al., 2014).
Emergency care in hospital units plays an important role in recovering and maintaining an individual’s health. Recovering health and maintaining it is based on quality health care and a multidisciplinary team focused on the individual as a whole, paying attention to aspects that involve acting effectively, efficiently, quickly and with good clinical and scientific knowledge (LUNA et al., 2014).
The nurse’s role is part of the aforementioned team and is essential for health services when it comes to promoting the health of clients/patients who are cared for in urgent and emergency services. Nurses take on the role of leading the nursing team and carry out actions focused on care, management, teaching and research. In care, nurses lead more complex actions, delegating less complex ones to technicians and/or nursing assistants, respecting the ethical and legal aspects of the profession (DE SOUSA et al., 2023).
It is considered essential that nurses working in the emergency sector adopt participatory leadership styles, which implies sharing responsibilities and delegating roles within the team. Fundamental skills for managing care include effective communication, strong interpersonal skills, leadership ability, decision-making skills and technical competence (LEAL, 2017).
These professionals not only coordinate patient care, but are also responsible for fostering a collaborative and efficient working environment. Clear communication is crucial to ensure that all information is transmitted accurately between team members, while interpersonal skills facilitate working together and foster an environment of mutual support. Effective leadership inspires confidence and motivation in the team, encouraging a high standard of care. In addition, the ability to make quick and assertive decisions is crucial in emergency situations, where every second counts. Finally, technical competence ensures that nurses can perform procedures accurately and safely, contributing to quality patient care (RIBEIRO et al., 2019).
When working in the emergency care sector, nurses must maintain control of what is happening and be aware of what they are doing and what is being delegated. Ethical and legal aspects must be considered important and extremely transparent, as recommended by the Nursing Code of Ethics and Law 7,498 of June 25, 1986 (REGIONAL NURSING COUNCIL), which provides for the regulation of professional nursing practice; nurses are responsible for, among other duties: planning, organizing, coordinating, executing and evaluating nursing care services (LUNA et al., 2022).
Based on this analysis, it is believed that the nurse, as the leader of the nursing team, must delegate functions to their subordinates, making them useful in the service. Respecting and treating others with dignity and respect is essential for healthy leadership and positive results. The managerial activities, known as administrative, are: keeping attendance statistics; leading the nursing team; coordinating the activities of reception, cleaning and concierge staff; solving problems arising from care; allocating resources; drawing up schedules for nursing professionals, controlling material resources; and maintaining the sector’s equipment (PEREIRA; DA SILVA FERREIRA, 2020).
Thus, we are facing a serious problem that affects nurses and transfers to them functional overload leading to physical, emotional and mental exhaustion, limiting their health actions focused exclusively on recovering the health of the individual in parts and not holistically, due to the excess of managerial activities that demand time, to the detriment of assistance activities and some nurses have a high workload that adds to the stress of the moment of work (DE SOUSA et al., 2023).
Nurses provide care in sectors that are considered stressful, both because of the workload and the specific nature of the tasks, and in this panorama we find the Emergency Unit and those who work there. He goes on to say that this professional must be provided with the minimum material and personnel to be able to provide effective and efficient care in the face of the complications that are very common in this unit (NASCIMENTO et al., 2021).
5 CONCLUSION
In conclusion, nursing professionals know that the key in emergency situations must be to remain calm and bear in mind that providing first aid does not exclude the importance of a doctor. Also, make sure that the conditions are safe enough to provide help without risk. Don’t forget that poor emergency care can further compromise the victim’s health.
It is also important to emphasize that professionals are guided by internationally regulated medical ethical principles, according to which there is no hierarchy of patients, a clear manifestation of Western egalitarian individualism. They are therefore caught between, on the one hand, loyalty to principles that are intended to be universally applicable and objectively defined (in cases of “saving lives”) and, on the other, concrete situations in which concrete subjects, doctors and patients, with their particular beliefs, values and conceptions of the world around them, are at stake.
When analyzing the dimension of emergency services, it can be seen that there is an appreciation of the health professional who works in emergencies, as this is one of the health professionals who needs to expand their knowledge on a daily basis, because the constant evolution in the forms of assistance and hospital equipment used to provide patient care, makes this professional feel the constant need for retraining, thus improving their field of work. One of the changes in this evolution is planned patient care.
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1Carajás College, Av. Vp Oito Quadra Especial Lote 2A, Folha, Nova Marabá, 68508-150, Marabá, Pará, Brazil;
2Tropical Diseases Hospital of the Federal University of Tocantins/ Brazilian Hospital Services Company (HDT-UFT/EBSERH), R. José de Brito Soares, 1015, Setor Anhanguera, 77818-530, Araguaína, Tocantins, Brazil;
3University Hospital of Brasília of the University of Brasília / Brazilian Hospital Services Company (HUB-UNB/EBSERH), Setor de Grandes Áreas, Norte 605, Asa Norte, 70840-901, Brasília, Distrito Federal, Brazil;
4Professor Alberto Antunes University Hospital of the Federal University of Alagoas / Brazilian Hospital Services Company (HUPAA-UFAL/EBSERH), Av. Lourival Melo Mota, S/N, Tabuleiro do Martins, 57072-900, Maceió, Alagoas, Brazil;
5Clinical Hospital of the Federal University of Uberlândia (HC-UFU/EBSERH), Av. Pará, 1720, Umuarama, 38405-320, Uberlândia, Minas Gerais, Brazil;
6University Hospital of the Federal University of Piauí / Brazilian Hospital Services Company (HU-UFPI/EBSERH), Campus Universitário Ministro Petrônio Portela, s/n – Ininga, 64049-550, Teresina, Piauí, Brazil;
7Walter Cantídio University Hospital of the Federal University of Ceará / Brazilian Hospital Services Company (HUWC-UFC/EBSERH), R. Pastor Samuel Munguba, 1290, Rodolfo Teófilo, 60430-372, Fortaleza, Ceará, Brazil;
8Maternity School Assis Chateaubriand of the Federal University of Ceará / Brazilian Hospital Services Company (MEAC-UFC/EBSERH), Rua Coronel Nunes de Melo, s/n, Rodolfo Teófilo, 60430-270, Fortaleza, Ceará, Brazil;
9Maria Aparecida Pedrossian University Hospital of the Federal University of Mato Grosso do Sul / Brazilian Hospital Services Company (HUMAP- UFMS/EBSERH), Av. Sen. Filinto Müler, 355, Vila Ipiranga, 79080-190, Campo Grande, Mato Grosso do Sul, Brazil;
10University Hospital of the Federal University of Maranhão / Brazilian Hospital Services Company (HU-UFMA/EBSERH), R. Barão de Itapary, 227, 65020-070, São Luis, Maranhão, Brazil;
11Doutor Miguel Riet Corrêa Junior University Hospital of the Federal University of Rio Grande / Brazilian Hospital Services Company (HU- FURG/EBSERH), R. Visconde de Paranaguá, 102, Centro, 96200-190, Rio Grande, Rio Grande do Sul, Brazil;
12Onofre Lopes University Hospital of the Federal University of Rio Grande do Norte / Brazilian Hospital Services Company (HUOL-UFRN/EBSERH), Av. Nilo Peçanha, 620, Petrópolis, 59012-300, Natal, Rio Grande do Norte, Brazil;
13 University Hospital Alcides Carneiro of the Federal University of Campina Grande / Brazilian Hospital Services Company (HUAC-UFCG/EBSERH), R. Carlos Chagas, s/n, São José, 58400-398, Campina Grande, Paraíba, Brazil;
14Professor Edgar Santos University Hospital of the Federal University of Bahia / Brazilian Hospital Services Company (HUPES-UFBA/EBSERH), R. Dr. Augusto Viana, s/n, Canela, 40110-060, Salvador, Bahia, Brazil;
15University Hospital of Grande Dourados (HU – UFGD)/Brazilian Hospital Services Company (EBSERH), R. Ivo Alves da Rocha, 558 – Altos do Indaiá, 79823-501, Dourados – Mato Grosso do Sul, Brazil;
16School Hospital of the Federal University of Pelotas (UFPEL)/Brazilian Company of Hospital Services (EBSERH), R. Prof. Dr. Araújo, 538 – Centro, 96020-360, Pelotas – Rio Grande do Sul, Brazil;
17University Hospital of the University of Juiz de Fora (HU – UFJF)/Brazilian Hospital Services Company (EBSERH), Rua Catulo Breviglieri Bairro, s/n – Santa Catarina, 36036-110, Juiz de Fora – Minas Gerais, Brazil;
18Federal University of Paraná Clinical Hospital Complex (CHC-UFPR)/Brazilian Hospital Services Company (EBSERH), R. Gen. Carneiro, 181 – Alto da Glória, 80060-900, Curitiba – PR, Brazil;
19Lauro University Hospital Wanderley (HULW-UFPB)/ Brazilian Hospital Services Company (EBSERH), R. Tabeliao Estanislau Eloy, 585 – Castelo Branco, 58050-585, João Pessoa – PB, Brazil;
20Anna Nery Nursing School, R. Afonso Cavalcanti, 275 – Cidade Nova, Rio de Janeiro – RJ, 20211-130, Brazil;
21Cesmac University Center, R. Cônego Machado, 984 – Farol, Maceió – AL, 57051-160, Brazil.