THE ROLE OF THE NURSING TEAM IN THE CONTEXT OF HOSPITAL URGENCY AND EMERGENCY
REGISTRO DOI:10.69849/revistaft/th10248071016
Renan Barros Braga1
Clívia Mirelly da Silva2
Wanaline Fonsêca3
Márcia Alves Ferreira4
Maria Divina dos Santos Borges Farias5
Nildo Francisco Silva de Arantes6
Alan Jefferson Alves Reis7
Amélia Carla Silva Oliveira Carvalho8
Irismar Emilia de Moura Marques9
Soraia do Socorro Furtado Bastos10
Jorge Bugary Teles Júnior11
Marcus Vinicius Pereira12
Rubiana Cordeiro e Silva13
Thiago Gomes Zaki Gerges14
Amanda Aparecida Dias15
Letícia Teixeira Torres16
Pollyana Patrícia Vasconcelos de Almeida Lopes17
Aline Amorim da Silveira18
Natália Sales Sidrins19
Marília Silveira de Melo20
Julliete dos Santos Holanda da Silva21
Islênia Maria Lopes de Oliveira22
Wigo Pereira Gomes da Silva23
Aline Márcia Pereira Pinheiro Silva24
Izabel Cristina Queiroz Malizia25
Thiago Alves Rabelo Campos26
Habynaara Freitas de Oliveira27
Daniela Uchoa Pires Lima28
Larissa Vanessa Ferreira Memoria29
Érika Brito dos Santos30
Arlanny Rose Ferreira Lima Amorim31
Luciene Lopes Bohrer32
Alda Helena dos Santos Carvalho33
Abstract
Today’s article will look at the importance of nurses in the hospital urgent and emergency care sector, as well as the skills needed to work in this sector. The aim was to study how the Brazilian scientific literature on the role of nurses during urgent and emergency procedures has been developing. One of the nurses’ first duties in the hospital’s urgent and emergency ward is to welcome the patient and their family when they arrive in the emergency department, carrying out the necessary procedures according to the level of risk the individual is at. At this stage, the professional must know how to assess the patient primarily, identify their health condition and provide appropriate care as soon as possible. The research is bibliographical in nature, respecting current literature from 2014 to 2023.
Keywords: Urgency. Emergency. Nursing practice. Hospital.
1 INTRODUCTION
The distinction between urgency and emergency in the context of health plays a crucial role in the organization and provision of medical services. According to the Brazilian Federal Council of Medicine, urgency is defined as “a health problem that requires immediate medical attention”, while emergency is characterized as “a health problem that implies imminent risk to life or intense suffering, requiring immediate medical attention”. These technical definitions are fundamental for guiding triage and prioritization in health services, ensuring that patients receive appropriate care according to the severity of their condition (DE ALMEIDA; ÁLVARES, 2019).
There is no doubt that pre-hospital care is extremely important for the survival of victims of any type of accident. This service is crucial, as it contributes significantly to reducing the time it takes to reach the appropriate hospital, as well as providing appropriate initial interventions that are vital for maintaining life. The rapid response of emergency professionals and the application of emergency medical procedures at the scene of the incident can make all the difference between life and death, ensuring that the patient arrives at hospital with a better chance of recovery (MARQUES, 2021).
Nurses work every day with patients who are at risk of death and who depend on this care to maintain their lives. The nursing team’s actions are always aimed at assisting patients in the best possible way, thus expressing the quality and importance of our profession. Studying, training and practicing are essential actions for the professional development of nurses, technicians and nursing assistants, so being concerned about the actions developed on a daily basis is fundamental (DA SILVA BARBOSA et al., 2023).
Many questions about humanization in the care of people who seek hospital emergency services have been addressed by the press and by users themselves, with disapproving approaches such as, for example, delays or even inadequate care by health professionals, inadequate physical area, lack of disposable material, equipment and human resources (DA SILVA; CABRAL, 2023).
Given these approaches, there is a need to understand the meaning of humanized care from the point of view of the companion. However, a humanized hospital is one whose physical, technological, human and administrative structure values and respects the person, placing itself at their service, guaranteeing them high-quality care (DE OLIVEIRA MARQUES, 2021). Initial care for trauma patients takes place in three successive stages: at the scene of the accident, during transport and at the hospital (PINTO, 2019).
The aim of this research is to show how the Brazilian scientific production on the role of nursing during urgent and emergency procedures has been developing.
The aim is 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 research has the relevance of helping to 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: How important is the nursing team in the hospital urgent and emergency care sector?
2 THEORETICAL FRAMEWORK
The role of nurses in hospital urgent and emergency care plays a fundamental role in providing immediate and effective care to patients in critical situations. In this context, nurses take on various responsibilities that contribute to the management and delivery of quality care (DE SOUZA et al., 2022).
For dos Santos Silva (2019), Basic and Advanced Life Support procedures are essential for emergency events that require immediate attention from the nurse’s technical team, such as cardiorespiratory arrests, for example. BLS consists of a sequence of non-invasive maneuvers for patients at risk of death. VAS, on the other hand, requires invasive procedures and circulatory and ventilatory support.
Care for trauma victims, so-called car accidents and urban violence are the biggest causes of trauma victims. As such, nurses and their teams need to be trained to receive patients in these conditions and act in accordance with the guidelines for Pre-Hospital and Hospital Trauma Care. This is another factor that highlights the importance and role of hospital emergency nursing (DE ALMEIDA; ÁLVARES, 2019).
Acute Myocardial Infarction and Stroke represent one of the biggest causes of mortality in the world. Therefore, it is essential that the nurse assigned to the emergency ward knows how to quickly identify the symptoms of these conditions and perform the care indicated for each case as quickly as possible, in order to avoid complications (CANAS, 2021).
For Farias & Brasileiro (2018), another fundamental skill for hospital emergency nurses is knowing how to identify pre-eclampsia and eclampsia early, as well as uterine and gestational bleeding. This is a constant demand in the emergency services of most health institutions for assistance with obstetric emergencies.
In short, the importance of urgent and emergency nursing is linked to the nurse’s ability and capacity to identify the condition of the newly arrived patient and carry out the appropriate procedures. Therefore, it is essential that the professional specializes in the area in order to develop these skills correctly, through undergraduate and postgraduate courses such as Intensive Care Nursing – ICU, or technical courses (MARQUES, 2021).
In nursing practice in health units, protocols are essential rules that guide care in urgent and emergency situations. According to Souza, urgency refers to critical situations that require immediate intervention to prevent serious complications, including risk to life if not treated promptly (SOUZA, 2021).
Emergency is characterized by critical and dangerous situations that, although they can wait a while, require an immediate response. As nursing professionals, it is crucial to understand that the ability to quickly identify these situations, determine their severity, and act efficiently in the face of threats to life are fundamental to improving the quality of care. This includes making quick decisions, managing resources, applying theoretical and scientific knowledge, demonstrating leadership, and using judgment, initiative, teaching skills, maturity and emotional stability (DA SILVA; MELO, 2023).
According to Cunha et al (2019), the nursing team in the hospital’s emergency department is made up of clinical-surgical emergency nurses, protocol nurses (reception – pre-attendance), coordinating nurses, nursing technicians and nursing assistants.
To this end, the care activities carried out by nurses in urgent and emergency care follow the following protocols: provide patient care together with the doctor, prepare and administer medications, enable the performance of complementary tests necessary for diagnosis, install nasogastric, nasoenteral and bladder probes in patients, perform tracheotomy changes and venipuncture with catheters, perform more complex dressings, prepare instruments for intubation, aspiration, cardiac monitoring and defibrillation, assisting the medical team in performing various procedures and monitor vital signs (FREIRE et al., 2019).
The nurse plays a crucial role in the emergency unit, getting involved in the detailed collection of the patient’s medical history, conducting thorough physical examinations to assess the state of health, and implementing specific treatment protocols for each case. In addition, they take responsibility for providing comprehensive health guidance, educating patients about preventive practices and ongoing care. These actions are not only aimed at immediate treatment, but also seek to ensure that patients understand the importance of continuity of care and regular monitoring of their vital indicators, thus promoting an effective and sustainable recovery (INNES et al., 2018).
It is crucial to note that nurses take on the role of leader in the nursing team, promoting activities related to care, management, teaching and research. In care, they lead highly complex interventions, while delegating those of lesser complexity to technicians and/or nursing assistants, always respecting the ethical and legal principles of the profession. Thus, they are responsible for coordinating the nursing team and play a vital and integrating role in the emergency team (KRZESIŃSKI et al., 2021).
Nurses’ working hours vary depending on the hospital or health service: some are eight hours a day, others are twelve by thirty-six, others are six hours a day. Regardless of the working day, everyone is faithful in saying that they hardly ever work just six, eight or twelve hours. They may extend their working hours from minutes to hours and those who don’t, know that there is often a need to do so (ZANETONI et al., 2023).
3 METHODOLOGY
This is a literature review 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, Nursing Team.
This is a literature review on the role of nurses in the care of urgent and emergency patients. A theoretical framework and a conceptual structure were drawn up to support the research by analyzing the published literature.
The articles were filtered using the inclusion and exclusion criteria, and then the titles and abstracts were read to ensure 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
The first appropriate assessment of the results ‘is the need for excellent training for nurses working in mobile units where important theoretical first aid procedures are presented in the moments after an accident, especially the first two hours are the most important to ensure the recovery or survival of injured people (PEREIRA, 2019).
The qualification needed to work in emergency units is essential for nurses working in sectors where patients face an imminent risk to their lives. According to the Standards of Practice in Emergency Nursing of the Brazilian Society of Emergency Nurses, this training is divided into three levels of competence: the first requires nurses to have basic skills to care for traumatized patients; at the second level, specific training in emergency nursing is essential; and at the third and final level, nurses must specialize in a specific area, trained to work in both pre-hospital and in-hospital environments (BUGS et al., 2017).
The conditions of competence are essential for delimiting and restricting the work of non-specialized nurses in emergency units, since the reality experienced in Brazil’s hospital units is that staff are hired on a temporary basis, without obeying the technical criteria for placing professionals in these critical care units, and this practice is a clientelist measure (DE JESUS; BALSANELLI, 2023).
A highly trained nurse, with access to modern resources, working in sync with a cohesive and well-coordinated team, has all the necessary conditions to carry out their responsibilities in an effective and problem-solving manner. This capacity not only guarantees an efficient response in critical situations, but also promotes substantial improvements in the quality of life of the community served. The value and importance of this professional on the front line of emergencies is undeniable, where their competence and dedication are essential for the care and well-being of patients (TRETTENE et al., 2016).
Emergency care in Hospital Units plays an important role in recovering and maintaining an individual’s health. Recovering health and maintaining it is established with 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 (SOUSA et al., 2019).
The nurse assumes the leadership role of the nursing team and develops actions focused on care, management, teaching and research. In care, they lead more complex actions, delegating less complex ones to technicians and/or nursing assistants, respecting the ethical and legal aspects of the profession (AMESTOY et al., 2016).
They consider that nurses in the emergency sector should adopt participatory leadership styles, share and/or delegate functions, with the main skills for managing care being communication, interpersonal relationships, leadership, decision-making and technical competence (SIQUEIRA; FAYH, 2023).
In the emergency care setting, it is crucial that nurses maintain effective control of the situation and are fully aware of their actions and the responsibilities assigned to them. Consideration of ethical and legal aspects must be transparent and of high priority, as defined by the Nursing Code of Ethics and Law 7.498 of June 25, 1986, which regulates professional nursing practice. According to these guidelines, nurses are exclusively responsible for planning, organizing, coordinating, executing and evaluating nursing care services, among other assigned responsibilities (PELÓGIA, 2022).
Nurses working in emergency services assist doctors in caring for clients/patients, including administering medication, carrying out tests, placing nasogastric, nasoenteral and bladder tubes, changing tracheostomies, complex dressings, preparing for intubation, monitoring vital signs and documenting the progress of clients and/or patients (PELÓGIA, 2022).
In terms of management, the nurse is dedicated to organizing the service with leadership, exercising autonomy and responsibility over the entire nursing team. Their role includes coordinating emergency actions in a logical manner and delegating responsibilities so that each member of the team operates in a coordinated manner, especially during simultaneous procedures necessary to ensure adequate ventilation (DA ROSA et al., 2020).
5 DISCUSSIONS
In this research, it became clear that nursing professionals recognize that, in emergency situations, it is crucial to remain calm and remember that providing first aid does not replace the need for medical assistance. It is also essential to ensure that conditions are safe enough for rescue, minimizing risks. In addition, it is important to note that inadequate emergency care can further aggravate the victim’s health (BOLZAN; POMPERMAIER, 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 is added to the stress of the moment of work (TRETTENE et al., 2016).
When we analyze the dimension of emergency services, we see 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 (SOUSA et al., 2019).
An emergency occurs when a particular situation is altered by a specific set of circumstances. Assistance during emergency and urgent situations involves the need to attend to a patient quickly. Emergency is defined as a situation in which care cannot be delayed and must be provided immediately (SILVA et al., 2020).
Emergency cases are assessed by all specialties, as there is an imminent risk to life and treatment needs to begin immediately. Within the sector, there is a Polytrauma room equipped with full support and a coordinated team to carry out the necessary procedures. Once the clinical condition has stabilized, the patient is transferred to basic support units, where they will continue to receive treatment (DE CARVALHO et al., 2023).
Management tasks, also known as administrative tasks, include: collecting care data; supervising nursing staff; coordinating the activities of reception, cleaning and concierge staff; solving problems related to care; managing resource allocation; drawing up schedules for nursing staff; controlling the use of material resources; and keeping the sector’s equipment in good condition (PEREIRA et al., 2020).
Finally, it is worth mentioning that nurses provide nursing care in sectors considered exhausting, both due to the workload and the various tasks performed, and in this scenario, there are professionals in the Urgency and Emergency Unit. In addition, it is emphasized that it is essential for this professional to have adequate access to material resources and sufficient staff to ensure the provision of effective and efficient care, especially in the face of the frequent critical situations in that unit (CARDOSO et al., 2021).
6 CONCLUSION
It can be concluded from the above that the nurse’s role as leader of the nursing team goes beyond simply delegating duties to those they lead. It is essential that they not only assign responsibilities, but also promote an environment where each member feels valued and able to contribute fully to the service. Respecting and treating others with dignity and courtesy is not just a superficial practice, but an essential pillar for building and maintaining healthy leadership. This behavior not only strengthens the bond between team members, but also enhances positive results in the workplace, promoting efficiency and well-being for everyone involved in patient care.
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1Especialista em Enfermagem, Faculdade dos Carajás, Marabá, Pará, Brasil
2Especialista em Enfermagem, Universidade Federal de Alagoas, Hospital Universitário Professor Alberto Antunes (HUPAA-UFAL)/Empresa Brasileira de Serviços Hospitalares (EBSERH), Maceió, Alagoas, Brasil
3Mestre em Alimentos, Nutrição e Saúde, Universidade Federal da Grande Dourados, Hospital Universitário da Grande Dourados (HU – UFGD)/(EBSERH), Dourados, Mato Grosso do Sul, Brasil
4Mestre em Gestão em Saúde, Universidade Estadual do Ceará, Hospital Universitário da Universidade Federal do Piauí (HU-UFPI)/(EBSERH), Teresina, Piauí, Brasil
5Especialista em Enfermagem, Centro de ensino unificado de Teresina (CEUT), Hospital Universitário Walter Cantídio da Universidade Federal do Ceará (HUWC)/(EBSERH), Fortaleza, Ceará, Brasil
6Especialista em Enfermagem, Centro Universitário Euro-Americano (UNIEURO), Hospital Universitário de Brasília (HUB)/(EBSERH), Brasília, Distrito Federal, Brasil
7Especialista em Enfermagem, Universidade Estadual do Piauí (UESPI), Hospital Escola da Universidade Federal de Pelotas (UFPEL)/(EBSERH), Pelotas, Rio Grande do Sul, Brasil
8Especialista em Enfermagem, Faculdade de Tecnologia e Ciências, Hospital de Doenças Tropicais (HDT-UFT)/(EBSERH), Araguaína, Tocantins, Brasil
9Especialista em Enfermagem, Centro Universitário Anhanguera de Campo Grande, Hospital Universitário Maria Aparecida Pedrossian (HUMAP)/(EBSERH), Campo Grande, Mato Grosso do Sul, Brasil
10Doutora em Enfermagem, Escola de Enfermagem Anna Nery, Rio de Janeiro, Rio de Janeiro, Brasil
11Especialista em Biologia, Universidade Federal da Bahia (UFBA), Hospital Universitário Professor Edgard Santos (HUPES- UFBA)/(EBSERH), Salvador, Bahia, Brasil
12Especialista em Enfermagem, Universidade Salgado de Oliveira (UNIVERSO), Hospital Universitário da Universidade Federal de Juiz de Fora (HU-UFJF)/(EBSERH), Juiz de Fora, Minas Gerais, Brasil
13Especialista em Enfermagem, Universidade Severino Sombra, Hospital Universitário de Brasília (HUB)/(EBSERH), Brasília, Distrito Federal, Brasil
14Especialista em Enfermagem, Faculdade de Ciências e Educação Sena Aires (FACESA), Hospital Universitário de Brasília (HUB)/(EBSERH), Brasília, Distrito Federal, Brasil
15Mestre em Enfermagem, Universidade Federal de Juiz de Fora, Hospital Universitário da Universidade de Juiz de Fora (HU – UFJF)/(EBSERH), Juiz de Fora, Minas Gerais, Brasil
16Especialista em Enfermagem, Universidade Federal do Maranhão, Hospital de Clinicas da Universidade Federal de Uberlândia (HC-UFU)/(EBSERH), Uberlândia, Minas Gerais, Brasil
17Especialista em Enfermagem, Centro de Estudos Superiores de Maceió, Hospital Universitário Professor Alberto Antunes (HUPAA-UFAL)/(EBSERH), Maceió, Alagoas, Brasil
18Mestre em Enfermagem, Universidade Federal do Mato Grosso do Sul, Hospital Universitário Maria Aparecida Pedrossian (HUMAP)/(EBSERH), Campo Grande, Mato Grosso do Sul, Brasil
19Especialista em Enfermagem, Universidade Federal do Mato Grosso do Sul, Complexo do Hospital de Clínicas da Universidade Federal do Paraná (CHC-UFPR)/(EBSERH), Curitiba, Paraná, Brasil
20Especialista em Enfermagem, Universidade Estadual do Ceará, Complexo do Hospital de Clínicas da Universidade Federal do Paraná (CHC-UFPR)/(EBSERH), Curitiba, Paraná, Brasil
21Especialista em Enfermagem, Universidade de Fortaleza (UNIFOR), Hospital Universitário Maria Aparecida Pedrossian (HUMAP)/(EBSERH), Campo Grande, Mato Grosso do Sul, Brasil
22Especialista em Enfermagem, Faculdade Maurício de Nassau, Recife, Pernambuco, Brasil
23Especialista em Enfermagem, Centro Universitário FAMETR, Hospital de Clínicas da Universidade Federal de Uberlândia (HC-UFU)/(EBSERH), Uberlândia, Minas Gerais, Brasil
24Graduada em Enfermagem, Centro Universitário Santa Terezinha, Hospital Universitário da Universidade Federal do Maranhão (HU-UFMA)/(EBSERH), São Luís, Maranhão, Brasil
25Especialista em Enfermagem, Instituto Tocantinense Presidente Antônio Carlos (ITPAC), Hospital de Doenças Tropicais (HDT-UFT)/(EBSERH), Araguaína, Tocantins, Brasil
26Especialista em Enfermagem, Faculdade de Ciências e Educação Sena Aires (FACESA), Hospital Universitário de Brasília (HUB)/(EBSERH), Brasília, Distrito Federal, Brasil
27Especialista em Enfermagem, Faculdade Estácio de Teresina, Hospital de Clínicas da Universidade Federal de Uberlândia (HC-UFU)/(EBSERH), Uberlândia, Minas Gerais, Brasil
28Especialista em Fisioterapia, Universidade de Fortaleza (UNIFOR), Maternidade Escola Assis Chateaubriand (MEAC)/(EBSERH), Fortaleza, Ceará, Brasil
29Especialista em Enfermagem, Centro Universitário Uninovafapi, Hospital Universitário da Universidade Federal do Piauí (HU-UFPI)/(EBSERH), Teresina, Piauí, Brasil
30Especialista em Enfermagem, Universidade Estadual Vale do Acarau (UVA), Hospital Universitário Walter Cantídio (HUWC)/(EBSERH), Fortaleza, Ceará, Brasil
31Especialista em Enfermagem, Universidade Federal de Alagoas, Hospital Universitário Professor Alberto Antunes (HUPAA-UFAL)/(EBSERH), Maceió, Alagoas, Brasil
32Especialista em Enfermagem, Universidade Federal do Rio Grande do Norte (UFRN), Hospital Universitário de Brasília (HUB)/(EBSERH), Brasília, Distrito Federal, Brasil
33Especialista em Enfermagem, Pitagorás ICF, Hospital de Doenças Tropicais (HDT-UFT)/ (EBSERH), Araguaína, Tocantins, Brasil