Page 640 - ACCCN's Critical Care Nursing

Emergency Presentations 617

Case study, Continued
0915h extubation, Maria complained of a headache and generalised
Maria’s condition suddenly deteriorated during transport to the weakness, but was able to eat, drink and mobilise. She spent a total
ICU. Her level of consciousness decreased, along with her respira- of 5 days in the ICU before being discharged to the mental health
tory effort. She was noted to be profoundly weak, with widespread service.
piloerection and muscle tremors. Assisted ventilation with bag– Mental health admission summary
valve–mask resuscitator commenced. Maria was diagnosed as having a maladaptive situational response
0920h and moderate depression with ongoing suicidal thoughts. She
On arrival in the ICU Maria was unable to protect her airway due stated to staff that she would not use insect killer again and had
to profound weakness and a reduced GCS. She was intubated with no other formal plan of how she might harm herself. The mental
midazolam 3 mg and vecuronium 10 mg given for induction. health admission was for a total of 5 days. At hospital discharge
Maria had no suicidal ideation. A community mental health team
Summary of ICU admission follow-up was arranged.
Maria required 3 days of ventilation. A pralidoxime infusion was
required for 2 days due to depleted cholinesterase levels. On

Research vignette

Fry MM, Rogers T. The transitional emergency nurse practitioner framework. The advanced role had made a significant contribution
role: implementation study and preliminary evaluation. Austral- towards meeting local service needs.
asian Emergency Nursing Journal 2009; 12(2): 32–7.
Critique
Abstract This paper described the implementation and evaluation of an
Background extended practice emergency nursing role, a transitional emer-
An implementation study was undertaken to develop and gency nurse practitioner (TENP). The role of the emergency nurse
employ Transitional Emergency Nurse Practitioners (TENPs) to practitioner and other extended practice roles have been described
address increased service demands. The TENP role was to be a in this chapter. This specific role was created due to the lack of
new advanced practice role, which was based on a Nurse Prac- available authorised emergency nurse practitioners, state health
titioner (NP) framework. The implementation study provided a funding and a need to meet an increase in service demand. This
roadmap for the introduction of the new nursing role. The imple- paper explored a number of features associated with this single
mentation study aimed to i) develop an integrated and supported site implementation.
Transitional Emergency Nurse Practitioner Role; ii) provide a
framework for practice and knowledge development; and iii) An initial six-month implementation plan was described, including
undertake a six month preliminary evaluation of the TENP work a communication strategy; a consultative process to define the
performance. TENP role and scope of practice; education; ongoing support struc-
tures; and assessment and feedback mechanisms. A framework for
Methods the role of the TENP was presented which focused on three main
The study describes the communication strategy, the consultative patient groups:
process for role definition, education, ongoing support structures 1. a ‘see and treat’ group consisting of minor illness and traumatic
and assessment and feedback mechanisms embedded in the conditions and where minimal medical supervision would be
implementation process. In addition, a six month mixed method required
preliminary evaluation was undertaken as a part of the implemen- 2. a ‘collaborative’ group of more complex patients where signifi-
tation plan. The preliminary evaluation included review of TENP cant collaboration with senior medical staff would be required
managed patient groups; peer audit of TENP documentation; a 3. a ‘consultative’ patient group where the TENPs would supervise
senior emergency physician survey of TENP work performance; or assist junior medical and nursing staff in various clinical
and review of TENP investigations and referrals. procedures.
Results The scope of practice for these patient groups was depicted in a
TENPs managed the care of, or were involved with 2730 patients role model. This framework and scope of practice provide clear
(10%) of which 68% (n = 1987) were in the ‘See and Treat’ group information and assistance for other sites considering implementa-
and 32% (n = 721) were the ‘Collaborative’ (742) and ‘Consultative’ tion of a similar role. The framework and scope of practice is an area
(22) groups. TENPs managed an average of 20 patients per 15 hour for further study and evaluation.
work day. Work performance evaluation identified the role was safe
and efficient and the staff supported the new role. A subsequent six-month postimplementation evaluation of the
role explored the total numbers of patients seen by the TENP, as
Conclusions noted in the Abstract. Of interest only a very small number of
The implementation study provided an effective framework for patients were seen in the consultative group (n = 22). There was no
the introduction of a transitional nursing role based on a NP discussion regarding the possible reasons for the small patient