Dilemma. Role conflict.
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Biomedical subjects
Publications and source records attributed to L Sbaih.
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The student may spend a lot of time and effort on an assignment or essay, and when the lecturer makes this comment about the finished product, may go ahead and submit it to a journal editor. If the editor returns the work with the comment 'our readers would be most interested in your work but it needs to be presented as a journal article', the student rarely feels able to spare the time or make the effort to rewrite and resubmit, and the work is never published. The article and the assignment could, however, be produced simultaneously, and below are some suggestions as to how this could be achieved.
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AT 5.00 am one Friday morning a 19-year-old woman was brought into the Accident & Emergency (A&E) department following a head on collision with a van. The young woman had sustained severe head injuries, along with a fractured pelvis and a ruptured spleen. Following resuscitative surgery, the patient was taken to the intensive care unit, where she remained unconscious following her head injury. Two patients from the van were admitted to A&E with minor injuries, and were discharged home mid-morning. When staff checked the woman's belongings and listed them in a property book, they discovered white powder in a small twist of white paper, which amounted to about the size of a pea. Staff present listed the substance in the property book and then locked it in the cd cupboard. Six hours later, following discussion with senior staff, two nurses disposed of the substance by flushing it down the toilet and recorded their actions with a witness signature from a senior nurse and pharmacist. Was this the best course of action from the viewpoint of the seriously injured patient and the other two involved in the van? What opinion would a police officer have?
In this third paper on the work of Accident and Emergency (A & E) nurses, the ways in which initial assessment is accomplished are described. In particular, the ability to gain an impression and use knowledge of 'normal cases' will be put forward.
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An ethnomethodological study was undertaken to explore the work of Accident and Emergency nurses, the aim of which was to analyse the ordinary, taken-for-granted and everyday work of those practising A & E nursing. This, the first of two papers, will examine the work of A & E nurses via a description of rules or maxims that underpin work and its everyday organization. Such a description will form the basis for part 2, which explores the specific rules of A & E nursing work. To understand the specific rules and the ways in which they contribute to organization and accomplishment of aspects of the work, the definition and use of rules should be put forward. Defining rules within the context of the work provides a means by which specific rules of work can then be explored. The rules of A & E work ensure that A & E nursing is seen and heard as a specific type of work with its own unique approach to talk and organization. This is tied in with peer and colleague views of what is deemed to be clinical competence within the A & E setting.
An ethnomethodological study was undertaken to explore the work of Accident and Emergency (A & E) nurses; the aim of which was to analyse the ordinary, taken for granted, everyday work of those practising A & E nursing. In this second paper on the work of A & E nurses, the specific rules or maxims of nursing work in A & E are introduced. From the analysis of materials gained: fieldwork notes, observations of nurses at work and conversations, a number of maxims of A & E nursing work were identified. Maxims direct, instruct and make nurses accountable for their work and the ways in which it gets done. That is, the presence of maxims underpinning A & E nursing work ensure that A & E nursing is seen and heard as a specific type of work with its own unique approach to talk and organization. Being aware of the maxims of A & E nursing work is not the concern of the nurse practising A & E nursing on a daily basis. Implicit and explicit reference to the maxims when talking about and doing the work provides nurses with impressions of who can do the job. Non-adherence by some nurses to the maxims of A & E nursing work often leads their colleagues to question their commitment to their choice of work setting. Maxims of A & E nursing account for the ways in which the work is seen, heard and talked about. Maxims direct the organization of work and its development within the A & E setting.
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The Scope of Professional Practice has the potential to revolutionise the practice of Accident and Emergency nursing. However, for such a revolution to take place re-evaluation of the thinking and doing of Accident and Emergency nursing is needed. In particular, many organisational approaches to work such as team-building and multidisciplinary work need to be recognised and the place of the nurse within them formalised. The make-up of nurses' work in Accident and Emergency needs to be understood, so that expansion of the role can encompass a wide range of 'caring' work as well as easily identify tasks. In addition the use of the Scope of Professional Practice should be based upon clarification and recognition of dilemmas which may lead to informed risk taking by Accident and Emergency nurses. Once nurses' work in Accident and Emergency is understood, the short- and long-term effects on the continuity of patient and family care of nurses' actions and non-action can be explored. Communication is seen as underpinning all professional and care development in relation to the use of the Scope of Professional Practice in Accident and Emergency. The art of listening as well as talking to colleagues, patients and families is important if the revolution is to take place.
Accident and emergency (A and E) work is undergoing many changes including a revision of trauma patient management, examination of medical and nursing skill mix and the introduction of health care support workers. Such changes affect all members of the A and E health care team, including nurses whose role has traditionally been in the provision of continuing care of the patient and family. A and E nurses' response to change and subsequent professionalization is poorly documented within current health literature, much of which reflects medicine's response to change within A and E departments. The following literature review illustrates that the examination of A and E related issues involves some exploration of the 'open access' policy and its perceived effects upon the A and E department.
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Meeting the needs of clients with mental health problems in the accident and emergency (A&E) department requires all members of the multidisciplinary team to be familiar with the Mental Health Act (1, 2). In particular, nurses registered on parts 3, 5, 13 and 14 of the Professional Register (3) and working in A&E should be aware of section 5 (4), the nurse's six-hour holding power (1) and its equivalent, section 25 (2) of the 1984 Mental Health (Scotland) Act (2), and the possible implications of their use in practice.