Section snippets

The nursing process

A nursing theory offers a way of looking at the discipline in clear, explicit terms that can be
communicated to others. It also provides direction and guidance for structuring nursing practice,
education and research, differentiating the focus of nursing from other professions.  The focus of 2

this paper is emergency nursing and the introduction of an emergency nursing assessment
framework (ENAF) for use within curriculum and the emergency department.
In the 1950s and 1960s, nursing leaders began
This paper discusses the uniqueness of the emergency nursing process and practice environment from other nursing
and caring situations. The complexity, uncertainty and sometimes urgency surrounding emergency nursing practice
requires a structured approach based on initial assessment and decision-making. A five step emergency nursing
assessment framework (ENAF) was developed primarily for use in educational contexts, for example, a Master of
Emergency Nursing at The University of Sydney and practice contexts, for example, the emergency department in
acute care hospitals.

The rationale behind the development of ENAF is presented in this paper with a diagrammatic representation and
discussion of each of the five steps. The importance of reassessment of the patient alongside effective communication
in clinical contexts is discussed in the context of the framework implementation.

The clinical environment of the emergency department is challenging as nurses must provide
care for patients of all ages and diverse clinical presentations. The primary distinguishing feature
of emergency nursing is the prominence of patients with undifferentiated diagnoses in a time
pressured environment, so the process of patient assessment is vital in these circumstances.
Nurses require in-depth knowledge and clinical expertise to provide care across the life span and
manage situational events such as patient overcrowding and complex technology. 1

Sometimes the cause of clinical symptoms and presentations are evident. However
consider the following clinical presentations, that could represent any number of clinical
conditions: A 38 year-old male with chest pain presenting slightly diaphoretic; an 80 year-
old female nursing home resident with fever; a 22 year-old female with severe abdominal
pain presenting pale after a syncopal episode. There could be several causes for these
symptoms requiring the request of varying investigations, as well as the potential for rapid
deterioration of the patient. These considerations occur within the context of the emergency
nurse caring for multiple patients simultaneously within a busy emergency department and
anticipating the patient's ultimate destination in order to facilitate patient flow and definitive
care. It is essential for the nurse caring for these patients to use a systematic approach to
the patient assessment process, as is proposed in this paper.