Running Head: TRAUMA CENTER REFLECTION
Trauma Center Reflection
Shelby Crow
Nursing Process IV
Patty Hanks Shelton School of Nursing
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On February 5, 2014 I spent my morning in the Trauma Center at Abilene
Regional Medical Center (ARMC). I was able to observe Triage in the Trauma Center
and asked one of the nurses what the Triage Protocol consisted of. When people come
into the Triage room of ARMC, they are given a number based on the severity of their
problem. If a patient is given a number 1, they are considered “critical” and need to be
treated immediately. The numbers range from 1 to 5, with 5 being the least urgent. A
patient labeled with a 1 or 2 are the nurses top priority until they are treated. Chest pain is
typically given the number 1 or 2 because of the serious complications that can be
associated with it. A person labeled with a 3 typically will need an IV or CT scan.
Patients that are a 5 are non-urgent and will be treated last.
When I asked the nurses about the 5 safety guidelines specific to the Trauma
Center, I received several different answers from the nurses. One of the nurses said they
were a locked down unit, triage unit, they had a visual of all the rooms, telemetry, and
many crash carts available in the center. In addition, the trauma center also had big
television screens that displayed where the nurses were in the center. One would need a
passcode to get through the doors from the hospital to the trauma center.
“The Critical Hour” for trauma victims is referring to the first hour that the
victims are at ARMC. While I was not able to see any trauma victims today, I know that
time can make a difference in life or death for a critical patient. In the first hour, the
nurses stabilize and transport the patient, or treat the patient right away in the trauma
center. The initial assessment and secondary assessment are done during this hour as
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well. Vital signs are taken immediately, and interventions to make the patient better are
begun.
The patient I was assigned was not in critical condition. He went to the
Emergency Room because he was vomiting and had diarrhea resulting in dehydration.
The nurse first took his vital signs and did a focused assessment on his problem. The
patient informed the nurse that he was not feeling well because he was sick all night. He
said that he was weak and felt as if he may pass out. The patient’s vital signs were
indicative of dehydration: tachycardia, decreased urination, decreased blood pressure.
The appropriate nursing diagnosis is deficient fluid volume r/t active fluid volume loss
aeb tachycardia, decreased urination, and decreased blood pressure. The nursing
interventions consisted of hanging one liter of saline to hydrate the patient and continuing
to check the patient for signs of re-hydration and the adverse effect of fluid overload. The
patient’s outcomes were that his vital signs would be within normal limits and he would
no longer have symptoms of dehydration. After the saline IV bag was empty, the patient
no longer had complaints of dizziness and general weakness. When the vital signs were
taken again, the patient’s vitals were within normal limits. The nurse began to prepare for
discharge right after she charted the patient’s new vital signs. The patient was discharged
shortly after with instructions to continue to stay hydrated and to report any signs of fluid
overload.
During my time at the trauma center, I was able to observe one ethical issue. On
the unit, there was a new graduate R.N. orienting to the Emergency Room. She was told
to go take vital signs for a patient that was about to be discharged. She took the vitals,
and the patient left the room quickly after she was done. The new graduate then realized
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she had forgotten to get the temperature and respirations of the patient and gave the nurse
the vitals regardless. The nurse noticed that the temperature and respirations were absent
from the sheet and charted the patient’s original vitals from the initial assessment. This is
a challenging problem because the patient had already left so it was impossible to get that
information. It is an important issue because the patient could have been running a fever
or could have had a small or large amount of respirations when he was sent home. I
would have confronted the new graduate nurse about the vital signs so she knew that they
were forgotten. This confrontation may prevent this mistake from happening again. Also,
I believe that the nurse should have charted that the vitals were not taken again instead of
charting the initial assessment vital signs.
It was a slow day at the ARMC trauma center, but I tried to make the most of the
situation and learn as much as I could. One thing I did notice was that the nurses worked
together as a team and were constantly willing to be in charge of more patients in order to
help each other. Surprisingly, this is rare from what I have seen during my other clinical
experiences. The main thing I learned in the trauma center is how important working as a
team and communication with that team is for a group of nurses on the floor. It creates a
better work environment for the staff, and provides better care to the patients. “The Joint
commission and other leading authorities of quality and safety in the United States
identified communication lapses as responsible for a large proportion of poor patient and
provider outcomes” (Patterson, Pfeiffer, Weaver, Krackhardt, & Arnold 2013). If a
traumatic situation would have occurred, the nurses failing to communicate could have
been crucial to the patient’s life. In trauma situations, it is necessary that the nurses work
together quickly to save the patient’s life. The other valuable lesson I learned was about
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learning to be a caring nurse to my patients. While one would think this is an obvious
statement, in a traumatic setting it could be very difficult to treat the patients as if they are
humans. “Caring is the heart and artistry of nursing so understanding what actions,
attitudes, and behaviors convey caring is essential to good practice” (Merrill, Hayes,
Cluckey, & Curtis, 2012). In the Emergency Room, patients typically do not stay for an
extended period of time, so it can be difficult to build a relationship with the patient. It is
important that the patient and their family know that you are doing everything possible to
perform the best care possible. A caring attitude towards your patients, even in a
traumatic situation, can be very important to the patient’s overall outcome.
Running Head: TRAUMA CENTER REFLECTION
References
Merrill, A. S., Hayes, J. S., Clukey, L., & Curtis, D. (2012). Do they Really Care?
How Trauma Patients Perceive Nurses' Caring Behaviors. Journal Of Trauma
Nursing, 19(1), 33-37. doi:10.1097/JTN.0b013e318249fcac
Patterson, P., Pfeiffer, A. J., Weaver, M. D., Krackhardt, D., Arnold, R. M., Yealy,
D. M., & Lave, J. R. (2013). Network analysis of team communication in a busy
emergency department. BMC Health Services Research, 13(1), 1-12.
doi:10.1186/1472-6963-13-109
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