Impact of Interruptions in Emergency Nursing

This paper will explore the impacts that interuptions have on emergency nursing. I will assess this by utilizing information gathered from 3 articles. All studies within these articles illustrate the detrimental outcomes that emergency nursing interruptions have on patients and nurses. When interruptions occur, it is likely that harmful outcomes will result. Indicating the need for further research of these situations and interventions needed to reduce the occurrence of them.

Introduction

The purpose of this paper is to identify interruptions in emergency nursing, and the effects that it has on patients and nurses, as well as strategies needed to reduce the number of these interruptions. Interruptions are things that impede something from happening, distracting an individual from doing the task at hand. There are nurmerous types of interruptions that can occurr. Some interruptions arise from other members of the health care team like doctors or nurses interrupting patient care to ask questions, or to give orders. The patient that is being cared for, other patients, family members, and other visitors may also contribute to interruptions experienced by nursing staff. Other interruptions can occur from alarms such as cardiac monitors,call bells, IV pumps, EMS radio systems, or overhead pages.

The emergency department evironment is fast paced, with unknown patient presentation, complaints, and events. This varying nature of the environment is what draws emergency nurses to this area of the medical field. There are nurmerous types of interruptions that can occurr within this setting. Medical professionals in this field of care are accustomed to trauma, cardiac arrest, and bizarre patient presentations. However, the familiarity of this unpredictable environment does not prepare nursing staff for the type and frequency of interruptions experienced during a work shift, and the unforseen consequences this could have for them and their patients.

Review of Literature

Nurses are the heart of health care, as nurses occupy the majority of time spent with patients during hospital stays. Interruptions during emergency nursing care effect the cognitive functions of nurses adversely resulting in memory deficits, decreased response times, increased mental workload, and an increased potential for error to occur (Forsyth et al. , 2018). According to Monteiro,Avelar, and Pedreira (2015), interruptions can delay patient care, jeopardize patient safety, and decrease quality of patient care. These consequences can result in patient disatisfaction as well as discontent among nursing staff.

Interruptions have occured infinitely in existance, as well as the health care system. Interruptions can contribute to errors made by nursing staff and risk patient safety. In 2015, the following article "Interruptions of Nurses’ Activities and Patient Safety: An Integrative Literature Review" was published. According to Monteiro,Avelar, and Pedreira (2015), this article was created using 29 studies reviewed from a database in which the following was searched, "interruptions and patient safety. " The studies used by these Brazilian authors came from multiple countries to include the United States, Australia, Denmark, Canada, Italy, United Kingdom, China, Sweden, and Germany. Hence, interruptions experienced by nurses and the effects on patient care is a world wide phenomena in which studies have been conducted.

In the chaotic environment of emergency departmnts interruptions are going to happen. Present day studies reveal the quantity and variety of interruptions experienced by emergency nurses. Forsyth et al. (2018), reports that emergency nurses experience 8. 7 interruptions per hour during a shift. Of these interruptions, "communication from other emergency room nurses accounted for 38. 7%, communication from physcians accounted for 8. 5%, communication from other health care staff was 15. 6%, followed by environmental interruptions at 19. 9%,pages and phone calls togther accounted for 12%, and unanticipated patient care accounted for 5. 5%" (Forsyth et al. , 2018). It was also determined that only 2. 1% of the interruptions were considered high priority (Forsyth et al. , 2018).

It is transparent that emergency nurses are faced with many interruptions throughout their work shift. Forsyth et al. (2018) states, "with the impact that interruptions have in the setting, it is not surprising that the emergency department has been identified as having the highest rates of preventable deaths and other adverse events. " Interruptions can occur during medication preparation, when gathering supplies, while performing assessments and interventions, when giving report, while documenting, and in the hallways. Monteiro, Avelar, and Pedreira (2015), reported that, "studies identified that 88. 9% to 90% of interruptions resulted in negative consequences, such as delay in treatment and loss of concentration," and the majority of interruptions occured during medication administration and while nurses where documenting. Interruptions during critical times such as these not only cause a delay in patient treatment, but can also result in patient safety issues and harm. Monteiro, Avelar, and Pedreira (2015), also mention that, "one study reports that interruptions unnecessary for care generate frustration, stress, and demotivate professionals. "Revealing that not only do interruptions affect patient safety, but also nursing staff morale.

In a constantly changing, fast paced, environment such as the emergency department nurses and other health care workers may feel the need to relay messages quickly, even if it means interrupting anothers task. Some perceive this as the everyday norm and have grown accustom to these interruptions, regardless of how it may affect them or the care they are providing. However, it is important to remember these established standards may have detrimental consquences. When examining interruptions Monteiro, Avelar, and Pedreira (2015) stated,"these occurrences are common in the practice of nurses and impact the quality and safety of care delivered to patients by interfering in staff member’s cognitive processes, potentially resulting in a great number of errors.

While studies indicate that interruptions may prompt increases in nursing errors, risk to patient safety, delays in care, and declining nursing staff morale; other studies also analyse the positive effects they can have. According to Monteiro, Avelar, and Pedreira (2015), " literature shows that interruptions do not always lead to adverse events and some may have a positive impact on a professional’s performance and care delivery because some interruptions may contribute to increased safety, increased comfort of patients, and help nurses to be more accurate in their tasks. " Interruptions like these can occur when nursing staff may not be aware that an order has changed while providing hands on care at the bedside. Another nurse may have to step in to inform them that a certain medication or intervention can be stopped or isn't needed as it has been cancled. Another example could be that one nurse may notice that another nurse is about to perform a task incorrectly. The nurse may interfer with the task in order to prevent the other nurse from making an error. Thus, interruptions can be potentially harmful or helpful, the distinguishing factor is dependent upon the circumstances to which they occur in.

A strategy that emergency nurses can use to minimize interruptions could be as simple as, encouraging nurses to stop and ask themselves is this a higher priority? Can this wait until the nurse is finished?If it is of higher priority than yes, an interruption is needed. However, if something is not crucial to the flow of the emergency department, a nurses safety, or a patients safety, then waiting is the practical thing to do. Secondly, designated areas can be established in which increased noise is not welcome or acceptable, by using signs that state do not disturb or quiet area; such as in medication rooms. Another significant strategy would be to educate all staff on the consequences of interruptions and the importance of minimizing them.

As an emergency nurse I deal with interruptions in my unpredictable work environment on a daily basis. I do understand the importance and benefit that some interruptions may have such as instances when a nursing task is being performed incorrectly. In this instance, an interruption is needed to prevent patient or nursing harm, or an error from occuring. However, more often than not, interruptions that I experience are avoidable as they do not take priority over what I'm doing.

I also understand the negative impact interruptions have as well. If someone is constantly getting interrupted while triaging or assessing a patient this can cause the nurse to lose focus of what they are doing, take attention away from the patient, and lead to improper documentation of patient complaints and findings. The same is true when documenting in a patients medical record. If these processes are hendered it slows the overall flow of the patient through the emergency department. It can also lead to patient harm as pertinent information may not be recorded in the patient's chart. Interruptions when gathering supplies for interventions can have the same results as you may not gather everything that is needed. Once, at the patient's bedside you may have to stop what you are doing to retrieve the items that you forgot, resulting in delayed patient care.

Interruptions can also have detrimental effects on patient safety. Being interrupted while preparing or administering medications could cause you to pull up the wrong medication, administer the wrong dose, or administer the dose to fast. You could also be assisting a patient to the bathroom or bedside commode when you're suddenly called away by someone else. During your absence your patient could attempt to get off the toilet and fall.

Another result related to interruptions is the negative effect it has on the nursing staffs esteem. Frequent and repeated interruptions are frustrating and stressful. They also add to the mental and physical workload of the nurse resulting in decreased nursing satisfaction and morale.

I could create many scenarios demonstrating negative consequences related to interruptions. Therefore, I feel it is very important for nurses to be mindful of other staff members. Determine if an issue is an imment priority or if it can wait before making interruptions.

Conclusion

Interruptions can play a significant role in distracting emergency nurses and interfere with decision-making skills; resulting in an increased risk for error. Nursing care provided in the critical care environment of the emergency department, requires concentration, precision, and exceptional critical thinking skills. Due to the unpredictable nature of the emergency room interruptions will arise and cannot be entirely avoidable. Therefore, it is important to focus on interventions needed to reduce interruptions, and educating all members of the health care team on the consequences that interruptions may have on the department including both patients and nurses.