Running head: TRAUMA CENTER PAPER 1 TRAUMA CENTER PAPER 8 Trauma Center Paper Meghan Inman Patty Hanks Shelton School of Nursing Trauma Center Paper Introduction The Trauma Center can be a fast paced, exhilarating place for nursing students as well as nurses. However, there are certain guidelines in place along with safety protocols to ensure that nurses provide prudent care and that patients and the nurses are safe. It is important in the trauma center setting to not only be fast but also be safe. Triage Protocol The triage protocol is different at Hendrick Medical Center because rather than use a numbering system, they use a color system based on severity of the patient. After a color assignment, the patient will then go the appropriate color location. If the patient is in a life-threatening condition such as a heart attack or stroke, they are given the color red. The next color below red its yellow reflecting conditions like chest pain. With a yellow color, the patient may be having symptoms leading to a life-threatening event that can receive interventions to prevent the life-threatening event. The next color is green which reflects stable patients that may need an intervention such as fluids to treat them. An example of a green patient is someone with gastroenteritis who has been nauseous and vomiting since the previous day. Safety Guidelines Safety guidelines are of the upmost importance in any area of the hospital. Not only are there safety measures in place for the patient but also for the physicians, nurses, and other staff. The first safety measure I noted was a badge scanner protects the access to the actual emergency department. One must be an employee of Hendrick or must be accompanied by an employee of Hendrick to come back. I believe this is in place to protect the safety of the staff. This keeps only authorized people and patients back in the exam rooms. The second safety measure in place is that there is always two to three security guards rounding in the Hendrick trauma center and checking on nurses. This is important for when a patient becomes combative or if a patient comes in feeling unsafe or abused. I think this not only promotes safety but promotes collaboration through all of the disciplines at the hospital. The third safety guideline noted is the staffing ratio. Throughout the day the charge nurse rounded the unit to ensure that there were enough nurses for the patient load. In On the Threshold of Safety: A Qualitative Exploration of Nurses’ Perceptions of Factors Involved in Safe Staffing Levels in Emergency Departments they discuss the positive and negative factors in safe staffing ratios. This study asked nurses about solutions to better staffing and they stated, “…having huddles throughout the day to reorganize care, establishing processes for other nurses in the hospital to provide patient care in the emergency department during surges, and engaging staff and administration in unde.

1. Running head: TRAUMA CENTER PAPER 1
TRAUMA CENTER PAPER 8
Trauma Center Paper
Meghan Inman
Patty Hanks Shelton School of Nursing
Trauma Center Paper
Introduction
The Trauma Center can be a fast paced, exhilarating place
for nursing students as well as nurses. However, there are
certain guidelines in place along with safety protocols to ensure
that nurses provide prudent care and that patients and the nurses
are safe. It is important in the trauma center setting to not only
be fast but also be safe.
Triage Protocol
The triage protocol is different at Hendrick Medical Center
because rather than use a numbering system, they use a color

2. system based on severity of the patient. After a color
assignment, the patient will then go the appropriate color
location. If the patient is in a life-threatening condition such as
a heart attack or stroke, they are given the color red. The next
color below red its yellow reflecting conditions like chest pain.
With a yellow color, the patient may be having symptoms
leading to a life-threatening event that can receive interventions
to prevent the life-threatening event. The next color is green
which reflects stable patients that may need an intervention
such as fluids to treat them. An example of a green patient is
someone with gastroenteritis who has been nauseous and
vomiting since the previous day.
Safety Guidelines
Safety guidelines are of the upmost importance in any area
of the hospital. Not only are there safety measures in place for
the patient but also for the physicians, nurses, and other staff.
The first safety measure I noted was a badge scanner protects
the access to the actual emergency department. One must be an
employee of Hendrick or must be accompanied by an employee
of Hendrick to come back. I believe this is in place to protect
the safety of the staff. This keeps only authorized people and
patients back in the exam rooms.
The second safety measure in place is that there is always
two to three security guards rounding in the Hendrick trauma
center and checking on nurses. This is important for when a
patient becomes combative or if a patient comes in feeling
unsafe or abused. I think this not only promotes safety but
promotes collaboration through all of the disciplines at the
hospital.
The third safety guideline noted is the staffing ratio.
Throughout the day the charge nurse rounded the unit to ensure
that there were enough nurses for the patient load. In On the
Threshold of Safety: A Qualitative Exploration of Nurses’
Perceptions of Factors Involved in Safe Staffing Levels in
Emergency Departments they discuss the positive and negative
factors in safe staffing ratios. This study asked nurses about

3. solutions to better staffing and they stated,
“…having huddles throughout the day to reorganize care,
establishing processes for other nurses in the hospital to
provide patient care in the emergency department during surges,
and engaging staff and administration in understanding the
complex interplay between adequate staffing and the
provision of high quality, safe, emergency care. … finding
ways to cope with the emotional toll and cultivate a
supportive work environment” (Wolf, Perhats, Delao,
Clark, Moon, 2017).
I agree that all of these things should be implemented into
emergency department nursing. They also discussed retaining
nurses and having more than one or two experienced nurses
working in the trauma center. This can be complicated because
many nurses get burnt out in a trauma center setting however, if
trauma centers implement what the nurses spoke of above it may
decrease the burn out in nurses. Within the Hendrick trauma
center I saw many nurses working together and helping each
other out and even doctors stepping in to help nurses.
The fourth safety measure implemented was the five
medication rights of medications four times before giving
medications to patients. They also would check with other
nurses if they had to calculate a drip rate or if they were giving
a high alert medication. The nurses also talked about the
implementation of the medication scanning system that they use
on the floors coming in June to help promote more medication
safety.
The final safety measure implemented is special trauma
rooms in place for large traumas that come in. Within these
rooms they have everything needed for any type of trauma. I
think this promotes safety because it promotes timely
implementation of interventions. Time is crucial in the trauma
center and so any measure to minimize time is going to promote
better outcomes and safety.
“The Critical Hour”
The “Critical Hour” is a term used to describe the first

4. hour that the patient is in the trauma center. This is the most
important time period for the patient because the sooner
interventions are done the better the patient outcome is. The
patient I will be discussing is a female who came in
complaining of a nose bleed lasting since 0200. The patient
arrived to the trauma center at 1000. Upon entering the room
the patient was not having any active bleeding of the nares.
When shining a pen light up the nares there were also no blood
clots or signs of trauma to the nose. The nurse questioned the
patient asking about medical history and any medications taken.
He also asked if she had done anything to stop the nose bleed.
Getting a health history from this patient was difficult because
she could not remember any of her medications or any history
of medical problems. The only thing she stated was that she
takes pills for her diabetes. The nurse asked about any use of
anticoagulants and the patient denied use of them. After this
question the patient stated that she had a mild stroke previously
and that her chest was feeling the same way it did when she had
the stroke. She showed no signs of residual deficits from the
stroke. The nurse then found the doctor and discussed the
assessment data with him. Although the patient denied using a
blood thinner the doctor believed she may be experiencing a
side effect or toxicity of the blood thinner. The nurse asked if
she could be moved to a different room and monitored via a five
lead electrocardiogram. The doctor said yes. When attached to
the five lead the patient was in normal sinus rhythm displaying
a P wave, QRS complex, and T wave. Once hooked up to the
five lead the patient complained of chest pain at seven out of
ten. The nurse informed the doctor and he ordered aspirin 325
mg and nitroglycerin sublingual. While the nurse gathered the
medications, I placed an 18 gauge IV in the right antecubital
fossa. I then collected “rainbow labs” which consists of a CBC,
CMP, PT, PTT, lactic acid, and troponin levels. Vitals were
taken and the values were within normal limits besides a
slightly elevated blood pressure. Her blood pressure was 135/85
and her oxygen saturation was 100% on room air. Her pulse was

5. 85. Respirations were 18. The labs came back with slightly
elevated troponins. Upon seeing the troponin levels, the patient
was admitted to Anderson 5, a telemetry observation floor to
monitor the chest pain at 1230. One nursing diagnosis for this
patient would be ineffective tissue perfusion: myocardial. One
intervention we performed was connecting the patient to the 5
lead EKG for monitoring. The other intervention was to keep
the patient NPO in case the patient needed to be rushed to the
cath lab. We not only did these two interventions. We gave
medications, ensured the patient stayed calm, and rested so she
did not place extra stress on her heart. One outcome would be
to relieve or lessen the chest pain of the patient. To help with
this we gave one nitroglycerin tablet. Thirty minutes later, I
went back and asked her about her chest pain and she said it
remained at a seven. Just before transferring the patient, she
stated her chest pain was at a five. I believe our intervention
was effective because in the end it did decrease the chest pain
along with the other interventions we performed.
Autonomy of the Trauma Center Nurse
Trauma center nurses must be able to think critically,
quickly, and be able to ac autonomously. They do many things
in anticipation for what may happen such as: starting an IV and
fluids, drawing labs, and hooking patients up to a five lead
EKG. Another part of nurse autonomy is within the Apollo
charting system. They can open up a patients chart, type in their
chief complaint and a list of orders will come through and the
nurse can implement the appropriate orders for the patient.
Ethical/Legal Dilemma
An ethical dilemma I observed was during our assessment
of the patient I discussed during the Critical Hour section.
When we would ask her questions about medical conditions or
we would name one she would say yes. This made it hard to get
to the root of the problem and provide treatment. When we left
the room and the nurse asked a more experienced nurse for
advice, the experienced nurse told him, “she may just be
looking for drugs and saying what she needs to get the

6. medicine.” Although the patient may be looking for drugs we
are still obligated to treat everyone the same. In my opinion, we
should have waited for a family member to come and ask them
more about her medical history.
My Reflection
I enjoyed my time in the trauma center. I was amazed at
how the entire team worked together and supported each other.
Although there were times when the floor would become very
busy, the nurses remained calm and were certain to give patients
the time they needed. What I learned from this experience was
to be patient when asking a patient questions and what
questions to ask to get to the root of the problem. There were
many times when I think a question would not be pertinent but
it would lead to a question that would help us identify the
problem. It was also interesting to see the dynamic between
nurses and doctors. They were very collaborative and the
doctors respected the nurses recommendations for treatment. I
think I would like to maybe work in the trauma center one day.
However, I would like to develop my critical thinking skills and
confidence in my autonomy before working in that setting.
References
Wolf, L. A., Perhats, C., Delao, A. M., Clark, P. R., & Moon,
M. D. (2017). On the threshold of safety: A qualitative
exploration of nurses’ perceptions of factors involved in safe
staffing levels in emergency departments. Journal of
Emergency Nursing, 43(2), 150-157.

7. doi:http://dx.doi.org/10.1016/j.jen.2016.09.003
Research the range of contemporary issues teenagers face today.
In a 500-750-word paper, choose one issue (besides teen
pregnancy) and discuss its effect on adolescent behavior and
overall well-being. Include the following in your submission:
1. Describe the contemporary issue and explain what external
stressors are associated with this issue.
2. Outline assessment strategies to screen for this issue and
external stressors during an assessment for an adolescent
patient. Describe what additional assessment questions you
would need to ask and define the ethical parameters regarding
what you can and cannot share with the parent or guardian.
3. Discuss support options for adolescents encountering external
stressors. Include specific support options for the contemporary
issue you presented.
Prepare this assignment according to the guidelines found in the
APA Style Guide, located in the Student Success Center. An
abstract is not required.
This assignment uses a rubric. Please review the rubric prior to
beginning the assignment to become familiar with the
expectations for successful completion.
RUBRICS:
A relevant issue facing adolescents is thoroughly discussed. An
explanation of external stressors associated with this issue is
well presented. Insight into adolescent issues and external
stressors is demonstrated
Strategies to screen for the chosen issue and external stressors
during an assessment for an adolescent patient are well
described. The strategies are highly relevant to screening for the
issue and external stressors. Additional assessment questions to
ask are presented and relevant. The ethical parameters regarding
what cannot be disclosed to the parent or guardian are clearly
presented. The strategies demonstrate insight into assessment
development for adolescent issues.
Support options for adolescents encountering external stressors

8. are thoroughly discussed. Specific support options for the
contemporary issue are described in detail. The support options
are relevant for addressing the external stressors, including
those specific to the contemporary issue. The options are well-
supported by evidence and rationale.
Thesis is comprehensive and contains the essence of the paper.
Thesis statement makes the purpose of the paper clear.
Clear and convincing argument that presents a persuasive claim
in a distinctive and compelling manner. All sources are
authoritative.
Writer is clearly in command of standard, written, academic
English.
All format elements are correct. Sources are completely and
correctly documented, as appropriate to assignment and style,
and format is free of error.
Trauma Center Research Paper Objectives
1. Describe Triage Protocol: how are patient’s triaged; what
are the numbers or colors used for triage during disaster
2. Identify 5 safety guidelines/practices specific to the
Trauma Center. Step beyond standard precautions! What
measures/guidelines are observed to protect staff, nurses,
doctors, other patients? REFERENCE A TRAUMA CENTER
SAFETY POLICY IN YOUR PAPER.
3. Define what "The Critical Hour" means for Trauma
Victims. Describe 60 minutes of patient care for a selected
patient in the Trauma area in which you are assigned. Choose a
patient, (critical, if available) and document 60 minutes of care
for that patient. Include Chief Complaint, history of present
illness, nursing interventions provided upon patient arrival to
ER room (example: O2, EKG, bp, etc) IV’s (site, type (ie 20 g),
Medications including fluids (crystalloids & colloids)
administered, Oxygen, diagnostics completed (example: labor,

9. testing), differential medical diagnosis considered upon patient
arrival, final medical diagnosis, disposition of patient (example:
admit, discharged, etc). Provide a care plan inclusive of 1
nursing diagnosis, 2 interventions, 1 outcome and evaluation of
your interventions and outcome
4. During your clinical experience, describe an example of
autonomy of the Trauma Nurse. Provide details of any ethical
and legal dilemmas the Trauma Nurse was confronted with
during your clinical experience. Include what the outcome was
and if you concur with how it was handled by the nurse. If you
did not identify an ethical and legal dilemma that occurred;
identify an ethical and legal dilemma that could have occurred
in the given situation and how it could be resolved
5. Reflect on your Trauma unit experience. Describe and/or
identify an issue new to you and what was gained from your
experience in the Trauma Center. This is time for personal
reflection of how you felt, what you experienced, etc. Examples
could be: what was learned; what would you do different/same
as a nurse in this role; what ethical issues did you see; what
type of doctor/nurse interactions were observed; was anything
observed questionable from an ethics, harassment, bullying, etc,
standpoint. This goes well beyond the “I liked what I did. It was
fast paced and I learned a lot” response!
6. APA format, typed, double spaced, title page, sentence
structure and spelling and grammar accurate. References are
required, including at least 2 peer reviewed nursing journal
articles. USE YOUR APA REFERENCE BOOK!!!!! Review the
Professional Writing Policy in your student handbook
7. Journal Articles used as a reference are provided, and/or
links are valid and journal article easily accessed.
8. LENGTH: Minimum 8 pages not including cover and

10. reference pages
SEE SYLLABUS FOR DUE DATE
Grading Criteria – Trauma Center Experience
Be sure to read the paper objectives prior to the experience and
paper write up!!
Please attach a copy of the grading criteria with your paper.
THANK YOU!!!
Content
Possible
Points
-------------------Comments--------------
Points
Received
Triage Protocol (how are patient’s triaged; what are the colors
used for triage during disaster)
10
5 safety guidelines/practices
10
The Critical Hour
Discussion of Focus Client
1 nursing diagnosis, interventions, outcomes and evaluation
45
Discussion of autonomy and ethical and legal dilemmas
12

11. Reflection on the Overall Experience (examples: what was
learned; what would you do different/same as a nurse in this
role; what ethical issues did you see; what type of doctor/nurse
interactions were observed; was anything observed questionable
from an ethics, harassment, bullying, etc, standpoint; etc)
10
APA Format with reference page.
Mechanics (Grammar, Sentence Construction, spelling, etc.)
Minimum 8 pages not including cover and reference pages
8
References provided and integrated including minimum 2 peer
reviewed nursing journal articles to support paper (2 pts each).
Journal Articles provided &/or links are valid and access
journal article (1 pt).
5
Total
100
Graded By
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