Nurses and the Manchester: rearranging the work process and emergency care?

Abstract

Objective: to understand the changing roles of nurses in labor division organization in hospitals from the Manchester Triage System implementation in an emergency hospital. Methods: this is an ethnographic study that used different production techniques and data analysis. Results: the Manchester Triage System organized flows and places resulting in quality of care and changes in work processes. Conflict relationships related to disagreements in risk stratification were present. Final considerations: the traditional roles of nurses have been transformed, but it cannot be said that there was a structural change in their position in labor division organization in hospitals. The frontiers of autonomy, therefore of increasing the professionalization of nurses, are neither fixed nor stable, expanding or contracting according to the micropolitical changes in the governance of care.

Determining factors of service priority in the risk classification of patients with chest pain

“…The classification organized to prioritize the patient, through the accurate and qualified assessment of the nurse at the service entry, contributes to rapid diagnosis and appropriate actions, enhancing the effectiveness of care (6,12) . In this scenario, nurses assume an important role, capable of carrying out risk classification due to their careful and expanded view of the conditions, with continued education, qualifications and training of these professionals being essential to support actions and increase the accuracy of the classifying nurse (6,10,13,24) . It is reiterated that mastering knowledge about the symptoms, typical and atypical, of coronary diseases or not, as well as risk groups and associated comorbidities makes it easier for nurses to assess and increases the efficiency of classification, intervening early when necessary, in addition to reducing complications related to the evolution of heart diseases (6,22,24,25) .…”

“…In this process, the role of the Nurse as the main actor in this care model stands out, as they are accustomed to provide comprehensive and humanized care for the patient, increasing the effectiveness of care. In this scenario, starting from the selection of the "Chest Pain" flowchart, a series of questions allow the nurse to differentiate the type of pain, resulting to the correct discriminator in the risk classification (12,13) .…”

Fatores determinantes de prioridade de atendimento na classificação de risco a pacientes com dor torácica

“…Nesse cenário, o enfermeiro assume importante função, capaz de realizar a classificação de risco devido a sua visão criteriosa e ampliada das condições, sendo a educação continuada, as capacitações e treinamentos desses profissionais imprescindíveis para embasar as condutas e aumentar a precisão do enfermeiro classificador (6,10,13,24) . Reitera-se que dominar os conhecimentos acerca dos sintomas, típicos e atípicos, das doenças coronarianas ou não, bem como os grupos de risco e comorbidades associadas faz com que o enfermeiro tenha maior facilidade em avaliar e aumenta a eficiência da classificação, intervindo precocemente quando necessário, além de diminuir as complicações relacionadas à evolução das doenças cardíacas (6,22,24,25) .…”

“…Destaca-se, neste processo, a participação do Enfermeiro como ator principal deste modelo assistencial, visto que está habituado ao cuidado integral e humanizado ao paciente, aumentando a efetividade dos atendimentos. Neste cenário, partindo da seleção do fluxograma "Dor Torácica" uma série de perguntas permite ao enfermeiro diferenciar o tipo de dor, para resultar no discriminador correto na classificação de risco (12,13) .…”

Nursing's Role in Risk Screening and Classification in Emergency Services in Brazil: An Integrative Review

“…Um trabalho realizado por Carapinheiro et al, (2021) sobre a implementação do sistema de triagem Manchester Triage System (STM), traz alguns relatos dos enfermeiros frente a esse sistema. O STM baseia-se na identificação da queixa principal do paciente e estabelece, por meio de fluxogramas de decisão e discriminadores, o tempo máximo para a primeira avaliação médica.…”