Usually the management is given under the guidance of a physician or an emergency nurse practitioner. The emergency nurse has had specialized education, training, and experience in assessing and identifying patients' problems in crisis situations. Along with that, the nurse prioritises, monitors, and provides continuous assessment of the acutely ill or injured patients. The role does not end there. She has also the role to support and attend to families, to supervise allied health personnel, and to teach the patients and families in a care environment that is time-limited and highly pressured. Nursing interventions are usually accomplished in collaboration with or under the direction of a qualified physician or nurse practitioner. The strengths of nursing and medicine are complementary in an emergency situation. Appropriate nursing and medical interventions are anticipated based on assessment data and current evidence for appropriate measures (Brook and Crouch, 2004, 211-216). The emergency health care staff members work as a team in performing the highly technical care for patients in an emergency situation, where taking an important decision matters, and research evidence can serve as a guide to make confident decision (Gerrish and Lacey, 2006, 3-15).
The Nursing process in the Accident and Emergency provides a logical framework for problem solving in this environment. Patients in the A and E have a wide variety of actual or potential problems, and their condition may change constantly (Lattimer et al., 2004). Therefore, nursing assessment must be continuous, and nursing diagnoses change with the patients' condition. Although a patient may have several diagnoses at a given time, the focus is on the most life-threatening ones; often, both independent and interdependent nursing interventions are required (Sakr et al., 2003). Therefore, it becomes pertinent to find out quickly which condition demands immediate care, so the patient may benefit from early and aggressive medical and nursing interventions, and the outcome of the condition is improved. The authors establish their point from references from already existent researches with evidence that early goal directed interventions in the A and E before admission to the Intensive Care Unit would significantly improve survival. The challenge to the A and E nurses are those of providing holistic care in the context of a fast-paced, technology-driven environment in which serious illness and death are confronted on a daily basis. Emergency nurses spend many hours learning to classify different illnesses and injuries to ensure that patients most in need of care do not wait to receive it. Protocols may be followed to initiate laboratory or x-ray studies from initial encounter while the patient might wait for a bed in the A and E if indicated (Hucker et al., 2005). The laboratory investigations are important in the sense that a quick and accurate detection of the pathophysiologic process needs to be detected before it becomes irreversible due to progression of the pathology, and it can be intervened at the earliest by different measures such as fluid resuscitation, correction of acid-base balance, pressor support, arrest of haemorrhage, respiratory support, or a multitude of other nursing intervent