Peace

In the song Let Peace Begin with Me, the composers point out that if there is to be peace on earth, it must begin with each individual. There are many definitions of the word peace. Some of these include the absence of war or other hostilities; a state of tranquility or serenity; and harmony in personal relationships. At this time of year, we all think a lot about peace.

This year there have been many challenges to the peace we would all like to see. A few years ago, the Journal of Emergency Nursing began the tradition of honoring those who serve our country by dedicating the December Journal cover to them. Peace in the absence of war or other hostilities is not possible this year, and the cover photo honors those who are working to save the lives of both Americans and the people of Iraq. Captain DeBias is “nursing” on the battlefield, just as one of the founders of modern nursing, Florence Nightingale, did 2 centuries ago. One wonders if peace (the absence of war or hostilities) is ever attainable.

This past August, Sigma Theta Tau International Honor Society of Nursing participated in the documentary Vietnam Nurses with Dana Delany. The documentary is based on a forthcoming book entitled The Fine Art of Nursing Care: Lessons in Healing from War and Art by Margaret Carson and Linda Finke. This documentary presents the experience of nurses who served in Vietnam. Many members of the Emergency Nurses Association, including past presidents, were a part of that difficult and painful time. (More information about the documentary and the book can be found at www.nursingsociety.org.) Another time, another war; one can question, have we learned anything from history?

In June, the Institute of Medicine (IOM) released its report and recommendations on the Future of Emergency Care, describing what we have all felt disturbing our domestic feeling of “peace.” Overcrowding, fragmentation of emergency medical services across the United States, a shortage of on-call specialists, a lack of disaster preparedness, and shortcomings in pediatric emergency care were found to be significant universal concerns. To establish a state of tranquility and serenity for emergency services and emergency care, the IOM recommends the creation of a coordinated, regionalized, accountable emergency care system; the creation of a lead agency; ending emergency department boarding and diversion; increasing funding for emergency care; enhancing emergency care research; promoting EMS research; and enhancing pediatric presence throughout emergency care. One questions, what actions will come from these proposals? Can these recommendations bring peace to emergency services and emergency departments?

Harmony in personal and professional relationships is an important aspect in the peace of emergency care. In July of this year, the Center for Medicaid (CMS) and State Operation/Survey and Certification Group issued a directive about the practice of “parking” patients in emergency departments. (The specific memo can be found at the www.ena.org web site.) Emergency Medical Treatment and Active Labor Act dictates that when a patient presents to a dedicated emergency department, the hospital has an obligation to see the patient, carry out a screening exam, and provide any care that is needed to stabilize the patient. Because of overcrowding, limited staff, and many of the issues identified in the IOM report, there has been an increase in the practice of “parking” patients and asking the transferring personnel to maintain patient care. One would hope that this problem can be solved because it undermines the foundation of harmony in the professional and personal relationships between the EMS and ED communities. Unfunded mandates continue to cause many problems throughout the practice of emergency care.

One may question, what does all of this have to do with peace beginning with each of us? First, it shows that nurses, especially emergency nurses, are essential components to creating peace in this world. It is important to identify and honor our present and past roles in conflicts to show that caring and healing knows no bounds. Second, the IOM report does offer some hope related to the problems emergency nurses have been facing for the past 10 years regarding emergency care systems and is now an opening story on the evening news. Finally, the directive from CMS points out that emergency nurses and emergency medical services must work together to maintain professional and personal harmony.

So, let this be the moment now, with every step I take, let this be my solemn vow … Let there be peace on earth and let it begin with me.