Category: Emergency Department

Introduction

Leadership and management tend to be regarded as distinct but related phenomena. The latter is typically concerned with the organization of the workflow (its planning, implementation, and control) while the former is usually related to the development and change, which is fuelled by enabling, motivating, and inspiring people (Algahtani, 2014). These definitions suit the nursing perspective of leadership and management (Wong, Cummings, & Ducharme, 2013). Apart from that, nursing leadership is closely connected to advocacy, in which case nurse leaders work to improve the healthcare and wellbeing of their community by developing, advocating for, and implementing health-related policies (Haycock-Stuart & Kean, 2013; Vaismoradi, Bondas, Salsali, Jasper, & Turunen, 2012). One of the nursing roles that are closely related to leadership and management is that of the head nurse of an Emergency Department (ED), and the present paper is devoted to its investigation.

In Australia, as well as other countries (Crossan & Shacklock, 2013), nurses are a major part of the healthcare workforce that is crucial for the community health (Duffield, Roche, Twigg, Williams, & Clarke, 2016, p. 2219). Apart from that, EDs are a significant element of modern healthcare that provides care for the injured and promotes the health of the community (Shoqirat, 2013). However, HNEDs are not just highly competent ED nurses; they also carry out managerial duties and take the role of the leader of their department. The combination of their detailed knowledge of the work of an ED nurse and the position of a manager and leader results in the ability of HNEDs to successfully manage the department and improve the performance of its nurses (Bamford, Wong, & Laschinger, 2013). In general, the role of an HNED is extremely extensive, which can result in noticeable occupational stress, but the education, training, and experience of the nurses help them to correspond to their numerous role requirements and provides HNED with the opportunity to contribute to the quality of ED care.

Role Scope

The scope of practice for a particular profession is the full spectrum of roles, functions, responsibilities, activities and decision-making capacity that individuals within that profession are educated, competent and authorized to perform (Nursing and Midwifery Board of Australia [NMBA], 2007, p. 1). The role of HNEDs is complex, but as healthcare managers, they have the primary purpose of ensuring the quality of care and patient safety in their department (Pegram, Grainger, Jones, & While, 2015). From the point of view of the enactment of the role of a manager, HNEDs are expected to organize and coordinate the work of their staff and perform planning and decision-making activities (Wang, Anthony, & Kuo, 2016). HNEDs also play a crucial role in enabling communication between their subordinates and superior managers; effective communication and cooperation, in turn, are very important for nursing settings (Walsh et al., 2015), including ED (Gilardi, Guglielmetti, & Pravettoni, 2013). Moreover, HNEDs are often involved in the organization of training for their unit to ensure that the knowledge of ED nurses is continually upgraded (Atakro, Ninnoni, Adatara, Gross, & Agbavor, 2016, p. 4). In certain cases, HNEDs can also be required to evaluate the performance of their staff and define the learning and organizational needs of their department (Wang et al., 2016, p. 43). As leaders, HNEDs enact their role when they work to motivate, inspire, and enable ED nurses to act and foster improvements in their department. Also, the role that nurses play from the point of view of advocacy, especially in the field of healthcare policy development and implementation, is applicable to HNEDs as nursing leaders (Haycock-Stuart & Kean, 2013).

Given the large scope of practice, the examples of HNED activities can be numerous. For instance, Zohar, Werber, Marom, Curlau, and Blondheim (2017) discuss in detail the messages that HNED can communicate to their nurses and also demonstrate that these messages can significantly affect the nurses behaviors. Similarly, Shirazi et al. (2015) consider nurse empowerment activities as a significant part of the HNED role. Also, workplace governance is directly connected to HNEDs since they are involved in multiple managerial and leadership-related activities as the key figures in the management of ED nurses (Wang et al., 2016).

With respect to leadership, it is noteworthy that a variety of styles and characteristics, which tend to have an influence on the effectiveness of leadership, can be adopted by HNEDs (Bamford et al., 2013; Shirazi et al., 2015; Vaismoradi et al., 2012). Also, the outcomes for the nurses can be affected by the leadership style; for instance, Laschinger, Wong, and Grau (2012) show that authentic empowering leadership helps to reduce emotional exhaustion in nurses. Finally, patient outcomes can also be affected by the leadership style; for example, Wong et al. (2013) show that transformational leadership tends to have this effect. Thus, HNEDs need to have some knowledge of the leadership and managerial tools that they can use.

The Regulation of Practice

The scope of HNEDs practice is rather extensive, which proves the significance of their roles while also calling for an equally extensive regulation. High-quality education, especially specialized education that specifically targets emergency nursing, is crucial for HNEDs (Atakro et al., 2016; Damkliang, Considine, Kent, & Street, 2015). Apparently, the experience is also very helpful, including professional and managerial or leadership experience; it can be regarded as an enabler that improves the quality of work of HNEDs as well as their confidence (Pegram et al., 2015, p. 325). Apart from that, there are formal requirements that HNEDs must take into account.

From the point of view of legal regulation, the practice of Australian HNED is guided by healthcare-related acts. A major act that is of significance for HNED is the Health Practitioner Regulation National Law Act (2009), which defines the general legislation for all health practitioners and includes important information on accreditation, registration, conduct, and other aspects of HNED work. Apart from that, the Act establishes the National Boards, which regulate specific health professions, and the Australian Health Practitioner Regulation Agency, which is a body that is supposed to support the Boards in a variety of ways (Health Practitioner Regulation National Law Act, 2009, pp. 83-84, 88-90). Of the Boards, the Nursing and Midwifery Board of Australia is responsible for determining standards for HNED education and practice. Also, the Health Workforce Australia can be mentioned as an organization that is busy with determining the needs and difficulties in healthcare workforce management in Australia and searching for policy-related means that can improve the situation (Buchan, Twigg, Dussault, Duffield, & Stone, 2015, pp. 164-165). Thus, the practice of HNEDs is predominantly regulated by general rather than role-specific legislation and organizations.

An Australian HNED is supposed to take into account the regulations, standards, and guidelines of the Nursing and Midwifery Board of Australia. In particular, the codes of ethics and professional conduct for the nurses of Australia that are provided by the Nursing and Midwifery Board of Australia [NMBA] (2008a; 2008b) are of importance for HNED. Apart from that, the organization establishes the standards of practice for nurses that are applicable to any area of practice, including ED (Nursing and Midwifery Board of Australia [NMBA], 2016b). These standards are continually updated to ensure the relevance of the requirements included in them (Nursing and Midwifery Board of Australia, 2016a). Finally, NMBA (2007) offers help for nurses in the form of tools that can improve practice. For example, NMBA (2007) has developed a national decision-making framework.

NMBAs (2008b) Code of Professional Conduct contains ten principles that require safe, competent, respectful, standardized, legal, and ethical conduct. The Code of Ethics of NMBA (2008a) includes eight requirements that also promote ethical, impartial, culturally sensitive, and responsible care. The seven standards of NMBA (2016b) demand that registered nurses make their practice legally immaculate, evidence-based, planned, safe, high-quality, and culturally sensitive; nurses are also supposed to ensure their own safety and ability to provide care. Apart from that, Australian nurses are required to develop meaningful relationships with their patients and peers. Finally, the standards demand comprehensive assessments and the evaluation of outcomes, which should be used to improve practice. All these requirements are applicable to HNEDs.

To sum up, NMBA (2008b; 2016b) offers comprehensive but generalized requirements, which can indeed regulate the practice of HNEDs. From the two codes and the standards, it can be concluded that the Board demands evidence-based and patient-centered care. As a result, the values of safety, competency, respect, and ethical practice appear to be central to the role of HNED.

Role Benefits and Outcomes

HNEDs are very important for the improvement of the outcomes of care (Wang et al., 2016). A systematic review by Jennings, Clifford, Fox, OConnell, and Gardner (2015) demonstrates that while the relationship between the performance of ED nurses and the cost efficiency of care cannot be detected, their work improves the quality of healthcare as well as the time of waiting, and, ultimately, the satisfaction of the clients. Apart from that, HNEDs have great clinical leadership potential, which helps them to improve the experiences of their subordinates and organize their units, improving their efficiency (Bamford et al., 2013).

As nurse leaders, HNEDs can facilitate and improve care through their capacity to develop the environment and atmosphere of safe care and the ability to integrate the activities of various healthcare providers (Vaismoradi et al., 2012). Zohar et al. (2017) show that the modification of head nurse messages can significantly improve the safety culture of their departments, leading to statistically relevant positive changes in safety and time climate as well as patient care. Naturally, these changes result in positive outcomes for patients and nurses.

Advocacy-related outcomes also seem to be of importance for patients, communities, and HNEDs themselves (Haycock-Stuart & Kean, 2013). However, Shoqirat (2013) points out that while ED nurses are being encouraged to contribute to community health promotion, the majority of them do not actually report being involved in the process or seeking to do so. In other words, while the role of HNEDs seems to require advocacy-related activities, it is not typically regarded as a primary or even significant aim.

In general, the outcomes of the role and related benefits are predominantly of use for patients as well as HNEDs subordinates. It is noteworthy that the stress of ED work can be significantly modified by successful managerial interventions (Adriaenssens, De Gucht, & Maes, 2013). Given the fact that HNEDs tend to be well-acquainted with the needs of ED nurses, they seem to be particularly capable of improving their experiences (Bamford et al., 2013). All these factors prove the significance of the role of HNEDs once again.

Role Experiences and Development Needs

The experiences of HNEDs are likely to vary across countries, but certain aspects of the role seem to be reported by nurses from various settings (Buchan et al., 2015; Crossan & Shacklock, 2013). For example, Atakro et al. (2016) report that in Ghana, ED nurses tend to experience understaffing, insufficient or ineffective training in certain areas of knowledge that they need to fulfill their role, and the lack of necessary resources (pp. 1, 4). The authors explain the issues by the lack of institutions that can offer quality emergency training to professionals in Africa. However, Pegram et al. (2015) survey nurses of the UK and discover that they also report training issues (their own and those of other staff members), resources shortage, and understaffing (pp. 318-319). The latter is classified as a particularly significant contributor to occupational stress by the respondents of the study by Pegram et al. (2015).

Understaffing is also characteristic of Australia, and it has been shown to decrease nurses ability to provide quality care (Duffield et al., 2016). Oostveen, Mathijssen, and Vermeulen (2015) point out that understaffing is an issue for the Netherlands as well, and they suggest that the key reason for the issue in developed countries is the rising demand for healthcare, which can be connected, among other things, to the aging population. It also apparently results in nurses being overworked (Kaddourah, Khalidi, Abu-Shaheen, & Al-Tannir, 2013). Oostveen et al. (2015) also point out that understaffing can be related to the lack of proper communication between managers and nurses where nurses opinions are overlooked. In this respect, the role HNEDs appears to become crucial as well since it is theoretically capable of improving communication between ED nurses and senior managers (Wang et al., 2016).

As a result, it appears that the mentioned issues are universal, even though the reasons for their existence may differ for countries with different levels of development, and they tend to result in a decreased quality of care. It is noteworthy that at least two of the mentioned issues seem to be acknowledged by the Australian government, including the Department of Health (2015). This fact can be supported by the governmental initiative More doctors and nurses for Emergency Departments, which was developed to improve the education of ED specialists in Australia to boost their numbers and quality of training (Department of Health, 2015, p. 51).

Concerning other experiences, ED nurses report the emotional strain and stress, which result from the specifics of the patients injuries, and the communication with the families of patients, which can lead to negative or positive situations (Atakro et al., 2016). There is also the possibility of the lack of support from subordinates, peers, or senior managers as well as the excessive pressure that results from the expectations of the surrounding people (Ericsson & Augustinsson, 2015; Pegram et al., 2015; Wang et al., 2016). Similarly, unsupportive environments can be an issue (Bamford et al., 2013). Moreover, nursing experiences are not isolated from global events; for example, the recent economic recession has resulted in difficulties with payments and employment (Buchan et al., 2015). Given the fact that HNEDs are often involved in staffing, scheduling, and training, these events are likely to result in multiple negative experiences for them, including personal and department-related ones.

The study by Pegram et al. (2015) also reports the possibility of positive experiences of manager nurses, which includes the feeling of being valued and accepted by coworkers (p. 325). It is apparent, however, that the investigation of negative experiences seems to prevail among the works that have been included in the current literature review. Still, the review cannot be regarded as perfectly representative, and the observation can be explained by the fact that the negative experiences of nurses are typically related to issues that require solutions. The cited works either attempt to point out the issues or search for their solutions, which are vitally important activities.

Educational and Job Satisfaction Needs

With respect to the needs of HNEDs, education and job satisfaction can be mentioned. Atakro et al. (2016) regard training at work as the most appropriate solution for the issue of insufficient training. Similarly, Damkliang et al. (2015) discuss educational interventions that can be applied to working ED nurses. Morphet, Kent, Plummer, and Considine (2016) also demonstrate that ED nurses can and should continue their education after graduation, and show that Australian nurses have multiple educational opportunities, many of which are provided by healthcare organizations. However, the availability of educational resources may vary for territories. Since communication skills are crucial for HNED (Gilardi et al., 2013; Wang et al., 2016), relevant training can also be regarded as a need. Also, Paganini et al. (2016) point out the significance of disaster preparedness for ED, including its nurses.

Job satisfaction is another important need for HNEDs as well as other nurses. This aspect of nurses work depends on multiple factors, including payment and other forms of recognition, schedule and other conditions of the work, relationships in the department and with other managers, and the availability of career and professional growth options (Crossan & Shacklock, 2013; Pegram et al., 2015). Apart from that, job satisfaction is affected by the negative experiences discussed above and the occupational stress considered below. Thus, the mechanisms of improving job satisfaction for HNEDs seem to be apparent.

Role Strengths and Weaknesses

When compared to other nurses, HNEDs have more autonomy and a greater opportunity to make a difference, which is rarely a possibility for regular nurses (Kaddourah et al., 2013; Oostveen et al., 2015). This feature of the role can be regarded as a significant strength, which can be used to achieve the desired outcomes at the level of ED or the community. However, the present analysis seems to indicate that current researchers are predominantly interested in the topic of issues that are related to the role. This observation can be explained by the fact that the studies are apparently aimed at resolving these issues, but the resulting report may seem to be rather one-sided as a result. Still, the present study allows to state that occupational stress is a complex and significant weakness of the role of HNEDs.

Occupational Stress

The role of an HNED is naturally correlated with specific occupational stress (Atakro et al., 2016; Pegram et al., 2015). Yuwanich, Sandmark, and Akhavan (2016) state that the problem mostly originates from the unpredictability of ED events as well as their stressfulness, which is also pointed out by Atakro et al. (2016). Yuwanich et al. (2016) suggest that ED can be a more stressful environment than some of the other nursing settings. The complexity of the work, which increases with new developments in the field of healthcare, is also a significant stressor (Ericsson & Augustinsson, 2015). The increasing workload (which is correlated with understaffing) can lead to job dissatisfaction and stress as well (Bamford et al., 2013).

Stress is a definite weakness in the role that is correlated with health issues (Yuwanich et al., 2016). While the specific outcomes of stress vary depending on personal and organizational characteristics, stress tends to reduce job satisfaction while contributing to emotional burnout (Admi & Eilon-Moshe, 2016; Adriaenssens et al., 2013). It follows from this fact that the issue is capable of undermining HNEDs health, thus making it difficult for them to carry out their practice: the quality of care tends to depend on nurses well-being (Admi & Eilon-Moshe, 2016). Yuwanich et al. (2016) show that nurses tend to search for ways to manage their stress with relative success; Adriaenssens et al. (2013) also point out that managerial interventions can be of use if they are aimed at improving the organizational predictors of stress. Here, it is noteworthy that HNEDs can be regarded as nurse managers, which implies that they may be required to introduce such interventions or advocate for them on their own. As a result, while the issue of occupational stress is acute, the solutions to it are available to HNEDs.

The Challenge of Development, Implementation, and Evaluation

According to Bryant-Lukosius et al. (2016), there exists a significant knowledge gap in the topic of the development and assessment of nursing roles. The authors view the determination of the methods of development and assessment as a significant step towards the improvement of the management of the roles (which is not limited to standards but also includes various educational and organizational initiative and related funding and so on) (Bryant-Lukosius et al., 2016, p. 205). The authors demonstrate that multiple frameworks for the development and evaluation of the nurse roles goals and objectives exist, including the Participatory Evidence-Informed Patient-Centred Process, which the authors promote for its qualities, including its evidence-based nature and the focus on the patient. The present study also demonstrates that NMBA (2016b) has developed a framework of standards, even though it can be regarded as very general. In fact, the suggestion of Bryant-Lukosius et al. (2016) about the lack of relevant research seems to coincide with the finding of the current literature review, which indicates that the topic of the role of HNEDs may be rather underrepresented in modern studies. As a result, it can be suggested that the development, implementation, and evaluation of the role is not only challenging; it also requires additional investigation. The present paper can be regarded as an attempt to summarise relevant knowledge, but additional research is clearly required for a deeper understanding of the role of HNEDs.

Conclusion

The present analysis suggests that the topic of the role of HNED is relatively underrepresented in recent literature. However, it is possible to supplement the few articles on this role with those of the roles of ED nurses and head nurses to achieve the following conclusions. First of all, the significance of the role of HNED is difficult to overestimate, and the scope of practice of HNED is most impressive. Basically, HNED is responsible for management and leadership in an ED, which can be exemplified by a vast number of activities that include but are not limited to planning, decision-making, coordinating, motivating, and advocating. The role of HNED can result in positive outcomes for patients and HNEDs co-workers; apart from that, the role presupposes active involvement in policy-making, which can be beneficial for HNEDs themselves.

Given the significance of the role, the regulations that are related to it and the educational and training needs of HNEDs are particularly important; also, their job satisfaction is known to affect their productivity in a positive way. The strengths of the role include its increased autonomy, which is rather rare for a nursing role; however, the issues and challenges seem to receive more attention from researchers. Possibly, the focus on issues can be explained by the fact that their elimination is crucial for the success of HNED role enactment. The key weakness of the role is the immense occupational stress which is caused by multiple contributing issues; the stress can be reduced by HNED or specific managerial interventions. The definition, evaluation, and development of the role also seem to be challenging, in particular, because of the relative lack of research on the topic. To sum up, the role of HNED is an extensive subject that requires further investigation with the aim of informing the actions of HNEDs and improving their performance.

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Abstract

Due to the fact that the trend of the growth of emergency situations, the issue of enhancement of the preparation for the prevention and elimination of emergency situations remains. It is also very important to point out the fact this issue is undoubtedly relevant nowadays. The study reveals the shortage of Emergency and Disaster Department at Health Authority Abu Dhabi and the need to improve the emergency preparedness by means of manpower, staff training, and innovative equipment. The research results suggest some appropriate solutions of the problem including the system of employees training and changes in the organizational structure of the regulator.

Investigation and Problem

Emergency situations are getting more and more widespread in todays society. The fact that one of the characteristic features of our time is the frequent occurrence of emergencies cannot be contested. In connection with this, the interest to the study of emergencies in the modern world is steadily growing. The research is related to previous researches done in the area under study that arise the question of the emergency staff preparation.

In particular, one might note Emergency medicine in the United Arab Emirates by Fares et al., 2014, or Emergency medicine in Dubai, UAE by Partridge Abbo, and Virk, 2009. In addition, as a result of recent events at Yaman, UAE needs to be prepared for emergency cases, and the Health Authority Abu Dhabi Capabilities mission is to provide the appropriate preparedness.

Statement of the Problem

Nowadays, one might note the shortage of professional doctors, the latest medical equipment, and innovative operational centres. In this regard, it seems necessary to address a problem of lack of the Emergency and Disaster Department at Health Authority Abu Dhabi (HAAD) Capabilities and the necessity to improve the preparedness of emergency by means of enhancing manpower, equipment, and training.

Purpose

The purpose of the paper is to express the relevance of the chosen theme demonstrating some current data and suggesting a set of suitable measures that might be taken into account in order to improve the situation. In other words, the paper is aimed at in-depth analysis of the current state of Emergency and Disaster Department at Health Authority and revealing adequate measures that would enhance the preparedness of emergencies from the medical perspective.

I believe that the above purpose would improve the current situation as prepared professionals orientate in the specific emergency situation better, they estimate it more accurately anticipating its development. In its turn, it makes the emergence of difficulties apparent and helps to exclude plenty of unexpected circumstances. Prepared doctors are less nervous, worried, operates quietly, allow fewer mistakes, and they do not create additional difficulties.

Arrangement and Approach of Study

The conducted investigation consists of five phases each of each is thoroughly considered and possesses a special role. First of all, I would like to present the proposal of the research including the target audience, methodology, and other aspects that would express the topicality of the problem. Second, I would consider the HR related organizational analysis based on credible sources indicating key points of the theme. Finally, I would provide the reader with the thought-out discussion of the research findings along with limited and justifiable concluding remarks. The research paper was chosen as the investigation format. In addition, the research is initiated in the framework of Emergency and Disaster Department at Health Authority Abu Dhabi Capabilities.

Project Proposal and Planning

Target Audience

Speaking of the target audience, it is important to emphasize that the research results might be interesting and helpful for a range of readers from an average reader to scientist with a degree. However, the general purpose of the paper is to provide the useful and comprehensible information for Health Authority Abu Dhabi authorities. Additionally, the research might be used for perspective investigations.

Methodology of Research

The literature overview was chosen as a methodology of the research as it is an indispensable part of the investigation. It is significant for determining the main areas of the research as well as for the implementation of the research process. The literature review would describe what has been done within the subject before, in particular, concepts, approaches of different authors, the current state of the problem, and a range of unsolved problems in the chosen field. Therefore, the literature review is chosen to designate the selected issue. Besides, it contributes to the explanation of the necessity of the study.

Corporate Description

The Organizations Activities

The organization under analysis is the Emergency and Disaster Department at Health Authority Abu Dhabi Capabilities. Its activity includes emergency patients treatment, transfer to the morgue section if required, and other operations.

Strategic Management

According to the Health Authority Abu Dhabi, its mission vision consists in healthier population procuring better access to health care services and constantly improving services quality (HAAD, n.d.a). What is more, its strategic objectives suppose the workforce attraction and training, emergency preparedness, wellness along with disease prevention, and other objectives. As for the business strategy, it is expressed improving medical outcomes and public health. The functional strategy comprises inspect and control for quality, filling critical gaps in capacity and insurance coverage, and being prepared for emergencies. HAADs top management role is to ensure the quality and preparedness of the provided services.

Current Projects Undertaking

Presently, the Emergency and Disaster Department at Health Authority Abu Dhabi Capabilities has two sections, which are the operation section and mortuary section.

Research Result and Data Analysis (HR related Organizational Analysis)

The following part of the paper examines HR related organizational analysis based on the literature overview. In their, Emergency medicine in the United Arab Emirates article, authors point out the main features of emergency medicine in the UAE as well as the challenges it has to face. For instance, they claim that there is the lack of training of the staff. The majority of states of the United Arab Emirates use the following classification of employee: education, training, and experience.

At the same time, the HAAD classifies ambulances into those providing basic life support (BLS / Type 2) or advanced life support (ALS / Type 3) (Fares et al., 2014a, p. 3). Thus, one might note the shortage of the professional training. The knowledge gained by staff in institutions is rapidly becoming obsolete increasing their need for a substantial renovation. Therefore, today, for the successful work, specialists should be aware well enough to understand the special and the common areas. Unfortunately, even within the medical community, many doctors do not understand the importance of emergency medicine and giving this branch more recognition is an important step forward (Bell & Rizvi, 2014b, para. 2).

The lack of the required skills leads not only to the inefficient operation but also to the reduction of the job satisfaction. The shortage of emergency medicine-trained, board-certified consultants in the UAE has a negative impact on the quality of emergency medicine training. They have little to no available time for teaching and research (Fares et al., 2014a, p. 6). Consequently, the systematic training of employees could reveal their full capabilities. Training is designed to prepare staff to the correct solution of a wide range of tasks and provide a high level of work efficiency. In addition, organizational changes become difficult to implement without timely training.

In order to achieve its organizational strategies, HAADs HR management periodically revises rating criteria in appraisal forms and processes. Moreover, the organization offers special training programs aimed at emotional integrity and enhancement of communicative skills of employees. As a result, it improves relationships between colleagues and patients. Besides, HAAD exerts every effort to remain attractive on labour market including the competitive salary, appropriate working environment, and remunerations.

Taking into account the above, it is possible to examine the effectiveness of techniques of performance appraisal. Accomplishing organizational objectives is ensured by means of encouragement strategy. Corporate HR management provides expertise, creates programs and practices, and manages timely and effectively. Moreover, the organization focuses on constant improvement of working conditions. It motivates employees to work harder and achieve high results.

Among challenges faced by the emergency medicine, there are working conditions of the personnel. Emergency staff provides emergency medical assistance to patients in different conditions. Nevertheless, advances in the development of medical equipment and means of communication have expanded the capabilities of these workers in the resuscitation and stabilization way in the emergency department (Trivedy, Hall, & Parfitt, 2010).

Increased opportunities of ambulance workers do not completely meet current requirements as they are now faced with increased risks in the performance of their duties. In particular, challenges facing them should be overcome quickly and often in poorly equipped facilities with limited access to the patient. The working environment might suddenly and uncontrollably become threatening in the biological, physical, and chemical aspects.

The dynamic and rapidly changing situation increase the risk of the medical staff. It is important to take into account health risks of medical rescue services personnel in the development of strategies to reduce this risk and prevent injuries during operations. The work of ambulance workers occurring in the uncontrolled and unequipped environment as well as responsibility for making major decisions with inadequate equipment and limited time often leads to occupational stress.

Errors and malfunctions, job dissatisfaction, and loss of the sense of patient care that might arise as a result of occupational stress, are a danger both for workers and for society to some extent. In order to mitigate the devastating effects of the nervous system associated with emergency cases, some techniques for stress relief should be applied.

It is also very important to stress the fact that authors argue the emergency equipment. Precisely speaking, there is a need to have the latest equipment in terms of communication between stakeholders. While the current one is TETRA, there is a necessity to have more innovative equipment that would help to trace the bed equipment in the regulator, etc. Moreover, the regulator organization plays a significant part in the emergency medicine effectiveness.

According to Fares et al. (2014b), it should be centralized. The centralized system of the regulator organization means the majority of departments integrated together in one body, but located, usually, on different floors or parts of the building. As a rule, in this type of organization, there is a single building rendered for technical facilities, catering department, outpatient, and autopsy department.

In its turn, new equipment would increase the speed of processing the material and expand the range of the researches. For example, automated analyzers ensure more accurate results excluding the human factor. It means that the analysis would be received in the regulator lab, and after conducting research within few days automatically head back. Such a system would not only increase the speed and improve the quality of the research, but also eliminate the need for paperwork and errors. What is more, such an organization would provide free communication between staff and patients transportation to the required location.

Discussion and Research Analysis

Research Findings

It goes without saying that there is a need to prepare for action in emergencies as it is the potential danger that might occur anytime. However, the nature of the emergency is that the awareness of this need comes already after the emergency actually happened. Usually, the need to prepare for is not regarded as urgent before the accident. The lack of Emergency and Disaster Department at Health Authority Abu Dhabi Capabilities leads to accidents and emergencies.

However, it is especially significant to emphasize that in a case like this one, the awareness of the need of the preparedness to emergencies and invest in their creation gives organizations the knowledge, experience, and resources enabling safe operation and performance requirements of morality and law and increasing the likelihood that doctors would cope with emergency situations in a timely manner. In addition, the total loss increases due to the lack of efficiency of methods to limit and eliminate emergencies.

For the organization of an effective system ensuring the preparedness for emergencies, it is necessary to realize its importance, consider the project, and support its creation. Consequently, the following purposes should be achieved:

• Awareness of the need to provide appropriate measures, planning, and support;
• Definition of long-term goals and objectives;
• Ensuring financial support to purchase the necessary medical equipment;
• Adequate staff training;
• Provision of the necessary organizational resources.

Based on the initiated research, a system of measures could improve the preparedness in emergencies. The proposed system that allows achieving the state of emergency preparedness focuses on an integrated approach to the prevention of such situations and the ability to cope with them in the case they appear. The system includes the following aspects:

• Organizational objectives and their implementation (a priority role and the need to prepare for action in an emergency);
• Risk management (identification, assessment, and mitigation of the potential dangers and risks);
• Definition of measures to cope with the unexpected situation or accident;
• Provide the necessary space, equipment, and materials;
• Training methods of detection, control, and warning about the accident;
• Evaluation and improvement of the entire system through regular inspections and tests;
• Periodic re-evaluation of risk factors and testing the effectiveness of the system (HAAD, n.d.b).

As a matter of fact, another important issue that should be taken into account is the assessment of risk factors. Analysis of risk factors allows identifying factors that are typical for a particular emergency. On this basis, the risk factors assessed in comparison with known criteria determine the degree of acceptable risk. In the case the risk is high, it is necessary to determine measures to be done to reduce it (for instance, to reduce the likelihood of an emergency, to decrease its effects, to eliminate all or, at least, part of factors).

As a result, the plan to reduce the identified risk factors should be developed and implemented. Similarly, on the same basis, the action plan in case of emergency should allow taking the most effective measures in the case of its occurrence. Identification and analysis of risk factors predict the perspective scenario of this or that situation development with high accuracy. Therefore, it would be possible to determine suitable actions necessary in each case.

Finally, the research explores the centralized organization of the regulator emphasizing that it is the best way of the regulator body organization. It guarantees effective communication and medical processes. Personally, I agree with the research analysis. Indeed, it would be better if all the departments would be united in the one body. In my point of view, it would eliminate the lack of the Emergency and Disaster Department at Health Authority Abu Dhabi.

Contribution of this Project

The research presents a systematic description of what actually is happening to emergency medicine department and staff. In my opinion, the research has made a significant contribution to the study of emergency situations in the HAAD regulator. The study reveals the lack of effectiveness of employees work in the Emergency and Disaster Department at Health Authority Abu Dhabi and proposes measures for the improvement of the situation.

Limitations

I consider that there are some factors that might impinge upon students research. For instance, the obsolescence of the information chosen for the analysis or some current events. However, I find that thee was no external factors that influenced my research.

Recommendations for Further Development within the Organization

Thus, the study could be utilized in further investigations. For example, it gives the perspective of the research in other medical institutions of the United Arab Emirates or in any other narrower specialty related to emergencies.

Conclusion and Lessons Learned

In conclusion, it should be stressed that the aim of this paper was to evaluate the lack of Emergency and Disaster Department at Health Authority Abu Dhabi Capabilities and to identify the areas of emergency preparedness requiring improvement. During the study, it was stated that there are some weak points need to be improved. Among them, one might mention the shortage of professional doctors, obsolete equipment, and inappropriate regulator organization. Consequently, the following measures should be taken correspondingly: adequate staff training, innovative equipment installation, and structural reorganization of the regulator.

Emergency situations are often viewed as unforeseen ones. However, in the modern era of advanced technology and communication systems, few events could be called really unexpected and very few of the accident unprecedented. Newspapers, hazard warning, accident statistics, technical reports  all that reliable data gives images of what could be waiting for. Nevertheless, methods for preventing and eliminating emergencies based only on past experience does not always guarantee the same level of their solution.

A good reinforcement of the regulator is personnel training concerning some risk factors and necessary actions. Deficiencies in staff training often determine the difference between the emergency patients recovery and causalties. Therefore, the staff training is the mechanism that determines the effectiveness of the HAAD regulator work and developed activities resulting in the healthier population. The emergency preparedness is ensured by the integration of all the necessary elements including the proper staff training, the high-quality special equipment, and regular examinations of the efficiency of undertaken actions.

Speaking of the procedural design flaws, the thing worth turning ones attention to is the shortage of illustrative material such as tables, diagrams, drawings, statistic material. Perhaps, it would be better if the study included some proved data or statistics organized in tables. However, I find that it is a strong point of the research that I referred to several reliable sources. Thus, the analysis of the can be proved. It could not be easily argued and denied, as there is evidence of it being taken from credible sources. As a result, the information presented in the research appears to be accurate and trustworthy.

Consequently, one may conclude that the goal stated in the research proposal was achieved because the useful and comprehensible information was provided.

References

Bell, J., & Rizvi, A. (2014). Lack of specialists is great challenge to emergency medicine, say UAE doctors. The National. Web.

Fares, S., Femino, M., Sayah, A., Weiner, D. L., Yim, E. S., Douthwright, S.,& Ciottone, G. (2014b). Health care system hazard vulnerability analysis: An assessment of all public hospitals in Abu Dhabi. Disasters, 38(2), 420-433.

Fares, S., Irfan, F. B., Corder, R. F., Abdulla Al Marzouqi, M., Hasan Al Zaabi, A., Idrees, M., & Abbo, M. (2014a). Emergency medicine in the United Arab Emirates. International Journal of Emergency Medicine, 7(4), 1-8.

HAAD. (n.d.a) About HAAD. Web.

HAAD. (n.d.b) Abu Dhabi Healthcare Strategic Plan. Web.

Trivedy, C., Hall., & Parfitt, A. (2010). Mastering Emergency Medicine: A Practical Guide. London: Hodder Arnold.

Define the issue. Include political, social, and economic background

Workplace violence refers to any act that may cause a hostile working environment at the place of work. Many researchers have argued that workplace violence is a cumulative set of actions that destroy the physical, mental, and psychological status of an individual in a working environment (Luck, Jackson & Usher, 2008). Traditionally, violent activities have been thought of as those emanating from physical actions. However, it should be noted that workplace violence is a total of all acts both verbal and physical that amount to assault, threats, coercion, destruction of property, intimidation, and all acts that amount to harassment.

Studies have documented that social reasons account for higher figures of workplace violence. According to Gates, Fitzwater & Succop (2003), certain personality traits are clear signals for workplace violence. Some studies have suggested that psychiatric diagnosis has been cited as an aggravating factor for violence. However, not all psychiatric diagnoses are linked to workplace violence. Important to note is that certain disorders such as schizophrenia, bipolar disorder, and depression are closely linked to high rates of violent behavior (Luck, Jackson & Usher, 2008).

The existence of vague and unsupportive institutional policies stands a high chance of facilitating workplace violence in healthcare emergency departments. Studies suggest that employees working in regions where political platforms do not provide progressive policies host potential risks of increased violence. Therefore, institutional policies that fail to address inequalities among staff can cause tension at the workplace (Luck, Jackson & Usher, 2008).

Similarly, unsound economic work, conditions render healthcare professionals at risk of developing and sustaining violence. In a study conducted by Gates, Fitzwater & Succop (2003), the researchers established a statistical relationship between frequency of experiencing harassment and role ambiguity, and occupational strain among healthcare professionals.

Work settings that render professionals economically insufficient have accounted for increased rates of violence. Perpetrators of workplace violence in healthcare emergency departments have demonstrated elements of economic stress. Studies have shown that aggressive acts against seniors are usually attributed to perpetrators perception of lack of financial independence and control.

Ethical concerns involved in discussing workplace violence

The issues surrounding workplace violence are a sensitive subject that investigators and stakeholders must give utmost concern. Researchers suggest that confidentiality and its limits are key ethical concerns that emerge in the course of dealing with issues of workplace violence (Gates, Fitzwater, & Succop, 2003). Research shows that healthcare professionals often conceal all the information accessed and learned in the course of their clinical environments.

The main question has been whether safeguarding the privacy of information relating to violence should override greater social good? The ability of healthcare professionals to conceal information regarding workplace violence should be taken seriously because lack of disclosure leads to continued violence. However, Taylor & Rew (2010) asserted that where workplace violence involves professionals working together, due diligence should be taken to avoid undue interference with the normal running of the department.

Discrimination at the workplace because of workplace violence continues to affect emergency departments. This occurs when medical professionals cut their social contacts with individuals identified as violent at the workplace. Therefore, isolation as a result of workplace violence should be taken with great care to leverage against escalating cases of violence (Taylor & Rew, 2010).

The other issue at hand that continues to face most emergency departments while addressing workplace violence is the detriment of occupational satisfaction of the victims of WPV. When individuals are identified as perpetrators of violence at the workplace, they usually suffer from occupational dissatisfaction. This arises out of the need to minimize the victims contact with patients and professional colleagues.

Explore possible options/alternatives for resolving the issue

Medical and healthcare institutions can set up institution-wide policies and processes that can curb this challenge. Although no single facility can avoid workplace violence, designing such progressive policies have a far-reaching influence on reducing rates of violence at workplace (Mason, Leavitt, & Chaffee, 2002).

Healthcare emergency departments can implement training programs tailored to deal with workplace violence. The adoption of informational support has been cited as successful effort that can reduce levels of symptoms and negative perceptions among healthcare workers. However, analysts have argued that this approach cannot influence the fear of future cases of violence (Mason, Leavitt, & Chaffee, 2002).

Studies indicate that implementing social-oriented programs helps both perpetrators and victims of violence to manage violence related stress. In a survey of 229 healthcare professionals, researchers established that support tailored for coworkers, seniors, and top management teams on the aftermath of a violent act were favorable in alleviating personality problems (Gates, Fitzwater, & Succop, 2003). These programs tend to cushion victims and perpetrators against future occurrences. Some studies have suggested that support programs have a positive influence on controlling and managing issues of isolation at an organizational and individual level (Pawlin, 2008).

The Best approach

The use of support programs in informing and supporting workers at emergency departments can be more sustainable compared to other remedies.

Rationale for selection of measure

The selection of this action operates on the principle that because economic and political factors are difficult to quantify, and that they vary in respect of perceptions, they cannot support a long-term measure for workplace violence. For instance, economic policies aimed at amending the financial positions of professionals change often. Social support programs on the other hand, develop intrinsic measures that can withstand the test of time.

References

Luck, L. J., Jackson, D., & Usher, K. (2008). Innocent or culpable: meanings that emergency department nurses ascribe to individual acts of violence. Journal of Clinical Nursing, 17: 1071-1078.

Mason, D. J., Leavitt, J. L., & Chaffee, M. W. (2002). Policy and politics in nursing and health care. Missouri: Saunders.

Pawlin, S. (2008). Reporting violence. Emergency Nurse, 16: 16-21.

Taylor, J. L., & Rew, L. (2010). A systematic review of the literature: workplace violence in the emergency department. Journal of Clinical Nursing, 20: 1072-1085.

Gates, D., Fitzwater, E., & Succop, P. (2003). Relationships of stressors, strain, and anger to caregiver assaults. Issues in Mental Health Nursing, 24(8): 775-793.

During the COVID-19 epidemic, Americas emergency rooms (ER) are the first point of contact for community-based care and hospital. Hospital emergency rooms are well-staffed and prepared to receive and care for COVID-19 patients that need extremely close treatment. As a result, emergency departments need to be strategically redesigned to handle the high patient load and continuously changing demands. Doctors treating patients in these rooms need extreme caution, and the hospital needs to take all necessary precautions to stop the virus from spreading to other people in the area who are not sick. Patients who are in serious condition are treated in hospital emergency rooms. This essay, therefore, discusses how to mitigate the Covid-19 type crisis in Americas emergency rooms.

First, the CDC advises hospitals to create a pandemic readiness committee and conduct thorough, logical planning based on each hospitals projected Flu Surge rate. It involves; naming a medical director who collaborates closely with emergency management and infection control, reducing irrational trips to emergency departments by using the phone and other internet-connected gadgets, and increasing the bed capacity to accommodate patients with COVID-19 (Toner et al., 2020). Toner et al. (2020) state that a Flu Surge 2.0 can be employed and that the number of hospitals should be changed following the Department of Health and Human Services planning assumption of severe crises.

Limiting the nosocomial spread of the virus might help mitigate the Covid-19 crisis. Health professionals are especially exposed to this respiratory illness due to the close contact and overcrowding of patients (Toner et al., 2020). The initial face-to-face engagement between patients and doctors may use video chat over the phone. The hospital may hire more personnel at the busiest times, or existing workers may be redirected. According to Cho et al. (2019), when an emergency department handles more than 50 patients daily, a three-hour thorough cleaning for a contaminated unit might slow the flow of ED check-ups and harm patient treatment. To reduce contamination of the hospital environment, adopting cough and respiratory etiquette and using surgical masks would be vital.

Additionally, coordination with neighboring hospitals is crucial for attracting new employees and volunteers. Those recruited to stop the diseases spread will start by vaccinating every team member. Shifting the clinical personnel to the area around the hospital and offering free medical childcare for ill families will help reduce the problems in the emergency room (Cho et al., 2019). Consequently, the workforce shortage might arise due to illness or family care as the Covid-19 outbreak spreads. The medical facilities should be ready and have strategies in place for staff shortages, as well as for their safety and the provision of tools for dealing with stress and anxiety.

The American government should make sure there is a constant supply of pharmaceuticals, testing and screening tools, and the availability of personal protective equipment (PPE). This will enable earlier detection of Covid-19 existence in a particular group by testing and creating an appropriate strategy for its handling (Whiteside et al., 2020). Making PPE available would also help prevent the medical staff from acquiring the virus and ease the problem of overcrowding in the emergency departments.

Finally, a resilient leadership and management team may be developed through restructuring healthcare governance at the federal, state, and local levels. Restructuring healthcare leadership would ensure that all areas in the United States are taken care of by providing proper measures to curb the challenges that might arise from Covid-19 (Whiteside et al., 2020). Additionally, managers and leaders have a significant influence on the essential medical choices that may have an impact on the COVID-19 pandemic mitigation measures.

In conclusion, the fight against COVID-19s spread in the United States and worldwide has relied heavily on emergency departments. Detection and isolation of infected individuals, adequate patient and medical personnel protection, reporting, efficient care, and education of society are all part of the COVID-19 pandemic response in multiple emergency rooms. The framework for responding to and comprehending COVID-19 is evolving quickly. Thus, the effectiveness of the overall process depends on the continuous and efficient mitigating measures discussed above.

Reference

Cho, M., Song, M., Yeom, S. R., Wang, I. J., & Choi, B. K. (2019). Developing process performance indicators for emergency room processes. In International Conference on Business Process Management (pp. 520-531). Springer, Cham.

Toner, E., Waldhorn, R., & Washer, L. (2020). How should U.S. hospitals prepare for coronavirus disease 2019 (COVID-19)? Annals of Internal Medicine, 172(9), 621622.

Whiteside, T., Kane, E., Aljohani, B., Alsamman, M., & Pourmand, A. (2020). Redesigning emergency department operations amidst a viral pandemic. The American journal of emergency medicine, 38(7), 1448-1453.

Operation research is the scientific and mathematical investigation and analysis of issues impacting complex systems. There has been an increase in the difficulty of providing good health care to citizens globally, especially in developing countries where few resources and the population is expanding quickly. Consequently, operations research methodologies have been created for various healthcare applications, including emergency department staffing, long-term care planning, and home healthcare planning operating room planning (Silal, 2021). Healthcare research may benefit hospitals in many ways, including helping them better manage their patients and offering better treatment while still being cost-effective.

By incorporating operations research services, specialists may assist in obtaining more full datasets, considering all available alternatives, predicting all potential outcomes, and calculating risk. Operations research may use cases to evaluate which methodologies are the most suited for solving the issue under consideration. Modern operational research methodologies include linear programming, simulation modeling, revenue cycle management, and risk and financial simulation models. Each of these approaches and models uses strategies that combine the objective with being reached, facts relevant to the particular aim, and identifying possibilities to achieve the stated goal, all to arrive at the best decision possible to create a successful conclusion.

One of these strategies would be very useful in minimizing the wait time in an emergency department. It has been shown that by using operations research approaches, hospital operations may be made more effective and efficient in several different ways. In todays world, the majority of appointments and errands will involve some level of waiting time. In the healthcare industry, wait time refers to the time before obtaining service or, in a healthcare facility, the time before receiving care is offered. Having long wait times in hospitals may result in the hospital not operating smoothly and patients feeling dissatisfied with their treatment at the institution. The amount of time a patient has to wait may affect their health. According to research, long wait times for health care are caused by a lack of capacity concerning demand, a failure to manage either capacity or demand effectively, and a considerable variation in demand for healthcare services over time (Kunwar & Srivastava 2019). Time and motion studies can identify and manage wait times, which are powerful techniques.

Understanding the reasons for emergency department wait times and developing models to support staffing changes is critical when looking at ways to reduce wait times. The use of quick assessment zones, enhanced triage processes, and tracking systems/whiteboards has reduced wait times and improved service quality in U.S. emergency rooms (Bagherian et al., 2020). In addition to giving the necessary information for identifying the reasons for the prolonged wait times, time and motion studies have also offered choices for optimizing front-end operations via implementing a team-wide care strategy.

In conclusion, operational research is currently being utilized as a vital tool to tap into previously untapped information, particularly in resource-poor nations. Administrators are using it as a searchlight to find what is still not in place in the current operations of hospitals. Scientists in healthcare settings should get more familiar with the subtleties of operation research to utilize them more often to improve the results of health programs and make them more efficient and effective. Even though operational researchers have addressed several issues in healthcare services, there is still considerable room for development and study in this field.

References

Bagherian, H., Jahanbakhsh, M., & Tavakoli, N. (2020). A review on the use of operational research techniques in the medical records department. Proceedings of Singapore Healthcare, 29(1), 4249.

Kunwar, R., & Srivastava, K. (2019). Operational research in health-care settings. Indian Journal of Community Medicine, 44(4), 295.

Silal, S. P. (2021). Operational research: A multidisciplinary approach for the management of infectious disease in a global context. European Journal of Operational Research, 291(3), 929934.

Tomaskova, H., & Weber, G.-W. (2020). Approaches combining methods of operational research with business process model and notation: A systematic review. PeerJ Computer Science, 6, e301.

The intensive care unit (ICU) is a healthcare specialty where medical professionals treat patients in critical conditions with a physiological crisis threatening one or more body systems or their lives. In such cases, care is focused on supporting failed systems when there is a high mortality risk. Such a line of work needs special training, incorporating medical care, monitoring, and comforting the patient and their family. It is often considered that not everyone is cut for this particular job; however, the skills required for working in intensive care may be useful to any nurse. Since nurses often deal with patients in critical conditions, acquiring the necessary skills to save and support their lives may be essential. Therefore, the current research examines the importance of intensive and critical care skills in nursing. For this purpose, a literature review was chosen as an adequate study method. The materials for the paper were selected to be peer-reviewed and dated no further than five years ago. The sources were found using the online public library PubMed with relevant articles within the healthcare industry. Three sources used in the research are two articles and a book. Isa et al. (2019, p. 38) explore ICU nurses strategies to cope; Woodrow (2018, p. 14) examines the set of necessary skills, while Ervin et al. (2018, p. 468) research their teamwork capabilities. The findings suggest that ICU nurses possess several key skills and knowledge important to any nurse. They include technical skills, highly-attentive monitoring skills, psychological knowledge for assisting patients and their families, individual assessment of behavior patterns and needs, accountability, and the ability to admit to making mistakes (Woodrow, 2018, p. 14). Moreover, ICU and critical care nurses are trained to endure high-stress levels and are familiar with several essential coping strategies (Isa et al., 2019, p. 41). This enables them to provide better quality care and stay alert in critical situations (Isa et al., 2019, p. 41). Since ICU and critical care skills often revolve around teamwork and cooperation, such skills as information sharing, cooperative decision-making, and conflict management are essential (Ervin et al., 2018, p. 468). The list of skills identified in the literature is a set of necessities that could be most useful to all nurses. Technical knowledge, monitoring attentiveness, and emotional support for patients fall under the daily routine of a nurse, making ICU and critical care training highly valuable for nursing. Coping and stress resistance skills are key elements of ICU training, but general nursing often lacks a proper introduction to self-care strategies. Additionally, teamwork is usually required in nursing but is rarely addressed in educational settings. In contrast, critical care programs often ensure graduates are good communicators and work well in teams since patients lives always depend on it. Due to this, ICU and critical care training can be considered most beneficial in nursing. Therefore, it is evident what important role critical and intensive care skills play in nursing.

Reference List

Ervin, J. N., Kahn, J. M., Cohen, T. R. and Weingart, L. R., (2018) Teamwork in the intensive care unit, American Psychologist, 73(4), p. 468.

Isa, K. Q., Ibrahim, M. A., Abdul-Manan, H. H., Mohd-Salleh, Z. H., Abdul-Mumin, K. H., and Rahman, H. A. (2019) Strategies used to cope with stress by emergency and critical care nurses, British Journal of Nursing, 28(1), pp. 3842.

Woodrow, P. (2018) Intensive care nursing: A framework for practice. London: Routledge.

Most of operating rooms (OR) in hospitals have limited capacity and incur huge costs. Improving the turnaround time is one of the most effective strategies that can be adopted to enhance OR capacity and reduce associated costs (Meyer et al., 2004, p.3). Another problem that hospitals grapple with is the waiting time in the emergency rooms (ER). Many patients spend considerable time in the ER waiting to be served. This paper will thus address strategies and tools that hospitals can use to identify prospects for performance improvements in OR as well as ER.

Data Required to Monitor Improvement in TAT in OR

One of the challenges that hospitals encounter is how to identify the data needed to monitor improvements especially in operating rooms (OR) and emergency rooms (OR). It goes without saying that many healthcare organizations have plenty of data. However, this data is scarcely translated into meaningful information for the benefit of the patients (Graham, 2008, p.10). There are several types of data that can be used to monitor improvement in the turnaround time in OR as well as reduce the waiting time in ER. For example, clinical data can be used to monitor performances in OR and ER. Clinical data consists of information about the health condition of patients, patients outcomes and data on screening processes. In addition, clinical data is used to measure a number of medical interventions including medication treatment, surgical processes, blood usage and infection control processes (Graham, 2008, p.10). Patient satisfaction data is another example. The hospital can use patients satisfaction data to identify prospects for performance improvement in OR and ER. Patient satisfaction data can be used to determine whether the patients were satisfied with the services they got from OR and ER. This type of data is also used to determine whether the environment at OR and ER was conducive and comfortable for recovery. Another critical data is the patient/family grievances. Data on grievances can provide critical information in terms of the potential problems within the OR and ER processes (Graham, 2008, p.11).

Employee satisfaction data can also be used to monitor improvements in TAT in the OR and reduce waiting time in the ER. Some of the salient features of the employee satisfaction data are: employee turnover data; absenteeism data; workplace accidents data; career prospects data; work load data; perception of safety data; dispute resolution data; as well as data on employee perception of management. Some of the data needed to monitor turnaround time in OR include data on timeliness of patient preparation; data on surgeon start-time; data on apparatus reliability; data on OR preparedness; and data on appropriate auxiliary medical staff (Graham, 2008, p.11).

Tools Used To Collect Performance Information

Patient Satisfaction Survey

Patient satisfaction survey is an important tool used to collect performance information in OR and ER. Survey can be used to collect information about patient opinion of care after healthcare services have been dispensed. There are various ways to obtain survey data. These include personal interviews, internet, e-mail, focus group discussions, and telephone interviews. The hospital can also mail survey instruments (such as questionnaires) to patients homes. The hospital can also administer surveys themselves or employ the services of an organization that specializes in data collection. In addition, the hospital can get survey replies directly from the patients after care has been dispensed (Graham, 2008, p.23). Survey instruments are used to collect information such as: responsiveness of medical staff, pain management, quietness and cleanliness of the hospital environment; time taken to get medical attention, discharge information and communication about treatment (Graham, 2008, p.25).

Telephone Interviews

Telephone interviews are also effective tools that used to collect performance information. Telephone interviews comprise of both open-ended and closed-ended questions that are used to collect data on patient satisfaction after healthcare services have been dispensed. Data collected through telephone interviews include the patients demographic attributes, time taken to arrive at the healthcare facility, patients experiences in terms of getting medical attention at the healthcare facility (particularly turnaround time at the OR as well as the waiting time in the ER). Telephone interviews are also used to assess whether patients were satisfied with the manner in which they were treated by the medical staff at the OR and ER. Telephone interviews is an effective tool to collect data because it gives opportunity to patients to express in their own words whether they were satisfied with the various medical services they received at the OR and ER. It also enables them to make suggestions on changes that should be adopted to improve service delivery at the OR and ER (Muhondwa et al., 2008, p.68).

Medical Chart Review

Medical chart review is also an extremely important tool used to collect performance information in OR and ER. This document is used to collect data on patients satisfaction as well as medical malpractices claims. Medical chart review contains important information such as medical reviews, medical therapies, medical litigations as well as medical misconducts by physicians, nurses and other employees at the hospital. The medical chart review document also contains summaries of personal medical records for each patient at the hospital, the medical procedures used to treat patients and the outcomes. Patients can also request a copy of their medical chart review to assess the type of medical treatment they receive. Medical chart review also contains information about the medical procedures that are relevant to patients specific status. The medical chart review enables the hospital to identify those areas that require urgent corrective measures to improve performance (Watson, 2003, p.13).

Tools Used To Measure and Display Quality Improvement Data

Control Charts

A control chart refers to a sequential time series plot that measures critical variables. The data plotted on a control chart can in form of rates, percentages, averages or even proportions (Woodall, Adams &Benneyan, 2011, p.2). A typical control chart has control limits (lower and upper thresholds) which are computed and plotted using process data. These limits describe the accepted range of deviation within which the plotted data must oscillate. Any data that fall outside the control limits may signal either quality deterioration or quality improvement (subject to the type of control limit crossed). Control charts are increasingly being used by hospitals measure and display quality improvement data. Some of the critical data measured by control charts include turnaround time in the OR, waiting time in the ER, patients satisfaction scores, post operative lengths of stay, emergency service response times, medication errors and infection rates. Control charts can be used by hospitals to study and monitor these variables (particularly the TAT in OR as well as waiting time in the ER) so as to make notable improvements in the quality of medical services dispensed. Control charts are thus valuable tools for monitoring quality improvement as well as assessing and validating improvement ideas (Woodall, Adams &Benneyan, p.2).

Comparison Charts

A comparison chart is a graphical diagram made up of observed (or actual) ranges, projected ranges and expected rates (lower and upper limits) for a specific period of time. The anticipated range is used to define the level of confidence that a given point differs from the average score. Comparison charts are mainly used healthcare institutions (especially in the OR and ER) to tell whether the chosen performance measure demonstrates one of the three forms of measurement results: excellent performance; average performance; or poor performance. The hospital is thus able to use data generated by comparison charts to identify areas (such as TAT in OR as well as waiting time in ER) that need improvement. For example, the comparison chart makes a comparison between the turnaround times in the operating room with its risk adjusted data or its comparison group. In essence, the comparison chart provides a useful guide to the hospital concerning whether it should carry on monitoring the performance improvement process (such as TAT in OR as waiting times in ER) in order to sustain the present level of performance or whether there is a justifiable reason to improve the present performance. Comparison charts can also be used within the hospital settings. For example, they can be used to monitor the TAT in OR for different periods. On the same note, comparison charts can also be used to monitor the waiting times in the emergency room. The data generated by comparison charts for different periods are compared to identify opportunities for performance improvements (Lee & McGreevy, 2002, p.129).

Conclusion

Both the OR and ER are crucial departments in any hospital. Nonetheless, they experience several problems that affect the manner in which healthcare services are dispensed. This paper has discussed various tools (such as survey methods, telephone interviews, control charts, etc) that can be used to improve the turnaround time in the OR as well as reduce the waiting time in the ER.

References

Graham, J. (2008). Managing Performance Measurement Data in Health Care. Washington D.C: Joint commission Resource.

Lee, K.Y., & McGreevy, C. (2002). Using Comparison Charts to assess Performance Measurement Data. Journal on Quality Improvement, 28, 129-138.

Meyer et al. (2004). Hospital Quality: Ingredients for Success: Overview and Lessons Learned. Washington, D.C: The Commonwealth Fund.

Muhondwa et al. (2008). Patient Satisfaction at the Muhimbili National Hospital in Dar es Salaam Tanzania. East African Journal of Public Health, 5, 67-73.

Watson, P.J. (2003). Improving Data Quality: A Guide for Developing Countries. Manila: World Health Organization

The Purpose Statement

A number of studies have noted that emergency departments of most hospitals around the world have poor patient satisfaction scores. According to Soremekun, Takayesu and Bohan, (2011, p. 668), satisfaction can be viewed as the difference between patients perceptions and their expectations. Olrich, Kalman and Nigolian (2012) acknowledge that hourly rounding is not new, it is only undergoing a resurgence. In the 20^th century, nurses commonly rounded on their patients. Currently, hourly rounding on patients by nurses and other hospital staff has reduced markedly due to staff shortages. Olrich, Kalman and Nigolian (2012, p. 23) argue hourly rounding offers a protocol to delineate actions that result in better patient outcomes. Other studies have proven that hourly rounding decreases patient call lights usage and improves patients satisfaction (Olrich, Kalman & Nigolian, 2012). Patients commonly use call light to attract the attention of hospital staff when they are in need of help.

Based on the findings stated in previous studies, the purpose of this study is to evaluate the effect of emergency department staff hourly rounding on clients satisfaction in a pediatric facility. The study is also based on the principle that patients satisfaction is influenced by the conduct of hospital staff (in terms of courtesy and communication) during hourly rounds.

Hypothesis

This study will be based in the emergency department of a pediatric facility. A pediatric facility of any given hospital is very important owing to the delicacy of its patients. Patients who seek services from the pediatric department are mainly minors. Thus, they are often accompanied by their parents. In this regard, parents or guardians of the patients (clients) will be the key respondents of the study. On the other hand, patients who will be old enough and willing to provide their views will also be interviewed. This study is based on the following hypotheses:

1. Hourly rounding by hospital staff on patients improves patients satisfaction.
2. Hourly rounding by hospital staff reduces the use of the call light button by patients.
3. Patients satisfaction is influenced by the conduct of hospital staff (in terms of courtesy and communication) during Hourly rounds.

Research Questions

How frequently did you use the call button?

• Did not use.
• Once in a while.
• Frequently.
• Very frequently.

How do you rate the hospital staff in the following?

Courtesy:

• Worse
• bad
• good
• very good

Paying attention to you and your childs needs:

• Worse
• bad
• good
• very good

Showing concern with regard to your childs progress:

• Worse
• bad
• good
• very good

How is the communication process?

• Very poor
• Poor.
• Good.
• Very good.

How well were you informed about delays?

• Very poor
• Poor.
• Good.
• Very good.

How well were you informed about the progress of your child?

• Very poor
• Poor.
• Good.
• Very good.

How well were you informed in terms of test results?

• Very poor
• Poor.
• Good.
• Very good.

What is your overall rating on how the hospital staff communicated to you?

• Very poor
• Poor.
• Good.
• Very good.

What is your overall assessment of your visit to the ED?

• Very poor
• Poor.
• Good.
• Very good.

Are you likely to recommend our ED to others?

• Very unlikely.
• Unlikely.
• Likely.
• Very likely.

The average scores will then be documented as per each individual question and the overall satisfaction.

References

Olrich, T., Kalman, M., and Nigolian, C. (2012). Hourly Rounding: A Replication Study. MedSurg Nursing,21(1), 23-36.

Soremekun, O., Takayesu, J., and Bohan, S. (2011). Framework for Analyzing Wait Times and Other Factors that Impact Patient Satisfaction in the Emergency Department. Journal of Emergency Medicine,41(6), 668-692.

Introduction

Most emergency rooms (ERs) in the US are in a quandary. They are witnessing a high number of patients which explains why issues of delays and diversions are more common. According to Moskop et al. (2019), most of the emergency rooms are overloaded beyond the required capacities. The authors further noted that ER visits in the US healthcare system account for 11% outpatient, 28% acute care visits and 50 % representing hospital readmission (Moskop et al., 2019). However, there is another group of patients that end-up in the ERs for non-urgent cases. To them, ER is the safety net of the safety net  Americans view it as both first and last resort (Griffey et al., 2020, p. 192). The problem started with the passage of the Emergency Medical Treatment and Active Labor Act (EMTALA) in 1986 which made it compulsory for hospital to provide emergency services to anyone needed care (Brown and Brown, 2019). It therefore follows that ERs overcrowding should be addressed through telephone triage and community paramedics where many medical issues can be directed to urgent care clinics and by making visits to a primary care physician.

Short-Term Solutions

Firstly, addressing the issue of overcrowding starts with ensuring there is proper use of emergency room. ERs should focus more of its efforts towards providing care to patients that are in dire need of these services. In essence, much attention should be on patients with life-threatening issues. Some of these issues, as elucidated by Griffey et al. (2020), include severe asthma attack, head injury, severe allergic reaction, difficulty breathing, chest pain and diabetic emergency. For instance, head injury meets the emergency room intake procedures which examine the severity and the status of condition. According to Savioli et al. (2020), head injuries may cause bleeding in the brain and tissue and layers surrounding the brain  these types of injuries are considered one of the main causes of disability and death in adults (p. 30). Additionally, by putting ER to proper use, there will be enough space and time to attend to mental-related and acute issues. Most cases reported in the ER relate to chizophrenia, bipolar disorder, anxiety disorders and schizoaffective disorder (Savioli et al., 2020). For example, bipolar disorder requires urgent care because it manifests through severe agitation, aggression and risk destructive behavior.

Secondly, some medical issues such as fever without a rash, dehydration, wheezing and abdominal pain can be addressed at urgent care centers or clinics. It is important to note that most urgent care centers have doctors and physicians assistants on stand-by to help any patient. As explicated in Raidla et al.s (2020) study, most of these doctors have adequate training in emergency and family medicine. In addition to this, most of them have a wide range of medical knowledge and skills to assist with diagnosing and treating a variety of illnesses. Bahadori et al. (2020), noted in their study that most of them will identify when a specialist is needed or when there is a potential emergency medical condition requiring an emergency room visit (p. 283). In essence, these facilities can help reduce congestion in the emergence room since most of them have X-ray machines, basic lab testing and equipment designed for minor issues such as stitching a wound and splinting a broken bone. Some states such as New York, New Jersey and Connecticut have technology-based care services which allow residents to book an appointment to see a care provider.

Thirdly, primary care clinics also play an important role in reducing overcrowding in the emergency room. According to Pinchbeck (2019) primary care is the first level of professional care where people present their health problems and where most curative and preventive health needs are satisfied (p. 105). Therefore, by consulting and visiting primary care physicians, patients will only call for emergency medical services (EMS) for valid reasons. Some of these reasons include life threatening injuries, acute issues and suicidal or homicidal feelings. Even some of these issues can be managed through primary care clinics which explain why it is important to seek their help before resorting to calling for EMS. As a matter of fact, most of these clinics provide first set of professional care to all patients by utilizing proactive approaches  they help with the management of chronic illness as well as promoting self-care. Ideally, primary care clinic should be the first safety net because they have a team comprising of highly dedicated professionals who are ready to offer the best medical services.

Long-term Solutions

Emergency rooms overcrowding can be addressed effectively through the adoption of telephone triage. According to Katayama et al. (2022), many countries such as Canadaand Australia have well-established and dedicated telephone triage services. Telephone triage nurses in these countries have a software in place that help them examine patients state of emergency and in turn, provide necessary services such as sending a doctor. More specifically, in Japan, telephone triage service was added to emergency care in Tokyo and Osaka in 2007 and 2009 respectively (Katayama et al., 2022). In Osaka, once a telephone triage nurse assesses a patient, they may direct the caller to a nearby medical facility based on the triage results (Katayama et al., 2022). The main reason why telephone triage is regarded as a long-term solution is because it brings into focus the human aspect of care. This is necessary because some callers may be truly concerned about their symptoms and having access to a triage helps provide reassurance. Similarly, callers may overestimate the severity of their illness, especially those that require the help of urgent care clinics, and up spending a lot of money in ER.

Emergency medical services should consider implementing community paramedic programs to help deal with the issue of overcrowding. As explicated in Agarwal et al.s (2019) study, a well-developed community paramedicine (CP) program can lower ER visits, reduce 911 emergencies, and increase patients quality of life (p. 56). For instance, community paramedics helps reduce the workload as well as improve patient care. It is imperative to note that overcrowding emergency rooms tend to increase both patient and staff anxiety. In addition to this, CP targets those patients who require an Urgent Care clinic or primary care physicians  it provides them with an alternative destination. Previously, ambulances were commonly used to transport patients to emergency room, but today PC programs have introduced an alternative transport destination aimed at improving patient care (Agarwal et al., 2019). CP also works closely with primary care physician to help treat patients without necessary transporting them to ER. Some of the in-home treatment offered by CP include: medication adjustment, blood draws, and wound care. Therefore, both physicians and EMS should collaborate in training community paramedics in an attempt to negate the need to visit ER.

Conclusion

Most emergency rooms in U.S are currently experiencing a surge in patients which explains why the issue of delays and diversions has become common. Most Americans view ER as both the first and last resort. As a result, these facilities end up being overcrowded by non-critical patients. As indicated above, telephone triage and community paramedics programs, once implemented, will help direct many medical issues to urgent care clinics or by visiting a primary care physician, this reducing the issue of ER overcrowding. it is imperative for patients to differentiate medical issues that require emergency services and those that could be addressed at urgent care clinics. For instance, ER should target mainly those patients with life-threatening issues such as asthma attack, head injury, severe allergic reaction, difficulty breathing, chest pain and diabetic emergency. Other medical issues such as fever without a rash, dehydration, wheezing and abdominal pain can be addressed at urgent care centers or clinics.

However, more emphasizes should be on the adoption of telephone triage and community paramedicine programs. These two, as cited above, are aimed at providing long-term solutions to the issue. On one hand, telephone triage service, once added to emergency care, allows nurses to assess patients, and decide whether they should visit ER or directed to urgent care clinics. Telephone triage is unique in the sense that brings into focus the human aspect of care. Community paramedic program, on the other hand, plays an important role of lowering ER visits, reducing 911 emergencies, and increasing patients quality of life. Overall, community paramedics work closely with primary care physician to help treat patients without necessary transporting them to emergence room.

References

Agarwal, G., Angeles, R., Pirrie, M., McLeod, B., Marzanek, F., Parascandalo, J., & Thabane, L. (2019). Reducing 9-1-1 emergency medical service calls by implementing a community paramedicine program for vulnerable older adults in public housing in Canada: A multi-site cluster randomized controlled trial. Prehospital Emergency Care, 12(3), 56-90. Web.

Bahadori, M., Mousavi, S. M., Teymourzadeh, E., & Ravangard, R. (2020). Non-urgent visits to emergency departments: A qualitative study in Iran exploring causes, consequences and solutions. BMJ open, 10(2), 282-357. Web.

Brown, H. L., & Brown, T. B. (2019). EMTALA: The evolution of emergency care in the United States. Journal of Emergency Nursing, 45(4), 411-414. Web.

Griffey, R. T., Schneider, R. M., & Todorov, A. A. (2020). Adverse events present on arrival to the emergency department: The ED as a dual safety net. The Joint Commission Journal on Quality and Patient Safety, 46(4), 192-198. Web.

Katayama, Y., Kitamura, T., Nakao, S., Himura, H., Deguchi, R., Tai, S., & Nakagawa, Y. (2022). Telephone triage for emergency patients reduces unnecessary ambulance use: A propensity score analysis with population-based data in Osaka City, Japan. Frontiers in Public Health, 10(5), 24-90. Web.

Moskop, J. C., Geiderman, J. M., Marshall, K. D., McGreevy, J., Derse, A. R., Bookman, K.,& &Iserson, K. V. (2019). Another look at the persistent moral problem of emergency department crowding. Annals of emergency medicine, 74(3), 357-364. Web.

Pinchbeck, E. W. (2019). Convenient primary care and emergency hospital utilization. Journal of Health Economics, 16(5), 102-242. Web.

Raidla, A., Darro, K., Carlson, T., Khorram-Manesh, A., Berlin, J., &Carlström, E. (2020). Outcomes of establishing an urgent care centre in the same location as an emergency department. Sustainability, 12(19), 81-90. Web.

Savioli, G., Ceresa, I. F., Luzzi, S., Gragnaniello, C., GiottaLucifero, A., Del Maestro, M., &Bressan, M. A. (2020). Rates of intracranial hemorrhage in mild head trauma patients presenting to emergency department and their management: A comparison of direct oral anticoagulant drugs with vitamin K antagonists. Medicina, 56(6), 30-80. Web.

Introduction

In their work, nurses should apply theoretical principles of nursing to their practice depending on the settings and specific needs of patients whom they serve. Much attention should be paid to identifying differences in needs and expectations typical of various groups of patients (Wetzig & Mitchell, 2017). The purpose of this paper is to analyze how the nursing metaparadigm and the personal nursing philosophy can be applied to serving patients from a trauma and emergency unit, what concepts should be added to the model in order to improve services, and how these changes can influence practice.

A Specialty Practice Area

A specialty practice area determined for this assignment is a trauma and emergency unit. Those nurses who work in this unit are expected to cope with emergency cases, support patients with minor and severe injuries, provide care for patients with burns, and guarantee the provision of services for patients with bone fractures, among other types of trauma. While working in this specialty area, nurses should develop their concentration, the ability to react to situations, the ability to provide emergency care, and skills in helping patients overcome stress.

Primary Needs of This Specialty Population

The population in a trauma and emergency unit includes adult patients who are victims of certain incidents and accidents that affect their physical state, emotional state and life in short-term or long-term perspectives. The basic needs of this population depend on the severity of a case. Those adult patients who have such trauma as bone fractures, which can be treated without complications, usually need primary support and education regarding minor modifications of their lifestyle (Wetzig & Mitchell, 2017).

However, the needs of those patients who experienced burns, severe wounds, and other types of complicated trauma require more support, care, detailed recommendations regarding treatment, and education regarding modifications of their lifestyle to cope with an unfamiliar situation (Gullick, Taggart, Johnston, & Ko, 2014). These patients can feel anxiety, be depressed, focused on pessimistic thoughts, and unable to care for themselves without support (Wetzig & Mitchell, 2017). This complex situation needs to be addressed by nurses.

The Nursing Metaparadigm and Personal Conceptual Model

Principles of the personal nursing philosophy should address the needs for care characteristics of the identified population. The reason is that this philosophy is based on the nursing metaparadigm, which consists of such concepts as a person, health, nursing, and environment. Currently, while providing care for patients with trauma, it is appropriate to refer to them as individuals who have different needs, diverse backgrounds, certain visions regarding their treatment, as well as distinct beliefs and ideas. As a result, this approach to caring can be viewed as patient-oriented. Furthermore, the understanding of patients needs is important to propose the most effective treatment to improve their health depending on genetic, physical, emotional, and intellectual differences.

In this context, nursing is viewed as a process of applying certain approaches in order to address patients needs and contribute to improving their health. Therefore, the concept of the environment associated with these ideas is based on creating a supportive and caring space for patients to improve their physical and emotional states. However, it is possible to add one more concept to this paradigm, and this concept is care or caring. To cover the identified populations needs, this concept should be discussed from the perspective of Jean Watsons Theory of Human Caring.

Jean Watsons Theory of Human Caring to Add to the Conceptual Model

To add a theoretical concept that is based on the nursing philosophy and which can guide practice to address patients needs to the personal conceptual model, it is important to refer to Watsons Theory of Human Caring. Watson formulated the principles of this theory in the 1970s. According to the theorist, the main purpose of nursing is to guarantee human caring, which can be defined as the creation of deep and dynamic nurse-patient relationships (Pajnkihar, McKenna, `tiglic, & Vrbnjak, 2017).

The result of these relationships is high-quality and patient-oriented care, which helps individuals address their needs, feel more optimistic regarding their treatment and receive the required support. From this point, the focus is on nurses creative (care and support) activities rather than curative (procedures) activities (Ozan, 2015).

Reasons to Choose Watsons Theory

Those patients who are usually observed in trauma and emergency units require care and support more than other patients because these individuals need help in their daily activities, they often feel frustrated and pessimistic, they are at higher risks of developing depression and anxiety because of factors associated with their health state. As a result, nurses in this unit are expected to not only offer treatment and education for patients but also provide care, motivate, demonstrate kindness, encourage, and support.

All these aspects are reflected in Watsons theory, as its key principles are associated with the development of trusting relationships (Pajnkihar et al., 2017). Thus, the principle of caring should be adopted in the facility with reference to the ideas declared by Watson, who accentuated caring as a moral perspective of nursing based on the concept of humanity.

How This Concept Will Improve Practice and Care

In the context of this theory, nurses are expected to follow certain Caritas, which are practices oriented to supporting patients on a daily basis. Working with trauma patients, nurses provide not only emergency support but also daily assistance, communication, consultation, and help in performing certain activities. While modifying practice with the focus on Watsons theory, it is important to concentrate on Caritas and help patients cope with their stress, examining settings, and changing habits (Gullick et al., 2014).

After applying this theory and the concept of caring to practice, nurses can guarantee that patients feel more comfortable in the context of a new situation, they build trusting relationships with a nurse, and they become oriented to recovery. Nurses will listen to patients and help realize their desires, they will respect them, and involve patients in a decision-making process (Pajnkihar et al., 2017). Therefore, it is possible to state the Watsons Theory of Human Caring can positively affect the practice of those nurses who work in trauma units and need to cope with patients fears, stress, anxiety, and depression, along with the inability to care for themselves.

Conclusion

The practice of nurses can be discussed as challenging, and they are expected to use principles of their nursing metaparadigm in order to address patients needs. However, nurses activities should be oriented not only to treatment but also to care. Therefore, the application of Watsons Theory of Human Caring is important in the context of a trauma and emergency unit to help patients recover and feel comfortable in a facility.

References

Gullick, J. G., Taggart, S. B., Johnston, R. A., & Ko, N. (2014). The trauma bubble: Patient and family experience of serious burn injury. Journal of Burn Care & Research, 35(6), 413-427.

Ozan, Y. (2015). Implementation of Watsons Theory of Human Caring: A case study. International Journal of Caring Sciences, 8(1), 25-32.

Pajnkihar, M., McKenna, H. P., `tiglic, G., & Vrbnjak, D. (2017). Fit for practice: Analysis and evaluation of Watsons Theory of Human Caring. Nursing Science Quarterly, 30(3), 243-252.

Wetzig, K., & Mitchell, M. (2017). The needs of families of ICU trauma patients: An integrative review. Intensive and Critical Care Nursing, 41(1), 63-70.