Category: Emergency Department

Teamwork is considered a major force that influences the interrelationships between individuals of the same group. Teamwork strongly controls how members of a group react and perform hence team dynamics are very important and at the same time vastly complex. It should be understood that team dynamics may exert a positive as well as a negative effect on the performance of a group. In a positive stance, team dynamics may generate bonded discussion with the members of the group. In addition, each member of a team that is positively influenced by teamwork feels that he belongs to the team and thus enjoys his presence and interaction in the team. More importantly, a team that carries a positive dynamical situation shows a greater level of motivation, as well as commitment to stick with the group, no matter what unfolds in the future. On the other hand, a team that is influenced by negative team dynamics has members who generally feel that they have been excluded from the majority of the members of the group. A negatively influenced team also has a less chance of having at least two individuals being included in every decision-making process, hence this group is usually observed to have subgroups or factions. A team that has negative interactions between its members also shows that the flow of information across the team is not complete, wherein only a few members are knowledgeable of the details and even the simple facts of issues that are related to the team. Such condition often results in miscommunications and as time goes by, misunderstandings ensue and oftentimes, the performance of the members of the team tends to be unsatisfactory.

Team dynamics involves the establishment of friendships or bonds between members of a group. Aside from the oral communications that occur between individuals of a team, there are also other forms of communication that influence the performance of a team. Nonverbal communication refers to the communication process that is associated with the transfer and receipt of messages that are not connected to the employment of words. The messages conferred by one individual to another are often associated with body language, as well as movements, posture, dressing or clothing, facial expressions, and even hairstyles. Nonverbal communication is thus strongly prejudiced by visual messages which serve as symbols of specific meanings to the listener. Other forms of paralanguage of nonverbal communication include the features of the voice of the speaker as well as the style of speaking. It should be noted that any characteristics related to tension as well as the rhythm of voice of the speaker’s voice may also influence a listener as to the manner of understanding the message that has been received.

In specific workplaces such as the critical care unit, nonverbal communications serve an important role in the interrelations among the members of the team. It is well known that the employees at a workplace such as the critical care unit need to work together and cooperate in order to achieve the status of a proactive and competent team (Hynes et al., 2008). Team dynamics, in the form of cooperation and harmony, are thus closely related to the trust and confidence of each team member to himself and to his co-workers, and these factors are often swayed by both verbal and nonverbal communications among individuals in the workplace. It should be noted that even if the right phrases and words were expressed by an individual, the actual message of the spoken words and sentences are often modified by the accompanying nonverbal signals that the listener sees in the speaker. These nonverbal signs may or may not be consciously being expressed yet it is a fact that these nonverbal signs often change the message that is sent out to the listener.

Leadership is strongly associated with taking risks by following one’s personal conviction, amidst conventional concepts and tough opposition. It is often misconceived as a form of charisma or the equivalent of management, yet these two factors play a role in the practice of leadership. Management pertains to handling complex organizations and making certain that particular things are working smoothly, that daily obstacle are resolved, and that the organization’s functions remain stable and uninterrupted. Leadership, on the other hand, is associated with having a goal and inspiring individuals to reach that particular goal. It is related to modifications of different factors, including internal and external forces, as well as the incorporation of new techniques in order to achieve such a goal. In the case of the critical care unit, the physician leads the critical care team in taking care of the patient (Wright et al., 2007).

Ethical leadership is important in the critical care unit because change is not beneficial at all if this specific profession or medical specialization is affected. Ethical leadership is challenging because it entails the incorporation of changes in the organization or profession for improvement of the patient as well as the delivery of healthcare to the patient, yet the leader should be aware that it also requires the preservation of the personal health and well-being of all members of the critical care unit concerned. Hence, ethics is important in the critical care unit because it is critical that leaders help their team members in the medical team in coping with any of the changes that will be introduced, as well as assisting them to envision that such changes will lead all of them towards their vision or goal (Kemp, 2007).

A competent ethical leader in the critical care unit should show concern regarding the practices, communities, professional associations, and the public policies that are related to their unit (Proenca, 2007). In addition, the visions and goals that an ethical leader possesses should because always be at the systems level and this is not the same as how medical fields are run, which are actually at the physician-patient level. Such a new concept of leadership, also known as the balcony perspective, is currently being introduced and tested in the medical field.

It has been documented that physicians generally are asked to take leadership positions accidentally. It seems that particular medical professionals are entrusted with positions that require another set of total commitment in guiding their team members to a certain goal in their profession. Research surveys have indicated that physicians accept leadership roles that are bestowed upon them because they have taken an oath that as physicians, their primary concern is patient care, yet it is also their social duty to express their ideas and emotions with regards to health issues. Such a task thus positions them in a leadership stance which both addresses health problems but also identifies factors that affect health (Wolfe, 2008). It has been expressed that acting as a physician is expected to start not after medical training but is actually highlighted as soon as they enter medical school.

Personal leadership in healthcare management has transformed from the old modes of leadership to the current versatile, flexible and collaborative version of patient care delivery. It guides the physicians to put their attention on the clinical, as well as research, teaching, and administrative issues that are related to medical fields. In addition, the critical care team leader must be able to balance his talents in theory, skills, and practice with self-reflection and ethics. The leader should be capable of engaging with the rest of his colleagues and not only identify the goal, but also support their efforts and acknowledge their achievements in their field of specialization.

One of the major responsibilities of a nurse is to provide support to a patient (Rochlin, 2007). It is thus a nurse’s duty to perform any task that will result in the augmentation of the healthcare of patients. It is unfortunate, however, that this nursing responsibility may not always be in accordance with the priorities of the healthcare facility or the physician in charge of a particular patient. Each field of medical specialization carries its own list of priorities and these may vary hence the nurse’s responsibilities may sometimes be in harmony with that of the other professionals’ goals and sometimes may not be in conformity. The disparities between the priorities of different healthcare professionals often result in ethical conflicts and personality clashes and this, in turn, affects the cost-effectiveness and quality that is delivered to the patient (guard-Wiebe, 2008). It should be understood that the occurrence of two different ideals instead of two similar ideals is random in the healthcare setting and this is also the case with other professional fields. The extreme cases of politics and conflict often end up with having to choose only one priority that will be supported and these may be the nurse’s job, care of the patient, and his personal goals. It is therefore very unfortunate to have politics in the nursing profession because there will always be a component that will suffer the consequences. Either the nurse will choose upholding his personal goals over maintaining his job or the nurse prioritizes the care of the patient over his personal goals. It is also essential that the concept of human nature be considered in such professional conflict in order to better understand the intricacies of conflict and provide clues for its resolution.

In creating a moral vision, a critical care team leader must be capable of meeting the needs of his team members, as well as recognize each member’s diverse role in the field of critical care. He must be able to acknowledge the relevance of the members of the organization or department, as well as accept any potential leaders in the group. The critical care team leader must also recognize that there are always certain underrepresented groups or members in his department and thus any barriers should be collapsed in order to have a collaborative group that functions at its maximum potential. It is also important to provide information to his team members that there are ample opportunities for them to develop, improve and enhance their skills and that there is always room for them to get involved and be active for the improvement of their unit.

References

1. Hagyard-Wiebe T (2008): Should critical care nurses be ACLS-trained? Dynamics. 18(4):28-31
2. Hynes P, Conlon P, O’Neill J, Lapinsky S (2008): Partners in critical care. Dynamics. 19(1):12-7.
3. Kemp KA (2007): The use of interdisciplinary medical teams to improve quality and access to care. J.Interprof.Care. 21(5):557-9.
4. Proenca EJ (2007): Team dynamics and team empowerment in health care organizations. Health Care Manage. Rev. 32(4):370-8.
5. Rochlin I (2007): Once a nurse, always a nurse: Irma Rochlin: nurse, legislator, maverick. Interview by Sybil Shalo. Am. J. Nurs. 107(10):86-7.
6. Wolfe B (2008): Implementing an ICU outreach team model. Dynamics. 19(1):24-9.
7. Wright B, Lockyer J, Fidler H, Hofmeister M (2007): Roles and responsibilities of family physicians on geriatric health care teams: Health care team members’ perspectives. Can Fam Physician. 53(11):1954-5.

Introduction

The present paper considers the role of an Emergency Room Head Nurse (ERHN), which combines leadership and managerial responsibilities, specifically within the settings of the Kingdom of Saudi Arabia. Emergency Room (ER) or Department constitutes a type of care settings where “emergency patients are accepted, and critically ill patients are rescued” (Zhu & Wang, 2015, p. 19). The specifics of these settings have an impact on the activities that ERHNs are supposed to perform; in particular, ER work is associated with increased stress and risk of violence (Atakro, Ninnoni, Adatara, Gross, & Agbavor, 2016). Furthermore, because of the combination of clinical, leadership, and managerial responsibilities, ERHNs is a very extensive role with high expectations (Jonson, Pettersson, Rybing, Nilsson, & Prytz, 2017). It is also associated with notable educational needs (Morphet, Kent, Plummer, & Considine, 2016). However, the acquisition of the necessary skills and competencies equips ERHNs to perform their duties in a way that results in positive outcomes for their clients and the profession.

Role Scope and Performance

The research on Saudi Arabian nurses, especially those operating within a specific environment and performing particular roles, is not very extensive, but it is still present. Saudi Arabia has less than 100 years of history, and nursing in it is younger (Al-Hazmi & Windsor, 2013), which might explain the shortage of literature. Furthermore, there is some research on the role of ERHN in other countries, as well as head nurses in different settings. Also, some policy papers are available. Consequently, the scope of the role of ERHN can be explored in the present essay.

Purpose

The general purpose of ERHN consists of ensuring the high quality of nursing care in their ER by enabling its processes and empowering its nurses. This purpose is achieved through the managerial and leadership activities that include, but are not limited to, the establishment and maintenance of policies, coordination of nurses’ actions, management of healthcare resources, development of healthy work environment, problem-solving, decision-making, nurse empowerment, and so on (Bai et al., 2017; Dahshan, Youssef, Aljouaid, Babkeir, & Hassan, 2017; Firouzkouhi, Babaeipour-Divshali, Amrollahimishavan, Vanaki, & Abdollahimohammad, 2016; Jonson et al., 2017). Thus, despite the short and direct purpose statement, the activities that are related to it for ERHN are rather numerous and varied, which indicates that the role is complex.

Common Features of the Scope of the Role

The role scope of ERHN can be characterised by three key features: manager, leader, and clinical nurse. Indeed, while mostly concerned with management and leadership, ERHNs are also involved in clinical duties, especially in case of major emergencies (Jonson et al., 2017). However, as a head nurse, ERHN is also expected to manage and lead ER nurses. The two roles differ; while a manager is concerned with aspects like scheduling, coordination, and organisation, a leader would motivate, engage, and empower (Kantanen, Kaunonen, Helminen, & Suominen, 2017). However, leadership and manager roles are generally interconnected (Kantanen et al., 2017), which is why they are not expected to conflict. Still, it is apparent that ERHN’s role includes three aspects which incorporate multiple functions and responsibilities and require a variety of competencies. The complexity of the role can be highlighted again.

Role Governance

Professional regulation/role scope from a registration authority

The legal regulations that ERHNs need to adhere to are established by the Ministry of Health (2018). However, these regulations are general; neither of them is meant specifically to regulate the conduct of ERHNs. The Saudi Commission for Health Specialties (2012) is the authority that is concerned with the registration of all healthcare professionals in Saudi Arabia, including ERHN. The registration requirements typically focus on qualifications (education), the source of education (nurses who have studied in a variety of countries can be registered in Saudi Arabia) (Hibbert et al., 2017), training, and experience (Saudi Commission for Health Specialties [SCHS], 2014c). To become registered professionals, ERHNs need to consider the requirements of the SCHS (2014c), but the roles that this body singles out do not specifically include ERHN or any other nursing leadership role. In other words, the SCHS (2014c) does not specifically describe the role scope of ERHN.

However, Saudi Commission for Health Specialties [SCHS] (2014b) is also responsible for the development of the curricula for relevant education complete with specific learning objectives and expected outcomes, as well as related certification procedures. The curricula exist for different specialities, including that meant for the Emergency Medicine specialists (SCHS, 2014b). An analysis of the curriculum indicates that Emergency Medicine professionals in Saudi Arabia are expected to be well-trained in their field of practice, as well as collaboration and communication skills. Furthermore, management and health advocacy are incorporated into the curriculum. Therefore, it can be assumed that these key competencies are expected from Emergency Medicine professionals in Saudi Arabia, including ERHNs, and ERHNs need to adhere to these requirements.

Another document that regulates ERHN conduct in Saudi Arabia is the Code of Ethics developed by the Saudi Commission for Health Specialties [SCHS] (2014a). A code of ethics with specifications concerning professional conduct is provided by the Ministry of Health (2018) as well. The key aspects included in the code are those related to patients, community, colleagues, oneself, as well as the profession; some more specific considerations like the conduct in particular cases are also considered. The Islamic values and laws are viewed as one of the sources of medical ethics in the codes, which is a specific feature of Saudi settings (Al-Hazmi & Windsor, 2013). Codes of ethics are the documents that ERHNs need to adhere to, and that can be viewed as regulatory for ERHN, but they can also be treated as a detailed guide that can be employed by ERHNs in personal practice and during the management of disputes and conflict situations.

In summary, no regulations designed specifically for the role of ERHN were found in the documents presented by the Commission or the Ministry of Health (2018). Similarly, no direct definition of the role of ERHN or relevant scope of practice was found in the legislation, regulations, or other documents presented by the two bodies. Still, it can be suggested that the Commission and the Ministry of Health (2018) provide some general guidance on the topic, especially with respect to the skills, competencies, experience, and ethical conduct that constitute professionalism in ER settings, nursing, and outside of both. Thus, ERHN can use these materials as supplementary to define appropriate behaviour within the context of Saudi Arabia.

Workplace role expectations/potential job description

From what can be gathered from the materials presented by the Saudi Commission for Health Specialties [SCHS] (2015), as well as job descriptions available on the Internet, the workplace expectations of ERHN mostly coincide with the information described above. The list of specific ERHN responsibilities is very extensive; it includes both general statements (for instance, the maintenance of high standards of care or the promotion of safety culture) and more specific ones (for example, the development of a training needs assessment plan or the appraisal of performance). However, it can be described as the mixture of managerial and leadership activities, as well as some clinical ones. Furthermore, ERHNs are expected to ensure patient satisfaction and protection, which can be referred to the above-mentioned codes of ethics (SCHS, 2014a). Thus, the potential job description reflects all the major elements of the ERHN role and corresponds to the literature on this topic and related ones (Jonson et al., 2017; Kantanen et al., 2017; Zohar, Werber, Marom, Curlau, & Blondheim, 2017). Overall, this information supports the idea that ERHN role is complex and suggests that its practice coincides with this theory.

Skills/Performance

Given the numerous functions that an ERHN needs to perform, the skills required to ensure high-quality performance are similarly diverse and multiple. However, they can be classified into those pertinent to specific elements of the role, as well as some general ones that are warranted by the specifics of the settings. Indeed, for any nurse manager, clinical skills and knowledge are significant, which is why head nurses are required to be familiar with the specifics of the nursing activities pertinent to ER (Kantanen et al., 2017; Zhu & Wang, 2015). Similarly, head nurses are expected to exhibit the knowledge of their settings, which would enable them to effectively manage their processes and resources (Kantanen et al., 2017). This knowledge can be viewed as a requirement for successful management in ER; because of its significance, nurses are only promoted to ERHN after they have had several years of experience in ER (Zhu & Wang, 2015). Thus, the understanding of ER nursing, related processes, and the specifics of ER settings is a key competency for ERHN.

In turn, managerial skills are also particularly important for head nurses, including ERHN (Firouzkouhi et al., 2016; Jonson et al., 2017). They incorporate the ability to manage resources (including human resources), solve problems, make decisions, and so on (Dahshan et al., 2017; Firouzkouhi et al., 2016; Jonson et al., 2017; Ogbolu, Scrandis, & Fitzpatrick, 2017). A specific example of managerial skills is the resource and patient flow management, which are extremely important in ER settings due to the instances of major accidents that tend to result in multiple casualties, and this duty is predominantly taken by ERHNs (Jonson et al., 2017). Also, head nurses might need some skills pertinent to financial management in case they are involved in it, which is not an unusual practice (Bai et al., 2017). In general, managerial skills are rather numerous and diverse, but ERHN needs to master them to ensure the smooth functioning of their ER.

Leadership competencies are also a requirement for ERHN. They are similarly multifaceted but tend to be concerned with the skills related to human resource management and strategy (Kantanen et al., 2017). Some of the pertinent abilities include communication, conflict management, organisational culture improvement, and so on (Kantanen et al., 2017; Parizad et al., 2017; Wang, Anthony, & Kuo, 2016). An example that has a special significance for ER is teamwork (SCHS, 2015). For ERHN, the ability to work in a team and organise one should be considered one of the crucial skills (Grover, Porter, & Morphet, 2017), and it is directly connected to leadership abilities.

The skills that are not directly related to the three role elements but are still pertinent to ERHN can be mentioned as well. Due to the specifics of the settings, multitasking is particularly important for ER nurses (SCHS, 2015), especially ERHN. Similarly, the stressful nature of ER environment requires the ability to manage one’s stress, possibly, with the help of special techniques (Atakro et al., 2016; Parizad et al., 2017). Thus, the specifics of ER settings may have some implications for the required ERHN competencies that are not directly concerned with their specific roles but would still assist them in the process of performing their duties. Overall, the skills that ERHNs need to be familiar with are multiple, but they can be generalised by referring to the key elements of ERHN role.

Example Activities

Some of the example activities of head nurses that have been discussed in the recent literature apply to those typical for ERHN. For example, supervision is a major aspect of ERHN’s role, and it can be achieved, among other things, through interpersonal communication which offers an opportunity for policy clarification and behaviour modification (Zohar et al., 2017). These activities can be viewed as predominantly leadership-related. On the other hand, the budgeting is a managerial activity (Bai et al., 2017). The development of safety culture, which is exceptionally important for ER (Zhu & Wang, 2015), likely involves both managerial (development and enforcement of policies and processes) and leadership (vision communication) activities. Finally, an example which is concerned with every aspect of ERHN’s role can also be proposed. In particular, during the response to a major incident, ERHNs tend to take responsibility for managing the processes and activities, as well as patient flow, by exhibiting clinical, managerial, and leadership competencies (Jonson et al., 2017). Thus, the example activities of ERHNs can be both general and settings-specific and might require the application of skills pertinent to different elements of the role.

Role Benefits and Outcomes

For the Profession

Given that nursing can be viewed as a relatively young profession in Saudi Arabia (Al-Hazmi & Windsor, 2013; Hibbert et al., 2017), its advancement is particularly important. According to the Code of Ethics of Saudi healthcare professionals, the profession can benefit from the actions of ERHN, in particular, due to the maintenance of high standards and their improvement (SCHS, 2014a). From this perspective, the activities like continuous education, training of nurses, quality improvement efforts can be viewed as geared towards achieving beneficial outcomes for the profession. Similarly, the Commission sees ethical conduct as a form of supporting profession, which can be acknowledged. By contributing to the development of the profession and maintaining its positive image, ERHNs can achieve beneficial outcomes for it.

For Nurses

Given the fact that ERHN directly works with ER nurses, creating the environment in which they can successfully perform and empowering them to achieve better results, the outcomes of ERHN work for nurses should be highlighted as a separate category. Nowadays, there is enough evidence to state that ERHN can affect the job satisfaction and productivity of ER nurses through their managerial skills (Firouzkouhi et al., 2016). Moreover, the effective leadership of nurse managers may affect the commitment and job satisfaction of nurses while also empowering them to contribute to better organisational outcomes (Dahshan et al., 2017). Consequently, ERHN is a major factor in ensuring the quality of nursing and, therefore, care within their ER (Ogbolu et al., 2017). Supportive management and leadership are also predictive of decreased burnout (Dahshan et al., 2017; Firouzkouhi et al., 2016; Hunsaker, Chen, Maughan, & Heaston, 2015). Therefore, ERHNs are essential for nurse development and well-being, which affects the productivity of the latter and helps them to realise their potential.

For Clients

As it was mentioned, the key purpose of ERHNs is to maintain high standards of the quality of care and ensure the functioning of ER. Both these outcomes are beneficial for clients. Moreover, there is some evidence indicating that ERHNs can achieve said outcomes. The quality of care is dependent on the personnel, and head nurses are concerned with empowering ER nurses and developing an environment, in which they can achieve positive outcomes with respect to the quality of care (Dahshan et al., 2017; Ogbolu et al., 2017). Regarding the functioning aspect, ERHNs achieve it even in the conditions of scares resources and time shortage that follows the patient influx during major emergencies (Jonson et al., 2017). Thus, it can be suggested that ERHN role has an impact on the availability and quality of care, which implies positive outcomes for clients.

Research also highlights the significance of the nursing profession for the healthcare of Saudi Arabia and the growing need for its services (Hibbert et al., 2017). Therefore, it can be suggested that the role of ERHN is also particularly important for the clients in Saudi Arabia since it contributes to the management and improvement of a service that is in particularly high demand in the country. This factor emphasises the above-mentioned outcomes and demonstrates their significance.

Furthermore, some additional beneficial outcomes can be mentioned. Saudi ERHNs are ethically obliged to ensure the protection of patient rights (SCHS, 2014a). In connection with this requirement, there is also an ethical responsibility for ERHN to engage in advocacy (SCHS, 2014b). Thus, the activities of ERHNs that are not necessarily directly connected to their managerial or leadership duties are also beneficial for patients, as well as the entire community.

For ER and Organisations

Managerial and leadership positions are also very important from the organisational standpoint. For ER, which is an exceptionally high-risk unit with routine resource shortages, overcrowding, and reduced contact with patients, effective leadership and management are crucial for its functioning (Atakro et al., 2016; Jonson et al., 2017). It should also be mentioned that nurses are a very large group in healthcare, which is vital for its functioning (Bai et al., 2017). They can be viewed as the key human resource (Bai et al., 2017; Firouzkouhi et al., 2016). The fact that ERHNs play a major part in ensuring the effective work of this resource implies that their activities are very significant for ERs and healthcare institutions. Thus, organisational outcomes of ERHN work can also be mentioned as a separate category.

Regarding the specific documented organisational outcomes, head nurses are concerned with human resource management and development, which results in the improved effectiveness and performance and decreased turnovers (Dahshan et al., 2017; Firouzkouhi et al., 2016). Apart from that, improved efficiency, including cost-efficiency can be the result of effective management performed by head nurses (Bai et al., 2017). Finally, by providing leadership and management, ERHNs ensure the smooth functioning of ER, even in the aftermaths of major incidents (Jonson et al., 2017). Thus, there is some evidence indicating that the role of ERHN has beneficial outcomes for ER and healthcare organisations at large. In summary, ERHN is a role of great importance that tends to have favourable outcomes for multiple groups of stakeholders.

Role Experiences and Development Needs

The experiences of ER work appear to be connected to ERHNs needs. Some of ER specifics include increased risks and the requirement for quick decision-making and action (Atakro et al., 2016; Zhu & Wang, 2015). Consequently, the work at ER is particularly stressful (Atakro et al., 2016; SCHS, 2015; Parizad et al., 2017). The exposure to death can also be viewed as a stressor (Pegram, Grainger, Jones, & While, 2015). These stressors are amplified during major emergencies that typically require nurses to take the lead and manage a large influx of patients (Jonson et al., 2017). This specific feature of ER determines some of the conditions of ERHN operation.

Moreover, according to recent research, chaotic and highly stressful environments like ER are also conductive of negative workplace behaviours, including issues like incivility, bullying, and bickering (Parizad et al., 2017). This problem can affect the employees, patients, organisation, and even profession. The issue of violence towards ER specialists, including nurses, has been pointed out as well (Atakro et al., 2016; SCHS, 2015). Many of the conflicts are supposed to be managed by the head nurse, and violence, including verbal, can also affect the morale of the nurses or ERHN themselves (Atakro et al., 2016). Finally, ER work is rather time-consuming, which can influence work-and-life balance, as well as other aspects of social life (Atakro et al., 2016). Thus, the environment of ER poses some specific challenges that affect the experiences and needs of ERHN.

All the mentioned challenges are significant both for ERHNs and other ER who ERHNs need to lead and manage while taking into account these issues. It has been established that effective leadership can reduce burnout and turnover intent (Dahshan et al., 2017; Firouzkouhi et al., 2016; Hunsaker et al., 2015), which implies that effective leadership in ER settings is exceptionally important. As a leader, ERHN is also expected to manage conflicts (Atakro et al., 2016), including those related to the aggression towards nurses and within ER. Moreover, the development of a culture that would balance out the issues of ER and promote professional behaviour and ethical conduct is also a responsibility of leaders (Parizad et al., 2017). Thus, ERHNs need to be able to assist other nurses in dealing with the above-mentioned issues while also focusing on their own needs (SCHS, 2014a). Based on the above-presented information, the latter are connected to the outlined problems and include the need for stress management, protection measures, and work-and-life balance achievement. This aspect of ERHN functions also illustrates the complexity of the role.

Other experiences of ERHN have also been pointed out in the research. The issue of limited resources and high workloads is not uncommon in ER, especially given the mentioned large influxes of patients. This issue is reported by multiple resources on the topic (Atakro et al., 2016; Grover et al., 2017; Parizad et al., 2017; Pegram et al., 2015). The problem implies the need for the careful management of the available resources, which is one of the many functions of ERHN (Kantanen et al., 2017). The issue of insufficient training is also often mentioned by the articles that review ER and ERHN nurses’ perceptions (Atakro et al., 2016; Pegram et al., 2015). This problem is associated with increased occupational stress experienced by the professionals who feel underprepared for their roles (Pegram et al., 2015), which highlights the significance of addressing the issue. Consequently, it can be suggested that ERHN exhibit a need for continuous training, which should be considered in detail.

Indeed, professional development is crucial for the quality of service in ER (Morphet et al., 2016). Consequently, educational needs are one of the most significant development needs when ERHNs are concerned, particularly because continuing education is crucial for ER nurses (Zhu & Wang, 2015). Workplace training and education related to a variety of skills that ERHNs are supposed to exhibit ensures the quality of their work and, consequently, the quality of care provided by their ER.

There is some evidence to head nurse training having positive impacts on their performance. As can be seen from recent research, the training pertinent to managerial skills of ERHNs can result in improved job satisfaction in ER nurses, as well as the empowerment of ERHNs themselves (Firouzkouhi et al., 2016). Similarly, the development of the head nurses’ communication skills can assist in decreasing miscommunication and certain unhealthy tendencies (like nurse-blaming), which eventually results in improved teamwork and performance (Zohar et al., 2017). Bai et al. (2017) also report that by providing ERHNs with sufficient training on financial management, an institution can boost their performance in this respect. The ability to respond to emergencies can also be trained (Jonson et al., 2017). Thus, continuous training and education appear to be the key to equipping ERHNs with the skills required for their performance and that of the nurses of ERs.

Regarding the literature on the topic of the experiences of ERHN, head nurses, and ER, it appears that most relevant studies have been focusing on the negative aspects. This factor can be explained by the attempts to identify the needs of the nurses and the areas that can be improved. Thus, the present analysis of ERHN experiences can conclude that ERHN role is particularly complex, involves operation in a rather chaotic environment and problematic conditions, and, consequently, requires significant investment in training that would prepare ERHN to perform all the relevant tasks. This conclusion coincides with the above-presented information since the complexity of the role implies notable workload, and the specifics of the settings would be expected to be connected to some challenges.

Conclusion

Despite the lack of research on the topic, which may be attributed to its nascent nature, the role of ERHN in Saudi Arabia can be analysed with the help of modern literature and pertinent policies. ERHN is a very complex role that incorporates managerial, leadership, and clinical elements. Each of the mentioned elements requires specific skills and competencies; also, ERHNs exhibit more general skills that are not directly connected to the discussed role aspects but assist in carrying out related functions. The regulatory bodies of Saudi Arabia provide some general guidance for healthcare professionals, but they do not specifically focus on ERHN. At the same time, ERHNs have some rather unique needs that are connected to the specifics of their practice settings and the key ERHN functions. In particular, the stresses and challenges of ER, along with the complexities of ERHN role, seem to highlight the significance of continued education for ERHN. By equipping ERHN with the necessary skills and knowledge, an organisation can help them to achieve the outcomes that are beneficial for the profession, individual nurses, ER and healthcare institutions, patients, and the community.

References

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Hibbert, D., Aboshaiqah, A. E., Sienko, K. A., Forestell, D., Harb, A. W., Yousuf, S. A., & Kelley, P. W. (2017). Advancing nursing practice: The emergence of the role of advanced practice nurse in Saudi Arabia.Annals of Saudi Medicine, 37(1), 72-78. Web.

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Jonson, C., Pettersson, J., Rybing, J., Nilsson, H., & Prytz, E. (2017). Short simulation exercises to improve emergency department nurses’ self-efficacy for initial disaster management: Controlled before and after study.Nurse Education Today, 55, 20-25. Web.

Kantanen, K., Kaunonen, M., Helminen, M., & Suominen, T. (2017). Leadership and management competencies of head nurses and directors of nursing in Finnish social and health care.Journal of Research in Nursing, 22(3), 228-244. Web.

Ministry of Health. (2018). Regulations. Web.

Morphet, J., Kent, B., Plummer, V., & Considine, J. (2016). Profiling nursing resources in Australian emergency departments.Australasian Emergency Nursing Journal, 19(1), 1-10. Web.

Ogbolu, Y., Scrandis, D., & Fitzpatrick, G. (2017). Barriers and facilitators of care for diverse patients: Nurse leader perspectives and nurse manager implications.Journal of Nursing Management, 26(1), 3-10. Web.

Parizad, N., Hassankhani, H., Rahmani, A., Mohammadi, E., Lopez, V., & Cleary, M. (2017). Nurses’ experiences of unprofessional behaviors in the emergency department: A qualitative study.Nursing & Health Sciences, 20(1), 54-59. Web.

Pegram, A., Grainger, M., Jones, K., & While, A. (2015). An exploration of the working life and role of the ward manager within an acute care hospital organisation.Journal of Research in Nursing, 20(4), 312-328. Web.

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Introduction

In contemporary society, representatives of different industries increasingly cooperate as the interdependence of their activities is becoming more and more evident. The same applies to the relationship between policy and legislation, on the one hand, and health care and nursing, on the other. The American Association of Critical-Care Nurses (AACN) demonstrates a proactive attitude towards enacting laws regarding nursing. This paper analyses the political function and significance of the AACN identify the three legislative initiatives it has formally supported, discusses the appropriateness and usefulness of these initiatives, and tweets on one of them.

Political Significance of AACN

The AACN suggests that nurses of at least a bachelor’s level should be politically aware. According to Thompson and Donaway (2018), it expects BSN-prepared nurses to be “involved in political processes that would influence healthcare policy” (p. 161). Thus, to effectively perform their function, nurses should not only have professional skills and knowledge but also have a political impact. This position is also reflected in the AACN’s organizational and collaborative activities.

It is a member of the Nursing Community Coalition (NCC) that actively expresses political statements about legislative developments and also “works directly with government agencies and lawmakers” to strengthen its influence (“AACN Legislation/Regulatory Action,” 2019, para. 1). It should be concluded that the primary political function of the AACN and other nursing organizations is to shape political processes related to healthcare.

Legislative Initiatives Supported by the AACN

The NCC that includes the AACN supports certain legislative initiatives and expresses special thanks to its promoters. For instance, the Coalition supported the House of Representatives in the passing of the Nursing Workforce Development Act of 2019 (H.R. 728). The law implies launching several nursing development programs to ensure an effective and differentiated patient care delivery system. This measure will have a particularly positive impact on people living “in rural and underserved areas” (“AACN Legislation/Regulatory Action,” 2019, para. 5).

The NCC also supported a law recognizing nurses who served during the Second World War and providing “them with honorable discharges, medal privileges, and veteran burial benefits (“AACN Legislation/Regulatory Action,” 2019, para. 14). Finally, nursing organizations have welcomed changes to legislation on the medical use of opioids in treatment that will allow for more flexibility in its application given the opioid use disorder increasing prevalence (“AACN Legislation/Regulatory Action,” 2019). Thus, the AACN and other NCC members provide valuable feedback that enables legislators to assess their performance.

Author’s Position and Corresponding Tweet

It should be noted that the issue of education and training of nurses is particularly relevant. It is not surprising that the legislator’s efforts to improve this situation have resonated with the nursing community. The Nursing Workforce Development Act of 2019 is, in my opinion, a necessary regulation that meets the most urgent demands. It will provide nurses with new instruments and knowledge to perform highly qualified patient care.

The recognition and awarding of World War II nurses is also a justifiable and fair measure, which is difficult to object to. The same applies to changes in legislation on opioid use, as the drug has extremely dangerous potential for physical and psychological addiction. However, I would like to tweet exactly the first legislative initiative mentioned above:

“The U.S. House of Representatives passed the Nursing Workforce Development Act of 2019, which, through the introduction of nursing development programs, could be a new step in the nursing profession. It’s our responsibility to pass it in the Senate! Share it with everyone who cares.”

Conclusion

Nursing organizations must have political influence on changes in legislation concerning their activities and related areas. The example of AACN and NCC demonstrates that a dialogue between the legislative authorities and representatives of the healthcare sector is possible and productive. The AACN and other nursing organizations express their political statements regarding effective legislative measures and believe that political involvement should be an inseparable characteristic of the nursing profession.

References

AACN Legislation/Regulatory Action. (2019). Web.

Thompson, M., & Donaway, A. (2018). Transitioning from RN to MSN: Principles of professional role development. New York, NY: Springer Publishing Company.

Introduction

The present portfolio contains the key elements of the educational program that was developed to educate twenty-six nurses working at the Emergency Unit of King Saud Medical City in Riyadh. The program covers three topics: Medication Errors (ME), Catheter Injection (CI), Technology Operation (TO). The nurses have various levels of education and experience, but they all report that they need additional training on the mentioned topics.

The key aims of the program consist of improving nurses’ knowledge and self-reported preparedness and confidence in managing the issues related to ME, CI, and TO. The following “specific, measurable, achievable, realistic, and timely” (SMART) objectives are proposed for the program (Murray, 2017, p. 347).

1. By the end of the program, all the nurses will demonstrate good (or better) knowledge of the three topics as shown by the total mark, which will be determined with the help of the assessment rubric adopted by the program.
2. By the end of the program, all the nurses will report improved preparedness to and confidence in managing the issues related to the three topics as evidenced by the self-reported preparedness element of the final test of the program.

The program development was guided by the conversational model (CM), which views the learning process as a complex of interactions between the learner, their peers, and the teacher (Atif, 2013; Stephens & Hennefer, 2013). Also, the information provided by the educational needs assessment (ENA) that specifically targeted the nurses of the Emergency Unit was used for the program. As a result of the employment of these tools, the program’s outline and content were developed along with evaluation strategies and resource considerations. The present portfolio introduces all these elements together with a reflection on the program development process.

Overview of the Program

Content Outline and Teaching plan

The twenty-six nurses of the Emergency Unit have assessed the educational gaps that they have, which allowed tailoring the program to the maximum benefit of the participants (Fairchild et al., 2013; Pilcher, 2016). As a result of ENA, the ME unit was divided into two parts: the theory module will take 8-10 hours, and the practice module will last for 4-5 hours. CI and TO units will be much shorter: the former will take 6-7 hours, and the latter will last for 4-5 hours. Additional time will be required for the review of the information, tests, and program evaluation.

Objectives/summaries for sessions

The program is going to include individual sessions devoted to the three topics. The following SMART objectives can be used to describe the content and learning outcomes of the sessions; they are developed by the program’s objectives.

• ME objectives.
  • By the end of the unit, nurses will demonstrate good (or better) knowledge of the key aspects of ME as shown by the total mark and program’s rubric. The key ME aspects include ME classification, prevention strategies, reporting procedures, and the culture of medication safety (Bush, Hueckel, Robinson, Seelinger, & Molloy, 2015; CARNA Videos, 2014; O’Connell et al., 2016).
  • By the end of the program, the nurses will report improved preparedness and confidence concerning ME as demonstrated by the self-assessment element of the final test.
• CI objectives.
  • By the end of the unit, all the nurses must demonstrate good (or better) knowledge of CI topics as evidenced by the total mark and rubric. The CI topics are catheter use and safety considerations with different groups of patients (Abolfotouh, Salam, Mustafa, White, & Balkhy, 2014; Öztürk & Dinç, 2014; Wallis et al., 2014).
  • By the end of the program, the nurses will report improved preparedness and confidence concerning TO as evidenced by the final test self-assessment element.
• TO objectives.
  • By the end of the unit, the nurses will demonstrate good (or better) knowledge of TO topics as measured by the final mark and rubric. The topics include emergency unit technology classification, safety, and confidentiality considerations, and new approaches to technology use (O’Connell et al., 2016; Strudwick, 2015; Thompson, 2013).
  • By the end of the program, the nurses should report improved preparedness and confidence concerning TO as evidenced by the final test self-assessment element.

Program content with rationale

The content outline of the program is presented in Table 1.

Video presentations have been chosen by the nurses as a preferred method of education; also, it is a well-established method for nursing education that can result in improved motivation, attention, and information retention (Forbes et al., 2016; Holland et al., 2013; Parwanda et al., 2014). As a result, videos are included in every unit and almost every session. The videos would be expected to foster interaction (class and group discussions, questions, and answers) and reflection (brainstorming, individual, and group analysis tasks). Interaction and reflection, in turn, are major elements of CM that highlight the interconnections between individual and social learning (Knewstubb, 2014). This fact explains the use of multiple interactive activities in the program. At the same time, CM views individual assignments as another form of learning-related conversation that occurs between the educator and the learner (Atif, 2013; Holmberg, 2016). As a result, individual activities are also included in the program.

Active participation in the mentioned activities is the program’s major vehicle for learning. It is expected that the interaction between peers will foster knowledge exchange, which is especially likely due to the differences in the Unit’s nurses’ age and experience (Lin & Lo, 2015). Apart from that, the interaction is meant to promote collaboration and mutual support (Schmidt & Brown, 2016; Walji, Deacon, Small, & Czerniewicz, 2016). However, it is noteworthy that nurses may have different learning styles and traits that can make it more difficult for them to participate in certain activities (Li, Yu, Liu, Shieh, & Yang, 2014). For example, introverts are less likely to be engaged in a discussion then extraverts. This specific problem will be resolved in group discussions, in which every nurse will be provided with some time for the presentation of personal thoughts and their discussion. Moreover, the use of a variety of activities, including individual and group assignments, discussions, video analyses, brainstorming, and some others, should help the nurses with different learning styles to learn.

One Session Content and Plan

Several ME sessions will be dedicated to the topic of prevention strategies. Table 2 presents a plan and the in-depth content of the first of these sessions. It will employ a video presentation (CARNA Videos, 2014) to introduce the topic; the choice of the activity is explained by the fact that the nurses of the Unit have marked it as a preferred one. After that, the session will aim to promote reflection in nurses during the personal ME situation analysis (Brown & Schmidt, 2016).

Then, the nurses will be invited to discuss their personal experiences or hypothetical ME situations to analyze the possible prevention strategies in small groups. The choice of this activity is guided by CM, which fosters interaction between learners, their peers, and teacher (Knewstubb, 2014). Also, the use of small (four-people) groups helps to fit the activity into the rather limited timeframe of the session and provides every participant with an opportunity to present their speech. The session will be concluded with the review of the prevention strategies mentioned during the lesson and a request to fill out the session feedback questionnaire; the latter is required for the evaluation of the program. Finally, the evaluation strategy for the lesson involves the group leader rubric presented in Table 3, which will be complemented with the participation rubric that is shown in its short form in Table 4.

Evaluation Strategies and Tools

A mixed-methods evaluation strategy will be employed for the course. Tests are going to be introduced at the end of each unit (ME, CI, and TO) and the program (see Table 1). Each of the unit tests will contribute 10% to the total mark, and the final one will account for 30%. These tests will evaluate the knowledge obtained by the nurses; also, the final test will include a self-reflection module for assessing the achievement of the B-objective of the program. Tests are a well-established method of assessment that can be effective in determining the learner’s knowledge, but they also have some limitations, including their inability to capture the learner’s skill in analyzing, synthesizing, and applying information (Rosselli, Dennison, & Dempsey, 2014).

As a result, 40% of the mark will be contributed by the nurses’ participation during the sessions, and this technique will be aimed at the assessment of the achievement of both A- and B-objectives of the course. The marking rubric is presented in Table 4; it is going to be provided to the nurses at the beginning of the program to help them to interpret their marks and employ the information for feedback and improvement. The participation in sessions is obligatory; if a significant event prevents a nurse from attending, the situation will be considered specifically.

An important aspect of evaluation is the solicitation of feedback, which is going to be carried out with the help of the selected tool. The course is going to promote continuous feedback, encouraging the nurses to review the questionnaire after every session to ensure that their ideas are communicated to the educator. The significance of this form of feedback is rooted in the primary features of CM: as shown by Atif (2013), Holmberg (2016), Knewstubb (2014), and others, the collaboration and communication of CM contribute not only to the learner’s development but also to that of the educator, which, among other things, is manifested in the improvement of the teaching methods and tools. Thus, the employment of a variety of assessment tools will help both learners and the educator to receive feedback on their activities.

Resource Requirements and Costing

The costs of the program are going to be minimal or non-existent. The rooms for the sessions will be provided by the Emergency Unit, and it is also ready to assist in resolving any staffing issues that may occur. The key required equipment includes at least one computer, one projector, and one or more whiteboards, which are going to be provided by the Emergency Unit. Also, nurses may need pens and paper, which the Unit will deliver. However, the nurses will be encouraged to employ their mobile devices for making notes, which is in line with the modern perspectives on these devices as tools for learning (Şad & Göktaş, 2013). Moreover, the nurses have reported no difficulties in working with mobile and computing technology during the ENA activity, which makes this option more feasible. As a result, the nurses will be provided with all the materials for their sessions (feedback questionnaire, rubrics for reference and group leaders, and tests) in their electronic form. Printed versions of these materials will also exist, and they will be copied if needed, which may lead to certain expenses. However, the program can function with little or no funding.

Reflection

Gibbs’ reflective cycle is a framework for reflection that has been used for various aspects of nursing (Husebø, O’Regan, & Nestel, 2015). It is going to be employed in this portfolio to organize the information related to the experience of developing the program.

Description

The event can be described as the multistage development of an educational program for the nurses of the Emergency Unit of King Saud Medical City in Riyadh.

Feelings

I have been most enthusiastic about the event: I found the task interesting and challenging. Also, it is a pleasure to work with the Unit because its administration and nurses have been very cooperative. Overall, the event evokes positive feelings.

Evaluation

I would highlight the positive elements of the experience, including the extensive support of the Unit’s administration and the enthusiasm of the nurses: for example, the learning needs evaluation questionnaire resulted in a 100% response rate. Challenges were also present, including budgeting and staffing considerations, which were resolved with the help of the Unit’s administration. The process of designing the program, especially the choice of the activities for nurses with diverse needs, was challenging, but the CM tool, as well as the reviewed literature and ENA, helped me in the process.

Analysis

Gibbs suggests employing the experience for learning purposes. From the reviewed event, I learned the significance of ENA: this tool is most helpful in customizing educational programs. Similarly, I discovered the positive features of CM, as well as its value for nursing education, and learned to apply it to my practice. Also, I was provided with multiple examples of the positive effects that the collaboration of nurses can have on project development.

Conclusion

Overall, the experience is rather insightful and has had a positive impact on my knowledge, skills, and emotional well-being. Gibbs also suggests considering the aspects that could have been done differently; in my view, I could have included a brief learning style determination element in ENA to be more certain about appropriate activities. The future feedback of the nurses on the sessions should provide me with more extensive information for this part of reflection.

Action plan

In the future, I will always seek to forge working relationships with relevant stakeholders, especially participants and administration, and I will pay great attention to the ENA element of program development.

Conclusion

The present portfolio includes the major elements of the educational program aimed at improving the knowledge, preparedness, and confidence of the twenty-six nurses working at the Emergency Unit of King Saud Medical City in Riyadh concerning ME, CI, and TO. These primary aims have determined the key objectives and content of the program and individual sessions. Apart from that, the content and assessment strategies can be rationalized by other considerations, including ENA results and CM, which proved to be very helpful in guiding the program’s design. Finally, resource and time management were also taken into account along with some additional considerations. Overall, the process of program development has been a positive and insightful experience, which can be partially attributed to the participants’ willingness to collaborate. The lessons learned from this project will be used for future ones.

References

Abolfotouh, M., Salam, M., Mustafa, A., White, D., & Balkhy, H. (2014). A prospective study of incidence and predictors of peripheral intravenous catheter-induced complications. Therapeutics and Clinical Risk Management, 10, 993–1001. Web.

Atif, Y. (2013). Conversational learning integration in technology enhanced classrooms. Computers in Human Behavior, 29(2), 416-423. Web.

Brown, J., & Schmidt, N. (2016). Service–learning in undergraduate nursing education: Where is the reflection? Journal of Professional Nursing, 32(1), 48-53. Web.

Bush, P., Hueckel, R., Robinson, D., Seelinger, T., & Molloy, M. (2015). Cultivating a culture of medication safety in prelicensure nursing students. Nurse Educator, 40(4), 169-173. Web.

CARNA Videos. (2014). Reporting errors [Video file]. Web.

Fairchild, R., Everly, M., Bozarth, L., Bauer, R., Walters, L., Sample, M., & Anderson, L. (2013). A qualitative study of continuing education needs of rural nursing unit staff: The nurse administrator’s perspective. Nurse Education Today, 33(4), 364-369.

Forbes, H., Oprescu, F., Downer, T., Phillips, N., McTier, L., Lord, B., …Visser, I. (2016). Use of videos to support teaching and learning of clinical skills in nursing education: A review. Nurse Education Today, 42, 53-56. Web.

Holland, A., Smith, F., McCrossan, G., Adamson, E., Watt, S., & Penny, K. (2013). Online video in clinical skills education of oral medication administration for undergraduate student nurses: A mixed methods, prospective cohort study. Nurse Education Today, 33(6), 663-670. Web.

Holmberg, J. (2016). Applying a conceptual design framework to study teachers’ use of educational technology. Education and Information Technologies, 22(5), 2333-2349. Web.

Husebø, S., O’Regan, S., & Nestel, D. (2015). Reflective practice and its role in simulation. Clinical Simulation in Nursing, 11(8), 368-375. Web.

Knewstubb, B. (2014). The learning–teaching nexus: Modelling the learning–teaching relationship in higher education. Studies in Higher Education, 41(3), 525-540. Web.

Li, Y., Yu, W., Liu, C., Shieh, S., & Yang, B. (2014). An exploratory study of the relationship between learning styles and academic performance among students in different nursing programs. Contemporary Nurse, 48(2), 229-239. Web.

Lin, S. W., & Lo, L. Y. S. (2015). Mechanisms to motivate knowledge sharing: Integrating the reward systems and social network perspectives. Journal of Knowledge Management, 19(2), 212-235. Web.

Murray, E. (2017). Nursing leadership and management: For patient safety and quality care. Philadelphia, PA: FA Davis.

O’Connell, E., Pegler, J., Lehane, E., Livingstone, V., McCarthy, N., Sahm, L. J.,… Corrigan, M. (2016). Near field communications technology and the potential to reduce medication errors through multidisciplinary application. Mhealth, 2, 29-29. Web.

Öztürk, D., & Dinç, L. (2014). Effect of web-based education on nursing students’ urinary catheterization knowledge and skills. Nurse Education Today, 34(5), 802-808. Web.

Parwanda, G., Rajan, J., Malar, A., Chacko, N., Choudhary, P., & Andrews, S. (2014). Effectiveness of video assisted teaching vs demonstration method on female urinary catheterization in terms of knowledge and practice. International Journal of Nursing Care, 2(1), 13. Web.

Pilcher, J. (2016). Learning needs assessment. Journal for Nurses in Professional Development, 32(4), 185-191. Web.

Rosselli, J., Dennison, R., & Dempsey, A. (2014). Evaluation beyond exams in nursing education: Designing assignments and evaluating with rubrics. New York, NY: Springer Publishing Company.

Şad, S., & Göktaş, Ö. (2013). Preservice teachers’ perceptions about using mobile phones and laptops in education as mobile learning tools. British Journal of Educational Technology, 45(4), 606-618. Web.

Schmidt, N., & Brown, J. (2016). Service learning in undergraduate nursing education: Strategies to facilitate meaningful reflection. Journal of Professional Nursing, 32(2), 100-106. Web.

Stephens, M., & Hennefer, D. (2013). Internationalising the nursing curriculum using a community of inquiry framework and blended learning. Nurse Education in Practice, 13(3), 170-175. Web.

Strudwick, G. (2015). Predicting nurses’ use of healthcare technology using the technology acceptance model. CIN: Computers, Informatics, Nursing, 33(5), 189-198. Web.

Thompson, P. (2013). The digital natives as learners: Technology use patterns and approaches to learning. Computers & Education, 65, 12-33. Web.

Walji, S., Deacon, A., Small, J., & Czerniewicz, L. (2016). Learning through engagement: MOOCs as an emergent form of provision. Distance Education, 37(2), 208-223. Web.

Wallis, M., McGrail, M., Webster, J., Marsh, N., Gowardman, J., Playford, E., & Rickard, C. (2014). Risk factors for peripheral intravenous catheter failure: A multivariate analysis of data from a randomized controlled trial. Infection Control & Hospital Epidemiology, 35(1), 63-68. Web.

The emergency department (ED), sometimes termed the emergency room (ER), emergency ward (EW), accident & emergency (A&E) department or casualty department is a hospital or primary care department that provides initial treatment to patients with a broadspectrum of illnesses and injuries, some of which may be life threatening and requiring immediate attention. Emergency departments developed during the 20th century in response to an increased need for rapid assessment and management of critical illnesses. In some countries, emergency departments have become important entry points for those without other means of access to medical care.

Upon arrival in the ED, people typically undergo a brief triage, or sorting, interview to help determine the nature and severity of their illness. Individuals with serious illnesses are then seen by a physician more rapidly than those with less severe symptoms or injuries. After initial assessment and treatment, patients are either admitted to the hospital, stabilized and transferred to another hospital for various reasons, or discharged.

The staff in emergency departments not only includes doctors, but physician assistants (PAs) and nurses with specialized training in emergency medicine and in house emergency medical technicians, respiratory therapists, radiology technicians, Healthcare Assistants (HCAs), volunteers, and other support staff who all work as a team to treat emergency patients and provide support to anxious family members. The emergency departments of most hospitals operate around the clock, although staffing levels are usually much lower at night. Since a diagnosis must be made by an attending physician, the patient is initially assigned a chief complaint rather than a diagnosis. This is usually a symptom: headache, nausea, loss of consciousness. The chief complaint remains a primary fact until the attending physician makes a diagnosis.

Patients arrive at emergency departments in two main ways: by ambulance or independently. The ambulance crew notifies the hospital beforehand if they are transporting a severely ill patient, and if the patients condition warrants, a physician may direct the ambulance crew to begin treatment while still en route. These patients are rushed to the emergency department’s resuscitation area, where they are met by a team with the expertise to deal with the patients’ conditions. For example, patients with major trauma are seen by a trauma team consisting of emergency physicians and nurses, a surgeon, and an anestheologist.

Patients arriving independently or by ambulance are typically triaged by a nurse with training in emergency medicine. Patients are seen in order of medical urgency, not in order of arrival. Patients are triaged to the resuscitation area, majors area, or minors area. Emergency/Accident and Emergency departments usually have one entrance with a lobby and a waiting room for patients with lessurgent conditions, and another entrance reserved for ambulances.

Medication errors can and do occur in all clinical settings. However, the complexity and fast-paced nature of care provided in the emergency department (ED) enhance the probability of errors occurring. Studies reporting medication errors in the ED setting have typically been limited to only one ED.

Data collected through USP’s two national voluntary medication error-reporting programs -MEDMARX and the Medication Errors Reporting (MER) Program—represent one of the largest reviews of ED errors reported from multiple facilities. (MER is presented in cooperation with the Institute for Safe Medication Practices.) An analysis of medication error records from both MER (1991-June 2003) and MEDMARX (calendar year 2002) uncovered 3,516 records of errors in the ED.

EDs were ranked as the fifth leading location of medication error in calendar year 2002. More than 300 unique facilities collectively reported more than 3,440 medication errors. The majority (94.8%) of errors did not result in patient harm. However, 5.2% did result in various levels of harm, with two fatalities reported.

Improper dose/quantity and prescribing errors (27%/22%) were the most common types of error committed (see Table 1). Performance deficit was cited as the leading cause of error (see Table 2). There were nearly 400 unique products reported, with heparin at 7.6% the most common drug reported in a medication error. Heparin was followed by ceftriaxone (3.0%), insulin (2.9%), meperidine (2.4%), and levofloxacin (2.4%). Patients appeared to receive medications for which they had previously reported allergies.

Medication errors and emergency room statistics reveal that emergency room departments have a greater rate of medication errors than any other facet of health care services. Patients in need of emergency room care are often those with the greatest need for urgent and proper care. The United States Pharmacopeia (USP) released the results of a major study regarding medication errors and emergency room cases in 2003. Since 1998, over 360,000 medication errors occurring in emergency rooms have been reported to the USP database. In 2001 alone, more than 2,000 cases of medication errors and emergency room cases were reported to the agency.

Timing is of the essence in emergency room situations and medications often need to be administered quickly and correctly. This haste, paradoxically, is one of the major causes of medication errors and emergency room departments need to have an efficient protocol in order to avoid these mistakes. The USP found that 23 percent of medication errors in emergency rooms were intercepted before they reached the patient, compared to 39 percent in other areas of hospital service. The combination of great pressures, a high speed and stressful environment, interruptions, and other complications makes medication errors in emergency rooms all the more likely. This fact, however, does not mitigate a patient’s right to receive prompt and appropriate medical care.

In terms of medication errors and emergency room situations, there are many different times at which an error can take place. There are three major types of errors that the USP have identified in the emergency room setting. Prescribing errors involve a physician’s failure to prescribe the correct medication. Omission errors involve a health care professional’s failure to administer a prescribed medication. Improper dosage errors occur when a patient receives the incorrect dose of a medication.

Medication errors can also occur when the wrong medication is administered altogether. Another consideration regarding medication errors and emergency rooms is a patient’s medical history, including current medications and known allergies. If overlooked, these can cause or contribute to medication errors and subsequent injuries. Communication breakdown among medical staff can also result in missed doses or duplicate doses of a medication.

There are steps that consumers can take to reduce the likelihood of medication errors in emergency room situations. Keeping a list of allergies and current medications can help avoid medication errors. Ultimately, it is the responsibility of medical professionals to administer the proper dose of a medication at the appropriate time. When medication errors occur in emergency rooms, they increase a patient’s risk for suffering injury and even death as a result of this medical negligence.

If you or a loved one has been injured as a result of medication errors in a health care setting, you may be eligible to seek compensation for your losses through a medical malpractice lawsuit. For more information on medication errors and emergency room cases, you may wish to contact a well qualified and knowledgeable attorney.

Based on these findings, the following conclusions can be drawn:

1. Nearly 6% of the errors resulted in some form of harm.
2. Distractions were the leading contributing factor to errors.
3. Omission errors were associated with patient deaths.
4. Errors involving improper dose/quantity (wrong dose) were associated more often with harmful outcomes than any other type of error.

References

1. Emily S. Patterson, Richard I. Cook, David D. Woods, Marta L. Render, “Examining the Complexity Behind a Medication Error: Generic Patterns in Communication”. Web.
2. David G. Schulke, “IOM Medication Error Identification and Prevention Study”. Web.
3. John P. Santell, “USP Patient Safety CAPSLink”. Web.
4. Michael R. Cohen, “ISMP Medication Error Report Analysis”. Web.
5. David P. Phillips., Jason R. Jarvinen, and Rosalie R. Phillips, “A Spike in Fatal Medication Errors at the Beginning of Each Month”. Web.

Introduction

Surviving natural disasters is one of the main problems that exist today. Humans have developed a lot of technologies to predict all types of catastrophes, but it is still impossible to avoid them completely. Force majeure situations cause a lot of deaths, and it is crucial to deal with them as effectively as possible. Centers for Disease Control and Prevention website provides information about preparedness in case of natural disasters, and it is also necessary to know about the role medical staff plays during severe conditions.

Role of Public Health Nurses

Natural Disasters and Severe Weather tab gives a list of possible natural disasters and provides some helpful information about this issue. To effectively respond to accidents, it is extremely important to learn more about the reasons for natural disasters and the way the staff makes emergency decisions (Zhou et al., 2017). For example, floods of any size cause tremendous destructions in flash flood prone or landslide prone areas. This catastrophe ruins houses and does not allow moving around in vehicles.

As a public health nurse, not only I have to possess a lot of knowledge about how to quickly help people with their physical traumas, but I should also know how to comfort them psychologically. During natural catastrophes, citizens often are forced to leave their homes, and that might lead to serious stresses as humans “develop bonds to physical places” (Knez et al., 2017, p. 11). Therefore, the preparedness plan for the flood for the Georgian state community will be to make sure the members are aware about this type of natural disaster and its devastating effects as well as the most functional ways to deal with it. Besides, people have to be educated about evacuation strategy and they will need emergency kits, food and water supplies. The key players accountable for the implementation will be the communication channels and also the local government.

Conclusion

To sum up, natural disasters, is a huge concern nowadays. They ruin buildings, destroy lands and property, and they take human lives. However, with a proper well-thought plan and other necessary preparations promoted by a well-trained staff, it is possible to manage the problem and manage to have a minimum loss. Thus, it is crucial to invest in human resources and educate local communities.

References

Knez, I., Butler, A., Ode Sang, Å., Ångman, E., Sarlöv-Herlin, I., & Åkerskog, A. (2017). Before and after a natural disaster: Disruption in emotion component of place-identity and wellbeing. Journal of Environmental Psychology, vol. 55, p. 11–17. doi.org/10.1016/j.jenvp.2017.11.002

Zhou, L., Xu Z., Wu X., & Fujita H. (2017). Emergency decision making for natural disasters: An overview. International Journal of Disaster Risk Reduction, 27, 567-576. doi:10.1016/j.ijdrr.2017.09.037

Evidence-based practice plays an important role in the advancement of medical research because it provides additional knowledge to improve clinical practice. This is why global health agencies and institutions consider it the “gold standard” of care management (World Health Organization, 2018). A critical part of evidence-based practice is the need to identify the most effective interventions that guide treatment decisions (Saenger and Minis, 2017). Particularly, this view is important in identifying appropriate therapies for selected groups of patients because their unique characteristics are relevant in making the right diagnosis and choosing correct treatment options. Therefore, nurses need to make sure that their care plans are based on empirical research (Yonkaitis, 2018). The first step to realise this goal is to appraise evidence-based studies as the main sources of clinical evidence.

This paper is a critical appraisal of a study, which focused on understanding trends of patient deterioration in the emergency department (Hudson et al., 2015). The study was selected for critique because it focuses on pattern recognition, which is an effective preventive strategy in public health management (World Health Organization, 2018). Indeed, early detection and management of deteriorating patients in the emergency department can help healthcare service providers to identify the most appropriate care for a patient. Caldwell, Henshaw and Taylor’s (2005) critique tool will be the overriding framework for this assessment. Its purpose is to ensure a valid and objective assessment of the appraisal. Relevant aspects of the critiquing tool that will be used in this paper include a methodological review and a strength vs. weakness analysis of the selected research article.

The title of the selected paper “Early Identification and Management of the Unstable Adult Patient in the Emergency Department” was detailed enough to provide a clear understanding of the journal’s main contents. The abstract also provided important details relating to the article, including the approach used (quantitative), the target population (deteriorating patients) and the broader aim of the study, which was to standardise an emergency observation chart to allow healthcare service providers to better understand patterns associated with a deteriorating patient in the emergency department. The paper’s title and study focus are consistent with the guidelines of Caldwell, Henshaw and Taylor (2005) on health research, which suggest that the title of an academic paper should concisely and identify the characteristics of a population, interventions used to undertake the research and desired outcomes. The selected study follows this format. The authors also have a lot of experience in the healthcare field, particularly in the areas of critical care, emergency and nursing management (Hudson et al., 2015). Their qualifications and experiences add credibility to the research.

The abstract of the article provides a detailed explanation of the key parts of the paper, including the research aim, background, methods, results and relevance to clinical practice. The use of a structured abstract made it easier to understand its main parts and interpret the findings without having to examine all the contents of the study. To further improve the article’s credibility, the authors explained the justification for using a quantitative approach, processes and techniques to design and conduct the investigation (Hudson et al., 2015). The main findings of the study and their implications on mental health management are also clearly highlighted in the abstract.

The authors also explained the rationale for conducting the study by comparing its findings with existing evidence in the healthcare field. They talked about the vital signs to look out for among deteriorating patients and the possible use of adult emergency flow charts to extract critical health information (Hudson et al., 2015). Their methodology was designed to explain how documentation could be used to identify patterns among deteriorating patients through early warning systems. They used this basis of investigation to explain the usefulness of chart designs in reviewing health data (Hudson et al., 2015). For example, the pieces of information recorded on emergency room charts were essential in understanding the difference between abnormal and normal vital signs for deteriorating patients. In line with this goal, in the literature review section of the study, the authors used relevant theoretical concepts and models to justify their investigations, while using that the aim of the study will guide the overall research process (Hudson et al., 2015). The authors also presented the aim of the paper as a lived experience for healthcare workers caring for unstable patients (Hudson et al., 2015). Their analysis emphasises the need to use quantitative approaches in assessing healthcare problems because statistics helped to identify known patterns of behaviours that represented vital signs in deteriorating patients.

Although conducting a study with non-human subjects attracts fewer ethical implications compared to those that do not use people (Wasilewski et al., 2019; Bunnik, Timmers and Bolt, 2020), the selected study had an ethical analysis despite not using human subjects. The ethical review contained in the article was consistent with standard guidelines used in recruiting human subjects in medical research (Samuel and Buchanan, 2020; Taylor and Pagliari, 2018; Mckenzie et al., 2017). Coupled with additional ethical approval sought from the ethical committee, the selected study sufficiently covered the ethical requirements for conducting a health research.

The quantitative methodological approach used in the study aligned with the research aim, which was to review adult emergency flow charts and identify trends of patient deterioration. Quantitative studies rely on the effective use of statistics to draw inferences about research variables (Nzabonimpa, 2018; Robbins et al., 2018). However, some statistical gaps emerged in the study, such as the lack of abnormal vital signs in some of the patients who visited the emergency department (Hudson et al., 2015). This finding was presented as a limitation of the study. However, it is common for such information to be omitted from secondary research investigations.

Although the omission of selected data was a limitation of the study, pieces of information relating to its design were discussed and their use justifiably explained. Furthermore, general concepts supporting the study were discussed in independent sections of the report (Hudson et al., 2015). The research design was based on an assessment of patient data recorded in the emergency room setting and a justification for its use provided. The medical flow chart information obtained from the emergency department also allowed for the provision of a detailed narrative of patient vital signs that would be assessed to recognise noticeable patterns of behaviour that are critical in understanding trends signifying patient deterioration.

Participants were not directly included in the study but the health outcomes of patients who visited the emergency room were studied instead. Data was obtained through secondary research and it involved the collection of published research information (Hudson et al., 2015). The quantitative research approach was used to collect research data. Its statistical features explains its use in the study because data collection was based on a review of standard operating chart data relating to emergency room visits. The authors ensured the research process was objective by using proven statistical data collection tools, such as the adult emergency department flow chart, with relative success (Hudson et al., 2015). The information recorded on the chart relates to people’s health information, which is ordinarily treated as private data. This analytical tool provides an upgraded technique of collecting medical data because healthcare service professionals used adult admission and discharge forms that were ineffective due to their inability to cover most details relating to a patient’s health.

Data analysis was done using IBM’s Statistical Packages for the Social Sciences (SPSS) because of the reliance on numerical data for analysis. The use of this software in medical research has been explored and found to be effective in the analysis of quantitative data (Fetters and Molina-Azorin, 2017; Topping and Timmins, 2019). Its generalizability explains its use in the selected research. It also provided a basis for developing structured findings due to the use of relevant statistical tools, such as the chi-square method (Molina-Azorin and Fetters, 2019). Its efficacy in this regard is consistent with the nature of quantitative studies.

Understanding the role of a researcher is important in reviewing the merits of medical research. Caldwell, Henshaw and Taylor (2005) mention its importance in both qualitative and quantitative investigations. Its significance has been further mentioned in mixed methods research (Fenge et al., 2019; Datta, 2018). Regardless of the relevance of researchers in interpreting new findings, the authors failed to articulate their role in interpreting their findings (Hudson et al., 2015). This omission was a limitation of their study, but it was not identified as such. Nonetheless, their merits in co-authoring the research project were pegged on their extensive experience in different areas of medical research. Relative to this assertion, it may be assumed that the authors believed that their role in the research could be undermined by their exclusive use of secondary research data to develop the findings because it denied them a direct role in the collection of research data. In this regard, there is a need to make further commentary on the journal to understand the authors’ reflections broadly.

The results of the investigation were presented systematically and with detailed information relating to the participants’ demographic information, the number of abnormal vital signs recorded and time taken from triage to pattern identification. Key sections of the article provided a summary of data gathered from 181 medical records relating to patients’ vital signs that were recorded during the post-implementation audit phase of the research (Hudson et al., 2015). This approach to data collection is justifiable because it is commonly used in reviewing quantitative research data (Hurst, McCallum and Tilles, 2019; Saldaña, 2018; Abbott and Scott, 2019). Particularly, the adult emergency flow chart helped to provide essential information to identify deteriorating patients based on their vital sign performance. This piece of information helped to link statistical data with the research aim, which was to use the adult emergency flow chart to identify trends in deteriorating patients. Tabulating the results helped to know a patient’s vital signs and identify those requiring additional care.

The discussion section of the article provided an overview of the main thematic areas identified in the research process. The researchers helped to contextualise the findings within the wider body of existing literature investigating the treatment of deteriorating patients. The discussion section also contained sufficient references from several contemporary pieces of literature, which have also discussed the research topic. This research approach is consistent with the criteria for analysing health research articles because they should be adequately referenced to understand how present findings compare with those of past researchers (Caldwell, Henshaw and Taylor, 2005). This link was established by identifying the relationship between the findings of the study with the research aim.

The authors provided a synopsis of the main strengths and weaknesses of their investigation as an introspective assessment of their contribution to the research process. This process is a critical part of self-appraising literature (Caldwell, Henshaw and Taylor’s, 2005). For example, the authors commented on the external validity of their findings by explaining that the findings could be limited in geographic use because they sourced data from two metropolitan hospitals (Hudson et al., 2015). Additionally, they recognised the use of a small sample as another limitation of their study (Hudson et al., 2015). This acknowledgement provided a basis for its recommendations, such as the use of a larger sample data to investigate the research topic.

Lastly, the conclusion section of the selected study offered valuable insights regarding the relevance of its findings to clinical practice. Particularly, the authors emphasised the usefulness of the study in the early identification of vital signs for deteriorating patients in the emergency department (Hudson et al., 2015). Consequently, they suggested that the research study would be helpful in identifying and monitoring unstable patients in the emergency department (Hudson et al., 2015). This information may be used to enhance practical measures or guidelines for identifying and treating deteriorating patients. In this regard, the findings are reasonable and realistic, as is expected of evidence-based research articles.

Broadly, the findings of the study adhere to the generally accepted standards of developing a succinct quantitative research paper. Its strengths are in the data collection and analysis process where the use of statistical software was important in reviewing data and linking them to the research aim, which was to use adult emergency department flow chart information to recognise trends among deteriorating patients. However, the limited volume of information collected from the two health facilities sampled made it difficult to extrapolate the findings beyond a small geographical location. This is why it is proposed that future research should use larger samples of data for in-depth analysis. The implications of these findings to medical practice are predicated on the need to urgently address these limitations and extrapolate the findings to a greater scope of research. Therefore, future studies should focus on filling some of the knowledge gaps identified in the selected article.

Reference List

Abbott, L. and Scott, T. (2019) ‘Reflections on researcher departure: closure of prison relationships in ethnographic research’, Nursing Ethics, 26(5), pp. 1424-1441.

Bunnik, E. M., Timmers, M. and Bolt, I. L. (2020) ‘Ethical issues in research and development of epigenome-wide technologies’, Epigenetics Insights, 13(3), pp. 1-10.

Caldwell, K., Henshaw, L. and Taylor, G. (2005) ‘Developing a framework for critiquing health research’, Journal of Health, Social and Environmental Issues, 6(1), pp. 45-54.

Datta, R. (2018) ‘Decolonizing both researcher and research and its effectiveness in Indigenous research’, Research Ethics, 14(2), pp. 1-24.

Fenge, L. A. et al. (2019) ‘The impact of sensitive research on the researcher: preparedness and positionality’, International Journal of Qualitative Methods, 18(3), pp. 1-10.

Fetters, M. D. and Molina-Azorin, J. F. (2017) ‘The journal of mixed methods research starts a new decade: the mixed methods research integration trilogy and its dimensions’, Journal of Mixed Methods Research, 11(3), pp. 291-307.

Hudson, P. et al. (2015) ‘Early identification and management of the unstable adult patient in the emergency department’, Journal of Clinical Nursing, 24(21), pp. 3138-3146.

Hurst, H., McCallum, K. and Tilles, S. (2019) ‘Dialoguing with the silent researcher: rethinking the role of the transcriptionist in qualitative research’, Methodological Innovations, 12(2), pp. 1-10.

Mckenzie, S. K. et al. (2017) ‘Ethical considerations in sensitive suicide research reliant on non-clinical researchers’, Research Ethics, 13(3), pp. 173-183.

Molina-Azorin, J. F. and Fetters, M. D. (2019) ‘Building a better world through mixed methods research’, Journal of Mixed Methods Research, 13(3), pp. 275-281.

Nzabonimpa, J. P. (2018) ‘Quantitizing and qualitizing (im)possibilities in mixed methods research’, Methodological Innovations, 11(2), pp. 1-10.

Robbins, T. et al. (2018) ‘Diabetes and the direct secondary use of electronic health records: using routinely collected and stored data to drive research and understanding’, Digital Health, 4(8), pp. 1-10.

Saenger, S. and Minis, M. A. (2017) ‘Using evidence-based practice and research in political arenas’, British Journal of Occupational Therapy, 80(8), pp. 457-458.

Saldaña, J. (2018) ‘Researcher, analyze thyself’, International Journal of Qualitative Methods, 17(1), pp. 1-10.

Samuel, G. and Buchanan, E. (2020) ‘Guest editorial: ethical issues in social media research’, Journal of Empirical Research on Human Research Ethics, 15(1), pp. 3-11.

Taylor, J. and Pagliari, C. (2018) ‘Mining social media data: how are research sponsors and researchers addressing the ethical challenges?’, Research Ethics, 14(2), pp. 1-39.

Topping, A. and Timmins, F. (2019) ‘Special collection editorial: mixed-methods research’, Journal of Research in Nursing, 24(5), pp. 283-290.

Wasilewski, M. B. et al. (2019) ‘Using Twitter to recruit participants for health research: an example from a caregiving study’, Health Informatics Journal, 25(4), pp. 1485-1497.

World Health Organization. (2018) Mental health atlas 2017. London: World Health Organization.

Yonkaitis, C. F. (2018) ‘Evidence-based practice and school nurse practice: a review of literature’, The Journal of School Nursing, 34(1), pp. 60-67.

Description of the Case

The patient was an 83-year-old gentleman that has been experiencing specific health problems for the past three weeks. This situation was new to him as he is an independent person with no prior history of other medical conditions requiring urgent treatment. The principal symptom of the patient was shortness of breath, which led to the hospital visit. After conducting an X-ray survey, acute pulmonary edema with right-side lower lobe pneumonia was diagnosed. The patient’s state’s principal indicators included a temperature of 38.6, a heart rate of 140 bpm, a blood pressure of 108/56, and a respiratory rate of 33.

Moreover, the elderly man was diagnosed with COVID and blood gas in respiratory acidosis. In accordance with his health condition, he needed to be intubated due to the inability to use the machine for further continuous positive airway pressure (CPAP) therapy. He also needed to inform the doctor in the hospital’s intensive care unit about such circumstances. According to the assessment of medical personnel, the patient was not that distressed and could go to a general ward. With the consideration of all the given conditions, the doctor explained his situation and possible options to him.

Feelings

I managed to influence the outcome for the patient and convinced the doctor to change the initial decision, which was to refuse intubation. As he explained to the elderly man, in the case of the provision of intubation, it would take time to get him off the ventilator. Therefore, the doctor did not consider it appropriate to use intubation. However, there were other facts to examine, and I felt that it would be wrong to exclude specific ethical concerns corresponding to ICN and APHRA codes of ethics. Hence, the effectiveness of multidisciplinary teamwork is conditional upon the correspondence to the mentioned ethical standards.

The patient was puzzled when he was not given enough time to think. The doctor simply stated that he does not want to be on life support. I considered it as a hasty decision and talked to him about the circumstances of the patient’s life who catered for his wife and was quite an independent person (Sabeghi, Nasiri, Zarei, Tabar, & Golbaf, 2017). All in all, I was happy to have been the patient’s advocate.

Evaluation

On reflection, I realized that it is vital for medical personnel to cooperate in terms of making decisions on the care provided for patients. In the case of the elderly patient, I managed to employ the model of closed-loop communication allowing participants to clarify the correspondence of an original message to its interpretation by the recipient (Salik & Ashurst, 2019). According to this approach, the receipt of information by the patient should be verified by the medical personnel so that he could make an informed decision on the preferred option of care provision.

However, from the point of the fact given above, the actions of the doctor can be viewed as unprofessional. He did not give the patient enough time to think or process the received information on further treatment and decided without his consent. It was seen by the reaction of the elderly man who did not understand what the absence of intubation means for him and what harmful consequences it might bring. My suggestion to explain to the patient the meaning of the doctor’s suggestion changed the situation.

Analysis

After deciding on the patient’s intubation, he was admitted to the intensive care unit, and this is a positive outcome considering his condition. The importance of such measures is defined by the possibility that the general ward will not take him on high flow. His medical condition and previous history allowed the medical personnel to choose this type of treatment. In this situation, the correct choice of further care of the patient was possible on the grounds of cooperation between the doctor and me as a registered nurse. My contribution to the success of this experience was the consideration of all of the circumstances of the man’s life as well as the idea to provide him with extensive information on available options and their consequences.

In the context of a hospital, it is vital to ensure effective communication between patients and medical personnel. For this purpose, various verbal communication tools are used, and one of the most suitable options for such cases is known as iSoBAR (Redley, Bucknall, Evans, & Botti, 2016). In the case of the elderly patient, it was critical to ensure its safe transfer to ICU with the provision of sufficient information on his condition and the choices he made being aware of their circumstances. This type of checklist allows medical personnel to facilitate communication between them in terms of patients’ diagnoses and other specificities.

In the case of the wrong decision, it would result in less satisfaction of the person due to the lack of understanding of the provided options. Moreover, such a situation would worsen the communication between him and the medical personnel, which is crucial for further decisions regarding the treatment. It would also impose additional risks due to the absence of intubation when it is needed.

Conclusion

In the process of provision of healthcare services to elderly patients, I have learned about the importance of cooperation when making decisions on the choice of available options with consideration of various circumstances. As a result, I improved my communication skills, which are vital in terms of discussing the issues with other doctors and nurses. They would help me in my future work as a registered nurse in negotiations and multidisciplinary team meetings. This experience allowed me to define my future learning direction. I performed relatively well in the situation requiring the use of communication skills but I need to adopt the models allowing me to develop them.

Action Plan

To enhance my communication skills, I intend to learn the approaches allowing nurses to respond quickly to changes. The next target is to study the practical implementation of such models of behavior as DRSABCD (Colbeck et al., 2018). This model includes the actions in the case of unfamiliar situations, and it would be helpful with such patients with unpredictable outcomes of treatment. Its use is critical for clinical care nurses in emergency departments as they have to be able to timely adjust to any emerging complications.

References

Colbeck, M.A., Maria, S., Eaton, G., Campbell, C., Batt, A.M., & Caffey, M.R. (2018). International examination and synthesis of the primary and secondary surveys in paramedicine. Irish Journal of Paramedicine, 3(2).

Redley, B., Bucknall, T.K., Evans, S., & Botti, M. (2016). Inter-professional clinical handover in post-anaesthetic care units: Tools to improve quality and safety.International Journal for Quality in Health Care, 28(5), 573–579.

Salik, I., & Ashurst, J. V. (2019). Closed loop communication training in medical simulation. [StatPearls].

Sabeghi, H., Nasiri, A., Zarei, M., Tabar, A. K., & Golbaf, D. (2017). Respecting for human dignity in elders caring in perspective of nurses and elderly patients. Medical Ethics Journal, 9(32), 45-70.

Telecare and digital health are an illustration of the new reality where people and doctors can establish communication without changing the location. It is beneficial for enhancing the quality of the provided help and reallocation of human and material resources in order to aid more patients (Clemensen et al., 2017). It is necessary to point out that telemedicine changes the methodology of treatment used by doctors or nurses (David, 2020). It requires establishing trustful relationships with the patient, as there is no opportunity to conduct a survey. The human has to explain to the healthcare worker his or her complaint in an honest and detailed way. The purpose of this paper is to examine the article by Zachrison and others (2020) and evaluate the advantages of telecare on the example of the functioning of emergency departments in the USA.

Emergency departments are associated with the resuscitation and hospital wards. However, it can be observed that death threats may take various forms (Zachrison et al., 2020). For example, a patient may want to commit suicide, and a rapid reaction of the psychotherapist is needed. In this case, telemedicine is the best option as it provides a chance to help a person in an immediate and efficient way without wasting time on transportation. The researchers came to the conclusion that telecare is used in the majority of emergency departments in the USA (Zachrison et al., 2020). Neurology and psychiatry are among the spheres where digital health is the most widespread method of treatment (Zachrison et al., 2020). A multivariable logistic analysis was implemented to make a detailed conclusion based on the numbers and statistics (Zachrison et al., 2020). Telecare is a perspective approach in the sphere of medicine, which is advantageous for organizing an efficient and rapid treatment process.

References

Clemensen, J., Rothmann, M. J., Smith, A. C., Caffery, L. J., & Danbjorg, D. B. (2017). Participatory design methods in telemedicine research. Journal of telemedicine and telecare, 23(9), 780–785. Web.

David, Y. (2020). Telehealth, telemedicine, and telecare. In A. Ladanza (Ed.), Clinical Engineering Handbook (pp. 550-555). Academic Press.

Zachrison, K. S., Boggs, K. M., M Hayden, E., Espinola, J. A., & Camargo, C. A. (2020). A national survey of telemedicine use by US emergency departments. Journal of Telemedicine and Telecare, 26(5), 278–284. Web.

Annotated Bibliography on Pain Management in the Emergency Department

The study by Vlahaki and Milne (2008) seeks to examine pain management in a rural setting. Their study was motivated by the lack of literature that examined poor pain management in rural emergency departments. Using data from the National Ambulatory Care Reporting System of a rural hospital in Ontario, the researchers discovered that pain management in emergency departments of rural hospitals is not as poor as in urban hospitals.

Downey and Zun (2010) conducted a study to identify the relationship between pain management in the emergency department and patient satisfaction. The researchers used several tools, including the Visual Analogue Pain Scale, Brief Pain Inventory, and Medical Interview Satisfaction Scale. A sample of 159 patients took part in the research. The patients were given some type of relief for their pain immediately after they arrived at the ED. The researchers found that pain management is significantly and positively correlated with patient satisfaction.

Pain management can also be improved by establishing a link between the emergency department and community health centers. This is what Staiger, Serlachius, Macfarlane, and Anderson (2010) found in their study. They argued that the major benefit of this type of pain management strategy is that it ensures the continuity of care. Thus, patients leaving the ED do not necessarily have to go back to the ED to obtain further care. The significance of continuous care has also been highlighted by Stupar and Kim (2007). The researchers argue that without continuous care, patients involved in a motor vehicle accident can develop severe pain, which can become fatal. Thus, continuous care and assessment are required.

Many patients think of using medications to manage their pain. Nevertheless, pain can also be effectively managed through physical therapy. This is the strategy that is proposed by Fleming-McDonnell, Czuppon, Deusinger, and Deusinger (2010). The researchers argue that physical therapists should be part of the ED core team of medical personnel. They further state that most pain problems are associated with functional problems, which can best be addressed by physical therapists. In addition to this, physical therapy provides a long-term solution, thus reducing the costs incurred by patients. The use of physical therapy is also supported by Lau, Chow, and Pope (2008).

Lau et al. (2008) made use of the Numeric Pain Rating Scale and the Numeric Global Rating of Change Scale to measure pain and patient satisfaction, respectively. The researchers found that participants in the experimental group (the group that received physiotherapy) were more satisfied with the pain management than the participants in the control group.

Victims of motor vehicle accidents (MVAs) are common in emergency departments. Accidents lead not only to pain but also to muscle spasms which make the pain worse. Thus, many physicians manage the pain using pain relievers in conjunction with muscle relaxants. Based on this, Khwaja, Minnerop, and Singer (2010) wanted to examine the effectiveness of muscle relaxants on pain management. They used a randomized controlled trial in which patients were administered to either the ibuprofen or cyclobenzaprine groups or both. The researchers found that the addition of muscle relaxants has no significant benefit in pain management in the ED.

Poor pain management in the emergency departments is affected by various factors, chief of which is the administrative practice. Thus, improving pain management in ED requires improvements in the department’s administration as well as analgesic practice (Thomas, 2007). In their study, Yanuka, Soffer, and Halpern (2008) proposed a structured intervention to improve the administration of analgesics in an urban ED. The intervention resulted in a 99% increase in the number of patients receiving analgesics and a 50% decline in the time it takes to administer analgesics to patients suffering from pain, thereby leading to improved quality of care and satisfaction among patients. Quality of care and patient satisfaction in the emergency department are also realized when the administration of pain relievers is part of a standardized protocol. This is what Zed, Abu-Laban, Chan, and Harrison (2007) discovered in their study. In the study by Zed et al. (2007), patients were administered propofol through a standardized protocol. This led to a high satisfaction level among the patients and physicians basically because the protocol was considered to be safe and effective in pain management.

Tools Used and Efficacy of the Therapeutic Approaches

The researchers reviewed the above-made use of different tools to measure the variables of the studies. However, I do not believe that the tools used affected the results of the studies in any way. This is because, in the studies that appeared to be similar in the objectives and variables to be measured, the results were similar despite the fact that different tools were used. A good example is a study by Lau et al. (2008) and Downey and Zun (2010). Both of these studies measured the level of satisfaction of patients with pain management but used different tools, yet the results were similar.

Each of the studies reviewed above made a case for the efficacy of the therapeutic approach. This was done by highlighting the effect (either positive or negative) of the therapy on patient outcomes, such as patients’ and physicians’ satisfaction levels, reduced costs, and reduced visits to the emergency department. Besides the study conducted by Khwaja et al. (2010), in which the researchers argued that the use of muscle relaxants has no benefit to pain management, the other studies found their therapeutic approaches to be effective in pain management. Nevertheless, the effectiveness of the therapeutic approaches is affected by many other factors, such as the time taken to provide pain relief and administrative procedures.

Evidence Summary of the Articles

The evidence presented in this paper is based on ten articles generated from an intensive search process. In order to answer the clinical question of this study, some of the articles chosen focus on the use of drugs to relieve pain, while the others focus on other intervention strategies used to manage pain in the emergency department. By including studies that focus on these two different approaches to pain management in ED, it is possible to compare the effectiveness of these two approaches and thereby identify the better alternative. The studies that focus on the use of medications to manage pain in the ED have not-so-promising outcomes in terms of long-term pain management, patient satisfaction, and efficacy of the approach. From the literature review and analysis, it is obvious that pain drugs relieve the pain but only on a temporary basis. Thus patients are forced to make frequent visits to the ED for their pain. On the other hand, the studies that focus on alternative strategies such as physical therapy to manage pain have promising results. It has been observed that physical therapy provides a long-term solution to pain problems, thereby reducing costs incurred by patients and congestion in the emergency department due to reduced visits.

Recommendation of a Nursing Strategy

Based on the evidence presented above, I would recommend a strategy that incorporates pain medications and physical therapy to manage pain in the emergency department. However, the pain medications should only be given upon arrival at the ED to provide immediate relief of the pain. Physical therapy should then be administered to the patients to provide long-term relief of the pain and to eliminate functional problems that come with chronic pain. The strategy should also incorporate improved administrative practices. For instance, more medical personnel should be hired in the emergency department to reduce congestion, waiting times, and queues. The administration of the pain medications should also follow a standardized protocol to ensure the safety and effectiveness of the medications.

Importance of Theoretical Model for Nursing Research

A theoretical model provides guidance to nursing research. It forms the basis upon which researchers formulate their research questions, construct their research design, collect data, analyze data and interpret the data. Without theory to guide the research process, a researcher would produce a study and data that make no sense and which do not add value to the existing knowledge of the practice. A theory can help a researcher to conduct a study that proves whether or not the theory holds in different circumstances. Theory-guided research is thus important in providing evidence-based nursing practice.

Reference List

Downey, V., & Zun, L. (2010). Pain management in the emergency department and its relationship to patient satisfaction. Journal of Emergencies, Trauma and Shock, 3(4), 326-329.

Fleming-McDonnell, D., Czuppon, S., Deusinger, S., Deusinger, R. (2010). Physical therapy in the emergency department: Development of a novel practice venue. Physical Therapy, 90(3), 420-426.

Khwaja, M., Minnerop, M., & Singer, A. (2010). Comparison of ibuprofen, cyclobenzaprine or both in patients with acute cervical strain: a randomized controlled trial. Journal of the Canadian Association of Emergency Physicians, 12(1), 39-44.

Lau, P., Chow, D., & Pope, M. (2008). Early physiotherapy intervention in an accident and emergency department reduces pain and improves satisfaction for patients with low back pain: a randomized trial. The Australian Journal of Physiotherapy, 54(4), 243-249.

Staiger, P., Serlachius, A., Macfarlane, S., & Anderson, S. (2010). Improving the coordination of care for low back pain patients by creating better links between acute and community services. Australian Health Review, 34(2), 139-143.

Stupar, M., & Kim, P. (2007). Delayed-onset post-traumatic headache after a motor vehicle collision: a case report. The Journal of the Canadian Chiropractic Association, 51(2), 83-90.

Thomas, T. (2007). Providing pain relief for patients in the emergency department. Nursing Standard, 22(9), 41-45.

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