Category: Emergency Department

Flanders, S.A., Harrington, L. & Fowler, R.J. (2009). Falls and patient mobility in critical care: Keeping patients and staff safe. Advanced Critical Care, Vol. 20, No. 3, AACN.

• Abstract Critical care and advanced practice nurses have a significant role in the creation of safe passage for patients in the hospitals in the United States
• Methodology This article written by three registered nurses have investigated the prevention of falls, early mobilization of patients in the intensive care unit and the safe handling of patients. They have conducted a review of relevant articles from Medline and CINAHL databases.
• Participants Relevant articles from the Medline and the CINAHL can be considered as the participants
• Data analysis Safety for patients and nurses can be achieved through various ways which include potential fall risk assessment, clinical judgment of nurses and fall prevention strategies like routine orientation of the patient, call light within reach, low beds, adequate lighting, nonskid footwear, assistive devices in getting out of bed, no dangling tubes and coiled drainage bags. Critically ill patients are to be assessed for physical conditions and implications of moving them with equipment attached. Mechanically ventilated patients are not allowed to move from their bed.
• Results. Engineering controls, administrative controls and behavioral controls are required to handle patients safely in hospitals. The nurse’ judgment is another essential factor.
• Nursing education implications Critical care nurses and advanced practice nurses are in a position to prevent falls, mobilize patients safely and engage in safe patient handling activities. They must be imparted training during their education courses and in the course of their work to allow them to keep abreast of the new situations.
• Final thoughts More nursing research needs to be done in this direction. The techniques employed in institutions always have room for improvement.

Helft, P. R., Bledsoe, P.D., Hancock, M. & Wocial, L.D. (2009). Facilitated ethics conversations: A novel program for managing moral distress in bedside nursing staff. JONA’s Healthcare , Law and Ethics, and Regulation, Vol. 11, No. 1, Wolters Kluwer Health/ Lippincott, Williams and Wilkins.

• Abstract Facilitated unit-based ethics conversations are helpful to overcome moral distress, the major problem for bedside nurses. This research reviews the response of participant nurses.
• Methodology A qualitative study is being done with an attendance survey followed by focus group discussions. The nurses’ satisfaction and their experiences with UEBCs, and how their challenges of issues of ethics have been met by the new program are being investigated
• Participants The 100 hospitals where UEBCs were established formed the participants.
• Data analysis The program has not been fully evaluated yet. However some data have been obtained. The nurses are grateful for the UEBCs. Many experiences have been found.
• Training in the programme has helped the nurses to come out and make their opinions. Nurses who complete the survey will be included in the focal group discussions.
• Results Results have not been obtained yet. A focus group study will elicit the more detailed qualitative experiences of nurses with UEBCs in 100 hospitals. The attendance surveys will provide information on the satisfaction of the UBEC program and whether it helped the nurses to resolve challenging ethical issues in clinical practice.
• Nursing Education implications A special curriculum of training is being planned for facilitators for the UEBCs so that the program can be made extensive and more effective.
• Final thoughts The efficient implementation of the UEBC program would be extremely useful for the nurses globally as their day-to-day experiences keep changing and diverse ethical issues are arising for which there are no immediate or theoretical solutions. They need discussion for resolution.

Lopez, D.P. (2009). Acetaminophen poisoning., AJN, Vol. 109, No. 9, Wolters Kluwer Health Retrieved on 15/10/09

Acetaminophen poisoning is an emergency situation which can be fatal if left undiagnosed. The relevance of the issue in present day society increases alarmingly as acetaminophen is an over-the-counter medicine. Lopez, a clinical educator, has written this thought provoking academic article starting with a case study. A theoretical discussion has been done in this academic article. The stages of acetaminophen poisoning and how hepatic toxicity could complicate matters have been highlighted. The significance of missing a diagnosis and the implications in present day society has been conveyed. The effect of education on statistics has been stressed.

Montague, K.N., Blietz, C.M. and Kacher, M. (2009). Ensuring quieter hospital environments. AJN, Vol. 109, No.9, Wolters Kluwer Health.

The ambient noise levels produced by hospital environments lead to adverse effects like stress, fatigue, exhaustion and burnout to the patients and nurses on duty. Hospital sounds emanating from movement of people, equipment, printers, televisions, public address systems and the ventilation system must be lessened by efficient designing of architecture with the collaboration of hospital staff. This article written by a design consultant and his friends has provided strategies for ensuring quieter hospital environments through special design of the architecture along with behavioral and administrative measures.

The WHO guidelines for acceptable noise have been mentioned: sound levels are not to exceed 35dBA during the day and 30 dBA during the night. The details of the furnishings open our eyes to the small changes that one can make to provide the soothing atmosphere for sound sleep and rest which patients and nurses need. The examples of hospitals which have adopted techniques to quieten their hospital environments have been given.

Winkelman,C. (2009). Bed rest in Health and Critical Illness: A body system approach, AACN, Vol. 20, No. 63, p. 224-266.

• Abstract “Bed rest is a common intervention for critically ill adults”. The benefits and adverse effects or the functional outcomes of bed rest have been exhaustively reviewed of patients in the critical care unit from empirical and anecdotal bed rest studies involving those from different hospital units: cardiovascular, pulmonary, skin, nervous system, immune system, gastro-intestinal and skeletal systems. Functional impairment and poor quality of life are assessed by measures of activity tolerance and ability.
• Methodology Review of classic and current studies which describe the consequences of long term immobility and bed rest has been done.
• Participants The bed rest studies that have been selected for the review
• Data analysis Molecular and systemic changes have been related to reduced quality of life in ICU patients. The physiological effects of bed rest of the ill patients have been obtained. The ICU acquired weakness has been associated with increased mortality. Medications worsen the ill effects of bed rest.
• Results: Changes after bed rest can vary from patient to patient. They influence the recovery. Upright positioning, range of motion and walking are considered useful to shorten the hospital stay of ill patients. After extubation, patients must be mobilized. ICU patients have pain, contractures and social isolation from prolonged rest. Rehabilitation is limited by reduced oxygen capacity, sluggish neurovascular reflexes, tachycardia, muscle weakness and fatigability. Upright position must condition the baroreceptors. The period between the bed rest and interventions must be related to the activity tolerance.
• Nursing education implications Nursing care in ICUs and critical care institutions and homes for the aged must be influenced by the information imparted in this research.
• Final thoughts More research needs to be done as patients with prolonged bed rest due to lengthened critical care are prone to the ill effects. Recovery and ambulation will be affected.

Role of major public health personnel

Public health personnel involved in the disaster have varied roles depending on their area of specialization and deployment. The public health inspectors are involved in inspection of food premises and of vendors to ensure that they are licensed and have a valid license to operate; they also inspect the sanitation and hygienic conditions of the food premises, nature and state of the food products being sold e.g. temperature. The director of public health heads this team. The public health environmental specialist took part in the assessment of damage on the environment caused by the sodium hydroxide, tornado and flooding. The public health personnel also took part in immunization activities; they assessed the need for tetanus vaccine and who should actually get the vaccine. They also ensured that the media was kept briefed on the situation hence public also kept informed (University of Minnesota, 2007). The public health nurse roles include community assessment and in this case this was demonstrated in the door to door campaign where PHN assessed the needs of the residents. During this door to door movement, they advised the residents on issues affecting their health that are related to the disaster and also on other issues that they are facing. Part of the assessment was on health needs, food needs. The public health nurse and the public health team participated in health education and health promotion activities. This was clear during the campaigns mobilize residents to boil water for at least five minutes before drinking or using it for domestic purposes. The residents were also educated on safety measures to take so that their health is not put at risk. The CHN also took part in the assessment of damage on roads, houses and environment as a result of the tornado, flooding and the chemical spill (University of Minnesota, 2007).

Chain of Command for community health nurse

The community health nurse works under the public health group that reports to the Medical/Health Branch director who reports to the Operations Chief (OP). The OC reports to the EOC commander.

Resources available to the community health nurse (CHN)

The CHN have several resources available at her disposal to be able to deal with situations outside her level of knowledge, skill, or authority. There was a telephone availed to her for purposes of communicating with other team members to ensure that they are informed on needs and services required that are outside scope of practice. A good example is when she calls the operations team to enquire on availability of shelter. There was also a referral system in which the CHN was able to refer all issues that she could not respond; some issues touched on security and safety, financial needs, the CHN could only refer the individuals to the relevant people. The CHN also had other members of the staff who helped her deal with issues not related to nursing. There were vehicles such as ambulance (not mentioned) as those who needed emergency medical care were transferred to hospital.

Measures taken during emergency encounters

The CHN sought the advice of other team members on what to do. In some instances, the CHN organized for evacuation of the residents to safer grounds/shelter. The nurse also organized for immediate transfer to hospital of those people who needed urgent medical attention. Although not mentioned, the nurse must have offered first aid services and attended to those who needed to be stabilized before transfer to hospital.

Actions to help people interviewed

During the door to door interview and assessment process, the CHN took actions to help people cope with situations after flooding. The CHN assessed the risk posed by the floods on the health and safety of the residents. In cases where the situation was not fit for human stay, the CHN organized for the transfer of the affected people to an area where they could get alternative shelter and those that needed medical care services were transferred to hospitals. The floods cut off transportation and even bridges were wiped off. This meant that there was no food and medicine supplies, the CHN nurse therefore ensured that these people got supplies through contacting the operations chief and the logistics chief who ensured that the supplies wee made available. The nurse also offered advisory services on how to boil water and maintain god sanitation and hygiene to prevent any outbreak of diseases. The CHN offered vital information after assessing conditions of the residential houses that were affected by the flood. Communication is very important in allaying anxiety and this is what the CHN did. This was done to allay anxiety and stress caused by the floods. The nurse gave the residents options so that they could choose what they thought was the best for them, the nurse did not decide for them.

Preparation of other nursing personnel

In order to ensure that other nursing personnel are fully prepared to respond to a similar emergency in which a much larger area is affected, the following have to be done: training on emergency response, this will equip them with necessary and relevant skills on how to respond to emergency of this nature; integration of the nursing personnel with other multidisciplinary team who are involved in emergency response. In any form of training, both nurses and the other personnel should be done together, this will ensure that they work as a team from the word go and not calling for emergency briefing meetings to allocate duties; carrying out of drills, this is where false alarms are raised so that their response is assessed and evaluated periodically, this will also help sharpen their practical skills; the nurses must also be trained on the use of emergency equipments so that they can be ready to perform any duty allocated to them during the emergency; they also need to be trained on communication skills and equipments during emergency situations.

References

University of Minnesota, (2007). Disaster simulation: Disaster in Franklin County.

Accountability is central to patient care for a nurse seeking to be an effective practitioner. The Codes and Standards that have been set forth by the nursing professional body demands that the practitioner be personally accountable for his or her actions, and omissions when handling patients are the basic tenets of accountability. This paper will provide a comparative personal reflection against the set standards of the American Association of Critical-Care Nurses.

Personally, I have a firm in my capabilities as an individual and as a nurse performing the duties expected from me. In the four sections used for evaluation of personal and professional accountability, my score will be reflected in the region that encompasses competent experience and skill. Under the first section titled personal growth and development, which encompass education advancement, continuing education, career planning and annual self-assessment and action plans, I must insist with authority that I on the right path to achieving expert practice. This implies that in the present, I am continuing my education in nursing, and the present activity that I am doing constitute self-assessment, though it is not an annual personal self-assessment.

The second assessment category entails the practices that are crucial to the nursing standards and scope. My experience and conduct are sufficient to earn me a high rating in this area. I have covered enough grounds and strides under the third category of assessment, professional association involvement, within the banner of personal of professional accountability. I have already made an application to the state’s nursing professional body. I have always held that the professional body will provide a crucial link to my transformation into the complete professional, otherwise known as the expert practitioner in this assessment form. On the fourth assessment category on certification, I have belief that I will in the due course of my career development amass enough certification in a specialty that I will consider in the future, otherwise my personal ratings is just on novice experience and skill.

The score on the second phase of assessment will be the full mark that is four out of four, and for the past years I have been in the institution I have learned a lot as a nurse student. I have developed new skills and can score favorably under all the four assessment criteria in this section. The first criterion includes understanding of the role that one is supposed to play in their job. The roles are usually stated in the job description, and the candidate must understand them clearly. As a nurse, I have a good knowledge of all that is needed from me, and this is evidenced from the time I was involved in student practice. During the time, I constantly delivered to the patients’ treatment and care expected from me at the time. A personal score would be full marks on this assessment section. In the future, I want to undertake further commitment and achieve higher accreditation within the discipline of nursing rising to the highest levels of academic development. In fact, I want to commit to a single line of research in the future. Further, I want to achieve a number of certification and professional acknowledgments in nursing.

In any profession, the aim for the top has always been the dream of any professional, and in nursing, the rising to top meaning attaining the level of nurse manager. To attain this level there are several facts that might come into play, and these include being the consummate professional, always acting with confidence, knowledge advancement, honesty, leadership, privacy respect, and have the passion always to seek more knowledge. I will also give the highest rating in this section, as I have full confidence in my pursuit for the best in the future. Under the personal journey skills, my score for each section would be the full marks, and that is a three out of the possible four. The personal journey disciplines in this form are assessment under three criteria, which include shared leadership and council management, action learning, and reflective practice. Honestly, I am on the path to achieving sufficient skills in council management though now I am learning from various mentors on the best way to developing the skills. Equally, I am in the process of developing the exquisite skills in action learning, but through the same said mentors, I will develop sufficient skills in problem-solving techniques. Nonetheless, I have a firm belief that in the present, I have polished my skills on reflective practice, and I can state with confidence that I have a deep knowledge of active practice as a leadership behavior. Finally, under the reflective practice reference behaviors and tenants a personal score shall be the full marks. Holding the truth, appreciating ambiguity, diversity in achieving totality, holding perspectives without judgment, discovery of potential, thirst for more knowledge, knowledge of things in life, nurturing the intellectual and personal self, and the desire to commit to oneself are vital to self-development (American Association of Critical Care Nurses, 2006).

Reference

American Association of Critical Care Nurses. (2006). Introduction to the Nurse Manager Inventory Tool. Web.

The process of disseminating findings and results associated with the intervention in the Emergency Department (ED) of the determined facility should include two stages. The first stage is connected with disseminating the findings to Emergency Department Manager, Nurse Administrator, and the facility’s staff. The second stage is associated with demonstrating the significance of the intervention to the large nursing community while referring to the findings and important positive outcomes.

The first approach to present the results of the project to the stakeholders is in a formal structured report on the project completion and outcomes. The formal report provided to the Emergency Department Manager and Nurse Administrator as supervisors of the project is expected to include the overview of the project steps and summary of the results with the focus on their practical significance. The informal report of the results to the other stakeholders, such as the ED staff participating and assisting in the project, should be based on demonstrating the PowerPoint presentation which overviews the stages of the intervention and presents the results in the form of tables, graphs, and figures in order to support conclusions with the help of the visual material.

When the results of the project are disseminated to the stakeholders involved in the solution implementation, it is necessary to present the findings and discuss the significance of the outcomes in the format that is accessible by the large nursing community. In order to disseminate the project’s findings and accentuate the importance of the outcomes in an appropriate form, it is important to prepare posters for placing them in the community’s clinics and hospitals. This information will be available not only to the nurses but also to the physicians as well as potential patients of the Emergency Department.

In addition to placing posters in the medical facilities of the community, it is also important to focus on publishing the results of the project in different professional or peer-reviewed journals. In this context, it is possible to combine the results of the project with the other interventions’ results that were previously conducted in the ED and related to the research question. Thus, the article on the association between staffing and patient satisfaction in the ED can be written in cooperation with the nursing leaders and researchers in the medical center. Moreover, the results of the project can be provided to the nursing community’s leaders for further use in seminars and conferences. In this case, the preliminary discussion of the results with the leaders of the local nursing community should be organized.

Thus, there are several strategies and methods that can be used in order to publicize the results of the project and accentuate the importance of the outcomes with the focus on the further application of the findings to the nursing practice. In this context, it is important to demonstrate the significance of the proposed approach to resolve the problem of short staffing in association with the patient satisfaction to the main stakeholders and other interested persons.

Introduction

Patient waiting time is a major issue in the provision of healthcare. This is because it affects the quality of care that patients receive in a hospital. The patient waiting time can influence the outcomes of the visit by the patient to the hospital (McHugh, Van Dyke, McClelland, & Moss, 2011). For instance, failure to attend to the patient fast enough can cause the patient’s condition to worsen. In this sense, patient waiting time can influence the outcomes of the treatment process, including patient satisfaction.

Definition of Patient Waiting Time

The term “patient waiting time” carries different meanings in different works depending on usage. Different scholars use it to express different sets of periods that relate to the time it takes patients to access health services. Sinreich and Marmor (2005) distinguished between two types of waiting periods as turnaround time and patient waiting time. In their view, turnaround time was the total time the patient spent in the hospital. On the other hand, patient waiting time referred to the time the patient spent in the waiting areas before accessing health services. The difference in the two periods was that the turnaround time included the period that the patient spent while receiving care. In a study of six major hospitals in Israel, the total patient waiting time as defined by Sinreich and Marmor (2005) constituted 51-63% of total turnaround time.

Roper St. Francis Healthcare (RSFH, 2010) looked at patient waiting time as the time it took to admit a patient after physicians made the decision to admit the patient. Their local terminology for this period was the “door to bed” duration. It referred to the total time it took between the arrival and the admission of a patient (RSFH, 2010). Sullivan (2012) on the other hand used the phrase “wait time” to refer to the duration starting with the arrival of a patient and ending with the time of discharge or admission (p. 2).

The comparison of the use of the term “patient waiting time” makes it clear that the use of the term is contextual. In broad terms, it may refer to any period where a patient is inside the door of the hospital but is still within the reception of the facility. It is possible to look at it as the dormant time spent in hospital, or the total time spent in hospital. Any work that seeks to address the delays in patient waiting time must define the term to clarify the intended meaning. Otherwise, the term is open to interpretation from various scholars.

Sullivan (2012) provided four metrics for measuring patient waiting time in Newfoundland and Labrador. These metrics form a very good set of indicators relating to the main issues for consideration when conducting an analysis of patient waiting time. The metrics include the time it takes to see a doctor after arrival at the hospital and the total time a patient spends in the ED. They also include the percentage of patients who leave without seeing a doctor, and the levels of patient satisfaction in the hospital. Each of them provides information relating to different aspects of the quality of healthcare services in any specified institution.

Ways to Reduce Patient Turnaround Time and Improve Service Quality in Emergency Departments

Summary of Article

This article examined the ways of reducing the time it took to serve patients in emergency departments. The article also explored how this reduction could improve the quality of services offered in emergency departments. The paper arose from the need to find ways of dealing with an increasing number of patients going to emergency departments. The paper was premised on the fact that patient waiting time can be used as a measure of the quality of healthcare provided in a healthcare facility, apart from clinical considerations.

Identification of Main Issues

The main issues raised in the article are as follows. First, the waiting times in hospitals located in the urban areas in Israel were on the rise (Sinreich & Marmor, 2005). Secondly, the authors felt that in order for the services offered by emergency departments to be effective, the services needed to be flexible and efficient (Sinreich & Marmor, 2005). The third issue raised by the researchers was the role that emergency departments were playing was changing. Specifically, the emergency departments were no longer used as a place for triage only. Rather, they were offering life saving services to reduce the risk of losing patients waiting for processing within hospitals.

Analysis of Major Research Variables

The researchers identified process components that contributed towards the time spent in hospital. They were able to identify and list 77 processes (Sinreich & Marmor, 2005). The purpose of this exercise was to find ways of measuring the time it took a patient to go through the processes. The researchers observed that no patient went through all the processes. Rather, the processes that a patient went through depended on the medical course needed to treat the specific patient. For instance, only patients who needed x-rays passed through this process. The data collection method used in the project depended on the measurement of the time that patients spent in each of the process components in the hospital.

Analysis of Research Hypotheses

The research hypotheses for this paper were as follows. First, the researchers felt that there was time lost in the emergency department in hospitals, which ended up lowering the quality of healthcare. The basis for this assertion was that the number of patients visiting emergency departments was on the rise and the speed of service in emergency departments was slow. Secondly, the researchers believed that it was possible to find ways of reducing the time each patient spent in the emergency department.

Analysis of Data Collection Methods

The data collection method used in the research project was a comprehensive time study in six hospitals in Israel (Sinreich & Marmor, 2005). Supervised student teams did the actual data collection at different emergency departments. During the period that the data collection took place, 1700 man-hours went into the data collection exercise.

Analysis of Data Analysis Methods

The method used to analyze the data was straightforward. The researchers used a set of measures to determine the main variables that they needed to quantify. These measures included the “average waiting time before examination by the first physician, and the average duration of examination by the first physician” (Sinreich & Marmor, 2005, p. 102). The researchers developed a comprehensive list of measures based on similar reasoning to determine how much time it took for a patient to access a service and the time the patient spent consuming the service.

Summary of Research Findings and Contributions

The main findings made by this project were as follows. First, the researchers found that the average waiting time for patients comprised 52-63 percent of total patient turnaround time in the emergency department (Santibanez, Chow, French, Puterman, & Tylesley, 2008). The services that contributed the most to wait time were accessing x-ray facilities, waiting for a physician to see a patient for the first time, and the time it took to carry out tests on blood samples.

Reducing Patient Wait Times and Improving Resource Utilization at BCAA’s Ambulatory Care Unit through Simulation

Summary of Article

This article resulted from the work of researchers at the Vancouver center of the British Columbia Cancer Agency (BCAA). The institution provides care for cancer patients. The research project focused on the Ambulatory Care Unit (ACU), which cares for non-hospitalized patients. The research project sought ways of reducing the patient waiting time in the ACU. To do this, the researchers developed a computer simulation model to determine the viable options in reducing the waiting time in the hospital. As a result, the researchers identified ways of reducing the waiting time by 70% and reducing space requirements by 25% (Santibanez, Chow, French, Puterman, & Tylesley, 2008).

Identification of Main Issues

The central concerns of the researchers were whether there was a way to reduce the patient waiting time in the ACU. One of the main issues that the researchers felt contributed to this problem was variable patient volumes. This arose because there was no system of rationalizing the appointments made by the physicians. The result was that there were more patients in the unit than the caregivers could handle, because the patients all arrived at the same time. The second concern for the researchers was that the unit had limited capacity for expansion. This meant that the unit could not increase the staff to take care of the extra patients. The third area of concern for the researchers was the inflexible physical layout of the hospital.

Analysis of Major Research Variables

The three main variables that the researchers used to model the operations of the unit were patient wait time, clinic overtime, and resource utilization (Santibanez, Chow, French, Puterman, & Tylesley, 2008). The patient wait time was the main issue that the researchers wanted to measure. They were trying to understand what leads to long waiting time in the hospital. The clinic overtime in this case referred to the time spent by physicians beyond the allotted working time. The third issue was resource utilization in terms of physical capacity and human resource.

Analysis of Research Hypothesis

The researchers used three propositions in this research project. First, they felt that there was a possibility of reducing patient waiting time by changing the physical layout of the facility. This arose from the observation that the layout made it necessary for patients and caregivers to move around unnecessarily. This led to the wastage of time. Secondly, the researchers felt that there was a possibility of reducing congestion and patient waiting time by adopting better scheduling policies. Finally, the researchers felt that there was an opportunity to reduce patient waiting time by rationalizing the allocation of caregivers to patients.

Analysis of Data Collection Methods

The main methods used to collect data were a comprehensive process and data analysis. The researchers compared the performance of the ACU with other BCAA centers to generate information regarding its performance. This helped them to identify potential areas for improvement. The researchers also collected primary data from the appointment booking system in use in the ACU. This system carried all information regarding the booking of appointments in the ACU. Other important data in the system included “patient volumes by time of the day, day of the week, and month” (Santibanez, Chow, French, Puterman, & Tylesley, 2008).

Analysis of Data Analysis Methods

The main method used for data analysis was by computer simulation models. The researchers developed a series of scenarios based on the data collected in the previous exercises. The researchers tested more than one hundred scenarios. The researchers used the scenarios to analyze issues relating to the operations and the processes of the system such as the time that the clinic opens for business. They also examined the appointment scheduling system, and the resource allocation processes in the ACU.

Summary of Research Findings and Contributions

The researchers found several ways in which the ACU could resolve the issues it was experiencing. First, the ACU should have considered redistribution of clinic workload. This would call for adjustments in the schedules of the physicians. Secondly, the researchers advised that the ACU should find ways of allocating examination rooms more flexibly to make it easy for the available physicians to see patients without having to use their personal workspaces. The researchers also advised the ACU to promote clinic punctuality to eliminate delays caused by late commencement of operations. Finally, the researchers recommended that the ACU should reevaluate its scheduling practices to reduce the number of patients waiting for services in the facility at any time.

The Relationship between Patient’s Perceived Waiting Time and Office-Based Practice Satisfaction

Summary of Article

The article relates to the research findings of a project designed to compare the relationship between waiting time and patient satisfaction in clinics belonging to the Wake Forest University Baptist Medical Center. The researchers were also trying to find the impact of the time spent with caregivers on the satisfaction of the patients. The analysis of the data involved examining the relationship between the levels of satisfaction associated with the time spent waiting for services and the time spent with a caregiver.

Identification of Main Issues

The main issue that was of interest to the researchers was the impact of waiting time on patient satisfaction. The researchers wanted to find out whether the time spent waiting for services had an impact on patient satisfaction at the end of the process. In addition, the researchers sought to find out whether this would affect the patient’s decision to come back to the facility on another visit.

Analysis of Major Research Variables

The main research variables for this project were patient waiting time, and the time spent with the caregiver. The first variable formed the basis for data collection. The researchers needed to know how this variable affected patient satisfaction. The second variable was time spent with caregivers. The researchers measured the impact this variable had on satisfaction. The researchers wanted to cross-reference the two durations to determine whether there was a correlation between the two durations.

Analysis of Research Hypothesis

The hypothesis the researchers used were as follows. First, the researchers expected to find a correlation between patient satisfaction and the waiting time in the hospital before seeing the caregivers. There was sufficient reference to this phenomenon in the literature the researchers reviewed. The researchers also expected to find a correlation between patient satisfaction and the time spent with a caregiver. The third hypothesis made by the researchers was that the overall level of satisfaction of a patient resulted from the correlation of these two variables. In other words, the satisfaction of a patient depended on both the time a patient spent waiting to see a caregiver, and the time spent with the caregiver.

Analysis of Data Collection Methods

The researchers used quantitative data collection methods. The first tool they used was the Consumer Assessment of Health Plans Study (CAHPS) global item, which has a rating scale of 0-10 (Camacho, Anderson, Safrit, Jones, & Hoffmann, 2006). A rating of 10 is given to the best healthcare provider, while the worst healthcare provides is rated zero. The researchers also asked the patients whether they were willing to return or not, based on their experience. This gave the researchers data on whether the patient was willing to return, or whether the patient was not willing to return (Camacho, Anderson, Safrit, Jones, & Hoffmann, 2006).

Analysis of Data Analysis Methods

The researchers used multivariate regression and logistic regression models to predict the three satisfaction ratings (Camacho, Anderson, Safrit, Jones, & Hoffmann, 2006). They made the actual estimates using the General Estimations Equations (GEE) methods (Camacho, Anderson, Safrit, Jones, & Hoffmann, 2006). The researchers also used an exchangeable working correlation matrix to adjust for clustering (Camacho, Anderson, Safrit, Jones, & Hoffmann, 2006).

Summary of Research Findings and Contributions

The main findings made by the researchers were as follows. First, the researchers found that patient satisfaction levels were lower than expected whenever a patient waited more than 20 minutes to see a caregiver and their visit time did not exceed 5 minutes. The researchers also found that the satisfaction level dropped by -0.10 rating points for every 10 minutes of waiting when the time spent with caregivers was more than 5 minutes. Satisfaction dropped by a wider margin (-0.30 rating points) whenever the visit time was less than 5 minutes

References

Camacho, F., Anderson, R., Safrit, A., Jones, A. S., & Hoffmann, P. (2006). The Relationship between Patient’s Perceived WaitingTime and Office-Based Practice Satisfaction. North Carolina Medical Journal , 409-413.

McHugh, M., Van Dyke, K., McClelland, M., & Moss, D. (2011). Improving Patient Flow and Reducing Emergency Department Crowding: A Guide for Hospitals. Rockville, MD: AHRQ.

RSFH. (2010). Quality Improvement Initiatives: Reducing Emergency Room Wait Times. The Consult , pp. 3-7.

Santibanez, P., Chow, V., French, J., Puterman, M., & Tylesley, S. (2008). Reducing Patient Wait Times and Improving Resource Utilization at BCAA’s Abulatory Care Unit through Simulation. Vancouver: Canadian Institute of Health Reseach.

Sinreich, D., & Marmor, Y. (2005). Ways to Reduce Patient Turnaround Time and Improve Service Quality in. Journal of Health Organization and Management , 88-105.

Background

Resuscitation is relatively new “to the world of evidence-based practice” (Moule & Albarran, 2009, p. 2). Unfortunately, it is founded on a limited body of scientific evidence. The existing evidence presents the basis for current best practice. Modern cardiopulmonary resuscitation has remained mainly the same since its introduction. In fact, the resuscitation techniques, CPR in particular, attract much less additional research than other areas of medical services. This tendency results in the lack of actions aimed at modernizing and improving current emergency medical practice. The enhancement of resuscitation procedure has a huge potential for preventing an extensive amount of deaths. Therefore, further research should be encouraged, as considering resuscitation activities those that suggest no improvements or alternatives is the wrong belief that costs millions of lives. Studying the existing evidence of the best resuscitation practices is of vital importance for any healthcare giver eager to provide the best treatment of his/her patients in emergency situations. International collaboration is also of paramount importance for creating the guidelines that can standardize the management approach to cardiac arrests and other life-threatening conditions based on the exchange of experience in saving adults and children (Moule & Albarran, 2009).

The responsibilities of nurses are directly related to eliminating the conditions putting the life and well-being of the patient at risk. Therefore, nurses should know how to deliver appropriate treatment and perform resuscitation procedures. The responsibilities of nurses include performing basic cardiac life support measures and maintaining the appropriate certification. Nurses should have the knowledge of CPR and use it effectively. The continuous refreshing of skills is of vital importance, as the abilities to perform appropriate procedures can become lower to critical levels if not used often. Many researchers suggest the methods of enhancing the appropriate attitudes of nurses to personal protection during resuscitation. Dwyer and Williams (2002) emphasize the essential role of educating nurses about the significance of providing appropriate resuscitation procedures. Makinen, Niemi-Murola, Kaila, and Castren (2009) support this view and consider intensive education able to reduce anxiety among the nurses.

Besides the knowledge about the resuscitation procedures, nurses need to be aware of precautions necessary for protecting them from possible transmission of diseases. Unprotected resuscitation is dangerous, as infections are one of the most important causes of morbidity and mortality related to clinical procedures (Vaz et al., 2010). Therefore, knowledge about appropriate personal protection is required. Pieces of protection equipment include mouthpieces, pocket resuscitation masks with one-way valves and other ventilation devices (Pankhurst & Coulter, 2009). Delivering resuscitation with the help of such equipment presents “a safe alternative” to mouth-to-mouth resuscitation (Pankhurst & Coulter, 2009, p. 85). By using such equipment, the caregiver prevents exposing his/her mouth and nose to the patient’s oral and respiratory fluids. It helps to prevent potential harm caused by the procedure to the caregiver, including being infected.

Certain factors affect the nurses’ compliance with the standards of using personal protection equipment during resuscitation. Nichol et al. (2013) studied such factors and identified availability of appropriate equipment, regular training and fit testing, and “organizational support for worker health and safety” as the main contributors to ensuring personal protection of nurses (p. 8). Ganczak and Szych (2007) also emphasize the importance of providing the availability of appropriate equipment for eliminating the risks of noncompliance with personal protection standards during resuscitation among nurses.

Arab countries are currently investing much money and efforts in improving their health care systems and ensuring the effectiveness of medical services. Personal protection of nurses is one of the issues that are of vital importance for providing the safety and efficacy of medical interventions. Sreedharan, Muttappillymyalil, and Venkatramana (2011) conducted a study aimed at revealing the level of knowledge about standard precautions among nurses in one of the Arab countries. The researchers gained the results that demonstrate that most nurses in the hospital in Ajman, the United Arab Emirates, are aware of standard precautions. However, the level of knowledge about the guidelines and implementations related to these precautions appeared to be lower than the appropriate (Sreedharan, Muttappillymyalil, & Venkatramana, 2011). The findings of this study help to understand the necessity of conducting further research on knowledge about personal protection during resuscitation and launch appropriate training programs.

Medical services in Saudi Arabia are largely funded by the government. The quality of health care in the country has been improved greatly during the last several decades (Almalki, Fitzgerald, & Clark, 2011). Though Saudi Arabia has achieved significant results in modernizing the health care system in a short period, the medical services in the country still need to overcome many challenges, which require the enactment of appropriate laws and policies (Almalki, Fitzgerald, & Clark, 2011). As in any country, nurses comprise a huge sector of the health care system in Saudi Arabia, and, therefore, the use of the protection equipment during resuscitation by nurses belongs to the vital issues that need to be properly assessed and improved if needed.

Critical Literature Review

Search Strategies

A literature search was conducted to explore peer-reviewed publications that provide information about personal protection equipment of nurses in Saudi Arabia. Three major databases were used for literature search, including Google Scholar, CINAHL, and Medline. Such search terms as “personal protection”, “protection equipment”, “resuscitation”, “nurses”, “Saudi Arabia”, and “emergency department” were used. As there is a very limited amount of literature about the research topic, the term “Saudi Arabia” was further substituted with the terms “Middle East” and “worldwide”. The search was limited from the period of 2005 to 2015. Only articles published in the English language were included.

By using the initial criteria, 30 articles providing information related to the research topic were found. The search was condensed, and ten articles were included while twenty articles were not included because they were not relevant to the research aim. The reference lists of the selected articles were hand searched to extend the search. It resulted in 5 more articles to be included in the review process. Overall, 15 articles were selected to be reviewed.

Summary of Reviewed Literature

The literature search has revealed that there is a very limited number of studies investigating the research topic. It is rather difficult to find a study investigating the personal protection of nurses during resuscitation in a major emergency department in Saudi Arabia. However, there are many studies related to the topic. Various studies investigate the specifics of the resuscitation procedures, the risks related to the procedure, and the importance of the usage of personal protection equipment in emergency departments in Saudi Arabia and worldwide.

Al-Turki et al. (2008) investigated knowledge and attitudes towards cardiopulmonary resuscitation among students in one of the universities in Saudi Arabia. This study sheds some light on the specifics of resuscitation in the country, as it shows how well the future specialists are prepared for such type of activities. The researchers conducted a cross-sectional survey among King Saud University Students in Riyadh, Kingdom of Saudi Arabia. The results showed that though attitudes to cardiopulmonary resuscitation (CPR) were positive, the knowledge about the topic was insufficient. The findings of the study demonstrate that more effort should put in the improvement of CPR skills among the potential healthcare givers in Saudi Arabia.

Alanazi (2012) conducted a study aimed at revealing the common problems faced by the members of emergency departments in Saudi Arabia. The investigation was based on the usage of the questionnaire that included eight different commonly experienced barriers. 140 paramedics from three different regions (Jeddah, Riyadh, and Dammam) of Saudi Arabia participated in the research. The results revealed that certain barriers put a threat on the efficiency of emergency interventions. Therefore, the authorities and administration should put more effort in eliminating the defined barriers. Training and education were also suggested as the essential part of the activities aimed at providing positive changes.

Gouda, Al-Jabbary, and Fong (2010) investigated the specifics of delivering resuscitation in Saudi Arabia in cases when the policy addressing patient care at the end of life should be addressed. The researchers emphasized that there is a lack of studies investigating the compliance of physicians in Saudi Arabia with Do Not Resuscitate (DNR) policy. A cohort study of data was conducted at King Abdulaziz Medical City. The results demonstrate that the compliance with the policy is relatively poor and proves the fact that the advance directive is not a common practice in Middle Eastern countries.

Chiang et al. (2008) attempted to evaluate the compliance of the performance of healthcare workers in emergency departments with standard precautions aimed at reducing the risks of being exposed to communicable diseases. The researchers conducted a prospective observational study to check if the workers of emergency departments use personal protection equipment and other methods to protect themselves from contamination. The results of the study demonstrate the suboptimal compliance with basic infection control methods. The findings of the study reflect the positive tendencies in providing the safe environment for primary caregivers worldwide.

Another study aimed at evaluating the effectiveness of strict infection control measures (ICMs) on emergency resuscitation was conducted by Chuang, Leung, Chung, Chang, and Cheng (2007). The researchers provided this retrospective observational study by collecting the appropriate data and analyzing the variables, including demographic data of patients, response time and duration of resuscitation, and results of resuscitation. The results of the study revealed that strict infection control measures implementation plays a role in the increased failure rate in emergency resuscitation. The findings of the study show that delivering an adequate care to patients and providing appropriate protection of healthcare workers while performing emergency resuscitation is very important during the outbreaks of contagious diseases.

Liang, Theodoro, Schuur, and Marschall (2014) managed to study the specifics of preventing infections in emergency departments while delivering care to the patients who have experienced life-threatening conditions. The researchers studied the current methods of preventing transmission of infectious organisms in emergency settings, including, hand hygiene, standard precautions, airborne precautions (usage of personal protection equipment in particular), droplet and contact precautions, and environmental control. The results of the study show that future research is needed to optimize and improve infection prevention in emergency departments. The findings of the study also demonstrate the significance of comprehensive approach to providing the efficient protection from contagious diseases.

Talikowska, Tohira, and Finn (2015) attempted to evaluate the relation between the quality of cardiopulmonary resuscitation and patient survival outcome. The researchers conducted a systematic review and meta-analysis to investigate the topic issue and revealed that the survival after cardiac arrest directly depends on the quality of delivered resuscitation. The findings of the study demonstrate the importance of ensuring the best training and education of all primary caregivers involved in the activities that include the performance of resuscitation.

Clements and Curtis (2012) managed to investigate the state of knowledge about the impact of nursing roles on hospital patient resuscitation. The systematic search and review of the literature helped to find out that nurses contribute significantly to providing positive outcomes of the resuscitation. The conducted analysis of the literature also revealed the lack of appropriate research and the need for further investigation.

Pothitakis, Ekmektzoglou, Piagkou, Karatzas, and Xanthos (2011) conducted a study aimed at investigating the nursing role in monitoring during cardiopulmonary resuscitation. A comprehensive literature review was provided and helped the researchers to reveal the significance of the role of nurses in providing appropriate resuscitation procedure.

Schumacher et al. (2008) investigated the methods of personal respiratory protection while conducting resuscitation of patients contaminated with chemical warfare agents. The researchers conducted a study aimed at testing the efficacy of state-of-the-art respirators during delivering resuscitation. The evaluation of the effectiveness of existing personal protection equipment is of vital importance as medical personnel can become exposed to chemical warfare agents during delivering resuscitation to patients with chemical contamination.

Greenland, Tsui, Goodyear, and Irwin (2007) investigated the possibility of use of personal protection equipment used during resuscitation procedures for tracheal intubation. The researchers found out that the use of appropriate personal protection equipment during tracheal intubation contributes to the safety of healthcare givers. The findings of the research help to understand the possible variations of the usage of the equipment used while conducting resuscitation and its effectiveness for providing the necessary protection of medical specialists during different procedures.

Coia et al. (2013) provided the guidance on the use of respiratory and facial equipment by healthcare workers. The guidance is based on the review of literature and expert consensus. The guidance includes the information about types of respiratory and facial protection equipment, the process of selecting and wearing the equipment, advice on respiratory and facial protection, future research, and evidence gaps. As the experience with outbreaks of respiratory contagious diseases has shown the possible difficulties faced by healthcare workers while using protection equipment, the researchers contribute to improving the situation by providing the extensive amount of efficient and relevant information.

Ehlenbach et al. (2009) investigated the specifics of delivering cardiopulmonary resuscitation to elderly people. The results of the study reveal that survival after in-hospital CPR does not appear to improve during the period from 1992 to 2005. Such findings show that the lack of research on possible improvements of resuscitations techniques leads to the lack of innovations able to save more lives.

Cowan and Haslam (2006) conducted a study aimed at assessing the guidelines on resuscitation. The researchers provided an analysis of recent claims and complaints handled by the Medical Protection Society. They also analyzed the problems reported to the National Patient Safety Agency. Many critical questions were defined during the study, including issues related to the competence of healthcare professionals and the effective usage of appropriate equipment. The study helps to understand the role of health caregivers in providing appropriate resuscitation able to save the life of the patient.

Lippert, Raffay, Georgiou, Steen, and Bossaert (2010) provided an investigation on the ethical issues related to resuscitation decisions reflected in the European resuscitation council guidelines. The researchers analyze the principles that should be considered by every healthcare provider while dealing with the situations suggesting end-of-life decisions.

Research Aim

Research Question

The research aim is to investigate the research problem that can be defined as the specifics of personal protection of nurses during resuscitation in the major emergency department in Saudi Arabia. The research question is whether the level of personal protection of the nurses in Saudi Arabia corresponds to the world standards and whether particular challenges related to the issue can be identified in this region.

Significance

Nurses often face emergency situations that require appropriate knowledge about all specifics of resuscitation procedure. Unfortunately, no studies investigate the specifics of personal protection of nurses during resuscitation in the major emergency department in Saudi Arabia. Many studies focus on the questions related to the topic issue. This research can help to identify the gaps in the literature presenting information about the topic issue and suggest further investigations necessary for determining the potential improvements.

References

Alanazi, A. F. (2012). Emergency medical services in Saudi Arabia: A study on the significance of paramedics and their experiences on barriers as inhibitors of their efficiency.International Journal of Applied and Basic Medical Research, 2(1), 34-37. Web.

Almalki, M., Fitzgerald, G., & Clark, M. (2011). Health care system in Saudi Arabia: An overview. Eastern Mediterranean Health Journal, 17(10), 784-793. Web.

Al-Turki, Y. A., Al-Fraih, Y. S., Jalaly, J. B., Al-Maghlouth, I. A., Al-Rashoudi, F. H., Al-Otaibi, A. F.,…Al-Shaykh, A. S. (2008). Knowledge and attitudes towards cardiopulmonary resuscitation among university students in Riyadh, Saudi Arabia. Saudi Medical Journal, 29(9), 1306-1309. Web.

Chiang, W. -C., Wang, H. -C., Chen, S. -Y., Chen, L. -M., Yao, Y. -C., Wu, G. -H.,…Ma, M. (2008). Lack of compliance with basic infection control measures during cardiopulmonary resuscitation – Are we ready for another epidemic?Resuscitation, 77(3), 356-362. Web.

Chuang, H. –L., Leung, W. –S., Chung, Y. –T., Chang, Y. –T., & Cheng, W. –K. (2007). Impact of enhanced infection control procedures on clinical outcome following resuscitation attempts.Journal of Hospital Infection, 67(3), 258-263. Web.

Clements, A., & Curtis, K. (2012). What is the impact of nursing roles in hospital patient resuscitation? Australasian Emergency Nursing Journal, 15(2), 108-115. Web.

Coia, J. E., Ritchie, L., Adidesh, A., Makinson Booth, C., Bradley, C., Bunyan, D.,…Zuckerman, M. (2013). Guidance on the use of respiratory and facial protection equipment.Journal of Hospital Infection, 85(3), 170-182. Web.

Dwyer, Trudy, and Williams, L. M. (2002). Nurses’ behaviour regarding CPR and the theories of reasoned action and planned behaviour. Resuscitation, 52(1), 85-90.

Ehlenbach, W., Barnato, A., Curtis, J. R., Kreuter, W., Koepsell, T. D., Deyo, R. A., & Stapleton, R. D. (2009). Epidemiologic study of in-hospital cardiopulmonary resuscitation in the elderly. The New England Journal of Medicine, 361(1), 22-31. Web.

Ganczak, M., & Szych, Z. (2007). Surgical nurses and compliance with personal protective equipment. Journal of Hospital Infection, 66(4), 346-351. Web.

Gouda, A., Al-Jabbary, A., Fong, L. (2010). Compliance with DNR policy in a tertiary care center in Saudi Arabia. Intensive Care Medicine, 36(12), 2149-2153. Web.

Greenland, K., Tsui, D., Goodyear, P., & Irwin, M. (2007). Personal protection equipment for biological hazards: Does it affect tracheal intubation performance?Resuscitation, 74(1), 119-126. Web.

Haslam, J. C. J. (2006). Resuscitation: turning guidelines into practice. Clinical Governance: An International Journal, 11(2), 160-165. Web.

Liang, S. Y., Theodoro, D. L., Schuur, J. D., & Marschall, J. (2014). Infection prevention in the emergency department. Annals of Emergency Medicine, 64(3), 299-313. Web.

Lippert, F. K., Raffay, V., Georgiou, M., Steen, P. A., & Bossaert, L. (2010). European Resuscitation Council guidelines for resuscitation 2010 Section 10. The ethics of resuscitation and end-of-life decisions. Resuscitation, 81(10), 1445-1451. Web.

Makinen, M., Niemi-Murola, L., Kaila, M., & Castren, M. (2009). Nurses’ attitudes towards resuscitation and national resuscitation guidelines – Nurses hesitate to start CPR-D. Resuscitation, 80(12), 1399-1404. Web.

Moule, P., & Albarran, J. W. (2009). Practical resuscitation for healthcare professionals. Oxford, United Kingdom: John Wiley & Sons, Ltd.

Nichol, K., McGeer, A., Bigelow, P., O’Brien-Pallas, L., Scott, J., Holness, D. L. (2013). Behind the mask: Determinants of nurse’s adherence to facial protective equipment. American Journal of Infection Control, 41(1), 8-13. Web.

Pankhurst, C., & Coulter, W. (2009). Basic guide to infection prevention and control in dentistry. Oxford, United Kingdom: John Wiley & Sons, Ltd.

Pothitakis, C., Ekmektzoglou, K. A., Piagkou, M., Karatzas, T., & Xanthos, T. (2011). Nursing role in monitoring during cardiopulmonary resuscitation and in the peri-arrest period: A review. Heart & Lung: The Journal of Acute and Critical Care, 40(6), 530-544. Web.

Schumacher, J., Runte, J., Brinker, A., Prior, K., Heringlake, M., & Eichler, W. (2008). Respiratory protection during high-fidelity simulated resuscitation of casualties contaminated with chemical warfare agents. Journal of the Association of Anaesthetists of Great Britain and Ireland, 63, 593-598. Web.

Sreedharan, J., Muttappillymyalil, J., & Venkatramana, M. (2011). Knowledge about standard precautions among university hospital nurses in the United Arab Emirates. Eastern Mediterranean Health Journal, 17(4), 331-334. Web.

Talikowska, M., Tohira, H., & Finn, J. (2015). Cardiopulmonary resuscitation quality and patient survival outcome in cardiac arrest: A systematic review and meta-analysis. Resuscitation, 96, 66-77. Web.

Vaz, K., McGrowder, D., Alexander-Lindo, R., Gordon, L., Brown, P., & Irving, R. (2010). Knowledge, awareness and compliance with universal precautions among health care workers at the University Hospital of the West Indies, Jamaica. The International Journal of Occupational and Environmental Medicine, 1(4), 171-181. Web.

Introduction

Hospitals have emergency departments (ED) for the specific purpose of providing medical care to patients who come to the facility without prior appointment. In most cases, the patients are brought in with conditions that require immediate attention from the medical staff. To this end, EDs are required to provide initial treatment to illnesses and injuries that may be life threatening (Quin 2000, p. 404). Operations in EDs go on for 24 hours, except in cases where patients and staff volumes are low. In the current paper, the author examines the process of care at the ED for patients presenting with chest pains. The study relies on data from a general hospital with a bed capacity of 100.

Care in an ED is provided though an 8 step process. To this end, practitioners are advised to make use of a time flow sheet in the assessment of cases presented to hospitals for primary care. Table 1 is an ideal time flow chart:

Table 1: Time Flow Chart

The patient flow table illustrates all the procedures carried out on a patient. As already mentioned, the author of this paper will examine the care provided to patients who are presented to the ED with chest pains. The first step involves registration. Particulars of the patient, such as their age and gender, are recorded. From here, the client is taken through the triage. According to Carson, Clay, and Stern (2010, p. 17), a triage is the immediate sorting of patients according to the seriousness of their condition. The other steps include placement on a bed as the patient awaits a doctor’s visit.

A series of tests, which include ECG, blood analysis, and x-rays, are carried out. Once the shift ends, an assessment of the patient is made (Carson et al. 2010, p. 18). Consequently, a decision to admit or discharge the client is arrived at based on the outcome of the shift assessment. A time-flow sheet is used to develop an ideal map of the process involved to provide care to patients. Consequently, issues like throughput time, value added time, and non-value added time can be calculated from the time-flow charts.

In this paper, a sample of 9 patients was obtained from the ED of the general hospital. The time metrics for each patient are illustrated in the paper, together with a map of the process of care. The data is used to establish points of delay within the primary care process. According to Carter et al. (2010, p. 22), once the points of delay are identified, it is possible to improve the process. To this end, the report provides an ideal future state value stream map for care at the ED.

Literature review

Overview of Chest Pain Treatment in Emergency Departments

Emergency departments are overwhelmed with incidences of people presenting serious conditions for treatment. A study by Quin (2001, p. 406) illustrates that many patients who come to EDs complain of chest pains. Quin (2001, p. 406) makes reference to the United States where chest pains make up for approximately 6% of attendance at EDs. The pain is associated with a number of conditions. One of them is acute coronary ailment. To this end, the process of care in such cases should ensure that triage identifies the patients with an acute coronary syndrome.

Effective treatment of an acute coronary syndrome depends on early diagnosis. The report by Carter et al. (2010, p. 32) indicates that patient care for individuals with chest pains suffers a setback when it comes to the discharge process. Carter et al. (2010, p. 32) suggest that premature discharge of such patients may result in fatalities. Negligence on the part of the doctor can impact heavily on their career. Consequently, time-flow sheets provide an ideal procedure for patient care at the ED.

The diagnosis of chest pain related illnesses is largely dependent on the mode of testing carried out on a patient. Quin (2000, p. 404) observes that the problem with emergency assessment patients is the limitations of diagnostic tests for acute or chronic related pains. For instance, electrocardiography (ECG) is used in the diagnosis of acute myocardial infarction. The study by Quin (2000, p. 404) found that only 40% to 65% of patients make use of the ECG. The diagnosis is even less useful among patients with unstable angina. Serum markers for myocardial necrosis can diagnose approximately 66% of patients with acute myocardial infarction on their arrival at the ED. The above are some of the diagnostic difficulties faced by physicians, which may result in misdiagnosis. ED physicians have a low capacity for taking in patients presenting with chest pains. The situation is especially critical when diagnosis is inconclusive.

The argument by Quin (2000, p. 403) illustrates the challenges faced by medical practitioners in EDs. Chest pains require complex testing procedures. Unfortunately, not many hospitals have the necessary equipment required for diagnosis of chest related ailments. Quin (2000, p. 404) points out that the success rate of diagnosis is usually around 63% in most EDs in the US. Nevertheless, the traditional approach to diagnosis for chest pains is expensive. In addition, it takes time to ascertain one’s exact ailment.

The challenges associated with the diagnosis of patients with chest pains create the need to examine ED units meant to cater for such cases. The process is evaluated to ensure that patients are provided with quality medical care (Carson et al. 2010, p, 41). The review of literature focuses on patients presented to the ED with symptoms associated with acute coronary syndrome. In the United States, the first unit for chest evaluation was established in 1981. According to Quin (2000, p. 405), chest pain care in EDs evaluates clinical effectiveness and proper patient care management in hospitals.

The degrees of pain are illustrated in the definition provided by Conway and Higgins (2011). The various terms are defined below:

Acute pain

It is pain that occurs suddenly, but which does not last for long. It is associated with a specific event, injury, or illness. Acute pain can be managed at an individual level when patients acquire over-the-counter medication. It can be a recurrent problem with pain episodes interspersed with pain-free periods.

Chronic pain

It is defined as long lasting discomfort. The pain can last for more than 6 months. In most cases, chronic pain is difficult to treat. It can be managed for many patients, but cure may be unlikely. Chronic pain can affect every aspect of a person‘s life with respect to their ability to work and perform common tasks. Persons with this discomfort find it difficult to maintain friendships and family relationships. ED helps to restore such patients to their normal routine.

Conway and Higgins (2011, p. 11) argue that patient care in the ED is dependent on the ability of the professionals to distinguish between the two types of pain.

Patient Management at Emergency Departments

Literature review on patient management with respect to chest pain evaluates the approach undertaken. The study by Quin (2000, p. 405) identifies 8 peer reviewed articles that discuss patient management in EDs. According to Quin (2000, p. 405), chest pain units should be located within the ED or somewhere close. Medical employees in such facilities focus on establishing risk levels depending on the nature of the chest pain. For instance, Quin (2000, p. 405) points out that non-traumatic chest pains pose a low risk with respect to acute myocardial infarction.

Medical practitioners face a huge task of identifying the exact illness relating to chest pains. The study by Quin (2000) points out that an effective diagnosis relies on an appropriate testing and triage procedures. The triage phase relies on the patient’s history, while the testing stage requires effective equipment. Quin (2000, p. 405) argues that the Goldman algorithm is the appropriate tool to use in triage. The algorithm is a validated tool that separates patients with chest pain into groups with differing degrees of discomfort. The separation is dependent on the history, examination, and ECG findings.

Effective patient management requires adherence to the protocols of ED. Carson et al. (2010, p. 77) recommend the use of time-flow sheets. The step-by-step procedure enhances the testing processes. As illustrated in Table 1, the time flow sheet exhausts all possible testing avenues before a diagnosis can be established. Patient management at an ED with respect to chest pains is dependent on strict adherence to the procedures illustrated in the time flow sheet.

The Process of Care for Chest Pains at EDs

Emergency workers deal with a number of situations. Chest pain is one of the most common chronic conditions presented to them. In this regard, studies have been carried out to evaluate the best techniques of an effective chronic care. For instance, the study by Conway and Higgins (2011, p. 98) found that there are special strategies aimed at providing chronic care at emergency departments. The primary objective of this care is to avert progression of complications associated with the chronic disease suspected.

The procedures recommended for application in an ED environment are meant to maximize the wellbeing and quality of life of the patient. According to Conway and Higgins (2011, p. 88), the care given to patients at an ED is sufficient to warrant a discharge. Consequently, effective patient care at the ED helps to decongest wards by avoiding unnecessary admissions. The arguments raised by scholars seek to evaluate the process of patient care to understand the models that can be applied.

The process of care in an ED environment is understood by elaborating all the requirements. In this regard, a suitable study evaluates the following questions, which are commonly raised:

1. What are some of the models of care for pain management that have been implemented and evaluated for their effectiveness in the ED settings?
2. How are hospital in-patient, ED, and out-patient pain services tailored to address chest pains?
3. Which models of care produce positive outcomes at individual and hospital levels?
4. Which models of care have no evidence of a positive outcome?

Existing studies on the subject demonstrate a strong conceptual commitment to the bio-psychosocial model of pain. Consequently, time flow sheets are developed to provide the necessary treatment strategies, which can be implemented to address increasing cases of chest pain in EDs (Conway & Higgins 2011, p. 4). The bio-psychosocial approach is the most recommended model of care for patients who come to the ED with chest pains. The model focuses on individual outcomes. However, Conway and Higgins (2011, p. 4) suggest that most ED members of staff are unfamiliar with this form of pain management. Such a review supports the need for a step-by-step procedure of care. Figure 1 is an illustration of an ideal model that can be used when carrying out patient care at an ED.

Patient registration

Patient care begins with the registration of clients upon entry into the ED. In this phase, particulars of the patient are recorded. According to Quin (2000, p. 405), the registration involves gathering information about the age, gender, occupation, and insurance details of the patient. The major objective of this phase is to place the patient in the hospital’s system for treatment and subsequent billing.

Triage

As already mentioned, triage is the process through which patients are sorted based on the degree of seriousness their conditions present. Carson et al. (2010) argue that “the terms ‘triage’ and ‘see and treat’’ are used confusingly” (p. 16). Patient care at ED views the two definitions in a unique manner. They are believed to be mutually exclusive. Triage can be carried out by any medical practitioner. However, the ‘see and treat’ process is a procedure carried out by a doctor. Triage evaluates the need for urgency in the provision of treatment to the patient.

There are different types of triages normally applied in an ED setting. According to Quin (2000, p. 404), the following are the main types of triages in the medical field:

1. Simple triage
2. Reverse triage
3. Undertriage
4. Continuous integrated triage
5. Advanced triage.

When it comes to the ED setting, some of these triages appear to work best. According to Conway and Higgins (2011, p. 13), an advanced triage is essential in EDs. It ensures that the necessary resources are availed for the patients who need them the most. To this end, the triage phase informs the actual treatment procedure to be administered to a patient.

Stabilization of pain

The pain endured by a patient with chest complications brings about unease to their bodies. In this regard, it is advisable to contain the pain presented by the clients. The stabilization of discomfort helps the patient to endure the remaining procedures without major complaints (Carson et al. 2010, p. 18). Consequently, pain killers are administered to the patient depending on their degree of pain.

Doctor consultation

Patients are required to give an account of their general feeling to the doctor. The symptoms experienced are pointed out. In this regard, the clients are advised to be as honest as possible. According to Conway and Higgins (2011, p. 17), consultation with a doctor is the starting point in ascertaining the actual diagnosis. The doctor will propose an ideal testing and treatment plan.

Comprehensive testing and results

Diagnosis of chest related conditions requires blood and x-ray testing. In this regard, requests are made to the laboratory and radiology departments to book the patient for testing. Consequently, the client undergoes a number of examinations in the respective areas. The results are then presented to practitioners for analysis and eventual diagnosis.

Shift assessment

Emergency departments have three main shifts. The morning, afternoon, and evening shifts are manned by different medical staff. According to Conway and Higgins (2011, p. 18), each shift has a medical staffer on call. The staffer makes an assessment of the results and the condition of the patient. Consequently, a decision for admission or discharge is made.

Patient Care at an Emergency Department

Overview

The previous discussions provide an insight into the process of care at an emergency department. However, a more practical approach is essential in establishing the entire process of care for patients with chest pains. In this regard, a study of 9 patients was carried to provide data for these purposes. The study aims to illustrate how time flow sheets for patients can be developed.

The ED caters for patients who require urgent medical assistance. According to Quin (2000, p. 404), patients are required to spend a maximum of three hours in the ED. Consequently, the procedures involved in the provision of care are required to take the least time possible.

The study comes up with a time metric for each patient. According to Quin (2000, p. 404), the process of patient care at the ED requires an evaluation of time metrics. A comprehensive evaluation of these concepts allows the medics to come up with an ideal mapping of the processes of care. The study illustrates instances of delay and how best to avoid them. By the end of the process, the author seeks to come up with an ideal state value stream map. The recommendations will greatly improve the process of care at various emergency departments around the world.

Time Flow Sheet

Time flow sheets illustrate the process of care in an emergency unit. Table 1 is a depiction of an ideal time flow chart. In this study, these flow sheets were prepared for a total of 9 patients. The study was carried out on all three shifts at the hospital. To this end, 3 patients were randomly selected from each shift. Tables 2 to 10 are representations of time flow sheets for the respective patients:

Morning shift

Table 2: Time flow chart for patient #1

Table 3: Time flow chart for patient #2

Table 4: Time flow chart for patient #3

Afternoon shift

Table 5: Time flow chart for patient #4

Table 6: Time flow chart for patient #5

Table 7: Time flow chart for patient #6

Evening shift

Table 8: Time flow chart for patient #7

Table 9: Time flow chart for patient #8

Table 10: Time flow chart for patient #9

As previously mentioned, the recommended duration of stay at the ED should not exceed 3 hours. The following is an analysis of the time metric for each of the patients in this study:

Morning shift:

• Patient 1: Time metric = 0713hrs to 0921hrs = 2 hrs 8minutes
• Patient 2: Time metric = 0923hrs to 1121hrs = 2 hrs 8 minutes
• Patient 3: Time metric = 1013hrs to 1219hrs = 2 hrs 6 minutes

Afternoon shift:

• Patient 4: Time metric = 1223hrs to 1414hrs = 1 hr 51 minutes
• Patient 5: Time metric = 1313hrs to 1509hrs = 1 hr 56 minutes
• Patient 6: Time metric = 1423hrs to 1600hrs = 1 hr 47 minutes

Evening shift:

• Patient 7: Time metric = 1651hrs to 1818hrs = 1 hr 27 minutes
• Patient 8: Time metric = 1659hrs to 1821hrs = 1 hr 22 minutes
• Patient 9: Time metric = 1713hrs to 2028hrs = 3hrs 15 minutes

The average time metric = total time metrics ÷ number of patients = 18 hrs ÷ 9 = 2 hrs

Current State Value Stream Map

Steps of the process

Figure 2 above is a representation of the current state value stream map (CSVSM). A study carried out by Conway and Higgins (2010) points out that the quality of a value stream can be improved by using a structured approach. The CSVSM is given a structure based on seven main tiers. Most CSVSMs are developed on the basis of the contemporary mapping procedure illustrated in figure 1. To this end, an ideal CSVSM is required to have the following steps:

1. Registration
2. Triage
3. Doctor’s Assessment
4. Diagnosis
5. Admission or Discharge

An analysis of the CSVSM illustrated in figure 2 reveals that there were some additional steps, which were included to make the process conclusive. The following is a sequential analysis of the CSVSM above:

1. Registration– The patient’s particulars are recorded. Details touching on insurance and biometrics are noted down.
2. Triage: At this stage, the client’s historical background is mapped out. The ED has three main categories into which the patients are clustered. The patients are sorted out based on the degree of their chest pains and the urgency for medical care
3. Categories of patients – The triage sorts out the patients into three categories. First, there are those with the most severe pain, followed by those who require multiple testing. The map provides care for patients with chest pains who do not require testing. In this regard, the ED takes into account the element of pain as discussed in the context of patient care.
4. Care Units – The patients with ‘the most’ severe pain are placed in the critical care unit. The clients who require multiple testing can be placed in either the critical or the intermediate care unit depending on their age. The elderly are placed in the former, while the young ones are placed in the latter. The patients who do not require testing are placed in the alternate care.
5. Doctor’s assessment: Doctors assess the patients in the respective care units and make recommendations with regards to the need for a diagnostic testing. Patients who do not require diagnostic testing are discharged. However, those who require testing are transferred to the diagnostic testing station. In this station, blood samples, scans, and X-rays are used to establish a concrete diagnosis. Consequently, an ideal treatment regimen is prescribed.
6. Exit from the Emergency Department – the patients are allowed to leave the ED upon after prescription. In this regard, the admission or discharge of a patient is dependent on their mode of treatment.

Average throughput time

The average throughput time helps in establishing the efficacy of patient care in an ED. According to Leslie (2009, p. 104), throughput time is one of the factors associated with ED environments. It is associated with the length of stay at a given hospital. According to Leslie (2009, p. 106), a number of studies have been carried out with a specific focus on the correlation between throughput time and ED factors. The arguments raised in these investigations indicate that the ED length of stay (LOS) increases substantially with a corresponding rise in admissions and ambulance arrivals.

Some studies found that daily mean LOS can increase as a result of elective surgical admission. Leslie (2009, p. 106) opines that some studies fail to provide a significant correlation between throughput time and hours of nursing coverage. In this regard, a computer simulation study of ED operations is needed to point out the relationship between throughput and laboratory service times. Leslie (2009, p. 106) points out that the relationship is inverse with respect to the number of medical staff at an ED facility.

From the observations made by Leslie (2009), it is evident that throughput time has a direct impact on ED patient care. The effect is realized as a result of the time taken to go through the various steps in a given CSVSM. To this end, an effective evaluation of throughput time must take into account the workforce and duration taken in the diagnosis phase. Leslie (2009, p.108) supports this perspective based on a comprehensive review of the literature. The literature review illustrates that techniques used to improve ED efficiency help in decreasing LOS.

The relationship between ED efficiency and LOS is brought about by environmental, demographic, and institutional variations. According to Leslie (2009, p. 108), there are significant differences between teaching and non-teaching, small community and large university, trauma and non-trauma centers, as well as large-volume and small-volume hospitals. The variations make it hard to come with a comprehensive indication of specific techniques. Leslie (2009, p. 108) argues that in some studies, the conclusions are not intuitive or widely accepted. For instance, one of the studies found that residents had a slower patient throughput compared to medical students. Unfortunately, there are no studies that provide a comprehensive comparison of ED establishments for all medical students involved.

The throughput process is dependent on the number of practitioners in an ED and their levels of skills. For instance, if there are experienced members of staff, the time taken in the various steps is reduced. Consequently, the throughput time is smaller. However, in cases where the staff members are few and inexperienced the time is extended through delays.

According to figure 2, the throughput time, non-value added time, and value added time for the CSVSM is calculated as follows:

Table 11: Time metrics for CSVSM

Points of Delay

The process of care in an emergency department is required to take the least time possible. Tables 2 to 10 illustrate a huge time spent in the diagnosis phase. It is noted that this stage is more time consuming compared to the rest. One of the reasons could be that the facility has slow machines. On the other hand, the personnel involved might have challenges in performing their tasks (Quin 2000, p. 406) Consequently delays are bound to arise. In this regard, Conway and Higgins (2011) observe that the staffing profile of an ED is dependent on the nature of the service provided.

I cases where tertiary chronic pain services are provided, the personnel include medical staff, clinical psychologists, physiotherapists, and nursing staff. Quin (2000, p. 406) argues that staffers in such establishments are required to have specialist knowledge and experience in pain management. Occupational therapists, pharmacists and psychiatrists can also constitute a pain unit ED. Notwithstanding the staff profile, close working relationships with other services that enable the effective management of pain related cases in an ED. There is also a need to ensure that an ED has enough administrative employees, who can support effective clinical service.

The argument made by Conway and Higgins (2011, p. 6) creates the impression that delays would be reduced in cases where EDs are adequately staffed. Synergy among all the members of staff helps to realize a swift improvement of the patient care process. Consequently delays would be greatly reduced. An elaborate analysis of the points of delay can be observed through the CSVSM in figure 2. The map has several redundant steps. For instance, the registration and triage can be merged to form one step. The roles of these two steps are complementary and can be carried out by the same medical practitioners (Leslie 2009, p. 105)

Future State Value Stream Map

The development of a future state value stream map (FSVSM) involves making proposals for change in the CSVSM. In this regard a number of recommendations, with respect to patient care, are necessary. The recommendations will help come up with a suitable FSVM which can be used a model for providing quality care to patients with chest pains at any ED.

Recommendations for a model of patient care at the emergency department

As already mentioned, chest pain is increasingly becoming a chronic disease. Medical practitioners are required to adhere to the laid down procedure with respect to the provision of care to patients with chronic conditions. The report by Conway and Higgins (2011, p. 52) cites the following as some of the strategies required in the provision of care to

1. preventing the onset of chronic disease for individuals and population groups
2. A reduction in the progression and complications of chronic diseases
3. Maximizing the well being and quality of a patient’s life
4. reducing avoidable admissions and health care procedures through the implementation of best practice in prevention, detection and management
5. Enhancing the capacity of the health workforce to meet population demand for chronic disease prevention and care into the future (Conway and Higgins 2011, p. 52).

Proposed FSVSM

The FSVSM is developed from the recommendations made above and the illustration in figure one. Figure 3 illustrates the changes to the map in figure 2. Several steps have been merged to come up with a short and efficient process of care.

As illustrated in figure three, there is a huge point of departure from the CSVSM in figure two. Quin (2000, p. 405) points out that delays in the ED contribute to poor quality of patient care. In this regard, several steps have been merged to reduce an extended period of stay within the ED. The triage is merged with the registration to reduce work duplication by the nurses at the facility. The care unit provides the temporary bed in which the patients will be examined. Based on the general nature of the conditions under examination, all the patients are recommended for a diagnosis once the doctor has made the necessary assessment. Consequently, treatment is provided.

According to Carson et al. (2010, p. 44), patients are referred to the emergency department and are forced to undergo a second triage. The clinician carries out this triage to identify the urgency in which a patient requires medical attention. However, in patient care in an ED requires the patients to be observed in a sequential manner. In this regard, waiting times in such a facility is not required to 20 minutes.

An ideal emergency department has both administrative and medical staff at the reception. In this regard, the patient route is dependent on the type of receptionist to whom a patient interacts with first. In the event that a patient is taken to an emergency department receptionist then they are forced to go though the emergency department ‘triage’. However, if it was the primary care receptionist then they went to primary care ‘see and treat’’. The two receptionists can provide for an ideal mapping since they will have the opportunity to provide a suitable plan of action for the patients (Carson et al. 2011, P. 45).

The proposed FSVSM takes into account the inefficiencies alluded to by Carson et al. (2011, p. 44) above. The proposed map provides for six main steps which would reduce the time taken to 1 hour as opposed to the time illustrated in the current study. The average time metric was found to be 2 hours. The calculations in section 1 illustrate that there were serious delays due to procedural matters.

General hospitals are characterized with emergency departments meant to deal with incidences that require urgent medical attention. The current paper has illustrated the particulars entailed in providing patient care to persons who exhibit chest pains. The study has established that proper care requires emphasis on the time taken for the whole procedure to be concluded. Studies by Carson et al (2010) and Quin (2000) are used to illustrate the importance of mapping of the patient care procedures. In this regard, Conway and Higgins (2011, p. 44) argue that there is an emerging body of evidence which points out the factors that may predispose people to particular responses to pain. Such studies allude to the fact that there is a need for a comprehensive screening process in an ED. The benefit of such screening helps to optimize early intervention. Consequently, care is provided to avert the occurrence of more chronic discomfort in the patient. Literature relating to the effect of these preliminary interventions in hospital admissions is scarce. Research is required with respect to issues like the length of stay and presentations illustrating how they affect patient care in emergency departments.

Mapping enables health practitioners provide comprehensive care to patients. The CSWSM provided for in the current study illustrates that there delays can emerge due to the existence of redundant steps. Emergency departments are required to come up with innovative ways through which throughput time can be reduced while at the same time providing the necessary care to patients.

Table 12 gives a summary of the time metrics relating to the FSVSM. Compared to the CSVSM, the throughput time is less. The same applies to the non-value time.

Table 12: Time metrics for FSVSM

Conclusion

As previously illustrated, a sample of 9 patients is obtained with respect to the ED at the general hospital. The time metrics for each patient are illustrated coupled by a mapping of the process of care. The time flow sheets for the 9 patients were essential in the establishment of points of delay within the entire primary care process. Carson et al. (2010, p. 22) point out that once the points of delay are identified, it is possible to provide ideas on how best to improve the process. The future state value stream map provided for in figure for care at the ED.

The applicability of literature and research touching on ED is limited. According to Leslie (2009, p. 105), studies vary from one institution to the other. Nevertheless, some studies point out a number of overarching alterations with respect to mapping. The alterations are essential in hastening the patients through the ED. In this regard, future studies touching on patient care in ED should highlight improvements in triage, urgent care centers, point-of-care testing, and bedside registration. The development of new models of mapping will enhance the provision of quality healthcare in EDs.

References

Carson, D, Clay, H & Stern, R, Report from the primary care foundation march 2010, Web.

Conway, J & Higgins I 2011, Literature review: models of care for pain management: final report, Web.

Leslie, S 2009, ‘Analysis of the literature on emergency department throughput’, Western Journal of Emergency Medicine, vol. 10 no. 2, pp. 104-109.

Quin, G 2000, ‘Chest pain units’, Western Journal of Emergency Medicine, vol. 173 no. 2, pp. 403-407.

Background

The Emergency Nurses Association (ENA) was founded to enhance the quality of emergency nursing services in the United States. In the mid 20^th century, leaders of registered nurses in various health care facilities found the need for a nursing association to be developed for nurses working in the emergency rooms. The main purpose of the development of the association was to enhance the skills of the emergency nurses and to help them to adapt to changing health care requirements. The ENA focuses on providing guidelines for care delivery for nurses in the emergency rooms. It also provides regular training and development programs to educate nurses and acquaint them with skills to cope with various situations. Nurses pursuing a career in the emergency room have a chance to register with the ENA. Nurses looking to become members of the ENA have an opportunity to contribute to the development of safety procedures in the ER. The association addresses various aspects of the profession, which will be discussed in this paper.

Purpose of the organization

The Emergency Nurses Association was developed for two main purposes, which include the enhancement of patients’ safety and increasing the quality of nursing services through the promotion of nursing excellence. The organization has developed guidelines that must be followed by registered nurses in nursing communities across the world. The guidelines are deeply enshrined in ethical practices, and they emphasize on providing better services that guarantee the attainment of wellness for the patients. The formation of the association was necessitated by an increase in the emergency room fatalities, and the concerned nurse leaders formed small organizations to look into ways of improving patients’ safety. The organizations shared ideas and guidelines were developed to facilitate safer nursing practices. Emergency nursing guidelines are designed to compel nurses to follow certain procedures that translate to faster recovery of the patients. The ENA was also developed to focus on the development of standards that must be followed by health care facilities. The standards entail the development of standard procedures for handling patients, and dictating specific ethical practices among the emergency nurses. The ENA also purposes to avail quality education to nurses in the emergency department. The ENA focuses on providing continuity in learning for nurses because service delivery should be continually enhanced in terms of quality (Hammond & Zimmermann, 2012).

Activities of the organization

The ENA is actively engaged in providing affordable training and development programs for registered nurses looking to join the emergency room teams. The association provides exams for aspiring nurses, and it has taken up the responsibility of offering scholarships to some of the nurses. The ENA Foundation works hand-in-hand with the ENA to produce qualified nurses for emergency response teams in healthcare facilities. One of the primary activities of the ENA is the development and financing of researches to look for directions in handling emerging issues in the healthcare system. The studies involve the development of new approaches to handling various emergencies, and educating nurses on the best methods to apply when enhancing safety in the facilities. Studies conducted by the ENA also focus on strengthening the skills held by nurses in the emergency rooms. As the application of technology expands in the emergency nursing field, the ENA looks to strengthen the skills possessed by the nurses operating machines in the ER (Hammond & Zimmermann, 2012). The ENA is also charged with the responsibility of providing representation for its members to their respective employers. Registered nurses who are members of the ENA have their needs addressed through the association, and their ideas are always considered in the development of new approaches to service delivery in the emergency room. The association has a global outlook on the trends in health care needs of patients in the ER.

Research interests of the organization

The ENA is concerned with influencing changes in emergency nursing through the nurse leaders, and researches help in providing scientific evidence on the viability of various approaches. The ENA has taken up the responsibility of advocacy of desirable changes in service delivery. The ENA has developed the Institution of Emergency Nursing Research (IENR), where nursing researches are conducted. The IENR follows the objective set by the ENA to ensure that the proposed changes in nursing approaches are evidence-based (Research, 2015). The research programs offer chances to nurse practitioners and students to develop their innovative ideas to improve the quality of nursing care in the emergency room. The association promotes the application of a multidisciplinary approach to expanding knowledge in nursing. The core principle of the ENA is to influence growth in the emergency nursing field, and technology is one of the areas that the company has emphasized in developing. It is also apparent that the association concerned with the current global health issues. For instance, the ENA is one of the global associations that are looking into developing knowledge on the best way to handle Ebola. Injury prevention studies are regularly conducted at the IENR to develop nursing approaches that minimize risks for the patients in the ER.

References

Hammond, B. B., & Zimmermann, P. G. (2012). Sheehy’s Manual of Emergency Care. Amsterdam, Netherlands: Elsevier Health Sciences.

Research. (2015). Web.

American College of Physicians. (2009). Nurse practitioners in primary care. Philadelphia: American College of Physicians.

This is a policy monograph compiled by a group of medical doctors, professional nurse practitioners, and policy-makers/analysts. This policy monograph, which also serves as a position paper explores the expanding roles of nurse practitioners brought about by the shortages of physicians, both anticipated and actual, in the provision of primary care. Here, the paper explores different issues including the scope of practice, prescriptive authority, and the third-party reimbursement in the nurse practitioner profession. Besides reviewing current journal articles regarding the general roles of nurse practitioners, the paper recognizes the need for nurse practitioners to team up with physicians in providing high-quality and patient-centered care. As a result, this paper provides useful information needed to complete the current project in that it serves as an additional resource that describes the roles of nurse practitioners in the physician-nurse practitioner teams. This is in recognition of the fact that the future of the healthcare sector depends on the development of resourceful and multidisciplinary physician-nurse practitioner teams (American College of Physicians, 2009, pp. 1-23).

American Medical Association. (2009). Nurse practitioners. Chicago: American Medical Association.

This module written by the American Medical Association in conjunction with the Missouri State Medical Association, the American Academy of Family Physicians and the American Osteopathic Association explores the demographics, education and training, licensure and regulation, professional organization, and current literature regarding nurse practitioners and other limited licensure healthcare practitioners. The information provided in this article is credible and useful in the completion of the nursing practicum project. For instance, the article provides an elaborate account on the nurse practitioner profession including the general duties/responsibilities and specialization of the nurse practitioners. Accordingly, this information can serve as the starting point in writing the current project. Furthermore, the article explores the most current literature regarding the general roles of nurse practitioners, which provides useful insights into the expanding roles of nurse practitioners occasioned by the changing trends in the healthcare industry (American Medical Association, 2009, pp. 1-142).

Hansen-Turton, T., Ryan, S., Miller, K., Counts, M., & Nash, D.B. (2007). Convenient Care Clinics: The future of accessible health care. Disease Management, 10(2), 61-73.

This article is written by professional nurse practitioners and medical doctors. In this article, the authors recognize the role played by convenient care clinics (CCCs) in actualizing the United States’ mission to provide high-quality, affordable, and accessible health care to the public. In CCCs, patients expect the same level of services including emergency services as those offered by conventional healthcare facilities. As a result, CCCs can be staffed by physicians, physician assistants, and primarily by nurse practitioners. Accordingly, this article explores the role of nurse practitioners in CCCs including the provision of emergency healthcare services. Therefore, this article will be very useful in the completion of the current project especially in providing insights into the role of nurse practitioners not only in the conventional emergency room setting, but also in the CCCs’ model of emergency rooms (Hansen-Turton et al., 2007, pp. 61-73).

Holleman, J., Johnson, A., & Frim, D.M. (2010). The impact of a ‘Resident Replacement’ Nurse Practitioner on an academic pediatric neurosurgical service. Pediatr Neurosurg., 46, 177-181.

This paper provides the results of a survey conducted by professional researchers drawn from the pediatric neurosurgery section in the University of Chicago Children’s Hospital. In this study, the researchers determined the role and the impact of introducing a pediatric nurse practitioner to a neurosurgical training program to compensate for the 80-hour workweek restriction program for resident doctors. The survey sampled the responses of physicians, nurses, and other care providers regarding the rate of satisfaction before and after the inclusion of the nurse practitioner. The results of the study show that the inclusion of the nurse practitioner in the pediatric neurosurgical service provides positive outcomes in terms of patient satisfaction and allowing the residents more time for their academic training. The most important role of nurse practitioners captured in this study is the provision of bedside clinical care in the absence of the resident doctor. As a result, this article provides additional information regarding the changing roles of nurse practitioners in the emergency rooms (Holleman, Johnson, & Frim, 2010, pp. 177-181).

Wilson, A., & Shifaza, F. (2008). An evaluation of the effectiveness and acceptability of nurse practitioners in an adult emergency department. International Journal of Nursing Practice, 14, 149-156.

This article provides the results of a survey conducted by registered nurses with the aim of investigating the level of acceptability and effectiveness of services provided by nurse practitioners in an adult emergency department. The results of the study show that most patients are satisfied with the quality of services offered by nurse practitioners in the emergency department. Furthermore, improvements were noted in terms of the flow of patients through the department. Despite utilizing a descriptive-explanatory study design, this survey reviews the most recent studies, and therefore, provides an up-to-date account on the expanding role of nurse practitioners particularly the role of maintaining patient satisfaction and clinical quality in the emergency department. As a result, this article is useful in the completion of the current project in that it provides important insights into the role of nurse practitioners in the emergency departments (Wilson & Shifaza, 2010, pp. 149-156).

References

American College of Physicians. (2009). Nurse practitioners in primary care. Philadelphia: American College of Physicians.

American Medical Association. (2009). Nurse practitioners. Chicago: American Medical Association.

Hansen-Turton, T., Ryan, S., Miller, K., Counts, M., & Nash, D.B. (2007). Convenient Care Clinics: The future of accessible health care. Disease Management, 10(2), 61-73.

Holleman, J., Johnson, A., & Frim, D.M. (2010). The impact of a ‘Resident Replacement’ Nurse Practitioner on an academic pediatric neurosurgical service. Pediatr Neurosurg., 46, 177-181.

Wilson, A., & Shifaza, F. (2008). An evaluation of the effectiveness and acceptability of nurse practitioners in an adult emergency department. International Journal of Nursing Practice, 14, 149-156.

The American Association of Critical-care Nurses (AACN) is a nursing organization with a health policy, which aims at ensuring that nurses in the acute and critical care field provide their services and contributions at optimum level. Their health policy advocates for a good working environment, palliative care, development of staff and addition of staff where needed. They have several legislative links with the government of the United States and organizations such as, the American Heart Association (AHA) where they address public health topics such as, caregivers’ needs, communication, bereavement and symptom recognition (Chulay & Burns, 2010).

The Center for Disease Control (CDC) is a public website that deals with various health programs. The Dose Reconstruction Health program is one of the leading health programs. This program was established in December 2000 under the public law 106-369, section 3624(a) (1). This was after people who worked on the nuclear device during the World War II fell sick from exposure to ionizing radiations.

The program was meant to compensate the affected people and their families. In my view, most people affected by the ionizing radiations during that time were senior citizens. The CDC should find a way of making it easy for them to access the compensation forms by incorporating them on the main website. The program should also compensate those families that have already lost a relative even if it is in the past ten years.

In reference to the video, carbon monoxide is a quiet killer and the sources of this dangerous gas come from combustion of compounds. This is quite dangerous during hurricanes, which cause power blackouts forcing people to use generators or gas. In protecting the environment, we protect ourselves from diseases. In essence, physical exercise is effective in alleviating diseases. The main concern is what ways we can use our immediate environment to make our life better, and ensure a sustainable environment at the same time.

In the first video, the staff members attempt to sensitize the relevant authority about disease outbreaks. For instance, the Katrina hurricane and its effect on human population. In the second video, it shows how radiological contamination affects a patient and the process of treatment (Armin, 2009). The main concern is whether the government is doing enough in its efforts to sensitize people on the issue. The government should put more effort in treatment and prevention of diseases.

This video is about the spread of the Ebola disease in Uganda. The video gives information on how the disease spread and brief statistical information of the number of deaths from this epidemic (www.cdc.gov/niosh/ocas/ocasadv.html). The role of the special pathogens branch is given, and the obligation of the Center for Control of Disease in case of an outbreak. The role of CDC is to collect specimen, characterize the disease and establish ways of controlling the disease. The species of a particular bat is identified as the reservoir of the disease and the problems facing health care system in Uganda (Armin, 2009).

According to the job post on an American newspaper, a registered nurse to be employed should have at least a diploma and two years experience. The career rewards for this post is the advantage of working in a hospital that offers further education for nurses holding a diploma. The main challenge of the profession is that all the nurses are stationed in the psychiatric ward and a carryover effect may occur.

References

Armin, A. (2009). Radiation Threats and Your Safety; A Guide to Preparation and Response for Professionals and Community. New York: Chapman & Hall Publishers.

Chulay, M & Burns, S. (2010). AACN Essentials of Progressive Nursing. New York: Mc Graw-Hill Publishers.