Nursing Response To Health Care Emergencies
Nurses are an important part of the health care team, and their inputs in the management of patients in emergency situations cannot be undermined. Good nursing practices are essential in the handling of such patients and providing quality care. (Hunsaker et al., 2015)
There are different environments in which nurses can provide emergency care, and these includes in the hospital especially for patients in the intensive care units, in accident scenes and fire tragedies, and in special homes e.g. nursing care homes for the aged.
During emergencies, a swift response is required, and patient handling should be evidence based. This area of how nurses handle patients in emergency cases has not been well emphasized and explored. This has resulted in poor nursing practices in emergency prompting the need to look at this area about management and provide performance improvement strategies. (Mickan & Boyce, 2006)
Roles of the Leader In Performance Improvement
Leaders at healthcare settings are the best place to bring transformative changes in nursing practice during emergencies. It is important that leaders understand reactions of people based on the changes that they may come up with and the leadership skills that are required of them to successfully implement the changes (Sullivan, 2013). These changes can include changes in policies at the ward levels or in the whole organizational structure. A good leader has several roles to perform to ensure there is an improvement in nursing care for patients in emergency situations and these include the following.
Coming up with a proper structure of how different patient nursing requirements should be handled and appropriate care given. Designing the structure in a way so as to allow stepwise management of patient needs for example in drug administration, providing patient nutritional requirements and offering patient advice during care. The leader should also define the relationship between nurses and other healthcare team members including general practitioners, pharmacists and others who may be relevant in meeting the patient needs during emergencies. Nurses should then be assigned their roles in emergency care to prevent overlapping of duties which may cause confusions in such situations. Each nurse is then encouraged to play his or her role well with enthusiasm to provide quality patient care (Sullivan, 2013).
Leaders should supervise how their nurses respond to emergencies to help identify their weaknesses and note areas that need to be improved. Supervision is also important when assessing if the laid down strategies (e.g. strategies for providing a quick response) are being implemented and the challenges met with their implementation (Gallagher et al., 2015).This can help in modifying the policies considering the interest of both the nurses and the patient care needs. The leaders should be ready to offers solutions in different situations for example in emergency areas with difficulty in access and areas that can pose risks to nursing emergency practice.
A nursing leader in emergencies should provide enough motivation to its members because this job is sometimes demoralizing especially the nurses dealing with accident emergencies. One way of providing motivation is by encouraging group work and ensuring each member play his or her role well enough to not burden other members with excess work. Providing proper remunerations is an important part of ensuring high quality of healthcare practice and efficient care in emergencies. Increasing emergency practice allowances will encourage others nurses who may be interested in joining the emergency care team. This also an indirect way of increasing workforce providing enough healthcare workers to manage the patients accordingly. (Mickan & Boyce, 2006)
A good leader should provide enough support to the staff. The support relevant in emergencies may include proper and efficient transport into the area where emergency care is needed. This can be done by ensuring there is enough ambulances for transporting the nurses to the areas of needs and the patients to the hospital individualized care can then be offered. (Hunsaker et al., 2015). Ensuring there is enough staff to handle the emergency patients considering the patients have different needs of care and management. Efficient patient care and management can only be achieved through proper structuring of different nursing roles and efficient coordination between individual nurses. The leader should enough the nurses are provided with enough protection during practices high-risk situations such as viral infection areas e.g. Ebola virus. Health car of the nurses must put considered first before they engage in any task that may pose their lives to risky situations. They should provide sufficient equipment and medicines that are used to planning emergency care for individual patient needs. (Gallagher et al., 2015).
The Types of Leadership Styles that can Effect Change
A leading nurse may be a nurse manager, or an executive nurse, responsible for all emergency care units. Rather than simply choosing a leadership style, an outstanding nurse leader typically uses several patterns depending on the situations he or she is faced.
There are two basic leadership styles: permissive and autocratic. These can be subdivided into sub-categories. A leader nurse who is a permissive Democrat, for example, engages her nurses in decision-making and allows them to work independently. Such a leader will be ready to listen to the staff on their ideas that when incorporated into the emergency care system can lead to better care. Opinions and ideas of fellow health workers should also be taken into consideration when making health care policies in the emergency department. When these ideas are included into care plan, the nurses are likely to perform their duties without feeling being pushed or forced. This will, therefore, lead to better care. (Mickan & Boyce, 2006)
A directive autocrat, on the other hand, gives instructions without seeking input and closely supervises his nurses. This kind of leadership is good, especially when dealing with junior nurses who do not have much experience in emergency care. The leader nurse comes up with guidelines on individual patient management profiles, and the nurses are expected to follow the guidelines. Close supervision is therefore required in such cases to ensure that the instructions given by the leader on patient management are appropriately adhered to.
An experienced nurse leader chooses the leadership style that works best in a given situation. For example, she may act as a permissive democrat when it is time to buy new equipment for her emergency unit. She can make arrangements to buy material, nurses want and then allow them to use it independently. When there is a back-up from junior nurses, on the other hand, it can be an autocrat directive that gives unilaterally less experienced nursing instructions while it closely monitors their work. (Sullivan, 2013).
Steps Required in Implementing Nursing Emergency Care Performance Improvement
The steps to improve emergency nursing care include; give nurses the right to prescribe in emergency clinical situations, rely on inter-professional collaboration to better manage emergencies, increase the presence of nurses in emergency wards, modify regulations so that nurse practitioners can use all their skills and formulate guidelines to ensure the safe delivery of care. (Mickan & Boyce, 2006)
The Right to Prescribe
For emergency situations, enabling nurses to prescribe in these clinical situations would improve continuity of care and reduce wait times for certain services through the increased use of nurses' knowledge and skills and the possibility to complete the care they have already begun.
This initiative would bring many benefits, including faster access to treatment and clinical follow-up, reduction of complications and costs associated with late care, avoidance of fragmented services and disruption of services awaiting a prescription. Note that France, England, Ireland, and Scotland have already developed models of care that allow nurses to prescribe in certain clinical situations. (Mickan & Boyce, 2006)
It is a fact that the incidence and prevalence of chronic emergency diseases (cancers, cardiovascular diseases, respiratory diseases, diabetes and others) are increasing, and the situation will be accentuated with the aging of the population.
Inter-professional teams should be established in front-line services to promote efficient care, increase the efficient use of resources and ensure the safe delivery of care. Better co-ordination would result from the creation of such teams and would avoid delays in the provision of services, as well as duplication of interventions, both on the front line and in specialized services. (Gallagher et al., 2015).
Emergency Care Nurses
Over the past decade, the needs of people living with conditions that may require emergency care have increased significantly. Today, nearly one in two residents is over 85 years of age, and most are afflicted with several chronic diseases. Their state of health makes them consume several medications, on average seven a day. Taking more than five drugs produces drug interactions that often require hospitalization to treat adverse events and stabilize health, as well as long-term follow-up. (Gallagher et al., 2015).
Institutions have focused on developing nursing competencies as the first element of change strategy, to support the overall work reorganization and to improve the accessibility, quality, safety and continuity of care and services offered to the patients. Results include a reduction in the number of falls, the number of medication errors and the number of pressure ulcers, as well as a reduction in transfers to the emergency room. (Mickan & Boyce, 2006)
The Safe Delivery of Nursing
For many years, budget constraints, rather than the needs of patients, have often led to the establishment of nursing staffing plans, resulting in an increase in the number of patients per nurse. Studies show that the increased patient-nurse ratio increases the workload and has negative impacts on safe care delivery, quality of care and clinical outcomes for patients. Also, in institutions, high nursing workloads would have a negative impact on recruitment and retention, which could result in high overtime costs, adding to an already problematic situation.
To address the concerns raised by the issue of required nursing workforce versus patient needs, jurisdictions and institutions have introduced a method to ensure a nursing presence that ensures safe delivery of care. The recommended methodology is based on assessing the needs of patients and determining the number of staff required, regarding numbers and skills, and not only by the number of patients per nurse. (Sullivan, 2013).
The Impacts of Workforce Cultures in Nursing Emergency Care
In emergency nursing, there are several factors of workforce cultures that affect response to changes in management. Some nurses may find it difficult to incorporate technological changes in patient care. These can include data management and planning of care, dosing calculations and patient care monitoring. This is a factor that can resist change and efficiency in emergency health care delivery.
In an emergency clinical setup where nurses are not individually in good terms can lead to deterioration of patient care and management. This is as a result of poor team work and communication in the organization. The poor relationship between the nurses and the leader will even worsen the situation as the nurses may fail to follow the instructions given by the leader. The manager should in this case act as the authoritative person placed at a better position to bring harmony to this organization. (Gallagher et al., 2015).
Sometimes the evolution of hospital reforms leads to a denaturation of the function of health facilities which become firms deemed on the production of their care activity and economic performance obtained by these activities. By this denaturation, health facilities become a receptacle of injunctions where caregivers are faced with paradoxes. Quality, regulative and normative framework verses customization of care, professional division verses continuity of care, organizational values ??verses professional values.
An emergency workforce with good ethical skills is essential in meeting patient management plans where there is a good interrelationship between the health workers and their leaders. This encourages proper coordination and teamwork, improved nurse determination and dedication to their work. (Hunsaker et al., 2015).
Barriers and Facilitators in Change Process and Management Strategies
The organizational structure has effects on the working environment of nurse managers. High-level nurse managers, who are involved in decision-making and who were early in the process, feel more empowered and appreciated by the organization, supported in their professional practice and ultimately recognized for the quality of their emergency care services. Their satisfaction with the role of the nurse manager and their influence with the higher authorities probably have an impact on the satisfaction of nursing staff and their perceptions of the quality of care. This facilitates changes in management strategies. (Mickan & Boyce, 2006)
Working relationships between nurses at different levels are a decisive influence on efficiency and satisfaction. Transformational leaders, organizational support and the quality of communication have an impact on the satisfaction of managers at different levels and the quality of care provided. Use of proper communication method that is accepted by all nurses engaged. In emergency care is important in ensuring all nurses in the emergency team are not left out when valuable information is to be passed. Proper communication channels can also be used in gathering the opinions of nurses in the team for future planning of care. (Mickan & Boyce, 2006)
On the other hand, organizations have undergone a major and ongoing restructuring that has created barriers to the effective role of nurse managers in a context where roles have been expanded and function expanded with the increase in the size and complexity of nursing, and the time devoted to monitoring and the financial situation have been cut. Access to adequate resources remains a key issue. Poor infrastructure can impede transport into an area of emergency, therefore, the affected patient may miss rapid response that would have been useful in saving their lives. Some emergency situations such as breathlessness in heart failure need quick response failure to which can have very severe effects on the health of an individual. (Sullivan, 2013).
Inadequate resources such as medicines and delivery equipment can complicate nursing emergency responses. Without these essential materials, there is no meaning in emergency response as patient management will be very difficult. Provision of these resources is critical to ensuring the success of an emergency care plan. (Gallagher et al., 2015).
Importance of Benchmarking Best Practice in Emergency Nursing
Benchmarking is usually designed as a process of research and implementation of best practices at the lowest cost. This performance research is based on collaboration between several structures. The basic principle of benchmarking is the identification of a point of comparison that is called benchmark against which everything can be compared. In emergency nursing care, this practice can be implanted by allowing a group of nurses to directly observe how their more skilled and experienced fellows respond to an emergency situation and patient care. (Mickan & Boyce, 2006)
Initially used as a method of comparing production costs against the competition of the same sector, benchmarking was then conceptualized and used as a method of continuous improvement of performance whatever the sector. (Hunsaker et al., 2015).
For more than ten years, the performance requirement has become a major challenge for the healthcare system. Three factors contributed to this: the need to control health expenditure, the need to structure risk management and the quality of care, and to meet the expectations of patients. These requirements have in particular facilitated the development of multiple national and international projects for the development and comparison of indicators. The term benchmarking has emerged as part of this comparative dynamics. Then and without necessary continuity, the concept of benchmarking was refined by referring to the analysis of processes and success factors that allowed for superior performance. Finally, Benchmarking has focused on finding best practices to meet patient expectations. At present, the use of this term is often overused by restricting it to a simple comparison of results when it is necessary to go beyond by encouraging exchanges of practitioners on their practices to initiate changes cultural and organizational structures within the comparative structures. (Mickan & Boyce, 2006)
Strategies for motivating and engaging staff and stakeholders in performance improvement
Staff Motivation Criteria
Physical conditions of work: overload i.e. too much work may lead to stressful situations for nurses and therefore proper mechanisms to manage this including increase patient nurse ratio is a good source of motivation. (Hunsaker et al., 2015)
Recognition of individual needs: for training, professional support, flexibility and openness to the needs of work/family balance. When nurses feel recognized within a health care team, they are likely to work with a dedication. Efficiently training the nurses in the emergency department will enable quick response with much experience reducing the chances of burnout occurring. (Mickan & Boyce, 2006)
A factor of quality and continuity of care is the motivation and sense of responsibility of the staff. A health service is worth as much as the competence and the application of its staff.
Both elements contribute to the social climate within teams and are factors of job satisfaction, which has a huge impact on the quality of the continuity of staff and that a positive assessment of his or her work is more stimulated to offer good emergency services and to be present.
Absenteeism and burnout are often the results of individual disinterest or lack of recognition of people and their need for valorization by the authorities and the system. The instability of the staff, through the need to resort to temporary workers, often less interested, impairs the continuity and quality of care. (Hunsaker et al., 2015)
Engagement of the staff and stakeholders can be done by ensuring proper communication strategies are put in place to enable efficient transmission of information within the organization. One way to achieve the goals of improvement in emergency healthcare management is to listen and communicate with a variety of stakeholders: healthcare consumers, the public, health service providers, community leaders, other partners, and media.
Patient emergency care has continued to focus on the three main objectives of community involvement:
Promote a better understanding of emergency nursing care and greater support for its programs to develop a person-centered health system; engage local communities to evolve the key targeted outcomes to change the emergency health system; collaborate with health service providers and partners to improve community engagement practices. (Gallagher et al., 2015).
It is imperative to note that nursing health care services performance improvement require effort from different stakeholders in the healthcare system and continuous support from the management. Good management skills are required in formulating and implementing these changes in patient management. Full cooperation of individual is essential to the success of these improvement strategies. If enough support is accorded to this to this important area of nursing practice, the best solutions will be resulted and therefore quality patient management in emergency situations.
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