Community health promotion strategies and outcomes

¶ … working of operating room nurses as a result of the nursing shortage and the general strain and intensity of the health care arena in general. Nurses in general fulfill a truly crucial role within the arena of patient care, these are the individuals who engage with patients and their relatives for the longest amounts of time, and are the ones who detect and evaluate all changes in their health status: this means that nurses are generally the ones who are the first to react to such changes and the first to initiate dialogue with other medical team members on the necessary intervention that needs to be made. The nurses are the ones who are capable of delivering the bulk of the pharmacological, physical and emotional interventions: thus, if they're fatigued or unable to work at the highest level of their abilities because of exhaustion, in the integrity of the healthcare facility is completely compromised.

After assessing and scrutinizing this issue in its entirety, the diagnosis developed was essentially that the over-working of nurses and the accompanying fatigue that they ensue and have to work through is incredibly dangerous: it poses a threat to them, a threat to patients and it compromises the integrity of the medical field as a whole. The diagnosis was stated as follows: "Full time operating room nurses who are called back after hours for emergency cases are at increase risk of injury, fatigue and potential to make errors. This surgical team has indicated from the data that nurses working after hours pose safety risks for themselves and patients. Planning with management needs to occur to address some of their issues and risks." One aspect of the diagnosis which was incredibly wise was that in order to properly gather real-time data on the issues that nurses face in the field and working on the front lines of care, a questionnaire would be developed and administered to these nurses. This is an essential part of the correction process. In order, to create the most specific program to address this hazardous situation, there needs to be the most accurate and precise evaluation of this population, their needs and shortcomings. For example, as a part of the diagnosis issued, the following questionnaire was proposed.

Questionnaire

"How many years of operating room experience do you have?

How often are you scheduled to take call after hours in your schedule?

How many extra shifts of call do you pick up?

What is your comfort level coming back to work after hours for emergency cases?

Do you feel obligated to come back for emergency cases?

Have you experienced injury at work? If so, how many and what area was affected?

Have you experience injury at work after hours? If so, how many and what area was affected.

Have you ever made an error (medication, charting, or other) after coming back for emergency cases?

What is your age?

What is your gender?"

Thus, the program which is developed needs to proactively address the needs of this population in conjunction with the vagaries and issues which abound in their field. The answers that the nurses provide in direct response to these questions need to be used and directly referenced in regards to the nuances and details of the program created.

Program Outline

One pillar of the program will revolve around a strategic napping program that will be effective immediately in each nursing unit. As a result of the fact that delivering sufficient nursing care warrants vigilance, complex cognitive functioning, superior dexterity and technical skills along with the ability and willingness to engage with patients on a mental, social and emotional level (McMillan, 2011). When nurses have achieved a higher level of rest and awareness, patient care is generally a challenge that can be met with a certain amount of ease and planning; however, because most nurses work with patients when they're exhausted, they enter a truly hazardous arena of caring for patients (McMillan, 2011). Because this is so commonplace for nurses to be working while exhausted, more and more healthcare facilities need to make sleep promotion a priority. "Most adults appear to need seven to eight hours of sleep per night, with fewer than seven and more than nine or more hours associated with increased morbidity and mortality (Bonnet and Arand, 2011). For people such as night shift workers, who sleep during the day, the amount of sleep obtained is frequently below recommended levels and its quality is poorer than in those who are able to sleep at night (Gold et al., 1992)" (McMillan, 2011). For nurses, factors like the demands and immediacies of patient care, the domestic needs of their own lives and environmental issues all work together to create a situation where getting enough sleep is paramount. Though the consistent nature of reports of sleep disturbance do demonstrate the aggravated need for strategic sleep promotion by hospitals and how they need to more vocally emphasize to nurses that it is their duty to engage in sleep and health and wellness (McMillan, 2011).

Thus strategic napping in the form of restorative napping needs to be emphasized by the health care facility as a means of valuing and promoting the importance of sleep. Restorative napping is referred to as developing purposeful sleep over brief periods and is something which has in fact been found to minimize exhaustion and to improve the performance and vigilance of healthcare workers (McMillan, 2011). In fact, a nursing study explored how when nurses were able to nap on breaks during their night shifts, 10 out of the 13 nurses who did so reported benefits such as improved energy and mood along with better overall decision-making (McMillan, 2011). However, despite the consistent benefits of napping during breaks, many facilities don't adopt it because of things like lack of facilities, interruptions, demanding caseloads and fear of inertia stemming from sleep (McMillan, 2011).

The strategic napping program needs to contain the following pillars as asserted by McMillan (2011):

Availability of nurses to engage in uninterrupted breaks where they can nap for at least 20 minutes.

Availability of time and a plan to recovery from sleep inertia post-nap so that they can successfully return to work.

Ability to create a nap room that is quiet, soothing, and close to the unit with a private area for each user and which is not used for multiple purposes.

Ability to furnish this room with things like beds, stretchers or chairs that recline.

Offer amenities like blankets and pillows or a locker so that team members can store their own.

Use of alarm clocks, timers or other devices that will allow nurses to know when their nap period is over.

Ability to create an atmosphere characterized by dim lighting.

Educational Program

Making sleep a priority will be one component of the overall program, as one reason that nurses don't get enough sleep is often because they don't value it adequately or don't acknowledge its importance sufficiently enough. Employees thus need to receive information about "circadian rhythms, sleep hygiene measures, shift work and its adverse effects, and a variety of strategies that can be used to reduce fatigue (e.g., judicious use of caffeine and napping during night shifts)" (Rogers, 2008). Thus, one component of the educational pillar involves asking managers to consider altering the starting times of shifts when possible in order to make schedules more compatible with the circadian rhythms of all employees and to make sure that no single employee is schedule for no more than two night shifts in a row (Rogers, 2008). In fact, managers need to be educated about the important nuances of sleep so that they will be able to adequately educate their team members about their specific sleep needs so that nurses can prioritize sleep in a meaningful way.

Stimulants

While coffee and caffeinated beverages are a staple of any nursing unit and can be used to combat the pervasive fatigue that so often afflicts nurses, just because nursing units have coffee readily available, doesn't mean that caffeine is being effectively used as a stimulant. Just like napping, caffeine needs to be treated as the tool that it actually is. "Generally, caffeine's onset of action occurs approximately 15 -- 30 minutes after ingestion and its effects last 3 -- 4 hours. Although tolerance can develop, significant increases in alertness and performance can be obtained with 200 mg of caffeine (approximately the amount of caffeine in one to two cups of coffee), with positive effects occurring with doses ranging from 100 mg to 600 mg" (Rogers, 2008). An additional benefit of caffeine is that studies have found that it works effectively on its own; it can work even more effectively when paired with napping. Another stimulant which has found to be of a certain amount of success is modafinil, which has had an impact on increasing the alertness of workers who suffer from a sleep disorder connected to shift work (Rogers, 2008). However, when supplying caffeine one should stock the kitchenettes and nursing stations in healthcare facilities with coffee beans infused with antioxidants, green teas and acai berries, so that each cup contains the most powerful amount of health and wellness benefits to the nurses who consume it.

Bright Light

Bright light should be included in this program, as a supplementary means of promoting health, rest and alertness among nurses, even though the effects that it will have on such healthcare professionals isn't going to be as pronounced as among others. "Protocols typically involve exposure to bright lights (approximately 2,500 lux) or normal lighting (approximately 150 lux) while working at a desk for periods of 2 to 6 hours. No one has evaluated the efficacy of intermittent exposure to bright lights or the effects of alternating exposure to bright lights with the dim lighting typically found in patient rooms at night" (Rogers, 2008).

Exercise

According to the most recent and relevant research, having shift workers engage in exercise can produce mixed results. "Exercise typically produces increased subjective alertness and improved cognitive performance in both sleep-deprived and nonsleep-deprived subjects. Exercising for 10 minutes, however, produces only transient (30 -- 50 minutes) increases in subjective alertness" (Rogers, 2008). Even so, many participants who have relied on exercise as a means of helping to boost alertness and to create a sense of wakefulness have reported the effectiveness of this intervention. Furthermore, exercise has long been recommended as a tool for nurses to engage in so that they can relieve and release much of the stress of nursing and dealing with the high stakes world of life and death that they encounter so frequently. Thus, even if exercise only gives temporary amounts of alertness to nurses, it can help them shake off the inertia they experience from naps, and can help them begin their shifts with a certain amount of momentum and vigour.

Goals and Objectives

Thus, at the very least, at the absolute minimum, the behavioral/lifestyle goals and objectives of the program need to revolve around helping nurses to better manage their lives and professional responsibilities underneath the truly demanding world of professional nursing -- a world which involves a tremendous amount of stamina and professional strength. Hence, the program is designed to help nurses better manage their obligations in an effective way, while dealing with the pervasive exhaustion that can creep in at times. The program wants to put an emphasis once more about the sheer importance of sleep and the absolute necessity that sleep is for a working nurse, and that if one cannot get enough sleep at regularly scheduled times, napping needs to be made a priority and done in a strategic way. Moreover, nurses who work on the night shift need mandatory training on the importance on strategic, restorative napping.

The social/environmental goals of the program are thus to foster a living healthcare environment that vocally and proactively values the power and importance of nursing. In hospitals or healthcare facilities a machismo or skewed sense of "toughness/strength" can be imbued upon the ability to deprive oneself of sleep. This can be staggeringly unhealthy and create a situation where a person feels that he or she is expected to work in a state of exhaustion and that such a state is the normalcy of the work environment. Hence, in order to promote real change, the entire nursing environment needs to change and needs to put a more aggravated value on sleep and making sleep a priority.

Furthermore, the healthcare facility needs to have the tools and resources in place that demonstrates without a doubt that they absolutely do value the importance of sleep and working while in a rested condition. Thus areas to nap, bright lights, high quality, anti-oxidant-infused coffee, are all essentials when it comes to the importance of supporting restfulness.

Proposal for Funding

The following proposal for funding will be made to all the donors and will be presented to them as a way for the healthcare facility to save money. Investing in their nurses who are some of the hardest working members of the professional healthcare team is essential. Making such an investment will no doubt save money for the hospital in the long run as it will reduce medication mistakes and other human errors that an exhausted nursing staff can unfortunately engage in. Thus, the total funding request is $100,000. $500 of that money will have to be re-invested annually. And so, there will be a onetime investment of $90,050. The bulk of that money will be to renovate one of the spare rooms in the hospital so that it becomes a more soothing and hospitable environment. This is so that this room can be outfitted with reclining chairs or napping pods that are in screened off areas so that nurses can rest. Furthermore, this is also so that the area can have a dimmer installed so that the lights can be made dim and to purchase a simple sound system which will play Tibetan chanting, the sound of rain falling and the sound of waves crashing on the beach. Lockers will be installed in this room so that employees can keep their gear stored along the walls and have pillows and blankets that they find soothing for their own use.

Player for Program Planning, Implementation and Evaluation

The leader who is in charge of the developing, implementing and ultimately assessing the effectiveness of this program will need to be a nurse leader of administration and development. Ideally, this person will be someone who has a history of working as a nurse, but who switched over to administration later on in her career. This detail is important because it means that this individual will have a clear understanding of the realities of nursing and will be able to offer relevant solutions to problems that nurses face. This former nurse, now nurse leader, will have a clear understanding of the exhaustion that nurses face and know firsthand just how dangerous it can be to both clinicians and patients and the entire hospital at large. However, this person will still have spent enough time as a leader among the hospital administration so she will know how to approach donors and other high net worth individuals or entities for funding. This person will understand the most effective way to go about proposing change and implementing change.