Ethical dilemma This essay will narrate a nurse’s ethical dilemma as experienced in a local emergency department. In addition, the paper will discuss the relevant codes of conduct and law and make recommendations based on the nurse’s ethical dilemma.
The subject in this case is a 93-year-old Alzheimer patient who was by then in an extended care facility. As the ailment worsened, she became unable to eat or drink anything, and this was a great threat to her health. It reached that point where the patient would not respond to any touch or voice. The physician in charge of her at this extended care facility had indicated that she would not thrive with that condition. The granddaughter to this ailing patient was the power of attorney. To make matters worse, the elderly patient had no advanced directive. The patient’s family had earlier been directed to send her to the emergency care department…...

Emergency oom Efficiency
Improving Emergency Department Flow by Using a Provider in Triage

Emergency room triage plays an essential role in the speed and quality of the emergency room departments. Triage represents only one small part of the process that determines quality of patient care. Emergency rooms can be crowded. Busy times are often unpredictable, making it difficult to avoid bottlenecks in the system. This has an affect on the amount of time between arrival and when the patient sees a physician. Patients can be in for frustrating long waits while sitting in the hospital lobby.Patients often leave the emergency room waiting areas without being seen because they get tired of waiting. These patients are referred to as left-without-being seen (LWBS). educing LWBS rates is crucial for improving quality of patient care in emergency rooms. Long waits also cause a potential liability for the hospitals, as patients that are critically ill may…...

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References

Arkun, A,, Briggs, W., & Patel, S. et al. (2010). Emergency Department Crowding: Factors

Influencing Flow. West J. Emerg Med. 11(1): 10 -- 15. PMCID: PMC2850834

Armstrong, J., Hammond, J, & Hirshberg A, et al. (2008).Is overtriage associated with increased mortality? The evidence says "yes." Disaster Med Public Health Prep. P. D: 18388647. 2(1):4-5;

Bieler, G., Paroz, S., & Faouzi M, et al. (2012). Social and medical vulnerability factors of emergency department frequent users in a universal health insurance system. Acad Emerg Med. 19(1):63-8.

Emergency Departments (EDs) have the highest levels of violence of any hospital units, and according to a 1994 survey, 97% or nurses in these reported verbal violence and 87% physical violence. All EDs have large numbers of uninsured patients, many of them with drug, alcohol of psychiatric problems, which increase the normal stress and anxiety of this environment and make violence far more likely. This problem is compounded by the fact that only 3% of EDs had full-time security on-site, which means that "prevention is the best method to deal with violence in the ED" (Hoag-Apel, 1998, p. 60). All EDs should do a risk assessment that includes the location, design, history and security measures in the facility; the type of in-house security staff, training and weapons, communications with local police and hospital security; nighttime lighting, parking areas, numbers of chemically dependent patients. It should note whether access is monitored…...

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REFERENCES

Hong-Apel, C.M. (1998). "Violence in the Emergency Department." Nursing Management, Vol. 29, No. 7, pp. 60, 63.

ange Nursing Theories
As a profession, nursing presents many challenges. Indeed, it is one of the most stress inducing jobs in the world, not only in terms of the physical toll and long hours, but also because of the emotionally exhausting nature of the work. For this reason, personnel turnover tends to be high and there is a general shortage of nursing personnel at hospitals. Because of the vital nature of the profession to the healthcare field and to humanity in general, many researchers have addressed the problem of high personnel turnover in the nursing profession, as well as factors like leadership, work efficiency and interpersonal relationships.

Of all the work environments within the nursing profession, the Emergency oom is probably the most stressful, which also leads to high personnel turnover. One approach towards a resolution is to find ways of enhancing nursing staff satisfaction. Increased satisfaction at work would lead…...

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References

Hopwood, C.J., Wright, A.G.C., Pincus, A.L. (2013, Jun.) The interpersonal core of personality pathology. Journal of Personality Disorders. 27(3). Retrieved from:  http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3675800/ 

Hwang, T.G., Younsuk, L., and Hojung, S. (2011, Jul. 1). Structure-oriented vs. process-oriented approach to enhance efficiency for emergency room operations: what lessons can we learn? Journal of Healthcare Management. 56(4). Retrieved from: http://www.biomedsearch.com/article/Structure-oriented-versus-process-approach/271594394.html

Lin, B.Y-J., Hsu, C-P.C., Juan, C-W., Lin, C-C., Lin, H-J., and Chen, J-H. (2011). The role of leader behaviors in hospital-based emergency departments' unit performance and employee work satisfaction. Social Science & Medicine. 72. Retrieved from: www.elsevier.com/locate/socscimed.

Lipsitz, J.D. And Markowitz, J.C. (2013). Mechanisms of change in interpersonal therapy. Clinical Psychology Review. 33.

ED Boading Plan
Emegency Depatment Ovecowding Due to Boading: Poposed Solution

The poposed solution fo the noted poblem of emegency depatment ovecowding due to the pactice of boading patients in the emegency depatment athe than admitting them to othe aeas of the hospital is elatively simple and staightfowad. In essence, the solution that is most suppoted by cuent eseach is to simply cease the pactice of inpatient boading in the emegency depatment, inceasing thoughput by stabilizing and admitting to othe depatments those patients that cannot be teated on an outpatient basis, and inceasing the numbe of beds and staff available in othe depatments to meet this shift (Gason et al. 2008; Viccellio et al. 2009). This solution has been found to be beneficial to medical staff and patients alike, and simply inceasing the amount of beds and staffing that exists in the emegency depatment does not have a simila effect (Walsh et…...

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references for Boarding Locations When Hospitals Are at Full Capacity. Annals of Emergency Medicine 51(1): 9-12.

Viccellio, A., Santora, C., Singer, A., Thode, H. & Henry, M. (2009). The Association Between Transfer of Emergency Department Boarders to Inpatient Hallways and Mortality: A 4-Year Experience. Annals of Emergency Medicine 54(4): 487-91.

Walsh, P., Cortez, V. & Bhakta, H. (2008). Patients Would Prefer Ward to Emergency Department Boarding While Awaiting an Inpatient Bed. The Journal of Emergency Medicine 34(2): 221-6.

Running head: Quality of Care in the emergency department provided by nursing practitioners Quality of Care in the emergency department provided by nursing practitioners 5Quality of Care in the Emergency Department provided by Nursing PractitionersDue to demographic aging, comorbidity, and scarce resources in primary and acute care, emergency departments around the globe see an increase in enrollment, significantly impacting care delivery and results. There have been calls for Emergency Department performance improvement techniques, highlighting the need to discover cost-effective care approaches in terms of cost-effective care schemes in terms of workforce optimization. The addition of additional care contexts, such as HSCP teams, necessitates well-established institutional culture. People, institutions, services, and platforms must all change to introduce effective practices. To discover implementation variables based on access to healthcare, stakeholders who obtain or deliver health care have become highly relevant.Roles of stakeholdersStakeholders are vital individuals who play an important role in the…...

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References

Griffiths, J., Maggs, H., & George, E. (2008). Stakeholder involvement’ background paper prepared for the who/wef joint event on preventing noncommunicable diseases in the workplace (Dalian/China, September 2007). WHO Report. Geneva, Switzerland: World Health Organization.

Section 2: Engaging Stakeholders in a Care Management Program. Ahrq.gov. (2014). Retrieved 15 July 2021, from  https://www.ahrq.gov/patient-safety/settings/long-term-care/resource/hcbs/medicaidmgmt/mm2.html .

Woo, B. F. Y., Lee, J. X. Y., & San Tam, W. W. (2017). The impact of the advanced practice nursing role on quality of care, clinical outcomes, patient satisfaction, and cost in the emergency and critical care settings: a systematic review. Human resources for health, 15(1), 1-22

2010; McCarthy et al. 2009; Zimmerman 2004). These studies have also shown that a reduction in boarding numbers and crowding can eliminate or reduce these problems.
After all of these considerations, the fourth step in osswurm and Larrabee's (1999) model for change is to design the actual changes to practice that should be implemented. In this case, this requires few additional resources other than learning materials for hospital staff to acquaint themselves with new procedures and practices -- there is no equipment necessary, and supplies used by the emergency department should actually decrease pretty much across the board as patients are more quickly sent to other departments of the hospital after stabilization (AEM 2008). The design, then, is one that is purely procedural, and should consist of clear triage and stabilization practices that effectively assess patients and determine the appropriate continuation of their care, whether that be on an outpatient…...

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References

Bair, a., Song, W., Chen, Y. & Morris, B. (2010). The Impact of Inpatient Boarding on ED Efficiency: A Discrete-Event Simulation Study. Journal of Medical Systems, 34, 919-929.

Boarding of Admitted and Intensive Care Patients in the Emergency Department. (2008). Annals of Emergency Medicine, 52(2), 188-189.

McCarthy, M., Zeger, S., Ding, R., Levin, S., Desmond, J., Lee, J. & Aronsky, D. (2009). Crowding Delays Treatment and Lengthens Emergency Department Length of Stay, Even Among High-Acuity Patients. Annals of Emergency Medicine, 54(4), 492-503.

Rosswurm, M. & Larrabee, J. (1999). Model for change to evidence-based practice. Journal of Nursing Scholarship, 31(4), 317-322.

For effective fulfillment of duties by health care professionals which will, in turn, give a quality service to patients under their care, there is a need for effective inter-professional communication among personnel in a hospital environment. While the concept of territory exists within a sector, that, however, should not be a barrier to a fluid collaboration among health workers of different backgrounds. There is a need to formulate a working communication strategy to solve the lingering inter-professional problems in hospital environments generally, and particularly, in the emergency department. As important as it is, a look at inter-professional communication in emergency department shows a seemingly unfavorable situation among practitioners involved in this one of the most significant subsectors of health profession (Varjoshani, Hosseini, Khankeh, & Ahmadi, 2014). Among other numerous issues in the department, this paper looks at the problem of boisterous atmosphere in the emergency department, explores the contributing barriers…...

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References

Gluyas, H. (2015). Effective communication and teamwork promotes patient safety. Nursing Standard (2014+), 29(49), 50.

Kessler, D., Cheng, A., & Mullan, P. (2014). Debriefing in the Emergency Department. Annals of Emergency Medicine.

Morley, L., & Cashell, A. (2017). Collaboration in Health Care. Continuing Medical Journal of Medical Imaging and Radiation Sciences, 48, 207-216.

Northouse, P. G. (2016). Leadership theory and practice (7 ed.). Thousand Oaks, CA, US: Sage Publications Inc.

Peterson, R. L., Peterson, D. R., Abrams, J. C., Stricker, G., & Ducheny, K. (2015). Training in Clinical Psychology in the United States: Practitioner Model. Wright, James D. International Encyclopedia of the Social & Behavioral Sciences, 517-523.

Varjoshani, N. J., Hosseini, M. A., Khankeh, H. R., & Ahmadi, F. (2014). Tumultous Atmosphere (Physical, Mental), The Main Barrier to Emergency Department Inter-Professional Communication. Global Journal of Health Science, 7, 1916-9744.

What is Situational Leadership? (2014). Retrieved from

http://online.stu.edu/articles/education/what-is-situational-leadership.aspx

The quality of care provided by the nurse practitioner in the emergency departmentAbstractOver the last two decades, Emergency department crowding has become an increasingly common occurrence. Longer wait durations in the emergency room are linked to higher disease and death and lower client satisfaction. Reducing emergency room wait times is complex, and clinicians' predicted needs have shown a sustained scarcity. There is a surge of attention in having advanced practice nurses engage in clinical care to a significant level as part of the attempts to find new ways to boost the staff. Providing quality care requires providing both the scientific and humanitarian aspects of nursing.The Rogers theory of unitary human beings enables nurses to function from a position of factual certainty while emphasizing the care they deliver. Personnel such as health care professionals, executives, and other professionals who undertake medical and non - medical roles play a significant role in…...

Workflow chart criticism: "A patient arrives in the ER"
First and foremost, this workflow could benefit from a clearer title. The flow does not merely delineate what happens when a patient is admitted to the ER but rather what transpires when a patient with a suspected cardiac condition is admitted via emergency medical services. As well as a more coherent title, this workflow could benefit from greater description in the different boxes of the flow. While it is true that a workflow chart is designed to be relatively economical in terms of verbiage, this workflow needs greater explanation of acronyms such as 'CP via EMS.' It is unclear what CP refers to at first. Presumably it refers to a suspected cardiac patient but the meaning of the acronym is ambiguous given the title and the fact that CP could refer to a variety of different things.

The next square notes that the…...

AbstractThe problem is extended wait times among paediatric patients at the selected Paediatric Emergency Department (PED). This is a result of failure by nurses and clinicians to effectively educate patients at discharge, which causes many patients to return for complications listed in their discharge instructions. The extended wait times lead to patient dissatisfaction and poor organizational outcomes as patients may leave without care. Hospital readmission within 30 days of discharge remain a serious health concern in the US. Statistics indicate that 1 in five Medicaid patients return to hospital within 30 days of discharge. Cumulatively, readmissions alone account for approximately $42 billion in health spending annually. A literature review was conducted to gather evidence-based knowledge on strategies for enhancing the effectiveness of discharge procedures. Evidence was gathered by searching for US-based primary research articles in the JAMA Network, Cochrane Open Access, the Directory of Open Access Journals, and the Digital…...

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References

Alper, E., O’Malley, T., & Greenwald, J. (2022). Hospital discharge and readmission. Upto Date.  https://www.uptodate.com/contents/hospital-discharge-and-readmission 

Bajorek, S. A., & McElroy, V. (2020). Discharge planning and transitions of care. Agency for Heathcare Research and Quality.  https://psnet.ahrq.gov/primer/discharge-planning-and-transitions-care 

Boden-Albala, B., Goldmann, E., Parikh, N. S., Carman, H., Roberts, E. T., Lord, A. S., Torrico, V., Appleton, N., Birkemeir, J., Parides, M., & Quarles, M. (2018). Efficacy of a discharge educational strategy versus standard discharge care on reduction of vascular risk in patients with stroke and transient ischemic attacks: The DESERVE randomized controlled trial. JAMA Neurology, 76(1), 20-27.

EMEGENCY DEPATMENT COSTS: FIXED AND VAIABLE COSTS 1Case 5.3: Costs of Care in the Emergency DepartmentWhat is an example of a fixed cost in an emergency department? A variable cost?Fixed costs are costs that do not change with changes in output levels (Smith, 2013). In the emergency department, fixed costs would remain constant regardless of the number of patients. An example of fixed costs in the emergency department would be the monthly salary of permanent staff such as emergency nurse practitioners and physicians. The salary is a constant amount agreed upon at the start of the contract period and would be a standard amount regardless of the number of patients one treats in a given period. The facility incurs the cost even when no patients visit.Conversely, variable costs are costs that change with changes in output or activity levels (Smith, 2013). They increase with increases in activity levels and vice…...

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References Lee, R. H. (2019). Economics for Healthcare Managers (4th ed.). Riverside, CA: American College of Healthcare. Shim, J. K., & Siegel, J. G. (2008). Budgeting Basics and Beyond (3rd ed.). New York, NY: John Wiley & Sons. Smith, W. (2013). Student Handbook to Economics: Entrepreneurship. New York, NY: Infobase Learning.

Emergency, Planning and Operations Methodology
In your opinion what were the main issues expressed by the States

Concerning Homeland Security and states rights at the 2002 State Emergency esponse Commission Conference? Please justify your position.

Most of the states attending the 2002 State Emergency esponse Conference expressed an overall sentiment that in relation to security, things are going to vary from state to state based on the capabilities of the emergency response agencies in each state, as well as the types of hazards that states are likely to face in addition to WMD's i.e. For example, states have to take into consideration whether they have chemical facilities, nuclear facilities and similar hazardous materials to address. State also has to take into consideration whether or not they have highways that are used to transport hazardous or nuclear waste materials.

Colorado made the point that secrecy regarding Homeland Security measures will not help. This opinion was…...

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References

Analysis for the Homeland Security Act." (2003). Retrieved November 22, 2003,  http://www.whitehouse.gov/deptofhomeland/analysis/index.html 

Hall, Richard., Adams, Barbara. (1998). Essentials of Firefighting, 4th Edition. Fire Protection Publications: Oklahoma

Homeland Security Act" (2003). Retrieved November 21, 2003,  http://www.whitehouse.gov/deptofhomeland/bill/index.html 

Homeland Security Act of 2003." Retrieved November 22, 2003,  http://www.theorator.com/bills108/hr1389.html

Effects of Short-Staffed Nursing in Emergency ooms Effects of Short-Staffed Nursing in Emergency oomsIntroductionThe emergency departments efficiency is a critical component of delivering quality and safe care within the health sector. The utilization of the emergency department significantly increased minus the corresponding increase in the available emergency services (amsey et al. 2018). As a result, to attend to the increased demand, it is proper to evaluate the various factors contributing to care delays (Schull et al. 2003). Scholars have established multiple hospital features associated with worse emergency rooms or emergency room time on ambulance plus emergency room crowding, hospital occupancy, the proportion of emergency department patients admitted, treating Physicians level of training, elective surgical admission number, socioeconomic status of the neighborhood, decreased nurse staffing, access to expedited diagnostic testing, and hospital occupancy.However, there is a lack of relevant data to connect hospital occupancy to overcrowding. According to Schull et al.,…...

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ReferencesChan, T. C., Killeen, J. P., Vilke, G. M., Marshall, J. B., & Castillo, E. M. (2010). Effect of mandated nurse-patient ratios on patient wait time and care time in the emergency department. Academic Emergency Medicine, 17(5), 545-552.Chang, A. M., Cohen, D. J., Lin, A., Augustine, J., Handel, D. A., Howell, E., ... & Sun, B. C. (2018). Hospital strategies for reducing emergency department crowding: a mixed-methods study. Annals of emergency medicine, 71(4), 497-505.Forster, A. J., Stiell, I., Wells, G., Lee, A. J., & Van Walraven, C. (2003). The effect of hospital occupancy on emergency department length of stay and patient disposition. Academic Emergency Medicine, 10(2), 127-133.Lambe, S., Washington, D. L., Fink, A., Laouri, M., Liu, H., Fosse, J. S., ... & Asch, S. M. (2003). Waiting times in California’s emergency departments. Annals of emergency medicine, 41(1), 35-44.Lucas, R., Farley, H., Twanmoh, J., Urumov, A., Olsen, N., Evans, B., & Kabiri, H. (2009). Emergency department patient flow: the influence of hospital census variables on emergency department length of stay. Academic Emergency Medicine, 16(7), 597-602.Polevoi, S. K., Quinn, J. V., & Kramer, N. R. (2005). Factors associated with patients who leave without being seen. Academic Emergency Medicine, 12(3), 232-236.Ramsey, Z., Palter, J. S., Hardwick, J., Moskoff, J., Christian, E. L., & Bailitz, J. (2018). Decreased nursing staffing adversely affects emergency department throughput metrics. Western Journal of Emergency Medicine, 19(3), 496.Rathlev, N. K., Chessare, J., Olshaker, J., Obendorfer, D., Mehta, S. D., Rothenhaus, T., ... & Litvak, E. (2007). Time series analysis of variables associated with daily mean emergency department length of stay. Annals of emergency medicine, 49(3), 265-271.Recio-Saucedo, A., Pope, C., Dall’Ora, C., Griffiths, P., Jones, J., Crouch, R., & Drennan, J. (2015). Safe staffing for nursing in emergency departments: evidence review. Emergency Medicine Journal, 32(11), 888-894.Schull, M. J., Lazier, K., Vermeulen, M., Mawhinney, S., & Morrison, L. J. (2003). Emergency department contributors to ambulance diversion: a quantitative analysis. Annals of emergency medicine, 41(4), 467-476.Wiler, J. L., Handel, D. A., Ginde, A. A., Aronsky, D., Genes, N. G., Hackman, J. L., ... & Fu, R. (2012). Predictors of patient length of stay in 9 emergency departments. The American journal of emergency medicine, 30(9), 1860-1864.

Emergency Plan
Business Name: MWV located in Covington VA

Number of Employees 190

Emergency management plan entails a system of managing resources, information analysis and decision making in the event of a tornado hitting the facility (Hubbard, 2009). The emergency management plan acts a guide to the responsible personal, the staff and residents within the facility on the steps to take upon the occurrence of a tornado. The emergency plan gives a description of the role that the pre-appointed Emergency Management Group (EMG) is expected to carry out in the event of a tornado. The Emergency Management group will serve as the overall authority over the activities in the facility relating to the occurrence of a tornado.

The emergency management policy is to ensure the safety of every individual within the facility and bring the facility to normal operations after an accident.

The head of the Emergency Management group is an appointed Incident Commander (IC)…...

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References

Hubbard, C. o. (2009). Emergency Response, Windshield Survey; Hubbard, . City of Hubbard Oregon.

Safety, C. f C.P. (2002). American Institute of Chemical Engineers. Guidelines for Technical Planning for On-Site Emergencies. . New York: CCPS-AICHE.

Integrating Health and Social Care Services: Enhancing Patient Outcomes and Quality of Life

Integrating health and social care services has emerged as a paramount strategy to enhance overall patient outcomes and improve their quality of life. By seamlessly connecting medical and social support systems, integration addresses the multifaceted needs of individuals, fostering a comprehensive approach to well-being.

Improved Patient Outcomes:

Enhanced Care Coordination: Integration eliminates the silos between health and social care providers, enabling them to collaborate effectively in developing and implementing patient-centered care plans. This ensures that patients receive the most appropriate services at the right time, reducing gaps and overlaps....

Telemonitoring for Heart Failure Management: Enriching Patient Outcomes

Heart failure (HF) is a chronic condition affecting millions worldwide, presenting a significant healthcare burden. Traditional care methods for HF involve regular office visits, but these can be inconvenient and time-consuming for patients. Telemonitoring has emerged as a promising alternative, offering a proactive and patient-centric approach to HF management.

PICOT Heart Failure Telemonitoring

PICOT (Population, Intervention, Comparison, Outcome, Time) is a structured framework used in healthcare research. For telemonitoring in HF management, the PICOT question is:

Population: Patients with heart failure
Intervention: Telemonitoring (remote monitoring of vital signs and symptoms)
Comparison: Traditional care methods (office....

1. Interprofessional collaboration, a vital aspect of contemporary healthcare, involves the seamless coordination and teamwork among healthcare professionals from various disciplines, including physicians, nurses, pharmacists, social workers, and therapists. This collaborative approach recognizes the distinct roles and expertise of each profession and leverages their combined knowledge and skills to optimize patient care. In this essay, we will delve into how interprofessional collaboration enhances patient care in healthcare settings, examining its benefits and implications for improved health outcomes.

2. Interprofessional collaboration promotes a holistic approach to patient care, ensuring that patients receive comprehensive and coordinated services tailored to their individual needs. By....

General Nursing

The Role of Nurses in Promoting Patient-Centered Care
Ethical Considerations in Nursing Practice
The Impact of Technology on Nursing Care Delivery
The Nurse's Role in Interdisciplinary Healthcare Teams
Nursing Leadership: Strategies for Empowering Nurses

Specific Nursing Specialties

Neonatal Nursing:
Advances in Neonatal Intensive Care
Nursing Interventions for Premature Infants
The Role of the Neonatal Nurse in Family Support
Pediatric Nursing:
Nursing Management of Chronically Ill Children
Promoting Child Health and Wellness in School Settings
Ethical Dilemmas in Pediatric Nursing
Critical Care Nursing:
Trauma Nursing: Managing Acute Trauma Injuries
Sepsis Management in Critical Care Settings
Nurse Prescribing in Critical Care
....