Hospitalization of Patients Without Identification Personal - Essay Example

?Critical Incident Component Critical incident A critical incident which I encountered involved a patient who was admitted into the hospital without any identification, who was also hysterical, aggressive, screaming, and manifesting a generally ‘crazy’ demeanour. He was dropped off in the emergency room by a building security guard after he apparently collapsed on the street. He did not have any wallet or identification with him, and when he regained consciousness a few minutes after admission, he was incoherent, and could not understand what was being asked of him. Since then, he was highly aggressive and hysterical. He punched one of the nurses who approached him so he had to be strapped down to the bed. He was uncooperative to medical attention and he was spitting at anyone who approached him. He was also squirming and screaming on the bed trying to get free from his bindings. Since he was manifesting symptoms which were related to a probably mental illness, he was wheeled into the psychiatric ward. However, the mental health physician who assessed him for mental illness negated a mental illness diagnosis; instead, he suggested that the patient may be suffering from hypoglycaemia. He was returned to the emergency room. His blood sugar was taken through a glucose meter strip and it indeed indicated that he had severely low blood sugar levels. Since the patient could not take any oral medications due to his aggressiveness, while being strapped down, a patent IV line was established and he was put on a Dextrose 50% drip. This was meant to increase his blood sugar. After about 10 minutes, he slowly regained his sensibilities and was no longer in a hysterical fit. We then explained what happened to him and he explained that he had Type 2 diabetes and forgot to take his diabetic medication that morning. Since he was so busy with work, he also did not get to eat breakfast or lunch. The last thing he remembered was walking on the sidewalk. He also said left his wallet at work and was planning to head back there to get it when he later collapsed. We asked him whom we could contact as next of kin and he gave his son’s cell phone number. Since he was not more cooperative, we took his vital signs. His vital signs indicated normal respiratory and heart rates, and slightly depressed blood pressure which was expected in his case. When his son arrived, I took the time to review with him the implications of his disease and the precautions he had to take in order to healthily manage his blood sugar levels. I also assessed his knowledge about his disease and his knowledge about diabetes was not encouraging. I explained to him the importance of maintaining normal blood sugar levels, and the importance of avoiding its extremes – hyperglycaemia and hypoglycaemia. I also reviewed with him the diet habits (carrying candies, a chocolate bar, or any sugary treats), as well as the medication habits he had to remember at all times in order to avoid such extremes. Component 2: Analysis In analyzing the above incident, the importance of resource management was established. Resource management is important in health care because it helps ensure that the appropriate intervention is directed to the right patient, at the right time, and in the right manner by the right person (Walshe and Rundall, 2001). Resources in the healthcare industry include the healthcare staff, the hospital equipment, the medications, the other health resources. In the current age of health budget cuts, resource management is a crucial element in healthcare (Pinczuk, 2010). Efficient management would help ensure an equitable and appropriate distribution of health resources to the patients and other healthcare recipients. Resource management also contributes to effective healthcare by ensuring that the resources would not be depleted, in the case of hospital supplies, equipment, and medications, or stressed and overworked in the case of hospital staff (Pinczuk, 2010). Resource management would help ensure a fair and equitable distribution of limited resources, making sure that those who need it the most would be able to receive it. Moreover, it helps ensure timely care, which, in the healthcare delivery is of primal importance (Pinczuk, 2010). Resource management secures efficient and effective delivery of health services; it prevents wastage and promotes interprofessional practice and teamwork (Roussel and Swansburg, 2006). In this incident, resource management was utilized in order to effectively deliver the health services which the patient needed. Upon his admission to the ER, he needed to be assessed, and I was immediately assigned to assess him. It was a timely intervention because it allowed me to review the patient’s symptoms in order to make a possible nursing diagnosis. His uncontrollable, aggressive, and hysterical actions were managed by physically restraining him until such time that an accurate diagnosis of his symptoms would be carried out. While strapped to the bed, he posed less danger to himself and to the staff. Using any sedatives or drugs to restrain him would not have been advisable because of the lack of patient history. Some unknown medical condition may preclude the administration of such drugs; therefore, the best intervention and management which could have been done in his behalf was strapping him to the bed. It allowed the health staff to efficiently carry out their other functions without being encumbered by the patient’s aggressive actions. It also promoted the use of appropriate medical care, allowing the health staff to administer interventions efficiently and with the least possible danger to the patient. As was mentioned, teamwork is a crucial part of efficient healthcare practice. Teamwork may also be laid out as interprofessional practice, where the different health professionals work with each other in order to establish clear and important goals. Dimitriadou, et.al. (2008) discusses that collaboration and teamwork is a process whereby common work is carried out via mutually accepted goals. It is also carried out upon the understanding of the qualities of individuals involved in the team; these qualities include competencies, knowledge, personality and behaviour (Dimitriadou, et.al., 2008). It is a dynamic process which involves “two or more healthcare professionals with complementary backgrounds and skills, sharing common health goals and exercising concerted physical and mental effort in assessing, planning, and evaluating patient care” (Dimitriadou, et.al., 2008, p. 141). Teamwork is a function which can be accomplished through open communication, delegation, and shared decision-making practices (Xyrinchis and Ream, 2008). In reviewing the critical incident, teamwork was apparent in the way the nurses were able to work with each other in managing the patient and other patients we had at the time. Since the patient was being aggressive, we discussed what we would do first in order to carry out our interventions. We helped each other in restraining the patient and a nurse was monitoring the patient at all times, making sure that he would not harm himself. Another nurse referred the patient to the psychiatric ward, and later, we assisted each other in administering the patient’s IV medication. We coordinated with the attending physician for appropriate and safe interventions and we also discussed possible options with the pharmacist in terms of safe medications to administer to a patient who had no medical history (Collins, 2005). Our collaboration and teamwork with the other health professionals led us to the appropriate decisions within the health practice, promoting safe conditions for the patient (Barrere and Ellis, 2002). There are four principles involved in operations management and these are: planning, organizing, leading, and controlling (Langabeer, 2008). Planning involves the establishment of goals and coming up with a strategy in the hope of achieving such goals. It may be based on strategy, wherein a plan for intervention would be supported by maximum efficiency; or it may be considered operational, wherein the number of staff is considered according to specific and efficient designation (Langabeer, 2008). Organizing follows the planning process, wherein decisions of what, where, when, and whom would be considered in order to achieve the plan or the goals. This principle includes various tools, including the organizational chart where the plan of care or the intervention is organized following the hierarchy of responsibilities and tasks. Leading is about motivating one’s employees or members in an organization. It is also about supporting one’s employees and members, eventually in the hope of getting them to do their responsibilities (Langabeer, 2008). Leading is a significant responsibility as it involves motivating one’s employees, directing them, and even preparing them for possible changes in the organization. Finally, controlling involves the process of monitoring progress of work and interventions, making sure that these are still directed towards the achievement of goals (Langabeer, 2008). Corrective measures are part of this process where necessary, and when it would be essential in the adequate achievement of goals. Using status reports, procedures, and budgets form part of the controlling principle. In applying such principles to this critical incident, there was a definite application of the above principles. First and foremost, we planned the patient’s care and we established goals as well as strategies in achieving such goals. Secondly, we organized our tasks based on our planned goals. The tasks were towards the determination of the patient’s condition and managing his symptoms. By organizing our interventions, we were eventually able to efficiently manage the incident. Thirdly, our leader – the head nurse – was efficiently guiding us during the critical incident. She helped us establish sound interventions and eventually guided us towards our goals. Finally, the control principle was achieved through patient monitoring and patient charting. It kept our tasks firmly within the standards of patient care and it also ensured that we were conscious of our actions as health professionals. Managerial tools used in order to evaluate employee performance include: balanced scorecards, key performance indicators, performance measures record sheets and the four column matrix. Balanced scorecards are often used as a tool to allow a manager to translate the organization’s goals into achievable actions (National Health Services, 2008). These scorecards have key performance indicators which can measure and monitor an employee’s performance; this also gives the manager an opportunity to optimise employee performance according to the indicators. These indicators are based on various perspectives and they assist organizations in focusing on patient service and employee satisfaction (NHS, 2008). The key performance indicators help managers specify the measures of employee progress towards the achievement of organizational goals. These indicators cover various areas in the clinical practice and once goals are set, these indicators help determine how well these goals are being met (NHS, 2008). Performance indicators include length of stay, mortality rates, readmission rates, and day case rates. If these indicators are very much different from the goals or from the health standards, then these areas may need to be reviewed for improvements. The performance measures record sheet is a tool which is utilized in evaluating specific aspects of performance and where these aspects need to be adjusted (NHS, 2008). Finally, the four column matrix is a tool which assists the groups and teams in coordinating their team objectives with the larger set of organizational objectives (NHS, 2008). In evaluating the right data, it is possible to secure the greatest impact on the organization. This matrix also helps the group refine the tools for improvement, allowing the general waiting times of the patients to be reduced. As was established by the critical incident, effective management and leadership skills are crucial to an efficient patient care. The head nurse showed much initiative and skill in her nursing leadership and his designation and delegation of responsibilities. She knew which people to assign to each work and she encouraged us, as well as guided us in our responsibilities. This was seen also with the physicians who firmly gave their orders and treatment interventions for the patient in assured and well-informed ways. In nursing, effective management is important in achieving favourable health outcomes because nursing is a very demanding profession and it usually takes up many hours of focused work (Healthcare Performance Institute, n.d). Effective nursing management is important because it can give the nurses the practical skills in order to assume management roles. With effective management, less medical errors would be committed in the practice and accurate patient care would be delivered on time (Singh, 2010). Moreover, effective management would mean that there is an efficient use of limited time, personnel, and resources, allowing these resources to be allocated for other patients who would also need care (Singh, 2010). The efficiency in nursing management in this critical incident was supported by the evidence, as well as the nursing skills, and efficient working habits of the nurses and other health staff. In order to manage conflicts in the healthcare practice, two possible solutions may be applied: collaborating and compromising. In this critical incident, both solutions were applied. First, collaborating is about seeking a win/win situation where a solution which would be satisfactory to everyone would be applied (Bass, et.al., 2008). This solution was applied when some members of the health staff were speculating about what to do to manage the patient’s aggressiveness. Some nurses wanted to physically restrain him, and some wanted to sedate him after he was ruled out for any heart conditions. After seeing the patient was uncooperative for any laboratory or diagnostic examinations, the group proposing the sedation agreed that the best means to restrain the patient was through the application of physical restraints. This solution satisfied everyone’s assessment of the patient. Another possible solution for conflicts would be to compromise. This is when a middle ground is reached and a practical solution based on traded concessions is considered (Bass, et.al., 2008). In the critical incident, this was applied when the mental health physician did not agree with the mental health illness diagnosis made by one of the ER doctors. He instead suggested that the patient be evaluated for hypoglycaemia. He agreed also that a negative diagnosis for hypoglycaemia would give him the motivation to re-evaluate the patient for mental illness. By applying this tool in conflict management, possible issues between and among the health professionals were prevented. The critical incident displayed the importance of communication within the healthcare professionals (Turnock, 2011). The incident was an agitating incident to deal with because we did not know who the patient was, nor did we know what his health condition and health history was. We also had difficulty in communicating with the patient because he was incoherent, aggressive, hysterical, and apparently could not understand us. We had conflicting diagnosis as to his condition and we could not get close enough to him to make possible any diagnostic tests. Even our decision to use physical restraints was not the most ideal medical decision. However, it proved to be the most effective intervention based on his current conditions. Communicating with each other and working as a team proved to be an effective means of managing the critical incident (Clarke, 2008). It allowed each health professional to perform his responsibilities with minimal interference and based on shared goals, mostly towards ensuring that the patient’s condition would be diagnosed and his symptoms managed (Plsek, 2001). Moreover, the critical incident was adequately managed with the proper application of compromise and coordination measures in conflict management. References Barrere, C. & Ellis, P. 2002, Changing attitudes among nurses and physicians: a step towards collaboration. Journal of Healthcare Quality, vol. 24: pp. 9–15. Bass, P., Talente, G., & Wood, J. 2008, Conflict Management in Health Care, Society of General Internal Medicine, viewed 04 December 2011 from http://sgim.org/userfiles/file/AMHandouts/AM06/handouts/WC08.pdf Clarke, I. 2008, Learning from critical incidents, Advances in Psychiatric Treatment, vol. 14: pp. 460-468. Collins S. 2005, Explanations in consultations: The combined effectiveness of doctors and nurses communication with patients, Medical Education, vol. 39: pp. 785–796. Dimitriadou, A., Lavdaniti, M., Theofanidis, D., Psychogiou, M., Minasidou, E., & Saountzi- Krepia, D. 2008, Interprofessional collaboration and collaboration among nursing staff members in Northern Greece, International Journal of Caring Sciences, vol. 1(3): pp. 140–146. Healthcare Performance Institute, (n.d), Effective Management Leadership in Nursing, viewed 04 December 2011 from http://www.healthcareperformanceinstitute.com/effective_management_leadership_in_nursing.jsp Langabeer, J. 2008, Health care operations management: a quantitative approach to business and logistics, London: Jones & Bartlett Learning. National Health Services, 2011, Quality Service Performance Tools, viewed 04 December 2011 from http://www.institute.nhs.uk/quality_and_service_improvement_tools/quality_and_service_improvement_tools/performance_management.html Pinczuk, J. 2010, Financial management for nurse managers: merging the heart with the dollar, London: Jones & Bartlett Publishers. Plsek, P. 2001, Complexity, leadership, and management in healthcare organisations, BMJ, vol. 323(7315): pp. 746–749. Roussel, L. & Swansburg, R. 2006, Management and leadership for nurse administrators, London: Jones & Bartlett Learning. Singh, D., 2010, Effective management of long-term care facilities, London: Jones & Bartlett Publishers. Turnock, B. 2011, Essentials of Public Health, London: Jones & Bartlett Publishers. Walshe, K. & Rundall, T. 2001, Evidence-based management: From theory to practice in healthcare, The Milbank Quarterly, vol. 79, no. 3: pp. 429-457. Xyrinchis, A & Ream, E. 2008, Teamwork: a concept analysis. Journal of Advanced Nursing, vol. 61: pp. 232–241. Read More

 

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