Evidence Based Practice - Research Paper Example

?Evidence Based Practice A. Area of Practice The area of practice is an emergency room in Baltimore, Maryland. The hospital in question, of Maryland Medical Center, is a large 750 bed teaching tertiary hospital in an urban inner city. The hospital has many specialties but is nationally ranked in cancer, cardiology & heart surgery, diabetes & endocrinology, ear nose & throat, geriatrics, nephrology, orthopedics, pulmonology, urology, neurology & neurosurgery. The emergency department contains 53 adult patient bed. In terms of traffic, the emergency department ranges between 120-180 visits per day with a range of 25-36 emergency department admissions per day. In considering the overarching community structure, West Baltimore has a total population of 620,961. The majority of households are composed of African Americans with 149,889 households; this figure is followed by white households occupying 85,994 homes. In terms of the region’s economic makeup, the area demonstrates diversity in terms of financial distinctions, yet there are increasing amounts of individuals living below the poverty line. The collection of this information designates a diverse community with varied medical needs. B. Technological Concern The specific technological aim in question, within the context of the emergency department, is related to the Health Insurance Portability and Accountability Act (HIPAA). This element was chosen as the emergency department demonstrates violation of these tenants. For instance, considerable overcrowding regularly occurs; similarly, patients’ experience decreased levels of privacy, as the computerized patient records allow increased access. Indeed, because of overcrowding HIPAA is violated in our adult emergency department more often then it should because patients are often interviewed in hallways; this necessitates a lack of privacy and allows others to overhear patients information. C. Research Discussion Nayeri and Aghajani (2010) examine patient privacy in the emergency room context. In examining things from this context, the authors begin with a broad philosophical investigation of the nature of privacy from the social science perspective. In these regards, two main notions of privacy are advanced. Nayeri and Aghajani (2010, pg. 167-168) state, Privacy can be seen as an individual’s freedom and having private space to be by oneself, being protected against physical and psychological intrusion, having the opportunity to achieve emotional release, ensuring that certain personal information is protected from others, and controlling how personal information is handled” and “Altman defines privacy as ‘the selective control of access to the self’ and Westin10 as freedom of choice. These are important notions in the context of the research discussion as they provide an overarching framework within to examine the nature of privacy in the emergency setting. The research goes on the articulate the core notions of privacy as consisting of autonomy and confidentiality. With the implementation of computer technology the research notes that there is increasing concern with patient privacy. As a result, the study examined privacy issues within this context. The research analyzed patient satisfaction with current medical privacy levels. The study was a descriptive analytical approach that involved 360 patients within three emergency departments. The study measured three areas of privacy: physical, informational, and psychosocial. The study results demonstrated that over half (50.6%) of the respondents believed that their privacy was either weak or average. Conversely, 49.4% indicated that their privacy was ‘fairly good’ or ‘good’. There were also demographic factors that correlated to some of the privacy statistics. Finally, the study demonstrated a strong correlation between perceived privacy and satisfaction. Shepherd, Ho, Shepherd, and Sivarajasin (2004) further considered patient privacy questions through the investigation of confidential registration in health services. While the authors acknowledged that a modicum of privacy is surrendered upon checking into a hospital ward, the varying extent that hospital software programs investigate personal information is an area of concern. The study functioned to “assess the effectiveness in terms of patient assessed privacy of confidential registration” (Shepherd, Ho, Shepherd, and Sivarajasin (2004, pg. 425). The study itself implemented 302 patients all over the ages of fifteen in examining the various issues within this investigate context. The specific research methods include a validated questionnaire on self-reported measures. The specific setting was a busy ED. The authors indicated that this setting was chosen because the diversity of the patient population made it so a wide sample base could be collected. The results were allocated by a statistician from the self-reported questionnaire. The questionnaire questions were derived from qualitatively determined investigations. The results contained a number of significant information. Shepherd, Ho, Shepherd, and Sivarajasin (2004, pg. 426) state that, “Overall, 302 patients were randomly assigned: 145 to the intervention group, 157 to the control group. Their characteristics were similar.” In terms of more specific result findings, the intervention patients felt as able as control patients to privately tell receptionists specific information. Significantly, more control patients indicated that they wished they could have spoken to the receptionist confidentially. In discussing these results, the researchers noted that providing patients increased privacy options has the potential to increase confidence and satisfaction in the medical experience. The main factor in achieving these increased confidence levels was confidential registration procedures. The study even indicates the specific confines needed for privacy indicating the need for, “screens 8 feet from registration desks” (Shepherd, and Sivarajasin, 2004, pg. 427). In terms of study limitations, the researchers note that the study lacked objective or evaluative outcome measures, as all outcomes were self-reported opinions. Moskop, Sklar, Geiderman, Schears, and Bookman (2009) investigate the challenge of overcrowding in the emergency department context. The researchers begin by providing an overview of the problem of hospital overcrowding, indicating that such concerns are by no means new. The researchers indicate that within the current literature there is disagreement over the extent and seriousness of the problem of emergency department overcrowding. Still, they argue that a number of objective elements can noted. Among these elements includes the notion that overcrowding occurs as an offshoot of the need for service and available resources. More specific indicating factors include the growing demand for emergency department care in the last fifteen years. Notably, the authors also consider the moral consequences of the issue of emergency department overcrowding. In this context of understanding they note, “Crowding has a variety of undesirable consequences, including increased patient waiting times, decreased ability to protect patient privacy and confidentiality, impaired evaluation and treatment, and difficulties in delivering person-centered care” (Moskop, Sklar, Geiderman, Schears, and Bookman, 2009, pg. 607). One notes the connection between overcrowding and privacy concerns. In the second portion of the research, the authors investigate strategies to overcome overcrowding issues in the emergency department context. In terms of barriers, the researchers note that the two major challenges are operational and financial barriers. In reducing overcrowding, the research argues that these specific areas must be diagnosed and overcome through strategic initiatives. In terms of operational strategies, the researchers argue that hospital environments develop multidisciplinary teams to address overcrowding. These teams can establish a number of measures to improve hospital efficiency. In terms of financial barriers, it’s argued that hospitals maximize income though high capacity operation. Hospitals can also institute a number of admission procedures, including giving elective admissions priority over emergency admissions. D. Literature Summary and Application The research discussion revealed a number of pertinent information that can be applied to the investigation of HIPAA violations. In terms of HIPAA privacy violations, Nayeri and Aghajani (2010) established medical notions of privacy as being highly important to the functional medical environment. Their study measured three areas of privacy: physical, informational, and psychosocial. The results demonstrated that over half (50.6%) of the respondents believed that their privacy was either weak or average – a statistically significant figure. While this study established patient concern and desire for privacy, Shepherd, Ho, Shepherd, and Sivarajasin (2004) examined the issue in more specificity considering its implementation in confidential registration of health services. This study implemented control and intervention patients as a means of statistically determining patient perspectives on medical privacy when speaking to a receptionist. The results proved significant in that many patients in the control group expressed a desire for increased privacy. The applicability of these results are such that allowing increased privacy levels could have a corresponding benefit for patient confidence and satisfaction; notably this is a theme that was also echoed in the research by Nayeri and Aghajani (2010). The 8 feet screen from the registration desks could be implemented in the University of Maryland Medical Center’s emergency room to increase patient privacy. While privacy is a major area of concern, another noted concern in this context is overcrowding. The issue of overcrowding was examined by Moskop, Sklar, Geiderman, Schears, and Bookman (2009). In considering the moral ramifications of overcrowding, these researchers noted an interrelation between overcrowding and patient privacy. The authors provide both operational and financial strategies to overcome overcrowding. It’s clear that the University of Maryland Medical Center must diagnose its overcrowding issue as operational or financial and then implement these strategic measures in reducing the overcrowding. Ultimately, overcrowding and privacy concerns are interrelated and can be alleviated through applying many of the tenats articulated above. References Moskop, John, David Sklar, Joel Geiderman, Raquel Schears, and Kelly Bookman. (2009) "Emergency Department Crowding, Part 1—Concept, Causes, and Moral Consequences." Health Policy and Clinical Practice. 53.5 (2009): Print. Moskop, John, David Sklar, Joel Geiderman, Raquel Schears, and Kelly Bookman. (2009) "Emergency Department Crowding, Part 2—Barriers to Reform and Strategies to Overcome them." Health Policy and Clinical Practice. 53.5 (2009): Print. Nayeri, Nahid, and Mohammad Aghajani. (2010) "Patients’ privacy and satisfaction in the emergency department: A descriptive analytical study." Nursing Ethics. 17.2: Print. Shepherd, JP, M Ho, HR Shepherd, and V Sivarajasin. (2006) "Confidential registration in health services: randomised controlled trial." Emergency Medicine. 23.1 : Print. Read More