1) The emergency department team was overwhelmed due to missing nurses and increased patient volume on a weekend. There was a lack of coordination, communication, and effective leadership among the team.
2) Due to the chaos, a patient with abdominal pain was neglected and later found to have ureteral bleeding, angering the patient.
3) Effective teamwork and leadership are important for the emergency department given its 24/7 operations and unpredictable environment. Interdisciplinary team assignments with clear roles and communication can help optimize patient care.
Study on Coping Strategies and Factors Associated with Stress, Among Nurses W...ijtsrd
Nursing professionals working in Intensive Care Units are challenged with high level of stress evolving due to critical condition of patients as well as urgency in decision making at life threatening situations. This makes Intensive Care Units more stressful place for working. Stress affects the emotional status which results into negative feelings hindering the care provided to patients. Study aimed to assess Coping strategies and factors associated with stress among staff nurses. Results showed the major coping strategies were used by the nurses including positive reappraisal, accepting responsibility and escape avoidance. Confronting coping was least used by the nurses. Factors like positive support and healthy work environment made level of stress less among nurses working in intensive units. Sunil Kumar Sondhi | Tarika Sharma | Dr. Anjana Williams "Study on Coping Strategies and Factors Associated with Stress, Among Nurses Working in Intensive Care Unit, New Delhi, India" Published in International Journal of Trend in Scientific Research and Development (ijtsrd), ISSN: 2456-6470, Volume-3 | Issue-2 , February 2019, URL: https://www.ijtsrd.com/papers/ijtsrd21551.pdf
Paper URL: https://www.ijtsrd.com/medicine/nursing/21551/study-on-coping-strategies-and-factors-associated-with-stress-among-nurses-working-in-intensive-care-unit-new-delhi-india/sunil-kumar-sondhi
Needs, Demands and Reality of People with Neuromuscular Disorders Users of Wheelchair by Thais Pousada in Examines in Physical Medicine & Rehabilitation
The Influence of Organisational Citizenship Behaviour, Job Engagement and Soc...iosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
Study on Coping Strategies and Factors Associated with Stress, Among Nurses W...ijtsrd
Nursing professionals working in Intensive Care Units are challenged with high level of stress evolving due to critical condition of patients as well as urgency in decision making at life threatening situations. This makes Intensive Care Units more stressful place for working. Stress affects the emotional status which results into negative feelings hindering the care provided to patients. Study aimed to assess Coping strategies and factors associated with stress among staff nurses. Results showed the major coping strategies were used by the nurses including positive reappraisal, accepting responsibility and escape avoidance. Confronting coping was least used by the nurses. Factors like positive support and healthy work environment made level of stress less among nurses working in intensive units. Sunil Kumar Sondhi | Tarika Sharma | Dr. Anjana Williams "Study on Coping Strategies and Factors Associated with Stress, Among Nurses Working in Intensive Care Unit, New Delhi, India" Published in International Journal of Trend in Scientific Research and Development (ijtsrd), ISSN: 2456-6470, Volume-3 | Issue-2 , February 2019, URL: https://www.ijtsrd.com/papers/ijtsrd21551.pdf
Paper URL: https://www.ijtsrd.com/medicine/nursing/21551/study-on-coping-strategies-and-factors-associated-with-stress-among-nurses-working-in-intensive-care-unit-new-delhi-india/sunil-kumar-sondhi
Needs, Demands and Reality of People with Neuromuscular Disorders Users of Wheelchair by Thais Pousada in Examines in Physical Medicine & Rehabilitation
The Influence of Organisational Citizenship Behaviour, Job Engagement and Soc...iosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
The state of having addressed basic needs for ease, relief, and transcendence met in 4 contexts of experience (physical, psychospiritual, sociocultural, and environmental)
Comfort involves identifying the comprehensive needs of patients, families, and nurses and addressing those needs.
Ergonomics- comfort at the workplace, promotes optimum function or productivity (Kolcaba &Kolcaba, 1991)
NANDA- comfort in terms of pain management
Confortare Latin- to strengthen gently
Understanding Oncology Nurses’ Grief: A Qualitative Meta-AnalysisLisa Barbour
Barbour, L. C. (2016, September 16-18). Understanding oncology nurses’ grief: A qualitative meta-analysis. A presentation at the Athabasca University 2016 Graduate Student Conference, Edmonton, AB.
Features of Saint Lucia In Travel + Leisure Travel Guide Plus More For 2016Saint Lucia Tourist Board
www.stlucia.org - Simply Beautiful Saint Lucia featured in a an assortment of prominent paper and online publications in North America including Travel + Leisure, Destination Weddings & Honeymoons plus more.
The state of having addressed basic needs for ease, relief, and transcendence met in 4 contexts of experience (physical, psychospiritual, sociocultural, and environmental)
Comfort involves identifying the comprehensive needs of patients, families, and nurses and addressing those needs.
Ergonomics- comfort at the workplace, promotes optimum function or productivity (Kolcaba &Kolcaba, 1991)
NANDA- comfort in terms of pain management
Confortare Latin- to strengthen gently
Understanding Oncology Nurses’ Grief: A Qualitative Meta-AnalysisLisa Barbour
Barbour, L. C. (2016, September 16-18). Understanding oncology nurses’ grief: A qualitative meta-analysis. A presentation at the Athabasca University 2016 Graduate Student Conference, Edmonton, AB.
Features of Saint Lucia In Travel + Leisure Travel Guide Plus More For 2016Saint Lucia Tourist Board
www.stlucia.org - Simply Beautiful Saint Lucia featured in a an assortment of prominent paper and online publications in North America including Travel + Leisure, Destination Weddings & Honeymoons plus more.
www.stlucia.org/blog - get a crash course on simply beautiful Saint Lucia with this Insider's Guide. Discover the best places to go, eat, party and stay. Also learn some of our creole phrases. Enjoy.
Creating an online peer based intervention for clinicians
suffering with psychological distress: The challenge ahead
Sally Pezaro*, Wendy Clyne, Emmie Fulton, Andy Turner, Clare Gerada. Coventry University, Coventry
Concept Synthesis Paper on Personal Nursing Philosop.docxmccormicknadine86
Concept Synthesis Paper on Personal Nursing Philosophy
Ancelle Jackson
South University
Advanced Theoretical Perspectives for Nursing
NSG5002 S09
Dr. Susan Stear
Running head: CONCEPT SYNTHESIS PAPER ON PERSONAL NURSING
CONCEPT SYNTHESIS PAPER ON PERSONAL NURSING
Concept Synthesis Paper on Personal Nursing Philosophy
The purpose of this paper is to identify, describe, and apply the concepts that underlie my personal nursing philosophy. I will give a brief overview of my nursing background, identify and describe the four metaparadigms of nursing, provide two other practice specific concepts that apply to my practice, and include a numbered list of five propositions that apply to those concepts.
Nursing Autobiography
When I was little, I dreamed of becoming a flight attendant, a lawyer, an architect, and a doctor. I never saw myself become a nurse someday. I must admit that my only motivation for pursuing a nursing degree in college was to get to the United States and make good money. But I didn't think that I would someday love the profession I never even imagined doing. It is for this reason that I believe that nursing is a calling. Being a nurse has its bittersweet moments and surely takes a lot of compassion, patience, empathy, and strength. While it's true that the long hour shifts can be physically exhausting, it's witnessing the most devastating situations in life that make this profession very challenging. On the contrary, our ability to heal, save lives, and make a difference in our patients' lives and their families, truly is very rewarding and incomparable to nothing. Being a nurse for almost five years has opened my eyes and changed my views about life and all other things. I first started working on a Telemetry/Neuro floor for about a year and a half before I decided to venture out and ended up working in an extremely busy ER in downtown Jacksonville, FL. I worked there for two years, and though it was a highly stressful environment, I enjoyed almost every minute of it. The ER has the kind of culture that is fast-paced, task-oriented, informative, and team driven. Having passed my certification in emergency nursing (CEN) recently, I can say that my knowledge base, assessment, and critical thinking skills, which I often use to guide me in my clinical decision making, have significantly improved since I became an ER nurse. It has molded me into a strong, hard-working, and competent nurse that I am today.
The Four Metaparadigms of Nursing
A metaparadigm is referred to as the global concepts and propositions that define a particular discipline and describes their distinction from other professions (Fawcett, 2000, p. 4). It consists of four stipulations: (1) a domain different from other disciplines, (2) all phenomena of interest to the discipline (3) a neutral perspective, and (4) a scope that’s international in nature
(Fawcett, 1996, p. 94). In nursing, there are four common interconnected basic concepts that include patient, ...
3/9/2018 OwlSearch
http://eds.b.ep.ezproxy.harford.edu/eds/delivery?sid=3b95e18f-74bb-48ad-a002-ff8f1f4500db%40pdc-v-sessmgr01&vid=4&ReturnUrl=http%3a%2f%2feds.b.ebscohos
Title:
Authors:
Affiliation:
Source:
Publication Type:
Language:
Major Subjects:
Minor Subjects:
Abstract:
Journal Subset:
Special Interest:
ISSN:
MEDLINE Info:
Entry Date:
Record: 1
Lateral Violence in Nursing and the Theory of the Nurse as Wounded
Healer.
Christie, Wanda; Jones, Sara
Arkansas Tech University, Russellville, AR
Assistant Professor and Psychiatric/Mental Health Specialty
Coordinator, University of Arkansas for Medical Sciences (UAMS)
College of Nursing, Little Rock, AR
Online Journal of Issues in Nursing (ONLINE J ISSUES NURS),
Jan2014; 19(1): 1-1. (1p)
Journal Article - anecdote
English
Work Environment -- Psychosocial Factors
Bullying -- Prevention and Control -- In Adulthood
Nurses -- Psychosocial Factors
Nursing Theory
Adult; Violence -- Classification; Students, Nursing; New Graduate
Nurses; Job Satisfaction; Stress, Psychological; Burnout, Professional --
Risk Factors; Patient Safety; Human Development; Empathy; Metaphor
Lateral violence (LV), a deliberate and harmful behavior demonstrated in
the workplace by one employee to another, is a significant problem in
the nursing profession. The many harmful effects of LV negatively
impact both the work environment and the nurse’s ability to deliver
optimal patient care. In this article, the authors explain how Conti-
O’Hare’s Theory of the Nurse as Wounded Healer can be used in
situations of lateral violence to resolve personal and/or professional
pain, build therapeutic relationships, and promote positive work
environments. A working model of the theory is applied to the
experience of LV in nursing to demonstrate the nurse’s path from being
the ‘walking wounded’ to becoming a ‘wounded healer.’ Implications of
this theory for promoting the process of healing and creating an
environment that disenables violence are presented; an example is
provided. The authors conclude that both practitioners and managers
must be aware of the occurrence of LV and of the need for healing. They
note that the ‘journey of the walking wounded’ is an ideal pathway to
bring about this healing. As nurses promote health in their patients, they
must also promote health in themselves and one another.
Core Nursing; Double Blind Peer Reviewed; Editorial Board Reviewed;
Expert Peer Reviewed; Nursing; Peer Reviewed; USA
Emergency Care; Nursing Education; Occupational Therapy;
Psychiatry/Psychology
1091-3734
NLM UID: 9806525
20140225
3/9/2018 OwlSearch
http://eds.b.ep.ezproxy.harford.edu/eds/delivery?sid=3b95e18f-74bb-48ad-a002-ff8f1f4500db%40pdc-v-sessmgr01&vid=4&ReturnUrl=http%3a%2f%2feds.b.ebscohos
Revision Date:
DOI:
Accession Number:
Database:
20150710
http://dx.doi.org/10.3912/OJIN.Vol19No01PPT01
104034835
CINAHL Plus with Full Text
Lateral Violence in Nursing and the Theory of the Nurse as W ...
Getting Your Feet Wet Becoming a PublicHealth Nurse, Part 1.docxgilbertkpeters11344
Getting Your Feet Wet: Becoming a Public
Health Nurse, Part 1
Lee SmithBattle, R.N., D.N.Sc.,
Margaret Diekemper, R.N., M.S.N., C.S.,
and Sheila Leander, R.N., M.S.N.
Abstract While the competencies and theory relevant to public
health nursing (PHN) practice continue to be described, much
less attention has been given to the knowledge derived from
practice (clinical know-how) and the development of PHN
expertise. A study was designed to address this gap by recruiting
nurses with varied levels of experience and from various practice
sites. A convenience sample of 28 public health nurses and seven
administrators/supervisors were interviewed. A subsample, com-
prised of less-experienced public health nurses, were followed
longitudinally over an 18-month period. Data included more
than 130 clinical episodes and approximately 900 pages of tran-
scripts and field notes. A series of interpretive sessions focused
on identifying salient aspects of the text and comparing and
contrasting what showed up as compelling, puzzling, and mean-
ingful in public health nurses’ descriptions. This interpretive
analysis revealed changes in understanding of practice and cap-
tured the development of clinical know-how. In Part 1, we
describe the sample, study design, and two aspects of clinical
knowledge development—grappling with the unfamiliar and
learning relational skills—that surfaced in nurses’ descriptions of
early clinical practice. In Part 2, which is to be published in the
next issue of Public Health Nursing (SmithBattle, Diekemper, &
Leander, 2004), we explore gradual shifts in public health nurses’
understanding of practice that led to their engagement in
upstream, population-focused activities. Implications of these
findings for supporting the clinical learning of public health
nurses and the development of expertise are described.
Key words: clinical knowledge, community health nursing,
home visiting, public health nursing.
While the competencies and theory relevant to public
health nursing (PHN) practice continue to be described
(Kenyon et al., 1990; Bramadat, Chalmers, & Andrusyszyn,
1996; Block et al., 2001), much less attention has been
given to the knowledge derived from practice (clinical
know-how) and the development of PHN expertise. This
study was designed to address this gap and to draw
on scholarship regarding the role of experience, percep-
tion, embodiment, and engaged reasoning in the develop-
ment of expertise (Schon, 1983/1994; Dunne, 1993;
Benner, Tanner, & Chesla, 1996; Dreyfus & Dreyfus,
1996; Benner, 1999, 2000a; Benner, Hooper-Kyriakidis,
& Stannard, 1999). In describing the experiential gains,
ethical discernment, and perceptual acuity central to clin-
ical expertise in acute care settings, Benner and her col-
leagues (1984, 1996, 1999, 2000b) have articulated crucial
distinctions between theoretical, applied knowledge
(knowing-that) and the practical, engaged reasoning
(knowing-how) that responds to.
Discussion 1 GeorgeIntroduction Teamwork is a significant aVinaOconner450
Discussion 1 George
Introduction
Teamwork is a significant aspect of health care delivery. With the increasing complexity and specialization of clinical care, healthcare workers have
to learn more complicated methods and procedures to achieve the desired patient outcomes. Teamwork is associated with reduced medical errors and
improve patient safety. Additionally, teamwork reduces staff burnout since a healthcare professional team is responsible for patient welfare (Zajac et al.,
2021). Various strategies are key to ensuring effective teamwork for better patient outcomes.
Strategies for effective teamwork during patient care
Effective communication across staff members of a clinical team increases teamwork efficacy, leading to improved patient outcomes. Working
towards a common goal, effective communication expands the traditional roles of each member to make decisions as a team (Zajac et al., 2021). One
particular strategy that worked for my clinical team is goal setting at the beginning of the scheduled activities so that each member has a clear purpose
for their roles for the day. Several studies also agree that goal setting provides the direction for implementing procedures and coordinated care.
Organizing regular meetings and using digital communication platforms such as emails and WhatsApp groups to convey information relating to patient
care to team members and debate suggestion is key to improving performance and, ultimately, patient outcomes.
Another effective team strategy is collaboration. By definition, health care involves multiple disciplines- nurses, doctors, and health care specialists
in different fields, working together, communicating often, and sharing resources (Zajac et al., 2021). A clinical team is made up of professionals of
different health specialities and responsibilities. Cumulatively, these differences contribute to the overall patient well-being and safety. The different
teams contribute to patient outcomes by understanding the patient presenting illness, asking them probing questions regarding their situation, making
an initial evaluation, discussing, and providing a recommendation based on their findings.
Strategies for ineffective teamwork during patient care
It is common for challenges to arise during teamwork. According to Hendrick et al. (2017), some of the most common challenges that impede a
team’s efforts to improve patient care include a lack of commitment of team members, different individual team members’ goals, and conflict
about how the team members individually relate to the patient. The input of individual members is vital to realizing the overall team’s goal. Therefore,
each member must demonstrate full commitment to the course of the team. Also, if the goals of the individual members do not align with the team’s
goal, then they might be less committed to achieving the team’s goal (Rawlinson et al., 2021). The healthcare team should help the patient understand
that their care is multidisci ...
ASSESS THE LEVEL OF STRESS IN NURSES OFFICESS RELATED TO JOB STATISFACTION AT...SachinKumar945617
INTRODUCTION & REVIEW OF LITERATURE OF ASSESS THE LEVEL OF STRESS IN NURSES OFFICESS RELATED TO JOB STATISFACTION AT VARIOUS HOSPITAL
IF U WANT TO MAKE YOUR RESEACRH, PROJECT, PPT ETC CONTACT ME ON
EMAIL SACHINGONE220@GMAIL.COM
REFERENCES FOR THE TWO ARTICLESQUANTITATIVEARTICLE 1McIe, S.docxdebishakespeare
REFERENCES FOR THE TWO ARTICLES
QUANTITATIVE
ARTICLE 1
McIe, S., Petitte, T., Pride, L., Leeper, D., & Ostrow, C. L. (2009). Transparent film dressing vs. pressure dressing after percutaneous transluminal coronary angiography. American Journal of Critical Care, 18(1), 14–20.
QUALITATIVE
ARTICLE 2
Osterman, P. L., Asselin, M. R., & Cullen, H. A. (2009). Returning for a baccalaureate: A descriptive, exploratory study of nurses’ perceptions. Journal for Nurses in Staff Development, 25(3), 109–117.
J O U R N A L F O R N U R S E S I N S T A F F D E V E L O P M E N T � Volume 25, Number 3, 109–117 � Copyright A 2009 Wolters Kluwer Health l Lippincott Williams & Wilkins
One critical role of the staff development spe-cialist is to facilitate competence and contin-
ued professional development of staff (American
Nurses Association, 2000). One approach to this is to
foster an environment which encourages staff to
advance academically, be it from the diploma or
associate’s degree to the baccalaureate level or
beyond. This is especially timely given the push for
Magnet recognition in many hospitals and given the
spotlight that has been placed on quality outcomes
and a culture of safety. Furthermore, although hos-
pitals struggle with fiscal challenges, the financial
benefit of supporting nurses who pursue advanced
education may not be immediately visible to admin-
istrators, but staff development specialists realize the
value of such a move, especially about improving
patient outcomes and enhancing patient safety.
When examining the impact of nurses’ educational
preparation on patient outcomes, Aiken, Clarke, Cheung,
Sloane, and Silber (2003) recognized
a statistically significant relationship between the propor-
tion of nurses in a hospital with bachelor’s and master’s
degrees and the risks of both mortality and failure to
rescue. . .Each 10% increase in the proportion of nurses
with [bachelor’s or master’s] degrees decreased the risk of
mortality and of failure to rescue. . .by 5%. (p. 1620).
Although this study has been the subject of some
controversy within the nursing profession, most
scholars agree that ‘‘[e]ducation makes a difference
in nursing practice. . .education broadens one’s knowl-
edge base, enriches understanding, and sharpens
expertise’’ (Long, Bernier, & Aiken, 2004, p. 48). The
value of these educational benefits, when applied to
patient care, is further clarified by the observation that
[n]urses constitute the surveillance system for early de-
tection of complications and problems in care, and they
are in the best position to initiate actions that minimize
negative outcomes for patients. That the exercise of clinical
judgment by nurses. . .is key to effective surveillance may
explain the link between higher nursing skill mix. . .and
better patient outcomes (Aiken et al., 2003, p. 1617).
The need for increasing numbers of baccalaureate-
prepared registered nurses (RNs) becomes more ob-
vious when viewed through the le ...
Below, I have two discussion posts from 2 of my classmates and I ne.docxtangyechloe
Below, I have two discussion posts from 2 of my classmates and I need one response for each post. Response must be at least 7 sentences and should contain 2 citations in APA style, thank you.
Student 1
Nursing shortages are not a new concept. As the Baby boomers age and more nurses retire, nurses' needs will intensify (American Association of Colleges of Nursing [AACN], 2021). The nursing industry is expected to increase 7% by 2029, with an estimated 175,900 RN openings each year through 2029 (AACN, 2021). Nursing shortages are multifactual. Nursing shortage factors include: nursing school enrolment is not growing with the demand, a significant portion of nurses are nearing retirement age, and insufficient staffing driving nurses to leave the profession (AACN, 2021). One area, in particular, that is sensitive to nursing shortages, and retention is correctional nursing. "Retention of nursing staff is more complex in a correctional facility" (Chafin & Biddle, 2013). One study noted only 20% of the nurses remained employed after three-years at this particular facility (Chafin & Biddle, 2013).
In a correctional facility, the primary focus is given to security, with healthcare being second. Providing care within a correctional setting is very different than a hospital setting. Facility security is always the focus and drive. How a nurse interacts with patients (inmates) within a facility is vastly different from a non-correctional environment. Being overly friendly or nice can wreak havoc and be deemed "over familiarizing" with inmates or been seen as a weakness by inmates creating a safety concern (Walsh, 2009). The correctional setting comes with its inherent dangers and stressors, leading to nurses' high turnover.
The prison I was formerly employed with has significantly reduced nurses due to terminations and resignments. As an employee with the Michigan Department of Corrections, a nurse can be pulled from any facility to fill the needs of another facility at any given time of which has recently happened. Marquette Branch Prison is to have nine registered nurses in total, and right now, they only have four RNs employed there. The facility has tried to offer signing bonuses to retain RNs. They have changed some procedures to make it safer for the nursing staff, such as correctional escorts when going to the cells, and have reached out to contract agencies to secure nurses. However, none of these measures have led to success. As the shortage increases, the remaining nurses are forced to work more overtime in an already demanding and stressful environment leading to an even faster turnover and increased safety concerns.
Living in a rural area already stresses the number of nurses available, and trying to recruit and retain nurses within the correctional system proves to be an even harder strain. Correctional nursing is a unique field of nursing with many added stressors. As long as there is a need for healthcare, the nursing shortage topi.
QUALITY IMPROVEMENT PROJECT: PROVISION OF GRIEF COUNSELLING TO MOTHERS WHO HA...Achoka Clifford
QUALITY IMPROVEMENT PROJECT: PROVISION OF GRIEF COUNSELLING TO MOTHERS WHO HAVE LOST THEIR BABIES.
It is a study under leadership and management course in nursing school.
It provides enough details on quality improvement projects that can be done on hospital especially to postnatal mothers who has lost their children.
It is a project that was done to reduce effects of bereavement on mothers that might lead to mental damage hence impact on quality of care in generally
Decision-Making in Nursing LeadershipNursing leadership requires.docxvickeryr87
Decision-Making in Nursing Leadership
Nursing leadership requires critical thinking and high cognitive ability as one has to make decisions regarding patient care, nurses' welfare, and team development. Nurse leaders make decisions regarding nursing practice, evidence-based practice, and points of advocacy in my organization.
While nurse leaders focus on ensuring nurses perform per the organization's expectations, they also advocate for nurses' and patients' welfare. For instance, nurse leaders had to advocate for nurses' safety, especially as they handle COVID-19 patients, ensuring they get the necessary personal protective equipment (Majers & Warshawsky, 2020). Ensuring nurses have adequate personal protective equipment further guarantees patients' safety and improves the quality of care as there is no transmission of the virus from one patient to another.
Nurse leadership focuses on issues affecting nurses, patients, and the healthcare organization. As a result, effective leadership among nurse leaders secures their decision-making on healthcare setting issues (Sfantou et al., 2017). Effective leaders identify problems in their space, gather views on how these problems can be solved, and communicate the recommendations with nurses and organizational leaders. As a nurse leader, I can be invited to the table and be an active participant in decision-making by demonstrating effective leadership and being proactive in finding amicable solutions to arising issues.
In summary, my organization makes decisions in a centralized manner where leaders decide on the way forward and communicate the recommendations to team members. While this organizational structure appears inclusive for all leaders, only effective leaders take the lead in making critical decisions regarding practice in their areas of practice.
References
Majers, J., & Warshawsky, N. (2020). Evidence-based decision-making for nurse leaders.
Nurse Leader
,
18
(5), 471-475. https://doi.org/10.1016/j.mnl.2020.06.006
Sfantou, D., Laliotis, A., Patelarou, A., Sifaki- Pistolla, D., Matalliotakis, M., & Patelarou, E. (2017). Importance of leadership style towards quality of care measures in
healthcare settings: A systematic review.
Healthcare
,
5
(4), 73. https://doi.org/10.3390/healthcare5040073
REPLY 2
In nursing, proper decision-making is essential because it aids in the collection, storage, and processing of data and the provision of knowledge and information. In carrying out and managing their activities and when working with patients, nurses depend on decisions made across all managerial levels (Namnabati et al., 2017). As one becomes more knowledgeable of the profession's decision-making process, new responsibilities and tasks emerge in the nursing sector. As a result, nurses will have to choose the right decision that best suits their needs (Ellis, 2017).Because of the scope and variety of nature programs in health care, nursing leaders must first consider the underlyin.
Dr. Katherine KolcabaComfort TheoryChapter 21FloriDustiBuckner14
Dr. Katherine Kolcaba
Comfort Theory
Chapter 21
Florida National University
NGR 5101 – Nursing Theory
Dr. Barry Eugene Graham
Introduction to
Dr. Katherine Kolcaba
Katharine Kolcaba was born and educated in Cleveland, Ohio.
In 1965, she received a diploma in nursing and practiced part time for many years in the operating room, medical–surgical units, long-term care, and home care before returning to school.
In 1987, she graduated with the first RN to MSN class at the Frances Payne Bolton School of Nursing, Case Western Reserve University (CWRU), with a specialty in gerontology.
While attending graduate school, Kolcaba maintained a head nurse position on a dementia unit. In the context of that unit, she began theorizing about comfort.
After graduating with her master’s degree in nursing, Kolcaba joined the faculty at the University of Akron (UA) College of Nursing, where her clinical expertise was gerontology and dementia care.
She returned to CWRU to pursue her doctorate in nursing on a part-time basis while teaching full time.
Introduction to
Dr. Katherine Kolcaba (Continued)
Over the next 10 years, she used course work from her doctoral program to further develop her theory. During that time, Kolcaba published a framework for dementia care (1992a), diagrammed the aspects of comfort (1991), operationalized comfort as an outcome of care (1992b), contextualized comfort in a middle range theory (1994), tested the theory in several intervention studies (Kolcaba & Fox, 1999; Kolcaba, 2003; Kolcaba, Dowd, Steiner, & Mitzel, 2004; Kolcaba, Tilton, & Drouin, 2006; Dowd, Kolcaba, Steiner, & Fashinpaur, 2007), and further refined the theory to include hospital-based outcomes (2001).
She has an extensive series of publications to document each step in the process, most of which have been compiled in her book Comfort Theory and Practice (2003). Many publications and comfort assessments also are available on her website at www.TheComfortLine.com. Kolcaba taught nursing at UA for 22 years and is now an associate professor emerita.
Kolcaba still teaches her web-based theory course once a year, and she represents her own company, The Comfort Line, as a consultant. In this capacity, she works with health-care agencies and hospitals that choose to apply comfort theory on an institution-wide basis.
She also is founder and member of her local parish nurse program and is a member of the American Nurses Association and Sigma Theta Tau.
Kolcaba continues to work with students at all levels and with nurses who are conducting comfort studies.
She resides in the Cleveland area with her husband, and near her two daughters, their children, and her mother. One other daughter resides in Chicago.
Overview of the Theory
In comfort theory (CT), comfort is a noun or an adjective and an outcome of intentional, patient/family focused, quality care.
Despite everyone’s familiarity with the idea of comfort, it is a complex term that ...
The case study discusses the potential of drone delivery and the challenges that need to be addressed before it becomes widespread.
Key takeaways:
Drone delivery is in its early stages: Amazon's trial in the UK demonstrates the potential for faster deliveries, but it's still limited by regulations and technology.
Regulations are a major hurdle: Safety concerns around drone collisions with airplanes and people have led to restrictions on flight height and location.
Other challenges exist: Who will use drone delivery the most? Is it cost-effective compared to traditional delivery trucks?
Discussion questions:
Managerial challenges: Integrating drones requires planning for new infrastructure, training staff, and navigating regulations. There are also marketing and recruitment considerations specific to this technology.
External forces vary by country: Regulations, consumer acceptance, and infrastructure all differ between countries.
Demographics matter: Younger generations might be more receptive to drone delivery, while older populations might have concerns.
Stakeholders for Amazon: Customers, regulators, aviation authorities, and competitors are all stakeholders. Regulators likely hold the greatest influence as they determine the feasibility of drone delivery.
The Team Member and Guest Experience - Lead and Take Care of your restaurant team. They are the people closest to and delivering Hospitality to your paying Guests!
Make the call, and we can assist you.
408-784-7371
Foodservice Consulting + Design
Specific ServPoints should be tailored for restaurants in all food service segments. Your ServPoints should be the centerpiece of brand delivery training (guest service) and align with your brand position and marketing initiatives, especially in high-labor-cost conditions.
408-784-7371
Foodservice Consulting + Design
Senior Project and Engineering Leader Jim Smith.pdfJim Smith
I am a Project and Engineering Leader with extensive experience as a Business Operations Leader, Technical Project Manager, Engineering Manager and Operations Experience for Domestic and International companies such as Electrolux, Carrier, and Deutz. I have developed new products using Stage Gate development/MS Project/JIRA, for the pro-duction of Medical Equipment, Large Commercial Refrigeration Systems, Appliances, HVAC, and Diesel engines.
My experience includes:
Managed customized engineered refrigeration system projects with high voltage power panels from quote to ship, coordinating actions between electrical engineering, mechanical design and application engineering, purchasing, production, test, quality assurance and field installation. Managed projects $25k to $1M per project; 4-8 per month. (Hussmann refrigeration)
Successfully developed the $15-20M yearly corporate capital strategy for manufacturing, with the Executive Team and key stakeholders. Created project scope and specifications, business case, ROI, managed project plans with key personnel for nine consumer product manufacturing and distribution sites; to support the company’s strategic sales plan.
Over 15 years of experience managing and developing cost improvement projects with key Stakeholders, site Manufacturing Engineers, Mechanical Engineers, Maintenance, and facility support personnel to optimize pro-duction operations, safety, EHS, and new product development. (BioLab, Deutz, Caire)
Experience working as a Technical Manager developing new products with chemical engineers and packaging engineers to enhance and reduce the cost of retail products. I have led the activities of multiple engineering groups with diverse backgrounds.
Great experience managing the product development of products which utilize complex electrical controls, high voltage power panels, product testing, and commissioning.
Created project scope, business case, ROI for multiple capital projects to support electrotechnical assembly and CPG goods. Identified project cost, risk, success criteria, and performed equipment qualifications. (Carrier, Electrolux, Biolab, Price, Hussmann)
Created detailed projects plans using MS Project, Gant charts in excel, and updated new product development in Jira for stakeholders and project team members including critical path.
Great knowledge of ISO9001, NFPA, OSHA regulations.
User level knowledge of MRP/SAP, MS Project, Powerpoint, Visio, Mastercontrol, JIRA, Power BI and Tableau.
I appreciate your consideration, and look forward to discussing this role with you, and how I can lead your company’s growth and profitability. I can be contacted via LinkedIn via phone or E Mail.
Jim Smith
678-993-7195
jimsmith30024@gmail.com
Org Design is a core skill to be mastered by management for any successful org change.
Org Topologies™ in its essence is a two-dimensional space with 16 distinctive boxes - atomic organizational archetypes. That space helps you to plot your current operating model by positioning individuals, departments, and teams on the map. This will give a profound understanding of the performance of your value-creating organizational ecosystem.
Comparing Stability and Sustainability in Agile SystemsRob Healy
Copy of the presentation given at XP2024 based on a research paper.
In this paper we explain wat overwork is and the physical and mental health risks associated with it.
We then explore how overwork relates to system stability and inventory.
Finally there is a call to action for Team Leads / Scrum Masters / Managers to measure and monitor excess work for individual teams.
Public Speaking Tips to Help You Be A Strong Leader.pdfPinta Partners
In the realm of effective leadership, a multitude of skills come into play, but one stands out as both crucial and challenging: public speaking.
Public speaking transcends mere eloquence; it serves as the medium through which leaders articulate their vision, inspire action, and foster engagement. For leaders, refining public speaking skills is essential, elevating their ability to influence, persuade, and lead with resolute conviction. Here are some key tips to consider: https://joellandau.com/the-public-speaking-tips-to-help-you-be-a-stronger-leader/
Employment PracticesRegulation and Multinational CorporationsRoopaTemkar
Employment PracticesRegulation and Multinational Corporations
Strategic decision making within MNCs constrained or determined by the implementation of laws and codes of practice and by pressure from political actors. Managers in MNCs have to make choices that are shaped by gvmt. intervention and the local economy.
Interdisciplinary teamwork in the emergency department: how does it work?
1. Ns. Arcellia Farosyah Putri, S.Kep., MSc
Vignette
I had a second night shift at emergency department when I was experiencing a very
bad moment with my team. Our emergency team was consisted of seven nurses
including one nurse who acted as nurses’ team leader, three emergency doctors and
two radiographers. We had six areas to cover at emergency department: triage,
trauma, non-trauma, pediatric, resuscitation and intermediate ward. Each nurse was
appointed to in charge in each area by my head nurse team. Each nurse was
responsible to take care of the patient within their covered area such as trauma, non-
trauma and pediatric. They treat the patients based on the doctors’ instruction
including laboratory and radiology check. At 1 in the morning, we missed two nurses
in the team because one nurse was sick and the other one was disappeared during the
shift, and so it was only five of us, including our nurse in charge. Moreover, because
it was weekend, patients, who came to the emergency department, was increase
significantly and some patients in resuscitation area were in a very bad condition,
even my team leader had to lend a hand to help us. There were no coordination and
lack of communication among team members that night. Everybody was busy with his
or her own tasks. The only communication, which was run that night, was only in the
term of giving instruction or hand over the patient. At this point, my team leader did
not do anything. She only focused on completing the tasks to help us treating the
patients. She was not trying to confront the misbehavior of my teammate
disappearance, who put our team in worsen situation. She was also not trying to
coordinate with the doctors. All she did was taking the doctors’ instructions again
and again, and distribute them to us, her team members. We were so overwhelmed at
that night, we try to covered other areas, where needed. Because of so much chaos
happened, we failed to observe the patients adequately. There was a patient who
came with complaint of abdominal pain and hard to micturition because we do not
have enough human resources that night, we have to make priority based on patient’s
urgency and this patient should wait a little longer. Time passed by, no one of us
remembered about the patient. The last thing I knew that, he shouted out loud because
of he was having the ureteral bleeding. He got very angry and threatened that he
wanted to report and expose this negligence to the media.
2. Ns. Arcellia Farosyah Putri, S.Kep., MSc
Interdisciplinary Teamwork in the Emergency Department:
How Does It Work?
Background
Entering 20th
century the complexities of current patient care requires specialized
healthcare professionals and also requires them to work collaboratively in order to
optimize patient care (Drinka and Clark, 2000; Hall and Weaver, 2001). This paper
aims to address issues, which are emerged from interdisciplinary teamwork in the
emergency department, as described on the vignette, and to provide possible
solutions. This paper is divided into two areas of analysis as: First, teamwork and
leadership issues in general and the second interdisciplinary teamwork system issues
in the emergency department.
Teamwork and Leadership
In clinical practice, the health care provider often faces problems that are interrelated,
complex and indefinite. Some problems are common and can be overcome easily with
a regular problem solving. However, many complex problems are uncommon and
finding the solution may cost time and effort (Drinka and Clark, 2000). According to
Thompson (2008) there are three issues which are faced by healthcare professionals
today: (1) preserving patient safety and quality, (2) lack of incentive, and (3) dealing
with lack of human resource. Besides these top three issues, healthcare professionals
today also face lack of relationships between academic and practice setting and lack
of competent people in leadership areas (Richardson and Storr, 2010; Thompson,
2008). In the healthcare setting, it is important to remember that these complex issues
can often result in patient errors, both directly and indirectly (Stelfox et al., 2006).
Thus, being aware of the consequences, establishing an effective health care team and
competent leadership may become the first steps to find a better complex solution
(Drinka and Clark, 2000; Finn, Learmonth and Patrick, 2010). Department of Health
of the United Kingdom (UK) in its publication, consistently believe that healthcare is
provided by a team and improving teamwork can increase the safety of healthcare
delivery (Department of Health, 2008a) (Department of Health, 2008b).
The word ‘team’ is widely used to refer to all groups from any workplace or area
(Finn, Learmonth and Patrick, 2010). In the healthcare setting, teamwork means “a
3. Ns. Arcellia Farosyah Putri, S.Kep., MSc
group of individuals with diverse training and background who work together as an
identified unit or system” (Drinka and Clark, 2000, p.6).
According to Drinka and Clark (2000) performance of the team really depends on its
members although organizational issues may also have the influence. Some factors
such as members’ former experiences, personal and professional attributes often
affect team’s achievements (Drinka and Clark, 2000; Firth-Cozens, 2001; Jenkins,
Fallowfield and Poole, 2001; Leonard, Graham and Bonacum, 2004; Stelfox et al.,
2006). Drinka and Clark (2000) also address that this former experience is not only in
reference to experiences with the previous team but also interpersonal experiences
with family, friends, cultural aspects and surroundings. As a result of this, each of the
team members has different characteristics from one to another (Drinka and Clark,
2000). In the healthcare setting, these diversities emerge in various subspecialty
departments or areas that may attract certain characteristics and people who share
unique goals and values for delivering care (Drinka and Clark, 2000; Kalisch and Lee,
2013). Kalisch and Lee (2013) conducted a cross-sectional study to examine the
variation of nursing teamwork components (trust, team orientation, backup, shared
mental model [SMM] and team leadership) in different units: ICU, medical-surgical,
intermediate, rehabilitation, pediatric, maternity, psychiatric, emergency department
and perioperative. Total of 3,769 staffs participated in the study. They discovered that
there were differences of nursing teamwork components in each unit. The level of
trust (0.15, p<0.05), backup (0.18, p<0.05), and SMMs (0.15, p<0.01) among team
members in the psychiatric ward was higher than in the ICU setting. Meanwhile,
backup component was higher in perioperative areas (0.24, p<0.05) than other units.
Although this research did not examine the relationship between the different
characteristics of nursing teamwork in each unit and the patient outcome, but other
researchers found a relationship between selected staff characteristic and teamwork
performance. They believe that the impact of these teams and their characteristics
determine how each team delivers care (Drinka and Clark, 2000; Manser, 2009;
Bristowe et al., 2012).
The final and the most critical component in an effective team performance is team
leadership (Larson and LaFasto, 1989). Adair as cited in Bolden et al., (2003)
recognized that there are three areas of the leader’s roles in teamwork (Action
4. Ns. Arcellia Farosyah Putri, S.Kep., MSc
Centered Leadership Model) as: Task, team and individual area. Larson and LaFasto
(1989) also identified three effective characteristics of leaders in a team: (1)
Determine visions and plans: They must know the way something could and should
be, (2) Create change: They influence their member to change as needed in order to
achieve the team’s goals, and (3) Unleash individual talent: They explore and bring
out team members’ contributing talent. These leader’s characteristics of Larson and
LaFasto is basically included within three areas of Adair’s Action Centered
Leadership Model.
Moreover, Drinka and Clark (2000) presented leadership responsibility based on
different types of team problems, which are: (1) common-simple problem, (2)
uncommon-simple problem, (3) common-complex problem, and (4) uncommon-
complex problem. When problems are simple, they occur frequently and they might
have more than one solution. Thus, any team members can take the lead (informal
leader), but the team should set rules that will help distribute the tasks. When
problems are complex, any team member can take responsibility for alerting the team.
However, the team should appointed a leader because a formal leader has more
legitimacy with the administrative and negotiation side of organization (Drinka and
Clark, 2000). Finally, based on leaders’ roles and responsibilities Drinka and Clark
(2000, p.133), define the team leaders as someone who “moves the work of the team
forward, directing the practice of healthcare toward the needs of the patient and the
viability of the system, using uncommon sense in common situations”. Many
researches indicate that the right person in a leadership role can add significant value
to any collective effort of a team (Larson and LaFasto, 1989; Manser, 2009; Hunziker
et al., 2011). Furthermore, leaders who are concerned and understand about different
characteristics of their team members and its dynamics will result in better teamwork
across units (Kalisch and Lee, 2013).
A review which is conducted by Hunziker et al., (2011) revealed that despite technical
skills, leadership skills also affect the outcome of a teamwork when performing
Cardio-Pulmonary Resuscitation. Another study run by Bristowe et al., (2012) in
clinical emergency settings explore inter-professional beliefs regarding effective
teamwork. A qualitative study involving five groups, which consists of 5 to 7
respondents each from doctors, midwives, and healthcare assistants, found that
5. Ns. Arcellia Farosyah Putri, S.Kep., MSc
effective teamwork rely on good leadership and staff experience. The importance of
leadership in the pediatric area was described in randomized trial research conducted
by Thomas et al., (2007) the result showed that lack of leadership and communication
is estimated to contributed around 70% of perinatal deaths and injuries. In addition,
there are many other researches that provide evidences in a relationship between poor
leadership and teamwork with patient outcomes in the emergency area (Salas et al.,
2008; Edelson and Litzinger, 2008; Hunziker et al., 2009).
Interdisciplinary Teamwork System in the Emergency Department
There are two key characteristics of the emergency department that should be
remembered in relation to work culture and environment and how they may affect
leadership and teamwork performance: (1) emergency department provides 24 hours
and seven days care (Milbrett and Halm, 2009) and (2) the healthcare provider at the
emergency department often deals with an uncertainty situation (Paley, 1996;
Chisholm et al., 2000). These characteristics lead to other issues, as described below:
1. Twenty-four hours and seven days care
As a result of this type of care providing, overcrowding in emergency
department become a common issue from time to time (John and Lynn, 1990;
Andrulis et al., 1991; Richardson, Asplin and Lowe, 2002; Fatovich and
Hirsch, 2003; Moskop et al., 2009). However, the number of patients coming
is imbalanced with the number of human resources that causes exhaustion
among healthcare providers (Kilcoyne and Dowling, 2007). This exhaustion
can cause cognitive and emotional strain that may impair effective individual
teamwork behavior and leadership (Gevers et al., 2010).
2. Uncertainty situation
Clinical area is an uncertain area and the emergency department is surely a
place in the hospital where an uncertainty level is extremely high.
Unpredictable patient and complex problems become the main features of the
emergency department (Shirley and Langan-Fox, 1996). To answering these
problems, it is required a complex solution from interdisciplinary healthcare
team under effective leadership (Drinka and Clark, 2000).
Drinka and Clark (2000) suggest that in complex clinical areas task distribution and
problem solving process must included a team, which consists of interdisciplinary
6. Ns. Arcellia Farosyah Putri, S.Kep., MSc
healthcare professional, to obtain optimum goals and prevent errors. Interdisciplinary
team defines as “a team whose members from many professions work together
closely and communicate frequently to optimize patient care” (Hall and Weaver,
2001, p.868). Moreover, Hall and Weaver (2001) explained there are six key concepts
of interdisciplinary teamwork, which are sharing the burden of care, understanding
equality in responsibilities and reciprocity, sharing a common goal, and trusting team
members.
Meanwhile, in the vignette, although there are healthcare professionals from several
disciplines in the emergency area, but by the process they worked individually, lack
of communication, which is by definition and concept, cannot be called
interdisciplinary healthcare professional team. In emergency department, the
healthcare professional such as doctors, nurses, etc. always assigned to a specific area
for one duration of a shift to perform a specific purpose of caring, as a team
(Fernandez et al., 2008). An experimental study was carried by Patel and Vinson
(2005) in the emergency department to look at the difference of patient outcomes that
were treated before and after team assignment system. The team consisted of
interdisciplinary healthcare professional: 1 emergency physician, 2 nurses and 1
technician. The results of this study showed association of a team assignment system
implementation with reduced percentage of patients who waited more than 3 hours for
treatment 17.8% before and 11.8% after (absolute difference -6.0%; 95% confidence
interval [CI] -4% to -8.1%), increased patient satisfaction 3.1%; 95%CI 1.0% to
5.3%), and improved coordination of care (absolute increase 3.6%; 95% CI 0.8% to
6.4%). This research has proved that the interdisciplinary team assignment system is
effective to enhance patient outcomes, both directly and indirectly. Thus, pointing to
the vignette problem of patient negligence, this type of team assignment system may
become a possible solution.
However, this type of assignment system (interdisciplinary team) can only be done
when there are multiple physicians, nurses and technicians on duty at one shift (Patel
and Vinson, 2005) and it is really difficult to be implemented in the real clinical
setting due to several reasons such as high cost and its complexity (Drinka and Clark,
2000). In detail, Drinka and Clark (2000); Hall (2005) explained that one of the
reasons why interdisciplinary teamwork is difficult to be implemented is because its
7. Ns. Arcellia Farosyah Putri, S.Kep., MSc
complexity which is emerged from the nature of healthcare professional’s training and
education cultures. Each discipline has different culture such as values, beliefs and
attitudes. These cultures affect the effectiveness of interdisciplinary teamwork
because each of healthcare professionals are trained to think critically only in their
own area of expertise and they are not aware about other areas. But Salas et al.,
(2008) answered this challenge. They conducted a meta-analysis research to examine
the relationship between team training interventions and team functioning. They
found that team training had a moderate, positive effect on team functioning (ρ =
0.34; 10% CV = 0.34; 90% CV = 0.34). Although this study was conducted in groups
that the members come from one type of discipline not interdisciplinary, but another
authors believe that several skills such as group, communication, conflict resolution,
leadership, and role blurring skills should be included in training and education
content to help improving interdisciplinary teamwork (Hall and Weaver, 2001).
Another possible solution to answering the complexity interaction among healthcare
professionals is by conducting reflective practice (Jarvis, 1992). Healthcare
professionals’ training, as has been said by Drinka and Clark, is individual based
training which conducted repeatedly in practice area after a long time it becomes habit
and more often makes healthcare professionals less aware about their surroundings
including the other area of expertise besides their area. Reflective practice acts as
their monitor to review possible things that have been missed during teamwork
process so they can achieve a better outcome (Jarvis, 1992).
In the emergency department, interdisciplinary teams often work under an
unpredictable situation with limited time period, yet the task should be done rapidly
and correctly, therefore an effective and strong leadership is needed (Rawlinson,
1990). Moreover, Drinka and Clark (2000) explained that interdisciplinary leadership
consists of six components: environment, situation, leaders, team members, power
and communication. They suggested that interdisciplinary leadership is about the
roles that are played by each of the team members. Both leaders and team members
must be aware of interchangeable roles among them depending on the environment
and situation (Drinka and Clark, 2000).
8. Ns. Arcellia Farosyah Putri, S.Kep., MSc
çèAcceptçè
èRejectç
Figure1. Essential Elements of Interdisciplinary Leadership
(Drinka and Clark, 2000, p.107)
Contrarily, on the vignette, the task distribution was detached based on profession not
as an interdisciplinary team. Doctors’ role is apart from nurses’ team. Their role was
always to give instruction of a treatment and act like a leader or coordinator of the
team all the time, which according to Xyrichis and Ream (2008) is not the basic
concept of interdisciplinary teamwork. Previous literature also showed that one of the
key concepts of interdisciplinary teamwork is the existence of shared leadership based
presenting problem (Drinka and Clark, 2000). However, other researchers argue that
shared leadership based presenting problem can only be effectively implemented in
chronic problems such as in the psychiatric area (Rosen and Callaly, 2005; Kalisch
and Lee, 2013) and cancer (Dysvik and Furnes, 2012). In these situations, the leader
can take turns among interdisciplinary team members depending on current patient
problems emerged. But due to a life saving condition, the leadership that is conducted
in the emergency department is a task-oriented situation. This means that the
leadership process demands more specific distributing tasks, assigning work, and
enforcing rules and procedures (Hunziker et al., 2011). Since the problems, which
arise, in the emergency department are often urgent problems, the leader who leads
the team in emergency condition should have all of the skills and capacities to
perform life saving. According to the world health organization’s regulation every
person, who has adequate competencies in performing life saving, is responsible to
act. Referring to this regulation, in emergency condition, doctors or other persons,
who have proven to have the best level of competency, will always be the team
Environment
Leaders: Formal and
Informal
Team Members:
Followers/Peers
Situation
9. Ns. Arcellia Farosyah Putri, S.Kep., MSc
leader. In other words, there will never be a shared leadership in the life saving
situation (World Health Organization, 2013). Nevertheless, not all patients who come
to the emergency department have a life-threatening situation. In fact, only 40% of
them are defined as a ‘true’ emergency (red triage), the rest are less emergency or not
in emergency condition (Andrulis et al., 1991). Hence, Drinka and Clark (2000)
suggested that it is important for a leader to understand the problems emerging in
different situations and match them with appropriate team practice.
There are four teamwork systems: (1) ad hoc/task group: consist of more than one
discipline/department which working together on a specific issue and then disbands
(2) a formal work group (un-disciplinary): consist of several people working together
continuously from one discipline/department, (3) formal work group
(multidisciplinary): consist of several people working together continuously from
various disciplines/departments but individual identities more important than
integrated diagnoses and do not work on team problems and (4) interactive team
(interdisciplinary team): consist of more than one discipline/department, team goals
for the patient and team, members are interdependent and allow collaboration. In
addition, of four teamwork systems, Drinka and Clark (2000) added autonomous
practice as a part of the system. Autonomous practice means that the leader requires
team members to work individually and independently in one sub-area and decides
quickly based on his/her knowledge to find appropriate solutions.
Another leadership issue in this vignette is regarding the ‘hands-on’ of nurse’s head
team. Overcrowding of the patients and lack of human resources forces the head team
to lend a hand in the emergency. Effective leadership is linked with effective
teamwork performance. Therefore, leaders who lend a hand in the emergency,
presumably become a less effective leader. The distraction, caused by performing two
different roles: team coordinating and patient caring, makes the achievement of both
roles is not optimal. This situation, tends to suffer team performance and, at the end,
the patient outcome (Hunziker et al., 2011).
The last leadership issue, arising, in this vignette is about the interaction of the head
team with the team members and how she addressed problems. According to Eagly
and Johannesen-Schmidt (2001) women’s leadership style tends to have communal
10. Ns. Arcellia Farosyah Putri, S.Kep., MSc
attributes, which means, they pay attention to people’s prosperity, act gently and
sensitively. In the workplace setting, they usually speak tentatively, sometimes
indecisively. Unfortunately, in a particular situation, which requires effective and
immediate solution, as in the vignette, these characteristics of leadership bring more
harm than good. There are two of the leader’s blind sides that can have a link with
gender leadership. First is confronts behavioral process. “Leaders who are unwilling
to confront and resolve issues associated with inadequate performance by team
members” (Larson and LaFasto, 1989, p.136). Second is a never-ending line of tasks.
“Leaders who take too many tasks for the team, who unquestioningly accept whatever
tasks, are given them” (Larson and LaFasto, 1989, p.137). They will overload the
team with tasks. These blind sides, apparently found more in women’s leadership
style than men (Larson and LaFasto, 1989). On the vignette, the first blind side
appeared when the head nurse did not do anything to confront a team member’s
behavior that left the post without any explanation on the first day. Druskat and Wolff
(2006) believe that there are two opposite effects when conducting confrontation to
resolve an issue. Conducting confrontation towards a member who breaks the rules
may have negative effects such as time consuming and emerging emotional issues
both on the member and other team members.
On the other hand, ignoring the behavioral problems may lead to a dysfunctional team
and performance. The leader should know when and how to perform confrontation.
Confront behavioral process, may become a potential solution, when it is carried out
effectively (Druskat and Wolff, 2006). The second blind side appeared when the head
nurse accepted any instruction from the doctor and not performing communication or
coordination earlier to solve the problems. At the end of the day, the results from this
chaos were ineffective team performance and patient complaints. An effective leader
should know when exactly to postpone, to distribute and to stop the tasks’ path flow
and re-arrange the strategy to solve the problem effectively and efficiently (Druskat
and Wolff, 2006).
Conclusion
Interdisciplinary teamwork is not always applicable to solve emergency patients’
problems due to their various level of urgency. Moreover, there are many factors that
should be considered when implementing this type of teamwork. Understand the
11. Ns. Arcellia Farosyah Putri, S.Kep., MSc
contributing factors and know how to address them may provide a better teamwork
performance, which as a result of this will also improve the patient outcome in the
emergency department.
Recommendation/Implication for Practice
After reviewing literature and finding evidence that discuss teamwork and leadership
issues in the healthcare setting, there are several recommendations that may help
improving teamwork performance in the emergency setting specifically and in other
healthcare contexts generally, where appropriate:
1. Overcoming lack of human resources and overcrowding patients
Hospital managers should find an effective way to overcome these two ‘old’
problems of almost every area in the hospital, especially in the emergency
department. System changing, this include revising patient’s path flow of the
emergency department, is necessary to support the implementation of an
effective team assignment system.
2. Matching team and task distribution based on the patient urgency
In the emergency department not all the patients who come are in emergency
situations (red triage). It is important to identify when, how, and what type of
teamwork systems that should be conducted based on patients’ level of
urgency. Interdisciplinary teamwork with shared leadership may not be
appropriate for a true (red triage) emergency patient.
3. Conducting leadership/teamwork training program
Working as a team is difficult and it is more difficult if the team members
come from many disciplines. Leadership/teamwork training programs can
minimize the gap among healthcare professionals and create better
understanding among them.
4. Nurturing Self-Awareness
Understanding the complex interaction among teamwork, leadership, and
contributing factors is not enough. Healthcare professionals should nurture
self-awareness through reflective learning to make sense those interactions
within the team, decide the best patient centered solution and put it into
practice.
12. Ns. Arcellia Farosyah Putri, S.Kep., MSc
References
ANDRULIS, D.P., KELLERMANN, A., HINTZ, E.A., HACKMAN, B.B. &
WESLOWSKI, V.B. (1991) Emergency departments and crowding in United
States teaching hospitals. Annals of Emergency Medicine, 20(9), 980–986.
BOLDEN, R., GOSLING, J., MARTURANO, A. & DENNISON, P. (2003) A review
of leadership theory and competency frameworks [online]. Centre for
Leadership Studies, University of Exeter. Available from: http://business-
school.exeter.ac.uk/documents/discussion_papers/cls/mgmt_standards.pdf
[Accessed 05/03/2013]
BRISTOWE, K., SIASSAKOS, D., HAMBLY, H., ANGOURI, J., YELLAND, A.,
DRAYCOTT, T.J. & FOX, R. (2012) Teamwork for Clinical Emergencies
Interprofessional Focus Group Analysis and Triangulation With Simulation.
Qualitative Health Research, 22(10), 1383–1394.
CHISHOLM, C.D., COLLISON, E.K., NELSON, D.R. & CORDELL, W.H. (2000)
Emergency Department Workplace Interruptions Are Emergency Physicians
“Interrupt-driven” and “Multitasking”? Academic Emergency Medicine, 7(11),
1239–1243.
DEPARTMENT OF HEALTH (2008a) NHS next stage review: A high quality
workforce [online]. Department of Health, London. Available from:
http://www.dh.gov.uk/en [Accessed 04/03/2013].
DEPARTMENT OF HEALTH (2008b) NHS next stage review: High quality care for
all [online]. Department of Health, London. Available from:
http://www.dh.gov.uk/en/publication [Accessed 04/03/2013].
DRINKA, T.J & CLARK, P.G. (2000) Health Care Teamwork: Interdisciplinary
Practice and Teaching, London: Auburn House.
DRUSKAT, V.U. & WOLFF, S.B. (2006) The effect of confronting members who
break norms on team effectiveness [online]. Available from:
http://pubpages.unh.edu/~vdruskat/Effect%20of%20confronting%20members.
...pdf [Accessed 30/03/2013].
DYSVIK, E. & FURNES, B. (2012) Nursing leadership in a chronic pain
management group approach. Journal of Nursing Management, 20(2), 187–
195.
EAGLY, A.H. & JOHANNESEN-SCHMIDT, M.C. (2001) The Leadership Styles of
Women and Men. Journal of Social Issues, 57(4), 781–797.
13. Ns. Arcellia Farosyah Putri, S.Kep., MSc
EDELSON, D.P. & LITZINGER, B. (2008) Improving in-hospital cardiac arrest
process and outcomes with performance debriefing. Archives of Internal
Medicine, 168(10), 1063–1069.
FATOVICH, D.M. & HIRSCH, R.L. (2003) Entry overload, emergency department
overcrowding, and ambulance bypass. Emergency Medicine Journal, 20(5),
406–409.
FERNANDEZ, R., KOZLOWSKI, S., SHAPIRO, M. & SALAS, E. (2008) Toward a
Definition of Teamwork in Emergency Medicine. Academic Emergency
Medicine, 15(11), 1104–1112.
FINN, R., LEARMONTH, M. & PATRICK, R. (2010) Some Unintended Effects of
Teamwork in Healthcare. Social Science and Medicine, 70, 1148–1154.
FIRTH-COZENS, J. (2001) Cultures for improving patient safety through learning:
the role of teamwork. Quality in Health Care, 10(2), 65-66.
GEVERS, J., VAN ERVEN, P., DE JONGE, J., MAAS, M. & DE JONG, J. (2010)
Effect of acute and chronic job demands on effective individual teamwork
behaviour in medical emergencies. Journal of Advanced Nursing, 66(7),
1573–1583.
HALL, P. (2005) Interprofessional teamwork: Professional cultures as barriers.
Journal of Interprofessional Care, 188–196.
HALL, P. & Weaver, L. (2001) Interdisciplinary education and teamwork: a long and
winding road. Medical Education, 35(9), 867–875.
HUNZIKER, S., JOHANSSON, A.C., TSCHAN, F., SEMMER, N.K., ROCK, L.,
HOWELL, M.D. & MARSCH, S. (2011) Teamwork and Leadership in
Cardiopulmonary Resuscitation. Journal of the American College of
Cardiology, 57(24), 2381–2388.
HUNZIKER, S., TSCHAN, F., SEMMER, N.K., ZOBRIST, R., SPYCHIGER, M.,
BREUER, M., HUNZIKER, P.R. & MARSCH, S.C. (2009) Hands-on time
during cardiopulmonary resuscitation is affected by the process of
teambuilding: a prospective randomized simulator-based trial. BMC
Emergency Medicine, 9(1), 3.
JARVIS, P. (1992) Reflective practice and nursing. Nurse Education Today 12(3),
174–181.
14. Ns. Arcellia Farosyah Putri, S.Kep., MSc
JENKINS, V.A., FALLOWFIELD, L.J. & POOLE, K. (2001) Are members of
multidisciplinary teams in breast cancer aware of each other’s informational
roles?. Quality in Health Care, 10(2), 70–75.
JOHN G.E. & LYNN, S.G. (1990) The etiology of medical gridlock: Causes of
emergency department overcrowding in New York City. The Journal of
Emergency Medicine, 8(6), 785–790.
KALISCH, B.J. & LEE, K.H., 2013. Variations of nursing teamwork by hospital,
patient unit, and staff characteristics. Applied Nursing Research, 26(1), 2–9.
KILCOYNE, M. & DOWLING, M. (2007) Working in an overcrowded accident and
emergency department: nurses’ narratives. Australian Journal of Advanced
Nursing, 25(2), 21–27.
LARSON, C.E. & LAFASTO, F.M. (1989) Teamwork: What Must Go Right / What
Can Go Wrong. California: SAGE Publication.
LEONARD, M., GRAHAM, S. & BONACUM, D. (2004) The human factor: the
critical importance of effective teamwork and communication in providing
safe care. Quality and Safety in Health Care, 13, i85–i90.
MANSER, T. 2009. Teamwork and patient safety in dynamic domains of healthcare:
a review of the literature. Acta Anaesthesiologica Scandinavica, 53(2), 143–
151.
MILBRETT, P. & HALM, M. (2009) Characteristics and predictors of frequent
utilization of emergency services. Journal of Emergency Nursing, 35(3), 191–
198.
MOSKOP, J.C., SKLAR, D.P., GEIDERMAN, J.M., SCHEARS, R.M. &
BOOKMAN, K.J. (2009) Emergency department crowding, Part 1—concept,
causes, and moral consequences. Annals of Emergency Medicine, 53(3), 605–
611.
PALEY, J. (1996) Intuition and expertise: comments on the Benner debate. Journal of
Advanced Nursing, 23(4), 665–671.
PATEL, P.B. & VINSON, D.R. (2005) Team assignment system: expediting
emergency department care. Annals of Emergency Medicine, 46(6), 499–506.
RICHARDSON, A. & STORR, J. (2010) Patient safety: a literative review on the
impact of nursing empowerment, leadership and collaboration. International
Nursing Review, 57(1), 12–21.
15. Ns. Arcellia Farosyah Putri, S.Kep., MSc
RICHARDSON, L.D., ASPLIN, B.R. & LOWE, R.A. (2002) Emergency department
crowding as a health policy issue: Past development, future directions. Annals
of Emergency Medicine, 40(4), 388–393.
ROSEN, A. & CALLALY, T. (2005) Interdisciplinary teamwork and leadership:
issues for psychiatrists. Australian Psychiatry, 13(3), 234–240.
SALAS, E., DIAZGRANADOS, D., KLEIN, C., BURKE, C.S., STAGL, K.C.,
GOODWIN, G.F. & HALPIN, S.M. (2008) Does team training improve team
performance? A meta-analysis. Human Factors: The Journal of the Human
Factors and Ergonomics Society, 50(6), 903–933.
SHIRLEY, D.A. & LANGAN-FOX, J. (1996) Intuition: a review of the literature.
Psychological Reports, 79(2), 563–584.
STELFOX, H.T., PALMISANI, S., SCURLOCK, C., ORAV, E.J. & BATES, D.W.
(2006) The “To Err is Human” report and the patient safety literature. Quality
and Safety in Health Care, 15(3), 174–178.
THOMAS, E.J., TAGGART, B., CRANDELL, S., LASKY, R.E., WILLIAMS, A.L.,
LOVE, L.J., SEXTON, J.B., TYSON, J.E. & HELMREICH, R.L. (2007)
Teaching teamwork during the Neonatal Resuscitation Program: a randomized
trial. Journal of Perinatology, 27(7), 409–414.
THOMPSON, P. (2008) Key challenges facing American nurse leaders. Journal of
Nursing Management 16(8), 912–914.
WORLD HEALTH ORGANIZATION (2013) Emergency response framework
[online]. World Health Organization, Switzerland. Available from:
http://www.who.int/hac/about/erf_.pdf [Accessed 30/03/2013].
XYRICHIS, A. & REAM, E. (2008) Teamwork: a concept analysis. Journal of
Advanced Nursing, 61(2), 232–241.