Emergency Department Overcrowding †Free Samples to Students

Question: Discuss about the Emergency Department Overcrowding. Answer: Introduction Emergency department across the world follow a triage system in order to manage the overcrowding in the department. An emergency triage basically improves the emergency care and to sort out the cases on the basis of urgency. This qualitative paper provides with an observational ethnographic approach to examine the problems faced in assessing mental health patients in the triages of the emergency department. It is a moderately regarded journal having the cite score 0.15. This journal has been published in Australia. The journal provides us with an insight of the usual problems that are faced in emergency tried for accessing the mental health patient, which would help to develop the evidence based nursing interventions that has to be conducted to mitigate the problems faced by the triage nurses. The authors of this article are Marc Broadbent, who is a registered nurse and contains a PhD in nursing from the school of nursing and Midwifery, Australia. Second author is Lorna Moxham, who is a mental health nurse and holds a PhD degree and belongs to the School of nursing, Midwifery and Indigenous health, NSW and Trudy Dwyer, who is also an RN having a PhD degree and belongs to the School of Nursing and Midwifery, Central Queensland University, Australia. The key points described to give the background of this paper are that the Australian emergency departments are the main centre for the clients having mental health illness in order to access acute health care. Although the exact number of the mental health presentations in the emergency departments is not known for sure, but the patients often have to wait in the ED waiting room till the physicians arrive which becomes difficult for the triage nurse of the emergency departments. The following paper also describes the disadvantages of the architectural set up of the triage room that makes the environment extremely noisy and undisciplined (Geelhoed de Klerk, 2012). Other factors that were focused upon were the lack of privacy (Fitzgerald et al., 2010). As per the interview taken by the ethnographer, the triage nurses desires for private rooms to deal with the mental health patients. The paper also focuses on the architectural design of the triage rooms that enhance the problem betwee n the client nurse communications. Thus this study was important as it would help to shed light on the difficulties faced by the triage nurses and to understand how the provision of quality care is balanced with the requirement to maintain the efficiency of the organization. This study also provides with the information that the there are certain important points that has to be enlisted for an ED triage that is accessibility, proper access to the examination areas, provision of modern equipments, control measure for infections, safety and confidentiality for the clients (Fitzgerald et al., 2010). A literature review was provided which focuses on the management of the patients in the waiting room of the triage and indicates that it is becoming an important area for evaluating the service delivery. Aims of research: The aim of this research is to provide information regarding the environments associated to the triage practice and mainly focuses on the management of the clients with mental health illness. This research study has been done in an ethnographic framework for observing the nursing practice emergency. This type of study is suitable for getting a deeper understanding regarding the emergency department. This paper also helps to draw attention on the interdisciplinary relationship between the specialist mental health nurse and the ED triage nurse. It can be seen that data depending on 8 weeks have been taken, which can be thought as enough time to understand the trend of a clinical setting. One emergency nurse was appointed to triage in the morning shift, two for the afternoon shift and one for the night shift. The sample population used in this design was well identified. Informal as well as formal interviews were taken from 28 triage nurses, who have received triage training and were entitled to work at the triage. The clients were never interviewed. 2 individuals and 10 group interviews were conducted with the triage nurses. Informations were tape recorded and documented which helped to strengthen the observational field data and which reflects reflexivity in the design. Recording of the interview sessions strengthened the trust worthiness of the survey. The data collection method would have been bias-free as the interviews were organized depending upon the availability of the nurses on the shift (Fitzgerald et al., 2010). The interviews taken were sufficiently trained. Face to face interaction with the participants helped to further analyze the researches. There were sufficient amount of data to evaluate the condition of the clinical setting. The participants recruited for the study was appropriate to the aims of the research. The data was collected exactly in the way that is appropriate to address the aims of the research. The relationship amongst the participants and the researcher had been adequately considered in this study. The ethical issue like maintaining of confidentiality had been addressed in this paper (Geelhoed de Klerk, 2012). This type of study can be regarded as the best possible method of sampling as it not only provided with the observational field data but also provided with the information gathered from the face to face interview taken It had helped the Ethnographer to contextualize what they are visualizing and hearing. The interview had helped the researcher to confirm the records obtained from gather observations and give a deeper understanding of the methods. The sample and the setting have been described appropriately which describes the architectural designs of the clinical setting. It helped to provide an idea regarding the different fallacies of the settings that contributed to the chaos in the ED. A systematic and comprehensive approach was taken for analyzing the data. During conducting the field study, an eclectic process was undertaken. Intuitions and ideas were documented during the field study. Extensive notes were jotted down from the taped interviews and critically analyzed to get the relevant findings. Each element of the data was analyzed and then compared with the other pieces of the data. During the conduction of the field study the ethical issues were considered. Throughout the research the four pillars of ethics have been kept in mind (Lowthian et al., 2010). All the triage nurses were imparted with prior information regarding their participation in the field study. The acknowledgement had been taken verbally and well as in fact sheets. Prior approval from the ethical committee had been obtained to continue the field study, Therefore it can be said that all the ethical perception has been addressed (Christ et al., 2010). The findings from the observational study and the interviews were relevant to the key issues. The findings were explicit and provided with a vivid description about the triage environment management. It provided with supported evidences both for and against the arguments of research. It can be known from the paper that there was a glass barrier which separated the client from the nurses and the small gap in the glass were the portals of the client- nurse communication. According to, the triage area becomes noisy and chaotic as the staffs have to raise their voices to overcome the surrounding noises. The article further focused on the requirements of the nurses for giving an appropriate care to the mental patients. Mental patients should be given special attention and should be provided with a holistic care of approach. The articles could provide how lack of confidentiality and privacy hampered the decision making process of the triage nurses. According to (Farrohknia et al., 2011) ED nurses are capable of managing to the mental health patients prior to their assessment by the doctor. According to (Christ et al., 2010) environment has immense impact on the health outcomes of the patients. Therefore the wish of the triage nurses for a private space is valid and should be addressed. According to (Christ et al., 2010) that would help to increase the safety of the mental health patients as well as the clients waiting in the waiting room. Limitations - The clients were never interviewed in the study. Interaction with the clients could have been useful for the ethnographer as that would have been an unbiased statement in part of the customer. Knowing the grievances of the customers would have enhanced the knowledge regarding the difficulties faced by the nurses in dealing with mental health patients (Lowthian et al., 2010). The perceptions of the participants reflected the social, cultural and historical context at the time of the field study. Therefore those aspects should also be considered before the analysis. Conclusion Triage nurses are usually at the first point of clinical contact with the patient and play a crucial role while dealing with a patient having a mental illness. They have to evaluate the type of illness, the vital signs and the patients explanation of emergency and the vital signs (Lowthian et al., 2010). They often face with the urgent requirements for quick decision making. Things become adverse when the client behavior changes due to the poor delivery of the care to the patients (Ganley Gloster, 2011). Recent researches have highlighted several factors that were responsible for disrupting the effective communication to the patients. This paper had rightly identified the various fallacies of the Australian triage design and the field study and the interviews has also helped to understand the possible strategies that can mitigate these problems and provides with the strategies how a mental patient can be handled with care in an emergency triage (Gorransson et al., 2008) This article indicates towards the broader scope of researches regarding the ED triage design, client and nurses experience. Relevance to nursing practice In the emergency department triage, adverse conditions are sometimes found like delay in providing the appropriate care, lack of confidentiality, failing to take decisions as whose life to save at first. These give rise to ethical challenges in the department (Geelhoed de Klerk, 2012). As per the four ethical principles of the bioethics that is respect for the autonomy, non maleficience, beneficience and Justice determines that starting point and helps one to detect the ethical challenges faced by the triage of the emergency department (Ganley Gloster, 2011). For addressing the ethical issues of the emergency department, one needs to have a more comprehensive ethical view. Additional insights are required to address a more comprehensive ethical view. The goal of the nurses should be to reduce delay and overcrowding in the EDS. In order to alleviate with the problems are different solutions proposed by the researchers like input-throughput-output process of ED crowding, lean thinking, operation research, units for observing chest pain, clinical decision units, rapid assessment zone (Wolf, 2008). As per this paper which focuses about dealing with mental health patients, it is evident that the architectural design of the triage waiting room is not enough warm, cosy or confidential for patients with mental illness. It becomes very difficult for them to communicate with the clients through the glass which makes the surrounding noisy (Wolf, 2008). Specific units should be there for attending the patients with mental illness. A separate quite space should to attend these special people. As per the study, the triage is often crowded with people like staffs, wards men and ambulance officers, which compromise the confidentiality of the patients. It should be rightly said that the triage nurse often provides appropriate care to the patient before being assessed by the doctor, in order to accomplish that a calm and peaceful environment is required (Geelhoed de Klerk, 2012). The architectural design of the health care setting makes it a very noisy environment which jeopardizes the rapid decision making and patient assessment. It is evident from the paper that there is only one main work space for the triage nurses. During heavy patient load, two triage nurses can create separate work space just by sitting next to each other, but there are no barriers between each clients and each can over hear each other, which can bring about adver se effects in the mental health patients. There should be sound attenuating tiles in the ceiling in order to prevent the outside noise to come inside and it becomes easy for them to communicate with the clients (Geelhoed de Klerk, 2012). There can be telephone triage system in order to provide after hours care to the patient (Purc?Stephenson Thrasher, 2010). Reverse triage system can be organized for enabling safe and rapid early discharge of the inpatients to promote additional capacity of the inpatients. MH client have discussed several ways that can improve the environment conducive for the mental health patient, like improving the communication between client and the staffs, using singe rooms, regarding the term MH with Well being(Geelhoed de Klerk, 2012). References Christ, M., Grossmann, F., Winter, D., Bingisser, R., Platz, E. (2010). Modern triage in the emergency department.Deutsches rzteblatt International,107(50), 892. doi:10.3238/arztebl.2010.0892 Farrohknia, N., Castrn, M., Ehrenberg, A., Lind, L., Oredsson, S., Jonsson, H., ... Gransson, K. E. (2011). Emergency department triage scales and their components: a systematic review of the scientific evidence.Scandinavian journal of trauma, resuscitation and emergency medicine,19(1), 42. https://doi.org/10.1186/1757-7241-19-42 FitzGerald, G., Jelinek, G. A., Scott, D., Gerdtz, M. F. (2010). 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