Preparedness for Nurses to Make Field Calls

Preparednessfor Nurses to Make Field Calls

InstitutionAffiliation:

Preparednessfor nurses to make field calls

Nurseshave a significant role in implementing a rapid response model inwhich they can make field calls within a microsystem (Institute forClinical Systems Improvement, 2011). The microsystem in this case isthe university’s health care system where students seek medicalcare ranging from infections, injuries, and burns. The purpose ofthis paper is to demonstrate how the nurses need to be empowered tomake field class. By scrutinizing the reports about injured studentsthat needed immediate response from nurses through making fieldcalls, it is evident that there is need to empower nurses withcommensurate resources that would enable them to perform their dutyeffectively. The strategies that this paper proposes are in theanticipation of urgent medical needs. Considering such findings, thepaper focuses on emergency nursing, which emphasizes theindividuality of the both the patient and the staff review ofjournal content emphasizes the value placed on student’s accountsof their experiences in forming nursing practice. Field calls alsotailor the patient assessment and management according to thepatient’s position on a range of issues. Clinical microsystems suchas this are often embedded in larger systems, including bothmesosystems and macro systems. The microsystem is easily understoodas the decisions that nurses make at individual level. Thisassignment focuses on re-conceptualizing the university’s caresystem, which is the microsystem to offer a path to achievingsustainable, tailored improvements aimed at providing the best carepossible to students. The quality of care of care outcomes across alllevels of the system can be no better than those achieved in theindividual clinical microsystem. Small changes in a clinicalmicrosystem like empowering nurses to make field calls, can have alarge downstream of effects and, most importantly, nurses and otherhealthcare works can be the agents of change in the institution.Clinical microsystem thinking such as the assertions andrecommendation in this paper, and methods offer a practical andstructured approach to improving quality, adding value, and reducingvariation by enabling frontline caregivers to lead the process ofchange.

Summationof Comprehensive Assessment

The5Ps assessment of the university as a microsystem and the relevantdata shows an increasing need for nurses in the institution’shospital to be equipped further to make field calls. 5 Ps of themicrosystem entails determining the purpose of the microsystem and itis fit within the overall vision of adopting a better response visionfor the university microsystem. Next, the ream identifies thepatients (students in this case) served by the microsystem and theprofessionals who work in the microsystem (the nurses and otherhealth care workers). Then, in a more challenging part of thisassessment process, the caregiving and support processes theuniversity, as a microsystem, uses to provide care and services aremapped, and the patterns that characterize the microsystemfunctioning are recognized and described.

The5 Ps of the university as a microsystem

Purpose:The purpose of implementation is to empower nurses to be moreprepared for to make field calls in the event of an emergency.

Patients:The students who are the main service recipients in the microsystemdo not have knowledge of the threshold the hospital should meet interms of emergency responses. A survey of students reveals that theyhave no idea about the vitality of the field calls to emergencyresponses. Interestingly, most nurses have articulate knowledge of atypical student patient. The student population is 15,000. Theaverage admission per day ranges from 80 to 100 students, which istwo thirds of the hospitals bed capacity. 10% of admissions areinpatient services. The average of undergraduates is 18 years, whilepostgraduates have an average age of 28 years.

Professionals:The most important professionals in the university as a microsystemare nurses because they provide response services when the studentsare injured or burned. Other supporting professionals are casualworkers who ensure that workers the health center is clean. Nurseswork in conjunction with doctors and consultants in providingspecialized care. The nurses in the microsystem are contented withthe workplace except that they need to be more empowered to respondpromptly to emergencies. By making them more prepared to make fieldcalls, they will be in a position respond promptly. These resultsemanated from a staff survey.

Process:The chart below shows the core processes in the hospital:

The diagnoses process

Filling the admissions forms for records

Verification if the student is registered for the semester

Admission or administration of drugs

Discharge

Patterns: The metrics of performance in the microsystem are recovery rates,efficiency, and social patterns. The social patterns include:

  • Adequate consultancy on ad hoc basis

  • Regular improvement meeting

LiteratureReview and Synthesis

Accordingto Diane Huber (2006), empowering nurses to receive emergency callswithin a particular microsystem is also a way of involving them indecision-making. Huber contends that decision making by nurses varieswith different governance models and may range from minimal orinformal participation to true sharing of authority andaccountability. These assertions apply to the situation in thismicrosystem: the university health care system. Huber considersimplementation of a model that gives nurses the ultimate authority tomake emergency fields calls as a unique form of empowerment thatmotivates them to respond rapidly whenever there is injury in theuniversity. Furthermore, when nurses have the authority to make thesefields calls, they recognize that they have legitimate power to makecritical decisions regarding their practice. In a model such as theone that Huber suggests, nurses would be more prepared to make fieldcalls because there is no transfer of power, but merely a change froman external to an internal locus of control. Huber explains thatauthority, in this case is not given or taken away to nurses as such,but the system simply prepares them for better response. Nurses atthe point of service are given the opportunity to be an integral partof the decision making process in averting the effects of a disaster.According to Huber, if nurses have the needed resources to make andrespond to field calls, they act on the opportunity and areresponsible for implementing changes to improve patient care qualityand the work environment. In Huber’s perspective, this kind ofempowerment is accomplished through the shared governance journeythat involves enabling nurses to make field calls at any given time.The evidence Huber gives suggests a statistically significantpositive relationship between nurses’ perception of sharedgovernance and empowerment.

Therehave also been changes in the nursing role in recent years, forexample the development of nurse practitioner roles and nurse-ledtriage. Central to both of these roles is the nurse’s key role inpatient assessment. According to Sbaih (2007) ethnographic researchstudy exploring how nurses “become” emergency nurses, there aredifferent problems that affect nurses when responding to emergencies.One of the key aspects that Sbaih critically discusses is fieldcalls. In Sbaih’s perspective, field calls empower nurses torespond to students who have been injured or burned. This is a veryvital source as far as microsystem improvement is concerned.

Stanley(2009) explores how the five Ps of assessment vitally influence thesteps that would be taken to transform a microsystem. Through thesteps that Stanly provides, it becomes easy to align field calls,which is the desired change, with the perspectives of staff in theirworking environment.

table of the reviewed articles

Study

Aim

Method

Major findings

Strengths and limitations

Diane Huber (2006)

The book explores how staff can use new communication technologies to improve the state of field calls in a microsystem such as the university

Primary research from qualitative grounded theory and participant observation

Implementation of a model that gives nurses the ultimate authority to make emergency fields calls as a unique form of empowerment that motivates them to respond rapidly whenever there is injury in the university

There are no indications of bias by the author, possibly because Huber’s work is solely based on primary research

Sbaih (2007)

The journal article provides a comprehensive discussion about field calls as an aspect of focus in a microsystem

Primary research from qualitative grounded theory and participant observation of outcomes in a microsystem that empower nurses to make field calls to save lives

Registered nurses appreciated help from staff they had high expectations in their services rather than those who would not respond promptly to emergency calls, evaded working with inexperienced team members. Time pressures limited prompt processing. RNs recognized responsibility for assigned the need for a field call framework

Investigator prejudice not considered. compound sites and large sample

Dartmouth University. (2014).

Observe the awareness of recent nursing graduates about learning to make clinical judgments.

Unstructured interviews

descriptive study, Qualitative Exploratory,

Chances of damaging credibility if registered nurses concerns not properly articulated to Drs. Experience is significant in making rapid response an during an.

Investigator prejudice not considered.

Emergency Management, (2014)

explain the factors that empower nurses decision-making in the pre-arrest period

Unstructured interviews

descriptive study, Qualitative Exploratory,

Nurses often relied on a person of authority to authorize their decisions. Found new level of responsibility when they become more empowered to respond to emergencies

Investigator prejudice not considered.

Fuller, R. (2014)

Classify the factors that may lead nurses to become agitated and foresee patient deterioration

Unstructured interviews

descriptive study, Qualitative Exploratory,

Nursing knowledge and experience influences the quality of assessment they make during emergencies. Insufficient time led to partial assessments of cases.

Investigator prejudice not considered.

Font, M.C. (2013)

Nurses knowledge and needs before, during and after difficult field call circumstances

Unstructured interviews

descriptive study, Qualitative Exploratory,

Teamwork, communication &amp were considered collaboration significant. Registered nurses concerned about feeling inadequate during emergency response. A positive learning strategy could fill this gap

Investigator prejudice not considered.

Institute for Clinical Systems Improvement. (2011)

Investigate first-hand experiences of nurses who have taken part in an in-hospital field call event or training

in-depth individual interviews,

interpretive approach

Semi-structured, Qualitative

Case study,

Nurses desired a joint team approach, sought clarification from experienced registered nurses. Some had negative comments from peers.

Inadequate to time and position in which use of insight and decision-making took place. Investigator prejudice not considered. compound sites and large sample size

Analysesand Improvement Plan Recommendation

Severaljournals and other academic work in nursing examining the economicsof emergency responses applications in a microsystem used thecost-benefits framework for this analysis (Dartmouth University,2014). The emergency Response Call System service has worked verywell and has demonstrated that the service is valuable for studentsor patients living in a particular jurisdiction. The service is lesscostly than the conventional methods using bureaucratic to respond tomedical emergencies.

Otherthan economic savings generated by an emergency call service, thereare other benefits of empowering nurses to effectively respond tomedical emergencies (Font, 2013). The intangible benefits are usuallydifficult to quantify, but should be considered when evaluating thepracticability of the service. Previous work also reveals that anemergency call service has made nurses’ services more easilyaccessible. As a result, nurses and affected students spend less timetrying to figure out how to provide basic care to an injured student.Staff requirements to do have occasional Field Call Training clinicsare imperative because nurses get invaluable information on emergencyresponse from experienced specialists. A regional practitionerattends during the consultation as well as the specialist. In otheremergency call applications, staffing costs are cut by usingspecially assigned nurses. For example, a trained nurse substitutesthe medical officer. The nurse sustains responsibility for organizingthe consultation, especially at the remote site where an accidents ora fire incident needed emergency response. Nurse-led interventionsare clinically viable and an effective way of conducting emergencycall and response services(Fuller, 2014). In its first years ofimplementation, the prompt response service in the institution hasdepended on research funding provided by the management. In thelonger term, it would seem sensible to use a proportion of thepotential savings created by the service to cover operational costs.

Thechange theory applied in this improvement plan is Lewin&quots changetheory. The main concepts in the theory are(Lewin, 1951):

Drivingforces: Driving forces are factors that push in the relevantdirection that the leader wants the institution to head hence,causing change to occur. The factors fundamentally create the impetusfor people to act in accordance with the needed change. Normally, achange of attitude is necessary as a primary driving force towardschange. The factors that act as a driving force towards change causea shift in the equilibrium in favor of the desired change. For thiscase, the driving force is the need for nurses to respond promptly tothe medical needs of students. The efficiency of the universityhealth system is essential for service delivery by nurses.

Restrainingforces: Restraining forces are factors that contradict drivingforces. They cause a reaction that opposes the need for change.Restraining factors originate from conservative individuals who areslow to embrace change. The factors shift the change equilibrium awayfrom the change the desired change. In this case, restraining forcescould be inadequate funds to implement an emergency response callsystem or a conservative management structure that is unwilling tolet nurses make critical decisions. For the change to occur, theleadership needs to first identify the restraining factors fromwithin and outside the university.

Equilibrium:In an equilibrium situation no change occurs. In this case, themanagement of the university’s healthcare system fails to agree ona set program that empowers nurses to respond during emergencies.

LeadershipStrategies Re: Implementation of the Recommendation

LeadershipCrafting of strategic vision: Fr this project to be adequatelyimplemented, the nursing leader should have the ability to define thevision of the project in the short and long-term perspective of theinstitution’s healthcare service(Fung, Lai, &amp Loke, 2009).The capability to technique a clear-cut strategic vision symbolizesan important intangible asset, which is a solution in strategyimplementation. Most plans implemented should be backed bywell-crafted vision to steer the nurses into the desired direction.Thus, for the purposes of plan implementation, leaders should be ableto formulate a vision that coincides with the intended strategy. Morespecifically, the specific individuality profile of theimplementation’s key actors in the different departments of theuniversity’s healthcare microsystem vitally determines the qualityof service.

Communications:Sometimes, strategies implementation of this type fails due to lackof two-way communication. It is, therefore, recommended the changeprocess should adopt two ways communication tools allow and solicitsquestions from nurses on issues related to the prepared strategy andits implementation(Baack &amp Alfred, 2013).The communications process should inform nurses about the innovativerequirements, tasks and activities they will perform, and,furthermore, explain the changed circumstances that characterize thechange. In this case, the university’s healthcare leadership hasthe responsibility to explain to nurses about the vitality of anddetails of the new communication system that gives them moreresponsibilities.

Useof leadership skills: the ability of nursing of leaders to make useof their range of skills to build the awareness and demonstrate thestrategy implementation procedure. Most of the strategy implementersare often aware of leadership expectations that the implementationprocess requires. Leadership should take advantage of skills andaptitudes such as, technical, theoretical, and practical skills, andhuman to create the need for transformation that can only happenthrough the proposed change. They should also the enhance strategycompletion receptivity through pass on knowledge, motivating andguiding to strategy implementation nurses.

Informationintelligence skills from leaders: IT is possible to have a have a lotof data but without commensurate information when there are nomechanisms to organize it properly in manner that extracts value fromit. Data only becomes information when it is converted to meaningfulinformation through analytics (Bulson &amp Bulson, 2011). This isdone through processing and presenting in a systematic way thatexperts can interpret and arrive at a given conclusion. When datagoes through this process it becomes information becomes because itcan guide the organization to make decisions based on it. The nurses’field calls to affected hostels present a great deal of data thatshould first be collected and processed to become information thatcan guide its management to make decisions that can enhance it. Thenursing leaders ought to ensure that the response database serves asthe center of all this data. The information intelligence componentfacilitates the utilization of the resultant information to make theright decisions about the direction of the business.

Visibilityinto the workflow refers to the possibility to locate and know thestatus of work in a system so that they can be monitored and advanced(Hynes, 2006). Visibility into the workflow can enable nurses tomodify response processes or to introduce others that can respond tomarket changes. It can also facilitate implementation of changebecause less training and testing is required to do so. Furthermore,its presence automates business rules in an organization for eachtask performed throughout the production process. Visibility into theworkflow lowers costs and increases the rate of productivity. It alsoimproves quality, organizational flexibility, operational efficiency,and competiveness (Department of Veteran Affairs, Department ofDefense, 2009). These parameters would definitely lead to the successof nurses.

Exceptionscreens are those screens in an information system that shows thesource of an entry in the call process during an emergency (EmergencyManagement, 2014). It is also common to aspects relating to thealternate part and the Replacement Part of supplies data in thesystem. Understanding how they work in an information systemfacilitates orders for the nurses as and when they to needs make thecall. An exception screen automatically displays the identity of thesupplier in question.

Aleader with strategic management skills will ensure that field callsoperations in emergency are enhanced over and over (Goodhue et al.,2010). They would also have to be retrained to acquire more skills inparticular areas of operation. Through it, employees are able totrack deliveries in good time and go to work points that requiretheir services. This is the resultant business intelligence thatarose when from adopting the system. Thus, it was able to bring downcustomer refunds. Improved student satisfaction led to more sales andsustained loyalty. All these factors at play reduced the effects ofslow response that students could face because of the absence ofefficient and supportive information intelligence.

Aleader that appreciates change, especially in technology wouldencourage the implementation of the process (Center for Biosecurityof UPMC, 2009). Using the database enables nurses to avoid the thickand usual layer of intermediaries. Their services are, therefore,dispensed to students in real time, making them effective than beforethe implementation of field calls capacity programs. Nurses ought toestablish a reputation as the source of high-quality services forstudents. Real-time data analysis is the reason nurses can makevaluable operational decisions hence, dispensing their services whenstudents need them most. They, therefore, identify quality as themost vital element of their service mantra.

Nurseleadership publications have underscored the need for managers andeducators’ to prepare student nurses and staff nurses in disasterpreparedness so they can respond promptly and efficiently. Leadersare expected to go further than the fundamentals of evaluatingprotocols and procedures and provide nurses with the skills needed tomake appropriate choices during tough times. Therefore, nurse leadersneed to have dialogue with staff about values and ethics that willapply during a disaster. These fundamental philosophies andprinciples will guide decision making in a situation where nursesneed to respond promptly

Prioritizationas a leadership strategy: Prioritization entails deciding which needsor problem require immediate action and which ones could be delayeduntil a later date because they are not urgent, Prioritization in aclinical setting is a process that includes envisioning clearlypatient outcomes but also includes predicting possible problems ifanother task is performed. Nurses use their experience in observingpatient progression through pathways to decide the task to performfirst. After working in a clinical setting from a while, a nurseobtains the experience on complications that may emerge inassociation with a particular clinical condition. As a guide to thecase in question, there are steps that determine the task that anurse should prioritize. The following criterion specifies the steps:

  1. Is it life threatening or potentially life threatening if the task is not done? Would another patient be endangered if the task is not done or the task is done later?

  2. Is the task essential for patient or staff safety?

  3. Is it essential to the medical or nursing plan care?

Delegationas a leadership strategy: Delegation is the act of transferring theauthority to perform a particular nursing task to a competentindividual in a selected situation (Institute for Clinical SystemsImprovement, 2011). The person selected to perform the task must becompetent. In this case, The Licensed Practicing Nurse is thecompetent individual to perform delegated actions for the registerednurse (RN). The RN selects the particular task given their knowledgeof the individual patient’s condition and that of their particularcircumstance. Because the nurse is prepared and has the knowledge andskills about it, the RN chooses to make judgments of this kind andshould be able to defend the choice made. Licensure and statute legalprovisions oblige nurses to delegate on a unique situation, patients,a member of staff involved, and to provide on-going follow-up.

Principlesof delegation

  • Frequently, the registered nurse (RN) must delegate the tasks when the levels of the members of staff are mixed. For example, the level may include LNP and RN staff members.

  • Before delegation, it is important to identify the role of the available staff.

  • The RN is responsible for providing care to the public within the professional and legal standards of the nursing practice.

  • Understanding legal authority, responsibilities, and accountability in delegation is essential for the nursing practice.

  • Nurses should be familiar with the delegation aspects of the Nurse Practice

Guidingnurses to utilize role dimensions: Although nurses are trainedprofessionals, they need to ware of advanced practices and nursingroles through their leadership within a microsystem. For this processto take effect, the leadership must ensure that nurses can articulateall advanced practices in emergency responses. It is theresponsibility of the leader to raise the level of awareness in themicrosystem so that nurses and other healthcare professionals caninternalize the vitality of introducing a field calls network.Nursing roles should actively shape roles allows the attainment ofnursing role dimensions that compliment patient care. These processescontribute to effective integration of role dimensions in themicrosystem.

Facilitatingsupport networks and mentorship programs: Nursing leaders should havethe capacity to integrate advanced nursing practices into thenetworking support, and mentorship programs. Some of the supportprograms that the nursing can instate are professional developmentpractices. The networking systems the leader can institute are theestablishment of Nursing practitioners and Clinical Nurse Specialistsjoint committee and interest groups that aim to facilitate fieldcalls. Leaders who finance and support CNS and NP roles in effectingan effective field calls services. Infrastructural support for fieldcalls includes providing phones at strategic points, availingfirst-aid kits and ambulances. Implementation and demonstrationinitiatives are the best action plans that nursing leaders caninstitute as follow-up initiatives.

Conclusion

Whennurses are actively involved in the rapid process in a microsystem,they become part of the process rather than recipients of patientswho need nursing care. It is also vital for nurses to have afirst-hand experience of the scene of injury so that they can advisedoctors on the based on what they know about the scene of injury orburn. A student who is injured in a hostel by a blunt object isguaranteed. When nurses are having the resources to make field callsthey gain the correct insights they need to enhance the quality ofservices in the microsystem.

References

Baack,S., &amp Alfred, D. (2013).Nurses’ preparedness and perceivedcompetence in managing disasters. Journal of NursingScholarship,45(3), 281-287. doi:10.1111/jnu.12029

Bulson,J., &amp Bulson, T. (2011). Nursing process and critical thinkinglinked to disaster preparedness. Journal of Emergency Nursing,37(5),477-483. doi:10.1016/j.jen.2010.07.011

Centerfor Biosecurity of UPMC. (2009). Hospitals rising to the challenge:The first five years of the U.S. hospital preparedness program andpriorities going forward. Retrieved May 3, 2015, fromhttp://www.upmchealthsecurity.org/our-work/pubs_archive/pubs-pdfs/2009/2009-04-16-hppreport.pdf

Centerfor Emergency Preparedness and Disaster Response.(2013). A quickguide to FEMA reimbursement for acute care hospitals. New Haven: TheYale New Haven Health System Center for Emergency Preparedness andDisaster Response. Retrieved May 3, 2015, fromhttp://www.ynhhs.org/emergency/pdfs/FEMA-ACH_ReimbursementGuide.pdf

DartmouthUniversity. (2014). Dick’sHouse: Dartmouth College Health Service. RetrievedMay 3, 2015, from http://www.dartmouth.edu/~health/

DartmouthUniversity.(2014). HealthPromotion and Wellness.Retrieved May 3, 2015, from http://www.dartmouth.edu/~healthed/

Departmentof Veteran Affairs, Department of Defense. (2009). VA/DoDclinical practice guideline for management of substance use disorders(SUD).Washington (DC): Department of Veteran Affairs, Department ofDefense. Retrieved fromhttp://www.guideline.gov/content.aspx?id=15676&ampsearch=alcohol+intoxication

EmergencyManagement, (2014).TheUniversity of Rhode Island.Retrieved May 3, 2015, from http://www.uri.edu/emergency/

Font,M.C. (2013).UConnPart 3: UITS Emergency Operations Plan.University of Connecticut Emergency operations.

Fuller,R. (2014). Uconnhealth emergency department.University of Connecticut Health Center. Retrieved May 3, 2015, fromhttp://www.uchc.edu/patients/services/emergency/

Fung,W., Lai, K., &amp Loke, A. (2009).Nurses` perception of disaster:Implications for disaster nursing curriculum. Journal Of ClinicalNursing, 18(22), 3165-3171. doi:10.1111/j.1365-2702.2008.02777.x

Institutefor Clinical Systems Improvement. (2011).Rapid Response Team – Health Care Protocol: Fourth Edition/July2011.Retrieved May 3, 2015, fromhttps://www.icsi.org/_asset/8snj28/rrt.pdf

Goodhue,C., Burke, R., Chambers, S., Ferrer, R., &amp Upperman, J.(2010).Disaster Olympix: A unique nursing emergency preparednessexercise. Journal Of Trauma Nursing, 17(1), 5-10.doi:10.1097/JTN.0b013e3181d915f0

Hynes,P. (2006). Reflections on critical care emergency preparedness: Thenecessity of planned education and leadership training fornurses.Dynamics,17(4), 19-22.

Lewin,K. (1951). Field Theory in Social Science. London: TavistockPublications.

Appendices

Appendix1

Tableof Evidence: Review of Literature

Topic: Field Calls protocols at Universities similar to the system

Study

Aim

Method

Major findings

Strengths and limitations

Diane Huber (2006)

The book explores how staff can use new communication technologies to improve the state of field calls in a microsystem such as the university

Primary research from qualitative grounded theory and participant observation

Implementation of a model that gives nurses the ultimate authority to make emergency fields calls as a unique form of empowerment that motivates them to respond rapidly whenever there is injury in the university

There are no indications of bias by the author, possibly because Huber’s work is solely based on primary research

Sbaih (2007)

The journal article provides a comprehensive discussion about field calls as an aspect of focus in a microsystem

Primary research from qualitative grounded theory and participant observation of outcomes in a microsystem that empower nurses to make field calls to save lives

Registered nurses appreciated help from staff they had high expectations in their services rather than those who would not respond promptly to emergency calls, evaded working with inexperienced team members. Time pressures limited prompt processing. RNs recognized responsibility for assigned the need for a field call framework

Investigator prejudice not considered. compound sites and large sample

Dartmouth University. (2014).

Observe the awareness of recent nursing graduates about learning to make clinical judgments.

Unstructured interviews

descriptive study, Qualitative Exploratory,

Chances of damaging credibility if registered nurses concerns not properly articulated to Drs. Experience is significant in making rapid response an during an.

Investigator prejudice not considered.

Emergency Management, (2014)

explain the factors that empower nurses decision-making in the pre-arrest period

Unstructured interviews

descriptive study, Qualitative Exploratory,

Nurses often relied on a person of authority to authorize their decisions. Found new level of responsibility when they become more empowered to respond to emergencies

Investigator prejudice not considered.

Fuller, R. (2014)

Classify the factors that may lead nurses to become agitated and foresee patient deterioration

Unstructured interviews

descriptive study, Qualitative Exploratory,

Nursing knowledge and experience influences the quality of assessment they make during emergencies. Insufficient time led to partial assessments of cases.

Investigator prejudice not considered.

Font, M.C. (2013)

Nurses knowledge and needs before, during and after difficult field call circumstances

Unstructured interviews

descriptive study, Qualitative Exploratory,

Teamwork, communication &amp were considered collaboration significant. Registered nurses concerned about feeling inadequate during emergency response. A positive learning strategy could fill this gap

Investigator prejudice not considered.

Institute for Clinical Systems Improvement. (2011)

Investigate first-hand experiences of nurses who have taken part in an in-hospital field call event or training

in-depth individual interviews,

interpretive approach

Semi-structured, Qualitative

Case study,

Nurses desired a joint team approach, sought clarification from experienced registered nurses. Some had negative comments from peers.

Inadequate to time and position in which use of insight and decision-making took place. Investigator prejudice not considered. compound sites and large sample size

Appendix2

FirstResponder Protocol for Dorm Room Calls

InitialApproach to the Scene (As utilized by EMTs)

(Source:Swanson,2014, First Responder Patient Care Protocols)

  1. Following the dispatch to a call, prior to arrival, the First Responder crew should organize their approach upon arrival

  2. It should be predetermined which crew member will perform the primary assessment and which will perform other duties

  3. Depending on the nature of the incident, particular equipment and supplies will be carried to the patient

A.Medical incidents:

 Airwaysupplies and oxygen

 AED

 Basiclife support supplies

 Medications

B.Trauma incidents:

 Airwaysupplies and oxygen

 BasicLife support supplies

 AED

4.When approaching the scene, each crewmember should ensure safety forthemselves (following OSHA policies and procedures)

5.An initial scene evaluation is vital to request the necessarypersonnel or resources required to properly manage the incident

6.Once safety and resources are verified, the patient is evaluated

7.If more than one patient is involved, a rapid triage assessment mustbe performed

A.It is a judgment as to which patient to evaluate first obviouslypatients appearing critical, either by mechanism of injury orexternal appearance, should take precedence

B.Regardless of patient number, an organized approach for a primaryassessment should be consistent

8.When initially confronting any patient, the EMT should alwaysintroduce self and provide reassurance

A.It is important, for it lets the patient know that you are a trainedindividual (not a bystander) who is experienced at dealing with thesetypes of incidents

9.Following the introduction, the patient`s chief complaint should beelicited

10.Patient evaluation should always be performed in a controlledenvironment conducive to privacy and protection

A.When patients are found outside, particularly, they should berelocated and evaluated in private if possible

Appendix4

MedicalInitial Assessment (Source:Swanson, 2014, First Responder PatientCare Protocols)

Airway

  1. Assess airway patency

    1. Ask all patients: “How is your breathing?”

      1. Answer to the question (regardless of answer) notes an open, patent airway

  2. Open airway using standard maneuvers (head tilt/chin lift or jaw thrust) as indicated

  3. Insert oral-pharyngeal airway or nasal-pharyngeal airway as indicated

  4. Suction as needed to maintain open airway

  5. Assess patient’s ability to protect airway per Airway Protocols

Breathing

  1. Assess respiratory effort and rate

  2. Assess breath sounds

    1. Auscultate left &amp right

    2. Auscultate anterior &amp posterior

  3. Assess pulse oximetry

  4. Administer supplemental oxygen as indicated (nasal cannula, face-mask, BVM) based on respiratory assessment, SpO2, and patient’s clinical status

Circulation

  1. Assess presence and quality of pulses

    1. Palpate radial, femoral, or carotid pulse (in order)

  1. Control any gross hemorrhage by direct pressure

  2. Assess skin color and level of consciousness

  3. Obtain baseline vital signs

Disability

  1. Assess neurological status

    1. Assess whether alert responds to voice response to pain unresponsive

    2. Assess GCS &amp if any focal neurological deficits

OtherConsiderations

  1. Obtain appropriate history from patient (and/or referring facility if interfacility transfer)

  2. Perform focused physical exam based on patients history and presentation

  3. Additional care per appropriate patient care protocol

  4. Reassess patient throughout transport and adjust care as

  5. At any point there is a change in the patient’s condition restart reassessment