2 Response to Discussion questions

7th edition of APA format. 1 paragraph with scholar authors only . 2 Reference need to be include.

Discussion 1:

Leadership Strategy in Scenario 1

The goal of most medical facilities is to reduce unnecessary visits to the Emergency Department (ED). While the term “unnecessary” is relative, it generally refers to a situation whereby a specific case could have been handled differently rather than visiting the ED. As a nurse in the affected nursing home, there are many strategies that one could utilize to reduce unnecessary ED visits. The nurse should take steps to understand the reasons many patients may need emergency treatment in the first place. Research shows that ED visits are mostly caused by inadequate chronic care management (Ouslander, 2019). Moreover, this issue could be due to a weak relationship between the care team and the patients. Conditions that requite emergency care develop over time, whereby the problem that is not diagnosed early is discovered later when it is too late. Research also shows that many patients might opt for emergency care since they do not know what other options are available to them (Ouslander, 2019). Therefore, learning about patients’ use of ED is critical to implementing effective strategies. This process requires increased communication, not only with colleagues but also with patients.

Figuring out what could be the cause of high ED visits also requires adequate access to care for patients during regular hours. Primarily, a department should work towards streamlining shift transition among the care teams. Through this approach, a nursing practitioner can eliminate any doubts regarding poor access to care being the cause of high ED visits. Nurses should also increase their communication with the patients in each visit and update new developments on a platform that can be accessed by everyone. In such a case, electronic health records might be substantially useful in the nursing home. The use of technology improves access to information and reduces most of the medical errors that could lead to ED visits. Patient navigation in healthcare could prompt them to opt for emergency services rather than primary care. Research shows that some patients who have poor experiences with primary care regularly return to ED for more appropriate support (Ouslander, 2019). Therefore, removing the barriers that undermine effective primary care should be a priority for nursing leaders. When compared with individuals with normal cognitive abilities, the rate of ED visits and hospitalizations is double for Alzheimer’s and dementia patients who suffer from cognitive impairment. A few of the most common reasons for ED visits among Alzheimer’s and dementia patients are syncope, falls, and delirium (alz.org, 2017).

Some of the best strategies that nursing leaders can use to address ED concerns include promoting multiple level communication and resolving workplace issues. Research shows that effective communication in the workplace is essential for dealing with most of the ED issues (Dyess et al., 2016). A nursing leader should encourage a culture that promotes transparency within the department. Having employees interact with one another regularly can facilitate the recognition of some of the issues that could impede care. Accessing information online is not enough if employees are not aware of the strengths and weaknesses of their colleagues. Face to face interaction promotes healthy relationships and creates a culture of trust and respect. Communication also helps in humanizing the workplace. Primarily, patients and nurses should be considered as people first rather than clients and employees. Shifting the perspective towards a more human interaction improves respect and increases the level of satisfaction (Dyess et al., 2016). In such cases, patients will be more willing to share all their concerns rather than concealing some of the issues that could be detrimental to their health. For example, if a patient feels that the information shared might be misconstrued by a nurse, he or she might be unwilling to disclose it until it causes severe complications. Thus, nursing leaders should eradicate barriers to primary care through effective communication and enhancing interaction among caregivers. The team characteristics and role of the team leader is outlined in Spath, (2018), through the four stages of development. Namely, Forming, Storming, Norming, and Performing. The team leader’s role is to direct the members and provide a supportive role by helping them move through the phases of achieving the targeted goal.

Discussion 2:

For scenario 1 provided above, a great leadership style example would be a transformational leader, which Spath defines as someone who allows others to come together to figure out a new creative solution, while taking an active role along with the staff and giving praise along the way (Yoder-Wise, 2019). Keeping Alzheimer patients from going into the ED will take the kind of teamwork that is led by the staff, and facilitated by an encouraging leader, empowering them to come up with ideas based on trends they see in their day-to-day practice.

Since the nursing home is part of a organized delivery system (ODS) including the hospital and emergency department services, the nursing home staff must work first together to look at their current patients’ records and obtain data that indicates what the top reasons are for the Alzheimer’s patients frequent trips to the ED (Yoder-Wise, 2019). Next, the nursing home team must work with the nursing leader and financial officers on the revenue budget by looking at the case mix and payer mix to help them come up with the best financial decisions for changes in practice (Yoder-Wise, 2019). In addition, it may be helpful to have a discussion with patients and/or families about cost of ED visits compared to costs of other alternative (but still high-quality care) methods of meeting patients’ needs (Yoder-Wise, 2019). Sometimes patients and families are simply not aware of the high costs that are generated with each ED visit; however, with simple education patients and families can learn what circumstances would be appropriate for ED trips and what other circumstances can be addressed by a physician (on site or at the physician’s office).

Lastly, the nursing home staff and leadership should come up with ideas that are low in cost, follow Medicare and Medicaid rules and regulations for reimbursement, utilize appropriate technologies for time efficiency and cost effectiveness, and incorporate evidence-based practice research to continue with high-quality care along the way (Yoder-Wise, 2019). With the nursing home being part of an ODS, coordinating care with other entities within that health system could prove beneficial such as a home health care agency, population health departments, telehealth programs, or physical or occupational therapists as examples. One study found that home health care agencies are very effective when it comes to decreasing readmissions, but it is feasible with the right screening tools in place specific to the disease being managed such as sepsis or Alzheimer’s (Yinger et al., 2020).