Review the Meyer article, Nursing Services Delivery Theory

 

An Open System Approach,” in this weeks Learning Resources. Focus especially on the information presented in Table 1 (p. 2831) and Figure 2 (p. 2833).
Reflect on your organization or one with which you are familiar. Within a particular department or unit in this organization, identify a problem the staff is encountering.
Using Table 1 in the Meyer article as a guide, analyze the department or unit, identifying inputs, throughput, output, cycles of events, and negative feedback. Consider whether the problem you have selected relates to input, throughput, output, cycles of events, and/or negative feedback.
Think about how you could address the problem: Consider what a desired outcome would be, then formulate related goals and objectives, and translate those goals into policies and procedures.
Research professional standards that are pertinent to your identified problem.
Reflect on the organizations mission statement and values. In addition, consider how addressing this problem would uphold the mission and values, while improving the organizational culture and climate. (Depending on the organization you have selected, you may have explored these in the Week 1 Discussion.)

Write a 3- to 5-page paper (page count does not include title and reference page) that addresses the following:

Describe a department or unit within a health care organization using systems theory terminology. Include a description of inputs, throughput, output, cycles of events, and negative feedback.

Describe the problem you identified within the department or unit using an open- systems approach, and state where the problem exists using the systems theory model (input, throughput, output, cycles of events, or negative feedback).

Based on this information, explain how you would address the problem as follows:

Formulate a desired outcome.
Identify goals and objectives that would facilitate that outcome.
Translate those goals and objectives into policies and procedures for the department or unit.
Describe relevant professional standards.

Explain how your proposed resolution to the problem would uphold the organizations mission and values and improve the culture and climate.

Paper should be set up as the sample paper attached.

The purpose of this assignment is to describe open systems theory related to a large emergency department (ED) located within Community Medical Center (CMC). It further describes the input, throughput, output, cycles of events, and negative feedback of the ED. A problem of dissatisfied patients within the ED is discussed and using the system theory model it is determined where the problem exits. A desired outcome is formulated and goals are identified to facilitate the outcome. Policy and procedures are identified, and relevant professional standards are discussed. The mission, vision, and values of the organization are discussed related to the problem resolution to improve culture and climate.

Systems Theory

Systems theory is used to identify problems and understand how things work. More specifically it can be used to identify the structures of a healthcare system and its boundaries, recognize the goals of a systems and its response to internal and external forces. A systems ability to adapt is important when responding to feedback and implementing new procedures. It is important to be a leader that management has a clear idea and understands the system to effectively accomplish the organizational goals (Hayajneh, 2007). The system theory uses concepts such as, inputs, throughput, output, cycles of events, and negative feedback to explore issues. Some of these issues include examining the interactions between patients and healthcare providers, stress and burnout of staff, financing of healthcare, leadership and change in organizations, health communication technologies, and interdisciplinary healthcare teams (Ruhl & Harter, 2013).

Input of the Emergency Department

A large healthcare organization known as Robert Wood Johnson Barnabas Health has a smaller hospital called CMC. Within CMC is a large ED that sees many patients a day and has a large volume of elderly in the area. The large elderly population in the surrounding area proposes challenges for the ED to manage large volumes of patients. Inputs are resources that are able to make an output for the systems. For example physicians and nurses (Hayajneh, 2007). In the ED at CMC inputs are gathered from staff, recipients of care, resources from sister hospitals, and materials. Nurses effort, physicians time, vital sign machines, intravenous (IV) start kits and the many other materials in the hospital that make it possible for the ED to provide care. A computer system was also purchased for charting. Evidenced based practice (EBP) guides policy development to assist physicians and nurses in providing the best care possible.

Throughput and Output of the Emergency Department

In systems theory throughput is what converts materials into services (Hayajneh, 2007). In the ED at CMC nurses are trained to take vital signs, start IV therapy, perform physical assessments of patients, and learn critical thinking skills to act in emergency situations. New nurses go through extensive training period to learn how to perform the many procedures that need to be performed and identify heart rhythms correctly. This is provided in a classroom by the education department and then they have one-on-one training in the ED by an experienced nurse. Nurses are also trained on how to use the computer system and chart appropriately. In open systems theory output relates to services provided. Strong inputs and throughputs must be available to provide good quality care of services (Meyer & OBrien-Pallas, 2010). In the ED outputs are providing care to patients, providing procedures, diagnosing, discharging, and the use of the computer software to effectively chart.

Cycle of Events and Negative feedback

Cycles of events is needed to renew the system to repeat the series of events (Meyer & OBrien-Pallas, 2010). In the ED the hospital receives information through accreditation. Receiving accreditation is not easy and all parts of the hospital must work together to achieve it. The ED is important in the cardiac and stroke accreditations as we have time limits to complete procedures that must be maintained for accreditation. If accreditation is not received certain cardiac and stroke procedures cannot be completed when a patient is in need. Negative feedback is information received about operational functioning (Meyer & OBrien-Pallas, 2010). In open system theory feedback is information of data gathered used to evaluate the system to make it more effective (Hayajneh, 2007). The reviews of patient satisfaction of CMC can be considered a feedback. In the ED negative feedback is received from patient satisfaction scores and patients accounts from surveys provided by the hospital. Negative feedback is also received from statistics maintained by the hospital such as the mortality rate, hospital acquired infection rate, medication errors rate, and adverse reactions.

The Problem

CMC uses business websites such as Yelp to monitor customer reviews. The Yelp website showed CMC to be rated as one star and had multiple accounts of dissatisfied patients and most complaints were about the lack of compassion and rudeness of staff. This included nurses, physicians, and registrars. CMC responds to these reviews on Yelp asking the dissatisfied customer to contact the patient satisfaction department to discuss the feelings patients had of inadequate care. Many times when inadequate reviews are received it comes from the ED. They are then displayed in the ED for staff to see where problems exist and where improvements could be made. The problem of dissatisfied patients starts in the throughput phase. The input is having the staff and equipment available to provide the quality of care. The throughput is where the ball is dropped. Nurses are trained on everything about how to take care of the patient but they are not taught empathy or compassion. They are not taught on how to handle situations and what to say when a person is severely ill by the education staff at CMC. It is also a very stressful environment and the nurse patient ratio is high. Burnout occurs easily and a nurses attitude towards patients occurs quickly changes within a year of working. Compassion fatigue is a term used to describe the emotional and physical exhaustion from witnessing physical and emotional suffering (Hamilton, Tran, & Jamieson, 2016). It needs to be addressed at the throughput stage to make progress when the output is completed.

Desired Outcome and Goals

A long term desired outcome would be to change the communities perception of staff in the ED. A short term desired outcome would be to increase patient satisfaction scores by 20%. A goal would be to make nurses resilient to the lack of compassion. This could be achieved by providing new nurses and existing nurses with educational classes on compassion. Another goal would be to correct compassion fatigue in providers of care. To avoid compassion fatigue nurses should have support by their manager, have someone to talk to, and peer provided support. All these factors have been shown to reduce stress and improve compassion (Hamilton, Tran, & Jamieson, 2016).

Policy and Procedures

Policy and procedures that could be initiated would be every 6 months all healthcare providers must attend a compassion class provided by management. Another policy would ensure all new nurses are provided with education on how to be resilient to compassion fatigue and taught how to handle stressful situation. A policy will also be initiated to provide all healthcare providers with support by having a meeting with management. Nursing management will be required to meet with all employees once a year to discuss areas that may cause extra stress and resolutions will be developed based on employee input. A professional standard of practice in nursing is that nurses effectively communicate through all aspects healthcare. This includes developing a positive nurse-patient relationship and communicating effectively with patients (American Nurses Association, 2010). By not being compassionate nurses are not holdinh up to the highest standards of nursing practice.

Resolution Improving Culture and Climate

The mission of CMC is to promote the well-being of patients through the best nursing care and by providing the newest best practice guidelines and technology. The vision is to empower everyone for optimum health and create a relationship that centers on both patient and families. The values are referred to as CARING: compassion, accountability, respect, innovation, nursing excellence, and genuine (RWJ Barnabas Health, n.d.). Values guide the way a company navigates (Collins, & Porras, 1996). The ED at CMC was not upholding the values of the organization. By making changes the values can be achieved by being caring and providing compassion to patients. Organization culture is the unique environment of a corporation that is based on shared attitudes, values, beliefs and rules (Business Dictionary.com, 2013b). Organizational climate is the workplace environment that influences actions and job performance (Business Dictionary.com, 2013a). For both organizational climate and culture to be changed it starts with management. The current attitude is not based on compassion but based on your in the ED and we are here to save your life. Management shares the same attitude and there is no focus on compassion for the patients. Management needs to change the shared attitudes of the staff in the ED at CMC to change job performance towards patients. Management sets the stage for how employees will act and the overall culture of the department. If management follows the values and portrays it to staff they will follow suit and the culture and climate can be changed (Marquis & Huston, 2015).

Conclusion

Through the use of open systems theory it can be seen through negative feedback there is a problem in the ED at CMC with patient satisfaction. By manipulating throughput in the open system theory this can be changed through education and incentives to staff. It will then achieve the values of the organization and change the organizational culture and climate. It starts with management setting the tone. With this plan the overall perceptions of the ED at CMC should change and increase patient satisfaction, in turn, achieving the desired outcome.

References

American Nurses Association. (2010). Professional scopes and standards of practice. Retrieved

from www.nursingworld.org

Business Dictionary.com. (2013a). Organizational climate: Definition. Retrieved from

http://www.businessdictionary.com/definition/organizational-climate.html

Business Dictionary.com. (2013b). Organizational culture: Definition. Retrieved from

http://www.businessdictionary.com/definition/organizational-culture.html

Collins, J. C., & Porras, J. I. (1996). Building your companys vision. Harvard Business Review,

74(5), 65–77. Retrieved from https://cb.hbsp.harvard.edu/cbmp/pl/58471638/58471686/

3b788b580bc27ee7686979294dace72f

Hamilton, S., Tran, V., & Jamieson, J. (2016). Compassion fatigue in emergency medicine: The

cost of caring. Emergency Medicine Australasia: EMA, 28(1), 100-103. doi:10.1111/1742-6723.12533

Hayajneh, Y. (2007). Management for health care professionals series: Systems & systems

theory. Retrieved from http://www.hayajneh.org/a/readings/Systems-Theory.pdf

Marquis, B. L., & Huston, C. J. (2015). Leadership roles and management functions in nursing:

Theory and application (8th ed.). Philadelphia, PA: Lippincott, Williams & Wilkins.

Meyer, R. M., & OBrien-Pallas, L. L. (2010). Nursing services delivery theory: An open system

approach. Journal of Advanced Nursing, 66(12), 2828–2838. Retrieved from the Walden

Library databases.

Ruhl, S. M., & Harter, L. M. (2013). Systems theory as scaffold for storytelling…and other

reflections on healthcare organizing. Health Communication, 28(7), 747-748.

doi:10.1080/10410236.2012.721336

RWJ Barnabas Health. (n.d.). Nursing mission, vision, and values. Retrieved from

http://www.barnabashealth.org/Nurses/Nursing-at-Saint-Barnabas-Medical-Center/Nursing-Mission-Vision-and-Values.aspx

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