The healthcare system is focused to improve the quality of life and safety of the community with various diagnosis, treatment and prevention plan that can be involved in the reduction of the health impairments in human beings. The work of the healthcare professional is to provide primary, secondary and tertiary care to the public health. The delivery of modern care varies from country to country and the also depends on trained professionals and paraprofessionals who all work together as a team. According to Purnell (2012), the culture of the healthcare workplace in the present is influencing in the delivery of person-centered care, clinically effectual, and progressing in the direction of improvement in response to the changing environment. Evidences reveal the fact in the year 2000, healthcare especially organizational and the corporate cultures gave too much attention on culture rather than the primary culture provided to the patients. As discussed by Grol et al. (2013), gathering on expertise with practice development which is a complex methodology that has the objective to attain effectual workplace cultures which are person-centered, in dissimilar healthcare settings can be applied in order to remove the toxic culture out of the healthcare sector. The respiratory specialty ward in a healthcare arena, there exist elevated amount of toxicity in the environment. Such toxic or inappropriate culture can produce negative patient health outcome. This report will focus on the caring culture that predominant in this specialty and the recommendations of improvement through a project will be discussed.
According to Jeffreys (2015), any established work culture is resistant to change and can be unreceptive to those who are trying to bring any modification. History reveals “Severe acute respiratory syndrome (SARS)” broke in Hong Kong in the year 2003. Around 1750 cases have been detected with SARS cases in the country between four months of 2003 and almost 286 people died during that period. The SARS has gone through three different phases. First one was outbreak in the teaching hospital where the students and hospital employees were affected. The second phase involved the outbreak in the community. The third phase is the elevation of the number cases which was estimated around eight hospitals and 170 housing estates in the city. However, in the recent past the work culture has taken a turn and has recognized the active organizational support to be an essential strategy in the achievement of potential practice development. (Dixon-Woods et al. 2013).
During this phase the prevention method that was adopted by Hong Kong involved five major steps. Firstly, education based on prevention and publicity was given, secondly, tracing of the infection source was done and thirdly, the five major controls were introduced. These controls involve isolation, surveillance, termination of the education sessions, epidemiological information exchange, and temperature check of the travelers at the entry and exit point and campaign based on cleansing. Moreover, the collaboration and communication between Mainland China and WHO was strengthened during this phase. Lastly, a diagnostic test related to SARS was developed. “The Pilot Scheme of Hospital Accreditation” was launched in the year 2009 in the month of May in Hong Kong which adapted the “Australian Council on Healthcare Standards (ACHS).” This helped in assessing feasibility of this accreditation, evaluation of readiness, recognize the infrastructure and implications of resources and recommendation of the future healthcare model.
Patient centered care can be defined as an approach which has gained much emphasis in the present days. It is an approach where the healthcare professionals constantly adopt patients’ perspectives and then mainstream the various aspects of the healthcare system and its related process. As stated by Weaver et al. (2013), patient care is an important aspect in the medical arena for every medical professional. With the advent of the modern technology there has been a drastic in the treatment procedure over the past few years. The advancement of technology have developed an environment which creates an efficient patient care and turns out to be helpful for the patient. In the recent years patient care has become first priority for the clinicians and has flourished in the current years (Smith et al. 2013).
Until the beginning of the twentieth century patients were not segregated according to the specific disease on basis of their diagnosis. As stated by Preston and Kelly (2016), the medical advances made during the Second World War have reflected the emergence of medical specialties. Although in the mid 1990s there were more nursing specialists, in regards to the respiratory specialty, very few have fulfilled the criteria based on patient care. As discussed by Carayon (2016), the roots of the nursing practice can be traced to the care and management of patients with tuberculosis and involve roles such as TB family visitor. According to Morgan and Yoder (2012), with the advent of 1980s, the advancement in the medicines and modifications in the delivery in terms of health care continued, the outcome has elevated the number of the clinical professionals in a broad range of respiratory setup. For example, work practice within TB clinics, “Chronic Pulmonary Disease (COPD),” asthma, ventilation services, sleep apnea services and pulmonary rehabilitation programs (Brownie and Nancarrow 2013).
Evidences reveal the fact that as the number of healthcare professionals increased with time in the last 5 to 10 years, in the respiratory specialty there has been an improvement in the knowledge and psychological issues in regards to respiratory care and management (Entwistle and Watt 2013). Moreover, technologies have made significant difference in realizing the requirements of patients living in the in factious prone zone. In this arena changes in the political climate, transformation in the leadership in the health professionals, organizational modifications, rising costs, pressures on the services and quality and rapid development in the technology and medicine over the last twenty years have certainly led to the construction of fresh, innovative and more efficient ways for improving this sector (Kogan et al. 2016).
Several studies reveal the fact that with the increase in demand of the respiratory care due to the elevation in the morbidity and mortality, the roles of the health care providers have also changed. Within the past few years there has been a change in the leadership qualities in the health practitioners. Still there exist certain flaws that can be improved transformation in the leadership, teamwork, person-centered care, implementing safety and promoting open communication. According to Starfield (2016), in the contemporary health care settings related to the respiratory ward needs management and leadership skills and the professionals provide compassionate care after identifying the physical, cultural, mental and spiritual framework in which the patients associated with respiratory diseases live. As discussed by Gaugler et al. (2015), the last few years have witnessed different grades of health practitioners with the training that is required for the health assessment, diagnosis and treatment. Trainees have started understanding the significance pulmonary rehabilitation and ask for opportunities to gain initial experience in this area. Knowledge of process of administration of supplemental oxygen and the suitable collection of patients since this is essential (Barry et al. 2012).
Person-Centeredness in your Practice:
According to Partridge and Baxter (2016), “Person-centered care” can be defined as an approach of providing care where the person availing the health facility is considered as an equal partner in developing, planning, and monitoring care to meet their needs. This approach considers the desires, values and social situations and lifestyle of the person availing the healthcare service. Being person-centered reflects that the healthcare practitioners always have the person’s safety, comfort and well-being uppermost in their mind. Person centered care is based on four principles and they are care, compassion, dignity and respect. As a part of the respiratory unit of my organization, I have the responsibility to improve on the person centered approach of care (Oshima and Emanuel 2013).
After the outbreak of the SARS in Hong Kong the “Hospital Authority Head Office (HAHO)” the number of hospitals treating this disease increased. Previously it was 13 acute hospitals and so limiting care was provided. But later more hospitals kept a sector for entertaining the SARS patients. As stated by Moorhead (2013), the past practice in the clinical field in the respiratory ward is evident enough to show that in the professionals including me deliver best results possible to the patient, give peer opinion to the patient’s family, also keep a check on the lifestyle of the patient like restriction in smoking. Sometimes patients with chronic pulmonary disorders get admission who are diagnosed, and clinically treated involving them in the taking certain medical decisions. In several occasions it has been seen that the organization has arranged for health programs that ultimately helped in improving the quality of service, skills of the health professionals and encouraged the patients to develop confidence related to self-management (Hockenberry and Wilson 2014). Moreover, this process has also improved the patient-clinician interaction and transformed it into collaborative partnership.
As a health care professional it is important to elicit the correct medical condition of the patient to him and his family members, make proper diagnosis, risk assessment and prevention plan. During the SARS outbreak period the “Infection Control Enforcement Team (ICET) was established in every hospital to obtain updated information regarding infection control policies from HAHO. A coordinated patient centered care was provided in regards to these policies. In addition to this delivery of the right treatment for respiratory failure, care for the active smokers, supporting the patient with behavioral change, self-management and work across professional and organizational barriers are a part of my person centered care practice (Quill and Abernethy 2013). Moreover, as it is a known fact that the respiratory ward is an area which is prone to infection that can be bacterial, viral of fungal infection. These are highly contagious in nature. In case of diseases such as tuberculosis, whooping cough, flu, mumps and rubella are highly contagious. In this ward different patients related to respiratory diseases get admitted every day. In order to reduce the “hospital acquired infection” rate and cure the patient cleanliness and maintenance of sanitation should be one of my first priorities (Hockenberry and Wilson 2014).
Evidences reveal the fact that there are several factors which contributes to the patient centered care. The factors involved are leadership, involvement of the patient and his family in the decision making, provision of supportive environment, strategy that needs to be communicated, quality of care, advanced technology and feedback (Barry et al. 2012). Empirical evidences based on the surveys conducted on patients reveal the fact that health care experiences provides another more quantitative assessment of progress. Evidences reveal that during the outbreak of the SARS infection in Hong Kong, in one case around 90 patients were suffering from SARS according to laboratory criteria, all required ICU care and out of these 90 patient four died. Statistical surveys reflects that even in this generation people who were infected by SARS still have a long term affect. (Hockenberry and Wilson 2014).
Although there has been improvement in the person centered care in the recent years, international survey conducted recently indicated that there are still several problems that exist in this area. According to Purnell (2012), the Commonwealth survey in five different countries revealed that there are still substantial gaps which exist between the physician and his patient related to communication in regards to treatment options and health management plans. Around sixty percent of the patient in United States complained about difficulty in getting emergency care on weekends or at nights. The CAHPS 2005 survey data shows on average sixty percent of respondents stated that health care practitioners explained the possible side-effects of medicine to them (Barry et al. 2012).
The “Center for Health Care Design” launched the “Pebble Project” in 2000 as a research attempt to systematically manuscript the evidence which is supportive and fostering physical environments are therapeutic for care receivers, encouraging the family involvement, promotive of staff efficiency, and curative for employees under stress. Presently more than forty percent of the organizations and they conducted systematic documentation. In one study patient centered care has been demonstrated in order to measure the improvement in patients with chronic diseases such as COPD. In 2002 meta-analysis of almost thirty nine interventional studies, revealed that thirty out of thirty nine studies found at least one process measure improved Purnell (2012).
Analysis of Caring Culture:
Culture is one of the most important aspects, when especially nursing is considered. One of the studies reveals the fact that culture is a key determinant that influences the quality of care. The effects of culture do not only impact on the wellbeing of the health care employees but also it can be recognized that their views are respected or not. Over the last two decades, constructing and developing an effective healthcare cultures which is evidence based and person centered has been the key objective to implement this into the nursing practice Partridge and Baxter. After the outbreak of the SARS in Hong Kong, the government has become aware of other infections and is prepared to experience and withstand more infection outbreak and also bioterrorism. The multidimensional and flexible health plans during the SARS outbreak has been successful in controlling the infection (2016).
It has been analyzed that the role and responsibility of the respiratory nurses in terms of secondary care is significant in developing and managing a care plan that is holistic, compassionate and dignified in nature. A multidisciplinary team (MDT) approach is required for providing holistic care to the patient. As discussed by Partridge and Baxter (2016), the MDT involves therapists, pharmacists and psychologists. In the recent few years secondary care mainly addresses diagnostic needs in the patients with acute and chronic disease and palliative changes such as patients with COPD, asthma, interstitial lung disease and cystic fibrosis. The management of the infectious diseases such as pneumonia, tuberculosis and influenza has become quite easy with the advancement in the technological tools and medications (Quill and Abernethy 2013).
According to Oshima and Emanuel (2013), the respiratory nurse gives care around exacerbation management, disease education, rehabilitation, palliation and smoking cessation. This is a key component in providing support in the nursing practice. As discussed by Quill and Abernethy (2013), it has been identified that the number of nurses that has been employed by NHS has grown in number with time and they have become more specialized. In the present few years, the culture of care in the nursing practice has changed. A holistic approach is needed to treat the patient rather than the disease, since several patients have co-morbidities.
Although the nurses in the recent few years have adapted the culture changes related to the patient care, there are still gaps that need to be filled in order to remove infection, morbidity and mortality from the respiratory section of the health organization(Quill and Abernethy 2013). The health practitioners need to understand the requirement of the patients and their families and provide care that can be person centered. Nursing care is also linked to several ethical issues and therefore, a nurse should be careful about these issues while providing nursing care (Oshima and Emanuel 2013).
The health care sector is responsible for providing care to the community based on the type of service, work culture and management. The delivery of modern care varies from country to country and the also depends on trained professionals and paraprofessionals who all work together as a team. The culture of the healthcare workplace in the present is influencing in the delivery of person-centered care, clinically effectual, and progressing in the direction of improvement in response to the changing environment. In order to plan the nursing care the patient need to be assessed physically, clinically and mentally which is also termed as holistic approach. There are several factors that a nurse and other health care professional need to incorporate in their practice in order to provide person centered care are therapeutic communication, team work, leadership, skill, open communication, high support and life-long learning. After the onslaught of the SARS in Hong Kong, the whole community has become aware of the emerging and dreadful infection. The evaluation of the hospital preparedness and plans has thus improved. Over the past few years this practice have been improved but still there exist gaps and flaws that can be implemented through designing of a project. Therefore, a project needs to be constructed regarding the promotion of nursing care in the respiratory specialty so that the rate of cure can be higher than the morbidity and mortality. Several recommendations can be incorporated into the project that can bring about change in the nursing health care culture. Such a project can develop the self-management of the patient, help to grow the effective communication among the patient and the health practitioner and lead to a successful clinical treatment in the respiratory specialty. The recommendations are as follows:
Person centered care in practice has been known to possess the ability for making a critical difference to the staff and patient care experience. Care and treatment should consider the preferences and needs of the patient. The recommended caring culture in this regard is that the people suffering from respiratory diseases should be provided the opportunity for making informed decisions regarding their treatment and care along with their care providers (Wildevuur and Simonse 2015). Effective communication between the patients and the care providers is essential and should be supported by the written information that is evidence based and tailored according to the needs of the patient. Care, treatment and information that the patients are given has to be culturally appropriate. On request from the patient, the carers and families should be involved in the decisions about care and treatment and they should be provided with the required support and information. Active engagement is suggested with the managers for ensuring a collaborative approach to manage and recognize the context where care is delivered (Satta et al. 2014). This is done so that the team can effectively work together for creating an improved culture of care. A culture of care should be developed to support person centered care in everyday practice acknowledging the fact that the implementation is challenging, chaotic, stressful and unpredictable. It is important to determine for ensuring that person centered care becomes a cultural norm for everyday practice.
Apart from person centered care, education can serve to build the capacity for improving respiratory care by empowerment of the healthcare workers to support, diagnose and detect their patients suffering from respiratory diseases by addressing the inequalities in their local contexts. Professional training and education of the healthcare workers is an essential part of improving the care culture as it acts as a global response to the challenges existing in the management of the respiratory conditions in primary care (Higginson et al. 2014). Adherence to the guidelines of care can also be beneficial for improving the duration of stay in the hospital and other outcomes. Educating the healthcare providers on the implementation of the new diagnostics can serve to improve the treatment and healing duration. The organizational culture has an impact on the care culture and consists of the norms, beliefs and values that are relevant to the care of the patient. It includes the behaviors and attitudes of the healthcare providers that are related to the safety of the patients and are considered appropriate and effective for promoting patient safety. Therefore, nursing leaders or leadership development has also a crucial role to play in improving the care culture in the respiratory ward. It is important for the nursing leaders to assess adequately the safety culture in the ward and develop a framework for guiding other healthcare personnel for working towards increasing the safety in their respective work settings (Kacmarek, Stoller and Heuer 2016). The safety cultural measurements that are action based helps the healthcare organizations to compare their records with various other organizations that in turn, helps to promote the attitudes that are safety focused and initiate the required intervention for improving the care culture in the ward.
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