Walden University

Master of Science in Nursing

 

 

 

Practicum Professional Development Objectives

 

1. By the end of 11 weeks, increase awareness of COVID-19 pandemic among hospital staff of Houston Methodist Hospital affecting its operations.

 

2. By the end of 11 weeks, Houston Methodist will identify the effects of COVID-19 to its budgeting process.

 

3. By the end of 11 weeks, the identified unit of Houston Methodist Hospital will identify the importance of teamwork in fight against COVID-19.

 

 

 

 

Journal Entry 1 (Week 3)

 

The pandemic of COVID-19 has affected most healthcare facilities’ operations with an inclusion of the Houston Methodist Hospital. The increase in the reported cases of the COVID-19 has led to the need for a social distance approach to preventing the spread of the disease. This, therefore, implies that limitation of the number of patients that require services that can be performed under a homecare basis, for instance, the hypertensive and the diabetes patients. This has also led to the floating of the staff to other units that demanded an additional number of staff. The rural healthcare facilities have been exposed to the financial blows, and the large healthcare system also experiences these effects due to the pressure from the COVID-19 pandemic. The Houston Methodist Healthcare facility is redeploying the workers with a reduction in the number of working hours and offering 70 percent of the base payment (Sasangohar et al., 2020).

One of the personal experiences concerning the effects of COVID-19 is fatigue. There is an overload on the healthcare system’s ability to respond to the pandemic. There is increased demand for the services to be provided by healthcare providers. At the same time, there is a redeployment of the employees to reduce the working hours, and this means that the remaining healthcare workers are being overwhelmed by the increased number of patients seeking healthcare services (Ortegon, 2020).

Despite the work overload, the morale in the working environment of this facility has been boosted. The Human Resource (HR) at the facility has developed a SharePoint Site that contains various toolkits that offer employees’ morale. The toolkit is composed of different activities; for example, workers are allowed to take a break to have fun and laughter; employees are reconnected with each other; there is an expression of the appreciation; the creativity of the workers are brought out; there is a change in the pace and taking of the breaks in between the working hours; and there is a celebration among each other when there is a success (Sasangohar et al., 2020).

Another experience is related to safety in the workplace, and this case, the hospital is prepared to provide the requirements equipment such as the mask, other Personal Protective Equipment (PPEs), and the handwashing practices. The observation of the hand hygiene practice can be graded at 97 percent since the majority of the healthcare workers observed this practice. The organization is affected since more equipment is supposed to be supplied to ensure that there is the protection of the healthcare providers from the risk of the COVID-19. The COVID-19 pandemic exposes many gaps in the healthcare system, such as the need to have a protective investment to increase large-scale epidemics and pandemic preparation (Sasangohar et al., 2020).

The Houston Methodist Hospital is reporting a low test of the COVID-19, and this makes it hard to detect the distribution. There is, therefore, a gap in the widespread and the subsequent contact tracing. The low reporting of the COVID-19 test implies that the Houston Methodist lacks the ability to test key portions of the patient population for this novel infectious public health threat. The lack of preparedness leads to poor patient outcome, and this cause personal emotional burden as a healthcare provider (Ortegon, 2020).

The Houston Methodist Hospital is recording a reduction in the number of patients in the ICU. This might be have been caused by the presence of the 5 best ICU units i.e., the cardiovascular, the medical. The coronary, the surgical, and the neonatal. The bed capacities are 311, and this implies that the healthcare facility is prepared to offer critical care services to the patients who test positive for COVID-19. Between March 15 to April 5th and 28th June to August 2, there was a rise in the ICU cases. The lessons from this are that there is a need for preparedness and training for the staff to help in dealing with such cases. It is shown that there is a need to have adequate supplies of the PPEs for the ICU staff, such as the anesthesiologists, intensivists, nurses, and respiratory therapists, among others (Sasangohar et al., 2020).

From March 15 to September 6 2020, Houston Methodist healthcare facility has reported high cases of total COVID-19 related census. The data indicates that there are high occupational risks to healthcare providers. Due to the highly contagious nature of COVID-19, the poor prevention guidelines is likely to expose the frontline healthcare employees. This, therefore, is an indication that the facility must always be prepared to promote workplace hygiene requirements and promoting the use of the PPEs.

The communication process is playing an important role in the provision of the healthcare facility. It helps in the reduction of medication errors and miscommunication in the healthcare facility. At Houston Methodist Hospital, the score of nursing communication is 78 percent, with the highest score in communication with the doctors. The Houston Methodists Hospital has been able to use the technologies such as telemedicine and the virtual ICUs to promote the ECMO-treated COVID-19 clients. Based on the personal experience, this has helped in the reduction of the traffic in and out of the hospital ICU patient rooms (Hannans & Olivo, 2017).

My Personal Experience:

“Disney it is,” my children happily exclaimed as spring break was just a few days away from our mini get away in March of this year. My heart leaped for joy and excitement, but was also being pulled back by the news locally and internationally about a certain Novel virus spreading from one country to another. Alas! It found its way to California, our get-away destination before summer and spring break.

We finally decided to pursue the plan and gave our children the best spring break ever. Little did I know that our worries of getting the virus on the trip was just the beginning of the worse time ahead, not only for our family, but for the entire world. Thus, the 2 infected individuals from Santa Clara California ballooned to more than 6 million today.

When I came back from that trip, everything changed. From mandatory mask wearing to total lockdown. People were told to stay home and that only “essential workers” were allowed on the road. Stores were shut down. Shelves were emptied like in the Zombie movies and apocalyptic series. It was surreal. Every week, the numbers doubled.

When I started to go back and work, units were turned to Covid floors. Some units closed because of canceled elective surgeries. Some units were combined like ours and our sister unit and with the Urology floor as well. I was asked to float to a Labor and Delivery Unit to provide leadership support. And, like many disasters that have come and challenged the system of our hospital, chaotic may it seems, our administration and leaders have come together to strategize plans and shift changes; hence, LABORPOOL was created. For those who were not able to work because of low census, the administration created HR94PD pay- a 264 hour pay for those being canceled or sent home because of low census status. ADA (American Disability Act) accommodation was also introduced to all employees as some are more vulnerable to get Covid 19 than others. Compassion fatigue is prevalent across all spectrums of the helping professions and is flourishing. Can we afford to ignore the consequences? If we do not care now, who will and when? At what cost, (Showalter, 2013)

Visitation policies were changed from one visitor to no visitor per patient. Exemptions were applied to those who are actively dying, in labor or mentally incapacitated. Changes were made from one week to another. As the numbers continuously surge every day, so as the fear amongst everyone. However, we felt that each person was doing everything to function and survive every day in this pandemic, be it for themselves, their family, and the patients. Hope is not lost and faith in humanity was restored as stories of heroism and sacrifices emerged. Compassion fatigue is a preventable and treatable phenomenon. Organizations with policies, interventions, and evaluation methodologies that address compassion fatigue risk may result in substantial employee benefit cost savings, uninterrupted professional nursing care, and increased patient family satisfaction and may continue to be regarded in communities as an optimal choice in End of life care, (Abendroth, 2006).

As a front liner of this country, I can only hope for a better tomorrow as I continue to be God’s instrument in His healing power and grace. As a Christian, I can only pray for those who are bereaved by the loss of their loved ones and those who are still in their sickbed. As a mother, I can only continue to provide protection to my kids from this deadly virus. As I always say to them, “Mask up, wash-up, and maintain your distance 6 feet away from others. Treat everyone as if they are infected with Covid”.

We will continue to work and heal as one.

References:

Abendroth M, Flannery J. Predicting the risk of compassion fatigue. A study of hospice nurses. Journal of Hospice and Palliative Nursing. 2006; 8(6): 346-356. http://dx.doi.org/10.1097/00129 191-200611000-00007

Hannans, J., & Olivo, Y. (2017). Craft a positive nursing digital identity with an ePortfolio. American Nurse Today. Retrieved from American Nurse Today.

Ortegon, L. (2020, September 8). Houston Methodist Hospital-Nursing Strategic Council.

Sasangohar, F., Jones, S., Masud, F. N., & Kash, B. A. (2020). Provider Burnout and Fatigue During the COVID-19 Pandemic: Lessons Learned From a High-Volume Intensive Care Unit. Anesthesia and Analgesia.

Showalter S. Compassion fatigue: What is it? Why does it matter? Recognizing the symptoms, acknowledging the impact, developing the tools to prevent compassion fatigue, and strengthen the professional already suffering from the effects. American Journal of Hospice and Palliative Care. 2013; 27(4): 239-242. PMid: 20075423 http://dx.doi.org/10.1177/1049909109354096

 

 

 

 

© 2012 Laureate Education Inc. 2

 

 

 

© 2020 Walden University 6

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MY PREVIOUS DISCUSSION with PROFESSOR:

Many of the challenges these nurses reported facing while talking to them mirror those that they faced before the pandemic, such as balancing family, work, and school and time management. Limited resources, longer shifts, disruptions to sleep and to work-life balance, and occupational hazards associated with exposure to COVID-19 have contributed to physical and mental fatigue, stress and anxiety, and burnout, (Adams, 2020). Similar to most hospitals in the COVID-19–affected areas, the Houston Methodist Hospital (HMH) system has experienced an overwhelming impact of this pandemic on personnel.

 

While the majority of surgical nurses reported being well-aware of what they needed to do to stay safe during the pandemic, many still struggled with concerns over mental and physical health. While the physical effects of COVID-19 have been documented extensively, nurses actually reported relatively greater concern over their physical health. The rapid spread of the COVID-19 pandemic revealed an overall lack of preparedness and insufficient training as well as limited supplies of PPE for ICU staff, including anesthesiologists, intensivists, pulmonologists, nurses, respiratory therapists, and other front-line providers in most affected areas.

 

March 2020, from the onset of the COVID-19 outbreak, it was apparent that testing for the virus, detecting its distribution through widespread surveillance, and subsequent contact tracing were major public health gaps. Most hospitals, including HMH, lacked the capacity to test significant portions of our patient population for novel infectious threats. This removed a highly effective infection control tool from our arsenal. Unfortunately, such unpreparedness, potentially resulting in poor patient outcomes, had a significant psychological burden on personnel.

 

The COVID-19 pandemic has revealed several issues related to current processes and established practices. Most importantly, the lack of established policies for pandemic triage, equipment ordering, and emergency management has led to systemwide inefficiencies and has increased the burden on health care workers. While business is booming in health care, all indicators point to a likely sustained overall economic downturn. This undoubtedly contributes to health care workers’ stress and anxiety. It is well documented that such uncertainty about future occupational stability (job security) is associated with a deterioration in mental well-being, (Pollard, 2001).

Several traits of resilient performance and improvisation have been observed at HMH. The incident command team was rapidly assembled; leadership–employee communication was constant and responsive; and human resources (HR) adapted policies to employee needs. To long-standing employees, these adaptations were not surprising, because our leadership and teams have literally weathered storms before, including in recent history, Hurricane Ike and Hurricane Harvey. Hurricanes are not pandemics, but their local effects are similar in terms of financial and emotional strains on employees, as well as sudden geographical isolation of both employees and patients.

 

As the hospital is not doing any elective procedures, which has freed up staff to help out elsewhere in the hospital. For those in designated COVID-19 units, the hospital has also increased its training, with a great deal of effort being around proper use of PPE. Houston Methodist has also adapted its pay to offer paid time off for staff missing work for exposure to the coronavirus, provided complimentary meals—from the hospital and community organizations—and maintains daily briefings with employees to keep them informed. Additionally, patients can access virtual urgent care online, which enables patients experiencing COVID-19 symptoms or wanting to avoid catching germs to connect with a virtual urgent care provider 24/7, according to Houston Methodist’s website.

 

 

 

References:

 

Adams JG, Walls RM. Supporting the health care workforce during the COVID-19 global epidemic. JAMA. 2020 March 12.

 

Pollard TM. Changes in mental well-being, blood pressure and total cholesterol levels during workplace reorganization: the impact of uncertainty. Work Stress. 2001; 15:14–28.

 

 

PROFESSOR: It sounds like your hospital is a wonderful place to work. The employee well-being does seem to be important to the facility and that is not the case in every facility. How is it going working toward your objectives? Do you anticipate any barriers to meeting your objectives?

 

MY RESPONSE:

Thank you for reading my post. I agree that the hospital that I am working with right now values the employee. I am anticipating barriers to meeting my objectives. With this pandemic, I know that this practicum is conducted in environments where constant changes and challenges are required, and dynamic interactions with various types of occupations, both professional and nonprofessional, exist (Lancaster et al., 2015).

 

During this pandemic, I know that everyone is now nauseated with the news and constant changes. I know that they feel like they are just obliged to answer and talk to me as I am their current Manager. I feel stressed and helpless because there seems to be nothing they can do about it (Anthony and Yastik, 2011).

 

I may revise the title of my project. I have “The Impact of the COVID‐19 Pandemic on chosen Surgical Nurses of HMH and their Practices”. Since COVID-19 is a new pandemic, though a lot of reading and research is starting to come out – I intend to do a literature review on how these nurses, not just Surgical nurses, respond to a pandemic. I am thinking of classifying the impact of COVID-19 to Nurses – may it be physically or psychologically, etc.

 

Another barrier is that I am on the frontlines of the pandemic response as a practicing Nurse Manager. A lot of my staff depend on me on the update or any changes with the hospital policy. I have a Nurse Director who is my preceptor that is on the frontline as well. We recently were visited by the DNV surveyors, and undoubtedly we prepared each unit we handle. We are also preparing for the MAGNET 5th Re-designation of the hospital. I feel that there are too many things on my plate right now. With the homeschooling of my two kids, ages 18 and 7, I needed to guide them as well.

 

As a student, I always tell myself that I know that I could learn through the lived experience of being a registered nurse and a graduate student during this worldwide pandemic. I appreciate you, Dr. Tara, for being considerate and understanding.

 

References:

 

M. Anthony, J. Yastik. Nursing students’ experiences with incivility in clinical education J. Nurs. Educ., 50 (3) (2011), pp. 140-144, 10.3928/01484834-20110131-04

 

G. Lancaster, S. Kolakowsky-Hayner, J. Kovacich, N. Greer-Williams. Interdisciplinary communication and collaboration among physicians, nurses, and unlicensed assistive personnel

 

J. Nurs. Scholarsh., 47 (3) (2015), pp. 275-284, 10.1111/jnu.12130

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