Awareness of Emergency Department Nurses of The Hospital’s Emergency Paper

Awareness of Emergency Department Nurses of The Hospital’s Emergency Paper

Hello my dear!We are almost there. The lit review must be expanded more.

Here some area to expand on:

1- The challenge of communication during the disaster for evacuate the patient, lack of training of communication.2- lake of knowledge of the HCIS in the hospital and how important to be engaged. In page 6 and about the JCI, You must also cite actual JCI document. You should be able to find the ref in Nofal’s paper.

How the Awareness of Emergency Department nurses of the Hospital’s Emergency Operation Plan is Critical in a Tertiary Hospital in Riyadh Disaster preparedness and response in the emergency department (ED) depend on nurses’ competence and familiarity with the emergency operation plan. Many factors place those ER nurses in a position to deal and share their responsibility, competencies, and awareness of the EOP with other ER professionals to manage any crisis. Standard practice requires that every hospital has an emergency operation plan (EOP), which defines how the hospital will respond to any hazard and recover. An EOP is important because it prepares the hospital to respond to different hazards, having varied durations, and scale. The EOP is developed using an all-hazards approach to ensure that the hospital is prepared for emergencies of different scales. More importantly, hospital staff needs to know of the existence of such a plan and comprehend its contents. When a disaster occurs, staff need to be prepared to implement the EOP. Although the preparation and maintenance of an EOP are essential, implementing this plan largely depends on the healthcare staff’s comprehension of its details. Statement of Purpose There is overwhelming evidence supporting the need to plan for events, hazards, and threats that may hinder healthcare access in a community. A healthcare organization remains a crucial aspect of the community and its ability to deliver care especially during a disaster or hazard is a measure of its utility to the community. Prince Sultan Military Medical City (PSMMC), located in Riyadh, is one of the most advanced health centers in Saudi Arabia and the Middle Eastern Region. Like other health centers, this hospital has developed and maintained an EOP in readiness for any emergencies that may occur in the community or internally in the facility. However, it is not clear whether ED nurses are conversant with the principles and processes outlined in the EOP for the hospital. Emergency nurses are instrumental in the response to a disaster since they are frontline staff in such instances. The purpose of this project is to determine how conversant ED nurses at Prince Sultan Military Medical City are with the hospital’s emergency operations plan and how prepared they are to apply the EOP in case of a disaster. Need for the Project The role of a hospital during and after a disaster is integral and critical for effective response and recovery. Following an incident that results in loss of infrastructure and surge of patients, a multifunctional and multijurisdictional response is launched with the local health systems in the midst of these responses. Without the proper infrastructure and expertise, healthcare centers and the workers in them can easily become overwhelmed when providing care (Madrigano et al., 2017). Therefore, staff in any hospital should prepare for any disaster through training to develop expertise on how to handle such an incident. Similarly, in PSMMC, the hospital and the staff should be well-prepared for any disaster that may occur. This project will ascertain and determine the level of preparedness in the medical center and develop an intervention to address gaps in knowledge and preparedness. The project focuses specifically on ED nurses who are central to any emergency and disaster response. The role of the nurse in a healthcare system is to provide care that enhances the patient’s healing and comfort. Nurses are thus instrumental in the preservation of life following a disaster. When a community experiences a disaster, nurses are on the front lines helping to rescue and attend to those who are affected (Madrigano et al., 2017). Nurses need a broad scope of knowledge to be effective in emergency response and management and the complexity of disasters requires that nurses are conversant with disaster response procedures. This project seeks to determine whether ED nurses at PSMMC understand the processes and procedures for disaster response and also assess their confidence on the same. This project is needed to provide certainty to the community that the local health system is well-prepared in case of a disaster. While narrowing the scope to Riyadh where PSMMC is located, the hospital is a crucial asset for the community and nurses in the medical city are paramount in any disaster that may strike the community. PSMMC is one of the largest and most advanced hospitals in Saudi Arabia. In the event of a disaster, it would be one of the core response centers for rescue and treatment of casualties. Its importance to the public cannot be overemphasized. Additionally, preliminary research in two government hospitals in Riyadh shows that majority of ED nurses did not have confidence in their disaster response knowledge and abilities (Alshehri, 2017). This research shows that there is need for more assessments and training for ED nurses in readiness for any disaster. Current evidence shows the importance of ED nurses in disaster response and also highlights the unpreparedness of nurses in some of the hospitals in Riyadh, Saudi Arabia. Literature Review Disasters The past few decades have seen a lot of disasters claiming millions of lives and billions in economic losses. According to Al-Bassam, Zaidi, and Hussein (2014), disasters have increased because of the inhabitation of areas prone to natural hazards such as flood plains, flanks of volcanoes, and low-lying subsiding areas in coastal regions. The most common natural disasters worldwide include tsunamis, earthquakes, floods, and hurricanes. The Kingdom of Saudi Arabia (KSA) is also prone to disasters and in the last three decades has lost lives and property due to the occurrence of such disasters (Al-Bassam et al., 2014). Disasters remain a critical threat to community and national development and people’s livelihood. It is necessary to define the term ‘disaster’ before delving into the history of disasters and their connection to PSMMC ED. According to the World Health Organization (WHO, n.d.), a disaster is “a situation or event, which overwhelms local capacity, necessitating a request to the national or international level for external assistance.” Other agencies may define disaster differently depending on the purpose of the definition and scope of operations. In summary, a disaster can be defined as an event that disrupts the normal functioning of a community and causes substantial loss of property and life, overwhelming the community’s ability to use its own resources in response and recovery (Preston et al., 2015). This definition focuses first on the effects of the event and the scope of the same. The effects are community-wide and hence the event affects a significant portion of the community. Moreover, the scope is such that it overwhelms the community’s capacity to respond due to loss of infrastructure and life. Additionally, emergency management agencies and agents view disasters as the ultimate events that a health system should respond to (Drabek, 2016). The ED responds to emergencies of different intensity and scope including events such as road accidents. However, when an event is classified as a disaster, the ED is often fully engaged in the response such that it dedicates all its infrastructure to respond to the event (Preston et al., 2015). Natural disasters include floods, earthquake, and hurricanes among others. Manmade disasters may include terror attacks, wars, human stampede, and explosions. The distinction between the two is that while natural disasters occur with no direct human involvement, manmade disasters are often a result of direct human engagement (Drabek, 2016). Regardless of the source of a disaster, emergency services are often critical to saving lives during the response phase. Therefore, they remain critical to the city of Riyadh. Saudi Arabia has experienced a lot of disasters which necessitate the preparedness of ED s and health care systems. The most common disasters affecting KSA are earthquakes, volcanic hazards, and flash floods. The Northwestern region of KSA has largely been affected by earthquakes and volcanic hazards while the central and western regions are known for flash floods (Al-Bassam et al., 2014). Some of the notable natural disasters in the kingdom include the earthquakes in the Gulf of Aqaba in 1983, 1990, 1993, 1995, and 2004 (Al-Bassam et al., 2014). Al-Bassam et al. (2014) recalled the 2009 Jeddah floods as a significant disaster that affected KSA. One of the most recent natural disasters is the COVID-19 pandemic which has so far caused over 6,200 deaths in the kingdom (Saudi Gazette, 2021). These disasters have highlighted the importance of emergency operations and expertise in the kingdom of Saudi Arabia hence the need for rigorous training of healthcare personnel on preparedness and response to disasters. Disaster Preparedness A crucial concept in emergency services is disaster preparedness which determines how well a unit or agency is prepared for different disasters. The primary goal of disaster preparedness is to prepare a response that will minimize damages and enhance the recovery process (Shalhoub, Khan, & Alaska, 2017). Healthcare agencies count damages of disaster in terms of impact on human life and hence disaster preparedness is the process of preparing a response that would minimize the impact of disaster on human life including injury and deaths (Shalhoub et al., 2017). Nurses have expertise in clinical work, interdisciplinary collaboration, and leadership and hence they are pivotal for the disaster preparedness phase (Shalhoub et al., 2017). It is critical to note that the entire process of preparedness, mitigation, and response involves interdisciplinary and interprofessional collaboration among different experts and agencies. Therefore, nurses need the skills for interprofessional collaboration to effectively prepare for any disaster. The first step of disaster preparedness is to prepare an emergency management plan. In the scope of health and medical services, this management plan is the EOP which is maintained in every hospital. Aspects that should be included in the EOP include the command and control plan, roles and responsibilities of parties to be involved in disaster, a communication system, specific response plans to the high priority and also unexpected disasters, and the Joint Commission International (JCI) requirements applicable (Nofal et al., 2018). The EOP is comprehensive in that a reader conversant with its contents and having been trained in their role should competently respond to a disaster. Although the EOP may be comprehensive, the main issue arises in the training and familiarity of the stakeholders with the EOP processes and knowledge included in the plan. Completion of the EOP includes the training of relevant stakeholders in the response plan (Nofal et al., 2018). Therefore, all organizations with an EOP are required to train their staff and other stakeholders in their roles and responsibilities to maintain a state of preparedness. State of Preparedness in KSA The Kingdom of Saudi Arabia has taken significant steps to enhance disaster risk management as a collaborative effort among agencies and within institutions. The Civil Defense Ministry of Interior oversees national planning and coordination of response and the Presidency of Meteorology and Environment is in charge of disaster mitigation (AlShowair, Parrillo, & Kofi, 2019). The kingdom has also taken significant steps to collaborate with governments and agencies in the region to ensure coordinated responses to both natural and manmade disasters. The Saudi Red Crescent Authority is in charge of medical emergency services in many areas of the kingdom and hence coordinates the medical response to any disaster that may occur in the nation (AlShowair et al., 2019). The Saudi Red Crescent collaborates with the Ministry of Health and Saudi Humanitarian Emergency Aid and Response Team (Saudi HEART) for preparedness and management of response efforts (AlShowair et al., 2019). On a macro-level, the kingdom presents readiness for disaster and has made efforts to mitigate hazards. Although the kingdom has a high level of preparedness on the national level, current evidence shows that there is a gap in the preparedness of ED nurses. Alshehri (2017) showed that majority of emergency nurses in two government hospitals in Riyadh lacked the confidence for disaster response despite having undergone training. Moreover, a study in Mecca showed that more than half of emergency nurses in that city had not fully read the EOP and were not aware of the larger disaster preparedness and response plans (Alzahrani & Kyratsis, 2017). Another study of the southern part of Saudi Arabia showed that although most emergency nurses showed knowledge of the theoretical aspects of disaster management, majority showed weakness in the practical dimensions of disaster response and management (Sultan et al., 2020). This evidence shows that a significant number of emergency nurses in Saudi Arabia either lack the knowledge and awareness of disaster preparedness or are not confident of their practical abilities to effectively respond to a disaster. Based on the review of current literature, it is apparent that disasters are common in the KSA and there is a need for preparedness. It has also been shown that healthcare organizations and their staff, especially nurses, are critical to the successful response to disasters. Having a well-maintained EOP is not enough for a healthcare organization. It is necessary for staff and all stakeholders to be aware of the EOP and be trained in their capacity for effective disaster response. The literature also shows that many nurses in the kingdom, and Riyadh in particular, may lack the practical skills to implement the processes and principles outlined in their organizations’ EOP. This review of the literature thus necessitates the current study in PSMMC to determine whether ED nurses are familiar with the EOP and competent to respond to a disaster. The current study thus focuses on PSMMC to determine any gaps in knowledge and competence and close those gaps through training to enhance ED nurses’ preparedness for disaster. Models for Planning and Preparedness Planning for mass casualty incidents (MCI) has been identified as a major requirement for disaster preparedness in healthcare organizations. Many healthcare organizations are faced with the challenge of assigning relevant resources to all requirements during a disaster (Repoussis et al., 2016). Nevertheless, the mixed integer programming (MIP) approach has been extensively used in MCI situations. According to Yip (2019), the method is a supply chain network programming model that is used to determine the relevant resources for each of the requirements. The aim of MIP is to allocate resources effectively to meet all the needs during the mass casualty incident. The objectives are to reduce response time and patient flow time in order to provide prompt and adequate care to those in need (Yip, 2019). The advantage of MIP is in the ability to react to uncertainties during disaster. The planning method is limited to management who are involved in the allocation of resources and conducting the entire operation as opposed to frontline workers such as nurses on the hospital floor (Repoussis et al., 2016). Other than the MIP which requires technological expertise, incident command systems (ICS) have also been extensively used and also proposed and implemented under the Federal Emergency Management Agency (FEMA) protocols (Faracas et al., 2020). ICS basically involves a centralized command system whereby a single authority (individual) provides the relevant orders under consultation with the bodies and stakeholders involved in the process (Rahmati-Najarkolaei et al., 2017). ICS may be implemented in different situations and in public disasters, the local authority determines the structure of the ICS. In hospitals, an ICS is established by the emergency operations center and in some incidences, a joint operations center is set up (Rahmati-Najarkolaei et al., 2017). In a hospital setting, readiness to collaborate among departments as well as with other disaster response bodies such as the fire department is key since it enhances the success of ICS (Farcas et al., 2020). Using an ICS provides the advantage of coordination of responses with a shared objective and plan of action to optimize resources and achieve the best outcomes for the population involved. Disaster Preparedness Standards Standards for disaster preparedness are advanced by regulatory bodies to ensure that hospitals and other entities are ready to handle a disaster when it occurs. As a rule of thumb, all healthcare organizations are required to have an EOP in place and train their staff on response to disaster (Khankeh et al., 2019). The extent of the EOP and training requirements may differ from one hospital to another and also depending on the type of hospital which the EOP is developed for. Regulatory bodies issuing standards and regulation requirements include the Kingdom of Saudi Ministry of Health (MOH) and the Presidency of Meteorology and Environment which are responsible for public health and disaster risk reduction respectively (Shalhoub et al., 2017). In other nations such as the U.S, the federal government issues general directions and state and local authorities are in charge of preparedness and response to disaster. Disaster preparedness standards are a collaborative effort between agencies and often developed with the different stakeholder roles in consideration. Moreover, despite having regulatory authorities and bodies in charge of preparedness and response, Saudi Arabia lacks national standards for disaster management (Alshaoub et al., 2017). Therefore, most of the standards used in the country are based on international bodies and consensus on what should be captured in an EOP. For instance, a study by Al Thobaity et al. (2019) showed that the five key factors of an EOP in Saudi Arabia hospitals include communication, safety and security, decontamination, survivor support, and surge capacity. These aspects of the EOP can be used in education, planning, and response activities and have been highlighted as the most crucial in Saudi Arabia hospitals (Al Thobaity et al., 2019). Despite the absence of national standards, most hospitals develop and rely on international standards such as the Health Standards Organization (HSO). Hospital accreditation with different bodies often requires compliance with set standards. For instance, Bajow and Alkhalil (2014) identify that many hospitals have only adhered to Joint Commission International on Accreditation of Healthcare Organizations standards in written form for accreditation purposes. The lack of national standards has been identified as leading to poor implementation of EOP with low utility in an actual disaster (Bajow and Alkhalil, 2014). The training level of ED nurses in the KSA is still lacking. According to Sultan et al. (2020), 28% of nurses in the KSA have inadequate knowledge and training on disasters and major incidents response. This review of the literature shows that nurses in hospitals in Saudi Arabia might have low disaster preparedness due to the current regulation and standards conditions hence the need to improve their competence in using the EOP. Methods Literature Review Search Literature used to develop the literature review section of this project was sought from peer-reviewed journals accessed through Medline Plus, Google Scholar, World Directory of Medical Schools, and an open Internet search. The criteria for the search included articles not older than 2014, peer-reviewed articles, or credible organizational reports such as the World Health Organization (WHO) an…