journal 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

Journal Entry 2 (Week 7)

Like in most healthcare facilities, the pandemic of COVID-19 has affected how Houston Methodist Hospital functions. As expected, the increase in the reported cases of the COVID-19 has called for more concentration, especially from the facility's manager. Further, the situation has demanded more involvement of the manager in the facility's daily operations as critical decisions have to be made not only frequently but also faster than ever before. Considering the size of the HMH, this has led to a heavy workload on all HMH employees, especially since the first case of the COVID-19 case was reported in the area where the hospital is situated. Actually, the main challenge I have observed during my practicum experience this period has been fatigue. Employees have been so busy attending huge numbers of patients during these trying times.

To deal with the challenge of workers’ fatigue and the feeling of “overworking” or being too busy, the facility has employed several theories in order to elevate their morale. Primarily, these are motivational theories. In the hospital, three motivational theories have been applied to improve employees’ morale. They include Maslow’s theory, McGregor’s theory X, and McClelland’s acquired needs theory. The Maslow’s order of needs theory is used by the hospital to focus on needs relating to self-concepts such as self-actualization and self-esteem. The theory triggers the employees' motivation through the use of external rewards (Diaz, 2011). For example, employees are reconnected with each other, they are allowed to take a break to have fun and laughter, there is an expression of appreciation, the hospital organizes celebrations among the employees whenever there is a success, and there is a change in the pace and taking of breaks in the working hours. The acquired needs theory is applied to motivate workers when addressing the acquired needs, including achievement and power, and affiliation. This theory’s motivation is based on administering task assignments, external rewards, job designs, providing feedback to employees, and setting goals. McGregor’s theory X assumes that workers do not like working and given an option; they would prefer not to work. The hospital applies this theory by closely monitoring employees as they carry out their tasks and sometimes motivating them through the rewards mentioned above (Kinicki & Fulgate, 2017).

The hospital focuses on extrinsic motivation. It involves rewarding the employees extrinsically. The hospital’s extrinsic rewards include positive feedback, monetary payments (such as paid off days), and recognition. To some extent, the hospital's approach is effective for several reasons. Despite many employees, including me, feeling overloaded, there is a high rate of; punctuality, task accomplishments, low rate of; labor turnover, absenteeism, and lack of teamwork.

However, despite the use of the above theories in addressing mental and physical exhaustion, which have been successful to some extent, I believe that the hospital can address the challenge more effectively by satisfying the employees’ extrinsic needs and intrinsic needs. To successfully motivate workers, extrinsic and intrinsic needs have to be satisfied with using the most appropriate approaches (Diaz, 2011). The hospital's motivation approach needs to go beyond only addressing the extrinsic needs and considering the intrinsic needs. Hence, besides applying the acquired needs and Maslow’s theories, the hospital can employ equity theory to ensure that we (workers) feel treated justly and fairly (Kinicki & Fulgate, 2017). Therefore, clear and specific motivating targets should be set, and the hospital has to ensure that whoever meets the set goals is rewarded in a given way.

Further, I believe that the management of the hospital can keep the employees more motivated by employing McGregor's theory Y instead of the current use of theory X. Unlike theory X, theory Y is more "hands-off” and does not involve micromanagement of people’s work. Theory Y assumes that the employees take pride in their work, and hence, they do not have to be monitored closely to execute their tasks properly. By embarrassing theory Y, the hospital will adopt a more participative leadership style as the theory believes that workers should be involved in decision making. Other theory Y assumptions which will likely lead to more freedom of workers thus reducing workplace stress are; employees are happy to work on their own initiative, they are self-motivated, solve problems creatively and imaginatively, view work as challenging but fulfilling, need a little direction, and seek and accept responsibility. Theory Y is particularly suitable in a hospital set-up where workers (medical practitioners in this case) are experts (Aithal & Kumar, 2016). By employing theory Y, I will not have to be involved in most activities or decision making. Consequently, I will realize a reduced workload, and the feeling of being so busy or tired will fade away. However, it is important to balance theory Y, and theory X as overreliance on either of the two theories may prove ineffective. Too much of theory Y gives people excessive freedom that may make them lose focus of the healthcare facility's objectives, while the restrictive nature of theory X can demotivate people and/or become non-cooperative(Aithal & Kumar, 2016).

My Personal Experience:

October is one of the busiest months of this year. On top of the daily and weekly lists of things to do, my employer sent out emails about DNV visitation and recertification alongside Magnet Visitation. These are some of the activities that are expected by the hospital administration to be complied with and met by all the units and departments hospital system-wide.

Before the clock starts to move forward to the days of the visit, planning is the first thing to do to begin the process moving. DELEGATION is the Key to move everything as planned. There is a committee for Magnet, and informing the committee's Chairperson would provide much ease on the days to come. Daily support, follow-up, and reporting would ensure that the project is progressing in time before the deadline. With these Champions and Chairperson, the following leadership strategies will be used - delegation and the empowerment strategy. The team is delegated with the responsibilities and empowered to perform them (Cameron 2012). This helps in raising the influence as well as morale. By the people having the responsibilities and the powers to do them, they also get the authority to do things that gives them a sense of self-worth.

The DNV visitation requires more scrupulous work as the unit needs to abide by the DNV guidelines. Some of these are making sure that the unit is tidy and organized, fire extinguishers not blocked, boxes are not found on the floors, no medications, food, and drinks left out in the open, no expired supplies, and no non-inspected pieces of equipment found on the unit, and so on to name a few. Time and again, huddles during shift change always help out in making sure that everyone on the unit receives the administration's communication and that they are aware of the things to do and not to do in the days to come. This will also help out prevent last-minute cramming. Again, the charge nurses are the best contact point in following up on the changes and preparations happening for the DNV visit. On the day itself of the visitation, the entire staff of that day will try to make a last sweep on the unit, making sure that no one or nothing is against the guidelines provided by the DNV. Staffing, daily schedules, and meetings would come easy after all the primary goals have been delegated.

References

Aithal, P. S., & Kumar, P. M. (2016). Organizational behavior in the 21st century–'Theory A'for managing people for performance. IOSR Journal of Business and Management (IOSR-JBM), 18(7), 126-134.

Cameron, K. "Positive leadership: Strategies for extraordinary performance." Berrett-Koehler Publishers, 2012.