In class, we were taught that the increase in demand and the decrease in resources can promote workflow and happier relationships.
The above YouTube video demonstrates how organization and teamwork can efficiently cut down the number of resources, while creating a less congested workflow and lend a helping hand to more families. At the beginning, George and Metro spent 3 minutes packing one box of food and necessities; however, they were able to pack one box in 11 seconds after creating a better system. In addition, the system allowed them to distribute the boxes to families in only 1.2 hours, which is less than half the time it took them before.
In cooperation with Toyota Production System and advice from other people, the system shifted from a disorganized environment to a workplace-efficient and organized environment. For instance, they reduced the sizes of the cardboard box so they could be easier to handle and allow for more space in the trucks. A conveyor belt also helped increase workflow in the environment because volunteers were able to stay in one place and handle one job instead of running around everywhere.
During the second half of the class, we discussed the purpose, advantages, and disadvantages of E-Shift in nursing. According to South West Local Health Integration Network (2013), E-Shift is defined as "a technology-based initiative that connects an enhanced-skill Personal Support Worker (PSW) in the home with a registered nurse via a web-enabled iPhone." E-Shift is a movement that involves the use of technology to solve the issue of declining nurses in the health care industry. More importantly, E-Shift works to improve the quality of life for those in palliative care by decreasing the number of hospital visits and the burden of caregivers (Health Quality Ontario). It can alleviate financial, physical, emotional, and mental burdens on the caregivers of the patients. The caregivers suffer from physical burden when they are constantly awake and alert to care for the patients and mental burden for caring for a loved one who will soon be leaving them. Additionally, E-Shift creates a more flexible environment and empowers staffs to work with more than one patient.
The E-Shift program ensures that each palliative patient receives the best optimal care during his/her last days by enhancing the skills of the health care providers involved in their care (Health Quality Ontario):
- PSWs receive intensive palliative training such as learning how to observe and report vital signs and symptoms to the registered palliative nurse that they are collaborating with
- PSWs are trained to operate Smartphones and computer technologies so that they can share and inform the RNs of the palliative patients' condition
- RNs are trained to provide virtual support and to effectively communicate with the PSWs involved in their patients' care
- CCAC Supportive Care Team are trained to operate and view electronic patient records
According to Health Quality Ontario, the E-Shift program is successful in ways that hospital readmission or visits have been reduced as 92.3% of the participants had not visited the hospital during the last weeks of their lives. Additionally, "32.6% more clients died at home as per their wish" in comparison to the 52% of non-participant clients who died without the use of E-Shift. Furthermore, 92.3% of the caregivers explained that they did not experience caregiver burden because they seek help from E-Shift.
Although the E-Shift program does serve as an advantage to patients in palliative care and the decline in nurses, there are disadvantages to participating in the program. For example, a lack of communication and understanding between PWSs and RNs can inhibit or negatively affect the palliative patients' health. Since the PWSs are only able to send photos or data via a smart phone, it is difficult for RNs to be able to make sense of the whole picture since they are not physically present to examine the patients. Additionally, if a blackout were to occur or if Privacy and professional accountability are two important factors as well. Since the PWSs will be caring for the patients in their homes, there is no doubt that the patients and their caregivers will feel invaded. The PSWs will need to be reminded to remain respectful and accountable for their actions. Furthermore, PSWs are reminded to maintain a professional boundary with their clients as it may be difficult for them to separate personal feelings from professional feelings.
In reflection, in class we were presented with a case scenario in which we had to choose whether or not we would want to admit an important person in our lives to the palliative care unit in the hospital. We were physically and mentally burden from caring for the important person. In addition, we were aware that the person wished to die peacefully at home; however, we could no longer care for him/her while feeling burdened.
In response, I would choose to care for the important person at home because as an individual I would like to fulfill that person's last wish- to die comfortably at home. Also, as a nurse I would need to respect my patient's desires and wishes as long as they do not interfere with or degrade the patient's health.
However, I am aware that I cannot force my limits upon myself to care for someone I can no longer look after because of physical and mental burdens. Thus, if possible, I would choose to seek help in caring for the person while fulfilling their wish to die peacefully at home. At the end of the day, I will continue to care for the important person in his/her home.
Furthermore, in reflection I will answer to the questions presented in the Learning Activities:
What are your thoughts regarding nursing care/service, whereby the nurse was never physically present? Does a nurse always have to be physically present to undertake the nursing role?
In my opinion, not all nurses need to be physically present in order to care for their patients. There are many nursing positions that do not require nurses to interact with patients at all such as a nursing professor who teaches theory courses in a nursing school. Other non-clinical nursing positions include nurse researchers, nurse advocators, or healthcare recruiters.
Nurses do not need to be physically present in order to serve their role as nurses because different nurses have different roles but similar purposes: to promote health.
Health Quality Ontario. Eshift -- Creating a virtual in home end of life care team. Retrieved from http://www.hqontario.ca/portals/0/Modals/pr/hc/en/pdf/success-story-south-west-en.pdf
HENRYandREL Supermarche. (2013). Meals per hour [Web]. Retrieved from http://www.youtube.com/watch?v=EedMmMedj3M
South West Local Integration Network. E-shift helps patients and south west CCAC. Retrieved from http://www.southwestlhin.on.ca/newsletter.aspx?id=60
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