Imogene M. King’s Goal Attainment Theory would be used in this case to understand turnover time in orthopedic surgery. A nursing theory provides a framework or a model to guide nursing practices and improve outcomes. The nursing profession, however, has experienced significant changes in the last few years. As a result, nursing practices, nurse staffing and patient outcomes have been affected critically. For instance, the shortage of nurses in critical units such as orthopedic surgery units has affected the turnover time (the period allocated for changing from one operation to another). Poor nurse staffing has increased stress levels of nurses, negatively affected job satisfaction and many nurses have opted out of the profession. Researchers have shown that when facilities have nurse staffing below the appropriate levels, then the rate of mortality increases. Therefore, there is a need for an adequate nurse-patient ratio in different units (Needleman et al., 2011).
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People pursue the nursing profession to change healthcare service delivery and outcomes. Nurses, however, should set certain goals for their patients and then embark on achieving those goals. As noted above, King’s Goal Attainment Theory would be applied to assist nurses in interaction with patients and meet health service delivery outcomes, specifically turnover time in orthopedic surgery units in a constrained nurse-patient ratio environment. King’s theory evaluates the conditions of the patient, identifies specific needs, promotes effective communication, selects the right interventions for the patient, solves the problem and evaluates outcomes.
Description of the problem/issue for which strategies will be developed
Nurse shortage is a critical global issue in the healthcare sector. It has several contributing factors, including low rates of nurse enrollment, high rates of nurse attrition and an increasing number of patients with chronic conditions among others. As a result, service delivery in critical units such as orthopedic surgery units has suffered poor turnover time. According to a study conducted by Avery and Matullo (2014), there is a growing focus on orthopedic and non-orthopedic operating room (OR) efficiency with a specific focus on costs of staff and hospital revenues and therefore turnover time has become a significant factor for consideration.
Orthopedic surgical units are high-resource intensive areas and therefore any delays could affect physicians’ productivity, lead to loss of revenues and affect patient outcomes. Consequently, understanding turnover time and reducing delays in such units are imperative for physicians and patients and enhance optimal utilization of operating room resources. In such instances, nurse managers must develop effective, standardized models to track activities in OR. Such models are useful in identifying and lessening overall delays and enhancing operating room usefulness.
Turnover time (TOT) is one of the most important effective measures of OR effectiveness (Kodali, Kim, Bleday, Flanagan, & Urman, 2014). Nurse managers understand the relevance of TOT on healthcare service delivery and outcomes. Kodali et al. (2014) have observed that several attempts have been made to enhance TOTs, in some cases, by the use of employment process improvement models. Many of these models for improving TOT outcomes have focused on workflows and statistical significance. In this case, they do not account for complex healthcare facilities’ structures, issues associated with implementation, expansion, long-term outcomes and sustainability. Healthcare facilities also have obstacles that could affect changes. These may include complex structures and organizational inertia that “OR leaders, managers, and change agents commonly face” (Kodali et al., 2014). Nurse managers and leaders, therefore, must be aware of several factors that inhibit or support certain TOT improvement approaches. This can result in effective change management and implementation of the proposed models.
Therefore, reducing turnover time is one aspect of a multifaceted solution in increasing efficiency, and studies have demonstrated that “orthopedic-specific staff can reduce turnover time” (Avery & Matullo, 2014). Some researchers have recognized the relevance of reduced turnover time in operating rooms. For instance, it has “a broad and significant impact on hospital administrators, providers, staff and patients and therefore contributes to major efficiency, quality improvement, and cost-reduction opportunities” (Bhatt, Carlson, & Deckers, 2014). This implies that effective models and theories of nursing should be applied to guide several aspects of operating rooms to enhance outcomes and turnover time for physicians and patients. Enhanced communication among a multidisciplinary team is critical for improved turnover time outcomes (Yeo, Gordon, & Nusem, 2014). In this regard, orthopedic units should have clear and straightforward sets of rules to manage operations, specifically for the team. This approach can reduce time taken to perform operation room procedures and increase patient outcomes.
In many healthcare facilities, nurse managers have declared the goals of increasing operating room efficiency (Ernst, Szczesny, Soderstrom, Siegmund, & Schleppers, 2012). Specifically, they focus on reducing tardiness associated with the first case of operating rooms (Ernst et al., 2012). Operating room management models and theories could be applied to achieve the desired outcomes. Nurse managers and leaders must therefore develop surgical suite control systems to aid their work. If they can focus on reducing tardiness in the first operation, then turnover time can reduce significantly. According to Ernst et al. (2012), the appointment of “an OR manager or the adoption of an OR charter support the goals of reducing tardiness” (Ernst et al., 2012) and therefore is necessary for effective utilization of operating room time.
Applying concepts and principles from the selected theory
King’s Goal Attainment Theory provides clear insights for nurse interaction with patients and other stakeholders within the nursing environment. The theory shows the relevance of stakeholders’ inputs in decision-making processes and care provision. It highlights the interaction between nurses and patients and the subsequent outcomes. Nursing, in this model, is a process that requires inputs, actions and interactions in which all stakeholders share information about their points of view on nursing issues. Overall, nurses and patients should share certain, specific objectives and issues and find alternatives to solve them and achieve desired goals.
Nurses should assess their patients during the interaction. In this case, nurses must understand patients’ from informed points of view as patients explain themselves, perceptions of health problems, and environments. As a result, nurses will have adequate knowledge about their clients and demonstrate dedication to practices (Avery & Matullo, 2014). Nurses should collect relevant information about patients during the assessment to improve processes (Kodali et al., 2014). Such information may include a history of health issues, growth, health conditions, and self-perception among others. Patients’ perception is a critical factor in data collection and interpretation. At the same time, there is always a need for effective communication to ensure that all data collected are verified and accurate and therefore reflect self-perception during interactions.
It is imperative to note that assessment is successful because of the dynamic nature of health. The theory posits that life experiences differ for people. In this case, people tend to adjust to different environments and related ‘stressors’ from both internal and external factors. Adjustment may require effective resources to achieve maximum outcomes.
King’s theory shows that assessment of patients should lead to effective goal setting for patients based on their conditions. The determined interventions must be implemented to achieve the desired goals. In this case, any assessment should focus on the transaction and health of the patient. The transaction involves interacting with patients in order to achieve the desired goals. The process must be goal-based. Nurses, therefore, should focus on the actual or potential health issues during patient assessments in orthopedic surgery units. The results shall improve comprehension of issues that affect patients’ health and healthcare organizational structures.
The theory provides a framework for planning in healthcare facilities. After the patient diagnosis, nurses must develop a care plan with various interventions to tackle medical issues of patients. Goal Attainment Theory requires nurses to set specific goals and make decisions on how these healthcare outcome goals can be achieved. In this case, nurse managers in an operating room can define the desired turnover time for patients. Nurse managers must understand that planning involves transaction with patients and other stakeholders to support decision-making processes and facilitate attainment of healthcare outcome goals. In this case, “a targeted, multifaceted and multidisciplinary approach could increase the percentage of operations that begin on time in operation rooms” (Wright, Roche, & Khoury, 2010).
The theory also requires nurse managers to define roles. Roles must focus on expected behaviors from physicians and nurses in operating room. For instance, orthopedic unit must have rules that clarify responsibilities, rights and obligations of a multidisciplinary team to avoid malpractices where nurses or physicians may engage in interventions beyond their scope of training. Developing effective, working relationship is therefore encouraged during planning for interventions.
Time is also relevant in this theory. It considers time as a sequence of events scheduled in a given manner. In operation room, turnover time should reflect a continuous flow of activities (orthopedic surgeries) in a successive order to reduce tardiness and delays. Changes must be noted and duration between one operation and another must be noted. In fact, time, expressed as turnover time in this case, is imperative for nurse managers and leaders in orthopedic surgical units who wish to improve turnover time.
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King’s Goal Attainment Theory provides opportunities for nurse leaders to implement their interventions to achieve the desired goals. This process involves execution of actual interventions to achieve intervention outcomes e.g. reducing turnover time in orthopedic surgeries. Transaction is also a critical part of intervention implementation. Transactions take place because of the perceived patients’ conditions, physicians’ roles and nurse working environment. Consequently, nurse managers must evaluate different perceptions, make judgments and act based on the responses. Nurses and physicians may react to these results in different ways with consideration of their shared points of view and commitment to improve turnover time operating rooms. The approach supports intervention implementation within a nursing context.
Communication is also a critical component of the model used in this case (Yeo et al., 2014). Physicians and nurses must communicate in operating rooms using different ways, directly or via communication gadgets. Poor communication could hamper attempts to reduce tardiness in operation rooms, and it therefore affects turnover time. Hence, nurse managers must define communication plans for operating room, as a distinct space is a complex healthcare organization.
Once nurse managers have implemented interventions for patients, they must conduct evaluation to determine attainment of the set goals. King’s theory reflects the need to attain the desired goals and determine their effectiveness and efficiency of nursing care, including turnover time.
Action must apply to results obtained from the evaluation process. Nurse managers should use evaluation outcomes to improve patient outcomes, nurse efficiency and turnover time. From this theoretical perspective, nursing practice should strive to restore, attain and sustain individuals’ health in case of any health issues. In this case, nurses and physicians must create goal-oriented actions to assist people to regain good health status or improve health conditions of people with chronic conditions or living with disabilities.
Nursing practices are now common in operating rooms and in long-term care facilities. Nurse managers can use different settings for health promotion because an operating room provides a good setting for a multidisciplinary team to communicate (Avery & Matullo, 2014). Healthcare stakeholders, including patients should provide inputs that could affect healthcare outcomes positively.
From this study, it is evident that nurse theory provides effective ways of overcoming nursing issues, including shortage. For instance, King’s Goal Attainment Theory requires nurse managers to assess, plan, implement and evaluate interventions with the aim of improving nursing practices and patient outcomes. The theory can assist in tackling nurse staffing issues and avoid burnout in operating rooms by improving turnover time. Nurse managers, therefore, should focus on the use nursing theories and models to improve outcomes in their units.
Avery, D. M., & Matullo, K. S. (2014). The Efficiency of a Dedicated Staff on Operating Room Turnover Time in Hand Surgery. Journal of Hand surgery, 39(1), 108–110.
Bhatt, A., Carlson, W., & Deckers, P. (2014). Improving operating room turnover time: a systems based approach. Journal of Medical Systems 38(12), 148.
Ernst, C., Szczesny, A., Soderstrom, N., Siegmund, F., & Schleppers, A. (2012). Success of commonly used operating room management tools in reducing tardiness of first case of the day starts: evidence from German hospitals. Anesthesia & Analgesia, 115(3), 671-7.
Kodali, B., Kim, D., Bleday, R., Flanagan, H., & Urman, D. (2014). Successful strategies for the reduction of operating room turnover times in a tertiary care academic medical center. Journal of Surgical Research, 187(2), 403-11.
Needleman, J., Buerhaus, P., Pankratz, S., Leibson, C., Stevens, S., & Harris, M. (2011). Nurse staffing and inpatient hospital mortality. The New England Journal of Medicine, 364(11), 1037-45.
Wright, J., Roche, A., & Khoury, A. (2010). Improving on-time surgical starts in an operating room. Canadian Journal of Surgery, 53(3), 167-70.
Yeo, C., Gordon, R., & Nusem, I. (2014). Improving operating theatre communication between the orthopaedics surgeon and radiographer. ANZ Journal of Surgery 84(5), 316-9.