one post and two responses

please provide APA references for both the post and response.

here is the question( the post)

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Discuss common themes across the assigned journal articles relative to public health preparedness from the emergency and disaster healthcare perspective.

and here I need (the two response) to two of my classmates.

first one

This is a hot-button topic for me. I have been an Emergency Department RN for years and currently, have a leadership/clinical role in the ED.

Common Theme:

  • Overcrowding / Using the ED for primary care
    • On any given night in the ED where I work, we are holding 5-20 patients due to mental health holds, ETOH intoxication, case management/placement issues or the hospital is full or does not have enough staffed beds. Each nurse is responsible for 4-5 patients and it is luck of the draw. I have had many nights where I have a trauma alert, a septic/hypotensive/unstable ICU patient, a cardiac alert and a rowdy patient who will not stay in bed. My job in the ED is to stabilize the patient and to get to a disposition– admit, transfer or discharge. My trauma and ICU patient would be staffed at a 1 RN to 1 patient ratio or a 2:1 ratio, depending on their stability. Yet, I am responsible for all four of them, often for hours because we do not have any beds open. It can be a terribly dangerous situation, especially when the trauma patient needs continuous monitoring for condition changes and I’m titrating drips (medications that require adjustments based on the patient’s condition/response to the medications) in the ICU patient’s room. You are essentially running around like a crazy person, instructing the intoxicated person to stay put, answering call lights for “sandwiches and blankets” and a million other requests. There is a HUGE need for observational units and I’m am glad that these are now covered by Medicaid. The problem, however, is the expense of building & staff these units in comparison to the bottom line.
    • We rate our patients on an acuity score (ESI) of 1-5, with 1 being the sickest, requiring immediate life-saving intervention, 2 requiring living-saving intervention within 30 minutes etc. When we are not moving patients (ie: throughput), two things happen. (1) Sick patients wait in triage for too long. (2) ESI 3,4,5 level patients get upset that they are not receiving care. Essentially, if you are dying, we will find a bed for you. If you are sick, we will find a bed for you very quickly and start treatment up in triage. If you have a cold, need an STI check or pregnancy test, you will be waiting. Here is the catch, hospitals receive reimbursement based on HCAHPS surveys (Hospital Consumer Assessment of Healthcare Providers and Systems). The surveys are sent out to patients and the scores reflect their opinion of the care they received. If they are admitted, they get a survey based on their in-patient care (not the time spent in the emergency department). If they are discharged from the emergency department, they get a survey based on their care in the ED. SO, if they are sick enough to get admitted, they do not survey the care in the ED. If they are well enough to go home, they do get a survey about the care in the ED. Well, using my example of the types of patients a nurse might be responsible at the same time, who do you think is getting the most attention? Obviously, my time at bedside directly relates to the stability of the patient; so the people I’m spending the most time caring for are not surveying me and the people I’m spending the least time with are surveying my care. In 2020, HCAHPS is adding even more weight to the survey results in relation to ED reimbursement.

Isaac, T., A. M. Zaslavsky, P. D. Cleary, and B. E. Landon. 2010. “The Relationship Between Patients’ Perception of Care and Measures of Hospital Quality and Safety.” Health Services Research 45 (4): 1024-40.

  • Martsolf, G. R., Gibson, T. B., Benevent, R., Jiang, H. J., Stocks, C., Ehrlich, E. D., . . . Auerbach, D. I. (2016). An examination of hospital nurse staffing and patient experience with care: Differences between Cross‐Sectional and longitudinal estimates. Health Services Research, 51(6), 2221-2241. doi:10.1111/1475-6773.12462

The second answer

Emerging Issues in Public Health Response to Disasters

America has been through many disasters that have exposed vulnerabilities present in the public health facilities. The aftermath of the abominable 9/11 portrayed health care facilities as unprepared to provide laudable emergency responses; inefficient communication between health care organizations coupled with poorly coordinated response characterized was the order of the day in the wake of the havoc.

Publications touching on fine-tuning public health organizations response to emergencies have been on the rise. The publications are aimed at enlightening health care practitioners, the general public, and other stakeholders in the public health space about disasters and how to handle them better. Some of the themes present in the publications are discussed below.

Many publications advocate for emergency medicine; this is a service that facilitates specific care for patients that have suffered life threatening injuries as a result of a disaster. The service is available around the clock to all American citizens regardless of their medical insurance status. Unlike the traditional public health, emergency medicine is more concerned with critically injured individuals. However, traditional public health and emergency medicine have been thought to be complementary to each other as the two have one goal: keeping the population healthy.

The Emergence of new roles for hospital emergency departments (EDs). Traditionally EDs are meant to provide urgent medical attention to critically ill or injured patients. However, in the wake of the recent disasters, EDs have added new roles to their job description. The new roles include the provision of services to uninsured patients, monitoring of public health, taking part in disaster preparedness, and providing medical attention to dispersed communities. All the mentioned roles are meant to medical needs of the society.


Committee on the future of emergency care in the United States health system (2007) Hospital-based emergency care: At the breaking point