Using Diverse Strategies to Enhance the Quality of Emergency Nursing

Friday, 28 July 2017

Hui-Ju Chung
Department of Nursing, Chi-Mei Medical Center, Tainan of Taiwan, Taiwan
Hui-Ching Hsu
Department of Emergency, Chi-Mei Medical Center, Tainan,Taiwan, Taiwan


As rapid economic development in Taiwan increases the living standard among the public, the needs for higher quality of medical services have also been growing, consequently gradually leading to more complaints about medical institutions. Enhancing the quality of medical services increases satisfaction and decreases the complaints from the patients. However, the enhancement of nursing quality on patients requires cross-sectional as well as longitudinal communication among medical staff, so as to effectively enhance patient-oriented nursing quality. Among those medical staff, nurses act as the coordinators between doctors and patients, and hold the key to cross-team resource integration. Nurses not only report opinions from patients and their families to medical teams, but also help medical teams to better understand thoughts and feelings of patients and their families. Therefore, this study aimed to, through clinical education and positive encouragement, enable nursing staff to identify feelings or understanding that hindered communication or caused misunderstanding in the process of doctor-patient communication in light of understanding, learning, practicing, discussing, and coordinating embedded in the communication theory. This study also attempted to help nursing staff to increase their self-awareness, and further develop emotion regulation, with good communicative skills utilized in medical teams to strengthen clinical nurse-patient communication and to enhance the quality of clinical nursing.


With the analysis of current situations and verification of previous literature for further unit complaint case analyses, project improvement based on factors related to complaints were as follows:

  1. Holding relevant in-service educational courses

  1. Communicative skills: error disclosure, conflict resolution, expression of sympathy, and apology conveyance.

  2. Analyzing underlying reasons to verify the ins and outs as well as attributes of an event, and to propose relevant improvements.

  3. Law regulations and basic knowledge related to medical disputes.

  1. Clinical practice – simulation

  1. Case discussion: Experiencing the feelings and understanding of the given communication and challenges in miscommunication between nursing staff and patients via simulations and role plays, allowing for angles and perspectives of reinterpretation.

  2. Demonstrating and explaining differences between negative and positive communication, reasons for success, and aspects that fit relevant theories.

  3. Discussing and practicing positive communication by probing into its challenges, reasons for success, and feelings/thoughts/behaviors embedded in a given communication.

  1. Ways of positive encouragement

  1. Setting up an honorary award: Publicizing patients’ recognition of nurses’ outstanding services.

  2. Awarding praise cards and gifts to nursing staff of outstanding services in ward meetings.

  3. Allocation of award fund: Superintendents allocated award fund to nursing staff of outstanding services.


The project, with diverse strategies employed for clinical education and improvement measures, calculated numbers of complaint and praise in the Emergency Department from 2013 to 2015. The results revealed that cases of nursing complaints decreased (2 cases/year in 2013 to zero case/year in 2015), that praises of nursing services increased substantially (22 cases/year in 2013 to 97 cases/year in 2015), and that patients’ satisfaction with nursing services was above 99%.

Discussions and conclusion

Medical practitioners and consumers all regarded the service attitude of nursing staff as one of significant indicators in medial service quality, and mentioned that service factors such as attitude and explanation were key to satisfaction. Nursing staff are normally in the forefront of serving patients and their families in medical institutions, thus service attitude and training of coping capacity is vital in nursing. Nurse-patient communication is also an important factor affecting job satisfaction with nursing staff. A study probing into the effects of nursing staff’s reception of communication training indicated that after the training of nurse-patient communication, the relationship between nurses and patients became closer and enhanced subsequent job satisfaction. In this project, diverse instructional methods were utilized, including communicative skills, analysis of underlying reasons, law regulations and basic knowledge related to medical disputes. Role play simulations that increased doctor-patient communication were also added, enabling participants to have hands-on experiences in doctor-patient communication in advance with diverse simulations. Ways of positive encourage for increasing the morale among nursing staff effectively lowered cases of complaints and greatly increased praises of outstanding services.