Nurses who take care of trauma patients run into this all the time. “The cervical spine is cleared,” they say. But who is “they?” How did “they” do it? What is the patient now allowed to do? And what’s the deal with this funky collar?
This 11 minute video will provide the answers to these questions and more! Enjoy!
A few papers have been published in the nursing
literature about the detrimental effects of interruptions experienced during
patient care. Unfortunately, these papers have never taken the next step to
determine why they occur, and what steps can be taken to decrease the frequency
of this problem.
A group at Wright State in Dayton OH tried to
tease apart the various aspects of this issue. They observed registered nurses
in a 23 bed SICU at a Level I trauma center. A total of 25 sessions covering 75
hours and multiple nurses were analyzed for the cause and duration of any interruption,
and whether it caused a switch from their primary task.
Here are the factoids:
Frequency (left) and duration
(right) of interruptions from each source. CL = call light, ECD = electronic
communication device
Bottom
line: This is a first look at the anatomy of nursing interruptions in the SICU.
They are much more common than you think. Task switching (either mentally or
physically) is something that humans do poorly. It always degrades performance,
and can ultimately lead to patient harm. Hopefully, operational protocols can
be developed to protect nurses from unnecessary or non-urgent interruptions to
improve quality of care.
Reference:
The anatomy of nursing interruptions in a surgical intensive care unit at a
trauma center. EAST 2016 Poster abstract #18.
Nurses have a complementary role with physicians in caring for children with orthopedic injuries. Typically, the child will have been evaluated and had some sort of fracture management implemented. In children, nursing management is easer than in adults since a child is less likely to need an invasive surgical procedure. Many fractures can be dealt with using casts and splints alone.
Here are a few tips for providing the best care for your pediatric patients:
Forensic Nursing combines nursing science with the investigation of injuries or deaths that involve accidents, abuse, violence or criminal activity. Sexual Assault Nurse Examiners (SANE nurses) are one of the most recognized types of forensic nurses, but they have special training in one type of injury. Forensic nursing programs typically involve a broader set of skills, encompassing some or all of the following:
Forensic nurses find that their additional training improves their basic nursing skills, and allows them to derive greater career satisfaction from helping patient in another rather unique way.
Approximately 37 training programs exist, ranging from certificate programs that require a specific number of hours of training, to degree programs (typically Masters level programs). Many of the certificate programs are available as online training.
Source: International Association of Forensic Nurses (http://www.iafn.org/)
“Insanity: doing the same thing over and over again and expecting different results.”
– Albert Einstein
This post applies specifically to nurses. I know it’s happened to you. Your patient is having a problem. You do a little troubleshooting, but you feel that a doctor needs to know and possibly take some action. So you page them and duly note it in the medical record. No response. You do it again, and document it. No response. And a third time, with the same result.
And now what? Call someone else? Give up and hope the patient improves?
What if the doctor on call is a known asshole? Are you even reluctant to call in the first place? Do you delay as long as you possibly can?
Believe it or not, I’ve seen many chart review cases over the years where this situation does arise. And every once in a while, the patient actually dies. Sometimes this is directly related to the lack of intervention, but sometimes it just sets the ball rolling that eventually leads to patient demise days or weeks later.
What’s the answer? We all want to provide the best care possible for our patients. But sometimes social factors (or pager malfunctions) just get in the way. Here’s how to deal with it.
Every hospital / nursing unit needs to have a procedure for escalating patient care calls to more advanced providers. When one of your patients develops a problem, you usually have a pretty good idea of what the possible solutions are. So call/page the proper person (PA/NP/MD) who can provide that solution. If they don’t give you the “right answer”, then question it. They are not all-knowing.
If they give you a good explanation, go with it, but keep your eye on your patient’s progress. If they can’t explain why they are giving you the wrong answer, suggest they check with someone more senior. And if they don’t want to, let them know that you will have to. Consider no answer the same as a wrong answer.
Don’t stop going up the chain of command until you get that right answer, or an explanation that satisfies you. The hard part here is going up the chain. You may not be comfortable with this. But you do have resources that can help you that have more authority (nurse manager, supervisor, etc). If they, too, are uncomfortable, then your hospital has much bigger problems (unhealthy workplace).
Example: trauma unit nurses at my hospital will call the first year resident first, then escalate to the junior and/or chief residents. If they don’t do the right thing, the in-house trauma attending gets the call. If they don’t handle it, then the trauma medical director (me) gets called. And, of course, I always do the right thing (chuckle). And our nurses know that the surgeons support them completely, since this facilitates the best patient care. The residents and PAs are educated about this chain of command when they first start on the trauma service, and it makes them more likely to choose the “right answer” since they know the buck may not stop with them.