The Patient Care Process

The only thing in the world that is consistent is change. Healthcare is rapidly changing on so many fronts. When I started as a paramedic around 2000 the standard at the time was to give all Cardiac Arrest patients sodium bicarb. Several years into my career we were instructed to move away from this practice. Many of the ‘old timers’ were upset as a result of the many lives they had saved while using bicarb. Change is difficult. It was difficult for those medics and it is difficult in many aspects of healthcare. However, the only way to improve from where you are is to change.
This week we discussed some aspects of changing the patient care process. We evaluated what might need to be changed in order to prevent patients from not receiving their pre-op antibiotics. Patients have a pre-op checklist. Making sure this antibiotic is on that pre-op checklist is one way to help ensure this error doesn’t occur. There is also something referred to as a ‘time-out’ prior to surgery. The operating room members discuss what is being done and on what patient and verify that everything is in order before they make the first cut. If the pre-op antibiotic were a part of this ‘time-out’ and a surgery was held up when it was not administered, how many times would the nurse forget to give it? It would also be caught immediately and be able to be administered at that time.
I have witnessed medication errors with the administration of antibiotics, they are easy to do. One of the ways we attempt to reduce errors with antibiotics is to never leave the room until you see the medication dripping into the collection chamber. As simple as this seems it has helped me to catch potential errors I could have made.medication-erroe-meme



Benchmarking is how we establish where we are, where we have been and where we are going. Prior to this module I had heard the term benchmarking and had a general idea that it was a means of measuring performance. This weeks lessons, discussions and critical thinking exercises expanded my knowledge and helped me to understand how critical benchmarking is to healthcare.

Benchmarks must be measurable, but more than that they must be specific to what you are trying to accomplish overall. Setting a benchmark for decreasing infection rates and then measuring call light responsiveness isn’t going to help change infection rates. Measuring hand hygiene on the other hand may help infection rates immensely.

While benchmarks need to be specific and measurable it is also important to learn from what and how others benchmark who have the same goals as you do. Diving into the specifics of the goal, the process, the measurement (benchmark), and the outcome are all equally important when trying to set and achieve a specific benchmark.

One thing that stuck out to me specifically is watching what others use as important benchmarks in providing care. My doctor uses lab values when he wants to justify a certain type of care for me and then also incorporates symptoms when he wants to deviate from what the lab values would indicate. It has spurred me on to be much more specific in managing my own care. There was a time I would trust my care to my doctor blindly and those days are over.

Benchmarking can also be compared to effectiveness. When I am speaking with a patient I inform them of what I think is going on with their care. We discuss what the Doctor has told them, what they are feeling, what role medications and treatment may be playing in the process, and each of these can have a type of benchmark tied to it. Even if you call that benchmark “normal response” or “expected response,” even an “unexpected response” incorporates a benchmark that we are either not meeting or exceeding. This weeks lessons helped me to realize I need to be specific and factual in how I perform any task as a nurse and critically evaluate my care against a benchmark of “High Quality Care!!”

Also this week I have purchased a new computer. I utilized industry standards, or “benchmarks,” to determine what make and model would be best suited to my needs. As a result of this new make and model, it is processing my images differently than in previous weeks. I have a benchmark meme that I have “inserted” into this post, yet doesn’t seem to want to show itself…..

We’ll see how well I overcome the obstacles of this new standard of computer my benchmarking helped me pick out. It would appear that this week my performance has declined with regards to media and I will need to re-evaluate and alter my knowledge to produce better results by incorporating proper media…..

Healthcare Professionals and Teams

1. Share what you had expected to learn about the topic before beginning the unit.

This week’s topic is healthcare professionals. The term healthcare professional is a very broad term. There are members of the healthcare team that have no background in medicine at all. For instance, the orderly who transports the patient from the surgical suite to the medical/surgical floor who spends his summers doing outside sales jobs and has no medical training. The other end of the spectrum is the individual with advanced doctorate degrees in areas of medicine with specific language that is not used in the general population. That individual is extremely intelligent but can’t communicate to another individual what his knowledge means without the use of a special medical dictionary and thesaurus. Being a medical professional doesn’t mean that you even have the specific knowledge to help in the situation at hand. As a paramedic I would encounter individuals on an emergency scene that would say, “I am a nurse” when asking that “nurse” for further qualifications to determine my resources I would find out that they were a nursing student doing their pre-requisites while working as a CNA in a podiatry clinic. Not exactly relevant to emergency care in the out of hospital setting. I have been a registered nurse for less than 6 months. When asked about specific areas of nursing where I have no experience I am as clueless as a small child on their mothers lap. However, put me in a room with a patient who needs a Rapid Response or a Full Code and I am as calm and comfortable as I can be and able to critically evaluate patient presentation, vital signs, applicable past history, contributing events to the patients deterioration and a wide range of other information.

2. What you actually learned from the unit.

The most important thing I learned in this unit was the limitations of what it means to be a healthcare professional. Nursing has such a broad range of skills and specialties that being a “Nurse” doesn’t guarantee any level of proficiency in any given setting. One individual might be the world’s leading figure on wound care and the last person in the world you would want starting an IV for you.

Another aspect of this topic that stuck out was how each member plays a role on a team. There are some members of the team that far exceed their educational limitations. Their experience with people and their own individual knowledge far outweigh their formal educational credentials. The most important take away from this topic as a whole is not to prejudge the members of the team you are working with but to adequately assess the level of knowledge and expertise and individual brings to the table.

3. Discuss your feelings/experiences from the activities (individual and team)?

We had a team exam this week. While this exam reduced my workload in some aspects it also reduced my GPA in another. When you are working with a team where you are unable to determine their strengths and weaknesses ahead of time, I learned that it is vitally important to allow time to evaluate their contributions to the team as a whole and not just hope for the best…

4. How you will utilize the information learned in your nursing practice.

When I am the individual with no formal experience with a given subject I like to ask a lot of questions. I like to ask how things were identified, how the individual processed them up to that point, and how they knew it was applicable to the given situation. I then like to tell that individual what I was thinking and why, where my thought process came from and ask them to evaluate the direction I was headed and give me feedback and what else I should have considered. When you have no experience with a given subject, the best way to overcome this shortcoming is to utilize the collective experience of your team and integrate their knowledge into your own experience.

5. You personal feelings about the material covered.

IHC is moving towards decentralized nursing stations in their new addition to the Utah Valley Hospital. I think this is going to eliminate a lot of learning and experience from medical unit staff. Being able to learn and process information from the most experience nursing staff and have that information assimilate down to the least experienced staff is going to become obsolete. The most experience and the least experienced may never even see each other in the decentralized setting. The least experienced staff will have an increase in never events while the most experienced staff may never realize there was someone her experience could have helped. But at least the administration will have cut down on socializing…..

There is a book by Tony Dungee titled “Extreme dreams depend on Teams.” Eliminating the team setting in the hospital environment is a big mistake. Building effective teams where the weakest members can learn and grow from the strongest members is essential to having everyone grow together.

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Legal and Ethical Issues in Quality and Safety in Nursing

I was surprised at several of the directions we were taken during assignments and discussions with this topic. I wasn’t sure exactly what we would focus on for legal and ethical issues because there are so many of those issues in healthcare. What surprised me the most is how quickly those issues arose with certain patients. One example is the 27 year old female patient suffering from chronic pain related to fibromyalgia. Seems like an issue of chronic pain and how to deal with it. The assignment went almost immediately to medical assisted suicide for this patient. I have experienced low back pain from falling down some stairs while fighting a house fire. That low back pain haunts me almost a dozen years later. I actually get angry when I begin to feel that pain. It frustrates me, it messes with my head, yet I have never thought of killing myself over that pain. While my pain isn’t as severe or as debilitating as others pain might be, I still don’t go down the road of suicide to escape that pain. It wasn’t something I had considered and therefore took me by surprise on this assignment.

I would say that this surprise is what I learned or re-learned during this unit. That just because I wouldn’t consider something in a specific situation doesn’t mean others aren’t considering it. This reinforces the idea that we really need to come to understand our patients and what they have on their mind. What might seem simple to us might be debilitating to them. Coming to a full understanding of their mindset, their coping mechanisms and the resources they are using to address their medical issues.

This assignment served as a reminder to me to step out of my own mind and try to understand what is going on in my patients. Their worries, fears and ability to identify and solve problems are so much different than mine. Rather than force my views on them, taking the time to understand their views will serve me well in the future and help me gain wisdom.


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Quality Improvement Strategies


QSEN- The song of my people

Quality improvement to me has always been one of those topics where we talk about making improvements but don’t actually discuss what it is we are going to improve. Or possibly that our focus is an improvement in an area that isn’t directly related to better health or an accurate measurement of health.

Quality improvement is essential in any competitive industry. Healthcare is no exception. Learning statistics like we perform 2,200 heart surgeries a year shows our advancement in medical technology. Following that statistic with the knowledge that that same number of surgeries are performed incorrectly or on the wrong patient demonstrates the need for constant quality improvement.

This unit actually pointed me in the direction of resources that are available for me to be a better healthcare worker. I found the information at QSEN to be  helpful in providing me with additional resources for that improvement.

During this unit we had several team based discussions. These discussions are always beneficial in analyzing our thinking and the thoughts of our colleagues. This allows us to gauge our own level of knowledge and make adjustments where needed.

I personally don’t believe true healing revolves around patient satisfaction. I believe true healing revolves around making tough and necessary changes to incorporate a better lifestyle for ourselves and our family. As a medical surgical nurse true healing comes as a result of a patient centered approach to a medical plan of care. Providing a safe and comfortable environment is essential in helping patients heal from medical procedures, however, patients need the truth about what is necessary for adequate healing and not just to be told what makes them happy.

Quality in Nursing Care

The topic for this week was Quality in Nursing Practice. We looked at different elements of quality that were important to us and elements that we felt would be important to our patients. As we approached this week I wasn’t sure what I would learn from the material but kept an open mind as I evaluated what others thought were important and what the material presented as important.

One thought that stuck out to me is that quality can be something different for each individual. Not so much that quality itself is different but the means by which each individual measures and evaluates it. That stuck in my mind that its important to understand the perspective of the individual you’re interacting with. Quality from a patient standpoint is going to be evaluated differently than quality from a corporations standpoint.

Understanding each patient I interact with and how they feel about quality care is the lesson I have taken from this weeks material. Being able to assess this in each patient and then provide quality care to their level of expectation is the challenge moving forward.

Critical Thinking

This week we were asked to consider the following questions,

  • What do you consider elements of quality care when receiving healthcare services?

One of the first elements of quality care when receiving services is problem solving. As a patient there are problems, pain control, infection control, are just two of many possible problems. What is being done about the pain? Is the pain management effective? Are my needs as a patient being met by the healthcare team?

Communication is another important element when receiving services. Does the healthcare team explain what is being done and why it is being done? Am I comfortable with what is going on before it gets done? It is important to me to receive the proper communication prior to administration of services.

  • What do you consider elements of quality care as a professional nurse?

As a nurse I believe in the same elements to providing quality care. Problem solving is one of the primary ways we are patient advocates. Do we have the tools and resources available to us to solve the patients problem? If not, what do we need to obtain to adequately solve that problem so that healing can occur?

Communication is an effective treatment to many patient anxieties. Communication can be a form of distraction regarding pain relief. It can be a treatment when patients are struggling to cope. Communication can be source of knowledge if that is lacking. Proper communication to the patient is crucial to a trusting, and healthy healing environment.

  • Are the two similar or different?

They are one and the same. When the needs of the patient are met by the competent care of a nurse a great deal of healing can take place.


Quality and Safety in Nursing Practice

My name is Charlee Smartt. I am enrolled at Utah Valley University pursuing my Bachelors degree in Nursing. I am currently a Registered Nurse working on a Medical Surgical floor. I began this blog a year ago while I was studying Cultural Diversity in Nursing. Since that time the influence of some of the worlds cultures have been introduced into my life. My wife and I have four children. Our oldest son has been in Peru for the last year. He loves the culture and the Peruvian people. Our second son leaves for Berlin Germany in a couple of months. He will be exposed to a wide variety of cultures while in Germany as they have taken in a large number of refugees from around the world.

I am changing the focus of my posts for the next several months as I focus on a deeper understanding of Quality and Safety in Nursing. I hope to be able to broaden my perspective, refine my actions, and better understand deeper issues surrounding Quality and Safety in Nursing.

Polynesian and Nursing Care

It’s called “The American Dream,” when you consider that nightmares are dreams I guess it makes sense. In the United States we push for bigger, better and more in all that we do. Everywhere we spread the “American Dream” we spread obesity, Type 2 Diabetes, technology that leads to a sedentary lifestyle and portion sizes that could feed a small family.

As I was reading about Polynesians and nursing care this week, I came across on article that references Captain Cook’s first contact with the Native Hawaiian people. He described them as healthy looking and muscular with almost no obesity. Today obesity is so common among pacific islanders that it is the norm for both men and women.

We try to spread Americanism everywhere we go. It doesn’t make a lot of sense and it is illustrated very well by the following story.

Asian culture and Nursing

As we have studied the Asian culture this week I have thought of how important asking questions is to Nursing professionals. While it may seem easy to spot someone who has Asian heritage, its an assumption to think they all adhere to the same level of Asian medical tendencies. Its so simple to ask any individual what cultural preferences they may have regarding their medical care. Each of us as an individual chooses what level of cultural involvement we apply to our beliefs. It’s always best to ask than to make assumptions.

Something else that I learned during the week is that as many as 75-100% of all Asians are lactose intolerant. That is a very high percentage. This plays an important role in calcium deficiencies and osteoporosis. Be sure to ask each patient about this and test if necessary.