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

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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