Nursing Skill: Tricks To Learn & Share

One of the benefits of using social media is the learning opportunities and e-communities of practice (eCOP) that it provides. So if you have a great nursing resource then please post in the comment section below, I will then add it into this post and create a YouTube playlist for anyone to access.  I will start off with this top video on how to remove a ring without having to cut it off (the ring, not the finger!).

Ring Removal Technique

The Flail

 

Please share any of your tips and tricks. I will add the suggested links into this post. Try to keep them clean!!

Empowerment and Leadership Processes

Burnout, well-being, mindfulness, job satisfaction, staff turnover, stress and work-life balance seem to be common discussion threads in healthcare, and in particular the critical care environments. The multi-modal issues identified mean we have provided a suite of resources that look at the leadership and process elements to support the work environment and also the all important team members.  Quality care can then be delivered from an effective, well resourced and supported team.

Leadership Process To Support The Environment    

Supporting Articles 

Dorman, T. (2017) From Command and Control to Modern Approaches to Leadership. ICU Management & Practice, 17 (3).

Guille C, Frank E, Zhao Z, Kalmbach DA, Nietert PJ, Mata DA, Sen S. (2017) Work-Family Conflict and the Sex Difference in Depression Among Training PhysiciansJAMA Intern Med. doi:10.1001/jamainternmed.2017.5138

Institute for Health Improvement (IHI). (2017) ICU Daily Goals Worksheet. http://www.IHI.org

Moneke, N., & Umeh, O. J. (2013). How leadership behaviors impact critical care nurse job satisfactionNursing Management. 44(1), 53-55.

Reader, T. W., & Cuthbertson, B. H. (2011). Teamwork and team training in the ICU: Where do the similarities with aviation end?Critical care15(6), 313.

van Schijndel, R. J. S., & Burchardi, H. (2007). Bench-to-bedside review: Leadership and conflict management in the intensive care unitCritical care11(6), 234.

Wiseman L (2010) Multipliers: how the best leaders make everyone smarter. New York: Harper Collins.

Wong, A. V. K., & Olusanya, O. (2017). Burnout and resilience in anaesthesia and intensive care medicineBJA Education.

 

Clinical Reasoning Cycle

Book Club: Levett-Jones, T. (Ed.). (2013). Clinical reasoning: Learning to think like a nurse. Pearson Australia.

Clinical Reasoning Cycle

Define reasoning as “the process by which nurses (and other clinicians) collect cues, process the information, come to an understanding of a patient problem or situation, plan and implement interventions, evaluate outcomes, and reflect on and learn from the process”.

“Clinical reasoning is often confused with the terms ‘clinical judgement’, ‘problem solving’, decision making’ and ‘critical thinking’. While in some ways these terms are similar to critical reasoning, clinical reasoning is a cyclical process that often leads to a series or spiral of linked clinical encounters” (pg.4 Levett-Jones, 2013).

Stages of the Clinical Reasoning Cycle

  1. Consider the patient
  2. Collect cues/information
  3. Process information
  4. Identify problems/issues
  5. Establish goals
  6. Take action
  7. Evaluate outcomes
  8. Reflect on process and new learning

Why is this book important?

For nurse training and education delivery, the stages of clinical reasoning can be incorporated into training sessions to discuss the clinical judgments and decision making during a care intervention and applying the ‘nursing process’.  Simulated nursing environments are an ideal educational approach to challenge clinical decision making and clinical reasoning skills. Nurses are the constant presence on the ward level, providing the monitoring and making judgments form the clinical reasoning encounters every shift over a patients hospital journey. Responding to complex and time critical events requires sophisticated abilities which expand further than pure theoretical knowledge, such as assessing and responding to clinical deterioration.

In the current economic drive for cost cutting measures across healthcare (nurses make up the majority of the healthcare workforce, so are often seen as a costly element), the drive to replace with lower skilled, trainees and eventually robots are factors for the nursing profession to consider. Nurses need to be able to understand and explain the role they play and have a voice to raise the profile of what it entails to be a nurse and the efficacy of such skills to maintain levels of care and safety.

Summary

Thinking on the go and decision making are skills to develop over time and with experience but need to be incorporated into nurse training. Nurses with effective clinical reasoning skills have a positive impact on patient outcomes (School of Nursing and Midwifery Faculty of Health, 2009). It’s important to remember, during all this consideration of the patient and reflective process that you (the nurse) are human and as such wont get everything correct all the time.

References

Levett-Jones, T. (Ed.). (2013). Clinical reasoning: Learning to think like a nurse. Pearson Australia.

Alfaro-LeFevre, R. (2015). Critical Thinking, Clinical Reasoning, and Clinical Judgment E-Book: A Practical Approach. Elsevier Health Sciences.

Interprofessional Ambulatory Care Unit. Clinical Reasoning User Manual. Edith Cowan University.

School of Nursing and Midwifery Faculty of Health (2009) Clinical Reasoning Instructor Resources. University of Newcastle.

The Underbelly of Research: Delving Deeper

There is a murky side to publication that can really push the boundaries of ethics and the integrity of how we may portray research and evidence based practice. As nurses we are trained to critique an article and question the quality, merits and transferability of the result findings. Now if you think your skilled at critiquing an article, think again and listen to this enlightening talk by Simon Finfer (Intensivist) on The Light & Dark Side of Research & Publication.

Take a read of Boldt: The great pretender which outlines one of the biggest research scandals of recent times about an internationally renowned researcher and the impact on the colloid versus crystalloid fluid debate.

Some terminology to delve further into from Elliott (2010):

  • Publication planning
  • Publish or perish
  • Ghost writing
  • Reprint revenue
  • Predatory journals
  • Predatory conferences
  • Medical Education & Communications Companies (MECC)
  • Medical Education Service Suppliers (MESS)

 

References

Colquhoun, D. (2011) Publish-or-perish: Peer review and the corruption of science. The Guardian.

Elliott, C. (2010). White coat, black hat: adventures on the dark side of medicine. Beacon Press [GoodReads Review]

Finfer, S. (2014) The Light & Dark Side of Research & Publication. Intensive Care Network.

Kolata, G. (2017) Many academics are eager to publish in worthless journals. The New York Times.

Parr, C. (2014) Imperial College professor Stefan Grimm ‘was given grant income target’. Times Higher Education.

Wise, J. (2013) Boldt: The great pretenderBMJ. 346:f1738.

Dunning-Kruger Effect

Journal Club Article: Kruger, J., & Dunning, D. (1999). Unskilled and unaware of it: how difficulties in recognizing one’s own incompetence lead to inflated self-assessmentsJournal of personality and social psychology77(6), 1121.

Dunning-Kruger effect

“In the field of psychology, the Dunning–Kruger effect is a cognitive bias wherein persons of low ability suffer from illusory superiority, mistakenly assessing their cognitive ability as greater than it is. The cognitive bias of illusory superiority derives from the metacognitive inability of low-ability persons to recognize their own ineptitude. Without the self-awareness of metacognition, low-ability people cannot objectively evaluate their actual competence or incompetence” (Wikipedia, 2017).

  • Over confidence and low self-awareness.
  • Compentency vs incompetence.
  • Doubt and low confidence.

“Incompetent individuals have more difficulty recognizing their true level of ability than do more competent individuals and that a lack of metacognitive skills may underlie this deficiency” (Kruger & Dunning, 1999.pg. 31).

Dunning-Kruger Study

Aims

Explored their predictions between competence, metacognitive ability, and inflated self-assessment.

Predictions

Participants would overestimate their ability and performance.

Method

  • 4 studies.
    • Humour: 30 item questionnaiare
    • Logical Reasoning: 20 item logical reasoning test
    • Grammar and Awareness
    • Competence: Group study tests.
  • Psychology undergraduates (earned credit for participation in the study).
  • Participants asked to assess their ability and test performance.

Results

The participants with limited knowledge reach mistaken conclusions and make errors, this is coupled with an inability to recognise these limitations.

Limitations of the Study

Small numbers of participants.  Not across a variety of professions, also undergraduate setting.

The authors recognise the limits of the testing method, and subsequently could a fault lie in the logic or methodology of the testing and thus provided incorrect results.

Relevance in Healthcare

Take a read and listen to this by PHARM: Prehospital and Retrieval Medicine (2017) and the great discussion points about the difficulty of competency in rare event situations. The considerations in education when discussing skills or best practice, not everyone is working in a big city hospital with support teams, technology and resources. Healthcare is delivered across the world in varied resource settings by individuals or teams and so it’s very easy to become judgmental when looking at care- it all goes way deeper into the wider healthcare landscape than just looking at the individuals metacognitive ability.

Keywords: Cognitive; feedback; metacognitive competence; skilled; unskilled; training; education.

References

Kruger, J., & Dunning, D. (1999). Unskilled and unaware of it: how difficulties in recognizing one’s own incompetence lead to inflated self-assessmentsJournal of personality and social psychology77(6), 1121.

Nursing Education Network (2016) Johari Window and Feedback.

PHARM: Prehospital and Retrieval Medicine (2017) Needle vs knife the view from the bottom of Mount Stunning Trueger.

Staub, S., & Kaynak, R. (2014). Is an Unskilled Really Unaware of it?Procedia-Social and Behavioral Sciences150, 899-907.

Wikipedia (2017) Dunning-Kruger effect.

 

3D Printing in Healthcare

Innovations and Making a Difference

Printing technologies for building prosthetics, drugs, cells and organs can be an alternative, quicker and cheaper way to develop healthcare into the future. 3D printing can be a disruptive power enabling building at a local level and smaller scale to meet specific needs.


BigRep-One
3-D Printed Prosthetic Hand - blue (5229) (18492491235)

 

 

 

 

 

 

What Is 3D Printing and How Does It Work?

 

Transforming Lives with 3D Printing – Future of Health

 

Resources

Enabling The Future (2017) A Global Network Of Passionate Volunteers Using 3D Printing To Give The World A “Helping Hand.”

Mesko, B. (2017). The Ultimate List of What We Can 3D Print in Medicine And Healthcare! The Medical Futurist.

Open Hand Project (2017) Open Hand Project.

Wikipedia (2017) 3D Printing.

Innovative Based Practice

Innovative Based Practice (IBP) allows for new ideas, technology and innovation to be introduced into ways of working. The fear of making mistakes in the risk averse culture that surrounds work may stifle innovation. But safety and ethics processes are present to protect against changes to clinical practice. This post is all about trying new ways of working, changing the team dynamics, using technology to improve efficiency. In healthcare money is normally tight/non-existant, so its advisable to try free or cheap software and technology. If the idea or innovation doesn’t work then it’s just time lost and onto the next idea, no one needs to worry about the financial impact. As a team the way failure is dealt with is vital, a ‘no blame’ environment and ‘team culture’ to accept and review the what, why and what could be done better next team creates a safe environment where innovation and change is embraced. Nothing in life works out 100% so why would it in the workplace. Those team members who revel in another’s failure, well it’s down to the team to set out behavioral expectations and create a team ethos.

Ideas are great, but to embed practice change is a difficult process. Things to consider:

The early adopters (The Champions) can help drive change with enthusiasm, but don’t forget the political and power aspects. Networking with the opinion leaders of the unit and harnessing their social networks is essential.

References

Christensen, C. M., Baumann, H., Ruggles, R., & Sadtler, T. M. (2006). Disruptive innovation for social changeHarvard business review84(12), 94.

Greenhalgh, T., Robert, G., Macfarlane, F., Bate, P., & Kyriakidou, O. (2004). Diffusion of innovations in service organizations: systematic review and recommendationsThe Milbank Quarterly82(4), 581-629.

Herzlinger, R. E. (2006). Why innovation in health care is so hardHarvard business review84(5), 58.

Hwang, J., & Christensen, C. M. (2008). Disruptive innovation in health care delivery: a framework for business-model innovation. Health Affairs27(5), 1329-1335.

Rogers, E. M. (1995) Diffusion of innovations. (5th ed.) Simon and Schuster, New York, USA. [summary article]

Ross, P. (2017) Deimplementation of Practice. Nursing Education Network.

Ross, P. (2017) Diffusion of innovations. Nursing Education Network.