As a critical care nurse there is such a broad spectrum of
knowledge that I have to acquire and maintain which can be a huge challenge. Over the years I have become systematic, but attentive,
with what I look for and how I complete my patient report in order to have all
the necessary information I need to provide the best care I can for my
patients.
Prior to seeing my patients I get report from the previous shift then take my time to review my VS, labs, diagnostics, medication profile and h&p. Mindful practice, to me, also entails staying current with education and evidenced based practice guidelines; not doing something just because that’s what we do but asking why we are doing things and how can we be doing things better for our patients.
Prior to seeing my patients I get report from the previous shift then take my time to review my VS, labs, diagnostics, medication profile and h&p. Mindful practice, to me, also entails staying current with education and evidenced based practice guidelines; not doing something just because that’s what we do but asking why we are doing things and how can we be doing things better for our patients.
However, I do believe that we set ourselves on autopilot at
times. For example, in the ICU we do VS
at least every 1 hour to 15 minutes depending upon patient status and IV drips. I often find that we continue to let blood
pressure cuffs run every 15 minutes when there isn’t an indication for it. We become unmindful that the blood pressure
cuff is going off so frequently and causing unnecessary discomfort to our
patients.
I also see a lot of nurses in the ICU place Foleys and
central lines when not necessary but solely on the fact that the patient is in
the “ICU”. I do have to say that we are
getting better at this as a unit and are moving away from this practice in
order to prevent unwanted outcomes such as CAUTI’s and CLABSI’s. There are also so many core measure and
guidelines to follow for Medicare and Medicaid now that we have to become
systematic and even overzealous with tests and interventions so that we don’t
risk losing reimbursement.
On the flip side, mindless practice doesn’t necessarily mean
that you are completely thoughtless but could imply that you have become an
expert at that particular skill. Yet, we
need to be aware that just because we are great at something doesn’t also mean
that there isn’t a better way to do it, as Langer (2007) describes in, When practice makes imperfect: The power of
mindful learning.
Medication Safety: A Patient's Story
This was truly a heart retching story of a young boy taken
too soon at the fault of substandard medical practice and personnel. I was appalled that the nurses failed to
uphold the value of our profession and code of ethics. It truly brought me to tears that a fellow
nurse pretty much ignored a child’s symptoms; showing poor judgment, lack of
patient advocacy and inferior assessment skills.
Like the mother said in the video clip, we have to be able
to look at the patient as an individual whole, take them seriously and be knowledgeable
about drugs that we give. I also feel
that collaborating with fellow nurses, physicians and pharmacist is a must and
should be done routinely to provide a comprehensive plan of care to our
patients.
Advanced practice nurses are key assets to
interdisciplinary care teams by providing a thorough and holistic approach to
patient needs. Essential competencies of
APRN’s acquired during extensive schooling will allow us to offer expert direct
care, use of evidenced based practice, leadership and promoting an environment
of Just Culture.
Langer, E.J. (1997). When practice
makes imperfect. The power of mindful learning. Reading, MA:
Addison-Wesley Publishing Co., 9-23
