Workplace Violence Training: Beyond Tabletop Exercises 

Breaking the rules of ordinary nurse behavior.

Have you ever thrown a fire extinguisher at a hospital visitor?

In this issue, “Workplace Violence Training Using Simulation” describes how one Ohio health system employs classroom learning, hands-on defense techniques, and simulated violence scenarios to prepare staff for potentially violent situations, including the presence of an active shooter.

Part of this training involves learning how to break the rules of ordinary behavior. This is hard for nurses, because it’s so ingrained in us to protect and never to harm. Grabbing a fire extinguisher to throw at someone, even if that person is holding a gun, is not the initial reaction most of us would have in this situation.

“People often freeze or panic in response to acts of aggression, assault, or other violence, including shots fired,” note authors Robin Brown and colleagues. The remarkable workplace violence training that they have developed at their hospital aims to empower staff to respond effectively in dangerous situations. Key points of discussion include learning to

  • recognize the potential for violence in a patient or visitor,
  • identify our own behaviors that may trigger a person who already is upset,
  • and perhaps most importantly, overcome our panic and take action.

[…]

2018-10-12T10:25:56-04:00October 12th, 2018|Nursing, nursing research|0 Comments

Who’s Listening to Hospitalized Patients with Hearing Impairment?

In my early years in nursing, attention to patients’ hearing deficits was a big deal. It was assumed that we couldn’t properly care for someone if that person couldn’t hear us. Every admission assessment included an appraisal of the patient’s hearing: “Hears ticking watch eight inches from each ear,” or “hears quiet conversation at three feet without difficulty,” or “patient states deaf in right ear,” or some other specific description.

When hearing difficulties were evident, a sign was prominently posted over the head of the bed, a note in red ink was written in the Kardex (those quick-reference summaries of key points on all patients that were updated daily), and a special label was affixed to the front of the (paper) chart.

A communication impediment, often ignored.

Why don’t we do these things anymore? I see little indication that the needs of a hearing-impaired patient are a clinical priority. The deficit is not noted on the whiteboards that seem to be standard issue in patients’ rooms today. As a hospital visitor, I watch with dismay as staff fail to acknowledge acutely obvious hearing impairments.

A family member has tumor-induced hearing loss in one ear, and I explain on every admission that people need to speak up when addressing him. I ask them to make use of his intact hearing […]

Is It Time to Relax Food Restrictions on Women in Labor?

Three years ago, I went into labor in the middle of the night, 10 days before my expected due date. Things ramped up fast, and by the time I got to the hospital an hour later, I was almost ready to have the baby. However, when my son’s heart rate suddenly dropped and wouldn’t recover with medication, I was told I had to have an emergency C-section immediately.

As I hadn’t planned on surgery, or labor, that night, I had eaten a full three-course meal earlier in the evening. The nurses asked me if I had eaten, and I had to admit yes, and then some! I did feel nauseous as the procedure began, but luckily the wonderful anesthesiologist quickly helped, when I told him how I felt, with some miracle medication in my IV. The surgery proceeded without incident.

Nil by mouth? New research questions a tradition.

It was with interest, then, that I read AJN’s March original research CE feature, “An Investigation into the Safety of Oral Intake During Labor.” In this article, the authors compared maternal and neonatal outcomes among laboring women permitted ad lib oral intake with those permitted nothing by mouth except for ice chips. Restriction of oral intake in laboring women has traditionally been, as AJN’s editor-in-chief calls […]

Nursing Assistants in Nursing Homes: Partners in Quality Improvement

“NAs know where the quality gaps lie.”

I loved working in a skilled nursing facility—the long-term relationships with residents and their families, the chance to really hone in on nursing basics, the opportunity to learn about life from people who had seen it all.

But what finally drove me away from this work was the mediocre quality of care in two different “homes” where I was on staff. I was angry and frustrated, and even after several years in nursing, still too inexperienced to understand what I could have done to make things better.

Including nursing assistants in QI projects: ‘crucial to success.’

Today, care is slowly changing. Nursing homes are now required to post on the web certain data about their patient outcomes (https://www.medicare.gov/nursinghomecompare/search.html), and to implement quality improvement (QI) initiatives. But have we regarded QI projects as the province of RNs and administrators only? In this month’s AJN, Kathleen Abrahamson and colleagues make the following observation:

“…nearly all changes driven by QI in work processes, schedules, approaches to care, or documentation will either affect or be carried out by nursing assistants. Thus, including NAs in QI efforts is crucial to their success.”

The truth of this statement is so clear, it might be called a “no-brainer.” As the authors […]

2018-02-21T09:51:50-05:00February 21st, 2018|Nursing, nursing research|0 Comments

Avoiding the Chaos of Unit Transfers

Photo by Photographer’s Mate 2nd Class Johansen Laurel, U.S. Navy.

Patient transfers between units can be less than orderly, resulting in miscommunication and frustration. Most ICU nurses have a war story (or two) that quickly comes to mind if asked about a memorable admission to their unit from the OR or recovery unit. I recall one instance, when I was a clinical nurse specialist covering critical care, in which I received a frantic call at 11:30 am from the ICU nurse manager.

Apparently, the ICU had been told they would receive a patient from recovery at about 2 pm. With this in mind, the ICU had arranged to transfer a patient out to a med-surg unit just after noon. The ICU manager had worked out the transfer time with the med-surg nurse manager to allow the med-surg RN to return from lunch before the transfer, and also to give the ICU nurse a chance to have lunch and prepare the equipment in the ICU slot for the new patient after it was cleaned by housekeeping.

But as it happened, the recovery nurse manager called the ICU at 11:30 am to say her unit needed the bed and the new patient would […]

Go to Top