Nurses vs. Computers: Predicting Risk of Patient Harm

Not All Signs of Potential Harm Are Quantifiable

From chego101, via Flickr

Hospital nurses have many, many responsibilities and tasks, but one of the most important is to ensure patient safety by assessing patients for changes that can signal worsening of a condition or a new potential harm. Creating special units like ICUs, recovery rooms, and step-down units; flags on charts; various alarmed monitors; and safety huddles are a few of the ways hospitals have tried to identify potential problems. Now we have computerized tools to do this—or do we?

The complaint I have heard most from nurses about the electronic health record (EHR) is its inability to capture all the nuances of patient care or various patient problems, especially those that don’t involve easily quantifiable measures like heart rate or lab values. (For more detail, read our November 2016 report on nurses’ concerns with EHRs.)

One cannot accurately use a check mark to convey certain patient behavioral parameters or the “can’t put my finger on it but something’s going on with this patient” assessment that experienced nurses often make. In the April issue of AJN, we published an important study that investigates just this issue: “Identifying Hospitalized Patients at Risk for Harm: A Comparison of Nurse Perceptions vs. Electronic Risk Assessment Tool Scores”

Deciding Whether […]

2017-04-19T10:43:15-04:00April 19th, 2017|Nursing, nursing research, patient safety|1 Comment
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Identifying and Addressing the Profound Mental Health Effects of Climate Change

Residents amid homes consumed by flood and fire, White Sulphur Springs, WV, June 2016. Photo © AP Photo / Steve Helber.

A new word for an era of increasing environmental instability.

A lot of attention is currently paid to the physical impacts of climate change, including extreme heat events, droughts, extreme storms, and rising sea levels. Far less attention has been paid to the psychological impacts of this change. For example, you may not be familiar with the term “solastalgia.” It’s related to the older word “nostalgia,” but was created to reflect the environmental and often related sociopolitical uncertainty of our current times—that is, of change that’s slow and incremental, and often even denied, and then sometimes rapid and catastrophic and impossible to ignore.

The term is explained in more detail in an April feature article in AJN, “Climate Change and Mental Health,” by Janna Trombley, Stephanie Chalupka, and Laura Anderko:

Solastalgia is a term coined a decade ago by philosopher Glenn Albrecht . . . It refers to the psychological distress resulting from degradation of […]

2017-07-27T11:38:15-04:00April 17th, 2017|climate change, Nursing, patient experience, Public health|1 Comment
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The Limitations of Rating Nursing Care by Customer Surveys

Ink and collage on paper by Julianna Paradisi 2017

Either They Loved It or They Hated It

While toasting the same English muffin for the second time that morning and cursing that it would make me late for work, I conceded we need a new toaster. It doesn’t matter whether I set the darkness level on 1 or 4;  the muffin comes out barely tinged. Select 5 or beyond, the muffin is burnt, and sets off the smoke detector. It’s time to buy a new toaster.

I found one I liked, shopping online. It had been purchased by over 1,500 other people; 55% of them rated it 5 stars. The other 45% of ratings ranged between 1 and 4 stars. The comments, however, were evenly split, 50/50. People either loved it or hated it. There was no in-between.

This made me laugh.

As with Toasters, So with Nursing Care

Likewise, many hospitals, in an effort to improve care, send out satisfaction surveys asking patients to rate their nursing care. In my experience, the results are similar to the toaster’s ratings: about half the patients rave about their care. Some mention their nurses by name, elaborating on specific details about their experience.

The other half complain bitterly that their […]

2017-03-31T10:28:07-04:00March 31st, 2017|Nursing, nursing stories, patient experience|3 Comments
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A Place for Faith: Despite Chronic Illness, a Return to Bedside Nursing

flickr creative commons/by krassy can do it

Relearning the Details of Clinical Nursing

After being away from bedside nursing for over 11 years, I recently returned to this role on the same medical-surgical floor I’d worked on 11 years earlier. The impetus behind such a drastic transition was, in part, my return to nursing education as a clinical nursing instructor. As an educator, I felt the need to update my own clinical skills as I instructed young nurses eager to enter my profession.

The other reason for returning to clinical nursing had to do with a spiritual pull I felt in my heart, a hope that I’d be able to to show patients the compassion, empathy, and patience they all deserved. I’d come to realize that I’d sometimes lacked these qualities when I was a younger bedside nurse. Now I felt that God was giving me a kind of ‘do-over’—and I had to at least try to live up to this expectation.

Within the first week of orientation, I quickly realized how different things had become in the nursing world. The last time I’d worked as a clinical nurse on this very unit in 2005, the hospital was still using paper documentation, private community physicians still rounded on their patients, and there were no ‘computers on […]

2017-03-08T11:17:02-05:00March 6th, 2017|career, Nursing, patient experience|5 Comments
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Nurses and Patient Safety: Parallel Histories

Photo from AJN archives.

I’m especially pleased that one of the CE articles in the February issue focuses on nursing’s role in creating a safe environment for patients: “Nursing’s Evolving Role in Patient Safety.” And in full disclosure, I was excited to see that the authors used the AJN archives to chronicle how nursing addressed (or didn’t address) safety issues around patient care.

From the earliest days of nursing through to the current complex systems in which we practice, nurses have been the health professionals responsible for ensuring safe passage of patients through the health care system. From Nightingale’s criteria for creating a healing environment to the “5 rights of medication administration,” patients rely on nurses to act as sentinels.

The authors reviewed 1,086 AJN articles from 1900 to 2015 and conducted a content analysis to identify patient safety themes. Aside from uncovering many fascinating (and sometimes alarming!) details of former health care practices, the authors drew this general conclusion:

“Emphasis on patient safety increased as patient care became more complex. As nurses developed a professional identity, they often put a spotlight on safety concerns and solutions.”

Here’s a quote from a nurse who wrote in 1908 about nurses’ duties:

2017-02-15T15:46:47-05:00February 15th, 2017|Nursing, nursing history, nursing research, patient safety|0 Comments
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Views expressed on the blog are solely those of the authors or persons quoted. They do not necessarily reflect AJN’s views or those of Wolters Kluwer Health/Lippincott Williams and Wilkins.
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