Strategy: A nurse can strive to use best available knowledge when making health care decisions Process: Critical thinking, to systematically search, use and evaluate research results.
Reviews and Meta analyses Sounds easy, doesn’t it?
In both these two example it has been more difficult to make nurses stop using strategies with no evidence that to implement new ones.
Moving on to the next area of change…. To implement briefing/debriefing was suggested by the project leaders and were discussed during the courses. The small team of nurses that work together during a shift met for a few minutes to plan their day. The purpose is that everyone have the same information and the same idea on how the job should be done. A set of issues is written down on a card. The first evaluation showed that this could save time and improve the communication within the team. At the end of each shift the debriefing is taken place and now the team is focusing on how everything went. What went well? What could have been better? What needs to be reported to the next shift? Any safety issues?
The weaknesses were that it took a long time to implement. Maybe because the idea came from the management? Another thing that might affect this was that there were no obvious leader. If briefing/debriefing should work everyone need to initiate it.
Another result of the project is the implementation of a check list. Before each RT the team tick of the items on the checklist to reduce the risk of errors. The first item is ID control, then if the right body area is treated. Is the set-up and positioning correct? And then it continues with couch settings etc. All of these areas have been involved in errors. The evaluation is on going but we can already see that the checklist have helped avoid medical errors.
Interrater and intrarater
Case 4 Conflict/ poor communication/failure to communicate b/w nurse and oncologist. The hospital and the national board of welfare have recently emphasized the risk of infectious disease, such as MRSA, and new rules on how the staff should be dressed etc has been introduced to reduce the risk of transmitting disease. The new rules includes, among other things: No rings, bracelets or watches are allowed Staff is not allowed to mix their scrubs with private clothes (except underwear) All scrubs should be changes every day Only scrubs with short sleeves are allowed in direct patient care A lot of focus is on the compliance of these rules, including unannounced controls. One of the oncologists, Olle, at the RTU is particularly liked by the nurses. He always have the patients best interest in mind, make prompt medical decisions and treat other team members with great respect. One of the nurses, Katrin, has a special responsibility for the compliance of the new rules and she is obligated to report the response to these rules. Some of the oncologists ignore these new rules, and Olle is one of them, He constantly mixes scrubs with private clothes and he is always wearing his watch and his rings. This issue is often discussed, during coffee breaks among the nurses and nurse assistants. Katrin starts to get hints from her colleagues, that it is her job to confront Olle. She feels a bit unease but decides to bring it up one day, when she met Olle in the lunch area and no one else is around. She simply asks him why he doesn’t follow the rules, since the risk of transmitting disease has been proven to drop radically, if staff follows the rules. Olle leaves smiling and says , well I just don’t believe in that. Katrin feels frustrated and feel she has to back off a bit since she is anxious to keep a good relation with Olle, since there has been some problems with one of there patients and they need to cooperate well to deliver good care. However, after a while she confronts Olle again. This time he tells her to get off his back and that he doesn’t believe in the scientific value of the studies that the hospital has built the new rules on. He also tell her that he always uses Alco gel and that he is definitely not is transmitting any germs to his patients. After this situation, Katrin drops the subject to avoid more conflict but feel at the same time that she is not doing her job as a nurse in a good way.
Evidence Based Nursing (EBN) Lena Sharp, RN, PhD, Karolinska University Hospital, Stockholm, Sweden