ANZICS S&Q 2014 - RRT: Judy Currey on educating ward nurses
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Judy Currey talks on educating ward nurses about RRTs. Presented at the ANZICS S&Q Conference 2014 on Rapid Response Teams.
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ANZICS S&Q 2014 - RRT: Judy Currey on educating ward nurses
- 1. CRICOS Provider Code: 00113B EDUCATING WARD NURSES A/Professor Judy Currey RN PhD Director of Postgraduate Studies Deakin University, Melbourne
- 2. CRICOS Provider Code: 00113B OVERVIEW • RRS / METS • Documentation / Tools • Experiential learning • Supervision / Skill Mix • Role Modelling • Clinical judgement / Decision making Knowledge Skills Attitudes Behaviours • What should RNs know? • Who teaches this? • When it is taught? • Role of ICU clinicians • Individual accountability
- 3. CRICOS Provider Code: 00113B EDUCATING NURSES Address conceptual problems of: • Lack of knowledge • Failure to appreciate clinical urgency • Lack of supervision • Failure to seek advice • Failure of the organisation (McQuillan et al., BMJ 1998; Wilson et al. MJA 1999; Massey et al., ACC 2008)
- 4. CRICOS Provider Code: 00113B LACK OF KNOWLEDGE Physiology and Pathophysiology • Airway • Breathing • Circulation • Compensatory mechanisms Unconscious incompetence Conscious incompetence Unconscious competence Conscious competence
- 5. CRICOS Provider Code: 00113B FAILURE TO APPRECIATE CLINICAL URGENCY Patient Assessment Pattern recognition, schemas • Approach to patient assessment • Confirming and disconfirming cues • Experiential learning • Pathophysiology / (de)compensation • Trajectory of recovery • Situational awareness (Considine & Currey, JCN 2014; Billett ALTC, 2011)
- 6. CRICOS Provider Code: 00113B FAILURE TO SEEK ADVICE Insight & limitations • Scope of practice • Clinical judgement and decision making • Authority gradients • Communication skills • Graded assertiveness – PACE, SPEAK UP • Documentation / Tools • Escalation Processes • RRS – Afferent / Efferent Limb Failure
- 7. CRICOS Provider Code: 00113B LACK OF SUPERVISION Models of Care Delivery • Patient flow not quality of care • Flatter hierarchy • Primary nursing • Skill mix • Role models • Resources for nurses
- 8. CRICOS Provider Code: 00113B FAILURE OF THE ORGANISATION Utilise System Processes • Predefined criteria • Documentation • Escalation process • Governance • Strategies to overcome afferent / efferent limb failure • Professional accountability
- 9. CRICOS Provider Code: 00113B A. Clinical Processes 1. Measurement and documentation of observations 2. Escalation of care 3. Rapid response systems 4. Clinical communication B. Organisational Prerequisites 5. Organisational supports 6. Education 7. Evaluation, audit and feedback 8. Technological systems
- 10. CRICOS Provider Code: 00113B CONCLUSIONS Educating and Learning • What • Where • When • Who • Why • How
Editor's Notes
- Commission report on education – Josh and JC responses
- Wilson et al MJA 1999 34.6% of the causes of AEs were categorised as "a complication of, or the failure in, the technical performance of an indicated procedure or operation", 15.8% as "the failure to synthesise, decide and/or act on available information", 11.8% as "the failure to request or arrange an investigation, procedure or consultation", and 10.9% as "a lack of care and attention or failure to attend the patient". AEs in which the cause was cognitive failure were associated with higher preventability scores than those involving technical performance. The main prevention strategies identified were "new, better, or better implemented policies or protocols" (23.7% of strategies), "more or better formal quality monitoring or assurance processes" (21.2%), "better education and training" (19.2%), and "more consultation with other specialists or peers" (10.2%). Of the 2613 prevention strategies identified in the 1182 AEs with high preventability, 24.7% (646) were for "better education and training", 20.9% (545) were for "new or better implemented policies or protocols" and 18.6% (486) were for "more or better formal quality monitoring or assurance processes".
- Commission report on education – Josh and JC responses
- The four stages - not sure, but claimed by Dr Thomas Gordon (Carl Rogers’ colleague) Unconscious incompetence The individual does not understand or know how to do something and does not necessarily recognize the deficit. They may deny the usefulness of the skill. The individual must recognise their own incompetence, and the value of the new skill, before moving on to the next stage.[2] The length of time an individual spends in this stage depends on the strength of the stimulus to learn.[3] Conscious incompetence Though the individual does not understand or know how to do something, he or she does recognize the deficit, as well as the value of a new skill in addressing the deficit. The making of mistakes can be integral to the learning process at this stage.[4] Conscious competence The individual understands or knows how to do something. However, demonstrating the skill or knowledge requires concentration. It may be broken down into steps, and there is heavy conscious involvement in executing the new skill.[3] Unconscious competence The individual has had so much practice with a skill that it has become "second nature" and can be performed easily. As a result, the skill can be performed while executing another task. The individual may be able to teach it to others, depending upon how and when it was learned.
- Primary survey vs symptom, risk, function, head to toe, system-based, vital signs
- Beaumont Empowerment
- What is measured counts – focus on flow not quality Metrics of competence, not expertise or performance management Without metrics, we have little or no accountability
- WHAT A&P, Patho, trajectory of illness/injury and recovery Patient assessment – primary/secondary survey WHERE Uni – all years, Hospitals WHEN everyday – whole of career approach WHO ALL of US to Teach & Learn Take responsibility and be accountable – me for curricula design, you for patient care delivery, supervision etc OUR ROLE as ICU RNs and Docs is to be the clinicians expected of us and that we are educated to be. WHY Our community is at risk – it is US not THEM HOW – will we teach and HOW will we KNOW it works and we’ve got there Any educational method that works – focus on OUTCOMES as well as processes and change as needed Measuring expertise not competence – focus on quality of staff not quantity and performance manage it.