“I confess, Curmudge. I’ve been looking ahead and can see that sometime you are going to teach me about problem solving.”
“That’s right, Julie. We’ll talk about problem-solving techniques used by groups. Things like root cause analysis and brainstorming.”
“Did you know that health care professionals do a lot of individual problem solving?”
“Of course I do. I’ve learned a lot since I began studying at Google University. I sense, however, that you are poised to teach me about problem solving in nursing, so I’ll sit back and let you be the teacher. But remember, Julie, the hands-on aspects of nursing are not my thing.”
“Okay, we’ll start with a placement test of your nursing knowledge. What are the two kinds of diagnoses?”
“That’s simple. Right and wrong.”
“No, no, Ancient One. The two kinds of diagnoses are medical and nursing. It looks as if we’ll have to start your nursing education at square one. Medical diagnosis is the act of distinguishing one disease from another, and a nursing diagnosis captures an individual patient’s reactions to actual or potential health-related problems. Nursing diagnosis is part of the Nursing Process, which includes Assessment, Diagnosis, Planning, Implementation, and Evaluation.”
“So when do you do this Nursing Process?”
“We do it virtually all the time. It should be second nature to an RN. If a patient experiences problems that would be expected from their diagnosis, our planning, implementation, and evaluation are relatively straightforward.”
“But what if your assessment reveals that the patient is experiencing unanticipated difficulties? That’s when your diagnostic and problem-solving talents kick in, right? I didn’t see anything in the nurses’ station labeled ‘Panic Button’.”
“No, but we have to determine right away if we should have pressed the button if we had one. Differentiation of criticality is one of our most important skills. That requires immediate recall of a lot of knowledge plus judgment and critical thinking. That’s why we assess and fulfill the training needs of new hires.”
“You’re not alone up there, Julie. I presume that in a critical situation you can get help from other nurses, the charge nurse, a hospitalist, or the rapid response team.”
“And if the problem is in an instrument, I can call BioMed or read the policy and procedure or the instrument manual. Remember ‘RTM’?”
“I seem to recall a slightly different abbreviation, but I definitely approve of the one you just used. But Julie, I suspect there are needs for a nurse’s critical thinking skills beyond just knowing when to call for help.”
“There sure are. A nurse’s knowledge and judgment are among the first lines of defense against medication errors and other threats to patient safety. Here are a few examples:
· In calls to physicians and hand-offs to the nurse on the next shift, practice SBAR (Situation, Background, Assessment, Recommendation).
· Know what physician orders to expect so you are not fooled by poor handwriting and can question an order that might contain an error.
· Be acquainted with a medication’s contraindications so you can discern when to have your dosage calculations checked by a colleague.”
“You could probably fill several pages with additional examples. Perhaps one of our future discussions should be devoted to patient safety. We wrote about this topic in our pre-Kaizen Curmudgeon days, and we ought to revisit it.”
“So, Curmudge, do you now appreciate the importance of problem solving in nursing?”
“I certainly do. Next time I’ll share with you how your training as a nurse has prepared you for Lean problem solving.”
“Curmudge, I can hardly wait.”
Affinity’s Kaizen Curmudgeon
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