Archive for October, 2010

Importance of Skin Assessment in Elderly and Child Abuse, comment

October 18, 2010

Skin assessment is a more valuable tool than we give it credit or time for. There are so many clues to a long list of health issues; from the varience in color, turgor, texture, temperature and thickness, to hair distribution, and condition of the nails.  All of these variances from norm could be linked to some health issue.  Issues like nutritional deficiency, allergy, local or systemic disease; such as melanoma or systemic lupus erythematosus; or they could be signs or the ‘remnants’ of abuse.

Unfortunately, I don’t think the nurse on the floor routinely gives skin assessment the time or attention needed to pick up on these clues.  The most opportune time to find these signs would be on admission, during the initial assessment. What I see on the floor, is short staffing more often than not, trying to care for more patients than can be fully cared for during their shift, and bed shortages, requiring ‘quick’ turnover.  I am also afraid that the gains in my staffing numbers over the past year are in jeopardy with the reforms and cuts in reimbursement that I think are coming. Thorough assessments are an essential part of health care, of preventative medicine, and all of our professional practices; so I truly hope there will be the time and ability going forward to complete this valuable task.

Original Post

May 26, 2009

Title: Importance of Skin Assessment in Elderly and Child Abuse

In studying skin assessment, one cannot help feeling overwhelmed. Without a desire to pursue dermatology, the unlimited amount of skin lesions, pustules, macules and papules can lead one to skim over information out of the pure necessity for mental sanity. The mind can only hold so many pictures at once. However, I do see the need to ensure the memorization and ability to recognize and diagnose normal skin variations. In reading articles and working with children and the elderly, one unfortunately sees the reality firsthand of physical abuse and neglect. This can often be recognized by assessing the skin. Breakdown, malnutrition, physical abuse, bruises, injuries at different stages of healing can all be noted by a thorogh assessment of the skin. As follow up care and the big picture should always be a part of our thought process in nursing assessment, the ability to note whether a skin assessment finding is simply normal or abnormal is vital to our practice.

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“Critical Incident” Stress in the Workplace, comment

October 4, 2010

In the thirty-five years of my professional career as a Registered Nurse, I have been involved in a wide variety of ‘critical incidents’; from the birth of an anacephalic baby, to MVCs with amputated limbs, to the loss of a patient to whom I had grown attached, to the death of someone too young, on our procedure table, that may not have happened if we had been able to care for him sooner.

 This last incident was the only time I had the privilege of a defusing and formal debriefing.  The hospital where I worked at the time, didn’t have a formal program.  We were given the chance to talk to our Child Advisor (I’m not sure of her exact title) when we, the cath lab staff, were so distraught over losing this patient during an angioplasty, on the table.  When I look back at this, I recognize it was very rudimentary, but it definitely helped us better than nothing at all. 

I’m thinking this is something I need to pursue for the facility where I work now.  There have been and always will be incidents that cause our professional staff emotional and/or physical ‘trauma’.  To provide a program that gives support for staff when they experience an untoward event with one of their patients, is only right when we ask them to provide Relationship Based Care. 

Original Post
April 4, 2004
Title: “Critical Incident” Stress in the Workplace

Many health care professionals at one time or another have experienced a “critical incident’ that has caused them strong emotional or physical reaction. The critical incidents vary from threats / assault, suicide, accidents, deaths or injury. These experiences may impair their ability to work safely and effectively in their care of patients for weeks or even months after the incident has occurred.

Nurses and other health care professionals are often expected to carry on after these incidents by simply relying on their own coping skills. However the use of formal debriefing in the workplace has been found to be a key component of recovery. Debriefing has produced many positive side effects for staff and their employers including:
• increase in team cohesiveness and mutual support.
• reduced sick time
• increased awareness of critical incidents and their impact
• decrease in staff turnover

Many hospitals and health care facilities have incorporated a formal model, the “Critical Incident Stress Management” (CISM) program that includes:
1. Defusing – a chance for to talk immediately after the incident, 45 to 60 minutes to restore order in a chaotic situation.
2. Formal Debriefing – longer, structured meeting including other professionals – chaplains, social or mental health workers.
3. Follow-up – possible long-term therapy to be arranged.

The best remedy for a nurse who has suffered this kind of reaction is often to get back to work as soon as possible; “to accelerate normal recovery in normal people with normal reactions to abnormal events.”

Should these programs not be adequate in reducing the after-effects, individuals and their co-workers should be aware of reaction symptoms that may occur. The following symptoms may be displayed:

Physical: nausea, rapid heart rate, dizziness, thirst, chills & headaches
Cognitive: poor concentration, disorientation, nightmares, memory
disturbances
Emotional: grief, guilt, fear, depression, anger, exaggerated responses
Behavioural: withdrawn, loss of appetite, sleep disturbances,
hyperalertness

Being aware of these symptoms when they occur and responding ethically and professionally will ensure that safe and effective patient care is maintained.

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