Learning sick vs. not sick

[Eatrealfood]

How the heck can you teach sick/ not sick without plain old time and experience? How do does one gain the ability to differentiate between the guy with a stubbed toe and is actually dying versus the woman with syncope and chest pain who is just fine? Have you ever taught someone this skill who wasn't getting it or learned it yourself?

[emtb2rn, BSN, RN, EMT-B]

When teaching I explain the clues I use to do a quick sick/not sick determination. And yes, experience plays a very large role in this skill. Yet common sense and basic observation will get you well on your way.

F'rinstance, my wife will nudge me when we're out & whisper "something's wrong with that person". When I look, I usually laugh and then point out what I see that corroborates her lay opinion. She spots chf, copd, pvd, and she once spoke up about a guy who wound up arresting in public (code was unsuccessful).

And yeah,some folks never get it.

[Guest219794]

I don't think it can be taught, but you can help somnebody learn it.

For starters,making them understand that it is a critical skill to be developed.

Then, checking with them on their initial impression on seeng a pt, whether it is their pt, or somebody else's.

Sick, or not sick?

Why?

This is second nature to me now, but I was never taught it. While being any good at it takes some mileage, I think the process can be accelerated by a good mentor.

[Anna Flaxis, BSN, RN]

I think time and experience are key in developing the ability to do a rapid visual assessment. This is one reason why experienced ED nurses should be doing triage, IMO.

There are parts of the rapid visual assessment that can be taught, though. I usually look at things like skin- are they pink, warm, and dry, or are they pale, ashen, and diaphoretic or clammy? I look at respiratory effort. Are their respirations even and unlabored, or are they working harder to breathe than they should be? I do a quick mental GCS- are they alert, responsive, and moving all extremities equally? These are usually my biggest clues, as they are easy to assess when a fully clothed patient approaches triage- hence the term "rapid visual assessment". Once in the back, you can look/listen/feel for other things that might be hidden under their clothing.

And of course with kiddos, the Pediatric Assessment Triangle is a good one. It can be done rapidly in triage, and can be taught.

The rest is, as others have suggested, gut feeling that you develop with time and experience.

[ATLIEN]

teaching someone how to do a good focused assessment and plain old practice/experience give someone spidey sense. It can't be taught in a power point:)

[JenERally]

When someone says that they're dying, take them seriously and don't brush it off as just being dramatic. The sense of impending doom can indicate that a patient is crumping before your eyes.

[akulahawkRN, ADN, RN, EMT-P]

Learning this isn't limited to nurses. Paramedics learn this too. It's very much an experiential thing. Having a good mentor is essential to speeding up the process of learning sick/not sick. I learned this years ago. It's something that I do every day, whenever I meet someone. They don't know it and I really don't pay much attention to it unless something piques my interest. That sense of "something is wrong" tends to be very accurate... once it's tuned. You don't have to know quiet yet what is wrong, just that something is.

[ER_AllTheWayMay]

I agree. We would say " they look a bit sh@t". It's actually a bit if a 'spidy' sense. Experienced ER nurses 'have it'. It's hard to 'learn'. It's defiantly 'time' is of the 'essence'.

But I actually think it's something a lot if nurses can learn. But not "ALL" nurses. Some people can't be taught. And they are never aware if the chaos and mayhem around them.

[ER_AllTheWayMay]

I forgot to say...

When I was a new grad. (5years ago ) I just could not see myself "ever" ever having that immediate, triage nurse, " gut" instinct.

.... I have it now.... (It was there all along)...it just takes time, experience and exposure.

[MassED, BSN, RN]

I do think it's a combination of common sense and paying attention to what's in front of you, not necessarily what someone is saying to you. Some patients are so hung up on one piece of information and it takes a good eye to get more details or for a patient to extrapolate on their symptoms. When in doubt, go with your gut. It has never failed me, but has in fact saved me countless times. Don't doubt yourself.

[tech1000]

I don't think you can learn it from a textbook or somebody teaching you. You just start realizing when somebody looks bad. I sometimes go grab the doc and say, "I don't have a clue what is going on, but SOMETHING isn't right and I want a doc to lay eyes on this pt." Sometimes the doctor is less than excited, sometimes the room ends up full. I used to not know for sure or just think everything must be serious if the patient said so or that its was more serious than I thought, but I tend to pick them up fairly quickly now.

[TexanTough]

Unfortunately, it's one of those things you acquire with support and assistance from your coworkers. When I was new, I asked a lot of questions about the 'worst case scenario' so that I could gain a sense of what to be prepared for if the S hit the F.

I have taught people who just didn't get it and were focused on tying the back of a gown while someone was in respiratory distress. I do feel that some catch on earlier than others (or some never catch on).