Difficulties in Patient Care and Identification

Nurses General Nursing

Published

As a nursing prospect and student, I was wondering what the common issues with identifying rooms and patients are in the workplace.

From a psychological stand point humans are innate to missing cues in high stress situations. Stress causes anxiety which can cause mistakes and confusion. To overcome these anxieties, devices like notes, or psychological reminders can be implemented. However, in a data heavy and personalized environment it is very common to miss information or misinterpret information. Especially in distinguishing a patient.

In such a high paced and dynamic environment where time and service is key, what makes it hard in identifying patient rooms? What makes it hard to distinguish the medical precautions that are to be taken when entering a patient's room? What indicators, or visual cues make it easier in distinguishing specific patient rooms?

Here.I.Stand, as for my experience in patient care I've worked in process and systems engineering and development for multiple organizations. As for my knowledge and experience on a floor/unit level, I'm not very familiar with the general consensus among nurses and those staffed on the floor. Thus, why I'm trying to understand the workflow of a unit by reaching out to those who do have more knowledge than me through outlets like forums, and coworkers.

Also, the "brain-fog" possibility came about due to repetitive mistakes by those on the floor at my institution. Whenever questioning others about why those mistakes were made, the main point between those questioned revolved around issues with handling stress and workflow. Due to the issues at hand, and answers to questions, I've found the central issue to be memory and forgetfulness. Which is not a surprise from a psychological stand point. Psychologically, it has been proven that the effects of stress on cortisol levels and the mind do decrease one's ability to remember information.

As a follow-up question, if more staffing is not currently a possibility, what do you believe could resolve issues with stress among patient care staff?

JKL33, thank you for clarifying. You are right, it is feasible but it is not preferred. It has been made clear to me that my institution is not trying to employ more nurses for shifts, if possible. Thus, the reason why I've gone in search of different methods to help ease the workflow.

Also, what are the practices that you've suggested in the past? What do you believe is best to optimize patient satisfaction while limiting the stress of our staff?

1) Staffing. Think about any other service you use (if we're going to talk about Nursing this way). If you see that the providers of that service are harried, are clearly hustling to keep up, do not spend one millisecond more than required with you, and then offer you some canned "I care about you" phrases before they rush off, would you feel satisfied? Would you believe you were getting the best service possible? I pick staffing as #1 because, not only would it improve patients' perception of care, it would improve actual care.

2) I think serious thought should be given to bringing back (recruiting and training) a more robust pool of volunteers who are allowed to address issues of comfort and other "pleasantry" issues that patients would appreciate. Modern-day "candy-stripers", if you will. There are numerous tasks they could perform with guidance/supervision. The legalities could be worked out, if anyone wanted to. They can do things like visit with patients (if patient desires), bring snacks and drinks (as approved by RN), provide reading material and/or help patients with internet access, dispense electronic devices for patients to use, help download "entertainment" such as approved media/movies, etc., they can frequently round to rooms to see if there are any needs (which would be reported to the appropriate personnel), they can help visitors navigate around the unit, they can bring extra chairs, extra pillows, warm blankets, adjust thermostats, etc., etc., etc. and do many other similar tasks as approved by RN. They are another face that patients would see and know that no one has forgotten about them.

3) I think we must educate patients about expectations. Whenever I mention this I get push-back about not arguing with patients and not telling them no. My vision is not one bit like that. Mine is that we would educate in a positive way, at the front end of the care experience. From my direct observations, a good number of dissatisfied people are dissatisfied directly because their expectation was not in line with good medical care/scientific principles. Easy example: All those who believe they need antibiotics for viral illnesses. If we provided more education on the front-end, there ARE many people who are then capable of seeing their care as a positive experience. I know this for a fact because I have been experimenting with it and have seen enough positive results to have pretty much incorporated it into all aspects of my practice now. Pro-active. Not "telling the patient they're wrong" after the fact. Two other reasons I love this idea are because it also 1) serves to demonstrate knowledge and expertise 2) it respects people. It shows them that you believe they have a right to information and that you believe they are capable of understanding. I can't think of anything much more disrespectful and patronizing than some of our current "patient satisfaction" endeavors.

Chris, perhaps your time would be better spent by addressing coworkers at your 'institution,' not by trying to convince us that we are also in a stressed-out brain fog. We are experienced nurses who simply do not agree with you. We have enough to do taking care of seriously ill patients. We do not need any clues visual or otherwise to remind us how to find our patients' rooms.

Specializes in PACU.

Chris,

Technology and one more thing to "look up" on the computer or another box to check is not the solution. We use the bright colored cards on the doors for precautions because they work.

The stress we have as caregivers is not going to be solved by technology, or by you.... it's sad to say, because I believe that you mean well.

I have no problem with the things you sited (room numbers, identifying patients, precautions), the issues I do have are related to too much to do in too little of time, (ratios are too high), unrealistic expectations from patients and administrators (MY own doctor told me having a bladder sling surgery was easy, in and out the same day... no wonder patients think they'll wake up after their bodies have been sliced and diced and not hurt!!)

But if I have to complete one more piece of paper work/screen on the computer... to make my job easier, I think I'll scream!!

Specializes in SICU, trauma, neuro.
Here.I.Stand, as for my experience in patient care I've worked in process and systems engineering and development for multiple organizations. As for my knowledge and experience on a floor/unit level, I'm not very familiar with the general consensus among nurses and those staffed on the floor. Thus, why I'm trying to understand the workflow of a unit by reaching out to those who do have more knowledge than me through outlets like forums, and coworkers.

Also, the "brain-fog" possibility came about due to repetitive mistakes by those on the floor at my institution. Whenever questioning others about why those mistakes were made, the main point between those questioned revolved around issues with handling stress and workflow. Due to the issues at hand, and answers to questions, I've found the central issue to be memory and forgetfulness. Which is not a surprise from a psychological stand point. Psychologically, it has been proven that the effects of stress on cortisol levels and the mind do decrease one's ability to remember information.

As a follow-up question, if more staffing is not currently a possibility, what do you believe could resolve issues with stress among patient care staff?

My patient care experience is fourteen years at the bedside, in acute, subacute, and critical care.

Alternatives to appropriate staffing? that's tough...I mean the fabled "let them eat cake" advice didn't fix French peasants' problem of lack of bread. Pt care staff are stressed because they are spread too thin, and they make mistakes because they rush. That is a fundamental issue that you can't simply throw cake at.

The Band-Aid type things that I'm thinking of that **may** help tend to involve evidence of our value on the part of management.

If more RNs aren't in the budget, what about more CNAs, or other service workers like JKL33 suggested? That would free up the RNs to focus on things that require a license, and provide help with ADLs or fetching turkey sandwiches.

Stand up and support the staff, when pts launch frivolous complaints. If pts or families choose to threaten, assault, or even verbally abuse staff, TELL THEM IT IS UNACCEPTABLE -- don't chastise the victim like it's their fault!

If physicians are misbehaving, management should address it with them and their superiors.

Don't have coverage for the next shift? Mandatory overtime is not an option... put on scrubs and use that nursing license and work.

Quit putting extra demands on staff when they don't even have time to do everything as it is.

Don't give lip service and donuts (to the day shift only) during nurse's week, and add ridiculousness like scripting the rest of the year. (Really, what other profession would EVER agree to scripting??)

Formulate plans to get staff off the floor for a full 30 minute meal break. Also for staff who eat from the caf, to actually make it TO the caf before it closes in the evening.

I work for the Ernest Shackleton of nurse managers, and the above things*** are what make me feel supported. Have you tried asking the staff nurses at YOUR facility what would be helpful to them? Are you working directly with nursing leadership and/or focus groups *of staff nurses* to find out what THEY feel they need? With all due respect, you have no patient care experience. (Working for hospitals doesn't equate with patient care.) You need to LEARN what would be helpful, before you can fix it. You can't simply decide what their fundamentals issues are, and expect them to respond to your misguided interventions.

*** Edited to add: we don't have customer service type staff at my hospital eirher. However my manager did fight and was granted the budget for more CNAs.

Specializes in SICU, trauma, neuro.
Here.I.Stand, with these precaution signs are they intuitive and secure? Is anybody able to change the precautions on the door? Is there any security measures to keep others from tampering with the precautions on the sign?

Sorry, I missed this earlier. Each doorway has a wall-mounted Plexiglass frame with open edges. The signs are laminated and sized to slide into the frames. To my knowledge, nobody has ever tried to breach them. I mean random people tampering with things in the hallway is going to be noticed -- actually, we don't allow visitors to linger in the hallways anyway. If they're not IN the pt's room, they have to leave the unit or wait in the family lounge.

Specializes in PACU.
Sorry, I missed this earlier. Each doorway has a wall-mounted Plexiglass frame with open edges. The signs are laminated and sized to slide into the frames. To my knowledge, nobody has ever tried to breach them. I mean random people tampering with things in the hallway is going to be noticed -- actually, we don't allow visitors to linger in the hallways anyway. If they're not IN the pt's room, they have to leave the unit or wait in the family lounge.

Agreed, in 25 years of nursing I have never once had a precautions sign moved or tampered with in any way.

The hospital doesn't seem to attract that type of person... the people there are stressed and just want their loved ones to feel better.

Specializes in Med Surg, Specialty.

Additional volunteers to utilize as mentioned earlier in this thread is a great suggestion.

Regarding utilizing technology, the two things I can think of are :

-improved call bell system. If a patient can type in their request/select one for a non urgent issue like needing another blanket or another box of kleenex, or refill of water(if they aren't NPO), and have that be routed to a volunteer, that would be fantastic.

-improved logistics for equipment. The amount of time I've wasted looking for/ordering routine equipment has been incredible. Its maddening when basic things like christmas trees aren't available and I have to go to another floor for one. Additionally this issue extends for equipment that is broken (we always seem to have only 1 working pulse ox on the floor since the others always were broken). I've also had issues with broken pumps, no portable oxygen tanks, etc. This is another area that a volunteer could handle. This also extends to medications not being available as well, so perhaps a volunteer could help the pharmacy department in some way so they could get the meds to us quicker and keep basic ones always stocked.

Agreed, in 25 years of nursing I have never once had a precautions sign moved or tampered with in any way.

Me either, but now I'm thinking it would be pretty funny if someone walked in, changed all the signs around, and walked out with three pairs of yellow hospital socks and a few snack-sized puddings.

JKL33, thank you for your honest feedback.

To elaborate on the project/problem I'm working on, I'm trying to lower the stress of our staff through easing their mind with visual cues and reminders. My goal is to implement new technology that makes it easier on staff to remember patient details. Thus, limiting the stress of memory on an individual.

Where do you believe I'm missing the premise? What would you define as the problem that should be the main focus?

Also, I'm not planning on spending my life solving this issue. I'm just reaching out to as many individuals with experience that I can, to help optimize the workflow at my employing institution.

Literally safe staffing is the best solution to this problem.

Sour Lemon, you slay me!! They'd probably come to the desk first to ask if we have any blue ones and maybe some jello because 'my aunt doesn't like pudding.'

Specializes in School Nursing, Hospice,Med-Surg.
JKL33, I completely understand your premise. I definitely agree that more employees on a shift would solve a lot of the issues we and many others face in the industry. However, from a business and management perspective, that is not a feasible solution for our current time and environment.

How much are you and other upper management/administration types like you being paid? You seem to be spending your time on completely pointless projects. I propose we get rid of your positions, hire new RNs to add to the floors to decrease nurse workloads. Problem solved.

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