how come we as nurses are taught and do things differently?

Nurses General Nursing

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I just had to ask because it seems no 2 nurses were taught the same way or do things such as skills the same way. For instance,I was taught the nursing theory using the Sister Callista Roy . But there is a sticky about Jean watson,who I have never heard of until I read that sticky. Even among nurses trained in the Usa it differs. As an example,there was this elderly woman receiving a gtube feeding who's bed was elevated 15 degrees.I asked her why she wasn't elevated at 45 degrees and she stated"we don't have an order to". Now,I thought it was common knowledge for nurses to know that with tube feeds the hob is to be elevated at all times to at least 45 degrees. Or (another example) when a pt. on a tube feed vomited and had 55ml residual and I was going to hold it for an hour. Along comes the supervisor who states "you have to turn it back on,we can't hold it that long. Fifteen minutes is good"

I also have a thread on here about documenting "asleep vs"resting with eyes closed". I learned some new things out of that thread and also the fact,that well,we are taught differently even when you take into account the different years and state boards we all graduated and were licensed in. Add the foreign trained nurses and it really gets confusing. Sorry,I'm just curious and its a slow night shift. (Ok,I'm admitting I'm using the blackberry and texting while at the nurses station)

Specializes in OB-Gyn/Primary Care/Ambulatory Leadership.
I actually have it in an old textbook of mine about 45 degrees.

Maybe that's the problem. Perhaps current research indicates that 30 degrees is preferable?

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This is why there is such a push for evidence-based practice. Tradition has been the basis for too many decisions. Imagine doing the actual research (experimentation, not just looking up what others have done) only to find out "the way we have always done it" was not the best way. Or to find out it was actually wrong!

Add to this mix the idea that there may be more than one right choice, and you will see why a single question can produce so many (and such different) answers.

I agree with the others. Stick with your facility's P&P. If you disagree with something you find there, seek out recent studies and other materials and communicate your thoughts to your manager or whatever committee is in charge of making policy changes.

"The way we've always done it" is not a good foundation for effective nursing practice.

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This is why there is such a push for evidence-based practice. Tradition has been the basis for too many decisions. Imagine doing the actual research (experimentation, not just looking up what others have done) only to find out "the way we have always done it" was not the best way. Or to find out it was actually wrong!

Add to this mix the idea that there may be more than one right choice, and you will see why a single question can produce so many (and such different) answers.

I agree with the others. Stick with your facility's P&P. If you disagree with something you find there, seek out recent studies and other materials and communicate your thoughts to your manager or whatever committee is in charge of making policy changes.

"The way we've always done it" is not a good foundation for effective nursing practice.

Well in home care my agency doesn't really have a "p and p" manual. The ltc has one, and I would be the first to admit I don't have time to look thru 10000 pages.

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Specializes in SICU,CVICU,ER,PACU.

Evidence-based practice would be my answer to you!

Your practice is your responsibility and your patient's safety and well being should be your priority.

Therefore, a N-years old manual is NOT a reference.

No one has time in our profession! Yet we still have to keep up with the latest literature and best practice.It is up to you to read and keep up with the latest trends and best practices.

HOB at 30 degrees is the standard of care in most places. Holding the feeds when the patient doesn't tolerate it is both a safe practice and common sense- Knowing where your feeding tube is (pre or post-pyloric sphincter) is of importance as well (they are not managed the same way)-Your supervisor is not the primary nurse, therefore, he or she does not have a say beyond advice.

If another nurse does something that you think is wrong, that is also your responsibility to call her up on it (and check your references).

There is so much more to cover, but if I have to sum it up, I'll say it again: Evidence-based practice

H~

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It's not "funny" but learned with tube feeds HOB> 30 and the dietician will say that if the residual is >200ml to cont. tube feed. But inevitably if my residual is that much AND contains bile, my patient will have it soon coming out the mouth. Has happened too many to times to count. Sometimes, too we learn faster ways to do things while "theo.rectically" performing procedures correctly

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So its how you want to do it.,and long as you have a favorable outcome and reach the goals. So in essence,however I decide to do something,I'm responsible for it,whether its done right or not. For example,there Is evidence that I read about that states its no longer reccomended to twirl a suction. Catheter aroud while inside a trach because they have holes on both sides anyway. Or that cpt during a feed doesn't causes vomiting,as long as its not vigorous.

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My question to you is, what is YOUR source for your information? You cited "common knowledge" for the HOB to be up 45 degrees for a patient receiving a tube feeding. I have never heard 45 degrees, in all my years of patient care (which, between CNA and RN years, is 14). Our HOB elevation "standard" for tube feeding is 30 degrees. Our P&P has "standing" orders for tube feedings, and that is one of them, as a matter of fact. For other things r/t tube feedings, the dietician will write specifics based on how long to hold based on what amount of residual, etc, so there isn't a whole lot left up to interpretation, most of the time. Some of it is common sense, though, and IMO, the nurse leaving the HOB up only 15 degrees since she "didn't have an order" to have it up any higher wasn't using any. As far as residuals go, if there are no orders to hold based on what it is, you have to look at how fast it's going, that is going to make a difference when determining how well the patient is tolerating it. If the residual on a 4 hour check is 50ml, say....not a big deal if it's going at 150ml an hour, but it IS a big deal if it's going at 20ml/hr. You have to look at the big picture. Long story short, it's not just what nurses are "taught to do," it's how nurses critically think, and that's not something that can necessarily BE taught, that's something that you can either do, or not do, for the most part.

She may have said "common knowledge" because if one reads Perry&Potter 'Basic Nursing' 2003,Mosby Inc. pg 756

it reads "Elevate head of bed 30 to 45 degress. Also states "If volume (residual) is greater than 100ml on several consecutive occasions, hold feeding and notify physician".

As you stated you have to look at the big picture, and use your nursing critical thinking :yeah:, and sometimes that really can't be taught.

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Maybe that's the problem. Perhaps current research indicates that 30 degrees is preferable?

Can you tell me what book you found this in? I'm all about EBP, I graduated 2yrs ago and this is a great example of EBP. To me 30-45 degrees is almost "splitting hairs", but, if EBP shows better outcomes (shearing issues?), it is definately something my employer may want to research.

Thankyou for the new info, it is SO hard to keep up with everything:nurse:

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how come we as nurses are taught and do things differently?

Because there is often no one right or wrong way to do something. Even with evidence-based practice...there's a lot of evidence. Conflicting evidence. With new evidence being generated constantly. There is also this little thing called judgement. Each situation presents its own unique challenges, and the nurse must operate within those.

Look at parenting. Is there one right or wrong way to parent? No. Nursing is no different. Same with medicine, engineering, teaching, architecture...

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This is why there is such a push for evidence-based practice. Tradition has been the basis for too many decisions. Imagine doing the actual research (experimentation, not just looking up what others have done) only to find out "the way we have always done it" was not the best way. Or to find out it was actually wrong!

Add to this mix the idea that there may be more than one right choice, and you will see why a single question can produce so many (and such different) answers.

I agree with the others. Stick with your facility's P&P. If you disagree with something you find there, seek out recent studies and other materials and communicate your thoughts to your manager or whatever committee is in charge of making policy changes.

"The way we've always done it" is not a good foundation for effective nursing practice.

Are there some nurses against evidenced based practice?

On another note,how would you tell a nurse whose been around for ages that new evidence shows it can be done this way,and the outcome would be better(without coming off as a know it all? (Ex. A new grad telling an older nurse how she was taught in school to do something)

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Quite frankly, I DO ask new grads how they were taught to do something; I can learn something new, research it if I disagree, and can correct if the new grad if it does not follow our p/p-or push to upgrade our p/p if the new grad is correct. Sometimes you need fresh eyes to make positive changes.

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