Second Guessing, Good or Bad?

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Specializes in Making the Pt laugh..

Recently I had a Pt arrive at our Emergency Department ./c vague symptoms dating several months, triage noted a vague-er cardiac Hx on file. I took him to the bay and set up the obs and ECG, (just in case). I hadn't got my ECG read or even got a usefull history when he yelled about a sudden pain and collapsed on the bed. Within a minute he was in resus and a further minute later a full resus was in progress. Unfortunately he did not make it. The circulation nurse told me that he had a AAA and that there was nothing that I could have done.

I found myself second guessing myself and my approach, not from guilt, rather how I could have done things differently and now find myself in this kind of mental "debriefing" quite often after a difficult Pt. I sometimes find faults in my "performance" but I worry that this may not be healthy and could possiby become obsessive.

Is this second guessing healthy or is it as I worry....obsessive? What do you all think?

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It's normal--well at least for me--to review your actions. I do it in nursing and I did it in my previous jobs. You can learn from that, as you usually find there are things you could have done or said somewhat differently, etc. It's kind of a personal QI and is a valuable tool.

The trick is to let go once you have conducted your mental review. In a hospital QI, a policy might be changed and then the matter is no longer active.

If you are obsessing, perhaps it would help you to write down the things you might do differently next time. That would give you a concrete and effective outcome from your mental review and could allow you to let it go.

The second trick is to know the difference between those things that change outcomes and those that simply make the patient feel a little better. Would anything short of miraculous powers allow you to diagnose and change the course of an AAA? I think the answer is no.

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Specializes in LTC, Memory loss, PDN.

Some call it debriefing and it's a valuable tool as long as you can stay objective.

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Specializes in Critical Care, Education.

Twisted ,

What you are describing is actually the mental process that produces high levels of expertise. There has been a ton of research on clinical expertise & proficiency aimed at figuring out why some people get there and others don't. Let's face it, some nurses with 20 yrs of experience seem to be just repeating "year one" over and over again. Dorothy del Bueno (RN, PhD) has a wonderful metaphor - "would you seek marriage advice from Elizabeth Taylor? Just because she has a lot of experience doesn't mean that she has expertise."

What makes the difference for you (and others who work to improve their skills & knowledge) is that you engage in self-examination/analysis after any new experience. This turns the experience into a learning event. Simply put, experts learn from their experience, and non-experts don't. This takes effort and frequently produces discomfort when we realize that we should have done something differently - but it is necessary.

I am not going to waste time advising you not to 'second guess' or ruminate over what you could have done differently. It would probably be a waste of time, because that is just how you are made - - you won't be able to stop any more than you could hold your breath for an hour. But try to realize that it is not a BAD thing. In fact, whenever possible, you should help newbies learn how to do it also.

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Specializes in Making the Pt laugh..

I would like to thank you all for your responses. I have always gone through things in my mind to see where I could improve, either clinically or in Pt care. I think the scare of witnessing a walking, talking person change so quickly made it a more prevalent occurence with a deeper/more complex mental "debriefing" .

The second trick is to know the difference between those things that change outcomes and those that simply make the patient feel a little better. Would anything short of miraculous powers allow you to diagnose and change the course of an AAA? I think the answer is no.

Don't worry on that score rngolfer, I know that I am good but modesty and common sense allows me to realise that there was nothing I could do in that situation. I will have to step back and make sure that any future events I can differentiate things I can change and those I can't.

Thankyou.

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Specializes in Staff nurse.

Hugs to you at this time.

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