Hi guys! Slight confession to this blog, it may cause you to open the proverbial can of worms that is Human Factors and Non-Technical Skills and make you want to delve more into it! This is ok…. but it may take up some of your time. A few links within this blog to other amazing resources.
Situation
You have been working in ED for 3 months and today you are shadowing a more senior nurse in ‘Resus’ learning that area of the job. The ‘Red Phone’ goes and you hear that a 58-year-old male is in cardiac arrest and the ambulance is going to be here in 10 minutes. You panic… you have recently done your trust basic life support but now it’s real and everyone seems to know exactly what to do and they are hurriedly getting pieces of equipment out and preparing the area.
Background
Nurses working in resus have varying levels of training but in an ideal world they would all be trained in advanced resus courses and have regular simulation before the real case, but this is just not always possible. I do of course, dream of a day where nurse education in the ED is standardised across the nation and education is at the forefront of improving quality (one step at a time!).
However, it’s not all bad, as it has been shown that sometimes being thrown in at the ‘deep end’ can increase autonomy and confidence as it shows you that you can cope. [1]
However, ED nurses must ensure they are aware of their own limitations and don’t lose track of what it is they do not yet know, this is where reflection can play a huge part in allowing you to the address the feelings you had and prepare yourself for the next time. [2]
For more on reflection check out Harmony’s blog coming soon.
Despite training and level of experience, cases that we see can be very challenging and emotive and require a good level of team working and good knowledge of the ‘human factors’ involved in emergency medicine.
So, what are these ‘human factors’ everyone keeps chatting about? We can group all the skills we do into technical and
non-technical.
It’s obvious what we would class as technical skills in resuscitation such as cannulation, CPR, or airway management. The non-technical skills are teamwork, communication, situational awareness and leadership, and are an essential companion to the technical skills to ensure safe and efficient task performance. [3]
Assessment
In this case, the assessment is our own assessment of how we can improve both our own non-technical skills and those of others and this comes down to identification. So, stop for a second, think about a case that you didn’t feel went as well as you would have liked or where you came away feeling uneasy about it- you don’t have to know why yet.
Take 5 minutes now and just review the communication between you and the patient, you and the clinician, the stress of the department, the kind of day you may have been having- were you late for work etc.) Go…………
Did you manage to ascertain what the problem was, chances are it wasn’t a technical skill but more likely a non-technical one. The NHS receives more complaints about communication failure than other technical things such as pain or wrong treatment. Now doesn’t this seem weird to you that we ‘the caring profession’ receive our most criticism for things which we can control. The things we can’t control like queues and overcrowding, people generally seem to accept.
Now back to the 58-year-old male in cardiac arrest……in that 10 minutes take the time to ask everyone their name (even if you are the most junior member of the team). Don’t be afraid to ask things like, “what do you expect of me?” or questions like “I am doing CPR so what would you like me to do if that is not required?” a good team leader will say, “in the event of this man getting a return of spontaneous circulation I would like you to do the observations.” Sometimes this will not happen and only you can initiate it.
Support the team leader and your colleagues by prompting questions like “if we need to activate the cath lab- would you like me to bleep them?” What you are doing is taking off small bricks of ‘cognitive load’ from someone who is trying to balance them without dropping them, which means they lose sight of everything else. The more bricks you remove the more they will see the whole team and clear space to make forward plans.
This applies in other situations of high stress in ED too like the RSI of a patient in ED resus (blog and video coming soon) where we are reminded to ask “what will we do if this doesn’t work?”
Recommendation
Read up on these non-technical skills in a variety of places, reflect on which of these principles are the main cause of your worst cases at work, it’s unlikely to be because a 58-year-old man has had a cardiac arrest. This is horrendous but this is a common event in ED and we get used to doing everything we can to save someone’s life.
I’ll end with a story of my own journey through this topic which may put this into perspective;
As I nurse I’ve sadly had ringside seats at some of the most barbaric and shocking scenes and all my worst cases stick in my mind but on almost every occasion it’s for a good reason, because I can rest easy knowing that we sweated blood trying to save the patients. The only reason I knew this in each of these cases was by talking to the team afterwards or debriefing and coming back to it again and again when required, also, by reflecting on it and then using that reflection to fuel my passion to share the educational benefits with as many people as I can.
I remember leaving the military very shortly after my last tour in Afghanistan and being asked questions like ‘what’s the worst thing you have ever seen’ and immediately I would regale a story, with the intention of showing people what can be achieved only to lose that person half way as often they weren’t prepared for the detail. Since then my worst cases haven’t been a patch on some previous cases and yet they have affected me more and it’s taken me a while to figure out why and truly understand the importance of the team, the communication, the stress and the debrief.
I was sat in the audience of SMACCDub in 2016 listening to Liz Crowe talk about love in the context of our work and it clicked, so click here to watch this amazing talk!!). I had an epiphany about everything I have been able to put into words in this blog. Your bad jobs/cases will be the ones you don’t feel listened to, you don’t feel part of the team, when you are new or you see bad practice. Only we can change that!
You can go on a course to learn resus but you must work at improving your understanding of the non-technical elements which are as we have seen arguably the biggest part.
Thanks for reading!
Ash
Check out the blog by Kirsty about our trip to the EMEC here
References
[1] Hollywood, E (2013). The lived experiences of newly qualified children nurses. British Journal of Nursing; 20(11); Available at: https://www.magonlinelibrary.com/doi/abs/10.12968/bjon.2011.20.11.665
[2] Fullstone, M. Hall, O. (2017). Military preceptees' journey in the emergency department. Emergency Nurse; 25 (8); Available at: https://journals.rcni.com/emergency-nurse/military-preceptees-journey-in-the-emergency-department-en.2017.e1669#R10
[3] The Resuscitation Council (2016). Advanced Life Support (7th Edition). London.
Curriculum codes- All of GNP 2- Team working Level 1 and level 2- forgot how to access our use the competency document click here for the blog on this