I See You, Nurse – a poem by Connor Bond

Sometimes another human can put words into form that capture your own feelings and views better than you can articulate yourself. Connor Bond (@Trauma_Mouse), Scottish Emergency and Critical Care nurse working in central London did just that with his poem “I See You, Nurse”. Connor shared this on stage at DAS SMACC in Berlin after winning the SMACCSLAM poetry/spoken word competition. Although I’d heard Connor’s poem when judging the competition, I was floored when sitting behind him, watching and listening as he stepped to the centre of the round stage in the middle of the Tempodrom. This will be released via the SMACC podcast in due course, but for whatever reasons personal or otherwise, I feel like a lot of us could do to hear this now. Over to Connor…


“After moving from the North of Scotland two years ago, I’ve worked between an emergency department and critical care in central London. Nursing on the frontline in a capital city can present it’s own unique issues, but I truly believe that we canall find ourselves facing challenges derived from our health systems, patients or upon reflection internally.

I often find myself uncomfortable when adorned with the title of “Saint” or “Angel”; I do feel that this is my vocation, but I hardly float around my ICU with a halo in situ! As nurses we are incremental to the holistic patient experience and often responsible for interventions that will drastically improve outcomes – I shall always remain proud of that.” Connor Bond


 

I See You, Nurse

Remind me, why do I do this?
Why I chase the rush
of chaos, of drama
of resus & trauma

Why I’ve held distraught mothers
Cared for fathers
and leant by the bedside to explain to brothers,
why their sister simply won’t wake up after
I switch off infusions
and call out after her.

On the surface I’ll hold steady,
dry and stern
but I crack on the underground home.
I hold thankless floodgates in my hands
Staying strong for
another shift,
another patient,
another family looking to be shown
Improvement in those lines and trends that I’ll struggle to decipher to a devastated mother, who wants her baby home.

But we’ll still push and still go
Stretching resources, and ourselves.
I’m doubled with patients,
double strength pressors,
double pumping,
double shot espresso for that fourth night in a row.

And then the ward round comes
and I ask myself
have I done enough?
are these lines labelled, is my bedside straight?
but can we be too tough,
on one another
and ourselves?

They call nurses “Angels”,
but my wings are long singed
from holding too tight to Dear Nightingale’s lamp,
but I carry on because I will it,
and because i can,
Because I’ve seen eyes open after weeks without sedation,
while family rallies behind a young man with such determination
as he takes his first steps for the second time in his life.

We are not Saints
We are not Angels
I will never cause miracles at handover
But I’ll give them my mind,
my hands,
my words
until my best is enough, no more.

Sim Workshop at TTC Copenhagen

This post is a resource for the Sim Workshop being delivered as part of dasTTC – The Teaching Course Copenhagen.

Thursday 22nd June 2017 – SOHO 0900-1200

Time Component Brief Description Faculty
0900-0920 Intro, Welcome and Psychological Safety Jesse Spurr
0920-0950 Sim for Elite Performers Plenary Talk Chris Nickson
0950-1030 Hive Mind Solutions

#FOAMsim

3 groups with a coach each

1.     In Situ Conundrums

2.     Communication and CRM

3.     More than one way to debrief

Objective: Develop a 15min teaching session

1. Chris Nickson

2. Sandra Viggers

3. Jesse Spurr

 

1030-1050 BREAK
1050-1140 Hive Mind Teach-Back Nominated facilitator(s) from groups 1, 2 and 3 teach back their group’s products to the whole delegation
1140-1150 Coaches Right of Comment Coach summary/take home points if any.  
1150-1200 The Future Agenda for sim Wrap-up and areas for inquiry Sandra Viggers

Psychological Safety Resources – http://simulationpodcast.com/2016/10/14/ep-4-safe-container-simulation/


Breakout Group 1 – The In Situ Conundrum

Coach – Chris Nickson

You’ve been running fortnightly scenarios in the nearby simulation centre. These are part of the resident training program and from time to time may get a nurse or two along depending on how busy the department is. While well evaluated, you see the residents go back to the shop floor and struggle to apply any of the lessons that the group agreed had been take homes from the previous sim session. They can’t find equipment, struggle to coordinate the multidisciplinary team and seem much slower to achieve critical actions in the real resus. You approach the Department director and the nurse manager and suggest starting to conduct one of the sim sessions in the department in a real resus bay once a month. This is met with resistance, “we’re too busy theirs not enough staff or time”, “the staff have done mock codes before, they really disrupt things and they hated them”. You go back to your office and try to come up with how you will make this happen. (Stimulus by Prof. Victoria Brazil, Simulcast)

 

Questions to address:

  1. What domains are particularly relevant in considering the use of in situ versus simulation lab?
  2. How do we manage the competing workloads and lack of buy in for in situ sim?

 

References:

Brazil, Spurr, Petrosoniak, Simulcast Episode 5, November 2016 – Put the Rubber to the Road

http://simulationpodcast.com/2016/11/22/ep-5-put-rubber-road-situ-simulation/

Life in the Fast Lane, Critical Care Compendium – In Situ Simulation, revised November 2016. https://lifeinthefastlane.com/ccc/situ-simulation/

Petrosoniak, A., M. Auerbach, A. H. Wong and C. M. Hicks (2017). “In situ simulation in emergency medicine: Moving beyond the simulation lab.” Emergency Medicine Australasia 29(1): 83-88.

Spurr J, Gatward J, Joshi N, et al Top 10 (+1) tips to get started with in situ simulation in emergency and critical care departments Emerg Med J 2016;33:514-516.


Breakout Group 2 – Communication and CRM through SIM, is it working?

Coach – Sandra Viggers

“McDonalds drive thru attendants are much better at Closed Loop Communication than health care professionals.”

David replayed the conversation in his head again, he had ordered the meal, she had checked what he’d ordered, there was a visual display of his order on the drive thru screen, he’d confirmed his order and she’d told him it would be available soon. It was textbook perfect. Call out. Check back. Confirmation. Completion.

“How do they do it so well?” he thought.

Maybe people get angrier when pickles turn up on their double cheeseburger than when we give their grandma the wrong drug? The world is a strange place when we can’t do something so simple when it’s critical, but we do it so well when the outcomes are meaningless.

“This demands more research.” he thought as he turned his car keys and backed out the car park.

“I’d better come back tomorrow.” (Stimulus by Dr Ben Symon, Simulcast)

 

Questions:

  1. Are CRM and Closed-Loop communications reductionist when applied to health?
  2. What explicit behaviours are we looking for and how can we functionally align our education strategies to achieve these?

 

References:

Härgestam M, Lindkvist M, Brulin C, et al

Communication in interdisciplinary teams: exploring closed-loop communication during in situ trauma team training

BMJ Open 2013;3:e003525. doi: 10.1136/bmjopen-2013-003525

Lorello, G, Hicks, C et al.

Mental practice: a simple tool to enhance team-based trauma resuscitation. CJEM. 2016 Mar;18(2):136-42. doi: 10.1017/cem.2015.4. Epub 2015 Apr 10.

Petrosoniak, A and Hicks, C

Beyond crisis resource management: new frontiers in human factors training for acute care medicine. Curr Opin Anaesthesiol. 2013 Dec;26(6):699-706. doi: 10.1097/ACO.0000000000000007.

Symon, B and Brazil, V. Simulcast Journal Club Podcast March 2017 http://simulationpodcast.com/2017/03/02/simulcast-journal-club-podcast-2/


Breakout Group 3 – Debriefing. Which way is best?

Coach – Jesse Spurr

Ellen felt anxious walking into the debrief room.

The ED team had just finished an in situ simulation where the focus was on rapid sequence intubation (RSI) in head injury, and using the new intubation checklist. This was the third sim session in a series the department had agreed to run following 3 patient cases where significant desaturation occurred during intubation attempts.

Ellen thought they’d done OK but had recognized a lot of the usual ‘bad habits’ that frankly irked her when she worked on the floor with these guys – no nasal prong O2, a pretty vague conversation about who was going to actually do the tube, and low level grumbles about the time it takes to do the checklist. She was particularly disappointed that those things had come up in the last sim, and that a couple of the nurses had participated in that previous sim. “How can we actually get this into their heads?” she thought.

Entering the debrief room, Ellen knew what she wanted to bring up, but felt her stress level rising. Reactions first, she thought, and then facts. What would be a good advocacy inquiry question? What else did they say in that debriefing course…..? Should she let the learners dictate the topics?

And she knew that the ED consultant who was in the scenario was not a big fan of sim, and anticipated he might be difficult. His performance is probably off limits for today, she thought.

Deep breath.

“OK guys that was great. Well done”…….. (Stimulus by Prof. Victoria Brazil, Simulcast)

 

Questions:

  1. Is there one perfect way to debrief?
  2. Produce a mind map for applying different debrief contexts.

 

References:

Brazil, V. Article review: Is there really more than one way to debrief? Debrief2Learn Sept 2016. https://debrief2learn.org/really-one-way-debrief/

Brazil, Spurr and Eppich, Simulcast Episode 2, August 2016 – Eppich Debriefing http://simulationpodcast.com/2016/08/17/eppich-debriefing

Cheng, A., K. J. Morse, J. Rudolph, A. A. Arab, J. Runnacles and W. Eppich (2016). “Learner-Centered Debriefing for Health Care Simulation Education: Lessons for Faculty Development.Simulation in Healthcare 11(1).

Eppich, W. and A. Cheng (2015). “Promoting Excellence and Reflective Learning in Simulation (PEARLS): Development and Rationale for a Blended Approach to Health Care Simulation Debriefing.Simulation in Healthcare 10(2).

Rudolph, J; Simon, R; Dufresne, R; Raemer, D (2006)

“There’s No Such Thing as Nonjudgmental Debriefing: A Theory and Method for Debriefing with Good Judgment”

Simulation in Healthcare: The Journal of the Society for Simulation in Healthcare., 1(1):49-55, Spring 2006

Symon, B, Simulcast Journal Club Summary August 2016 – Debrieifer Knows Best

http://simulationpodcast.com/wp-content/uploads/2016/08/SIM-Journal-Club-August-2016-Summary-version-4.pdf

 

 

Podcast Ep. 8 – Slaying Headaches and Sharing Knowledge

This podcast was recorded live at a Metro North Hospital and Health Service Research Principles series. I was invited to speak on Using Social Media to Share Research Outcomes. As part of the session I invited Dr Erik Wood, Staff Specialist in Emergency Medicine at Redcliffe hospital to have a chat about his first clinical trial as PI. The recording was intentional left raw with minimal editing as the intent was to show how easy it is to use podcast as a medium to share your research.

The below flyer was used to raise awareness amongst the medical and nursing team in the ED.

ALiEM – How I Stay Healthy in EM


Those who know me, are acquainted with the fact that I love to keep fit (some may say a little obsessively). It was a privilege to be able to share a little of my personal philosophy and also be the first nurse to post in the How I Stay Healthy in EM series on Academic Life in Emergency Medicine. This series, edited by Dr Zafrina Poonja and features an insight into how people balance the pressures of working in Emergency with staying well themselves. For my offering head here.

 

Can We Stop (Predict) The Drop? – April No Falls Month

For many Australian hospitals, April is ‘No Falls Month’. This month we have a full-scale education attack against one of the most prevalent forms of in hospital patient harm – the fall. In the consistent form of Injectable Orange we have a not so hidden curriculum – critical appraisal and evidence based practice. There is a wealth of information relating to best practice in preventing falls and harm from falls, however there is little to guide the accurate prediction of future falls for geriatric patients presenting to the Emergency Department. This is of importance, because not every person presenting with a fall is admitted to hospital and as such, the potential to reliable screen and intervene or refer to supporting services is a primary and preventative health priority.

As part of our education this month, I would encourage the enthusiastic ED nurse to read the following article. While reading the article, take the next step and cast a critical eye at the quality of the systematic review. Here is the CASP tool to help with this appraisal. Once you have formed your own opinion have a listen to the podcast below. We’d love to hear your thoughts and also any great initiatives you are using to help prevent falls and harm from falls in your ED or wards, leave a comment below!

Remember this all counts toward your nursing continuing professional development. Pro-tip on organising and capturing your CPD activities: keep a portfolio. Quite simply, document your intended personal learning objective; identify a high quality resource that addresses this (article, workshop, conference); document a reflection on your achieved personal learning outcome. For a comprehensive overview of a Nursing Professional Portfolio head to this guide from the ACN. My newly discovered resource for keeping track of CPD portfolio is this great app from Ausmed Education.


The Article

Carpenter, C. R., Avidan, M. S., Wildes, T., Stark, S., Fowler, S. A., & Lo, A. X. (2014). Predicting Geriatric Falls Following an Episode of Emergency Department Care: A Systematic Review. Academic Emergency Medicine : Official Journal of the Society for Academic Emergency Medicine, 21(10), 1069–1082. http://doi.org/10.1111/acem.12488


The Podcast

For the uninitiated, The Skeptics’ Guide to Emergency Medicine (The SGEM) is a weekly podcast hosted by the brilliant Dr Ken Milne, Canadian Emergency and Family Medicine Physician. Ken pitches a clinical case and then reviews a recent or ‘Hot of the Press’ article that may potentially answer the question. Ken will invite a guest skeptic to help appraise the ‘game changer’ quality of the article and for select episodes will discuss with a principal author of the publication. The SGEM uses the Best Evidence in Emergency Medicine (BEEM) appraisal tools to form the structure of the conversation and also to subversively teach us a reliable and reproducible format for our own critical appraisal.

In this episode Ken discusses the above article with it’s primary Author Dr Chris Carpenter addressing the following case and question.

Case: 84yo woman (Mrs. C) who lives independently and alone in her own home presents to the emergency department via ambulance with a standing level fall. She was bending over to pick up a letter that had dropped off her desk, lost her balance and hurt her left, non-dominant arm. After the fall she was afraid to stand and could not reach her telephone so she laid on the floor calling for help until a neighbor heard her and called 911. She notes infrequent falls at home with no prior injurious falls. Her past medical history includes hypertension and a remote history of breast cancer, but she does not take anti-platelet or anticoagulant medications. An appropriate physical exam is performed and reveals an isolated left shoulder injury. The x-ray of her left shoulder is negative for any fracture. She is diagnosed with a minor contusion and provided with some acetaminophen. The daughter-in law arrives to take her home, but asks if Mrs. C is at risk for further falls in the future.

Question: Can healthcare personnel accurately identify subsets of geriatric adults at increased risk of falls or injurious falls in the months following an episode of emergency department care?

SGEM#89: Preventing Falling to Pieces