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.

ED Nurses Vent and Haemodynamics Workshop

This post captures some of the resources discussed in the ED Nurses Vent and Haemodynamic Monitoring workshop at Redcliffe Hospital. These resources are high quality FOAM and can help with expanding upon the learning and piqued curiosity from the workshop. Happy self-directed learning.

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.


Arterial lines, central lines and haemodynamic monitoring

Quick snapshot on Arterial lines – http://lifeinthefastlane.com/ccc/arterial-line/

Literally the whole chapter on Haemodynamic Monitoring, an amazing resource – http://www.derangedphysiology.com/main/core-topics-intensive-care/haemodynamic-monitoring

arterial pressure waveform

Image from Deranged Physiology


Acute Respiratory Failure

Medscape emedicine overview of Respiratory Failure – http://emedicine.medscape.com/article/167981-overview

British Thoracic Society Guidelines for a host of diseases, diagnoses and therapies in ARF – https://www.brit-thoracic.org.uk/standards-of-care/guidelines/


Non-Invasive Ventilation

NIV Clinical Practice Guidelines – http://www.aci.health.nsw.gov.au/__data/assets/pdf_file/0007/239740/ACI14_Man_NIV_1-2.pdf

Q&A format NIV for the criitcally ill patient from LITFL – http://lifeinthefastlane.com/non-invasive-ventilation/

LIFTL Critical Care Compendium NIV – http://lifeinthefastlane.com/ccc/non-invasive-ventilation-niv/

Great 5 minute overview of NIV


Rapid Sequence Induction/Intubation

RSI Checklist Podcast and host of resources – https://emcrit.org/podcasts/intubation-checklist-2-0/

The Vortex Approach : a unique and systematic approach to safe emergency airway management – http://vortexapproach.org/

Nice overview of indications for RSI

RSI Dump Sheet adapted from KI Docs


Post-Intubation Care

The go-to package for post-intubation, EMCrit – https://emcrit.org/podcasts/post-intubation-package/


Mechanical Ventilation

For those that want EVERYTHING, here is the chapter from Deranged Physiology – http://www.derangedphysiology.com/main/core-topics-intensive-care/mechanical-ventilation-0

Don’t forget the importance of alarm settings – CritIQ video

A huge suite of brilliant videos from Respiratory Review – The Principles of Mechanical Ventilation

A short lecture on basic ventilator settings using the Hamilton T1 – https://www.youtube.com/watch?v=XOt4nMrJgww

Hamilton T1 online settings simulator – https://www.hamilton-medical.com/.static/HAMILTON-T1/start.html


The Crashing Ventilated Patient

This is a brilliant lecture with some good mental models and mnemonics for assessing and treating the patient who crashes post-intubation

Fortnight of SMACC Talks: December 1st – 15th

As many of you know, there is a close relationship between the SMACC conference and Injectable Orange. Each fortnight we will be sharing a few of our favourite talks from the 2016 SMACC Dublin Conference as they are released via podcast or vodcast. Every past talk from the previous SMACC conferences are available via the SMACC website. For those of you who haven’t experienced SMACC, we hope these serve as the wardrobe door to your educational Narnia.

 
05/12/16 – Things that scare me

Speaker: Ross Fisher
Meta-description: In our professional and private lives there are things that scare us, how we manage that fear defines us.
Podcast:

Video:

THINGS THAT SCARE ME-Ross Fisher from Social Media and Critical Care on Vimeo.


06/12/16 – Where is the love in critical care?

Speaker: Liz Crowe
Meta-description: Critical Care is a place where love/passion and commitment must flourish, professional to patient, leaders to teams and colleagues, educator to trainee, skill to humanity- this is how we do it while maintaining our technical skills and our sanity.
Podcast:

Video:

WHAT’S LOVE GOT TO DO WITH IT–Liz Crowe from Social Media and Critical Care on Vimeo.


07/12/16Disaster Triage: Who gets what?
Speaker: Sara Gray
Meta-description: What happens in a mass casualty disaster when you run out of beds? Out of ventilators? Out of blood? Come discuss how (or whether) we should triage scarce resources during disasters.
Podcast:

Video:

Disaster Ethics- Who gets what- -Sara Gray from Social Media and Critical Care on Vimeo.


12/12/16 – The Immediate Responder and the Disaster Gap.
Speaker: Christina H. Hernon, M.D., FACEP
Abstract: After a major formative experience at a life-threatening mass casualty incident (MCI), emergency physician Christina Hernon felt incredibly unprepared despite over 2 decades of training in emergency and first response. Despite every first aid, first responder, and emergency course teaching students to ask, “Is the scene safe?” and instructing them not to enter an unsafe scene, all of this training is completely inadequate for those present the very moment an incident occurs, who are then amidst and surrounded by an unsecured and potentially unsafe scene. Afterwards, she had an acute stress reaction exactly like after rough calls in prehospital Emergency Medical Services, yet was offered none of the typical supports offered to first responder agencies or hospital personnel. Feeling somehow betrayed, but unsure what to be mad at, she tried to understand why she felt so unprepared and overlooked. In deconstructing and reflecting on the experience, she self-identified neither as bystander nor first responder, but as an on scene, immediately responding, victimized rescuer. Realizing that she didn’t fit into any already existing category, she uncovered a new group of rescuers and an undefined time period that we need to give attention to. The Disaster Gap is the time between the moment an incident occurs, through the first call for help, and until the first of the clearheaded First Responders arrives. In this definable time gap, the only available rescuers are people who are on scene when the event happens, who may be traumatized by their experience themselves, and who, regardless of tools or training, take immediate action to help another person or make the situation better. These Immediate Responders are present at virtually every scene and have been for all of time, yet we know very little about them, their actions, their safety, their impact, and their recovery. By trying to understand the Disaster Gap and Immediate Responders, we can improve training, preparedness, resilience, and recovery.
Podcast:

Video:

The Impromptu Immediate Responder- Christina Hernon from Social Media and Critical Care on Vimeo.


Don’t forget to subscribe to the SMACC Podcast – via iTunes or your preferred podcast app. Also remember there is a third and final small release of tickets for DASsmacc Berlin on the 1st Feb 2017.