Sarah Webb: You Can’t Handle the Truth: Chains of Command
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Transcript of Sarah Webb: You Can’t Handle the Truth: Chains of Command
Why can’t nurses take command?
Critical Care Nurses
Advanced Life Support
2013 Training Requirements:
Advanced life support
The advanced life support (ALS) course must be completed during introductory, basic and advanced training and develops advanced skills in managing cardiac arrest and other medical emergencies. While the course covers advanced resuscitation skills, it is also designed to develop leadership and team skills in managing such emergencies. ALS teaches skills that are required during training and by specialist anaesthetists. If the trainee does not attend a specific ALS course, their hospital department may organise a similar course or study as approved by the supervisor of training. The supervisor of training is not responsible for organising the course but should assist the trainee.
The Truth…
Nurses and resuscitation leadership
Source Purporse Setting Design Findings
Gilligan et al. (2005)
Do nurses with ALS training provide good team leadership in cardiac arrests
Five UK EDs Prospective quasi-experimental 57 participants in simulated scenarios
• Nurse’s time to defibrillate were equal to those doctors with ALS training.
• Recommendation that experienced nurses assume the ALS leader role where a senior doctor is not available.
Lin et al. (2009)
Is a senior nurse more skillful at resuscitation
1200 bed metropolitan medical centre, Taiwan
Cross-sectional observational study 55 head nurses
• Age, work experience related to skills in assisting with CPR.
Kirk (2006)
Review of the RapidResponse Team
10 acute care hospitalsU.S.
Literature review
13 papers
• Nursing leadership ensures clear definition of roles and responsibilities.
Makinen et al. (2007)
Assess resuscitation skills to facilitate an educational program
2 University Hospitals Sweden and Finland
Observational,convenience sample of 150 nurses
Nurses trained in resuscitation leadership had superior non-technical skills.
Clements & Curtis(2012)
Assess the impact of nursing roles in trauma and in hospital resuscitation
Australia Literature review
18 papers
Nurses involved in trauma and other resuscitations contribute to effective communication, leadership and teamwork, which ultimately impact patient outcomes.
Traditional chains of command Non-technical skills
Awareness of each other’s skills
Dr Michael DeVita, University of Pittsburgh
Should Critical Care nurses take a leadership role in
resuscitation?
Teach ALS and CRM
Empower
Ask
Mentor
YES!!
References• Churchman JJ, Doherty C (2010) Nurses’ views on challenging doctors’ practice in an acute hospital. Nursing
Standard. 24, 40, 42-47. Date of acceptance: March 5 2010.
• Clements, A., & Curtis, K. (2012). What is the impact of nursing roles in hospital patient resuscitation? Australasian Emergency Nursing Journal.
• Eastwick-Field, P. (1996). Introducing nurse-initiated management of cardiac arrest. Nursing standard (Royal College of Nursing (Great Britain): 1987), 10(26), 46.
• Foot, C., Host, D., Campher, D., Tomczak, L., Ziegenfuss, M., Cohen, J., & Nunnink, L. (2008). Moulage in high-fidelity simulation-A chest wall burn escharotomy model for visual realism and as an educational tool. Simulation in Healthcare, 3(3), 1-5.
• Gill, F. J., Leslie, G. D., Grech, C., & Latour, J. M. (2012). A review of critical care nursing staffing, education and practice standards. Australian critical care.
• Gilligan, P., Bhatarcharjee, C., Knight, G., Smith, M., Hegarty, D., Shenton, A., . . . Bradley, P. (2005). To lead or not to lead? Prospective controlled study of emergency nurses’ provision of advanced life support team leadership. Emergency Medicine Journal, 22(9), 628-632.
• Numata, Y., Schulzer, M., Van Der Wal, R., Globerman, J., Semeniuk, P., Balka, E., & FitzGerald, J. M. (2006). Nurse staffing levels and hospital mortality in critical care settings: literature review and meta‐analysis. Journal of advanced nursing, 55(4), 435-448.
• RPN, R., & Alberto, L. (2006). Consensus Forum: worldwide guidelines on the critical care nursing workforce and education standards. Crit Care Clin, 22, 393-406.
• Stein L (1967) The doctor-nurse game. Archives of General Psychiatry. 16, 6, 699-703.