As the complexity of patients continues to increase, it’s easy to forget our most basic nursing skills when some days we are just trying to save a life and get a bathroom break. However, the more complicated our patients become the more important it is to perform the basics. My very first nurse preceptor, who was one of the best nurses I have ever worked with, emphasized the importance of these skills and made it clear that the best nurses can manhandle both complicated and basic skill sets. This, of course, was all with the patients’ benefit in mind. So without further ado, don’t forget the following on your next shift.
Hand hygiene has been studied for a couple centuries now and the CDC has been perfecting a protocol for decades. Whichever way you look at it, the effectiveness of hand washing has been more than well documented. Wash your unsoiled hands with hand sanitizer when walking into a patients’ room, leaving a patients’ room or after any contact with a patient. Of course, if your hands are soiled or your patient has C. Diff, please wash your hands with soap and water. Also, hold others accountable. I know we’ve heard it all before, but seriously wash your hands and tell everyone else to do it too. Make Florence proud.
If your patients are lying in bed, immobile, for any period of time, turn them at least every two hours. Once again, with patients’ increasing acuity and chronic illness, they are more susceptible to pressure ulcers. I could talk about how Medicaid and Medicare are no longer reimbursing for hospital acquired pressure ulcers, but the monetary cost is not nearly as important to me as the physical cost to the patient.
I have worked in several I.C.U.’s and I’ve heard every excuse in the book regarding why patients can’t be turned. So, when you decide to skip the turn, check yourself. Is your patient REALLY too unstable to turn? Will you REALLY wake your patient up?
This is another one where accountability is imperative. I know it’s tough at 0200 when you’ve started your IV of coffee and red bull to stay awake, but stand up and ask your fellow nurses if they need help turning their patients. The same goes for dayshift when everyone is so busy that turning is easy to overlook. The less busy nurses should make the effort to offer help repositioning.
Finally, I know I’m pushing it, but don’t forget to float heels and elbows with pillows, readjust the pillow behind your patient’s head, reposition the ET tube and/or ND tube and check for wrinkles in the sheets. Pressure ulcers are no joke.
For my I.C.U. nurses or nurses who care for chronically trached patients, oral care is imperative for the prevention of ventilator associated pneumonia (VAP) and several other issues. Effective oral care has been proven to reduce incidences of VAP. Occurrences of VAP were further reduced when oral care was bundled with other interventions, like elevating the head of the bed to at least 30 degrees.
Most hospital policies recommend oral care with 2% chlorhexidine solution every two to four hours. Also, don’t forget the oral moisturizer packet included in the oral care kit, this helps protect the oral mucosa from the irritating chlorhexidine.
Working in nearly any bedside nursing environment today is taxing. However, if you have time to talk or listen to your patient, take advantage of it. Understanding your patients’ goals for care and natural behavior can be more beneficial than you may think.
“Patient-centered care” is a newer buzzword with the academics, but basically it comprises the ideas of customized, empathetic and compassionate care for each patient. It has been proven to reduce costs and increase patient satisfaction.
For example, consider two similar heart failure patients. By communicating and understanding the patient’s goals for care a provider may learn that one is a good candidate for an LVAD and the other would be happier medically managed. Each patient has a different life and different goals that should be recognized.
Nurses basically invented compassionate care. In the midst of our crazy healthcare environment, we just need to try and bring it back on our hardest days.
Aside from the fact that chlorhexidine baths have been proven to decrease the risk of central line infections, baths are a very useful nursing tool. My first nursing preceptor, who I mentioned above, was a master of the quick and thorough bath. She bathed her I.C.U. patients every shift because most of the time they needed it, but also because it was the best way to comprehensively assess the patient. When I started working night shift, I used baths as a tool to help my patients’ sleep. Even when they would try to refuse, I encouraged them to accept and nearly 100% of the time, they were thankful and much more relaxed.
This rounds out the top five for me. Are there any basic nursing skills that are frequently missed?
Danielle is the owner of her nurse blog Nurse Abnormalities.