Fundamentals of Mechanical Ventilation

About Fundamentals of Mechanical Ventilation

Management of the Mechanical Ventilator is the responsibility of the Respiratory Therapist; although, nurses must be aware of the settings and alarms to effectively care for patients who require an advanced airway. Accordingly, fundamentals of Mechanical Ventilation will enhance a nurses understanding of current modes and settings of ventilation.

In summary, students will learn how to apply critical thinking when modifications to PEEP, FIO2, Rate and Tidal Volume occur. Additionally, modes of ventilation, such as AC, SIMV and Pressure Support, along with the Trigger, Control, and Cycle will be discussed. Fundamentals of Mechanical Ventilation also includes knowledge of exercise-appropriate assessments, and safe weaning techniques. Last but not least, students will learn the adverse events of mechanical ventilation, such as hyperoxia, barotrauma, VAP, decreased cardiac output, absorptive atelectasis, and more.

Why you should choose NEO for Mechanical Ventilation

Because RN’s are the first to encounter a ventilator related problem, it is essential for nurses to thoroughly understand the basics of Mechanical Ventilation. However, all the  intricacies of the mechanical ventilator can often be overwhelming for nurses and new grads. In addition, acute as well as critical care nurses often encounter numerous issues related to ventilator management. Overall, the purpose of the Fundamentals of Mechanical Ventilation course is to provide understanding and confidence to nurses who work with mechanical ventilators. For New Grads and students, we offer the 5 Finger Discount to help you build a stellar resume.

Course Information

Course Fee: $115.00

Textbook Included

Awarded 6 Contact Education Hours

Schedule online or call us at 866-266-2229

Costa Mesa

San Diego

Fundamentals of Mechanical Ventilation course for experienced, transitioning, or new grad nurses

NEO Blog

Nurses Eat their Young

Lateral violence is a form of nurse bullying For instance, lateral violence occurs when another nurse deliberately instills harmful behavior in the workplace to another employee. Most noteworthy, nurse to nurse bullying remains extremely common in various hospitals and healthcare facilities. Nursing remains one of greatest occupations at risk for lateral violence. As a matter of fact, roughly 44% to 85% of nurses reported being victims of bullying (Christie and Jones, 2014). Most notably, 93% of nurses reported witnessing lateral violence in the workplace. In most cases, the experienced nurse served as the perpetrator, whereas the New Grad and Student Nurse served the role of the victim (Jacobs & Kyzer, 2010). Due to it’s prevalence, most cases of lateral violence go under-reported. Astonishingly, many nurses have accepted this type of behavior, and considered it normal, but it is not! It’s time to ask yourself if you will continue to be part of the high percentage of nurse victims and nurse bullies? We hope the answer is, NOT ANYMORE! The nursing profession has consistently ranked #1 in honesty and ethical standards among professionals; which makes the rampant bulling an hazing that persists among nurses much more surprising. The ongoing ubiquity of lateral violence has inspired the creation of the popular term “Nurses Eat their Young.” Coined in 1986, “Nurses Eat their Young” describes the hostility young nurses face at the hands of more experienced co-workers (Colduvell, 2017). Today, new graduates, including new hires still suffer from intense bullying in the workplace. You may be thinking, what causes a nurse to become a bully. Reasons as to why nurses become bullies include: Lack of autonomy, accountability, and control in the workplace (Colduvell, 2017) Management may also contribute to the act of lateral violence Roughly 56% of nurses, in 2014, suffered lateral violence at the hands of a manager or supervisor (Townsend, 2016). According to American Nurse Today, managerial bullying may result from; organizational instability due to downsizing, restructuring, high manager-turnover, and autocratic leadership styles; as well as, oppressed group behaviors; and last but not least, organizations that focus on productivity, plus financial outcomes rather than patient-centered care. Furthermore, managers who bully, in many cases, learned by example. In the past, they themselves were victims or lateral violence and now serve in a position of power. In addition, Townsend, (2016), states that managers who bully tend to have low self-esteem or low clinical competence. Also, managerial bullies often target nurses who demonstrate competence; who remain well-liked by others; and nurses who have received special recognition. There are many reasons why co-workers, supervisors, as well as managers bully others, these are just a few reasons why. Theory of the Nurse as a wounded healer Created by Conti-O’Hare, the Theory of the Nurse as a Wounded Healer states that a nurse’s experience with lateral violence can either transform him or her into an advocate of bullying or a perpetrator of lateral violence. The result of lateral violence, most often pain and fear, can be carried throughout one’s life. The effects of bullying do not automatically resolve. All victims of lateral violence require some form of intervention. In fact, one’s ability or inability to cope with the trauma can profoundly affect one’s capability to care for others. Nurses should recognize their wounds in order to transform their pain and acquire transcendence. In a profession devoted to healing others, such as nursing, requires a nurse to heal him or herself first in order to thrive. Pierre’s Story of lateral Violence Nurses Educational Opportunities provides a RN Refresher course where nurses have shared their experiences with incivility in the workplace. Pierre, a young African-American man was one of several sharing his experience that cost him his license. Pierre served as a doctor in Africa. When he migrated to the United States he chose to pursue a career in nursing and eventually achieved his nursing degree. As a new grad employee, Pierre became the target of verbal and indirect bullying, plus social isolation. A group of nurses banded together to sabotage Pierre by altering his documentation and reporting false accusations. Pierre felt powerless, being that he was a new grad, he felt he had inadequate support. Ultimately the bullying became so severe to the point where the group of nurses began to place stuffed toys of monkeys in his work-space. Pierre personal experience of lateral violence was aggressive, intentional and frequent. Pierre reported his experienced to management to no avail. Management notoriously do not resolve the problem because they can’t or won’t! Since the entire staff was involved, the management couldn’t fire the entire staff. Ultimately nothing was done and Pierre was given the choice to deal with it or transfer to another hospital. Stories like Pierre’s are so common that in 2015,  the Professional Issues Panel on Incivility, Bullying, and Workplace Violence developed a new ANA position statement on this hot topic. Key points of lateral violence by the American Nurses Association (ANA) According to the ANA, the key points are as follows: The nursing profession will not tolerate violence of any kind from any source RN’s and employers must collaborate to create a culture of respect Evidence-based strategies that prevent and mitigate incivility, bullying, and workplace violence promote RN health, safety, and wellness and optimal outcomes in health care The strategies are listed and categorized by primary, secondary, and tertiary prevention The statement is relevant for all healthcare professionals and stakeholders Subtle forms of bulling include: sabotage, withholding information, excluding others, unfair assignments, or downplaying accomplishments. This is referred to as incivility. Even more, The Joint Commission, Division of Health Care Improvement, has condemned lateral violence by stating “bullying has no place in healthcare.” In addition, The Joint Commission released an advisory of safety and quality issues listing the following forms of abusive conduct. These include: Verbal abuse Threatening, intimidating or humiliating behaviors (including nonverbal) Work interference – sabotage – which prevents work from getting done In addition, the five recognized categories of workplace violence include: Threat to professional status (public humiliation) Threat to personal standing (name calling, insults, teasing) Isolation (withholding information) Overwork (impossible deadlines) Destabilization (failing to give credit where credit is due) Types of Lateral Violence Overt lateral violence can include name calling, threatening body language, physical hazing, bickering, fault finding, negative criticism, intimidation, gossip, shouting, blaming, put down, raised eyebrow, rolling of the eyes, verbally abusive sarcasm, or physical acts such as pounding on a table, throwing objects or shoving a chair against a wall. Covert lateral violence is initially more difficult to identity and includes unfair assignments, marginalizing a person, refusing to help someone, making faces behind someone’s back refusing to work with certain people, whining, sabotage, exclusion and fabrication. The effects of nurse to nurse bullying For one thing, lateral violence leads to depression, the inability to focus, anxiety, burnout, post-traumatic stress disorder and sleep disturbances. In addition, victims of bullying have higher rates of work absences, plus lower rates of productivity due to stress and distraction (Townsend, 2016). According to a 2013 study performed by Longo, older nurses suffer the greatest effects of bullying. Older nurses are susceptible to cardiovascular, gastrointestinal, and skeletal disorders, as well as chronic headaches. Furthermore, victims are not the only ones to suffer the consequences of lateral violence. Alternatively, patients may feel the consequences through the lack of communication, teamwork, collaboration and leadership. According to the American Association of Critical-Care Nurses, unhealthy work environments contribute to increased hospital-acquired conditions and readmission’s. In addition, toxic environments promote the likelihood of errors, adverse patient outcomes and mortality. As a result, a hospital may end up with low patient satisfaction scores and decreased financial reimbursement. Lateral violence is often viewed as a “rite of passage” that builds resilience New grads often bypass this type of behavior by trying to build tough skin. However, does having “tough skin” protect the victim from their emotions within. Let’s explore what the new grad or returning nurse might do to avert lateral violence: First, admit to yourself that you’re hurting and something is wrong. Many victims dismiss or minimize the event, or even blame themselves. Resist the temptation. If it feels bad, it is bad. And if you allow this behavior, that person is sure to repeat it, not because he or she a bad person, but because they doesn’t realize their behavior is wrong. Here are five keys to responding appropriately to lateral violence in the workplace: Manage your emotions. Self-awareness is crucial in managing your emotions and your responses. First of all, take time-out and calm yourself. If you try to deal with the perpetrator while upset, you’re likely to behave unprofessionally. Use empathy. Try to find out where the person’s behavior is coming from to help you understand what’s triggering his/her bad behavior. Bad behavior reflect poor self-esteem and serves as a wall to keep others out. Bad behavior is learned behavior. Someone who behaves badly has learned this behavior brings some kind of reward such as power or attention. An appropriate response may be, “I’ve noticed you’ve been more impatient lately. Are you okay? Is there something going on I should know about?” Assert your boundaries. Asserting your boundaries tells others what behaviors are unacceptable. If you say nothing, your silence implies the behavior is acceptable. Rather, tell the person directly that her behavior is inappropriate, such as, “Please lower your voice.” “Did you realize you were yelling?” Make direct request. Tell the person directly how you want to be treated or how the two of you can work together. Try to establish a mutual goal for you both to work on. “Would you tell me how you would like me to do this procedure better rather than reporting me to the unit manager?” “In response, I will try to listen to you and do the procedure in a way that you like.” Reach out to others. Ask others for help. A mediator is someone who may be able to negotiate between to people. Choose a mediator that knows the perpetrator on a personal basis. The mediator will be able to address the situation with empathy and therefore, resolving a difficult situation without creating a war. Be careful, choose the right mediator that can accomplish resolution. The wrong mediator can create a war. Methods to avert workplace bullying Experienced nurses have demonstrated their concerns regarding difficulty communicating with new grads or transitional nurses. These are a few of their concerns: Nurses report that new grads portray a sense of “all knowing.” This is particularly annoying for seasoned nurse who are trying to mentor the new grad. In addition, nurses report that new grads portray a sense of “entitlement.” This is also particularly annoying for seasoned nurses who have earned their privileges. Next, nurses report that new grads are “lackadaisical.”  This is also particularly annoying for the seasoned nurse to mentor a new grad with no enthusiasm and puts forth a half-hearted effort. Lastly, New grads, if you ask for help, be ready. If you’re asking for IV insertion help, have all equipment ready so that the mentor doesn’t have to do the leg-work of retrieving catheters, tubing, arm boards etc. Here are some actions you can take if you are the victim of lateral violence. It’s up to you to set your boundaries. If you fail to do this, you create a situation cloaked in ambiguity. If a clear line isn’t drawn, you’ll never know when it’s crossed, which will cause you grief down the road. By setting a clear boundary and making what is clear to the aggressor, you are removing any possible vagueness that could seep into your interactions. You need to ask yourself “how far is too far?” as well as ask yourself “when exactly does this become bullying?” Parameters need to be identified first to fix any problem – the playing field needs to be clearly marked. If the rules are never clarified, how will anyone know whether the rules have been broken? Document…

The Baby Friendly Initiative History

Congratulations Southern California Nurses, for your efforts in promoting the Baby Friendly Initiative. Hospitals and Maternal-Child Health departments have set a powerful example for women nationwide. To summarize, in 2007 only 29% of USA hospitals used breastfeeding measures. By 2013, this percentage increased to 54%. Additionally, in California, rates increased to as much as 94% for some breastfeeding and 70% for exclusive breastfeeding. Indeed, the attainment of Baby Friendly designation has proven to be a strenuous, but worthwhile journey. More than one million infants die worldwide every year because they are not breastfed exclusively for 6 months.  If 90% of babies were breastfed exclusively for 6 months, 911 lives could be saved. In addition, $13 billion could be saved in healthcare costs.  What is the Baby Friendly Initiative? The Baby Friendly Initiative was launched worldwide in 1992 in collaboration with WHO and UNICEF as a quality improvement project. This initiative is a global effort that encourages governments to develop and implement a policy on infant feeding. To clarify, hospitals who provide a positive environment for breastfeeding receive the coveted Baby Friendly recognition.  This process is not easy! Hospitals, must work rigorously to implement strict standards as outlined by the Ten Steps to Successful Breastfeeding. Secondly, healthcare staff must ensure that breastfeeding rates remain above a certain percentage to retain Baby Friendly status.  Most notably, the goal is to empower healthcare workers with appropriate education to provide effective breastfeeding counseling. What does it mean to be a Baby Friendly Hospital? Baby Friendly designation means that maternal child health departments have successfully implemented the Baby Friendly Initiative’s Ten Steps to Successful Breastfeeding. In short, these steps include: providing appropriate education to enable mothers to make informed decisions about infant nutrition; also, encouraging skin-to-skin immediately following birth; and offering Lactation Specialist services throughout and beyond the hospital stay. Not only does this initiative help to reestablish optimal infant nutrition, but it has also proven to improve health outcomes in developed countries. In summary, the risks of formula feeding for infants include: an elevated risks of childhood obesity; type 1 and type 2 diabetes; leukemia; and sudden infant death syndrome. Moreover, in women, the lack breastfeeding increases the incidence of: pre-menopausal breast cancer, as well as, ovarian cancer; retained gestational weight gain; type 2 diabetes; myocardial infarction; and metabolic syndrome. Southern California hospitals who implemented the Baby Friendly Initiative It is essential for California obstetrical nurses to continue protecting breastfeeding and maternal-child bonding. The percentages of breastfeeding varied among all California hospitals. Below is a summarized list of Southern California hospitals who have: successfully implemented the Baby Friendly Initiative and Ten Steps to Successful Breastfeeding; or, met the Healthy People 2020 Breastfeeding Objectives; including, hospitals who promote the International Code of Marketing of Breast-Milk Substitutes. California hospital feeding rates are acquired from Genetic Newborn Screenings collected within 24 hours after birth. This data does not accurately reflect ongoing breastfeeding after 24 hours of birth. Alternatively, this data does indeed demonstrate that the proponents of Breastfeeding have been successful in their efforts to communicate the value of Breastfeeding to the community. For more information on breastfeeding rates visit the California’s Department of Public Health website. Hoag Hospital Some breastfeeding = 96% Exclusive breastfeeding = 75% St. Jude Medical Center Some breastfeeding = 93% Exclusive breastfeeding = 63% St. Joseph Hospital Some breastfeeding = 94% Exclusive breastfeeding = 80% UC Irvine Medical Center Some breastfeeding = 91% Exclusive breastfeeding = 70% Community Hospital of  San Bernadino Some breastfeeding = 90% Exclusive breastfeeding = 65% Arrowhead Regional Medical Center Some breastfeeding = 88% Exclusive breastfeeding = 77% Loma Linda University Medical Center Some breastfeeding = 92% Exclusive breastfeeding = 71% Kaiser, San Diego Some breastfeeding = 97% Exclusive breastfeeding = 79% Palomar Medical Center Some breastfeeding = 96% Exclusive breastfeeding = 72% Paradise Valley Hospital Some breastfeeding = 96% Exclusive breastfeeding = 72% Scripps Memorial Hospital, Ecinitas Some breastfeeding = 97% Exclusive breastfeeding = 91% Scripps Memorial Hospital, La Jolla Some breastfeeding = 98% Exclusive breastfeeding = 87% Scripps Mercy Hospital, Chula Visa Some breastfeeding = 96% Exclusive breastfeeding = 83% Scripps Mercy, San Diego Some breastfeeding = 96% Exclusive breastfeeding = 85% Sharp Chula Vista Some breastfeeding = 95% Exclusive breastfeeding = 73% Sharp Grossmont Some breastfeeding = 94% Exclusive breastfeeding = 72% Sharp Mary Birch Hospital Some breastfeeding = 92% Exclusive breastfeeding = 81% Tri-city Medical Center Some breastfeeding = 96% Exclusive breastfeeding = 74% UC San Diego Medical Center Some breastfeeding = 96% Exclusive breastfeeding = 75% The history of breastfeeding The history of breastfeeding is a fascinating topic. In the beginning breast milk was the only available food for infants. Wet nurses served as alternatives when mothers became ill or passed away. Subsequently, the industrial revolution took place and the need to work caused women to separate from their infants. Wet nurses became a commodity and thus desired or required by many people. As a result, the cost of their services increased. As a matter of fact, early in the 20th century, the attainment of a wet nurse served as a status symbol for the wealthy. For disadvantaged mothers, “dry nurses” irrupted. However, dry nurses often fed newborn infants pablum, an inadequate form of nutrition for infants less than six months of age. Furthermore, the proliferation of American Hospitals in the late 1800’s to early 1900’s further caused a divide between mothers and their own breast-milk. During this time hospital’s advertised their environment as a safer and cleaner place to deliver infants compared to midwives. Anti-midwife and wet nurse propaganda further antagonized their reputation. Articles and posters such as these left a bad taste in people’s mouths. Consequently, society began to shift away from longstanding maternal care practices. In addition, advances to formula feeding further led to the substitution of artificial feeding. As a result, formula milk became known as scientifically superior to breast milk and formula companies were born. The Maternalist Movement The Maternalist movement began with a group of women who wanted to “clean up the environment.” Overall, these reformers encouraged wives and mothers to make the world a safer and cleaner place to live in. Technology provided that possibility in regards to infant nutrition. Well-off mothers could take pride in providing the latest nutritional technology for their babies, whereas underprivileged women could not afford bottles or formula milk. Over time, breastfeeding became associated with uneducated and low income women. On the other hand, formula feeding became affiliated with more civilized, well-off, and conscientious mothers, Additionally, maternalists were enthusiastic about scheduling. They encouraged women to run their home in a clean, organized manner with a passion for scheduling babies. In fact, their motto was “A good mother is a scheduling mother.” According to the standards of the movement, Breastfeeding was to occur only during certain hours of the day. For example, they encouraged four hours of rest between feedings and not at all during nighttime hours. Lastly, this movement unknowingly supported formula milk by causing lactation insufficiency, therefore prompting mothers to turn to formula feedings. Formula promotion In the 1960’s and 1970’s aggressive formula promotion led to wide-spread abandonment of breastfeeding. In addition, companies enlisted hospitals and healthcare professionals to distribute formula by providing free samples. Being that formula was expensive, mothers often diluted the compound to make it last longer. Consequently, many infants died of malnutrition and infections. Moreover, the rapid increase of infant mortality rates in 1974 inspired the United Kingdom to publish “The Baby Killer,” which documented the horrific results of formula feeding. In particular, this booklet exhibited graphic images of malnourished infants and starving infants. Even more, in the past, the United States government went to extreme measures to support formula manufacturers and lobbyists; for the reason that it preserved the US economy. The national battle between Breast Milk and Formula Milk Most noteworthy, in response to the associated risks of formula milk the World Health Organization developed the Who Code, also known as International Code of Marketing of Breast-milk Substitutes. To summarize, WHO’s international health policy declares that the advertisement of formula products are unethical and causes harm to infants. Therefore, formula milk sales or free handouts should be legally restricted. Other proposals of the WHO code include: Restriction of free formula samples given by the hospitals Removal of misleading labels that suggest formula is healthier than breast milk Prevention of marketing through healthcare providers that idealize bottle feeding. Furthermore, the Carter administration, which governed from 1977-1981, was pro-code. In contrast, the Reagan administration opposed the policy due to the fact that it would impact American Corporations. In 1981, under the Reagan administration, the U.S cast the only vote against the WHO code. Formula lobbyists were behind the decision to reject the code. As a result, the U.S. became the leader in restricting formula marketing strategies. During this time Nestle was the largest manufacturer of formula products. The international battle between Breast Milk and Formula Milk Each nation had the option to implement or reject The WHO Code. The results were: 118 countries adopted the code. 3 countries abstained 1 country voted against the Code – that was the U.S. Most notably, the United States government argued the WHO code by using the prospect of antibiotics and clean water supplies to continue making safe and viable formula. The U.S. stands alone as the one modern democracy that has not found a way to reconcile its financial, political, and philosophical concerns. The Code does not restrict manufacturing, sales and use of formula, it is only about marketing. Currently, most nations have legislation to enforce the code, while the U.S. does not. In addition, all major formula companies claim to be Code compliant, but according to a watch dog group (IBFAN), none are. How formula makers get around the law Direct marketing through healthcare facilities with free samples is still legal and commonly seen. In actuality, it is not really free. Formula companies simply increase the cost of formula powder to offset the “free samples.” Other examples include: Similac sponsors the web site kidsgrowth.com Enfamil sponsors WebMD Nestle sponsors “World Breastfeeding Week” and all materials are adorned with formula company logos. Moreover, when disasters occur the American Red Cross arrives with formula sponsored by companies to save the day. This cost of formula milk Formula feeding and all that needs to be purchased can consume 25-50% of the family income. These include: The purchase of formula The purchase of bottles and nipples The healthcare cost of childhood conditions that breast milk could have prevented Also, breastfeeding contributes to natural birth spacing which can decrease unwanted pregnancies. Global strategies to improve breastfeeding rates The Global Strategy urges that hospital routines and procedures remain fully supportive of the successful initiation and establishment of breastfeeding through the Baby Friendly Initiative. Including: Reassessment of Baby Friendly designated facilities. Expanding the Baby Friendly Initiative to include clinics, health centers, and pediatric hospitals. Furthermore, all governments should develop and implement a comprehensive policy on infant and young child feeding; in the context of national policies for nutrition, child and reproductive health, and poverty reduction. All mothers should have access to skilled support to initiate and sustain exclusive breastfeeding for 6 months. In addition, healthcare workers should ensure the timely introduction of adequate and safe complementary foods, certainly, with continued breastfeeding for up to two years or beyond. Healthcare workers should be empowered to provide effective feeding counseling. Additionally, their services should be extended in the community by trained lay or peer counselors. Also, governments should review progress in national implementation of the International Code of Marketing of Breast Milk Substitutes. Similarly, new legislation or additional measures should be created to protect families from adverse commercial influences. Last but not least, governments should enact imaginative legislation protecting the breastfeeding rights of working women, to include, establishing a means for its enforcement in accordance with international labor standards. So far, the best strategy for improving breastfeeding rates has been the Baby Friendly Initiative. Although other strategies exist and…

How to Develop your Critical Thinking Skills

“Inquiring minds want to know” Critical thinking is the ability to think clearly and rationally about what to do. Nurses with critical thinking skills are able to understand the logical connections between patient adversities and treatment. To illustrate, a reciprocal connection exists between a nurse and his/her patient where the nurse is the patient’s advocate and the patient relies on the nurse to be his or her advocate. Moreover, nursing is an honorable profession, and nurses are the heart and soul of the healthcare system. It is the nurse that the patient spends the most time during his or her stay in the hospital, therefore critical thinking for nurses is a crucial skill to have. In addition, clinical experiences are important throughout a nurse’s career – students or experienced – nurses require a road-map to patient care decisions. Without a road-map, nurses are unable to function with Critical Thinking Skills. This article will provide the reader with some insight on how to “Develop your Critical Thinking Skills.” The Critical thinking nurse has curiosity We often have said curiosity killed the cat. Yet, the nurse with curiosity may save lives. Much like a detective of a crime scene, the nurse must first identify the crime or for the nurse, the adversity. The crime scene, like the adversity, has connections between what has or is occurring with the evidence that exist. The evidence gives a road-map to determining the reason for the crime, the contributing factors, and the cover-up’s of the crime. The first step in critical thinking is to identify the adversity To develop your critical thinking skills one must first identify the adversity. The adversity may be simply be not knowing the connection between two concepts. In the past, we had to make our way through volumes of textbooks to arrive at an answer. Textbooks are written with intensity and complexity. In today’s world we have a quicker way to arrive at the unknown; that is the Google search. With Google, we can research our unknown efficiently. There are volumes of reading materials available for research to acquire the answer to the unknown. After identifying the adversity and then researching, we must then dismiss any information that doesn’t have relevance. All of this begins with curiosity. The nurse that is curious is the nurse that will develop critical thinking skills. Critical thinking is the intellectual disciplined process of actively and skillfully conceptualizing the unknown and then applying the rational. The Trauma Nurse For example in the Trauma Unit, the nurse must anticipate injuries according to the mechanism or injury. If the patient sustained an injury on his/her left side, the nurse must have knowledge of what organs are present on the left side of the body. This is basic knowledge for the trauma nurse and requires basic thinking. Next, he/she must then determine the adversities that may exist with injuries to those organs. He/she may determine the liver has been injured. Then he/she must determine the significance of liver damage. The critical thinking nurse must think about the functions of the liver, the signs and symptoms of liver damage and what diagnostics are needed to create an informed decision regarding treatment. You can see, critical thinking begins with basic knowledge and then with curiosity. This capability will allow the nurse to critically think about the dynamics of liver damage. The ER Nurse The ER nurse must have an awareness of compensatory mechanisms that keep the body alive. Compensatory mechanisms include: heart rate, which speeds up in order to deliver more blood to the vital organs; respiratory rate, which speeds up to compensate for the delivery of more oxygen to the organs; and peripheral circulation, which shunts to the core of the body to conserve the existing blood supply. Therefore, the heart rate and respiratory rate need to remain high. These compensatory mechanisms must remain in place until the etiology of the problem is defined. When these compensatory mechanisms can no longer keep the body alive, the blood pressure (BP) will drop. The BP is the deciding factor for the patient to be determined as stable or unstable. The nurse that is able to critically think about the dynamics of compensatory mechanisms is better able to understand the dynamics of a sick patient. The Pediatric Nurse The Pediatric nurse must also have an understanding of compensatory mechanisms. If the child has increased work of breathing, increased respiratory rate, and increased heart rate, then the child has respiratory distress. A critical thinking nurse often questions the patient’s prognosis.For example, is the child getting better or worse if their work of breathing, heart rate, and respiratory rate decrease? Most nurses will respond with “the child is getting worse.” But the child may be getting better. How would you determine if the child is getting better or worse? The nurse must have critical thinking skills to arrive at this answer. The nurse that explores more evidence is the nurse with critical thinking skills Next, the pediatric nurse must explore more evidence such as the oxygen saturation. Does the child need more supplemental oxygen to keep the oxygen saturation within normal limits? The child may be getting worse if the oxygen saturation continues to drop. On the other hand, if the oxygen saturation is within normal limits, the child will be determined to be getting better. In addition, a good critical thinker is able to rapidly identify respiratory distress. Early identification of respiratory distress in children provides a window of opportunity to “fix” the problem before it progresses into respiratory failure. If a child goes into respiratory failure, the outcome will be bleak. Furthermore, a child’s appearance provides more evidence for the nurse to determine a problem. Children are unique with their appearance because they either “look good” or “look bad.” A child “looks good” if they have good tone and interact with their parents with good eye contact. A child “looks bad”, if they have poor tone, do not interact with their parents, and have a glassy stare. Critical thinking for nurses is a requirement for all acute care environments, especially the Pediatric Unit. The nurse who is not a lifelong learner and does not want to acquire more knowledge will not develop this ability. The critical thinking nurse is a lifelong learner Most notably, nurses who pursue higher education, continuing education, or those who read evidence-based articles are the most valuable employees. Acquiring memberships for AWHONN, American Nurses Association, and last but not least, the American Association of Critical Care Nurses is also of value due to their informative journals on groundbreaking research. For example, a Labor and Delivery nurse may want to learn about the use of Nitric Oxide as an alternative to an epidural. Epidurals may contribute to the need for neonatal resuscitation shortly after birth. In addition, Nitric Oxide has also shown to improve recovery rates for C-section mothers. This is new valuable information for Obstetrical nurses. Many pathways exist to help you develop your critical thinking skills. Topics that nurses may want to learn more about include; how to improve patient care methods, better treatments, and new policies on exiting care methodologies. It is up to the nurse to want to pursue this information whether its through classes, medical memberships or google searches. EKG Interpretation Most nurses require EKG Interpretation to critically think of the adversities of the body. This skill is most often difficult for nurses. Yet, the nurse with curiosity will tackle this skill with determination. With this skill the ER nurse will be able to determine if the patient is having a heart attack. In addition, the nurse will then be able to determine the area of the infarction and ultimately determine what to anticipate for the patient. The patient that has damage to the Left Lateral Wall will have diminished cardiac output. Moreover, the patient that has damage to the Inferior Wall will have diminished ventricular refilling. The patient that has damage to the Septal Wall will have conduction defects. Further, the nurse will learn that ischemic changes are the forerunner of a heart attack. Therefore, the nurse must be able to determine those ischemic changes to avert damage to the myocardium. Remember, this began with curiosity and then progressed to determination. The Telemetry Nurse must have an understanding of Premature Contractions Some premature contractions are benign and some are life threatening. Premature contractions that originate in the atrium (PAC’s) are not life-threatening. Also, Premature contractions that originate in the AV node (PJC’s) are not life-threatening. But those that originate in the ventricles (PVC’s) have the propensity to be life-threatening. Premature Ventricular Contractions, or PVC’s, do not “kick out” much cardiac volume. Therefore, the more PVC’s the greater the concern. PVC’s may originate from several foci in the ventricle’s. Multi-focal PVC’s are more dangerous than uni-focal PVC’s. PVC’s that have patterns such as quadrigeminal, trigeminal, and bigeminal become a greater concern. PVCs that land on a T wave can be catastrophic. This is called the R on the T phenomenon. Remember, this began with curiosity and then progressed to determination and ultimately to critically thinking. Even the Labor and Delivery nurse is not exempt from the EKG Interpretation When Premature contractions occur the machine reads this premature contraction as an increase in heart rate. Usually premature contractions create a pause after the premature beat, therefore the machine indicates a decrease in heart rate. When observing the baseline of a fetal heart rate, the Labor and Delivery nurse will assess a spike upward followed by a spike downward. This indicates a premature beat has occurred. In understanding this, the critical thinking nurse will then delve into the ramifications of premature beats. A serious ramification includes diminished cardiac output which results with poor perfusion to the fetus. Remember, this began with curiosity and then progressed determination and ultimately critically thinking skills. Code Teams & EKG Interpretation The nurse that responds to a “Code Call” must understand which ventricular rhythms are life-threatening and which ventricular rhythms are dangerous because the interventions are different. Polymorphic Ventricular Tachycardia’s are life-threatening and require defibrillation. Monomorphic Ventricular Tachycardia’s are dangerous and may require Synchronized Cardioversion, medications or defibrillation, depending on the pulse and blood pressure. This is basic knowledge for the nurse that responds to a Code Call and this nurse must have Critical Thinking skills. This nurse began with curiosity and determination that progressed to critical thinking. 12-Lead EKG Interpretation Most often, once the nurse has acquired knowledge of Basic EKG Interpretation, he/she becomes inspired to learn 12-lead EKG. The nurse has developed that curiosity as well as the need to become empowered. An empowered nurse is one that is stronger and more confident in his/her nursing practice. By learning 12-lead, the nurse can determine the EKG changes that occur with Pericarditis vs Acute Myocardial infarction. Both have the chest pain, and both have ST segment elevation but the manner in which the ST segment elevation presents itself on the EKG are different. Next, he/she can then determine the appropriate intervention. What is more, 12-lead EKG Interpretation can uncover congenital defects that put the patient in harm’s way, especially on the soccer fields where young people suddenly go into cardiac arrest. Once the child goes into cardiac arrest, the outcome is often bleak. If this defect is discovered prior to the arrest, the child may be armed with an implanted automatic defibrillator which will save the child’s life. In addition, nurses have known for years that one cannot determine an Acute MI with a Left Bundle Branch Block. Now you can. Have I peeked your curiosity? The nurse in today’s world can use the Sgarbossa Criteria to determine if an Acute MI is hiding behind a Left Bundle Branch Block. Are you curious? Management of Assaultive Behavior Management of Assaultive Behavior is an interesting course to determine why a person “acts out” to get their way. As a child did you “throw a temper tantrum” to get your way? Did it work? If that…