New Brains

The Old Way...

  • Every nurse has a "brain" -- a piece of paper with meds and times due, must-remember patient facts, and scribbled vitals.
  • We collect brains in our brain museum.
  • The need is real -- nursing work has a huge memory burden. But there's a better way than using a piece of paper.

Eight Things I Must Remember as I Do My Nursing Job

There are lots of things that a I must juggle as I work my shift.  With years of experience, many nurses are able to master these mental gymnastics and become skilled at moment-to-moment decision-making.  Nonetheless, all nurses, novice and seasoned, can benefit from well-designed memory aids.  Here are eight types of mental tasks that such aids support.

  1. First, there are those often-omitted nursing tasks identified in studies by Kalisch as "missed care". These are ambulation, turning, delayed or missed feedings, patient teaching, discharge planning, emotional support, hygiene, intake and output documentation, and surveillance.  "The consequences of missed care are far-reaching in terms of patient outcomes. If the missed care, for example, is ambulation, a patient may be discharged from the hospital in a debilitated condition and may be required to have weeks of physical therapy. Not turning a patient may result in skin breakdown and pressure ulcer formation. The absence of patient teaching may lead to complications and readmission. Mouth care missed with ventilated patients may lead to ventilator-associated pneumonia. Not bathing a patient could lead to not detecting a skin breakdown at an early stage." [1] Several reasons have been reported by nursing staff for these omissions, including the complexity of the work.  A memory aid can help prevent missed care.
  2. At the start of a shift. I like to identify for myself (in collaboration with my patient if possible) my main goal for this patient on this shift.  It could be something as simple as "OOB to chair" or as complex as "restore fluid balance".  When I'm on top of my game, I prompt myself with this small piece of information every time I enter the patient's room.  It helps me stay focused.  When I'm interrupted, flustered, or sidetracked, a tool that helps me stay on target is helpful.
  3. Another helpful reminder regards patient precautions such as droplet precautions that mean I should don a mask and gloves as I enter the room.  At some hospitals, a sign is posted on the door that provides this reminder, but at others it isn't. Furthermore, there are some precautions that are never posted, e.g. that the patient is at risk for pressure ulcers or aspiration. This is another piece of information I want to be reminded of at the right moments.
  4. Yet another memory aid that helps me fine-tune my efficiency on my nursing shifts relates to fetching supplies. Traveling down the hall consumes time and shoe leather. Mentally disciplined nurses think ahead and fetch all the supplies they'll need for the next hour on a single trip.  Alas, my brain doesn't work well that way. A tool that could support me in this mental feat is most welcome.
  5. Perhaps the most familiar memory support tool is the to-do list.  This is in the nursing care plan, but that addresses the needs of only a single patient, and only tasks for those things that have been explicitly ordered.  I want to know what is needed by all my patients, not just one, in a single, combined list, and I want to know all my tasks including the routine nursing tasks (nutrition, hygiene, assessments, etc.) not just the things that have been ordered. In other words, I want a nurse-centered list, not a single-patient list, and not a lisst only of things that are billable.
  6. Also important is the ability to foresee work "crunches" -- clusters of tasks that are all due at about the same time.  When I can predict those, I can get a head start on them and not be taken by surprise or fall behind.  Similarly, it is helpful to know when I can expect an expanse of relative calm and inactivity;  this helps me decide when to take a break.  Both of these time management feats are supported by a tool that shows tasks over time and enables me to look ahead.
  7. Remembering to follow-up on patient issues is another nursing memory task that is occasionally failed.  For example, when bathing a patient a lesion is observed that should be documented and discussed with the team.  A quick yet reliable mechanism for jotting a reminder or flagging a patient datum could prove invaluable.
  8. The single most important thing an effective time management tool can do is to help me know what to do RIGHT NOW.  When I can see a list of ALL the tasks that are due now or soon, I can choose the most important and tackle it next, and I can also be confident that none are forgotten.  Support for prioritizing and for remembering reduces stress.

Needless to say, NurseMind's to-do list combined with a carefully-design graphical user interface sustains all these memory burdens.

Refs

[1] Kalisch, "Missed Nursing Care, A Qualitative Study," J Nurs Care Qual, Vol 21, No. 4, pp 306-313, 2006.

OR nurse with iPhone

The New Way... Better than Paper

  • It has your to-do list in it and makes sure you don't forget anything.
  • It knows what time it is, compares task deadlines to the present time, and alerts you to what's imminent or late. You don't have to study your brain to figure out what's due.
  • It knows how long things take, keeps track of what's left to do, compares that to how much time you actually have and tells how much slack you have (or how much overload).
  • It's better than paper for recording vital signs:
    • Quicker than writing
    • Knows the units for each vital sign
    • Counts respirations and heartbeats (you don't need to watch a clock any more)
  • It remembers your patients from yesterday in case you have them again today.
  • Tap a button and it assembles the information you need for an SBAR to a doctor or to your replacement at shift change.
  • It keeps track of your shifts worked and tasks performed over weeks, months and years, and reports this information back to you when you're building your resume or reviewing your work history.
  • For hospital management, it aggregates this data across entire units and provides summaries of how (groups not individual) nurses spend their time, data never before available.
  • Paper does none of these!

The Details

NurseMind supports the nurse on the job and collects data that's never been available before, about what nurses actually do, how often, when, and where. The working nurse will know more about what she or he has done than ever before.

In addition to the program that runs on the iPhone or iPod Touch in the nurse's pocket, there is a web site where a database collects aggregate data. Industry standards of privacy, security, and nursing nomenclature are supported:

  • Data collection is HIPAA-compliant.
  • Tasks are defined using NANDA terminology.
  • Electronic communication is secured by means of Secure Sockets Layer (SSL) encryption for protection from eavesdropping, tampering, or message forgery.

The benefits to the nurse are subtle but valuable: NurseMind lets the machine keep track of the details. It spares her the remarkable effort that nurses have traditionally sustained to remember all the details of the myriad tasks they perform. At last, the nurse can devote all her mental energy, experience, and skill to the clinical work itself and to patients!

In addition to the app, you get:

  • A work diary
  • A user manual
  • A well-maintained web site
  • Support
  • Best of all, a community of users sharing tips and techniques and their shift definitions, fine-tuned for their hospital units
Unlike most iPhone apps, NurseMind has a company behind it, not just a one-person hobby shop.  It is focused on safety and quality of nursing care.  Its mission is to help you improve the quality of your nursing work experience so profoundly that you won't want to do it any other way.