The Importance of Educating in Real-Time
Submitted by Lauren Lebo BSN Student, Nyack College, NY ; Maureen Kroning RN EdD
Working in the acute care hospital, provides many opportunities to learn. As healthcare workers, we must recognize and act quickly on any situation that puts a patient at risk. A recent situation occurred in the hospital that required both the need to act and to provide education in real-time.
A very sick ventilated patient was wheeled past on a stretcher accompanied by the respiratory therapist and a nurse’s aide. The patient was being brought back to his room after having an electroencephalogram (EEG) performed in the EEG lab which was located on the first floor of the hospital. It took just a second to notice something was wrong with this scenario.
Assessing the situation, I asked myself the following questions:
• Where was the nurse from the EEG lab?
• Was a nurse supposed to be accompanying a sick vented patient back to his unit?
• Does our hospital policy clearly state how we should transport ventilated patients from one unit to the other?
• Did the unit nurse know the patient was coming back unaccompanied by a nurse?
• Was report given to the patient’s nurse on the unit?
I recognized a safety issue unfolding. By asking questions I was utilizing critical thinking. As a nurse leader, confronting and educating staff about situations like this is a must. It is always much more effective to educate in real-time especially in situations that can put a patient at risk.
As the situation unfolded, the nurse and the anesthesiologist provided their account of the situation. The nurse from the EEG lab informed me that she tried to call and give report but the nurse on the unit was busy. She also said the Anesthesiologist offered to accompany the patient back to his room and thought that he had done so. The nurse’s account prompted me to talk to the Anesthesiologist as well. When I spoke to the Anesthesiologist, he said he could not fit into the elevator and let the respiratory therapist and the nurse’s aide ride with the patient while he waited for the next elevator. This situation promoted an opportunity to educate not only the nurses but the medical team as well.
An essential skill, critical thinking, had not be used in the decision to transport this patient. Critical thinking involves examining the situation at hand, analyzing what is occurring, and acting based on what will create the best outcome and highest level of care. According to, The Critical Thinking Community, “Critical thinking is that mode of thinking — about any subject, content, or problem — in which the thinker improves the quality of his or her thinking by skillfully analyzing, assessing, and reconstructing it. Critical thinking is self-directed, self-disciplined, self-monitored, and self-corrective thinking. It presupposes assent to rigorous standards of excellence and mindful command of their use.”
Critical thinking includes “interpretation, analysis, evaluation, inference and explanation of a specific situation based on evidence, methods, concepts, criteria and contexts, with the ability of self-correction and regulation” (Chit Ming, 2014, pg. 2). Critical thinking is essential in making high stake decision. Healthcare providers need to develop competency using critical thinking. Critical thinking skill is especially essential for nurses as more autonomy is being given to nurses to make more independent patient care decisions.
The first priority was to assess that the patient was safe and in no distress and thankfully this was the case. Confronting and providing education about the situation as it was unfolding in real-time was absolutely necessary. Educating the EEG nurse about the importance of providing report or hands-off-communication to the unit nurse was an instrumental part of the education provided.
A hand off communication is an accurate, clear, and specific summary of the patient passed from one healthcare provider to another. It is a comprehensive report on the patient's condition, with a focus on the patient's safety. There are many different methods of hands-off communication, one of the most common being an SBAR report. In an SBAR report, the Situation, Background, Assessment, and Recommendation are communicated from one provider to another (Amato-Vealey, Barba, & Vealey, 2008, pg. 763). What is most important is that no matter what method used, seamless transition of patient care occurs from one provider to the other.
The entire hospital unit received education that day about both the necessity to accompany patients back to the unit by a RN or a Licensed Independent Practitioner (LIP) who stays with the patient until they are safely transported to their assigned unit and about the importance of providing hand-off-communication. Scenarios like this one are not so uncommon in many healthcare institutions. According to a study done by Wolters Kluwer Law & Business mistakes in hospitals account for 98,000 deaths a year and the cost to Americans of these mistakes is estimated to be nearly $1 trillion annually (Andel, Davidow, Hollander, & Moreno, 2012).
Today’s healthcare environment is often hectic. Nurses are accountable to administer medications, perform procedures, educate patients, document, and communicate between other healthcare professionals, among many other tasks throughout the day which leaves the possibility of an error occurring not so unfathomable. Therefore, it is essential that nurses as well as all healthcare workers use critical thinking when providing patient care. Providing education in real-time can provide great opportunity to learn. It is important to remember that it only takes a second for a medical error to occur which can result in harm to the patient, the nurse and to the entire healthcare institution.
Amato-Vealey, E., Barba, M., & Vealey, R. (2008). Hand-off communication: a requisite for perioperative patient safety. AORN Journal,88(5), 763-774 12p. doi:10.1016/j.aorn.2008.07.022
Andel, C., Davidow, S. L., Hollander, M., & Moreno, D. A. (2012). The Economics of Health Care Quality and Medical Errors. Journal Of Health Care Finance, 39(1), 39-50 12p.
Chit Ming, Y. (2014). Concept mapping: A strategy to improve critical thinking. Singapore Nursing Journal, 41(3), 2-7 6p.
The Critical Thinking Community (2015) Website