November 16, 2018

Simple To Complex Nursing Interventions

Simple to complex interventions is a common trend in nursing. Textbooks often lead to concrete thinking and an inability to think in this manner, as books list interventions randomly and in no specific order. What you learn, mainly the steps to nursing interventions are usually done concurrently. When someone is coding, I don't have to do one thing at a time. I can grab defibrillation pads, while catching an amp of epinephrine in one hand, while telling someone to get me a doppler for me to drop some peripheral IVs for access, and lowering the bed for the provider to intubate. The point being, nursing isn't something that happens in a particular order or sequence. It's five things going on at once. I wouldn't fixate on what you think "should" be done first and then second (in most, not all, clinical situations). I would focus on simple to complex nursing interventions.

If you had to either elevate the head of the bed or get an arterial blood gas (ABG) for someone in respiratory distress, I'd say elevate the head of the bed first. It's simple and easy to do. Yes, the ABG can provide quality information, but as a nurse, you go from simple to complex. Nursing school and the NCLEX-RN exam aren't trying to confuse you. They are trying to get you to see what matters and what can be done in the immediate moments of crisis. What can or should be done when certain disease processes present themselves. Respiratory distress? Elevate the head of the bed, apply an oxygen device, collect the vital signs, perform focused respiratory and cardiovascular assessments, then call the provider. You shouldn't be going straight to intubation. Least to most invasive. If you can resolve this issue by applying a nasal cannula oxygen device, why would intubation even be on the table? You shouldn't be calling the provider first, either. What are you going to tell the provider? You have no information to disperse. These are simple things. Don't go 0 to 100 real quick (in my Drake voice), haha. I'm not sure if you've seen the intubation process, but it takes a few minutes. The nurse has to grab medications, call respiratory, make sure the mechanical ventilator is ready and on standby, prepare per provider orders, order upcoming chest x-ray... it's a lot and takes time.

If there is a crisis, you are expected to assess the crisis. Simple to complex actions. Stethoscopes and head to toe assessments, yaasssss! I know, they aren't sexy, but they are pillars of the nursing profession. What you see, what you hear. That is where it's at folks. I don't know where you work, but many of the providers I interact with don't perform head to toe assessments. They perform focused assessments of systems that are under review. Most don't even have a stethoscope (and that's fine). Providers create medical plans, they treat and evaluate disease processes. YOU ARE THE ASSESSMENT GO-TO PERSON! There is no fail-safe, you are it. Don't go all central lines and cardiac catheterizations on me. Simple, safe interventions is the name of the game. One student asked me, "Why would I assess lung sounds if I'm giving fluids?" I asked her, "How would you assess if the patient was hypovolemic or hypervolemic? Give me your head to toe assessment." After about 45 seconds, she finally keyed on why lung sounds were significant in fluid administration. I promise you, nursing isn't hard, it's all about simple to complex operations. Don't tell me pharmacology, don't tell me central venous pressure (CVP) measurements. The NCLEX isn't assuming everyone will work in critical care. What can you see? When you close your eyes to visualize this patient, what are you looking for? The answers are within you, take it one step at a time and don't go all CSI lab on me. Keep it simple.

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