Exploration of the concept of missed nursing care was pioneered by Dr. Bea Kalisch, RN, of the University of Michigan. Her 2006 paper in the Journal of Nursing Care Quality, Missed nursing care: a qualitative study is a classic in the field.
She identified nine elements of regularly missed nursing care:
Something that was made endlessly clear to us in nursing school was that upon completion we would still "know nothing". That is, the real training would not happen until we were hired, and it would be at the hospital's expense. We could expect several months of limited productivity before we would be able to function fully as autonomous professionals.
What is patient acuity? Why do we need to know it? Conceptually, it's a measure of how much care a patient requires. We need to know it because in order to do effective nurse staffing, we must know how much work each patient represents for each nurse. We need a metric.
The longer I use NurseMind in my nursing work, the more its value to me grows. What makes NurseMind's value grow?
Personalization (it becomes tuned to the way I work)
Connectedness (others use it and we talk about it)
Prestige (colleagues use the shifts and protocols I create)
History (my work experience records accumulate and yield valuable diaries)
Mastery (I'm good at it)
Presence. When you've got it, you're at your professional best. You walk into your patient's room and from the first step all your senses are trained on what's there. A whiff of C-Diff, perhaps, or that unmistakable pitch to the cries that mean kidney stones. All your experience and judgment is in action. This is what it feels like to be a truly great nurse, the kind patients hope for and doctors trust. Can we be that kind of nurse? Can we do it consistently? How do we get there? What are the obstacles? How can we overcome them?
You can set alarms on tasks. They ring when the task is past due. That is, you will hear a kind of ringtone if the task's deadline arrives before you've marked the task done. This is a much-appreciated feature for busy nurses doing many things at once and wanting to make sure everything is on time. But why do they sound like that?
What makes a sound suitable for this purpose is a matter of taste -- everyone's is different! -- and we're happy to add one if you request it.
Since the beginning of this project, we've fretted about correct terminology in the medical context.
We are building a to-do list manager with timings. Everybody understands those words in ordinary work contexts but in healthcare there is specialized terminology. Fortunately, we found clarifying definitions in Gooch and Roudsari, "Computerization of workflows, guidelines, and care pathways: a review of implementation challenges for process-oriented health information systems," JAMIA 18:6, Nov. 2011.
We have successfully completed the first of several software beta tests. The site was a busy surgical hospital in Nebraska. Four nurses (Andrea, Bridget, Cathy, and Raime) used the software intensively for four consecutive 12-hour shifts (Andrea and Cathy in two day shifts; Bridget and Raime in nights). We learned a lot, caught and repaired some bugs, and are most encouraged by the positive outcome. Here are a few observations.
Above all, safe practice. That means forgetting nothing, remembering and doing all the steps of every procedure, protocol, and care plan.
Empathy. Conveying that sense of sincere caring, being sensitive to emotional states and needs, and taking the time to sit with patients, listen to them, or simply be with them.
In The Checklist Manifesto (2009), p. 122, Atul Gawande says that when you stop for a moment in the course of your work to consult a checklist, it's a "pause point". Then you use the checklist in one of two ways: