SHSU027
Patient Safety…
INTRODUCTION
Clinical Decision Making, Human Behaviours and Patient Safety are all inextricably linked
in professional nursing practice. In the context of health care delivery each decision taken is
underpinned by knowledge and application of patient safety mechanisms/policies and an
understanding how Human Behaviours affect key decisions. However, with recent reports
stating the NHS continues to have 230 preventable deaths per week there is much more to be
done.
Patient safety is everyone’s business. When patient harm occurs, caregivers involved
are devastated along with the patient and family, yet for far too long many health care
workers have had to navigate this storm alone. The Clinical Human Factors Group, promotes
the application of Human Factors science in all areas of healthcare and is a useful resource
for all health care professionals. However, it is up to all nurses and AHPs to demand that a
systems approach be enabled in our healthcare workplace, along with a just culture that
cultivates the sharing of knowledge and helps prevent patient harm from occurring altogether.
BACKGROUND AND PREPARATION
Although errors can be attributed to individuals, they are often the product and natural
consequences of defective systems that allow errors to go unnoticed. The safety and well-
being of patients within the hospital system is the fundamental goal of the NHS Boards and
health care professionals. That said, the imperfect nature of humans incorporates
vulnerability within systems such that errors and adverse events are unavoidable. Many errors
have little to no consequence and often go unnoticed; occasionally they translate into an
important adverse event.
Human Factors…
INTRODUCTION
Human factors approaches underpin patient safety and quality of improvement science,
offering an integrated, evidenced and coherent approach to patient safety and quality
improvement and clinical excellence.
The principles and practices of Human Factors focus on optimising human
performance through better understanding the behaviour of individuals, their interactions
with each other and with their environment. By acknowledging human limitations, human
factors offers ways to minimise and mitigate human frailties, reducing medical error and its
consequences. Human factors is also a body of knowledge covering physical, psychological
and other characteristics applied to the design of things used by humans.
All humans are fallible therefore, individual adoption of these concepts offers a
unique opportunity to put patient safety and clinical excellence at the centre of care delivery.
, SHSU027
Human factors principles can be applied in the identification, assessment and management of
patient safety risks, and in the analysis of incidents to identify learning and corrective actions.
More broadly, human factors understanding and techniques can be used to inform quality
improvement in teams and services, support change management, and help to emphasise the
importance of the design of equipment, processes and procedures.
BACKGROUND AND PREPARATION
Recommendations from the Francis Report (2013) requires every single person serving
patients to contribute to a safer, committed and compassionate and caring service. Thus, all
nurses and AHP’s should be committed to delivering care based on fundamental standards.
Behaviour at all levels needs to be in accordance with at least these fundamental standards
and the NMC Code (2018) with the overriding value being that patients are put first. All
nurses should enter into express commitment to abide by their NHS values and philosophy.
Relationships and Interpersonal Skills…
INTRODUCTION
Over the previous year we have been introduced to the communication skills which are the
building blocks required to establish a therapeutic relationship. These core communication
skills are the essential skills that allow healthcare workers to connect with people they come
in contact with. The ability to establish a relationship with an individual and their family
requires advanced skills, known as interpersonal skills. Interpersonal skills are a combination
of communication skills, relational skills, values, beliefs and behaviours. This part of learning
draws together these main elements in the context of clinical practice. There is good reason
for including the theoretical aspects of interpersonal skills within this clinical skills module.
Back in 2005, Kidd, et al highlighted that many healthcare programmes teach these
separately and note that it is vital to be able to take a history, share information, explain
procedures and discuss treatment options and their effects when working with people. In
clinical practice communication and clinical skills are practised simultaneously, therefore
education programmes should introduce, teach and practice them at the same time.
TRAUMA INFORMED PRACTICE: LISTENING AND RESPONDING TO
PSYCHOLOGICAL CONCERNS
It is important that physical health needs are not seen in isolation from people’s emotional
health needs as increasingly evidence is demonstrating that there is a strong relationship
between the two capacities. A trauma informed approach to nursing practice is about ensuring
that as health care practitioners, we do not do more harm by inadvertently or ignoring or
being unaware, of the sensitives that a clinical intervention might evoke for a person.
Psychological trauma is defined as either:
, SHSU027
● Type 1 or single trauma: these can be identified as an event that happens on a single
occasion but may range from RTA to assault and rape.
● Type 2 or complex trauma: unusually occurs interpersonally and over a period of
time. Complex trauma refers to childhood abuse/neglect; or in the content of war,
torture or human trafficking.
Remember that the term trauma can refer to a wide range of abusive or neglectful experiences
and the effects are different for everyone. SAMHSA (2014) refers to this as the three E’s. the
first of these is Events (including Adverse Childhood Experiences), the second, event is
Experienced and the third, the Effects of the trauma which are very much dependent on each
individual and the three E’s are a good way of reminding yourself of the importance of
relational person centred care.
Although the trauma may be in the past, experiences in the present day can cause
significant distress.
Interventions such as taking bloods, cervical smear tests or catheterisation are a few
examples on which past psychological trauma can be re-triggered by a clinical intervention.
The ‘re-triggering’ can lead to people feeling acutely frightened, anxious and also
avoidant of clinical encounters. ‘Re-triggering’ can also lead to flashbacks of past trauma,
disturbance in mood and sleep and most importantly, often being unable to communicate
what is happening to them.
One of the most effective ways of ensuring that you are taking care to do more harm
is ensuring that your relational and communications skills are open, collaborative,
trustworthy, transparent and empowering. So it is about offering choice, listening and
responding to concerns and creating trusting relationships regardless of how transient they
are. This can be done by embracing the five principle of trauma informed practice:
1. Realising how common the experience of trauma and adversity is
2. Recognising the different ways that trauma can affect people
3. Responding by taking account of ways that people can be affected by trauma to
support both physical and emotional recovery
4. Ensuring all opportunities are taken to Resist re-traumatisation
5. Create transparency and trust in Relationships
Airway…
ASSESSMENT OF AIRWAY
Complete airway obstruction will rapidly cause cardiac arrest therefore, your first actions
should always be to ensure that the airway is open and to get expert help immediately. You
can perform the head tilt, chin lift manoeuvre (if no cervical spine injury is suspected) to
open the airway.
Airway obstruction can be partial or complete. Complete obstruction will very quickly
result in cardiac arrest and partial obstruction may result in exhaustion, hypoxic brain damage
, SHSU027
and complete obstruction. When assessing airway obstruction think about the anatomy of the
upper respiratory tract:
Level of Obstruction Potential cause
Pharynx In the unconscious person the most likely cause is the tongue. May
also be caused by foreign objects or matter e.g. vomit, blood
Larynx Laryngeal obstruction - anaphylaxis, burns injury resulting in
oedema
Laryngeal spasm - caused by inhaled foreign object
Below the Larynx Uncommon but may be caused by excessive bronchial secretions,
pulmonary oedema, aspiration of gastric contents or severe
bronchospasms.
LOOK
What do you observe when you first approach your patient?
● Is there obvious difficulty in breathing - this may present as increased work of
breathing where more effort is required to try to entrain air and accessory muscles will
be used (e.g. sternocleidomastoid, pectoralis major). Is the patient showing signs of
distress?
● What is the colour of your patient? Central cyanosis (a blue tinge of the lips and
mucous membrane of the mouth) may be seen. This is a late sign of impaired
oxygenation an is a clear cause for concern. The blueish tinge is observed as
deoxyhemoglobin is a blueish colour whereas oxyhaemoglobin is red.
● Is your patient showing signs of choking? This may be apparent through both
observation and sounds that they are making. A classical sign is the patient grasping
their throat.
● Can you see anything in the mouth or oropharynx that might be causing the
obstruction? Is there any swelling in and around the mouth and lips (for example
angioedema)
● Can you see any paradoxical chest movement? The normal pattern of movement of
the chest is up and out, whereas when there is airway obstruction you may observe a
‘see-saw’ pattern where the chest moves inwards and the abdomen rises.
● What is the level of consciousness of your patient? As soon as the level of
consciousness is impaired you need to think of a potential threat to airway patency.
As the level of consciousness decreases, the person loses the protective airway
mechanisms such as the gag and cough reflexes
LISTEN
The sound made, or lack of it, can indicate the type or level of obstruction:
● Gurgling suggests the presence of liquid/semisolids in the main airways
● Snoring occurs when the pharynx is partially occluded by the tongue
Patient Safety…
INTRODUCTION
Clinical Decision Making, Human Behaviours and Patient Safety are all inextricably linked
in professional nursing practice. In the context of health care delivery each decision taken is
underpinned by knowledge and application of patient safety mechanisms/policies and an
understanding how Human Behaviours affect key decisions. However, with recent reports
stating the NHS continues to have 230 preventable deaths per week there is much more to be
done.
Patient safety is everyone’s business. When patient harm occurs, caregivers involved
are devastated along with the patient and family, yet for far too long many health care
workers have had to navigate this storm alone. The Clinical Human Factors Group, promotes
the application of Human Factors science in all areas of healthcare and is a useful resource
for all health care professionals. However, it is up to all nurses and AHPs to demand that a
systems approach be enabled in our healthcare workplace, along with a just culture that
cultivates the sharing of knowledge and helps prevent patient harm from occurring altogether.
BACKGROUND AND PREPARATION
Although errors can be attributed to individuals, they are often the product and natural
consequences of defective systems that allow errors to go unnoticed. The safety and well-
being of patients within the hospital system is the fundamental goal of the NHS Boards and
health care professionals. That said, the imperfect nature of humans incorporates
vulnerability within systems such that errors and adverse events are unavoidable. Many errors
have little to no consequence and often go unnoticed; occasionally they translate into an
important adverse event.
Human Factors…
INTRODUCTION
Human factors approaches underpin patient safety and quality of improvement science,
offering an integrated, evidenced and coherent approach to patient safety and quality
improvement and clinical excellence.
The principles and practices of Human Factors focus on optimising human
performance through better understanding the behaviour of individuals, their interactions
with each other and with their environment. By acknowledging human limitations, human
factors offers ways to minimise and mitigate human frailties, reducing medical error and its
consequences. Human factors is also a body of knowledge covering physical, psychological
and other characteristics applied to the design of things used by humans.
All humans are fallible therefore, individual adoption of these concepts offers a
unique opportunity to put patient safety and clinical excellence at the centre of care delivery.
, SHSU027
Human factors principles can be applied in the identification, assessment and management of
patient safety risks, and in the analysis of incidents to identify learning and corrective actions.
More broadly, human factors understanding and techniques can be used to inform quality
improvement in teams and services, support change management, and help to emphasise the
importance of the design of equipment, processes and procedures.
BACKGROUND AND PREPARATION
Recommendations from the Francis Report (2013) requires every single person serving
patients to contribute to a safer, committed and compassionate and caring service. Thus, all
nurses and AHP’s should be committed to delivering care based on fundamental standards.
Behaviour at all levels needs to be in accordance with at least these fundamental standards
and the NMC Code (2018) with the overriding value being that patients are put first. All
nurses should enter into express commitment to abide by their NHS values and philosophy.
Relationships and Interpersonal Skills…
INTRODUCTION
Over the previous year we have been introduced to the communication skills which are the
building blocks required to establish a therapeutic relationship. These core communication
skills are the essential skills that allow healthcare workers to connect with people they come
in contact with. The ability to establish a relationship with an individual and their family
requires advanced skills, known as interpersonal skills. Interpersonal skills are a combination
of communication skills, relational skills, values, beliefs and behaviours. This part of learning
draws together these main elements in the context of clinical practice. There is good reason
for including the theoretical aspects of interpersonal skills within this clinical skills module.
Back in 2005, Kidd, et al highlighted that many healthcare programmes teach these
separately and note that it is vital to be able to take a history, share information, explain
procedures and discuss treatment options and their effects when working with people. In
clinical practice communication and clinical skills are practised simultaneously, therefore
education programmes should introduce, teach and practice them at the same time.
TRAUMA INFORMED PRACTICE: LISTENING AND RESPONDING TO
PSYCHOLOGICAL CONCERNS
It is important that physical health needs are not seen in isolation from people’s emotional
health needs as increasingly evidence is demonstrating that there is a strong relationship
between the two capacities. A trauma informed approach to nursing practice is about ensuring
that as health care practitioners, we do not do more harm by inadvertently or ignoring or
being unaware, of the sensitives that a clinical intervention might evoke for a person.
Psychological trauma is defined as either:
, SHSU027
● Type 1 or single trauma: these can be identified as an event that happens on a single
occasion but may range from RTA to assault and rape.
● Type 2 or complex trauma: unusually occurs interpersonally and over a period of
time. Complex trauma refers to childhood abuse/neglect; or in the content of war,
torture or human trafficking.
Remember that the term trauma can refer to a wide range of abusive or neglectful experiences
and the effects are different for everyone. SAMHSA (2014) refers to this as the three E’s. the
first of these is Events (including Adverse Childhood Experiences), the second, event is
Experienced and the third, the Effects of the trauma which are very much dependent on each
individual and the three E’s are a good way of reminding yourself of the importance of
relational person centred care.
Although the trauma may be in the past, experiences in the present day can cause
significant distress.
Interventions such as taking bloods, cervical smear tests or catheterisation are a few
examples on which past psychological trauma can be re-triggered by a clinical intervention.
The ‘re-triggering’ can lead to people feeling acutely frightened, anxious and also
avoidant of clinical encounters. ‘Re-triggering’ can also lead to flashbacks of past trauma,
disturbance in mood and sleep and most importantly, often being unable to communicate
what is happening to them.
One of the most effective ways of ensuring that you are taking care to do more harm
is ensuring that your relational and communications skills are open, collaborative,
trustworthy, transparent and empowering. So it is about offering choice, listening and
responding to concerns and creating trusting relationships regardless of how transient they
are. This can be done by embracing the five principle of trauma informed practice:
1. Realising how common the experience of trauma and adversity is
2. Recognising the different ways that trauma can affect people
3. Responding by taking account of ways that people can be affected by trauma to
support both physical and emotional recovery
4. Ensuring all opportunities are taken to Resist re-traumatisation
5. Create transparency and trust in Relationships
Airway…
ASSESSMENT OF AIRWAY
Complete airway obstruction will rapidly cause cardiac arrest therefore, your first actions
should always be to ensure that the airway is open and to get expert help immediately. You
can perform the head tilt, chin lift manoeuvre (if no cervical spine injury is suspected) to
open the airway.
Airway obstruction can be partial or complete. Complete obstruction will very quickly
result in cardiac arrest and partial obstruction may result in exhaustion, hypoxic brain damage
, SHSU027
and complete obstruction. When assessing airway obstruction think about the anatomy of the
upper respiratory tract:
Level of Obstruction Potential cause
Pharynx In the unconscious person the most likely cause is the tongue. May
also be caused by foreign objects or matter e.g. vomit, blood
Larynx Laryngeal obstruction - anaphylaxis, burns injury resulting in
oedema
Laryngeal spasm - caused by inhaled foreign object
Below the Larynx Uncommon but may be caused by excessive bronchial secretions,
pulmonary oedema, aspiration of gastric contents or severe
bronchospasms.
LOOK
What do you observe when you first approach your patient?
● Is there obvious difficulty in breathing - this may present as increased work of
breathing where more effort is required to try to entrain air and accessory muscles will
be used (e.g. sternocleidomastoid, pectoralis major). Is the patient showing signs of
distress?
● What is the colour of your patient? Central cyanosis (a blue tinge of the lips and
mucous membrane of the mouth) may be seen. This is a late sign of impaired
oxygenation an is a clear cause for concern. The blueish tinge is observed as
deoxyhemoglobin is a blueish colour whereas oxyhaemoglobin is red.
● Is your patient showing signs of choking? This may be apparent through both
observation and sounds that they are making. A classical sign is the patient grasping
their throat.
● Can you see anything in the mouth or oropharynx that might be causing the
obstruction? Is there any swelling in and around the mouth and lips (for example
angioedema)
● Can you see any paradoxical chest movement? The normal pattern of movement of
the chest is up and out, whereas when there is airway obstruction you may observe a
‘see-saw’ pattern where the chest moves inwards and the abdomen rises.
● What is the level of consciousness of your patient? As soon as the level of
consciousness is impaired you need to think of a potential threat to airway patency.
As the level of consciousness decreases, the person loses the protective airway
mechanisms such as the gag and cough reflexes
LISTEN
The sound made, or lack of it, can indicate the type or level of obstruction:
● Gurgling suggests the presence of liquid/semisolids in the main airways
● Snoring occurs when the pharynx is partially occluded by the tongue
