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PubMed · 10562115

Dealing with problems in clinical practice.

M Lowry
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Abstract

The identification of problems and how they are dealt with is affected by the individual perspectives of all parties involved. Mike Lowry discusses how groups of nurses often have difficulty accepting that problems exist and suggests ways they might go about identifying and dealing with them.

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Clinical CompetenceDecision Making, OrganizationalGroup ProcessesHumansInterprofessional RelationsNursing ProcessNursing StaffProblem SolvingThinkingJournal ArticleReview

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M Lowry. Dealing with problems in clinical practice.. https://doi.org/10.7748/ns1999.08.13.48.43.c2663

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Problems for clinical judgement: 3. Thinking clearly in an emergency.

The resuscitation of a patient in extremis is frequently characterized by chaos and disorganization, and is one of the most stressful situations in medicine. We reviewed selected studies from the fields of anesthesia, emergency medicine and critical care that address the process of responding to a critically ill patient. Individual clinicians can improve their performance by increased exposure to emergencies during training and by the incorporation of teamwork, communication and crisis resource management principles into existing critical care courses. Team performance may be enhanced by assessing personality factors when selecting personnel for high-stress areas, explicit assignment of roles, ensuring a common "culture" in the team and routine debriefings. Over-reliance on technology and instinct at the expense of systematic responses should be avoided. Better training and teamwork may allow for clearer thinking in emergencies, so that knowledge can be translated into effective action and better patient outcomes.

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