The Human Factors Nurse

Human Factors and Human caused climate change are increasingly interacting as we all start to adapt our nursing practice for the Anthropocene

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https://www.routledge.com/Second-Victim-Error-Guilt-Trauma-and-Resilience/Dekker/p/book/9781466583412 #

Second Victim: Error, Guilt, Trauma, and Resilience How do people cope with having

If we really want to fix a broken system we must first start by supporting our secondary victims. The trauma of incidents is real and has lifelong consequences. Sydney Dekker is doing amazing work in this space at the moment

Second Victim: Error, Guilt, Trauma, and Resilience Download Citation | Second Victim: Error, Guilt, Trauma, and Resilience | How do people cope with having "caused" a terrible accident? How do they cope when they survive and have to live with the consequences ever after?... | Find, read and cite all the research you need on ResearchGate

Firstly, I send my heartfelt condolences to the victim of a systemic failure. This is a human factors accident 101. I also send my condolences to the secondary victim - the nurses and doctors who this event will impact on for life. They went to work doing the best and the system let them down. There’s no ‘Just Culture’ in this… there’s no fatigue management, no workload or stress management and worst of all there’s no two way assertion process… the key to assertion gradients is that the recipient also listen… https://www.abc.net.au/news/2022-08-24/coronial-inquest-aishwarya-aswath-death/101357058?fbclid=IwAR0ilmMloxSnUAAknP0Y2QofZdN0WIHHmNecMH6L-WOR7PDbJ9BGP94bzaM

Nurses and doctors who oversaw Aishwarya Aswath's care set to give evidence at inquest into tragic death As a coronial inquest begins into the death of Aishwarya Aswath at Perth Children's Hospital, the seven-year-old girl's family hopes the hearings provide clarity on what happened in her final hours.

"For me, the most rewarding part of this job is knowing that I’m taking people to care they could otherwise not receive"

We teamed up with NSW Ambulance, to bring you this interview with Erin Holmes who has kindly shared her experience as an NSW Air Ambulance Flight Nurse / Midwife.
Read the Q&A here:
https://thenursebreak.org/whats-it-like-being-a-nsw-air-ambulance-nurse/

Flight Nurses Australia
Australian & New Zealand College of Emergency Nursing
Australian College of Critical Care Nurses
Australian College of Midwives (ACM)
College of Emergency Nursing Australasia
NSW Health
Australian College of Neonatal Nurses

Our system has not effectively managed the threats, we are doing our best to manage the increased error rate, but we now must focus on managing the undesired state… Nurses! Now is the time to use all your non technical skills- graded assertiveness to advocate for your breaks and own health, workload management through prioritisation and task shedding along with good threat and error management is paramount in these times… As our colleagues who managed the Ebola outbreak say, “there are no emergencies in a pandemic”. Stop. Think. Slow down. Accept quality of care will degrade, human error will increase, and patients will unnecessarily die.

The Human Factors Nurse Nursing and Midwifery Humans Factors Practitioner

This is part of good human factors and a generative safety culture… basically the very basis of threat and error management… this actually instils me with confidence… terrible journalism in this story… https://australianaviation.com.au/2022/01/concerns-raised-over-rusty-qantas-pilots-making-basic-errors/?fbclid=IwAR3Uk6Y27YEKh0nMq-7R9Yl7r41u5FVAf54ULd1gTbp1FXFoINhF77l4Gfw

Concerns raised over rusty Qantas pilots making basic errors Qantas has flagged concerns that a number of its pilots are now making errors in routine operations, and seem to require more time to complete standard procedures, following months of stand-downs and heavily reduced flight schedules.

Today is world patient safety today. This year the focus is on birthing safety. As a proud midwife - I ask you, “where is the safest place for a woman to birth?”

World Patient Safety Day 2021 For World Patient Safety Day, 17 September 2021, WHO urges all stakeholders to “Act now for safe and respectful childbirth!” with the theme “Safe maternal and newborn care”. Approximately 810 women die every day from preventable causes related to pregnancy and childbirth. In addition, around...

Information processing and decision making is one of the key elements of nursing and midwifery practice! I love sharing my learnings to help optimise every nurses’ performance. Nurses are like fine tuned athletes! And I’m so proud of many of my colleagues having great debates on decision making and situational awarensss models! My comments on this great post by The Nurse Break: The nurses gut instinct may be quantified in a few theoretical ways. Firstly it may be known as ‘naturalistic decision making’. In this style of decision making the nurse uses pattern recognition to make swift judgements based on previous experience. Also known as recognition primed decision making - the nurse makes a quick decision based on experience. The greater the experience the more effective the decision making. It has up to 75% efficacy. It’s efficiency is debatable in the novice (an expert is defined as 7+ years). Most people know this as fast thinking versus slow thinking made famous by Daniel Kahneman. Secondly, it could be decision making based on heuristics or ‘rule of thumbs’ - once again based on experience but a heuristic is open to bias errors. Finally, it’s all part of the information processing of situational awareness. Situational awareness is made up of three concepts - perception, comprehension and projection. The gut feeling is based on perception - that ‘something is not right with this picture’ so to build a clearer mental model further information is needed. Once again experience and biases will impact on this style of decision making. What is intriguing to me is the gut feeling of so called novices - unconscious competence also plays a part. You don’t know what you don’t know! Fascinating topic!

Some evening food for thought.....Nurses and a GUT FEELING.
By saying we have a 'gut feeling' that something is wrong with a patient, are we unintentionally doing nursing a disservice and undermining nurses intelligence?

POST IN COMMENTS: Should we be changing the terminology from gut feeling to something that reflects correctly the knowledge behind the 'gut feeling'

"Intuition is more than simply a "gut feeling," and it is a process based on knowledge and care experience and has a place beside research-based evidence. Nurses integrate both analysis and synthesis of intuition alongside objective data when making decisions. They should rely on their intuition and use this knowledge in clinical practice as a support in decision-making, which increases the quality and safety of patient care."

Source: Melin-Johansson C, Palmqvist R, Rönnberg L. Clinical intuition in the nursing process and decision-making-A mixed-studies review. J Clin Nurs. 2017 Dec;26(23-24):3936-3949. doi: 10.1111/jocn.13814. Epub 2017 Jun 22. PMID: 28329439.

I had a great Human Factors professional development day with CTG Training in Brisbane today. It was great to share industry learnings from rail, health, aviation, paramedicine, mining and defence. The educationalist in me is overdosing on learning excellence.