It is not a secret that there is a shortage of nurses in the US, and there has never been a better time to enter this career. Traditional nursing colleges are unable to provide spaces to all the applicants who want to enter this profession, and a plethora of online courses have been created to fill the gap. This also means that a large number of new nurses are going through schooling or training at the same time, which leads to senior or more experienced nurses picking up the slack. While this offers multiple opportunities for career advancement, it can put time pressures on a busy hospital or clinic, where getting to a patient quickly can mean the difference between life and death. Student nurses must be trained adequately on the ABCs of nursing, and this should be done with a trained senior professional.
The ABCs of nursing
In most professions, devices are used to help trainees learn the vital parts of the job, and in most cases, these are mnemonic devices. ABCs have been used in many professions, such as sales, where they stand for ‘Always Be Closing’. The ABCs of nursing involve assessing the patient for ‘Airway, Breathing and Circulation’. This mnemonic device helps nurses to remember the crucial steps in assessing which patient should be treated first and helps them with prioritizing. This is an important step for nurses when working in a busy emergency room or trauma center and can also be one of the most challenging aspects of the job. Nurses are vital for patient care and are usually the first line of assessment when an individual comes in with a serious trauma.
Airway
Ensuring a clear and patent airway is crucial as it allows for the exchange of oxygen and the removal of carbon dioxide. If an airway is compromised, it can lead to respiratory distress or failure. Addressing any obstructions, such as foreign objects or swollen tissues, and maintaining an open airway are essential for a patient’s survival. Nurses assess a patient’s airway by performing something called a respiratory objective assessment (ROA). This includes interpreting vital signs and inspecting the patient’s skin color, breathing patterns and respiratory status. Physically checking the patient through palpitations or listening through a stethoscope are other ways that nurses can assess the patient’s airway status.
There are several indications that there is an airway obstruction, such as having difficulty breathing, retracting the respiration muscles, a rocking chest motion, absence of breath sounds or abnormal breath sounds, cyanosis, and signs associated with hypoxemia (low levels of oxygen in the blood). If a nurse discovers that there is an obstruction in the airway, then there are steps that need to be taken immediately, such as placing the patient in a supine position with their head on a pillow, tilting the head backward and extending the neck.
Assessing the airway for an obstruction ensures that no other treatments are performed that could possibly harm the patient if the obstruction is not removed. Being adept at this technique and knowing what needs to be done quickly and efficiently is crucial to the welfare of the patient and the first step to excellent care. Seasoned nurses who are knowledgeable in the assessment steps can teach newer nurses how to perform assessments efficiently. Seasoned nurses often have the chance to show their leadership skills in this clinical setting, and with advanced degrees they can move into higher positions quickly.
Degrees such as a Master of Science in Nursing (MSN) can give a seasoned nurse the credentials they need to gain more autonomy or secure a management or executive position. One of the nurse practitioner advantages is that these dedicated professionals can practice without supervision of a physician. Therefore, they are able to open up practices in areas that need them the most. Seasoned nurses can apply to online schools such as Elmhurst University and attain an advanced degree. Online courses are crucial for working professionals to get the knowledge they need in a flexible schedule.
Breathing
Adequate breathing is necessary to supply oxygen to vital organs and tissues. Assessing the rate, depth and rhythm of breathing, monitoring oxygen saturation levels, and observing for signs of respiratory distress or failure are crucial in determining the urgency of intervention. Prompt interventions, such as administering oxygen or initiating mechanical ventilation, can prevent further deterioration. When assessing a patient’s breathing, nurses will use the ‘look, listen and feel’ approach. This involves looking for signs of respiratory distress, assessing the pattern of the respiratory cycle for up to 15 seconds, and counting the respiratory rate for 60 seconds.
There are several signs that indicate that the patient is in respiratory distress, such as rapid breathing and shortness of breath. Other signs include shallow breathing, using other muscles to breathe, wheezing, and bluish color of the skin, lips and nails. A high-pitched breathing sound can also indicate distress, as can the flaring of the nostrils. When there is a visible sinking of the chest in between the ribs or above the clavicle, this is a sign of respiratory distress. Altered mental status and grunting during exhalation are also indicators.
It is imperative that nurses know these signs and become adept at recognizing them immediately, especially when triaging several patients at once in a busy emergency department. The signs of distress can be subtle and knowing them well can mean the difference between life and death for some patients.
Circulation
Circulation involves the delivery of oxygen and essential nutrients to organs and tissues through the bloodstream. An assessment of circulation includes evaluating the patient’s heart rate, blood pressure and peripheral pulses. Identifying any abnormalities, such as signs of shock, hemorrhage or cardiac arrest, enables immediate interventions such as administering fluids, initiating CPR or providing cardiac medications. A seasoned nurse will also understand that these symptoms can differ in both men and women and should be able to determine the level of distress they are in.
There are several ways that a nurse can assess for circulation issues, such as checking for any changes in body temperature and whether there is any discoloration of the hands. Pulse checks and blood pressure checks are also crucial in assessing whether there is poor circulation in the patient. There are five Ps that are involved with assessing circulation: pain, paresthesia, pulse, pallor and paralysis. This assessment goes hand in hand with ABCCS, which is airway, breathing, circulation, consciousness and safety.
Prioritizing the ABCs in nursing ensures that the most critical and life-threatening conditions are addressed promptly, improving patient outcomes. Without a clear airway, adequate breathing and proper circulation, a patient’s condition can deteriorate rapidly, leading to severe complications or even death. By prioritizing these three aspects, healthcare providers can stabilize a patient’s condition, initiate appropriate treatment plans, and prevent further harm or organ damage.
Overall, the ABCs of nursing prioritization are a fundamental framework that guides healthcare professionals in recognizing and addressing immediate life-threatening conditions, maximizing the chances of patient survival, and promoting optimal patient care.
The importance of practicing self-care
One of the reasons why it is important for nurses to practice the art of self-care is so that they can always be working at their best. Some ways that nurses can practice self-care in a busy medical setting include taking regular breaks throughout the day, staying hydrated, eating well, practicing mindfulness, establishing boundaries, seeking support, practicing self-compassion and getting enough sleep.
Taking regular breaks
Nurses often have demanding schedules, but taking short breaks throughout the day can help to reduce stress and prevent burnout. Nurses can use breaks to relax, stretch or engage in activities that help them to unwind. The best way to remember to take breaks is to have some sort of alarm system on a phone or a smartwatch that acts as a reminder to stop for five minutes, stretch, walk around or get some fresh air. It may not seem like a lot, but the effects of stepping away and taking a moment to reflect can make all the difference between burnout and coping.
Staying hydrated
It is easy to forget to drink water throughout the day. When the body is dehydrated, the feeling of fatigue hits quickly. Setting an alarm for drinking water might sound silly or over the top, but it works well. A reminder every half hour or so to drink some water can help a nurse keep up their energy and maintain their stamina throughout the day. It can also work as a regular break that allows an individual to stop and rest for a few minutes before getting back to work.
Eating well
Eating healthy meals and snacks throughout the day can keep energy levels stable and prevent the afternoon crash that so many people feel when they are busy all day. Nuts and yogurt are just a few options for quick snacks that can be eaten on the go quickly.
Practicing mindfulness
Even when a nurse feels that they are fine and don’t need a break in their day, having a set time to practice mindfulness, breathe in and out, and step back for a minute or two can help to keep the momentum going. When this is practiced regularly, it becomes a habit that improves mind, body and spirit and can keep a nurse going at maximum effectiveness all day.
Establishing boundaries
Nurses often feel a sense of responsibility for patient care, but it’s important to set boundaries to prevent feeling overwhelmed. Know when to say ‘no’ to additional tasks if the workload is already heavy and make sure to keep the lines of communication open with the team when help is needed. A nursing team works best as a cohesive unit, which means that all the members are working together toward excellent patient care. This means that each individual nurse also needs to be working at peak effectiveness, so when someone needs a break, someone else can fill in the gap.
Seeking support
Nurses should always build a support network with their colleagues and find time to discuss challenges they are experiencing. The best thing about this support network is that everyone is under the same amount of stress, so they understand the challenges. Nursing is a rewarding but challenging career, and supportive colleagues and managers can help a nurse feel that they have people to turn to if they need help.
Getting enough sleep
Adequate sleep is vital for physical and mental wellbeing. Prioritizing a consistent sleep schedule and creating a sleep-friendly environment ensures that an individual is well-rested for their shift. Overtiredness can lead to careless mistakes, and in a profession such as nursing, those mistakes can have dire consequences. There are many apps that help with winding down, which can help an individual relax and settle into a restful slumber.
Practicing self-compassion
Being kind to oneself is essential in navigating the challenging field of nursing and maintaining a suitable demeanor for colleagues and patients. Acknowledging individual efforts, achievements and limitations can go a long way to providing a nurse with the same care and understanding toward themselves as they give to others.
Conclusion
By practicing self-care along with the ABCs of patient assessment, nurses can ensure that they are at their peak performance and giving their patients the very best in care. A seasoned nurse who takes care of themselves as well as others can lead by example and show new nurses how important a proper assessment can be when working at the peak of their abilities.
