Sunday 10 April 2022

COVID-19, Nursing Degree, Nursing Degree US, Nursing Exam US, Nursing Professionals, Nursing Responsibilities, Nursing Skill

Healthcare workers throw around the term triage like seasoned Italian bakers throw around pizza dough, but many laymen do not understand the full extent of the triage process. The word triage originates from the French word “trier” which translates into English “to sort.” One of the first documented occasions of a medical triage system occurred during the Battle of Jena in 1806 when the lead physician categorized people into three groups to assess who required the most urgent evacuation from the battlegrounds: dangerously wounded, less dangerously wounded, and slightly wounded. The physician that developed this system also takes credit for being the first to utilize ambulances, or horse-drawn buggies with a medical team, to expedite care. 

Triaging has always been a critical part of war medicine, but the priorities for triaging during battle or massive casualty incidents have a slightly different goal than the typical emergency department triage system. Rather than trying to save the sickest people first, they focus on saving as many people that have a higher likelihood of surviving and going back to being active soldiers in the war. Modern-day mass casualty triage systems are categorized by color:

◉ Black (dead)

◉ Red (immediate)

◉ Yellow (delayed)

◉ Green (minimal)

As an emergency nurse, I have thankfully never been directly involved in a mass casualty incident such as the shootings in Las Vegas or Orlando in recent years. However, I have been a part of scenarios in which we were given a “heads up” by local law enforcement that an active shooter was in the service area of the hospital. We were instructed to start preparing for potential “mass cas” patients. In this case, the charge nurse designated one nurse as the triage nurse that would stand out in the ambulance bay and have the job of triaging by color and making the decision of which patient should receive which level of care. This horrendous scenario goes against everything that we stand for as nurses when you have to make the call that someone might be too injured to even attempt to save their life; when the resources could be allocated to save four other lives instead. 

More often, though, the triage system plays an active role in every Emergency Department each time a patient walks, or wheels, through the doors. 

In America, the standard triage system is called the ESI, or Emergency Severity Index, and is a number system from 1 to 5 with 1 being the most critical, and 5 being the most non-acute. An ESI level 1 means that the patient requires “life-saving measures” and needs treatment immediately. A patient scored a 2 indicates that the patient has a high-risk scenario or could have vital signs that are in the dangerous category. Nurses dictate levels 3 to 5 based on the number of resources the patient is going to require which include radiology tests, blood work, medications, procedures, or EKGs. Patients that require multiple resources are level 3’s, 1 resource are level 4’s, and no resources are level 5’s. This numeric system helps indicate which patients in a crowded waiting room should receive the first room once one opens up, and helps physicians see who might be the highest risk and should be evaluated first. 

Acting as the role of a triage nurse on a busy day can leave you with exhaustion that differs from working a typical assignment in the ED. You have one of the highest liabilities within the department because you are responsible for deciding who sees a doctor first, and who can sit and wait for four more hours. If you make the wrong decision, a patient could be sent back out to wait and have a fatal event while someone else was seen before them. Sometimes working in triage feels like a long game of twenty questions; a good nurse needs to be experienced enough to know which questions to ask that will help them decide how sick they might actually be. 

Working in a triage room for twelve hours can provide some of the most comical stories since you get to hear a little bit about every patient’s problems that day. The line of “Sir/ma’am, what brings you into the Emergency Department today?” gives a wide-open arena for patients to fill in the missing space with their choice of stupidity. In many ways, wearing a mask for the past two years has been extremely helpful in hiding my reactions as patients begin to explain the reason for their ED visit. Responses such as “I just tripped and fell onto the soda bottle and it is stuck, well you know where,” to “I just was minding my own business, and someone came and stabbed me,” to “I have this toenail, and there is a part of it that is about to fall off,” are all statements I have heard, and the challenge to remain non-reactionary can be a true struggle. 

The job is complex. You become the gatekeeper for the department and are often placed in a tricky situation when a family member knows their loved one is in the department, but they are either critically ill or might not want the family back, and the triage nurse has to take the wrath from the family about not being allowed back. On busy days, the triage nurse constantly has to deal with sick, hurting, and often grumpy patients who have been waiting for hours and hours to be seen, and the toll weighs on you both physically and emotionally. It is a mixture of customer service and being the face of the department, as well as implementing astute medical knowledge and assessment skills. The triage process is much more complex than many people might expect, and triage nurses often go unrecognized by patients as playing such a vital role in patient safety. 

Hopefully, patients will change their response from “why did they get to go back before me, I have been here for two hours already,” to “thank you for saving lives and asking the right questions to help the entire community out.”


Saturday 2 April 2022

Nursing Responsibilities, Nursing Professionals, Nursing Career, Nursing Skill, Nursing Practitioners

End-of-life decisions may be amongst the hardest decisions any family member might have to make for a hospitalized loved one. But with the proper advanced health care directives, it can make those decisions easier and less confusing. Unfortunately, most patients do not have advanced directives, especially those in the younger generations. The reality is that unless someone has a terminal illness or works in healthcare, they may not even know what an advanced directive is. 

MIDEO Card is changing the conversation. 

A revolutionary new app, MIDEO Card which stands for My Informed Decision on VidEO, is a video advance directive as well as a video medical order for life-sustaining treatment. The video is in the patient’s own words and has been formulated to translate all wishes into medical provider understanding.

What is an Advanced Directive?

Generally, advanced directives are done via a paper form that can be filled out in the hospital or online and printed. These forms discuss life-sustaining medical treatment and prolonging life. 

According to the American Cancer Society, “life-sustaining medical treatment is any medical intervention, medication, or anything mechanical or artificial that sustains, restores that would prolong the dying process for a terminally ill patient.” These may include : 

◉ Breathing machines

◉ CPR (cardiopulmonary resuscitation) including use of an AED (automated external defibrillator)

◉ Medications such as antibiotics

◉ Nutrition and hydration (food and liquids) given through feeding tubes or IVs

Once an advanced directive has been filled out it then needs to be given to your healthcare provider and placed into your health file. This can be problematic, especially in the case of an emergency. If an advanced directive is completed at home and never given to the primary healthcare team, it is possible that no one will know a patient’s true end-of-life wishes. Furthermore, if the patient is taken to a  hospital out of state or not associated with their primary healthcare provider, then there will not be accessible to the advanced directive.

This is problematic. 

MIDEO eliminates this by creating a digital footprint for the advanced directive and allows all providers access to it regardless of the healthcare system or state. It’s all done with a QR code and smart device. 

According to a 2017 study, of 795,909 people in the 150 studies analyzed, 36.7 percent had completed an advance directive, including 29.3 percent with living wills. The proportions of terminal individuals to healthy individuals were similar. Based on this large study as well as others, it is evident that end-of-life discussions are essential to properly care for patients. 

“Improving end-of-life care has been a national conversation for some time now, presumably because it will affect all of us at some point and is a very personal matter,” said senior study author Dr. Katherine Courtright of the Fostering Improvement in End-of-Life Decision Science Program at the University of Pennsylvania in Philadelphia.


MIDEO is designed to allow patients to directly speak their wishes with a representative and is stored on a digital identification card.

MIDEO takes the planning and consultation out of the hands of the hospital and hospital healthcare providers. MIDEO has a team of healthcare specialists that work with patients to find the options that are not only personalized but also the best for them and their loved ones. 

As hospitals continue to feel the strain of the ongoing pandemic and nursing shortage, there are fewer and fewer resources dedicated to informing patients about advance directives and end-of-life decisions. MIDEO is helping to remove the strain. 

Currently, there are three options available for MIDEO Card. Each provides a personalized virtual meeting with a specialist to discuss all aspects of advance directives and end-of-life wishes. 

Essential Package (designed for healthy individuals):

◉ Includes a standardized guided process with a Qualified Healthcare Professional to create your safety statement

◉ 2 Copies of the Identification Cards.

Vital Package (designed for individuals with multiple medical problems or ages 60 & above):

◉ Includes a guided process and detailed healthcare evaluation with a Board Certified Physician to create your safety statement

◉ 2 Copies of the Identification Cards.

VIP Healthcare Concierge Advocate (designed for Individuals (e.g.: those with cancer) Who Require Navigation Through the Complex Medical System Who Have Specific Goals to Be Achieved): 

◉ Includes the Vital Package, but also includes a designated Concierge Physician Advocate who will be available to assist and provide guidance 24 hours a day.

While there is a fee associated with the use of MIDEO Card, most major health insurance plans including Managed Medicare and Medicare with supplemental insurance plans have covered the cost of MIDEO in full or for a small co-pay.  

As of January 1, 2016, Medicare-approved billing codes allow individuals to receive Advance Care Planning Education & Counseling. Commonly, this is considered the end of Life planning or counseling.        

How It Works?

According to the website, the MIDEO video is accessed by any type of smart device including a smartphone and/or tablet. The camera feature scans the QR code technology on the MIDEO ID card of the patient. The video is then quickly retrieved within seconds in a safe and secure manner. 

MIDEO suggests informing all healthcare providers of the QR code and having it stored in your patient file so that it can be accessed immediately if needed. 

The video aspect is essential to the success of MIDEO and the future of advanced directives and end-of-life planning. Because many states allow individuals to complete advanced directives online without assistance, it is possible that individuals do not fully understand the choices presented to them or that they can make their own that are listed. 

“As I like to say, the form is only as good as the conversation and the shared understanding that goes along with it,” said Dr. Rebecca Sudore of the University of California, San Francisco School of Medicine who wasn’t involved in the study.

“Some people do fill out these forms with families or lawyers, and then the forms sit in the dusty recesses of a back drawer and they are not available or shared with family and friends, especially before they are needed,” she told Reuters Health by email.

As Americans live longer, especially with chronic medical conditions, and healthcare continues to make advancements against the fight of once terminal diagnoses, it is essential that individuals make their end-of-life wishes known to not only their families but also to their healthcare providers. MIDEO Card takes away the guesswork. It leaves a lasting gift to families and loved ones having to make difficult decisions. 




Popular Posts

Blog Archive

Total Pageviews