November / December 2017   Comments

Violence prevention and nurse safety

I have been trained in critical incident stress debriefing and violence prevention, so I really appreciate any efforts to support the front-line nurse.

It is exciting to know violence prevention is being taught to nurses (Promising Practices, September/October). But ensuring safety in our practice is more complicated. In community care and acute care, I have often been alone or been asked to work in what could be considered potentially unsafe and unpredictable conditions. I have been assaulted several times on the job. I recovered and took appropriate measures to address my health and well-being after the incidents. Most of the time, I had to advocate to receive followup and treatment. I’ve occasionally had a manager who cared enough to make sure I was all right or who told me to take time off after a violent incident. More often, I was asked to return to work after being assaulted, because there was no one to replace me.

It is lovely to talk idealistically about preventing violence, but, in reality, it takes adequate staffing and a team of trusted colleagues who have the experience to deal effectively with violent clients. Policies and training help, but what is needed is supportive management. In my experience, that is more the exception than the rule.

– Brenda Rosenau, RN, MA
Vancouver. B.C.

Blood pressure measurement skills

I have some concerns about the brief article advocating use of automated sphygmomanometers over manual measurement of blood pressure (Perspectives, July/August). Although I agree with the study findings indicating that automatic devices may give a more precise measurement and are useful in cases of monitoring hypertension, there are many clinical reasons for nurses to be skilled at taking manual BPs. For example, an automatic device may not pick up pulsus paradoxus, supraventricular tachycardia, cardiac murmurs and scores of other pathologies that a skilled nurse may be able to identify when auscultating a blood pressure. There are also times when BP monitoring should only be done manually, such as when patients are receiving high doses of blood thinners or TPA during stroke therapy. Manual measurements may also be more appropriate in very young and very old populations.

I am concerned that overreliance on automation will create an unfamiliarity and lack of competence in young nurses for basic clinical tasks like taking a manual BP. Valuable clinical knowledge can be obtained by taking manual measurements, and all nurses should be proficient at this skill. In addition, they should be routinely correlating electronic and manual measurements.

– Heather Mercer, RN, B.Sc. 
Kelowna, B.C.

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