Full Moon in the ER

            Hello everyone! Last night I was back in the ER again, and we tried something a little bit different with our project; instead of screening only older adults presenting with confusion or delirium, we decided that we would do a convenience sample and screen every older adult in the ER that was over the age of 65 so that we can determine the prevalence of mental status change as well as determine which screen works the best.

            But so far, no one screen has worked the best; I believe this is because every patient is different and their situations and conditions are unique, so the test that worked for patient 1, might not be the best one to use for patient 2 even though they appear to be presenting the same way.

            This is a very important discovery, because often times only one screening tool is used and many cases of delirium and/or confusion are missed. Also, we added a 4^th screening tool called the TRST tool, which is a good indicator of patients that may return to the ER because of a history of falls, trouble with medication adherence, and difficulties with instrumental activities of daily living.

            We did about 5 screens last night and they went very well! It was a little crazy in the ER last night, I’m not sure if it was because of the full moon or Halloween…but it was very busy and fast paced. It was a lot of fun though! I plan on going back to the ER on Friday to continue with my project. 

Off Week

            Hey guys! Not much to update you on this week, as it was an off-week for me in the ER. Although I miss being active in my research, it was also fabulous to have a week to catch up with some school work since a lot of my assignments have somehow caught up with me this semester! I’ll be back in the ER next week though, so be sure and stay tuned for more updates and stories about my experiences!

Modifications and Encouragement

            Hello again! This past week has been very busy for me and for our research project! As you already know, last week was the pilot for our data collection form, which showed me areas in our form that needed to be modified in order for the collection of data and the script I use to be more fluid and user-friendly.

            Modifying the data collection form was a LOT easier said than done! The first thing that I did with our form, was turn it into a packet by consolidating all of the screening tools into one document. This sounds simple, but the saved forms that I had, couldn’t be copied and pasted into my new document due to their formatting, so I had to type up all of the forms manually. Which again may sound simple, but trying to manually figure out proper spacing and font size, etc. is a pretty tedious task, especially for the “technologically impaired”, such as myself! In addition to putting all of the screening tools in one place, I made some changes to the patient information section. Although I did not get a chance to test out my revised collection packet this week, I can already imagine how much better it will work for us, and for the future members of the health care team that may adopt our screening tools.

            On a side note about my project, I helped out with some of the activities at the UAB School of Nursing Alumni Weekend, and when talking with some of the more “seasoned” nurses there about my project, I was surprised at all of the interest and encouragement they all had for my project; all of them said that monitoring for cognitive changes in the elderly is so important in actual practice and that they were thrilled that I was pursuing this topic. Hearing the praise from these nurses that I aspire to be, really meant the world to me and made me excited all over again for my project and the opportunities and experiences I’m gaining because of it. 

A snapshot of how "organized" the modification process was 

Full Speed Ahead!

            Hey everyone! So yesterday I was finally able to pilot the data collection form, and all of our screening methods we’ve put together! We piloted the study on one elderly patient with alterations in mental status.

            I was pretty nervous at first going in there and trying to collect various data and use the screening tools for the first time! I can definitely appreciate role playing and making a script before hand now…which is something I’m going to make sure to do before next week when I go back. But hey, you can’t run without trying to crawl first, right?

            Yesterday also showed me areas on our data collection form that I need to modify to make for more fluid documenting and questioning, and rather than having 3 separate screening tools and a data collection sheet, I am going to figure out a way to consolidate all of that into one “data packet” per patient. I’ll probably start to work on the consolidation process tomorrow after I plan out how I want to do that today.

Part of our data collection is following through with the patients we collect data from and seeing where they are discharged/admitted to, which requires me to stay with the patient and monitor them and what happens to them from the time of admission until discharge; this can be a pretty long process, but the experience is invaluable because no two patients (even the ones that present the same way) are medically treated the same. The next few times that I go to the ER, I will be going at night (between 10pm-7am) so that we can get a wide variety of patient data, not only data from patients who come during the day.

            As for my experience in the ER, I absolutely loved it! The entire ER team was so welcoming and helpful! After only being in there for not even an hour, it was easy to tell that the team really is a family. Apart from collecting data from the elderly patient with alterations in cognition, I was also exposed to many emergency situations, learned some good lessons about charting, how to communicate with various members of the ER team (including the police officers and EMT personnel), and I learned a lot about how to prioritize nursing actions. I think the most important thing I learned yesterday was how to communicate with patients who are confused or delirious and how to monitor for mental status changes in those patients; this is going to be something that I can take with me throughout my nursing career no matter what field I go into.

            Another exciting thing to come out of our project is the possibility of presenting it at the NICHE Conference in Philadelphia in April of next year as well as presenting it at the UAB Expo, also in April! I never in a million years would have thought that I would be involved in something so important and groundbreaking, but I wouldn’t trade this experience for the world.

            I look forward to seeing our project grow and progress over the upcoming months and I can’t wait to see the results of everything that we’re doing! Exciting things are happening in the ER at UAB! J

 Dr. Kellie Flood and myself

Everyone working hard in Pod 3 in the ER at UAB

If there is no struggle, there is no progress...

          Hello again everyone! Well, this week didn’t go quite as planned as a huge miscommunication set me back until next week. However, this has shown me the importance of thorough communication and being "Gumby". I know that everything happens for a reason, so maybe I just wasn’t meant to start until next week. Speaking of next week, my fall break is on Thursday and Friday, so hopefully I can get plenty of hours in during that time to make up for the time I lost this week. I’m still very excited to get started!