With all the information bombarding you daily, there is no way you or any nurse can know everything. Even if you have specialized in one area for your entire nursing career, you are still going to need to look up something sometime. But how do you find out what you don’t know you don’t know? Answering this question involves nurse mentoring each other.
Several nurses were discussing why an elderly, demented resident, Ethel, had recently begun striking out at the CNAs who got her up for the day. Was it their approach? Did Ethel not like getting up? Ethel was no longer able to speak so we needed to figure out the answer without her input.
Her nurse, Lynn, said emphatically, “She’s not in pain!”
“How do you know that?” I asked her.
“I just know,” Lynn replied.
“But how do you know? What signs and symptoms lead you to believe Ethel is not in pain?” I pressed her to support her statement.
“She does not moan or grimace when we touch her.” Lynn stated.
Now we were getting somewhere. Lynn was explaining how she reached her conclusion.
“So, everyone who is in pain will moan or grimace? How do we know Ethel is not in pain? Why is she striking out?” I challenged her. I wanted Lynn to think about alternatives.
When Lynn did not have an answer, I proposed an experiment. “Pretend, Lynn that your right shoulder hurts. However, because you are demented, like Ethel, you cannot tell me it hurts. What are you going to do if I grab that shoulder?” I reached over to Lynn and lifted her right shoulder.
“I would shove you away.” Lynn responded.
I had made my point. Now it was time to test our hypothesis. We obtained an order for an analgesic to give Ethel an hour before she usually got up. Within a few days Ethel had stopped hitting.
Through this experience, Lynn discovered something she didn’t realize she didn’t know. Nurses, continue to learn by making sure you follow the nursing process. Gather information from the patient, their family and the patient’s chart. Be careful not to make assumptions or jump to conclusions. Look up anything you don’t know about the patient’s diseases, treatment or medications. Think critically. Get input from other nurses. Constantly question if your nursing diagnosis is correct. Chose and evaluate your interventions carefully. Then you will discover what you didn’t know you didn’t know.