The Power of Observation: Small Changes, Big Impacts in Patient Care
Small, sometimes overlooked signs can make all the difference in patient care
Top Winter Clinical Skills to Master
Over the next five weeks, we will cover clinical skills that must be mastered. Here is the list of what we are covering:
This week: The Power of Observation
Comprehensive Clinical Assessment Skills: physical assessment, infection control, and prevention
Medication administration Proficiency
Clinical Judgement
Effective communication and Patient Education
Upcoming WEBINAR! Reserve your spot today!
Webinar: Vital signs Gone Viral
When: January 23rd at 4 pm.
Costs:
$25: Early Registration
$30: After Jan 6th with video replay for two weeks
$35: VIP package Q & A with Rhoda after the webinar
$50: Lifetime access to the video replay
———————————————-
As a nurse, you are often the first line of defense when noticing subtle changes in your patient’s condition. These small, sometimes overlooked signs can make all the difference in patient care.
Part of being a good nurse is being observant and curious..Even the most minor changes in a patient’s condition can reveal more significant issues—such as early signs of infection, cardiac complications, or neurological decline.
Today‘s blog encourages you to become observant in your regular life. It also encourages new nurses and NCLEX students to develop sharp observation skills. Say you are at the grocery and a robber comes in. What can you remember about what he wore, or how tall he was, etc.? Pick someone in the store when you are shopping and have your family or a friend help you see how correct you are.
Effective nurses use all their senses to detect even the most subtle changes.
Why Observation Matters:
Nurses must rely on more than just vital signs or charts. Effective nurses use all their senses to detect even the most subtle changes.
Key Points to Observe:
- Changes in behavior (restlessness or confusion is more likely due to low oxygen levels, or medications - if new meds were just added or if a procedure was done)
- Physical signs (color changes: blue - low oxygen, red - increased temperature, sweating - change in blood sugar or blood pressure)
- Subtle vital signs (a slight increase in heart rate, blood pressure changes)
- Non-verbal cues (gripping the bedrails, facial expressions)
Case Study
Case Studies – How Small Observations Save Lives
Case Study 1: Subtle Change in Mental Status
Scenario: A new nurse notices that an elderly patient, typically alert, is becoming disoriented and confused. The nurse also observes that the patient cannot recall the day or recognize their family member.
Action: The nurse immediately reports this change to the doctor. Upon further examination, it’s discovered that the patient is suffering from early signs of sepsis, a life-threatening infection. The early intervention prevents further complications.
Lesson: Observation of subtle changes in mental status can be a critical sign of infection or other conditions, leading to early diagnosis and better outcomes.
Case Study 2: A Small Drop in Blood Pressure
Scenario: A nurse notices a slight drop in blood pressure in a post-operative patient who has been stable for several hours. The drop doesn’t seem extreme, but it’s enough to raise concern.
Action: The nurse alerts the surgical team, who orders additional tests. It’s discovered that the patient is bleeding internally, and immediate action is taken to address the issue.
Lesson: Small changes in vital signs, such as blood pressure, can indicate a developing problem, such as internal bleeding, that may not be immediately obvious.
Case Study 3: An Unexpected Change in Breathing Pattern
Scenario: A nurse observes a post-surgical patient’s breathing becoming labored and irregular. The patient has not expressed pain, but the nurse notices a rapid increase in respiratory rate.
Action: The nurse investigates further and discovers signs of a pulmonary embolism, an emergency condition that could be fatal if not treated quickly.
Lesson: Observing small, seemingly inconsequential changes, such as an irregular breathing pattern, can indicate serious underlying issues, like a pulmonary embolism.
How can you hone your observational skills?
Developing Strong Observation Skills
How to Hone Your Observational Skills:
Practice Active Listening: Pay attention to what patients say and how they say it (watch their body language).
Cultivate Awareness: Stay observant of all your patients’ behaviors and reactions, no matter how minor they seem.
Make it a Habit: Regularly assess your patient even when there are no apparent signs of distress.
Use Technology Wisely: Utilize patient monitoring systems and EHRs, but don’t rely solely on technology to alert you to issues.
Stay Calm and Focused: A calm and focused nurse is likelier to notice small changes.
Grab your own copy of the Observation Checklist!
To help new nurses and NCLEX students develop their observational skills, here’s a downloadable checklist to guide your observations during each shift: downloadable form in the comments
Observation Checklist:
Patient Behavior:
☐ Is the patient unusually restless or anxious?
☐ Are they confused, disoriented, or unable to recognize familiar faces?
☐ Have they mentioned any new or unusual symptoms?
Physical Changes:
☐ Have you noticed changes in skin color (pale, flushed, cyanosis)?
☐ Is there swelling, bruising, or any unusual lumps or bumps?
☐ Are there changes in posture or facial expressions (grimacing, guarding)?
Vital Signs:
☐ Are there any fluctuations in vital signs outside of normal parameters?
☐ Is there an increased heart rate or a drop in blood pressure?
☐ Have you noticed irregular breathing patterns or changes in oxygen levels?
Non-Verbal Cues:
☐ Is the patient gripping the bedrails or showing signs of discomfort?
☐ Are they taking shallow or avoiding deep breaths (signs of pain)?
☐ Are they hesitating to speak or respond when asked questions?
Overall Impression:
☐ What does your gut instinct tell you? Trust your intuition.
Let’s decide now at the beginning of the year to work on our observation skills. To use our observation skills and remember that they are invaluable in identifying and addressing early signs of complications. These small changes can have a significant impact on patient outcomes.
Be sure to use your observation checklist in your daily routine to improve your clinical skills.
** When can you remember the last time you caught a small change in a patient’s condition that led to better care or saved a life?
Let us know your thoughts in the comments below! Your answers will be hidden in our poll. Please click the link in the comments to take the poll - it’s only three questions!.
Let’s Keep the Conversation Going!
We’d love to hear from you! Feel free to leave your comments or questions below—let’s make this a conversation!
If you are not on our email list, click the contact link here.
Comment below!
I invite my readers to join a discussion in the blog comment section to share tips and support each other in developing this essential skill.
Share your thoughts and experiences in the comments:
When can you remember the last time you caught a small change in a patient’s condition that led to better care or saved a life?
How will you practice daily observation?
Any tips or stories you'd like to share with your fellow new nurses?
Ready to embark on this learning journey? Let's make this learning experience interactive and fun!
Share your answers in the blog comments to learn from each other.
Don’t forget to follow me on my Instagram account @nclex_one_on_one_tutoring and share it with your colleagues!
