Fool's Foils for Fasciculating Fingers

 

 

This problem was never addressed in nursing school and I have also never seen it in a textbook. It was never even discussed among nurses until I began working in the operating room.  We were like a family, albeit dysfunctional, but there was a sense of being more open with our problems. No, the problem isn't drugs or sexuality. It's hand tremors.

This is for you that have  been in a situation where someone is yelling, Get that blood going STAT.  You just got a beautiful dark red blood return in that flash camber of that #18 Angiocath.  Now it's time to start threading it into one of the last remaining veins and YIKES!  My fingers won't stop shaking.

If you're in nursing abomination administration, or any other non-bedside care area of nursing this is not for you. This is for nurses in the trenches, under stress, and that care about their patients to the point of being self-sacrificing. It's definitely disconcerting when you have to perform a task and your hands shake. Exacerbating factors include being tired, stressed, or harangued. Things you encounter everyday. Here are some tips that helped me with this problem.

When you're threading that angiocath, hold it between your thumb and index finger while your other 3 fingers are in contact and braced by the patients arm. Most everyone intuitively does it like this but it does help if you think about being stabilized by being in contact with the patient. This also helps if the patient jumps or moves.

Limit caffeine, this is hard but does work. Avoid alcohol.

Keep your arms adducted and braced against your body when possible. Limit the distance you reach out. For me, the further I reached away from my body, the worse the shaking.

Keep your hands warm. This is another good reason for handwashing. Being cold really exacerbates the problem of involuntary tremors.

In the OR practice handling the instruments. Be able to open and close clamps and needle carriers without  having your fingers in the holes.  Practice extending your index finger straight up to the pivot hinge on the scissor to guide and stabilize it. When loading a needle holder don't worry about getting it positioned in the jaws right away. Swing the needle over to contact the needle holder and slide it up the side to the jaws, finally adjust the angle of the needle in the jaws. You can do this very quickly without loss of speed.

If you have to do something one-handed like cut a suture for the surgeon don't over reach. Get in as close to you can and stabilize that free hand on something like a mayo stand or retractor. Think of that steady support as your anchor. This really helped me.

Verbalize  your shakiness if appropriate. Our chief of surgery would when the occasion warranted it yell out "My hands are getting tired and shaking"  His hands always stabilized after acknowledging the problem. This won't work in the ER with patients around, but you can say this to yourself and it does work.

When capping a needle, angle the cap upward, brace the base of your thumbs together and deliberately bring the needle down onto the cap, then slide the needle into the cap. That way you won't have to worry about exactly lining up the needle with the cap.

Put a calm relaxing spin on whatever is in your physical environment. I used to imagine those hot, bright OR lights were beaming down from heaven. I learned this trick from an old time surgeon and discovered you can put a good spin on just about anything. Whenever the s--- hits the fan, there are usually bright lights somewhere, so this can work in other places too.

If you're wearing gloves imagine them stabilizing your hands and fingers. I think they may actually do this, but that probably borders on being delusional.

I did google this issue for a contemporary take on hand tremors. About the only thing suggested was Beta blockers. This probably does work, but in critical areas of nursing you need all the sympathetic tone your nervous system can muster. Bad things usually happen very quickly and you don't need anything slowing your response.

Try not to develop spasmophobia where you overthink or worry about your hands shaking. You are in very good company if you have this problem. Florence Nightingale's hands probably shook  when she made her rounds in that Crimean battlefield hospital.

This problem is a manifestation of how much you care for your patients and that you are doing real nursing at a patient's bedside. Nursing bigshots, administrators, and indusrtrialists never had to worry about their hands shaking or even getting anything  under their manicured nails.  The bedside nurse is where the rubber meets the road.  You are the person getting things done.