15 Jul DEFLATION OF TRACHEOSTOMY CUFF FOCUSING ON COMMUNICATION AND COMPETENCE
1) Read the case study, “Hospital’s Duty to Ensure Competency” on pages 183-184 in the textbook. 2) Write a paper that addresses the case study’s two Discussion prompts. Include a detailed rationale for your answers. 3) Prepare this assignment according to the APA guidelines found in the APA Style Guide, located in the Student Success Center. An abstract is not required. 4) This assignment uses a grading rubric. Instructors will be using the rubric to grade the assignment; therefore, students should review the rubric prior to beginning the assignment to become familiar with the assignment criteria and expectations for successful completion of the assignment.
Instructions given for essay : “1500 word ( 10% additional words are permitted) reflection which focuses on at least 2 of the 6cs of nursing ( I have chosen communication and competence) the chosen area for reflection should demonstrate application of your knowledge and to analyse the evidence to include discussion about how this impacts on your personal responsibility and professional codes of conduct within your role and future practice You must also include an action plan as an appendix that critically analyses personal and professional development. Your student number should appear at the top of every page (no name as they are marked anonymously) STUDENT NUMBER 15970921 You should include a word count at the end of the work The word count includes all text from the first word of the essay to the last(including tables and citations, quotes and lists) but NOT including referencing NOR appendices.” This reflective essay will be adopting Gibbs Reflective Cycle (2008) which allows a systematic and structured analysis and reflection of an event. The model was created by Professor Graham Gibbs and appeared in Learning by Doing (1988). Confidentiality has been preserved by anonymizing the patient in accordance with the NMC Guidelines (NMC Jan 2015) stating that nurses should act in accordance with the code, using an ethical and legal framework to ensure patient well-being and respect confidentiality and he will therefore be referred to as ??Jesse? throughout this essay. This essay focuses on the difference in 2 practitioners with very different outcomes and my assumption that the first time I witnessed this procedure being performed, it was the best practice. However, less than 24 hours later, the same procedure was carried out on the same patient and the outcome was very different. I feel this was due to the increased communication and competence of the second practitioner with the patient and myself as the second person assisting rather than observing and it led me to reflect and research the correct protocol. (description) Jesse had been admitted to the ward from ICU following suffering a SAH (Sub-arachnoid haemorrhage) 2 months previously. He had a tracheostomy in situ and with recent recorded decreased secretions and Jesse being more alert and responsive and communicating through eye blinking and smiles appropriately, it was felt that a trial for deflation of the tracheostomy cuff would be carried out to assess tolerance of airflow through the upper respiratory tract. The inflated cuff does not allow the patient to speak and swallow. Jesse was in a vulnerable position due to lack of verbal communication and therefore time was needed to ensure he understood exactly what was about to take place along with the possible outcomes. (feelings) During the procedure with the first practitioner, I felt uncomfortable as he did not converse with Jesse or explain what he was doing but appeared nervous himself and depended a lot on observing the vital signs on the monitor and was lead by these. I felt that maybe he was not competent with this procedure and also maybe felt uncomfortable with me observing. He consistently watched the pulse rate and the saturated levels in oxygen and when Jesse started to cough and his pulse became raised and oxygen levels started to drop slightly, he just said that Jesse was not tolerating the deflated cuff and he immediately inflated it again. When he left the area, Jesse and I looked at each other and he smiled. I told him that maybe it would take a while for him to tolerate the cuff deflated and that it probably was not unusual for this to happen at first attempt. I also told Jesse I had not watched this before and I thought he had done well throughout the procedure. I then thanked him for allowing me to watch. However, when I watched the same procedure the following day, the whole procedure was a completely different experience for myself and the patient. The practitioner introduced herself and me and explained exactly what was going to happen and what both our roles would be. She had already asked if I would assist her as it is easier with 2 people working together. As she explained and reassured Jesse continuously, she asked me to deflate the cuff as she used the suction whilst watching Jesse??s face continuously. She told him it would be uncomfortable and irritating as the air used the upper airways again and that coughing was expected. As he coughed, she reassured him and said it was all going well. With this comfort being given, Jesse listened well and as instructed took deep breathes in through his mouth. He did cough but recovered quite quickly and then continued to breathe calmly through his mouth and nose. Throughout the procedure, I held his hand and the practitioner rubbed his arms and chest reassuringly. The practitioner continued to talk to Jesse and myself and we had a three way conversation with Jesse giving feedback with eye blinking and smiling. We waited a full 10 minutes with observations of Jesse??s vital signs being taken once. Once the practitioner was happy that Jesse was comfortable, she explained to him what would be the next steps and again told him how well he had coped with the procedure, she left. I remained with him for a further 10 minutes and we talked about how it must feel weird using the upper airways again after have the tracheostomy in for so long and he smiled and nodded in agreement. I felt extremely happy with the outcome and saw the importance of confidence and competence as well as the continued communication with the patient. (evaluation) To enable individuals to maintain maximum possible of independence, choice and control, communication has to be sustained at the highest level possible. The practitioner should be confident and competent with the procedure they are to undertake and should follow all protocols of the trust at all times, whilst showing compassion to the patient, maintaining eye- contact and giving reassurance both physically and verbally. I will in future find the courage to discuss my concerns with my colleagues and other professionals to ensure that good practice is always delivered and that if I feel uncomfortable about another practitioner??s performance, then I will speak up. Analysis Communication is seen as a fundamental component and language difficulties can lead to insufficient care and poor quality nursing (Jirwe et al. 2010, Jacobs et al. 2006) Communication is therefore central to every interaction with a patient. Non- verbal cut-offs should be avoided and consultations should always allow the patient to feel involved with the care they are receiving and feel warmth and compassion from the care giver. (British Journal of General Practice 2015) Conclusion Based upon the literature reviewed during the analysis, it is evident that the first practitioner did not view the procedure holistically and involve Jesse fully in what he was carrying out. Maybe the outcome would have been different on the first attempt if Jesse had had the procedure explained and eye contact had been maintained in a calm and relaxed manner giving him confidence in the practitioner. Over the past few years, more patients with tracheostomies are being cared for on wards rather than in Intensive care settings due to the demands for these beds. (Russel C., 2005). However evidence suggests that there has been a lack in additional training in knowledge, skills and therefore confidence to meet the unique needs of these patients safely and adequately and patients care can sometimes be compromised as a result. (Paul F., 2010) Effective communication is challenging for patients with tracheostomies and therefore extra time should be taken to reassure the patient by means of verbal and non verbal communication (ie. : gestures, sign language, pointing, facial expressions or even pen and paper or flash cards). Patients with tracheostomies can be challenging and nurses and other practitioners should ensure they gather experience and knowledge and take appropriate training both theoretically and practically in this area. They will therefore become more competent practitioners. References British Journal of General Practice, June 2015. Bringing Research to General Practice. Gibbs, G. 1988. Learning by Doing. A guide to teaching and learning methods. Oxford: further Education Unit, Oxford Jacobs,E., Chen,A. H.M.,Kaliner,L.S., Agger-Gupta,N.et al. 2006. The need for more research on language barriers in health care: A proposed study research agenda. Millbank Quarterly. 84 (1), pp. 111-133 Jirwe,M., Gerrish,K., and Ermami,A. 2010. Student nurses experiences on communication. Journal of Caring Sciences (3) p435-444 Nursing and Midwifery Council, 2015. The NMC Code of Professional Conduct: Standards for Conduct, Performance and Ethics: Nursing and Midwifery Council. 1. Russell C (2005) Providing the nurse with a guide to tracheotomy care and management. British Journal of Nursing 14(8): 428??433 [Abstract]
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