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Letter from Zambia 3: A salutary lesson in the value of a team approach

Our students identified a potential risk to the patency of the patient’s airway

Our students identified a potential risk to the patency of the patient’s airway

Today, we took the teaching to the bedside. At the invitation of the Critical Care Unit we selected some of the patients that the students were caring for and asked them to practice their assessment skills by delivering an A-E approach of the patient’s condition and nursing and medical needs.

The aim of the session was twofold. Firstly, we wanted to demonstrate to the students that their skills and knowledge would now enable them make a significant difference to the way they were able to assess and plan care for their patients.

Secondly, we wanted to demonstrate to elements of the care team, who can sometimes be dismissive of the nurse’s role in holistic patient management, that critical care nurses can and do make a difference to patient outcomes. Although we had no way of predicting the success or otherwise of this strategy, we were delighted with how the session unfolded.

The first patient that the students assessed had been ventilated on the unit for a significant amount of time. Following a detailed examination of the patient the students drew up a number of nursing and medical interventions that were required to manage the patient’s care during the following 8 hour shift.

Proactive

Most importantly for us was that they were proactive in their care management both recognising and feeling confident in raising concerns regarding the patient’s condition directly with the medical team rather than waiting for the medical team to take the lead during routine rounds.

During their detailed examination the students observed that the cuff of the patient’s tracheostomy tube was not inflated. They were invited to consider the possible reasons for this, i.e. damage to the tube or as part of a weaning management plan. But most importantly they identified the potential risk to the patency of the patient’s airway.

The students took the lead in briefing the doctor and as a result of their intervention the decision was taken to change the tracheostomy tube.

This was a significant moment for our students and we hope that on reflection, they had felt empowered by their actions. Whilst the risk to the patient may well have been identified by others later in the day, we reasoned that due to the nature of the unit, where patients numbers can increase dramatically over a short time period, together with the lack of qualified staff (critical care nurses can typically be expected to be caring for up to 4 patients at a time), the intervention had been significant. 

The students observed the changing of the tracheostomy tube, for some the first time they had seen the procedure in a ventilated patient, and confirmed that they had found the session a salutary lesson in the value of the team approach to managing patient care.


About the authors

   

Major Chris Carter (pictured) is a critical care nurse and nurse educator at the Defence School of Healthcare Education, Department of Healthcare Education, which is co-located at Birmingham City University, UK

Kevin Crimmons is an Associate Professor, Head of Adult Nursing, Birmingham City University, UK

Major Sue Viveash is a Nurse Educator at the Defence School of Healthcare Education, Department of Healthcare Education, which is co-located at Birmingham City University, UK.

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