Improving Nurses Skills Regarding Airway Management - Term Paper Example

Improving Emergency Nurses Skills Regarding Airway Management Name Institution Improving Nurses Skills Regarding Airway Management Airway management is a vital skill for health care practitioners taking care of the critically sick or injured patients and is thus, a basic routine of emergency medicine. According to Kennedy and colleagues (2014), emergency nursing skills are crucial to the well-being of the patient. Among all health practitioners in the hospital setting, nurses spend more time with the clients, caring for them. Therefore, an emergency department nurse is bound to come across cases where the client will need airway management. To enhance the quality of services offered in healthcare, nurses should stay updated on the current and improved techniques of airway management. This project focuses on improving emergency nurses’ skills regarding Airway management of an individual aged over fourteen years old. Acquiring the practical proficiency will be essential in enabling efficient tackling of risk situations in the clinical setting leading to enhanced understanding of critical methods used to intubate patients that both professionals and students can learn (Amiel et al., 2016). Additionally, the process would ensure mastering of the area of practice for a deeper understanding of all the characteristics of the airway and the necessary care. By being competent and knowledgeable in practice, the nurses would be able to foster life-saving activities. Hence, the project will focus on emergency nurses with the use of various relevant tools such as videos and manuals to expand their skills in airway management. The exercise aims at achieving a clear understanding of the up to date techniques of airway management in a patient aged over fourteen years for the delivery of quality nursing care in emergency medicine. Background Airway management was initially the work of anaesthetists majorly done during surgeries; the professionals would undergo a minimum of three months during in the early times. However, around the 1980s attitudes as well as the extent of knowledge started changing and several emergency units started using advanced airway techniques such as rapid sequence intubation (RSI) among others (Falgani, Kennedy, & Jahnke, 2014). There have since been recurring calls for enhancement in the airway training of Australian emergency health care providers as well as all over the world, especially, physicians and nurses. Several hospitals have adopted a system to ensure the education of professionals. Acquisition of the skills would be able to offer a more seamless crossing point between the emergency units and critical care departments. According to Garmon and colleagues (2017), given the scarcity of anaesthetists in Australia, emergency nurses and physicians should be able to handle all airway interventions in the department. Therefore, there is need to foster a deeper understanding of airway management among nurses to ensure that they are comfortable with handling any situations requiring the interventions. The matter of comprehension of airway anatomy among different health care practitioners is essential in managing emergencies. In the delivery of health care, teamwork is quite crucial for effective communication and provision of quality care. However, Hubert and colleagues (2014) note that the straining communication between airway experts and other primary service providers such as nurses is as a result of non-standardized jargon, the hurried pace and intrinsic confusion of emergency situations. As a result, there is a lack of sufficient knowledge on airway management among nurses working in the emergency department. To offer consistent and quality care, it would be necessary that the health care providers in the unit have a flowing and unconstrained communication. The latter is only possible if primary care providers including nurses can understand the airway anatomy and the techniques for interventions. Constant reviewing of the knowledge and skills is also vital to ensure they are up to date. Severely ill patients presenting to the emergency department often have a risk of acute respiratory obstruction among other complications. Airway emergencies can present with hypoxia and anoxia that can lead to permanent brain damage in a short time. If the primary caregiver has no sufficient training in how to intervene during such events, the life of the patient is at great risk. Also, the practitioner may have the training but due to a lack of confidence, make mistakes that may cost the client’s life. Hence, it is essential for nursing, medical, and other providers to understand main points in airway anatomy and management to avoid momentous mortality and morbidity. Continuous review and training of nurses in the emergency department on airway management would not only build their confidence and understanding but also allow them to appreciate the significant of evidence-based practice founded on the expansion of one’s knowledge (Kennedy et al., 2014). According to Amiel and colleagues (2016), the capacity to offer quality emergency care services is dependent on a well-trained workforce. In the modern day, there is an increasing momentum for improved emergency medicine as a field. The World Health Organization (WHO) has called attention to the significance of the ability of health care facilities to provide excellent care, acknowledging the growing inference for public health given the growing problem of traumatic emergency conditions among others. Nurses present the fortitude of the emergency care workforce, comprising the majority of practitioners working in the units. Hence, improving emergency nursing capacity necessitates a thorough consideration of the functions of the professionals as well as the skills they acquire. By looking at the situation from the aforementioned perspective, systems can be put in place to improve nurses’ skills in airway management effectively. According to Falgani, Kennedy and Jahnke (2014), the lack of autonomy in decision making is part of the reason several emergency nurses are not well versed with airway management. Nurses’ autonomy tends to suffer great influence from power dynamics in the health care facility hierarchy. Instead of initiating nursing interventions independently, nurses rely on orders and guidelines from airway experts in the emergency departments. As a result, they are unable to build their confidence in handling airway emergencies. Therefore, though regular training, nurses can become proficient in the area and will practice autonomy in airway management. Consequently patient will be able to receive quality life-saving care in the units. Thus, to ensure nurses have a deeper understanding and knowledge of practice in their departments, improving emergency nurses’ skills regarding airway management is the aim of this project. Methods The project aimed at enhancing emergency nurses’ proficiency in airway management thus necessitating the use of tools such as video clips. The selected video clips showcase the step to step procedure that nurses can employ in airway emergency interventions. The videos also focus on airway anatomy which is a critical area of knowledge for effective practice. According to Garmon and colleagues (2017), nursing is a practical profession that has to match theory and practice. Therefore in nursing education, there is a need to ensure that the trainees not only understand the knowledge in the area but can also apply it in their daily operations. Hence, the use of video clips was essential for wholesome learning. The videos not only teach about various concepts of airway management, but they also demonstrate how to carry out the interventions. The video clips thus offer the necessary guideline for nurses to use in practicing airway management and at the same time provide a body of knowledge that promotes evidence-based practice in emergency medicine. Evidence (300 words) The project focused on a vast source of evidence to ensure efficiency in the achieving of the objective. Through the use of various sources of literature on emergency nursing practice and airway management, it enabled the development of the project based on a strong background of knowledge indicating the need for an intervention to enhance skills among nurses. The sources were mainly peer reviewed journals acquired from various valid databases. The journals focused on a collection of literature, studies, and results based on actual problems and solutions regarding the deficiency in knowledge and skill in handling airway emergencies among nurses. Therefore, using the knowledge acquired from the evidence, there was the identification of the steps to take in initiating the project successfully. On the project the use of video clips as a methodology that would enable wholesome learning was essential. Therefore, it was vital to ensure that the video clips used are valid and relevant about the objectives of the activity. Hence, the quality checklist for podcasts tool (See appendix) came in handy in assessing the quality of the video clips. A quality checklist for podcasts is a widely recognized tool used to evaluate the quality of health professions training resources. The tool provides a guideline on factors to consider in checking for the validity of the resources used in the project. The process was vital since health care is a sensitive field concerned with the wellbeing of humans thus necessitating the use of quality and current material to educate trainees. The assessment of the excellence of the video clips was also crucial to ensuring that they are clear enough to meet the purpose of educating the targeted group. Hence, using a wide and valid source of evidence the project was able to start and continue effectively to the end for successful results in meeting the objective. Discussion The project was a significant learning experience on airway management. Predicting and recognizing respiratory decompensation is a critical step in emergency airway management. Hence, emergency nurses must be knowledgeable about the indications and methods for airway intervention and how to foresee difficulty in gaseous exchange. Through the video clips, it was clear that the fundamental approach comprises ensuring airway patency, safeguarding from aspiration, and giving sufficient oxygen and ventilation. There are various interventions that nurse can take during an airway emergency. The care provider should be able to assess for indicators for endotracheal intubation such as stoppage or imminent collapse of oxygenation or ventilation, airway obstruction, incapacity to maintain the airway, probability for clinical worsening, and delivery of medication. The airway, breathing, and circulation (ABC) are the basis for initial response to airway emergencies as they guide the assessment and intervention process. Lesson Learnt From Each Video Video 1 talks about the first the steps of airwave response that include the opening and clearing of the airwave. The clearing is done using the head tail chin limb where the physician places one hand on the head and the other on the chin while tilting the head back and lifting the chin to open up the airwave. This method is recommended for patients without head trauma. Jaw thrust manoeuvre is used in patients with suspected head injury. In this method, one places the finger on the angles of the lower jaw and lifts the head up with both hands. The seconds step is clearing the airwave to remove foreign materials and secretions using a large suction catheter. The third step is maintaining the airwave using an airwave adjunct. There are two types of airways; the Oropharyngeal Airway (OPA) used in patients who are unconscious and lack gag reflex while the Nasopharyngeal Airway (NPA) is used for unconscious patients who have a gag reflex. The second video talks about the endotracheal tube which is the optimal method of managing the airwave during cardiac arrest. Wrong intervention attempts may lead to hazards like trauma to the oropharynx, incorrect placement in the oesophagus, and prolonged interruptions in compressions and ventilations. However despite these hazards, there are several benefits of the endotracheal tube including keeping the airway patent, allowing suctioning of the airway, delivering high concentrations of oxygen, providing an alternative route for drugs should intravenous method fail, and protecting airway from aspirations. The third video talks about the laryngeal mask airway that is a supraglottic device that can be inserted without visualizing the glottis while chest compressions continue uninterrupted. The laryngeal mask airwave is a tube with an inflatable mask placed in the patient’s mouths. Before using the mask the tube should be deflated to ensure there are no folds and lubricated at its base with a water soluble lubricant. The mask is placed at the roof of the mouth with the base facing down. The mask is then inflated to provide oxygen into the trachea. A lack of chest rise with ventilations is an indication of folding of the mask or it being shallow. In this case, the mask should be reinserted. Partially inflating the mask during insertion helps to prevent folding. My Reflection I ran an education session with the emergency department nurses on airway management in an adult, that is, a patient aged over fourteen years old. I did a lot of research on the topic to ensure that I delivered adequate content that would have an impact on the skills and practices of the nurses and my peers as well. I was a bit nervous because I was not sure whether they would appreciate the input or some would end up not showing up by looking at it as wastage of their time. However, I was impressed by the turn-up, so many emergency nurses showed up for the activity including students. I was able to divide the sessions into two to ensure that everyone had a chance to participate without having to abandon their work. My key teaching methodology was the use of video clips. I started out by introducing myself and reviewing the aim of the project and its significance in nursing practice. Most of the trainees acknowledged that a lot of emphasis was put on paediatric airway management while that of adults was given little attention due to the presence of experts that would handle the emergencies. However, there was a growing need for airway management skills among emergency nurses with the increasing trauma and critical conditions burden. The nurses were grateful that someone had taken the initiative to look for the relevant material and initiate a training session in the facility. Having established the readiness of the trainees to learn I was able to take them through the process. We watched the videos and later practiced the skills we had learned on mannequins. It was not an easy experience trying to learn the techniques. St some point, I felt the pressure to exhibit perfection since I was the one who had initiated the training session. Many nurses would come to ask me to help them master the procedures. However, I was able to work with airway experts who volunteered to join in on the sessions and elaborate where necessary. As a result, we were able to have a fruitful learning experience and peer-teaching exercise that imparted airway management skills among emergency nurses. Through the project, I was able to learn that practice is a vital aspect of learning nursing skills. The airway management procedures are not that difficult, however, with the tension during emergencies one could easily make terrible mistakes that could lead to morbidity or mortality. Hence, it was vital to frequently engage one’s skills in the field to gain the confidence to intervene during emergencies efficiently. After the session, the chief nurse of the emergency department gave a speech on the importance of continuous learning and improvement activities in nursing. She reminded us that health care is a frequently changing area of study with new techniques coming up all the time. She emphasized on the significance of staying up to date and going beyond one’s abilities to foster nurses’ autonomy in practice. The project was a complete success as the nurses were able to demonstrate mastery of airway management skills through practice sessions. I was also able to learn the importance of team work in nursing and other medical professions. By working together to meet the objective of the project each person was able to learn an essential skill and also get the chance to pass the knowledge to others. Conclusion The project was successful in meeting its objectives. A large number of emergency nurses were able to show up for the learning session. However, some who were not on duty during the two sessions complained that they missed out on the experience. To ensure that more nurses can get the knowledge on airway management, the head nurse of the department received copies of the videos and manuals that are relevant to the training. Hence, during their availability, more nurses including those working in other departments will be able to learn on the topic. The project pointed out the fact that there is a clear lack of adequate knowledge and skills on airway management among nurses that limits their confidence to practice independently. Thus, more initiatives to enhance proficiency are necessary to build the confidence of nurses to deliver quality care autonomously. Airway management is not a field only relevant to the emergency department but also other units as all sick patients are at risk of complications. In the future, further input and research on clinical education are necessary to enhance the provision of quality services as well as evidence-based practice. Over time, nurses will be able to improve their skills by attending training sessions. References Agarwal, A., Marks, N., Wessel, V., Willis, D., Bai, S., Tang, X., & Carrol, J. L. (2016). Improving knowledge, technical skills, and confidence among oediatric health care providers in the management of chronic tracheostomy using a simulation model. Pediatric pulmonology, 51 (7), 696-704. Amiel, I., Simon, D., Merin, O., & Ziv, A. (2016). Mobile in situ simulation as a tool for evaluation and improvement of trauma treatment in the emergency department. Journal of surgical education, 73 (1), 121-128. Falgiani, T.m Kennedy, C., & Jahnke, S. (2014). Exploration of the barriers and education needs of non-pediatric hospital emergency department providers in pediatric trauma care. International Journal of Clinical Medicine, 2014. Garmon, E. H., Stock, E. M., Arroliga, A. C., & Bean-Lijewski, J. D. (2017). Effects of training on resident physician emergency airway management skills. Canadian Journal of Anesthesia/ Journal canadien d’anesthesie, 1-3. Hubert, V., Duwat, A., Deransy, R., Mahjoub, Y., & Dupont, H. (2014). Effect of simulation training on compliance with difficult airway management algorithms, technical ability, and skills retention for emergency cricothrotomy. The Journal of the American Society of Anesthesiologists, 120 (4), 999-1008. Kennedy, C. C., Cannon, E. K., Warner, D. O., & Cook, D. A. (2014). Advanced airway management simulation training in medical education: a systematic review and meta-analysis. Critical care medicine, 42 (1), 169-178. Appendix 1- Videos Quality Video Title Video Quality Video Link ACLS Basic Airway Management The video is from reliable and certified producers of education content. The video presents content that is relevant and useful to the topic of airway management. The source is clear and designed in such a way that students can obtain adequate knowledge from it. https://www.youtube.com/watch?v=wZ2fbBOTvac ACLS Using Endotracheal Tube The producers are certified and recognized educational authors. The video’s design focuses on articulating the topic adequately to improve skills. The content is education and resourceful. https://www.youtube.com/watch?v=BNf5FtIU-5U ACLS Using LMA The video is credible as it is from certified authors and producers in medical education. The content is resourceful in learning and practicing airway management skills. The design is efficient for easy accessibility and clear view of the clip to acquire the necessary knowledge. https://www.youtube.com/watch?v=1vxc9BAXnF0 Read More