Professional Documents
Culture Documents
a specific client group. The skill was selected to underpin the appropriate
therapeutic interventions within the patients. The tracheostomy suction would be
reflected within this assignment by using a reflective model based on the
previous practice on the tracheostomy patients. The skill was focused on the
management of airway due to the blocked of the patients’ respiratory. As Siviter
(2004, p.165) explains the important of reflection is about gaining self-
confidence, identify when to improve, learning from own mistakes and behaviour,
looking at other people perspectives, being self-aware and improving the future
by learning from the past. I select to reflect and discuss this skill for my reflection
based on the past incidents because I want to improve my suctioning skill for
tracheostomy patients in managing airway for future practice. In order to achieve
the goal, the adequate knowledge underpins regarding the skill was essential to
be explored to offer the safe practice. Therefore within this assignment, the
knowledge that contributes to the way in performing the skill also been identified.
In this reflection, I would use Gibbs (1988) Reflective Cycle. This model
was a recognised framework for reflection. The essential of using model in the
reflection was supported by Brooker and Nicol (2003, p16) because it provided
the conceptual frameworks in structuring the nursing practice. As Gibbs (1988)
model consists of six stages to complete one cycle which is able to improve my
nursing practice continuously and learning from the experience for better practice
in the future. The cycle starts with a description of the situation, analysis of the
feelings, evaluation of the experience, analysis to make sense of the experience,
a conclusion of what else could I have done and final stage is an action plan to
prepare if the situation arose again (NHS, 2006). Baird and Winter (2005, p156)
state that a reflect is to generate the practice knowledge, assist an ability to
adapt new situations, develop self-esteem and satisfaction as well as to value,
develop and professionalizing practice.
Generally, tracheostomy is a preferable intervention to the patients which
involved in long term mechanical ventilation especially in the critical care
settings. McPhee et al (2008, p200) indicates the tracheostomy is done due to
the respiratory failure and the obstruction above the larynx. Therefore in order to
enhance the patients’ airway, the patients underwent the intubation procedure
under the surgical intervention. According to Barnett (2005, p4) tracheostomy is a
surgical opening in the anterior wall of trachea. The tracheostomy provided more
comfort to the patients by clearing secretions which could reduce the resistance
of respiration (Marino and Sutin, 2006, p495). Once the surgical intervention
done, the suctioning via the tracheostomy tube would be performed to assist in
clearing the blockage of the respiration airway. Furthermore, the tracheostomy
tube suction is a vital skill in a way to promote better and effective respiration for
the patients. Barnett (2008, p26) supports that the suction technique allow the
secretions out from the patients’ chest via the tracheostomy and consequently
provide the patent airway.
Therefore if the patients could not breathe through the tracheostomy tube
that indicated that there was blockage occurs in the tube. Since patients were not
able to cough or secrete by themselves, I performed the suctioning procedure to
assist in secreting the mucous. Barnett (2006, p6) identify the cough reflex had
been impaired because of the tracheostomy tube which prevents to clear the
secretions through coughing. Buglass (1999, p500) state that the patients could
not have the sufficient intra-abdominal pressure to cough due to the
tracheostomy. According to Barnett (2008, p25) mention that suctioning would
be perform due to inability of the patients to secrete the mucous on their own in
order to maintain the patent airway .The reason of performing the procedure was
related to the patients’ conditions which occur due to the respiratory problems.
The tracheostomy tube should provide the patent airway for tracheostomy
patients in breathing process. However as the patients need more oxygen, the
administration of supplemental oxygen was provided to improve the breathing
process. Therefore the continuous monitoring of saturation oxygen of the patients
via pulse oximetry was applied to show the reading of the oxygen level in the
body. The purpose of the tool is to measure the arterial oxygen saturation of
haemoglobin by continuously monitoring the patients’ oxygenation status (Editors
of Nursing2008, 2008, p42). The decrease of the saturation oxygen indicated that
patients were consumed the less oxygen even the administration of oxygen was
provided. This situation specified that the airway was blocked. During performing
the suctioning, the saturation oxygen was continuously monitored. Instead of
that, the figure could determine and note the differences of the oxygen level of
the patients before and after the suctioning. The purpose is to indicate whether
the patients responding to the therapy or deteriorate because the normal range is
between 98%–100% (Higginsons and Jones, 2009, p458). The suction catheter
was inserted intermittently to allow the patients consumed oxygen. However after
the suctioning performed, the saturation oxygen increased. This situation showed
that the tube was patent and patients did not require suction.
Apart from that, I could clearly observe the colour of the nail beds patients
changed. The normal colour of the nail beds’ patients were pink but gradually
changed to slightly blue. I analyzed that the patients had the peripheral cyanosis.
Hadaway (2009, p 50) determine the cause of cyanosis is due to impair venous
return in the lower extremity. Apart from that according to Martin (2009, p1)
cyanosis occurs when approximately 5g/dL of deoxygenated haemoglobin in the
capillaries produce the dark blue colour which also indicate of hypoxemia. Moore
(2003, p52) suggests that the size of the catheter should not be more than half of
the diameter of the tracheotomy tube in order to prevent hypoxemia. Therefore, it
shows that the correct size of catheter contributed to the effectiveness of
tracheostomy suction depend on the patients’ size of tracheostomy tube.
During the suctioning, the mucous were secreted out from the tube. I
noticed the colour of secretion during suctioning. Colourless, green and yellow
were the colour of secretion from the patients. According to Johnson et al (2008,
p452) those condition presented due to either viral or bacterial infection resulted
from the inflammatory cells or sloughed mucosal epithelial cell. The findings were
documented to the patients’ record and inform to the senior staff nurse. The
physician notified from the findings from the senior staff nurse and further
treatment was conducted.
I performed the further suction based on the same principle of actions but
using new gloves and catheter. This is recommended by Dougherty and Lister
(2004, p699) to repeat the same actions by using the new sterile gloves and
catheter. I disposed the used sterile gloves and catheter into the clinical waste.
Furthermore, Anderson (2006, p138) advises to use waterproof trash bag to
discard the gloves and catheter. Dougherty and Lister (2004, p699) explain that
the suction catheter should be used once in order to reduce the risk of infections
during suctioning. Moreover, Timby (2008, p854) suggest that the further suction
should be performed unless the saturation oxygen remained 95% and above.
Nazarko (2008, p121) explains that suction could enhance the droplet
transmission of infection. Therefore, the skill was performed in aseptic technique.
Evidence (Thompson, 2000, p6) showed that it is important to apply aseptic
technique when performing suctioning for tracheostomy patients in hospital. The
next consideration was the frequency of further suction could be performed. In
my experience, I did the further suction twice. According to evidence presented it
was recommended that the maximum of suctioning were twice (Thompson, 2000,
p5). However Nicol and Bevin (2004, p288) argue that the tracheostomy
suctioning should be repeated until the secretion and breathing sounds clear.
This situation leads to the ability of decision-making to apply the best practice
depend on the patients’ condition within the clinical practice.
The effective suctioning provides the clear airway to the respiration take
place. I felt glad because the skill I performed offered the patients more effective
in breathing. The patients’ saturation oxygen increased and patients were
evaluated after implementing the suction intervention. In performing the skill, the
patients’ priorities were fulfilled such as privacy and safety. Price (2008, p52)
state that the patients would feel valuable when the nurse concerned about their
situation by showing the sensitivity, responsively and adaptable in nursing care.
Based on my experiences about suctioning, I realized that the skill did not only
require the competency but the underpinning knowledge within the actions during
the procedure and the way I evaluated the situations. Price (2008, p50) mentions
that the underpinning knowledge is likely based on the clinical experience
research.