Challenges Faced By A Nurse During An Endotracheal Intubation Procedure

Procedure of Endotracheal Intubation and the Nurse’s Role

Question:

Write a reflective essay about the clinical situations.
 

Being a registered nurse, I have faced many clinical situations in my clinical practice which was challenging for me. Those experiences helped me to hone my professional skills in nursing. During my current clinical placement, I came across a patient who had Type I respiratory failure and required an endotracheal tube. I have used emancipatory reflection to explain the whole scenario. Caring for and treating this patient came as a challenge for me. The first challenge I faced when I had to put the endotracheal tube on patients. Though intubation is done by physicians, nurses also need to know its procedure of application in times of emergency. I as a nurse felt it as a challenge to carry out the process accurately without causing trouble to the patients. This type of critical reflection is important for me as a nurse as it will help me identify forces that come in the way of caring for patients. This learning process will help me to increase my competency skills in my profession. Emancipatory reflection will help me to identify the mistakes I have done in my nursing practise, so that I can rectify it in the future.

This section will explain what happened while carrying out intubation procedure on the patient. While preparing for intubation of the patient with the endotracheal tube, it was necessary for me to know about its procedure accurately. Since I was doing it for the first time in my clinical practice, so I was a little nervous whether I will able to put the endotracheal tube properly or not. The patient had hypoxia, and endotracheal intubation was required of her to check the patient’s airway problem. A patient who requires mechanical ventilation is intubated with the endotracheal tube for the short period. For long term use tracheotomy is needed for patients. Endotracheal intubation is necessary to improve airway obstruction, hypoventilation, cognitive disorder and cardiac arrest. As a registered nurse I need to have proper knowledge of handling intubation equipment and medications given before applying it. This skill will only help me in responding quickly when emergency situations come in the clinic (Bahar et al., 2015). 

Physicians have the responsibility of inserting endotracheal tube. But I also had many roles in this procedure. Since the patient was in respiratory distress, I had to put bag valve mask and attach the patients to pulse oximeter. It was necessary for me to coordinate the entire task with my physician and other nurses involved. I assisted in preparing the laryngoscope; other nurses checked vital signs of patients. Certain premedications are given intravenously, but I was not getting access to patient’s veins. My senior nurse taught me how to insert a line. I had to position the patient properly so that the physician could insert the tube comfortably. I had to prepare sedative medication in correct amount immediately as it is given 2-3 minute prior induction (Padilha et al., 2015). Everything had to be done quickly and accurately. Though I faced problem in the beginning, it was empowering me when I realized that how significant my role was in the process. I had to prepare the laryngoscope and bulbs and check that it was working properly. The most critical part was assisting the physician during insertion. I had to inflate the cuff to the desired pressure using a syringe and check the position of the tube. The task was not over here, after intubation I had to check its steadiness by using tape. I had to monitor pulse oximeter and check if both chests were rising equally. The final act was to attach the patient to the mechanical ventilator. The physician then adjusted the ventilator setting according to patient’s response (Bernhard et al., 2012).

Communication with the Medical Team

The intubation procedure was not the end of my responsibility. Now I had to take care of the patient with an endotracheal tube. I had to check patient’s respiratory status after every two hours and check oral mucosa for signs of redness and inhalation. Such patient has a risk of tracheal necrosis, so I had to monitor cuff pressure regularly to maintain it to 20 to 25 mm Hg (Chuo et al., 2014).

Another challenge was communicating with the patient and their family to convince them about the need for the endotracheal tube. The patient family was a non-English speaking family. Language came as the first barrier in explaining them things.  Anyhow, I managed to explain them in their language that the patients breathing were deteriorating, and intubation was the only method to improve her airway clearance. When they realized that it will bring relief to the patient then only they gave consent for the process. Before carrying out the procedure I had to prepare the patient for the intubation process. It told her about what will happen. The patient felt nervous about it, but I managed to calm her down. Fortunately, everything went well for the patient and me. I felt overjoyed to overcome the challenges and perform my duty efficiently (O’Hagan et al., 2014).

Now I will explain my practical experience of communication with the medical team during the process. This experience made me realize that appropriate communication is paramount in intensive care unit. Any wrong instruction taken can risk patient’s life. I was very nervous, but I did not show it in my body language. NO one realized my inner state of mind, and I collaborated with the medical team according to the instruction. I made sure that I took prompt action at their orders and implemented everything according to strict professional requirements. I analyzed the risk versus benefit of my smallest mistake during the procedure. This made is extra-conscious and acts responsibly. I had heard about cases where miscommunication between team members risked patient life and created chaotic situations. This experience made me aware of the kind of communication skills required in communicating with the medical team (Russ et al., 2013).

I realized that though development in drugs and technology is crucial in critical care, a best practice is reflected in non-technical skills too such as communication skills. This intubation procedure gave the opportunity of learning advanced communication skills in my profession. I came to know that when the medical team makes defined treatment goals, then a lot of time is saved in ICU. Everything moves there at a fast pace but with accuracy to avoid any clinical mishap. There were some instructions which I could not understand, but I made it sure to clarify it immediately to prevent medical disputes. I either took help from senior nurses or asked them apparently in the case of any doubt (O’Halloran et al., 2015). Each and every involved medical staff received precise verbal and written clinical information in IC. I am very proud of my profession of nursing. I felt good that I will contribute in giving relief to patients in discomfort. I also made sure to give psychological comfort to the patient (Schmutz & Manser, 2013). So after intubation process, I communicated with the patient via spelling board, electronic aids and icon charts. I tried my best to understand patients mind and what is disturbing her or making her uncomfortable. I tried to make the patient calm by caring attitude and telling the patient how his breathing has improved after intubation. 

Importance of Non-Technical Skills

This section is about emancipatory reflection. I exercised my power as the nurse to handle the patient undergoing intubation. Though I wanted her consent in everything, but there are some medical nuances which patient don’t understand but which is necessary for the patient. So I did not listen to her unreasonable demands. Initially, the patient did not want to undergo the process by any means; I had to be strict then. I made her aware of the consequences of what will happen to her if she does not undergo the process. When the patient realized it may risk her severely then only, she agreed to it. The patient was afraid of all the injection that I had to administer it to her by diverting his/her attention somehow (Bradley, 2015).

During my nursing course study, I had learned about fundamental nursing values such as understanding human dignity, integrity, social justice and passion for caring people. Nursing is all about developing empathy and connection with people. I empowered my nursing value of understanding and connection with patient efficiently. I regularly monitored the patient and asked her frequently about any problem that she was facing after intubation. I made sure to make small conversation with the patient after regular intervals to develop a rapport with the patient and distract them from the health-related distress (Brooks, 2015, January). 

I realized that maintained equity between medical staff enhanced the quality of medical care. This equity is achieved by educating each staff about the attitudes and practice necessary while working in the team. Effort and contribution of each member are valued. The collective effort of all staff members together helps in achieving the high standard of care. Each employee is made aware of risk involved in the care and how to make efforts to minimize the possibility. Individual patient safety and cultural safety is a priority for them. Healthcare Organization also plays a role in delivering equity to staff members. They regularly develop new practice guidelines and policy to provide equity-oriented care, improving care process and giving positive health outcomes (Betancourt et al., 2014).

From the above critical reflection of the intubation procedure, I can conclude that nursing job required a lot of patience as well as attentive and caring attitude. I realized that during intubation procedure, I have to be very attentive and respond to the physicians order immediately. So in the future i would like to carry out the procedure more efficiently. Though initially I may be lacking in some aspects, but in the future, I will develop my skills of carrying out complex clinical procedure as well as communicating with patients. I will bring new changes in my practice so that I could satisfy both my patients as well as my health care team where I work. My goal is to be renowned as a skilful nurse who values her patient’s life, and I will try to bring all my nursing knowledge into practice in real situations.  

Reference

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Betancourt, J. R., Corbett, J., & Bondaryk, M. R. (2014). Addressing disparities and achieving equity: cultural competence, ethics, and health-care transformation. CHEST Journal, 145(1), 143-148.

Bradley, H. (2015). Self-Determination, End-of-Life Decisions, and the Role of Nurse Practitioners. Creative nursing, 21(1), 11-14.

Brooks, B. A. (2015, January). An Emerging Role: The Nurse Content Curator. In Nursing forum (Vol. 50, No. 1, pp. 51-54).

Chuo, J., Aftab, S., Heimall, L., Soorikian, L., Provost, L., & Ades, A. (2014). Impact of team building using a novel technique (planned experimentation) to standardize endotracheal tube taping practice in the NICU. Journal of Hospital Administration, 3(5), p135.

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Schmutz, J., & Manser, T. (2013). Do team processes really have an effect on clinical performance? A systematic literature review. British Journal of Anaesthesia, aes513.