I am currently on my cardio prac, in the intensive care unit. Most of the treatment for each patient involves suctioning and manual hyperinflation. In order to perform MHI you must squeeze a bag that has a resouvoire of O2 into the pts lungs. The bag holds 2L, and the amount that you squeeze the bag determines the tidal volume delivered to the pt. I was instructed by my supervisor to deliver a tidal volume of 1L, so squeeze half the bag basically.
The nurse that was looking after my patient I found to be very nosy and intrusive (considering I was being closely supervised by the physio in charge at the time). He told me to go easy on the MHI and that I was delivering too great a tidal volume and that I would hurt the pt. I then proceeded to lower the tidal volume even though I knew I was supposed to give a 1L amount of O2, as I was intimidated by the nurse.
My supervisor then interrupted him and said that I was supposed to give a 1L tidal volume in order to re-inflate the areas of atelectasis and help with secretion clearance. The nurse then backed down and left the room. My supervisor then told me I my technique was correct.
In the future if I know I am correct (and especially if I have been given direct orders from my supervisor) I will be more assertive to allied health staff. I feel that as I am a student my opinions/knowledge are inferior to actual members of staff, but I will work on being more confident in what I have to say/offer. In the future I will try to tell the nurse diplomatically the rationale behind my treatment if it is questioned, and hopefully this will help the ignorant nurse understand the technique better and have confidence in my skills.
Subscribe to:
Post Comments (Atom)
1 comment:
I suppose I can relate in someway to this, as I was also at ICU earlier this year. I think in the situation I would have reacted the same way, given that there is one on one nursing contact for patients in ICU I would have felt pressured by any criticism. However, given that patients in ICU are extremely vulnerable, it is quite possible that by altering technique to appease other staff members, you are doing the patient a great disservice. I think having th physio there for support was very beneficial, and that having the clinical reasoning to support the treatment is vital. However, being a student you do get the impression that your opinions arent as developed as members of staff, even though you know your method is correct.
Post a Comment