Introduction
Tracheostomy is a surgically created operation involving the opening in the trachea. A Tracheostomy tube is placed in the incision so as to secure an airway at the same time preventing it from closing (Carpen 1). Any hospital should first lay down a hypothetical-general structure on how to deal with patients requiring Tracheostomy medical attention, both in terms of operation and care. Therefore, hospitals should ensure that new nurses have an understanding (either basic or professional expertise) on Tracheostomy management. But if the nurse(s) do not have any background on the same, then the hospital should take the responsibility of creating awareness and educating the nurse(s) on management and handling of Tracheostomy.
Hospital Policy and Procedures on Tracheostomy Management: Their Benefits & Help to New Nurses
A program for Tracheostomy is very essential in any hospital setting. This is so because over the years there has been an increase in the number of patients requiring Tracheostomy care. A proliferation of patients in the ear, nose and throat (ENT) wards has seen their admission to general wards (Russell 1). This calls for any nurse providing services to the hospital to have a clear, definite understanding and at least a basic knowledge and expertise on Tracheostomy management. The hospital should therefore create a policy that ensures all nurses, both new and current, are trained on the basic Tracheostomy management which should enable them to understand the definition as well as the purpose of Tracheostomy care; which is to maintain the patency of the airway thereby preventing the skin surrounding the incision. (RN.com 1)
The policy should also ensure that the nurses understand the procedure of Tracheostomy care which starts by suctioning the patient’s airway through a Tracheostomy (RN.com 1). This is followed by removal of the gauze dressing from the site where the amount of color and drainage is noted (Lippincott & Wilkens 453). A sterile technique is used after cleansing the external portion of the tube and the skin using hydrogen peroxide. Then cotton-tipped applicators are used to clean around the stoma (RN.com 1). Then immediately after, the area is wiped by use of gauze which is dipped in sodium chloride there after a new Tracheostomy dressing is applied If it was a post operation for the patient, then the disposable inner cannula is removed but if it is not a disposable cannula then, it is removed and cleaned with hydrogen peroxide then rinsed in sodium chloride before re-inserting it back to the incision. Before the procedure is undertaken, there is the need to have the kit for the operation ready. It should also be noted that prior to suctioning, the patient is preoxyginated and a sedative should be used incase a patient is in pain during the procedure (Carpen 1).
The hospital policy should also ensure that the Tracheostomy management program enlightens the nurses on awareness of complications, both immediate post-operative and long term complications associated with the operation. The nurses should also seek to understand the fundamentals underlying routine care which involves: supervision and monitoring, humidification, continuous suctioning, management of abnormal secretions, Tracheostomy tube tie changes, stoma care, feeding and nutrition, oral care as well as home care and communication (Lippincott & Wilkens 462).
The program should also ensure that the nurses are aware of the different types of Tracheostomy patients e.g. comatose patients, larynx cancer patients, burnt patients with inhalation damage, COPD patients on mechanical ventilation and pediatric patients with congenital airway obstruction (Russel 1l). They should also understand the various reasons as to why Tracheostomy procedures are undertaken which range from: bypassing an obstruction, maintaining an open airway, removing secretions more easily and oxygenating and providing mechanical ventilation on a long-term basis (Russell 1).The nurses should also learn the decanulation process and procedure as well as be aware of special conditions underlying children, new and current patients. Therefore, the policy should provide compliance to continued learning and research coupled with emerging trends on Tracheostomy care and management by the new and current nurses.
This therefore, calls for a specialized nurse to spear-head such a program. This is because Tracheostomy management requires immense training and experience thus basic nursing training is not conclusively adequate. According to Russell, there is a deficit in the Tracheostomy care among nurses in the general ward. Therefore the policy should seek to include at least one experienced, fully fledged nurse in each general ward to guide and direct the new nurses on Tracheostomy-related patient care and medication. The nurse specialist should also ensure the new nurses learn how to do a clinical audit and research on Tracheostomy thus encouraging the continual development of Tracheostomy service within all the wards in the hospital. According to Russell, an audit data shows that the support of nurse specialists on Tracheostomy within all wards has greatly reduced the rate of delays related to discharges. On the other hand, re-admission of the same patients has also reduced in the same specter.
Conclusion
It should be noted that a nurse specialized in Tracheostomy care and management has an ultimate responsibility in provision of patient care at the hospital and also at a home care setting (RN.com 1). Therefore, the program should be able to equip new nurses with knowledge and expertise that they can handle Tracheostomy patients with temporary or on long-term conditions. With such a program and supporting policy, the nurses and hospital rating would increase as it would yield good patient response which would see hospitals improve their Tracheostomy care services in the long run.
Works Cited
Carpen Harper. “Tracheostomy Care Guidelines, Nepean Hospital: Sydney West Area Health Service”Nepean Health Library, 2005: 3 – 32. Web.
Lippincott, Williams & Wilkens, Best practices: evidence based nursing procedures. Published June 23, 2006. (2nd edition). Springhouse.
Nursing Management of Adult Patients with Tracheostomy. 2010: no pag. Web.
RN.com. “Update on Tracheostomy Care: San Diego”. 2006: 4 – 16. Web.
Russell Claudia. “The benefits of Tracheostomy specialist nurses: NHS Trust-Cambridge”Journal of Tracheostomy Practioners , 2001: n. pag. Web.