Nursing Reflective Essay on Tracheostomy and Pressure Area Care

Nursing Reflective Essay 1
NURSING REFLECTIVE ESSAY
by
Name of the Class
Professor
Name of the School
Date

Nursing Reflective Essay 2
Introduction
The main purpose of this essay will be to reflect on a critical incident which occurred
during my work placement by analyzing my actions, reactions and feelings during and after the
incident. The essay will cover key concepts related to tracheostomy and pressure area care.
Reflective practice in nursing involves deliberately analyzing one’s actions and thoughts as part
of the process of learning, critical thinking, documentation and coping with critical incidents
(New Zealand Nurses Organization 2015, p.1). The model that will be used for my reflection is
Gibbs Reflective Cycle which involves a description of the critical incident, what my feelings
were, an evaluation of what was good and bad about the experience, an analysis of the incident
and an action plan (2015, p.6). I will also discuss specialty knowledge, evidence-based practice
and reflection under NMBA guidelines for standards of practice as well as reflect on what I
learned to guide my future clinical practice.
Application of Specialty Knowledge to Practice
Pressure ulcers are injuries that occur when there is a breakdown of skin over a period of
time caused by continuous pressure on certain areas of the body. This constant pressure leads to
ischemia of the underlying tissue because of lack of oxygen and blood to the area (Bhattacharya
& Mishra 2015). Pressure sores usually develop in patients who are immobile and suffer from
health conditions that require them to be confined to a bed or chair for extended periods of time
(Cooper 2013). Pressure area care involves activities that are aimed at treating ulcers when they
develop such as assessing the wound, removing necrotic tissue, cleaning and dressing the sore,
relieving any pressure exerted on the wound (Osuala 2014).

Nursing Reflective Essay 3
Tracheostomy tubes are used to treat airway obstructions, manage secretions and treat
patients who have chronic respiratory failure or sleep apnea that is severe and obstructive
(Sebastian et al. 2015). The management of tracheostomies is a good example of
multidisciplinary care within the healthcare system. Many medical, nursing and allied health
staff such as pathologists, specialist nurses, neck surgeons and respiratory therapists are needed
to provide effective care to tracheostomy patients (Bonvento et al. 2017).
The job duties of a tracheotomy specialist nurse include suctioning of the tubes, stoma
care, checking if the cuff tubes have pressure, maintaining the patient’s airway patency,
responding to and managing tracheostomy emergencies, changing tracheostomies of hospitalized
and community patients, weaning and decannulation procedures, educating the patient and their
family about tracheostomy care and selecting the right tracheostomy tubes. These nurses work in
conjunction with other nursing staff in the unit to care for tracheostomy patients (Agency for
Clinical Innovation 2013, p.6).
Analysis of Actions, Reactions and Feelings in Context of Professional Practice
The first step in Gibbs model is a description of what happened (2015, p.6). The critical
incident that occurred is that my patient’s tracheostomy tube fell out as I was performing
pressure area care. The patient immediately went into respiratory distress by struggling for
breath. The ward person initiated oxygen therapy via nasal cannula to address this while pressing
the emergency button to alert the nurses at the station. She next placed a trachemask that was
next to the bed over the stoma to maintain its patency. Because the tracheostoma was less than a
week old, there was a mad rush to insert a new tube before the stoma collapsed. After this