"Nursing Practice Guidelines" is a wonderful example of a paper on care. In the current era where the nursing practice is based on evidence reported from research, it is unacceptable to continue with practice because it has been carried out in the past. Similarly, nursing guidelines continually review recommendations based on the most recent scientific evidence. Although the experience is important when considering recommendations for patient management, nurses should ensure that they stay up-to-date with information in the field of medicine in order to remain relevant. Most practices become outdated, and new ones replace them continually.
One such practice involves saline installation into advanced airways, for example, the endotracheal tube or tracheostomy before or during suctioning. An assessment of the literature has proven that the procedure is not effective for patients and may even have negative outcomes. Throughout the years of clinical practice, clinicians usually instill small unit-dose vials containing saline inside an open tracheostomy to loosen secretion or stimulate a more productive cough. This procedure makes the patient gag while the clinicians only think that the discomfort is temporary, for the greater benefit of clearance of the airway.
However, they never consider the fact that they are inflicting harm to the patient. Although the guidelines have been recently revised to discourage the practice, most nurses (almost 90%) still practice saline instillation before suctioning (Ayhan et al. , 2015). The effects may be fatal especially for patients in the intensive care units. The literature in nursing journals does not clearly state when saline instillation was first used. It has become a traditional practice in nursing after recommendation by nursing guidelines, even though the procedure was refuted in later versions of the guidelines.
The rationale behind the procedure is because saline was thought to loosen mucus secretion, thus facilitate the easy clearance of the airways. Consequently, the practice has been embraced by many nurses and is still being practiced today. The latest research shows that the installation of saline to facilitate the clearance of the airways is not effective. Alternative methods have been recommended in several studies. These include moisturizing the inhaled oxygen, using mucolytic agents, and effective mobilization (Zahran & El-Razik, 2011; Iranmanesh, 2011).
Saline instillation results to further discomfort to the patient, and still fails to achieve the desired results. For example, it has been revealed that after saline instillation, about 18% is expelled, and the rest remains in the lungs thus inhibiting sufficient oxygen supply to the blood (Iranmanesh, 2011). Ensuring adequate moisturizing of the inhaled gas, however, loosens the secretion significantly without any serious side effects. Adopting alternative methods for the procedure has got positive implications for the patient. The negative side effects of saline installation are avoided, thus increasing the comfort of the patient while undergoing treatment.
Side effects of saline instillation include damage to the bronchial surfactant, decrease in post suctioning oxygen saturation, bacterial colonization, and flushing of particles into the lower respiratory tract (Nance-Floyd, 2011). For the nurses, adopting alternative ways of carrying out the procedure is beneficial because it reduces patient discomfort and increases the efficiency of their procedures. Patients will also develop trust in health practitioners. Furthermore, humidification is a cheaper option compared to saline instillation, thus saves revenue for the institution. To implement these changes in practice, I would have to discuss with the administration first to get their consent.
Key stakeholders in the decision-making process include the nurse in charge, the medical superintendent, and any other departmental heads involved. A presentation on the benefits of alternative methods would help to convince them of the importance of the matter. In the presentation, I would include the latest evidence from journals and other academic sources while also pointing out the potential risks of saline installation during or before suctioning. Patient opinions on the matter would also be provided to get an alternative perspective. The implementation of the research has got several limitations.
First, a lot of literature is contradictory in the way saline installation should be used. For instance, certain studies show that saline installation reduces the chances of ventilator-associated pneumonia and chronic lung disease rates (Christensen et al. , 2010; Lorente, Blot & Rello, 2010). Other guidelines also report that saline instillation has negative effects only when used routinely (American Association for Respiratory Care, 2010). However, these and other studies (Caparros, 2014) acknowledge that there is a need for more research on the area to clarify the significance of saline instillation before or during suctioning.
Other outside barriers may also hinder the implementation of the new research because the saline installation has become a traditional procedure and nurses may feel reluctant to change. The ongoing debate also makes the change more difficult to adopt. To overcome these challenges, continual professional education is required for the nurses. New evidence on the effectiveness of nursing practices is constantly produced, and this may contribute to finding information easily. The best way to overcome the variation in recommendations of studies is to examine each one individually.
For instance, some studies may report the results of a specific respiratory condition, age group, or hospital setting. Distinguishing these factors is important to avoid misapplication of scientific knowledge. Also, research done in the institution will provide more applicable solutions. Patient opinions, mortality and morbidity records, and staff opinions are some of the important data sources for such research. Implementation of these changes would involve an interdepartmental approach to ensure that the equipment is available, and the personnel well informed about the procedure.
The clinical staff will be trained on how to perform properly suctioning without the need for saline instillation. They will be taught alternative methods that are specific to their departments including the pediatrics, newborn and adult departments. Also, the administration will have to provide the necessary equipment and training materials. Prior notice will be made in order to facilitate the prompt acquisition of the equipment. A notification will similarly be sent to all involved personnel to inform them in advance about the changes and training sessions.
As it will be essential to avail more education on the issue and other related matters, a schedule will be planned on when the sessions will be held, including the topics of discussions. Staff opinions will also be incorporated while planning the implementation process.
American Association for Respiratory Care. (2010). AARC Clinical Practice Guidelines.Endotracheal suctioning of mechanically ventilated patients with artificial airways 2010. Respiratory care, 55(6), 758.
Ayhan, H., Tastan, S., Iyigun, E., Akamca, Y., Arikan, E., & Sevim, Z. (2015). Normal saline instillation prior to endotracheal suctioning: “What does the evidence say? What do the nurses think?”: Multi-methods study. Journal of Critical Care.
Caparros, A. C. S. (2014). Mechanical ventilation and the role of saline instillation in suctioning adult intensive care unit patients: An evidence-based practice review. Dimensions of Critical Care Nursing, 33(4), 246-253.
Christensen, R. D., Henry, E., Baer, V. L., Hoang, N., Snow, G. L., Rigby, G.,& Eggert, L. D. (2010). A low-sodium solution for airway care: results of a multicenter trial. Respiratory care, 55(12), 1680-1685.
Iranmanesh, S. (2011). Comparison of the endotracheal tube suctioning with and without a normal saline solution on heart rate and oxygen saturation. Iranian Journal of Critical Care Nursing, 4(3), 117-120.
Lorente, L., Blot, S., & Rello, J. (2010). New issues and controversies in the prevention of ventilator-associated pneumonia. American journal of respiratory and critical care medicine, 182(7), 870-876.
Nance-Floyd, B. (2011). Tracheostomy care: an evidence-based guide to suctioning and dressing changes. Am Nurs Today, 6(7), 14-16.
Zahran, E. M., & El-Razik, A. A. (2011). Tracheal suctioning with versus without saline instillation. Journal of American Science, 7(8), 23-32.