Lo Chun Kit will complete his master nursing study and then plan to start his doctoral program(Nursing) in 2018.He is from Hong Kong and a registered nurse in United Christian Hospital. He has completed a presentation at the 22nd Asian Pracific Society of Respiology(APSR) Congress 2017 in Sydney.
Background and Aims: Tracheostomy is regarded as a “high-risk, low-incidence” care. Mismanagement leading to airway occlusion could be fatal. In nursing, tracheostomy is usually introduced as airway management. More deeply knowledge like tracheostomy tube or its emergency management are not included. The handover communication and observation were found inadequate. The quality of tracheostomy care is aimed to be improved. Methods: Database searches were conducted from CINAHL, British Nursing Index and Medline. Publications dated 2008–2017 were applied. The keyword “Tracheostomy” was searched by title. ‘Adult’ and “nursing” were the related terms. Results: 8 methods to improve the standard of tracheostomy care were identified: (a)Tracheotomy record, including information of indication and type of tracheostomy and the tracheostomy tube can improve the handover communication between shifts and during intra/inter-hospital transfer. (b)Observation chart based on the tracheotomy record to remind staffs in basic care and assessment of tracheotomy site can help detecting or avoiding emergency. (c)Regular standardized in-service tracheostomy training including emergency management to update staffs’ knowledge is necessary. Stimulation-lab training method is recommended in this issue. (d)A dual lumen tubes with subglottic suction tracheostomy tube should be used in patient to avoid tube blockage and ease the clinical decision in cuff deflation by measuring the amount of sputum. (e)Velcro ties tracheostomy holder showed lesser potential in skin abrasion than twill tape should be encouraged. (f)A multidisciplinary approach in tracheostomy care including swallowing, nutrition, mobilize secretion and communication should be coordinated formally. (g)Staffs should be equipped and identify alternative means to facilitate patient communication to relieve frustration from tracheostomized patient due to loss of verbal communication. (h)Weaning and decannulation protocol should be built up to facilitate the tracheostomy progression. Conclusions: Items (a),(b),(c),(e) & (g) are implementing in a respiratory ward(Figure 1) and showing great improvement in care. Evaluation will be finished in February 2018.
Mrs.Duangkaew Rod-ong has completed master degree of nursing for 13 years from Khon Kaen University. She is the Nurse specialist and Psychiatric Nurse and work at outpatient Department.Srinagarind Hospital,Faculty of Medicine, KhonKaen University, KhonKaen,Thailand.
Cleft lips and palates (CLP) are congenital facial deformities that affect patient’s breathing, swallowing, talking, and often resulting in unclear communication. These facial defects also limit the ability of intellectualization, socialization and education of the children. At the same time, families are affected by both feelings of loss and regret, and have to face those challenges arising from their children due to the facial abnormalities. Restorative care for the patients with CLP requires clear care goals. The care includes correction of the defect and restoration of the physiological functions, and also psychological care in order to develop the image that children will have for themselves from adolescence to adulthood. Care and rehabilitation require close coordination of multidisciplinary teams and understanding for patients and families, social context and the disease. Family adjustment, understanding from society around and limitations on access to medical services, is important factor that need to take into account when providing care for the patients with CLP in order to meet the real need of the patients and their families. Tawanchai centre has been trying to improve the care of this group of patient by integrating care of the various sectors. A home visit project was conducted to see family context from the real situation with the aim of making the care team understands the system that links care from families, communities, hospitals, and various levels of care. This would lead to a complete care system appropriately for each age group and promptly detect emerging problems from the care in order to be a truly complete care model.