All student nurses should experience a critical care placement, argues staff nurse Rachel Davies
Since I started working in intensive care eight years ago, I have seen how much the field has developed in both medical and nursing practices. It really is one of the fastest developing areas in health care, with regular technological and medical advancements.
That is why I believe intensive care can be a very fulfilling and rewarding placement for nursing students, and qualified staff nurses with at least twelve months post-qualification experience.
However, the prospect of a placement or new job in intensive care can be quite intimidating. When I was a nursing student I had a three week placement on a neurological intensive care unit and can remember how daunting it felt not knowing what to expect from such a specialised area. Despite this, the brief placement was very informative; my only complaint would be that it was too short. I certainly learnt a lot about looking after intensive care patients with a head injury.
After I qualified I worked on a medical admissions unit for eighteen months and then moved to work in intensive care. Even as a qualified staff nurse it was an unnerving experience entering an intensive care unit again.
When the first come to intensive care, students and qualified staff nurses are often concerned about what they can and cannot touch without setting of an alarm or causing something to go drastically wrong. But the truth is that unless an intensive care patient is incredibly unstable then nothing should in theory go wrong.
Also, intensive care patients are inevitably sedated and attached to a ventilator to support their breathing, various wires to monitor their vital signs, and pumps to deliver drugs. When observing an intensive care patient in this state for the first time, it can feel quite unnatural, as the patients can’t talk back to you. But we always tell students and relatives that although they are sedated patients can potentially still hear them. That is why it is important for student nurses to learn that you still have to involve patients in their care, by keeping them informing about what is happening to them.
Because all the organ systems of the body are monitored in such minute detail, a practice educator once suggested to me that looking after an intensive care patient is a careful balancing act, making sure each system is as close to normal as possible. To help students and qualified staff understand this, practice competencies can be utilised. Each critical care network (groups of intensive care units in a region) usually has its own practice competencies.
Student nurses can expect to learn about and amass knowledge of each bodily system. For example, they can expect to learn about the:
- respiratory system (assessment of the system, including aspects of ventilation and blood gas interpretation),
- circulatory system (assessment of the system, including ECG interpretation, A-line and CVP lines, Inotrope support, and fluid management),
- renal system (Hemofiltration and renal support).
As well as learning about and examining each bodily system, students can also expect to observe patients care, utilising a variety of care bundles and specially designed protocols and guidelines. The care bundle idea was first introduced by Fulbrook and Mooney (2000). The idea is that by grouping several practices together you can improve the outcome for intensive care patients.
I believe that all student nurses should be offered a placement in intensive care, so they can see how bodily system are assessed and learn about care bundles. This will have a positive effect on the care patients receive on other wards, as students will take numerous transferable assessment skills with them back to the ward. Since I began working in intensive care I now feel that if I had to go and work on another ward I would be more aware of subtle changes in a patient’s condition and feel more capable to act upon them.
Rachel Davies is a staff nurse in critical care