As well as tracheostomy care I am learning so much about the different roles they have in the U.S. I have been lucky enough to speak to some of these staff members as well as observe their practice.
Nancy Sujeta (wound and Ostomi nurse specialist):
Nancy was kind enough to show me some of her roles within the hospital. The wound care nurses at JHH work with both wound pressure care as well as the colostomy patients. This role in the UK is divided between tissue viability nurses and stoma nurses, as far as I’m aware.
We saw a few sacral and heal wounds on the cardiac ICU. This prompted a very interesting discussion regarding preventative measures in the surgical cardiac patient.
Because these patients have to undergo lengthy operations, often on bypass and suppressors, they are a great risk of developing pressure damage.
One way in which to combat this is by providing extra extra support to these areas with dressings prior to the operation.
Nancy did quote some research regarding this but I have forgotten the title and author. Apologies Nancy, however I’m sure you would be able to find it if interested.
Nancy discussed the role of there physical therapists in wound care, which prompted a meeting and time for me to shadow their practice also.
PT wound care (physical therapists in wound care):
This is again another role of the physical therapists in the U.S. that I was unaware of.
I found out that these PT’s do exactly the same training but just specialised into wound care. Because of their underlying knowledge of anatomy, it seams to make a nice bridge into wound care practice.
The team discussed how this role does not exist in every state and every hospital, but does appear to be getting more understood and utilised.
They can deal with anything from wound cleaning and dressing to ultrasound, pulse lavage and surgical debridement of wounds.
I was able to see a pulse lavage on one patient. This is the process of cleaning the wound with, what is basically, a water jet. The pistol is able to pulse the water and suction simultaneously to clean the wound. The wound was then debrided and redressed.
This is another example of advancing practice within healthcare with the team we already have around us, and using those skills as well as developing new ones.
Grand rounds = ORL research @ JHH
Finally I had the opportunity to go to ORL grand rounds.
The 2 presentation topics were:
1. Quality of life with acoustic neuroma (QOLAN) study
2. Mammalian target of rapamycin (mTOR) is a key regulator of immunodulation in lynphocytes and effector cells in laryngotracheal stenosis.
Although very complex, it was great to see what research is being done and the opportunities they have in the U.S. with grants and funds to carry out this research.