Your placement within Respiratory Medicine will be a unique opportunity to gain skills and experience with patients suffering with both long-term (chronic) and short-term (acute) respiratory illnesses. You could undertake this placement during any point in your course – a good basic knowledge of respiratory illness will benefit you greatly.
Your placement will typically be on a medical ward and will primarily deal with respiratory cases although within some trust respiratory medicine is mixed with medical cardiology to create a cardiorespiratory ward – this is because the two specialties are closely linked and share multiple traits.
What to Expect from your Placement
The ward routine will differ from trust to trust, but this is something you will pick up quickly.
You will see the day-to-day management of chronic conditions such as asthma, COPD, bronchiectasis, pulmonary fibrosis and possibly cystic fibrosis. These patients are usually very independent and very informed about their conditions.
There will also be plenty of patients with acute conditions such as ‘community acquired pneumonia’ (CAP), ‘hospital acquired pneumonia (HAP), pneumonitis, upper respiratory tract infections (URTI), pulmonary oedema, pneumothorax and other varying kinds of chest sepsis.
If you get the chance, you should take the opportunity to gain experience with Tracheostomies, providing basic care, suctioning and weening.
You should get plenty of experience managing a septic patient. You should familiarise yourself with ‘Sepsis 6‘ and clinical escalation within your trust; Doctors, CCOT, Emergency Medical Teams, Hospital at Night etc.
Finally you may get the chance to see patients using non-invasive ventilation (NIV), the device is a way of removing carbon dioxide from a patients blood without fully ventilating them on intensive care. Beware however, the NIV device can only be used by Registered Nurses who have completed a competency assessment.
Preparing for your Placement
There are a few things you can do to prepare for your respiratory placement;
Try and visit your placement before you start. Wards can vary greatly. Visit the area you have been assigned to before you start and ask if there is anything you should be aware of prior to starting.
Identify your learning needs and outcomes. Identify these early and be aware of the skills you want to develop or learn – this will help you get the most from your placement.
Brush up on your anatomy and physiology. Familiarise yourself with the mechanism of breathing and gas exchange.
Learn the difference between Type 1 and Type 2 Respiratory Failure. There is a critical different between type 1 and type 2 respiratory failure – it is important you have a good grasp of this concept.
Research area-specific medications. You should read about commonly used bronchodilators, inhalers, diuretics, anti mucolytic agents and antibiotics. You could also invest in the Drugs in Use (Nursing and Health Survival Guides).
Look at types of oxygen delivery. Nasal cannula, high-flow, low-flow, venturi masks, trachy masks.
Look at ABCDE assessments and their importance. This systematic approach is used for the assessment and treatment of patients ABCDE model.
You should also familiarise yourself with good inhaler techniques as this is a skill respiratory nurses teach on a daily basis.
Getting the most from your placement
Respiratory wards and usually very busy places, although you are supernumerary their will be jobs you’ll be asked to undertake independently once deemed able. There will be the chance to easily obtain learning outcomes and measures of practice.
You should use this placement to gain experience managing a patient load, managing a septic patient, clinical decision-making and, if possible, arranging insight visits with specialist areas.
The final and most important piece of advice I can give you is to ask questions and get involved.