Clinical Reasoning Judgement

[kathleen07]

I encountered a scenario at placement and am wondering what others thoughts are on whether I went about it correctly or not?

It was in my final nursing placement, and my 3rd week of the 9 week placement at a respite facility for children with disabilities (providing their parents a break whilst we care for them here)

I was caring for a child who has cerebral palsy (and other complex co-morbidities)

She requires suctioning in order to help her to cough and for the removal of ariway secretions.

One day, it was just me and the Health Care Assistant (HCA) in lounge (where the children usually play/spend their day interacting with others) when I noticed this child needed suctioning (she makes a specific "whoo-ing" sound when she does).

As I was going to suction her, the HCA told told me she didn't need suctioning as that was a normal noise for her. However, I knew that she did (her resp effort was definitely increased, and she was making the whooing sound).

I explained that reason why I was going to suction her, but still the HCA looked displeased.

I suctioned her anyway.

The suctioning turned out to be beneficial for the child-her resp effort was reduced and she looked more comfortable.

On reflection, I wonder if I should have found and asked a nurses second opinion?

I think i made a good call, used clinical rationale and judgement.

What do you think?

[Double-Helix, BSN, RN]

Look at it this way- was suctioning going to harm the patient? Provided you are allowed and capable of performing the skill correctly, suctioning a patient when it isn't necessary (once) is not going to harm them. So if the patient seemed to have an increase in respiratory effort and you were questioning whether suctioning would be beneficial or not, I would definitely go ahead and try suctioning because if the patient didn't need it, they wouldn't be harmed but they could be harmed by withholding suctioning. You made the right call.

However, if you're questioning your judgement, there is an RN readily available and waiting for their opinion does not pose a risk to the patient, then it's always good practice to double check.