Training activity information
Details
Prepare and perform respiratory monitoring to include:
- Pressures
- Flows
- Loops
- Compliance
- Resistance
Type
Entrustable training activity (ETA)
Evidence requirements
Evidence the activity has been undertaken by the trainee repeatedly, consistently, and effectively over time, in a range of situations. This may include occasions where the trainee has not successfully achieved the outcome of the activity themselves. For example, because it was not appropriate to undertake the task in the circumstances or the trainees recognised their own limitations and sought help or advice to ensure the activity reached an appropriate conclusion.
Reflection at multiple timepoints on the trainee learning journey for this activity.
Considerations
- Limitations of techniques
- SOPs
- Local and national guidance
- Interpretation and validation of waveform
- Interpretation of the waveform for diagnostic value
- Patient centred care and support
- Communication with patients, relatives and the clinical team
Reflective practice guidance
The guidance below is provided to support reflection at different time points, providing you with questions to aid you to reflect for this training activity. They are provided for guidance and should not be considered as a mandatory checklist. Trainees should not be expected to provide answers to each of the guidance questions listed.
Before action
What does success look like?
- Identify what is expected of you in relation to preparing and performing advanced respiratory monitoring, including scrutinising and troubleshooting respiratory monitoring.
- Consider how the learning outcomes apply, specifically in relation to monitoring respiratory function and practicing safely.
- Discuss with your training officer to gain clarity of what is expected of you in relation to criteria defining successful setup and performance of monitoring for pressures, flows, loops, compliance, and resistance, and successful initial interpretation of these parameters and graphics.
What is your prior experience of this activity?
- Think about what you already know about respiratory mechanics, ventilation modes, and the principles behind measuring pressures, flows, compliance, and resistance.
- Consider possible challenges you might face during the activity, such as obtaining stable measurements, interpreting noisy signals, or troubleshooting equipment issues.
- Recognise the scope of your own practice for this activity i.e. know when you will need to seek advice or help, and from whom. You will need to seek advice from your Training Officer when required, for example if you are unable to troubleshoot noisy signals or equipment issues.
- Acknowledge how you feel about preparing for and performing respiratory monitoring.
What do you anticipate you will learn from the experience?
- Consider the specific skills you want to develop, such as setting up monitoring equipment and obtaining reliable measurements and graphics.
- Identify the specific insights you hope to gain into how changes in patient condition affect these parameters or how to use loops to diagnose respiratory issues.
What additional considerations do you need to make?
- Consult actions identified following previous experiences of this activity or similar tasks.
- Identify important information you need to consider before embarking on the activity, such as device-specific setup, calibration requirements, patient-ventilator interactions, or factors that might distort readings or waveforms.
In action
Is anything unexpected occurring?
- Are you noticing anything surprising or different from what you anticipate whilst preparing and performing respiratory monitoring?
- Are you encountering situations such as:
- You get unexpected respiratory monitoring parameters (e.g., high pressures, low compliance, unusual flow/volume loops)?
- You encounter technical issues with the ventilator settings, circuit connections, or monitor display of waveforms/parameters?
- Setting up and interpreting this detailed respiratory monitoring compares differently to previous experiences?
How are you reacting to the unexpected development?
- How is this impacting your actions? For example, are you responding to the situation appropriately? Are you adapting or changing your approach to troubleshooting by checking patient-ventilator synchrony, circuit integrity, or lung mechanics if parameters were surprising or waveforms abnormal? Did unexpected findings or issues affect your confidence in interpreting the patient’s respiratory status or troubleshooting the system?
- Consider the steps you are taking in the moment, such as checking patient-ventilator synchrony, circuit integrity, or lung mechanics if parameters were surprising or waveforms abnormal.
- How are you feeling in that moment? For instance, are you finding it difficult to make sense of complex respiratory monitoring data or resolve equipment issues? Is it affecting your confidence in interpreting the patient’s respiratory status?
What is the conclusion or outcome?
- Identify how you are working within your scope of practice. For example, are you successfully establishing and interpreting respiratory monitoring parameters, contributing to the assessment of the patient’s condition, while working within your scope? Or are you needing support because the complexity of the abnormal flow/volume loops suggests an acute lung pathology (e.g., severe auto-PEEP) requiring immediate senior clinical intervention?
- What are you learning as a result of the unexpected development? For example, are you mastering a technique for interpreting specific waveforms (loops) or troubleshooting ventilator monitoring issues from the unexpected event?
On action
What happened?
- Begin by summarising the key steps you took when preparing and performing advanced respiratory monitoring parameters.
- Consider specific events, actions, or interactions which felt important, such as obtaining a reliable measurement of static compliance or successfully using flow/volume loops to assess patient-ventilator synchrony.
- Include any ‘reflect-in-action’ moments where you had to adapt to the situation as it unfolded, for instance, immediately scrutinising and troubleshooting respiratory monitoring when a flow-volume loop showed signs of significant auto-PEEP.
- How did you feel during this experience, e.g., did you feel focused on maintaining technical accuracy or challenged by the complexity of the abnormal loop interpretation?
How has this experience contributed to your developing practice?
- Identify what learning you can take from this experience regarding preparing, performing, and interpreting respiratory monitoring. What strengths did you demonstrate, e.g., systematic approach to measuring compliance and resistance?
- What skills and/or knowledge gaps were evident, e.g., difficulty linking specific waveform features or flow loops in the diagnosis of a patient’s clinical respiratory condition?
- Compare this experience against previous engagement with similar activities – were any previously identified actions for development achieved? Has your practice improved in understanding the physiological meaning of the pressure/time scalar?
- Identify any challenges you experienced, such as needing to seek advice or clarification on scope of practice regarding scrutinising and troubleshooting respiratory monitoring when the parameters suggested a critical change in lung mechanics, and how you reacted to this.
What will you take from the experience moving forward?
- Identify the actions or ‘next steps’ you will now take to support the assimilation of what you have learnt, including from any feedback you have received, with regards to reviewing the use of ventilation waveforms/flow loops in the diagnosis of a patient’s clinical respiratory condition.
- What will you do differently next time you approach respiratory monitoring, for instance, by proactively performing a systematic inspection of the pressure, flow, and volume scalars before measuring compliance?
- Do you need to practise any aspect of the activity further, such as interpreting complex flow-volume loops or key learning outcomes related to applying techniques to monitor respiratory function?
Beyond action
Have you revisited the experiences?
- How have your subsequent experiences of troubleshooting respiratory monitoring or managing ventilator settings based on complex mechanics since completing this specific training activity led you to revisit your initial approach or decisions during that activity? For example, encountering unusual flow/volume loops in a subsequent patient with severe restrictive lung pathology forced you to re-evaluate the depth of your initial interpretation of compliance and resistance during your first attempt at this training activity.
- Considering what you understand about respiratory mechanics, waveform analysis, and lung protective ventilation now, were the actions or considerations you identified after your initial reflection on this training activity sufficient? How have you since implemented or adapted improvements in your systematic approach to performing and interpreting pressures, flows, loops, compliance, and resistance based on further learning and experiences? For example, how you proactively integrated the use of ventilation waveforms and flow loops in the diagnosis of a patient’s clinical respiratory condition based on further learning.
- Has discussing abnormal pressure-volume loops or the impact of compliance/resistance data on ventilator adjustment with colleagues, peers, or supervisors changed how you now view your initial experience in this training activity? For example, how professional storytelling with a respiratory specialist about a case where misinterpretation of flow data led to patient-ventilator dyssynchrony refined your understanding of the critical nature of comprehensive respiratory monitoring.
How have these experiences impacted upon current practice?
- How has the learning from this initial training activity, in combination with subsequent ventilation management and respiratory mechanics experiences, contributed to your overall confidence and ability in complex data interpretation (loops, compliance, resistance) and troubleshooting monitoring issues, particularly in preparing for assessments like DOPS or OCEs? For example, how your accumulated technical proficiency, skills in interpreting graphical data (loops), and knowledge of respiratory mechanics now enables you to confidently scrutinise and troubleshoot respiratory monitoring (e.g., assessing lung compliance or resistance) during a DOPS or related assessment.
- How has reflecting back on this specific training activity, combined with everything you’ve learned since, shaped your current approach to respiratory monitoring and ventilator data analysis? How does this evolved understanding help you identify when something is beyond your scope of practice or requires escalation? For example, how your evolved approach means you now routinely seek advice from the Training Officer or Senior Clinician immediately when complex abnormal respiratory loops or parameters (e.g., suggestive of severe auto-PEEP or highly compromised lung compliance) suggest an acute pathology requiring immediate clinical decision-making.
- Looking holistically at your training journey, how has this initial advanced respiratory monitoring experience, revisited with your current perspective, contributed to your development in meeting the learning outcomes related to applying techniques to monitor respiratory function? For example, how this foundational experience has supported your development in developing proficiency in complex data interpretation and understanding respiratory physiology vital for ventilator management.
Relevant learning outcomes
| # | Outcome |
|---|---|
| # 6 |
Outcome
Apply techniques to monitor temperature in critically ill patients. |
| # 8 |
Outcome
Practice safely in accordance with guidance and legislation to minimise risk in all elements of patient care. |