Training activity information
Details
Advise on ventilation strategy
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
- Assisting healthcare professionals with regards to option appraisal, bedside support/teaching for option appraisal where required
- Setting alarms
- Contingency planning and emergency equipment
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 selecting appropriate ventilation modes and patterns based on patient sedation level and lung condition.
- Consider how the learning outcomes apply, specifically in relation to selecting the appropriate mode and pattern of ventilation.
- Discuss with your training officer to gain clarity of what is expected of you in relation to justifying the selection of modes and patterns for complex patient conditions.
What is your prior experience of this activity?
- Think about what you already know about modes and patterns of ventilation (e.g., pressure controlled, volume controlled, SIMV, BiPAP) and how they apply to different patient conditions and pathophysiologies.
- Consider possible challenges you might face during the activity, such as incomplete clinical information or conflicting opinions from the multidisciplinary team.
- 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 the complexity of the justification for a ventilation strategy requires consultation outside routine protocol.
- Acknowledge how you feel about embarking on this training activity, particularly if it involves giving advice to other team members.
What do you anticipate you will learn from the experience?
- Consider the specific skills you want to develop, such as selecting and justifying ventilation modes and patterns.
- Identify the specific insights you hope to gain into matching ventilation strategies to complex or varied patient scenarios and integrating knowledge of sedation and lung mechanics.
What additional considerations do you need to make?
- Consult actions identified following previous experiences of advising on or troubleshooting ventilation settings.
- Identify important information you need to consider before embarking on the activity, such as reviewing relevant guidelines, protocols, or literature on mechanical ventilation strategies for different patient populations.
In action
Is anything unexpected occurring?
- Are you noticing anything surprising or different from what you anticipate whilst formulating or discussing the ventilation strategy?
- Are you encountering situations such as:
- The patient’s clinical status or response to current settings differs from your expectation, necessitating an immediate modification of the proposed mode or pattern?
- The multidisciplinary team’s input introduces an unexpected clinical consideration (e.g., specific surgical constraint or unexpected fluid balance issue) that challenges the initial ventilation strategy?
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 immediately reassess the patient or the recommended strategy? Did you need to seek immediate advice or clarification from a colleague or training officer?
- Consider the steps you are taking in the moment, such as:
- Immediately reassessing the patient’s lung mechanics (e.g., compliance/resistance) or sedation level to ensure the strategy matches physiological needs
- Adapting your communication approach to address the unexpected consideration raised by the team
- How are you feeling in that moment? For instance, did the unexpected element challenge your confidence in providing the advice? Were you able to adjust your approach effectively?
What is the conclusion or outcome?
- Identify how you are working within your scope of practice. For example, are you successfully integrating the unexpected clinical input and formulating a justified ventilation strategy? Or are you needing support because the complexity of the unexpected clinical issue requires consultation outside routine protocol?
- What are you learning as a result of the unexpected development? For example, did you gain new insight into selecting modes based on sedation or lung condition, or identifying potential clinical issues?
On action
What happened?
- Begin by summarising the key steps you took when advising on the ventilation strategy, including the patient’s clinical state and the mode and pattern proposed.
- Consider specific events, actions, or interactions which felt important, such as successfully justifying the selection of a specific mode or pattern based on lung mechanics or engaging in a decisive discussion with the multidisciplinary team.
- Include any ‘reflect-in-action’ moments where you had to adapt to the situation as it unfolded, for instance, immediately re-evaluating the proposed ventilation pattern when a colleague raised an unexpected clinical consideration (e.g., specific surgical constraint).
- How did you feel during this experience, e.g., did you feel confident in adapting your strategy or stressed by the conflicting clinical information?
How has this experience contributed to your developing practice?
- Identify what learning you can take from this experience regarding advising on ventilation strategy. What strengths did you demonstrate, e.g., systematic approach to linking sedation level to mode selection?
- What skills and/or knowledge gaps were evident, e.g., unfamiliarity with justifying complex ventilation patterns for rare lung pathologies?
- Compare this experience against previous engagement with similar activities – were any previously identified actions for development achieved? Has your practice improved in efficiently formulating and justifying ventilation strategies?
- Identify any challenges you experienced, such as needing to seek advice or clarification on scope of practice regarding justification for a ventilation strategy that required consultation outside routine protocol, 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 improving your ability to select appropriate modes and patterns based on diverse pathophysiologies.
- What will you do differently next time you approach advising on ventilation strategy, for instance, by proactively reviewing resources on specific modes and patterns to match complex or varied patient scenarios?
- Do you need to practise any aspect of the activity further, such as justifying the selection of modes and patterns for complex patient conditions or key learning outcomes related to selecting the appropriate pattern of ventilation?
Beyond action
Have you revisited the experiences?
- How have your subsequent experiences of advising on ventilation strategies, especially for complex lung pathology (e.g., ARDS or COPD), since completing this specific training activity led you to revisit your initial approach or decisions during that activity? For example, how an instance where a subsequent case involved complex lung pathology (e.g., ARDS or COPD) forced you to re-evaluate the rigidity of your reliance on initial algorithms for mode selection during your first attempt at this training activity.
- Considering what you understand about linking ventilation strategy to patient pathophysiology and integrating sedation levels 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 justification for ventilation mode and pattern selection based on further learning and experiences? For example, how you proactively reviewed and integrated advanced strategies (e.g., PRVC, BiPAP) based on further learning.
- Has discussing specific ventilation strategies or general approaches or the impact of patient outcome following a strategic change with colleagues, peers, or supervisors changed how you now view your initial experience in this training activity? For example, how professional storytelling with a senior colleague about a patient’s response to weaning strategy refined your understanding of the critical nature of meticulous strategy selection.
How have these experiences impacted upon current practice?
- How has the learning from this initial training activity, in combination with subsequent advising on ventilation strategies experiences, contributed to your overall confidence and ability in integrating physiological data with technological constraints to justify therapeutic ventilation strategies, particularly in preparing for assessments like DOPS or OCEs? For example, how your accumulated skills in selecting appropriate ventilation modes and patterns, coupled with effective communication of the rationale, now enables you to confidently discuss and defend a complex ventilation strategy selection during a Case-Based Discussion (CBD) or Observed Communication Event (OCE) assessment.
- How has reflecting back on this specific training activity, combined with everything you’ve learned since, shaped your current approach to clinical decision-making regarding mechanical ventilation? 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 the complexity of the justification for a ventilation strategy requires consultation outside routine protocol [based on conversation history] or when the patient’s response to the chosen strategy is highly unexpected, recognising this requires specialist medical input to resolve the clinical issue.
- Looking holistically at your training journey, how has this initial advising on ventilation strategy experience, revisited with your current perspective, contributed to your development in meeting the learning outcomes related to selecting appropriate mode and pattern of ventilation, and assessing clinical issues? For example, how this foundational experience has supported your development in integrating physiological understanding with technology application, improving your ability to interpret ventilator settings set by others.
Relevant learning outcomes
| # | Outcome |
|---|---|
| # 1 |
Outcome
Select the appropriate mode of ventilation related to the patient’s level of sedation. |
| # 2 |
Outcome
Select the appropriate pattern of ventilation with respect to the patient’s lung physiology/pathophysiology. |
| # 6 |
Outcome
Assess clinical and technical issues with ventilators and troubleshoot accurately. |