The use of chest tubes or thoracostomy tubes dates back to the 5th century. While the use of chest tubes has become a standard procedure in the hospital setting, many nurses find chest tube management intimidating and may feel overwhelmed.
Managing chest tubes can be stressful.
I am a professional practice leader (PPL) in two medical-surgical units (a cardiac medical unit and a pre-liver transplant transitional care unit) at a tertiary care hospital. The roles of the PPL include serving as a unit educator, supporting bedside nurses and improving patient outcomes.
In the units that I support, the frequency of nurses taking care of patients with chest tubes is about once every six months. Because nurses infrequently encounter this patient population, they may feel uncomfortable. The words “chest tube” evoke anxiety. Whenever a patient with a chest tube is admitted, the nurses call me for assistance.
Chest tube management in our unit is considered a high-risk, low-volume therapy. According to Helman et al., high-risk, low-volume therapies are “practiced infrequently and carry an increased risk to patients because of their complexity.”
Nurses play a critical role in the effective and safe care of patients with chest tubes. It is vital that nurses are knowledgeable and comfortable with chest tube management.
Why can chest tube care be intimidating?
Several factors can be considered as to why chest tubes are intimidating for many nurses. Chest tube care is complex. It can be especially challenging for nurses who don’t understand how chest tubes function or have limited exposure to patients with chest tubes.
High rates of nursing turnover are another factor potentially affecting nurses’ confidence with chest tube care. New nurses hired during and since the COVID-19 pandemic may have nontraditional educational and training experiences and are uncomfortable with chest tube care and maintenance. Further, with many experienced nurses leaving the workforce, it may be challenging to find qualified preceptors to support novice nurses in a hospital setting.
Reducing anxiety with knowledge and a checklist
Direct care nurses face competing priorities throughout their shifts while taking care of patients with complex needs. I was challenged to find a way to address the educational needs of these nurses, who often work in dynamic and stressful environments. How can I make the nurses’ experience with chest tubes less intimidating?
My quest led to the development of an initiative called “No Scare Chest Tube Care,” which includes two evidence-based strategies: just-in-time training and a checklist with the goals of addressing the nurses’ practice gaps in chest tube management and increasing their confidence.
Just-in-time training, a method used by Toyota, is an innovative approach to education that enables learners to acquire skills at the point of need. Clinical educators should consider using methods, like this one, that address the needs of nurses to be effective.
Because patients with chest tubes are infrequent in our medical-surgical unit, just-in-time training can help educate nurses when needed, and it enables educators to observe and provide real-time feedback. Just-in-time training offers the flexibility that bedside nurses need. The checklist, a standard visual tool, can systematically guide nurses in the observation and monitoring of patients with chest tubes. Using a checklist to improve the nursing care of patients with chest tubes has been supported by published evidence.
Using the checklist created by Sasa (2019) as a guide, I developed a chest tube checklist for nurses as part of their handoff report. It includes evidence-based practices, troubleshooting, and our organization’s policy on chest tube management.
At the beginning of the initiative, I provided a chest tube in-service during shift huddles and just-in-time training for nurses whenever a patient with a chest tube was admitted. The chest tube checklist was emailed to all nurses in my units, and a physical copy was placed in the charge nurse binder as an easily accessible, centralized resource. The charge nurse or the assigned nurse prints a copy of the checklist to use as a guide during bedside reports or handoffs.
To address knowledge and practice gaps for our newly hired nurses, chest tube education and a checklist review are included in the onboarding process. Pre- and post-implementation surveys were also conducted. After implementing the initiative, we measured an increase in the knowledge and comfort level of nurses caring for patients with chest tubes.
Implications for Practice
Nurses navigate complex care situations in a rapidly evolving work environment. As educators, we need to be flexible and use teaching strategies that are tailored to the needs of learners.
Teaching Resources
- Manage Chest Tube Drainage Systems
- Ask the Experts: Stripping or Milking of Chest Tubes
- Use of a Digital Air Leak Detection Device to Decrease Chest Tube Duration
From Scaring to Caring
The nursing care of patients with chest tubes does not have to be intimidating. Just-in-time training offers flexibility and enables nurses to learn new skills when needed. Checklists provide a step-by-step guide that makes complex chest tube care easier to manage. Consider these educational approaches to support your nurses.
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