The nursing role in oxygen treatment: working at a hyperbaric oxygen clinic offers the only nurse a variety of satisfactions and challenges.

My job as hyperbaric and wound care nurse at the Oxygen Therapy Clinic is varied and thus, very interesting. The "wound care" aspect of my role consists of wound care assessments, which include taking photos and measurements, and also taking bloods and transcutaneous oxygen measurements. I spend a lot of time with patients, educating them on how they can assist their healing. I use resources provided by various groups such as the diabetic society, various nutritional pamphlets and I have designed my own resources. I have designed a "smokers' wall" with some facts about smoking and wound healing. I have also designed a poster on the four stages of wound healing so patients can visualise what we are aiming for and how I am planning their care. The clinic is part of a large Australasian wound care study at present, the Hyperbaric Oxygen Therapy for Chronic and Problem Wounds, so I do all the work needed to enrol patients in the study and collate the data. I am occasionally asked to talk to nursing groups about different aspects of wound care or HBOT.

Patient assessments

The "hyperbaric" part of my role involves assisting our physician with the assessments required to ensure patients are fit enough to have treatment. This consists of tests such as spirometry, vision, audiometry, tympanic testing and, the old favourites, temperature, pulse, respirations and blood pressure. In this role I also educate patients on the treatment and what it involves. Treatment is carried out in a chamber and begins with air pressure at normal surface pressure. The pressure is gradually increased to the equivalent of being 14 metres under water. At this pressure, oxygen is forced into the blood vessels and tissues. As the nurse involved, I have to think of the special cares patients may need while in the chamber, eg elderly people may need to stand for a period to prevent pressure areas, or those with diabetes need to have had a good meal before treatment. I sometimes accompany patients in the chamber. No pens or electronic equipment are permitted, so I can catch up on reading.

There are two sorts of chambers. The monoplace chamber, in which one patient can recline, is like a Perspex tube so both the patient and the operator can see each other. The patient can listen to music via a headset while treatment occurs. The whole chamber has pressurised oxygen in ti so the patient doesn't have to wear a mask or hood. The multi-place chamber and can fit a maximum of six sitting patients and an attendant, or the chairs can be removed to allow a reclining patient to be treated. The multi-place chamber is fitted out with a television screen. Patients also have the option of listening to music or reading.

Oxygen is delivered via a clear plastic hood or a mask. The attendant breathes the air in the chamber but commences on oxygen 45 minutes before surfacing to remove any risk of developing decompression illness (bends).

Treatment times vary according to patients' conditions. Patients whose wounds are being treated usually have 30 treatments, each of two hours per day. The frequency of the treatment depends on the wound and the products being used. The clinic normally operates from Monday to Friday but we continue weekend treatments for patients with acute conditions. An average of 12 patients a month are treated, 40 percent of these for problem wounds. Twelve patients a month may not sound many but most are having 30 treatments and are coming in on a daily basis. Twelve patients a month equates to 360 HBOT treatments and 40 percent of these patients are also having wound care at the clinic.

An interesting part of the role is helping market the business and raising awareness of our work. It is a private clinic, established by a commerical diver and paramedic, Peter Young, in 1999, after two years' preparatory work. He is the managing director. The clinic also employs one full-time and one part-time doctor, myself, three chamber maintenancetechnicians an administrative worker and a general suport worker.

As with all jobs, there is a mixture of challenges and rewards, with the tatter outweighing the former. Before taking on this job last year, I was the clinical nurse educator in the Plastic and Reconstructive Unit at Auckland's Middlemore Hospital. I miss the acute nursing and the trauma I used to dear with in my former job. As the only nurse in the clinic, I also miss working with other nursing colleagues.

One of the main frustrations of my current role is having patients referred to us who we could help, but, because funding is not approved, we are unable to treat them. I get frustrated that too often HBOT is the ambulance at the bottom of the cliff rather than being used to prevent wounds worsening.

But the rewards of the rote are far more important. I enjoy spending quality one-on-one time with patients. I love having the time to do "extras" such as organise transport to a tangi, make a cup of tea, really listen to someone who needs to talk. I love being in control of the wound care I'm responsible for, making a plan, having dressings stay intact and seeing results. It is also very satisfying learning new skills and extending myself personally and professionally.