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ASSESSMENT OF TRACHEOSTOMY CARE PRACTICES IN A SIMULATED SETTING
Title
ASSESSMENT OF TRACHEOSTOMY CARE PRACTICES IN A SIMULATED SETTING.
Creator
Bolsega, Thomas, Sole, Mary Lou, University of Central Florida
Abstract / Description
Background: Although a tracheostomy is a common procedure for patients who require prolonged mechanical ventilation, little evidence exists as to the best practices for performing tracheostomy care to maintain the airway and promote skin integrity. Therefore, variability is likely, which may negatively impact patient outcomes. This study described tracheostomy care practices of registered nurses (RNs) and respiratory therapists (RTs) who regularly perform tracheostomy care in critical care...
Show moreBackground: Although a tracheostomy is a common procedure for patients who require prolonged mechanical ventilation, little evidence exists as to the best practices for performing tracheostomy care to maintain the airway and promote skin integrity. Therefore, variability is likely, which may negatively impact patient outcomes. This study described tracheostomy care practices of registered nurses (RNs) and respiratory therapists (RTs) who regularly perform tracheostomy care in critical care settings. Methodology: The descriptive study was conducted following informed consent. RNs (n=15) and RTs (n=5) were asked to perform tracheostomy care on a simulated mannequin patient. An array of supplies (both required and not necessary) was available to perform tracheostomy care. The procedure was video-recorded and the researchers also used an observation checklist. Equipment used and steps performed were compared to hospital policy and the American Association of Critical-Care Nurses (AACN) Procedure Manual. Data were analyzed with descriptive statistics. Results: The majority (80%) of participants were female and held a baccalaureate degree; median experience was 5 years. Equipment selection varied widely; supplies used by 50% or more of participants included non-sterile gloves, hydrogen peroxide, cotton swabs, disposable cannula, foam ties, and gauze dressings. The order of steps was variable with unique differences noted among all participants. The most common sequence was hand hygiene, clean flange, clean stoma, change inner cannula, change ties, and apply dressing. No one performed in the order recommended in the AACN Procedure Manual. Wide variability in practices emphasizes the need for establishing an evidence-based approach for performing tracheostomy care. Discussion: Research supported the belief that variation to technique and supplies does exist when performing tracheostomy care. Tracheostomy varied from provider to provider within one hospital unit, demonstrating the need for further research and protocols for tracheostomy care. Education on existing protocols and evidence-based practice should be conducted to ensure that providers are following unit protocols.
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Date Issued
2015
Identifier
CFH0004746, ucf:45359
Format
Document (PDF)
PURL
http://purl.flvc.org/ucf/fd/CFH0004746
AN EVALUATION OF TRACHEOSTOMY CARE ANXIETY RELIEF THROUGH EDUCATION AND SUPPORT (T-CARES): A PILOT STUDY
Title
AN EVALUATION OF TRACHEOSTOMY CARE ANXIETY RELIEF THROUGH EDUCATION AND SUPPORT (T-CARES): A PILOT STUDY.
Creator
Crosby, William, Sole, Mary Lou, University of Central Florida
Abstract / Description
Background: Home care of a patient with a tracheostomy after surgery for head and neck cancer requires the caregiver to be proficient with new equipment and required skills. The responsibility of managing an artificial airway, may lead to an increase in caregiver anxiety. Education of caregivers varies; it is often a 1:1 impromptu instruction provided by the patient's nurse and/or respiratory therapist. The purpose of this study was to evaluate the effect of the T-CARES course on caregiver...
Show moreBackground: Home care of a patient with a tracheostomy after surgery for head and neck cancer requires the caregiver to be proficient with new equipment and required skills. The responsibility of managing an artificial airway, may lead to an increase in caregiver anxiety. Education of caregivers varies; it is often a 1:1 impromptu instruction provided by the patient's nurse and/or respiratory therapist. The purpose of this study was to evaluate the effect of the T-CARES course on caregiver anxiety and tracheostomy suctioning competency. Method: A quasi-experimental non-randomized control group design was used. The independent variable was method of instruction (T-CARES versus standard). Dependent variables were caregiver anxiety and tracheostomy suction competence. Caregivers (n=12) self selected into groups based on availability to attend T-CARES course. The control group was to receive the unit-based standard of education. The experimental group participated in the T-CARES course. Only one person chose to be in the control group; therefore, data were analyzed for the experimental group only (N=11). The T-CARES course, created by the researcher, was standardized and instructor-led; it incorporated media and simulated practice. Caregiver anxiety for both groups was obtained before (State/Trait Anxiety) and after (State Anxiety) tracheostomy care instruction was provided. Tracheostomy suctioning competence was assessed using a standardized checklist for participants in the T-CARES study group only. Demographic data were summarized with frequencies and descriptive statistics. Given the small sample size, non-parametric statistics were used for data analysis. Results: Data were analyzed from the experimental group only (n=11). The majority of caregivers were women (n=7), white/caucasian (n=10), married (n=8), employed full time (n=7), and were high school graduates or higher (n=10). The mean age of participants was 50.8 years. Seven of the participants reported previous caregiver experience. Mean score of caregiver trait anxiety was 36.8. Mean caregiver state anxiety score was 50.5 before, and 34.3 after the T-CARES intervention. A Related-Samples Wilcoxon Signed Rank Test was performed on the pre and post T-CARES intervention state anxiety scores. The T-CARES intervention significantly reduced anxiety (p=.008). Tracheostomy suctioning competency for 9 of the participants was evaluated upon completion of T-CARES. Mean score was10.8 skills performed correctly out of a possible 14. Caregivers' responses regarding their biggest fear/concern about tracheostomy care included "not doing it right," "trach coming out or being blocked," "hurting the patient," and "not being able to help in an emergency." Participants' suggestions for future improvements were creation of a Spanish language course and the addition of supplementary training to include CPR, First Aid, and the management of feeding tubes. Discussion: Research supported the hypothesis that the T-CARES course would be successful in reducing state anxiety. The T-CARES course also had a positive impact on tracheostomy suctioning competency, though without a control group it is difficult to quantify the effect. The continued development and dissemination of T-CARES to all tracheostomy patients and their caregivers may ease their transition home. The views expressed are those of the author and do not reflect the official policy or position of the US Air Force, Department of Defense or the US Government.
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Date Issued
2012
Identifier
CFH0004138, ucf:44824
Format
Document (PDF)
PURL
http://purl.flvc.org/ucf/fd/CFH0004138