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 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.

Medical-surgical nurses at the project site demonstrated a knowledge deficit regarding the care of adult patients with a tracheostomy. Such knowledge deficits could expose patients to higher risks for infection, bedsores, prolonged hospital stays, increased costs, increased caregiver burden, and death. The purpose of this project was to develop an educational program to improve nurses'€™ knowledge and confidence in the provision of evidence-based tracheostomy care to answer the question if the content of an evidence-based educational program developed to improve nurses'€™ knowledge and confidence in managing adult patients with tracheostomy on a medical-surgical floor would meet the expectations of a panel of content experts. Bandura'€™s self-efficacy and social learning theories provided theoretical guidance for the project. Five local nurse practitioners served as content experts and made recommendations about how the program could be improved, as well as suggestions relating to the wording of and the time allowed for the simulation aspect of the program. Content experts used a 5-point Likert-scale survey to evaluate the education at the completion of the program. Results showed that all reviewers strongly agreed that the content of the program was relevant, was based on the best available evidence, and was well organized and easy to follow. This project may promote positive change on the medical-surgical floor by improving providers'€™ knowledge, skills, and confidence in the provision of care based on the best available evidence, which may lead to improvements in the quality of care provided to tracheostomized patients.

Often, education regarding low volume and high-risk procedures, like tracheostomy, are ignored. Lack of experience, skills, and human resources can lead to decreases in confidence levels, diminished quality of care, and potentially an adverse event. The purpose of this DNP project was to prepare simulation-based education on the tracheostomy procedure and provide hands-on education to bedside nurses. The project answered the question: To what extent will a simulation-based teaching method adequately prepare staff nurses in a post-acute surgical unit to perform this high risk low volume procedure? The Johns Hopkins evidence-based model method was used to assist in translation of the practice change process. The International Nursing Association for Clinical Simulation and Learning standards were used to design simulation scenarios. Surgical acute care nurses (n = 35) including day and night shift nurses, new graduates, and experienced nurses participated. Groups of five to eight nurses participated in a two-hour simulation session at hospital simulation center. Pre- and post-surveys on confidence level data, and National League of Nursing evaluation tool data on educational practices and simulation designs were collected from all participants. Paired t-test statistics showed a significant increase in confidence level from pre to post education (p < .001). Because of the significant impact on patient care due to preventing complications and by improving nursing staff's level of confidence, the project may contribute to positive social change.

Tracheostomos priežiūros veiksmai bei sekreto išsiurbimo iš tracheostominio vamzdelio technika gali įtakoti komplikacijų dažnumą ir lemti paciento saugumą, pasveikimo galimybę, gydymo trukmę bei gydymo kainą. Svarbu, kad slaugytojai žinotų mokslo tyrimais pagrįstas rekomendacijas apie tracheostomos priežiūrą ir jas pritaikytų klinikinėje praktikoje. Tyrimo tikslas – Išanalizuoti slaugytojų žinias ir įgūdžius atliekant tracheostomos priežiūrą. Tyrimo uždaviniai. 1.Ištirti slaugytojų žinias apie tracheostomos priežiūrą prieš ir po mokymų. 2. Nustatyti slaugytojų įgūdžius atliekant tracheostomos priežiūros veiksmus. 3. Palyginti slaugytojų žinias apie tracheostomos priežiūrą ir jų taikymą praktikoje. Tyrimo metodai: Tyrimas buvo vykdomas 2013.04.20–12.20 LSMUL Kauno Klinikų keturiuose skyriuose bei vienoje iš Slaugos ir palaikomojo gydymo ligoninių. Tyrimo duomenims rinkti buvo naudojamas tyrimo autorių sukurta anketa ir slaugytojų praktikinių veiksmų stebėjimo protokolas. Slaugytojų anketinė apklausa buvo vykdoma du kartus: prieš (n=90, atsako dažnis–96,77 proc.) ir po (n=86, atsako dažnis–92,47 proc.) mokymo. Stebėtos 99 sekreto išsiurbimo iš tracheostomos vamzdelio procedūros. Tyrimui atlikti buvo gautas LSMU Bioetikos centro pritarimas BEC-KS(M)-198. Išvados. 1. Prieš mokymus didžioji dalis slaugytojų teisingai žinojo požymius, rodančius siurbimo poreikį, sekreto išsiurbimo trukmę, kiek giliai įvesti atsiurbimo kateterį, galimas sekreto siurbimo komplikacijas. Po mokymo... [toliau žr. visą tekstą] / Actions of tracheostomy care as well as the technique of secretion suctioning from tracheostomy tube can influence the incidence of complications and determine patient‘s safety, possibility of recovery, the duration of treatment and the cost of treatment. It is critical for nurses to be aware of tracheostomy care recommendations based on scientific research and to apply them in clinical practice. The aim – to analyze nurses’ knowledge and skills in tracheostomy care. Objectives:1.To examine nurses’ knowledge on tracheostomy care prior to training and after the training. 2. To identify nurses’ skills while performing actions of tracheostomy care. 3. To compare nurses’ knowledge on tracheostomy care and their application in practice. Research methods: The research was conducted on 20-04-2013 - 20-12-2013 at the hospital of Lithuanian University of Health Sciences Kauno Klinikos in four departments and in one of the Nursing and supportive care hospital. A questionnaire created by the authors of the research and an observation protocol of nurses’ actions in practice was used to collect the data of the research. A survey on nurses’ was conducted twice: prior to training (n=90, response rate – 96.77%) and after the training (n=86, response rate – 92.47%). We observed 99 procedures of secretion suctioning from tracheostomy tube. The research was conducted with the approval BEC-KS (M)-198 from the center of Bioethics of Lithuanian University of Health Sciences. Conclusions. 1... [to full text]