The population of medically fragile adolescents has grown in recent decades because of the sequelae of prematurity, injuries, and chronic or terminal illnesses. Medically fragile adolescents who require respiratory assistance are part of this unique population with challenges in their daily lives, yet as nurses, we know little about their experiences and the best approaches to use in caring for them. The purpose of this study was to explore the experiences of medically fragile adolescents who require respiratory assistance. Interpretive phenomenology was used to describe and interpret the experience of 11 medically fragile adolescents who required respiratory assistance. The adolescents ranged in age from 13 to 18 years of age and required respiratory assistances of tracheostomies, ventilator support, and Bi-level positive airway pressure (BiPap). Audiotaped semi-structured interviews were conducted with the adolescents. Data analysis was completed using the steps delineated by Diekelmann and Allen (1989). Six themes and one pattern were identified from the interviews with the adolescents. The major themes were “Get to know me”, “Allow me to be myself”, “Being there for me”, “No matter what, technology helps”, “I am an independent person”, and “The only one I know of”. This study explored medically fragile adolescents who required a specific technology, respiratory assistance, within a distinct developmental stage. These adolescents have a clear view of who they are as a person. They want nurses to view them as a person, not just a patient. The adolescents felt that friends were there for them when they needed support. This was in contrast to those that they did not consider friends who were judgmental. Technology had meanings that encompassed enhanced daily living and existing as a part of their day, not their whole day. The adolescents viewed themselves as an independent person and were actively engaging in activities and strategies to achieve their goals of independence. This study contributes to nursing knowledge by helping nurses to understand what these adolescents experience in their daily lives and aiding nurses in providing better care for these adolescents. Recommendations for nursing practice, education, and research were identified in this study.

Background: The delivery of an aerosol via a tracheostomy tube has been previously described with both a tracheostomy collar and a T-piece, but not with a Wright mask, or aerosol mask. The primary purpose of this study was to quantify lung doses using different interfaces: tracheostomy collar, Wright mask, and aerosol mask. The secondary purposes were to compare albuterol delivery between an opened vs. a closed fenestration hole and also to determine the effect of inspiratory time:expiratory time (I:E) ratio on aerosol delivery. Methods: A teaching mannequin (Medical Plastic Labs, Gatesville, TX) with a tracheostomy opening was used. Two of the mannequin's bronchi were connected to a "Y" adaptor, which was attached to a collecting filter (Respirgard ™ II 303, Vital Signs, Englewood, CO), which was connected to a breathing simulator (Harvard Apparatus Dual Phase Control Respirator Pump, Holliston, MA) through a corrugated tube. Settings for spontaneous breathing were respiratory rate 20/min, and tidal volume 400 mL. The I:E ratios were adjusted in the first and second comparisons at 2:1 and 1:2, respectively. The nebulizer was operated by a flow meter (Timemeter, St. Louis, MO) at 8 L/min with 100% oxygen. In every condition, the flow was discontinued at the end of nebulization. The nebulizer was attached to the tracheostomy collar (AirLife™, Cardinal Health, McGaw Park, IL) in the first group, the Wright mask (Wright Solutions LLC, Marathon, FL) in the second group, and the aerosol mask (AirLife™, Cardinal Health, McGaw, IL) in the third group. Drug was eluted from the filter and analyzed by spectrophotometry (276 nm). Data Analysis: Paired t-test, one-way analysis of variance (ANOVA), repeated measures ANOVA, post-hoc and pairwise comparisons were performed at the significance level of .05, using PASW version 18.0. Results: Aerosol delivery was greater with the tracheostomy collar than the Wright mask and aerosol mask (p < .05). Closing the fenestration hole increased aerosol deposition significantly at 2:1 ratio (p = .04) compared to opening the fenestration at 1:2 ratio. I:E ratio and aerosol delivery were directly related. Increasing I:E ratio from 1:2 to 2:1 improved aerosol delivery significantly with tracheostomy collar-fenestration opened (p = .009), Wright mask (p = .02) and aerosol mask (p = .01). Conclusion: This study indicates that the use of a tracheostomy collar is the best method of delivering aerosol therapy among the three interfaces. The I:E ratio of 2:1 caused greater aerosol deposition than 1:2 ratio. The aerosol deposition was better when the fenestration hole was closed compared with opened fenestration.

Bakgrund: Trakeostomi erhålls av patienter som behöver en fri luftväg, både i akut skede och under en längre tid. Trots att trakeostomin är en viktig livsuppehållande åtgärd, medföljer risker. Kommunikation ligger till grund för god personcentrerad omvårdnad, som är en av sjuksköterskans kärnkompetenser. Personcentrerad omvårdnad lyfter fram patientens styrkor, tillgångar och involverar personen i sin omvårdnad. Syfte: Syftet var att undersöka patientens upplevelse av omvårdnad kring sin trakeostomi. Metod: En allmän litteraturstudie genomfördes i databaserna CINAHL, PubMed och Psycinfo. Resultat: Att ha en trakeostomi uppfattades som en känslomässigt påfrestande upplevelse. Trakeostomin påverkade patientens förmåga att kunna tala, vilket uppfattades som fysiskt och psykiskt påfrestande. Behovet av innehållsrik information, tålamod och närvaro från sjuksköterskan var viktiga delar för att skapa trygghet och lugn hos patienten. Att involvera patienten i sin omvårdnad medförde gynnsamma förutsättningar för den personcentrerade omvårdnaden och skapade tillit i vårdrelationen. Slutsats: Föreliggande studie visar att trakeostomerade patienter upplevde obehag som kunde förebyggas genom personcentrerad omvårdnad. Personcentrerad vård uppnåddes när patienten involverades, fick innehållsrik information och gavs tålamod i den icke-verbala kommunikationen. / Background: The tracheostomy enables a clear airway for those who need it, both in emergent situations and when needed for a longer time. Although this is a lifeprolonging intervention, tracheostomy is accompanied with risks. Communication has a pivotal role for person centered care, which is one of the nurse’s core competence. Person centered care highlight the patient’s strengths, assets and involves the patient in their care. Aim: Hence the aim of this study was to analyze the patient’s experience of their nursing care around the tracheostomy. Method: A general literature study was conducted in the databases CINAHL, PubMed and Psycinfo. Results: The tracheostomy was perceived as emotionally challenging. The tracheostomy affected the patient’s ability to speak, which was physically and mentally challenging for the patient. The need for comprehensive information and patience from the nurse was important to create a sense of security and calmness in the patients. To involve the patient in their care brought favorable conditions for the person centered care and created trust in the nurse. Conclusions: This study shows that tracheostomized patients experience discomfort that can be prevented by person-centered care, comprehensive information and having patience during the non-verbal communication with the patient.

A traqueostomia percutânea é um procedimento realizado rotineiramente na Unidade de Terapia Intensiva (UTI), guiada por broncoscopia. Recentemente, a ultrassonografia tem surgido como uma ferramenta potencialmente útil para assistir à traqueostomia percutânea e reduzir as complicações relacionadas ao procedimento. Um ensaio clínico randomizado, aberto, paralelo, de não inferioridade, foi conduzido comparando a traqueostomia percutânea guiada por ultrassonografia com a traqueostomia percutânea guiada por broncoscopia, em pacientes sob ventilação mecânica na UTI. O desfecho primário, a falência do procedimento, foi definido como um desfecho composto, incluindo (1) a conversão para traqueostomia cirúrgica, (2) o uso associado e não planejado da broncoscopia ou da ultrassonografia, ou (3) a ocorrência de uma complicação maior. Um total de 4.965 pacientes foram avaliados quanto a elegibilidade. Desses, 171 pacientes foram elegíveis e 118 foram submetidos ao procedimento, com 60 pacientes randomizados para o grupo ultrassonografia e 58 pacientes randomizados para o grupo broncoscopia. A falência do procedimento ocorreu em um (1,7%) paciente no grupo ultrassonografia e um (1,7%) paciente no grupo broncoscopia, sem diferença no risco absoluto entre os grupos (intervalo de confiança de 90%, -5,57 a 5,85), na análise \"conforme tratados\", não incluindo a margem de não inferioridade pré-especificada de 6%. Nenhum outro paciente apresentou uma complicação maior em ambos os grupos. As complicações menores relacionadas ao procedimento ocorreram em 20 (33,3%) pacientes no grupo ultrassonografia e em 12 (20,7%) pacientes no grupo broncoscopia, (P = 0,122). A duração do procedimento foi de 11 [7-19] vs. 13 [8-20] minutos (P = 0,468), respectivamente, e os desfechos clínicos também não foram diferentes entre os grupos. Em conclusão, a traqueostomia percutânea guiada por ultrassonografia é eficiente, segura e associada com taxas de complicações semelhantes à traqueostomia percutânea guiada por broncoscopia, em pacientes sob ventilação mecânica na UTI / Percutaneous Dilational Tracheostomy (PDT) is routinely performed in the intensive care unit (ICU) with bronchoscopy guidance. Recently, ultrasound has emerged as a potentially useful tool in order to assist PDT and reduce procedure-related complications. An open-label, parallel, non-inferiority, randomized controlled trial was conducted comparing the ultrasound-guided PDT with the bronchoscopy-guided PDT in mechanically ventilated critically ill patients. The primary outcome was procedure failure, defined as a composite end-point of conversion to a surgical tracheostomy; unplanned associated use of bronchoscopy or ultrasound during PDT; or the occurrence of a major complication. A total of 4,965 patients were assessed for eligibility. Of these, 171 patients were eligible and 118 underwent the procedure, with 60 patients randomly assigned to the ultrasound group and 58 patients to the bronchoscopy group. Procedure failure occurred in one (1.7%) patient in the ultrasound group and one (1.7%) patient in the bronchoscopy group, with no absolute risk difference between the groups (90% confidence interval, -5.57 to 5.85), in the \'as treated\' analysis, not including the pre-specified margin of 6% for noninferiority. No other patient had any major complication in both of the groups. Procedure-related minor complications occurred in 20 (33.3%) patients in the ultrasound group and in 12 (20.7%) patients in the bronchoscopy group, (P=0.122). The median procedure length was 11 [7-19] vs. 13 [8-20] minutes (P=0.468), respectively, and the clinical outcomes were also not different between the groups. In conclusion, ultrasound-guided PDT is effective, safe and associated with similar complication rates and clinical outcomes compared with bronchoscopy-guided tracheostomy in mechanically ventilated critically ill patients

There has been a worldwide increase in the number of tracheostomies performed on the paediatric population, particularly during the first year of life, which has also been evident at Red Cross Children’s Hospital in South Africa. Infants and toddlers with tracheostomies present with multiple risk factors for having or developing dysphagia and/or communication difficulties, due to the effects of the tracheostomy on the development of feeding, speech and communication, as well as the underlying medical conditions that necessitated the tracheostomy, and associated medical, social and environmental factors. There is, however, a dearth of literature in the area of paediatric tracheostomies in the South African context, particularly with regard to feeding and communication. The purpose of this study was to determine the incidence and describe the nature of dysphagia and communication difficulties in infants and toddlers with tracheostomies in the South African context, and detail the need for speech-language therapy intervention. It also attempted to determine whether there was an association between the underlying medical condition and the incidence of dysphagia and/or communication difficulties. A retrospective, descriptive survey of the folders of infants and toddlers with tracheostomies within the age range of 0 – 3 years from 2002 – 2004 at Red Cross Children’s Hospital was conducted. A checklist for dysphagia and communication difficulties in infants and toddlers with tracheostomies was developed and used to collect data from participants’ medical records. Results indicated that 80% of the study population presented with dysphagia. Oral phase difficulties were documented in 81.25%, pharyngeal phase difficulties in 60.9% and oesophageal phase difficulties in 79.7% of the dysphagic sample. Communication difficulties were recorded in 94% of the sample population. Speech production difficulties were documented in 78%, receptive language delays in 87% and expressive language delays in 96% of the sample population with communication difficulties. No statistically significant association was established between the underlying medical condition and the incidence of either dysphagia or communication difficulties. The results in the present study support the limited available literature, and the need for early speech-language therapy intervention for infants and toddlers with tracheostomies. / Dissertation (M (Communication Pathology))--University of Pretoria, 2007. / Speech-Language Pathology and Audiology / M (Communication Pathology) / unrestricted

No description available.

No description available.

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]

Bakgrund: Trakeostomi är ett kirurgiskt ingrepp där en öppning skapas i patientens luftstrupe vilket ofta medför att patienten förlorar sin förmåga till verbal kommunikation. För att skapa en väl fungerande kommunikation mellan patient och sjuksköterska behöver alternativa kommunikationsmetoder användas.   Syfte: Syftet var att undersöka patienters upplevelse av kommunikation vid trakeostomi samt att undersöka vilka metoder som kan användas för att etablera en välfungerande kommunikation mellan patient med trakeostomi och sjuksköterska när tal inte är en möjlig kommunikationsmetod. Metod: Litteraturstudie av 14 vetenskapliga artiklar varav sju kvalitativa studier och en kombinerad kvalitativ och kvantitativ studie av patientens upplevelse av att kommunicera vid trakeostomi och sju kvantitativa studier av olika kommunikationsmetoder.  Resultat: Att kommunicera med trakeostomi upplevs av patienter som frustrerande och fysiskt påfrestande. Att inte kunna förmedla sina känslor och behov leder till att patienter upplever sociala svårigheter och känner rädsla, oro och isolering från omvärlden vilket har en stor påverkan på patientens välmående. Metoder för icke verbal kommunikation som studerades var datoriserad tolkning av läpprörelser samt olika former av kommunikationstavlor som styrdes antingen genom ögonrörelser eller via en pekskärm. Samtliga metoder som studerades visade på möjligheter till en ökad förmåga att uttrycka sig och kommunicera sina behov för patienten  Slutsats: Patienter med trakeostomi som inte kan kommunicera verbalt befinner sig i en utsatt situation där sjuksköterskan spelar en betydelsefull roll för patientens välmående genom att uppmärksamma patientens åsikter och behov. Det är en nödvändighet att etablera en välfungerande kommunikation genom användning av icke-verbala kommunikationsmetoder för att kunna ge patienten en vård av god kvalitet. För att kommunikationen ska bli välfungerande krävs att kommunikationsmetoderna anpassas utefter varje enskild patients behov och fysiska förmåga vilket i sin tur kräver att sjuksköterskan har kunskap om olika icke-verbala kommunikationsmetoder och är medveten om betydelsen av en välfungerande kommunikation. / Background: Tracheostomy is a surgical procedure where an opening is made in the trachea. As a result, the patient often loses his or her ability to communicate verbally. To establish a well-functioning communication between the patient and the nurse there is a need for using non-verbal methods for communication.   Aim: The aim of this study was to examine patient experiences of communicating with tracheostomy and also to examine available methods for non-verbal communication between patients with tracheostomy and nurses. Study design: A review based on 14 studies was conducted. Seven were qualitative studies and one combined qualitative and quantitative describing patient experiences of communicating with tracheostomy. Seven studies had a quantitative design exploring nonverbal communication methods.  Results: Patients experienced frustration, physical exhaustion and mental stress while communicating with tracheostomy. Not being able to communicate feelings and needs leads to feelings of fear, anxiety and isolation, which has a great impact on the patient's well-being.  Methods for non-verbal communication which were examined was computerized reading of lip movements and different types of communication boards managed by eye tracking or with touch screen. All of the methods appeared to give the patient´s an increased possibility to express themselves and communicate their needs.   Conclusion:  Patients with tracheostomy are put in an exposed situation when they aren´t able to communicate verbally. The nurse has a great impact on the patient´s well-being by paying attention to his or her needs. Establishing a well-functioning communication by using nonverbal communication methods is essential to provide the patient with a good quality care. The methods for communication has to be individually adjusted to each patient’s needs and physical condition. This requires knowledge by the nurse about different non-verbal methods for communication and the importance of a well-functioning communication.

The primary objective of the current study was to attempt to establish whether there is a need for a dysphagia training programme for nurses and speech-language therapists working with acute tracheostomised patients in critical care units in South Africa. The research design that was adopted for this project was within a mixed methods approach framework. An exploratory descriptive survey design using semi-structured face-to-face interviews was used. The final sample consisted of interviews with 20 speech-language therapists from eight different hospitals with critical care facilities and 12 nurses from four different hospitals with such facilities. Data from the close ended questions were analysed using descriptive statistics, while remaining data from open ended questions were thematically analysed and the constant comparison method was applied. The data demonstrated that all speech-language therapists and 10 out of the 12 nurses were in agreement that there was a need for a dysphagia training programme for nurses in critical care for tracheostomised patients presenting with dysphagia. An important and unexpected result of this study was that speech-language therapists themselves required additional training in this area. The data demonstrated that the majority of speech-language therapists and nurses were of the view that they had received minimal theoretical and practical hours on tracheostomy screening, assessment and management at an undergraduate level. Overall, the results of the current study suggested varied practices in the screening, assessment and management of tracheostomy and dysphagia, particularly with regard to blue dye testing, suctioning protocols and cuff inflation and deflation protocols. The research significance and implications of the study included the need to improve undergraduate training for speech-language therapists and nurses in the area of dysphagia and tracheostomy, to alert professional training bodies regarding institution of additional licensing and qualifications for speech-language therapists and nurses in the area of dysphagia and tracheostomy, and to thereby improve the situation of clinicians practising in dysphagia and tracheostomy management through the development of guidelines, protocols and position papers. An important implication of this research is that it established the need for a dysphagia training programme for both speech-language therapists and nurses in critical care in dysphagia and tracheostomy, and thereby monitoring the efficacy of this programme and measuring/monitoring the outcomes of multidisciplinary teamwork in the assessment and management of dysphagia and tracheostomy in critical care.