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Original Investigation |

Inpatient Nursing and Parental Comfort in Managing Pediatric Tracheostomy Care and Emergencies

Cedric V. Pritchett, MD, MPH1,2; Melissa Foster Rietz, FNP-BC3; Amrita Ray, DO, MPH4; Michael J. Brenner, MD4; David Brown, MD4
[+] Author Affiliations
1Division of Pediatric Otolaryngology, Ann and Robert Lurie Children’s Hospital of Chicago, Chicago, Illinois
2Department of Otolaryngology–Head and Neck Surgery, Northwestern University, Chicago, Illinois
3Presbyterian Medical Services, Farmington, New Mexico
4Department of Otolaryngology–Head and Neck Surgery, University of Michigan Health System, Ann Arbor
JAMA Otolaryngol Head Neck Surg. 2016;142(2):132-137. doi:10.1001/jamaoto.2015.3050.
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Importance  Tracheostomy is a critical and often life-saving intervention, but associated risks are not negligible. The vulnerability of the pediatric population underlies the importance of caregiver comfort and competence in tracheostomy care.

Objective  To assess inpatient nursing staff and parental perspectives in managing tracheostomy care.

Design, Setting, and Participants  Cross-sectional analysis of survey data from (1) a volunteer sample of inpatient nurses in a tertiary care, freestanding pediatric hospital in the Midwest, assigned to clinical wards that provide care for children with tracheostomy tubes and (2) a consecutive sample of families whose child underwent tracheostomy tube placement at the same institution between March 1 and December 31, 2013.

Main Outcomes and Measures  Nurse and parental comfort in managing acute and established tracheostomy tubes. Nursing data were analyzed with attention to years’ experience and primary unit of practice.

Results  Respondents included 129 of 820 nurses (16% response rate) and family members of 19 of 38 children (50% response rate). When queried about changing established tracheostomies, 59 of 128 nurses (46%) reported being “totally comfortable,” including 46 of 82 intensive care unit (ICU) nurses (56%) vs 13 of 46 floor nurses (28%) (P = .002) and 48 of 80 nurses with at least 5 years’ experience (60%) vs 12 of 49 less experienced nurses (24%) (P < .001). For managing accidental decannulation of a fresh tracheostomy, 61 nurses (47%) described being completely uncomfortable, including 27 of 83 ICU nurses (33%) vs 34 of 46 floor nurses (73%) (P = .006), and 33 of 80 nurses with at least 5 years’ experience (41% ) vs 28 of 49 less experienced nurses (57%) (P = .03). Most families felt prepared for discharge (16 of 17 [94%]) and found the health care team accessible (16 of 17 [94%]), although only 5 of 18 families (28%) indicated that tracheostomy teaching was consistent.

Conclusions and Relevance  Nurses’ comfort with tracheostomy was higher among nurses with at least 5 years’ experience and primary ICU location. Whereas parental comfort with tracheostomy care was high, lack of consistent instruction highlights the role for standardized education in tracheostomy care.

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Figure 1.
Nurses’ Comfort With Changing Established Tracheostomy

At least 5 years of experience and primary intensive care unit (ICU) assignment were associated with increased comfort in managing nonemergent tracheostomy change.

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Figure 2.
Nurses’ Comfort With Accidental Decannulation of Fresh and Established Tracheostomy Tubes

Intensive care unit (ICU) nurses reported significantly higher comfort levels compared with their non-ICU colleagues in managing accidental decannulations (P = .049 for fresh tracheostomy, P = .03 for established tracheostomy). Among non-ICU nurses, there was a statistically significant relationship between experience and comfort handling accidental decannulations (P = .03).

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Figure 3.
Nurse Interval Since Last Tracheostomy Tube Change Performed, by Location of Practice

Intensive care unit (ICU) nurses reported less time since they last performed a tracheostomy change compared with non-ICU nurses (58 of 82 [71%] vs 19 of 46 [41%] within the past year). Whereas only 6 ICU nurses (7%) reported never having changed a tracheostomy, 15 non-ICU nurses (33%) had never completed a tracheostomy change.

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Figure 4.
Parental Ratings of Tracheostomy Teaching

Teaching inconsistency was the primary area of concern cited in parental education. Almost all parents indicated satisfaction regarding inpatient nurse and/or therapist availability, overall quality of teaching/understandability, and their comfort at discharge to care for their child with a tracheostomy. However, teaching consistency was identified as a potential arena for improvement.

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