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Original Investigation
February 2016

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

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
Abstract

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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