Tracheostomy (Warrenville, Ill.)最新文献

Objective: To evaluate an educational intervention to promote confidence, knowledge, and skills in tracheostomy tube change among nursing students.

Methods: The study, conducted at the at the Johns Hopkins Center for Immersive Learning and Digital Innovation, enrolled nursing students without prior experience in tracheostomy tube change. The intervention included a pre-recorded presentation, faculty demonstrations with a Tracheostomy Care Training Simulation Model, and participant practice demonstrating skills. Primary outcomes included confidence, knowledge, and competency with tracheostomy tube changes. Secondary outcomes included number of attempts required to achieve competency and time required per attempt. The study followed STROBE guidelines with repeated measure design.

Results: Participants in the study (n=50) had a mean age of 30 years, were predominantly female (83%) with a bachelor's degree (76%), most often in the third semester of nursing school (45%). Participants showed a mean improvement of 3.58 points out of five (SD: 0.56, P<0.001) across 11 pre- and post-test items. Every confidence assessment improved, with the largest increase in assessing tube placement. Knowledge assessments improved across all eight test items in the first test-retest interval, showing an improvement of 1.14 points out of five (SD: 0.89, P<0.001). Competency assessment improved in the first test-retest interval of 1.01 points out of five (SD: 0.65, P<0.001). On serial assessments, time to complete tracheostomy tube change decreased from 2.39 to 0.60 minutes. Faculty deemed 95% of participants competent after only one skill testing iteration.

Conclusion: An educational intervention, combining digital presentations with interactive faculty-led simulations and practical skill assessments, successfully elevated nursing students' confidence, knowledge, and competency in tracheostomy tube changes.

The past decade has witnessed unprecedented progress in tracheostomy care, through communication, dissemination, and implementation of key drivers including interprofessional education, team-based care, standardized protocols, patient and family engagement, and data-driven practice. Improved safety, efficiency, and quality of tracheostomy care reflects contributions from fields of competency-based education, evidence-based practice, and quality improvement. These elements are interconnected, reinforcing one another to enhance patient care. Competency-based interactive education emphasizes active and practical learning through simulations and case studies, which enhance the clinical skills essential for high-quality care. These educational strategies are grounded in clinical research, ensuring that care practices are continually updated and aligned with the latest evidence, thereby bridging the gap between research findings and clinical application. Quality improvement processes such as Plan-Do-Study-Act (PDSA) cycles refine care delivery in real-world settings. Implementation science promotes the uptake of evidence-based practices, ensuring that discoveries translate to improved health outcomes, quality of care, and overall system performance. In each of these domains, patient and family engagement ensures alignment with patient needs and values. The Global Tracheostomy Collaborative leverages this integrated approach through international educational symposia and webinars, comprehensive data analyses, and a learning community that promotes innovative technologies like in situ simulation and augmented and virtual reality. Together, these approaches enhance the learning and application of best practices in tracheostomy care. The continuous, dynamic interaction of education, research, and quality improvement, grounded in patient-centered care, fosters excellence and innovation in care of patients with tracheostomy.

Background: Tracheostomy, a common procedure performed in intensive care units (ICU), is associated with communication impairment and affects patient well-being. While prior research has focused on physiological care, there is a need to address communication needs and quality of life (QOL). We aimed to evaluate how different types of communication devices affect QOL, speech intelligibility, voice quality, time to significant events, clinical response and tolerance, and healthcare utilization in patients undergoing tracheostomy.

Methods: Following PRISMA guidelines, a systematic review was conducted to assess studies from 2016 onwards. Eligible studies included adult ICU patients with a tracheostomy, comparing different types of communication devices. Data were extracted and synthesized to evaluate QOL, speech intelligibility, voice quality, time to significant events (initial communication device use, oral intake, decannulation), clinical response and tolerance, and healthcare utilization and facilitators/barriers to device implementation.

Results: Among 9,228 studies screened, 8 were included in the review. Various communication devices were employed, comprising both tracheostomy types and speaking valves, highlighting the multifaceted nature of interventions. Quality of life improvements were observed with voice restoration interventions, but challenges such as speech intelligibility impairments were noted. The median time for initial communication device usage post-intervention was 11.4 ± 5.56 days. The median duration of speech tolerance ranged between 30-60 minutes to 2-3 hours across different studies. Complications such as air trapping or breathing difficulties were reported in 15% of cases. Additionally, the median ICU length of stay post-intervention was 36.5 days. Key facilitators for device implementation included early intervention, while barriers ranged from service variability to physical intolerance issues.

Conclusion: Findings demonstrate that various types of communication devices can significantly enhance the quality of life, speech intelligibility, and voice quality for patients undergoing tracheostomy, aligning with the desired outcomes of improved clinical response and reduced healthcare utilization. The identification of facilitators and barriers to device implementation further informs clinical practice, suggesting a tailored, patient-centered approach is crucial for optimizing the benefits of communication devices in this population.