Authors (including presenting author) :
Tsoi SCT (2)(3), So HM (1)(2), Chau LTC (3), Hui TPB (3)
Affiliation :
(1) Department of Intensive Care, Pamela Youde Nethersole Eastern Hospital (2) Nethersole Clinical Simulation Training Centre, Pamela Youde Nethersole Eastern Hospital (3) Nursing Services Division, Pamela Youde Nethersole Eastern Hospital
Introduction :
The tracheostomy-related complications were challenging and potentially life-threatening. Novice nurses have minimal experience in tracheostomized patients, which further hampering their confidence in managing related care and handling emergencies. However, structured training regarding tracheostomy care for novice nurses was limited.
Objectives :
To develop a structured, comprehensive training program for novice nurses to equip knowledge, skills to engage daily tracheostomy nursing care, to identify and provide early engagement to tracheostomy emergencies.
Methodology :
Nursing Services Division from PYNEH, HKEC Nurse Consultant (Intensive Care) and Nethersole Clinical Simulation Training Centre collaborated to develop a structured training program for newly graduated nurses.
The training program including:
(1) 45-minutes basic tracheostomy knowledge education via didactic lectures. Essentials of airflow mechanism regarding tracheostomy tube which is crucial in differentiating and managing tracheostomy emergencies were highlighted. Electronic education resources were available to facilitate understanding.
(2) 40-minutes procedural skills practice via special–designed transparent homemade tracheostomy models. Four skill practice stations were (a) Airflow Mechanics, Tracheostomy Tubes & Emergency Preparedness; (b) Tube Security & Cuff Pressure; (c) Suction & Humidification; (d) Tracheostomy Dressing. Practice-doing by participants and underlying rationales revealed via guided discussion were provided by experienced Clinical Preceptors and Advanced Practice Nurses.
(3) 60-minutes simulation training allowed candidates to experience a structured and safe approach to managing three difficult tracheostomy patients. A quick guide for four emergency algorithms and tracheostomy emergency “red-flags” were applied and emphasized. Debriefing was provided after the simulation to facilitate the discussion.
An evaluation was done via a questionnaire after each training session. Questions including the satisfaction toward the tracheostomy session, understanding of tracheostomy, and ability to handle tracheostomy emergencies were asked. 6-points Likert scale was used. Self-perceived valuables (4-points Likert scale) including confidence in caring patients with tracheostomy were asked before and after training.
Result & Outcome :
Eight identical training programs were commenced from Oct 2018 to Dec 2019. A total of 180 respondents completed the training and questionnaires. About 96% of respondents rated the tracheostomy session were useful (Mean score 5.18). Comparison of the pre- and post-course evaluation score showed the participants had increased confidence (Wilcoxon Signed-Rank Test, p< 0.001), improved understanding in tracheostomy (Wilcoxon Signed-Rank Test, p< 0.001), and increased ability in handling tracheostomy emergency (Wilcoxon Signed-Rank Test, p< 0.001), the results showed statistically significant. This structured tracheostomy management training program was effective and efficient for novice nurses to fill the knowledge gap regarding tracheostomy, to sharpen the tracheostomy care skills via procedural skill practice, and to “preview” and experience tracheostomy emergencies via simulation. The training helped to increase the competency of novice nurses to provide high quality and safe nursing management to tracheostomy patients.
