Division of Pediatric Otolaryngology, Ann and Robert Lurie Children's Hospital of Chicago, Chicago, Illinois2Department of Otolaryngology-Head and Neck Surgery, Northwestern University, Chicago, Illinois.
Presbyterian Medical Services, Farmington, New Mexico.
JAMA Otolaryngol Head Neck Surg. 2016 Feb;142(2):132-7. doi: 10.1001/jamaoto.2015.3050.
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.
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.
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.
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.
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.
气管切开术是一种关键的、常常是救命的干预措施，但相关风险不容忽视。儿科人群的脆弱性凸显了护理人员在气管切开护理方面的舒适度和能力的重要性。
评估住院护理人员和家长在管理气管切开护理方面的观点。
设计、地点和参与者：对（1）中西部一家三级护理、独立儿科医院临床病房的志愿抽样的住院护士（分配到为带气管造口管的儿童提供护理的病房）和（2）2013 年 3 月 1 日至 12 月 31 日期间在同一机构接受气管造口管放置的连续抽样的家庭的调查数据进行横断面分析。
护理人员和家长在管理急性和已建立的气管造口管方面的舒适度。对护理数据进行了分析，重点关注工作年限和主要工作单位。
调查对象包括 820 名护士中的 129 名（16%的回复率）和 38 名儿童中的 19 名家庭成员（50%的回复率）。当被问及更换已建立的气管造口时，128 名护士中的 59 名（46%）表示“非常舒适”，包括 82 名重症监护病房（ICU）护士中的 46 名（56%）和 46 名普通病房护士中的 13 名（28%）（P = .002），以及 80 名至少有 5 年工作经验的护士中的 48 名（60%）和 49 名经验较少的护士中的 12 名（24%）（P < .001）。对于管理新鲜气管造口的意外脱管，61 名护士（47%）表示非常不舒适，包括 83 名 ICU 护士中的 27 名（33%）和 46 名普通病房护士中的 34 名（73%）（P = .006），以及 80 名至少有 5 年工作经验的护士中的 33 名（41%）和 49 名经验较少的护士中的 28 名（57%）（P = .03）。大多数家庭都对出院做好了准备（17 名中的 16 名[94%]），并且认为医疗团队可以接触到（17 名中的 16 名[94%]），尽管只有 18 名家庭中的 5 名（28%）表示气管造口术教学是一致的。
具有至少 5 年工作经验和主要 ICU 工作地点的护士对气管切开术的舒适度更高。虽然家长对气管切开护理的舒适度较高，但缺乏一致的指导强调了标准化教育在气管切开护理中的作用。
