Cook Children's Medical Center, Fort Worth, Texas, USA.
J Spec Pediatr Nurs. 2022 Apr;27(2):e12366. doi: 10.1111/jspn.12366. Epub 2021 Dec 19.
Children who are tracheostomy dependent require comprehensive caregiver preparation for safe hospital-to-home transition. Although a structured discharge education program successfully trained caregivers to provide routine daily tracheostomy care, emergency response training was limited, lacking realistic experiences. Initiation of simulated emergency training for caregivers indicated performance confusion related to tracheostomy cardiopulmonary resuscitation (CPR). This study evaluated the effectiveness of an evidence-based tracheostomy CPR education intervention via caregiver participation in a high-fidelity simulation of a home-based emergency scenario on the performance of essential behaviors, comfort, and satisfaction.
The study utilized a prospective descriptive pre- and post interventional design; 44 caregivers of children who were tracheostomy dependent participated. All caregiver participants completed: video- and instructor-assisted specialized tracheostomy CPR class, high-fidelity simulation performance of a home-based emergency (respiratory failure with cardiac arrest), postsimulation video debriefing, performance assessment with an objective scoring rubric, and pre- and post simulation surveys on levels of comfort and satisfaction.
On the performance of essential emergency management behaviors, 86.4% of caregivers performed all four behaviors, but only 36.4% performed these essential behaviors in order. Post simulation caregiver comfort with emergency management significantly increased from pre simulation (p = .001). All caregivers were satisfied with this training and would recommend simulation of home-based emergencies for all caregivers. Qualitative feedback from caregivers revealed themes of gratitude and the importance of hands-on practice with guided debriefing/feedback. Study power was 0.98.
Objective evaluation of caregiver performance demonstrated specialized tracheostomy CPR education prepared caregivers to respond in a home emergency. Caregivers viewed simulation as an opportunity to gain hands-on experience and improve emergency responses. It may be beneficial for other similar programs to include specialized tracheostomy CPR and emergency scenario simulation in their discharge education protocols and subsequently compare this program to other similar programs to establish best practice guidelines.
依赖于气管造口术的儿童需要全面的护理人员准备，以实现安全的医院到家庭的过渡。虽然结构化的出院教育计划成功地培训了护理人员提供常规的日常气管造口术护理，但紧急情况响应培训是有限的，缺乏真实的经验。对护理人员进行模拟紧急情况培训表明，他们在进行与气管造口术心肺复苏术（CPR）相关的操作时存在困惑。本研究通过护理人员参与家庭紧急情况的高保真模拟，评估了一种基于证据的气管造口术 CPR 教育干预措施的有效性，该干预措施针对的是基本行为、舒适度和满意度。
本研究采用前瞻性描述性干预前和干预后设计；44 名依赖气管造口术的儿童的护理人员参与了研究。所有护理人员都完成了：视频和讲师辅助的专业气管造口术 CPR 课程、家庭紧急情况（呼吸衰竭伴心搏骤停）的高保真模拟、模拟后视频讨论、使用客观评分量表进行表现评估、以及模拟前后关于舒适度和满意度的调查。
在紧急管理的基本行为表现方面，86.4%的护理人员完成了所有四项行为，但只有 36.4%的护理人员按顺序完成了这些基本行为。模拟后，护理人员对紧急管理的舒适度明显提高（p = .001）。所有护理人员都对这种培训感到满意，并会推荐对所有护理人员进行家庭紧急情况的模拟培训。护理人员的定性反馈揭示了感恩和使用指导讨论/反馈进行实际操作的重要性这两个主题。研究的功效为 0.98。
对护理人员表现的客观评估表明，专业的气管造口术 CPR 教育使护理人员能够在家庭紧急情况下做出反应。护理人员认为模拟是获得实践经验和提高紧急反应能力的机会。对于其他类似的计划来说，将专业的气管造口术 CPR 和紧急情况模拟纳入其出院教育计划中，并随后将该计划与其他类似的计划进行比较，以确定最佳实践指南，可能会有所裨益。
