Tripathy Swagata, Shetty Asha P, Hansda Upendra, P Nanda Kumar, Sahoo Alok Kumar, V Mahalingam, Mahapatra Sujata, Mitra Jayanta Kumar, Rao P Bhaskar, Sanyal Kasturi, Panda Itimayee, N Guruprasad, Sahoo Jagannath, Eborral Helen, Lone Nazir, Haniffa Rashan, Beane Abi
Anesthesia & Critical Care, AIIMS Bhubaneswar, Bhubaneswar, Odisha, 751019, India.
College of Nursing, AIIMS Bhubaneswar, Bhubaneswar, Odisha, 751019, India.
Wellcome Open Res. 2025 Feb 28;8:285. doi: 10.12688/wellcomeopenres.19340.1. eCollection 2023.
The paucity of state-supported rehabilitation for chronically ill patients with long-term tracheostomies has ramifications of prolonged hospital-stay, increased burden on acute-care resources, and nosocomial infections. Few interventions describe home rehabilitation of adult tracheostomized patients. Almost none involve stakeholders. This paper describes the All-India Institute of Medical Sciences (AIIMS) ICU rehabilitation (AIR) healthcare intervention developed to facilitate home rehabilitation of chronically ill tracheostomized patients.
The AIR intervention development was based on the experience-based codesign theory (EBCD). A core research-committee studied prevalent knowledge and gaps in the area. Patients-carer and health-care stakeholders' experiences of barriers and facilitators to home care resulted in an intervention with interlinked components: family-carer training, equipment bank, m-health application, and follow-up, guided by the Medical Research Council (MRC) framework. Healthcare stakeholders (doctors, nurses, medical equipment vendors) and patient-carer dyads were engaged to gather experiences at various stages to form smaller codesign teams for each component. Multiple codesign meetings iteratively allowed refinement of the intervention over one year. The Template for Intervention Description and Replication (TIDieR) checklist was used to report the AIR intervention.
The first component comprised a minimum of three bedside hands-on training sessions for carers relating to tracheostomy suction, catheter care, monitoring oxygenation, enteral feeding, skincare, and physiotherapy, buttressed by pictorial-books and videos embedded in a mobile-application. The second was an equipment-bank involving a rental-retrieval model. The third component was a novel m-health tool for two-way communication with the core group and community of other patient-carers in the project for follow-up and troubleshooting. Home visits on days 7 and 21 post-discharge assessed patient hygiene, nutrition, physiotherapy, and established contact with the nearest primary healthcare facility for the future.
Findings support the EBCD-based development using active feedback from stakeholders. Assessment of feasibility, process and effectiveness evaluation will follow.
国家对长期气管切开的慢性病患者康复支持的匮乏，导致住院时间延长、急性护理资源负担加重以及医院感染。很少有干预措施描述成年气管切开患者的家庭康复。几乎没有涉及利益相关者。本文描述了全印度医学科学研究所（AIIMS）重症监护病房康复（AIR）医疗干预措施，该措施旨在促进慢性病气管切开患者的家庭康复。
AIR干预措施的开发基于基于经验的协同设计理论（EBCD）。一个核心研究委员会研究了该领域的现有知识和差距。患者-护理人员和医疗保健利益相关者对家庭护理障碍和促进因素的经验导致了一个具有相互关联组成部分的干预措施：家庭护理人员培训、设备库、移动健康应用程序和随访，由医学研究理事会（MRC）框架指导。医疗保健利益相关者（医生、护士、医疗设备供应商）和患者-护理人员二元组参与在各个阶段收集经验，为每个组成部分组建较小的协同设计团队。多次协同设计会议在一年中反复进行，以完善干预措施。使用干预描述和复制模板（TIDieR）清单报告AIR干预措施。
第一个组成部分包括为护理人员提供至少三次关于气管切开吸痰、导管护理、氧合监测、肠内喂养、皮肤护理和物理治疗的床边实践培训课程，并辅以嵌入移动应用程序的图画书和视频。第二个是涉及租赁-取回模式的设备库。第三个组成部分是一种新颖的移动健康工具，用于与项目中的核心小组和其他患者-护理人员社区进行双向沟通，以进行随访和故障排除。出院后第7天和第21天的家访评估了患者的卫生、营养、物理治疗情况，并与最近的初级医疗保健机构建立了未来联系。
研究结果支持基于EBCD并利用利益相关者的积极反馈进行开发。后续将进行可行性、过程和有效性评估。
