Education Model for Pediatric Tracheostomy Management: Improving Nursing Knowledge and Confidence

Abstract

Purpose: The purpose of this quality improvement project was to increase knowledge and confidence for nurses and nurse practitioners performing pediatric tracheostomy management in the pediatric intensive care unit, utilizing targeted tracheostomy education.Background: Pediatric tracheostomy prevalence continues to increase in our organization, along with adverse airway events and complications; most events were preventable. A literature review demonstrated quality tracheostomy education improved knowledge and confidence in tracheostomy management for healthcare professionals. Most healthcare professionals do not receive formal tracheostomy care education and no standardized tracheostomy education exists. Methods: All pediatric intensive care unit nurses and nurse practitioners were invited to participate. This project provided a confidence survey and an objective knowledge multiple-choice questionnaire before and after attending a comprehensive pediatric tracheostomy education program. The program used didactic and case-based simulation methods. Confidence was measured on a 5-point Likert Scale and knowledge was measured as the percentage of correct questions. Results: Three subjects participated; two nurses and one nurse practitioner. Participants had varying levels of tracheostomy management experience. Participants self- reported a mean confidence of 3.2 in tracheostomy management in 10 categories, which improved to 4.1 after completing the program. The mean multiple-choice questionnaire scores were 0.8 (80%) prior to the program. Post-education program multiple-choice questionnaire scores were 0.77 (77%), which did not demonstrate an increase knowledge. Two participants volunteered comments that the program was “very informative” and one requesting additional education. Conclusions: This project had a small sample size that could not be statistically analyzed. No improvement in tracheostomy knowledge was observed, however, confidence performing tracheostomy care improved following tracheostomy education. Nurses, hospitalist attendings, and nursing educators from other units have requested access to the tracheostomy education program since closure of the quality improvement project, demonstrating a need for comprehensive tracheostomy education. A larger sample size needs to be obtained for additional data collection to determine tracheostomy program effectiveness.