Pediatric and Neonatal Tracheostomy Caregiver Education with Phased Simulation to Increase Competency and Enhance Coping

Abstract

PurposeInfants and children with medically complex needs depend on their caregivers for activities of daily life and specialized care of various devices they need to survive. Caregiver education is a primary goal in discharge planning to ensure safe, competent home care for these medically fragile children. Standard of care is bedside teaching. The Family Tracheostomy Program complements traditional training with a phased process of simulation. The purpose of this QA/QI project was to increase caregiver competency and decrease anxiety level for pediatric tracheostomy care through simulation training. MethodFor two years, the pediatric and neonatal intensive care units trained twenty caregivers of new tracheostomy patients with the supplementation of simulation to standard bedside training. Using a five-point rating scale, caregivers completed pre- and post- tests for separate skills and scenario training sessions. ResultsSkills scores were hypothesized to increase after simulation training. In a small sample (n = 20), scores increased from pre-test (μ = 11.45, SD = 4.88) to post-test (μ = 22.6, SD = 2.01). This change was significant (t(19) = 10.78, p < 0.001). Scenario scores were hypothesized to increase after simulation training. In another small sample (n = 15), scores increased from pre-test (μ = 23.40, SD = 7.11) to post-test (μ = 28.73, SD = 2.31). This change was significant (t(14) = 3.78, p < 0.001). ConclusionSimulation as a complement to bedside caregiver education increased caregiver competency and decreased anxiety levels for these samples. Practice implicationsOrganizations caring for neonatal and pediatric tracheostomy patients might consider providing additional support with a phased method of simulation as part of caregiver education.