Focus on Pediatrics: Trach care requires intensive education
Checklist ensures that topics are covered
A year ago, Phoenix Children’s Hospital implemented an educational program to teach parents of children with new tracheostomies about trach care because many insurance companies in the state limited the length of stay for children undergoing this procedure, and families were not always comfortable with the requirements of home care. Also, there are not a lot of support services available for these families, reports Penny Morgan Overgaard, RN, coordinator of the trach airway program.
"You have parents that are going home doing nursing care that even nurses are a little unsure of because it is such a low-frequency, high-risk procedure," says Morgan Overgaard.
Prior to surgery, parents learn what the trach is, why the child is getting one, and what kind of care will be needed in the home environment. Parents are given a trach to examine and they are also given materials to read that covers some of the parenting challenges. The hospital’s web site has photos of children with tracheostomies of all different ages so that they can see what their child might look like following surgery.
Pre-surgery education used to be left to the surgeon, nurses, and respiratory therapists, but the surgeons usually were rushed and inpatient staff did not know how to teach to the home environment, says Morgan Overgaard.
"We also talk to the parents about our expectations for what they will need to do in order to be able to take their child home with a trach or a trach and a ventilator," she says.
Education about tracheostomy care begins once the surgery is complete. Parents are given a checklist of 25 things they must learn. The educational team includes trach airway program staff, nursing staff, respiratory therapy, a dietitian, speech pathologist, occupational therapist, pharmacist, case management, and child life.
Following is an example of some of the educational categories and the team that teaches the particular topic:
- Basic information about the tracheostomy and how it will change a family’s life — trach airway program staff
- What families need to do to plan for going home — trach airway program staff
- A demonstration of all types of suctioning with education on what it is, why it is done, and how it is done — respiratory therapist
- Education on why and how to change the tracheostomy tube with education on why and how it is done — nurse
- Key meal-planning points — dietitian
- How to help the child speak — speech pathologist
- Special needs for dressing the child — occupational therapist
- Education on prescribed medications — nurse and pharmacist
- Equipment vendor will deliver to the family’s home and how to operate and clean the equipment — case management
- Things that need to be done to help get the child back to school or day care — child life
Lots of hands-on learning
A lot of the basic education is completed in seven days; in that way, when the physician changes the trach for the first time, parents can watch and begin practicing changing the trach shortly thereafter. Also, Morgan Overgaard has nurses demonstrate the suctioning and changing of the trach while standing shoulder to shoulder with the parent. She has found this to be more effective than having the parent stand across from the nurse to watch the procedure.
"It is a fairly complicated skill, so the nurse needs to have the parents on the same side of the bed so they can translate it to their own hand," she says.
The education begins with verbal instruction followed by demonstration. Then the parents begin to practice what they have learned under the watchful eye of the health care team. The last step in the education process is to have the parents stay in a room with their child at the hospital to see if they are ready to care for the child at home. This practice is called nesting.
"They stay in a room for a couple days, basically doing all the home care using their equipment but with a nurse nearby. In this way, they really start thinking about the issues that might come up when we send them home," says Morgan Overgaard.
For more information about teaching parents about trach care, contact: