Abstract
Background: The child with a tracheostomy (trach) represents a medically fragile, high-risk, population. There are many different care aspects caregivers must learn and demonstrate before discharge. Our education process includes a combination of written instructions, classroom session, practice on a manikin, and bedside demonstration. The primary aim was to increase caregiver confidence in skills by providing a training doll for skills practice. The secondary aim was to evaluate the impact of the dolls on time to complete training and length of stay (LOS).
Methods: Caregivers of children undergoing trach training were provided a modified plastic doll with trach tube the first week after trach placement to practice skills. At that time caregivers have written information and are able to practice skills hands-on (except trach change) with bedside staff prior to the classroom session. Questionnaires were utilized to assess caregiver confidence in skills. The first survey was given at the time of the classroom session and the second was given after training completion. Survey domains included use of the doll, skills practiced, and confidence with each skill. A retrospective and prospective chart review of children with a newly placed trach compared outcomes with and without training dolls. Chart data included demographics, diagnosis, ventilator requirement, trach placement, classroom session, length of time to complete training, and length of stay. Retrospective data included children with trach placement in 2019, caregivers completed training and did not receive a doll. Prospective data were those with trach placement in 2020–2021 and received a training doll.
Results: The study included 55 children (27 with training dolls, 28 without). The majority in both groups were male, ventilator dependent, and had bronchopulmonary dysplasia. Doll questionnaires were completed by caregivers of 12 (44%) children. Most utilized the doll to practice skills. Confidence was increased from the first to second survey for trach change and resuscitation bag use. Length of time to complete training was 3.6 ± 1.9 months (no doll) and 3.1 ± 1.5 months (doll) (P = .18). LOS was 6.9 ± 4.5 months (no doll) and 5.1 ± 3.8 months (doll) (P = .09).
Conclusions: Tracheostomy training dolls seemed to help improve caregiver confidence with some skills. Multi-modal education may assist with individual caregiver learning needs and preferences. Time to complete training and LOS were not significantly changed with use of the dolls.
Footnotes
Commercial Relationships: None
Support: Arkansas Children's Research Institute
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