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

PURPOSE: Infants 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. METHOD: For 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. RESULTS: Skills 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). CONCLUSION: Simulation as a complement to bedside caregiver education increased caregiver competency and decreased anxiety levels for these samples. PRACTICE IMPLICATIONS: Organizations caring for neonatal and pediatric tracheostomy patients might consider providing additional support with a phased method of simulation as part of caregiver education.