Manejo fonoaudiológico do paciente traqueostomizado no contexto da Covid-19: uma revisão do conhecimento atual / Speech therapy management of the tracheostomized patient in the context of Covid-19: a review of current knowledge / Manejo fonoaudiológico del paciente traqueostomizado en el contexto del Covid-19: una revisión de los conocimientos actuales

Introdução: O SARS-CoV-2 se estabeleceu como um dos principais agentes etiológicos de instabilidade da função pulmonar e repercussões no trato respiratório. Devido à necessidade de suporte ventilatório prolongado, pode ser observado aumento na demanda da indicação da traqueostomia. Objetivo: verificar as evidências disponíveis sobre o manejo fonoaudiológico da traqueostomia em pacientes com COVID-19, através de uma revisão breve do conhecimento atual. Método: As buscas foram realizadas nas bases de dados do Pubmed, Lilacs, Scielo, Web of Science, Scopus e Google Scholar, no período de agosto de 2020, através dos descritores "tracheostomy and COVID-19", extraídos do Medical Subject Headings (MeSH) e dos Descritores em Ciências da Saúde (DeCS). Resultados: seis estudos foram selecionados, de acordo com os critérios de elegibilidade. O processo de desmame do cuff ou troca da cânula da traqueostomia foi sugerido após resultado negativo para COVID-19. Os estudos sugerem avaliação clínica da deglutição, o uso de cânulas sem fenestra, com cuff insuflado. O uso de equipamentos de proteção individual foi fortemente indicado durante os procedimentos. Não há consenso quanto à intervenção fonoaudiológica para pacientes traqueostomizados com COVID-19. Conclusão: Esta revisão não mostrou evidências científicas sobre o manejo fonoaudiológico da traqueostomia em pacientes com COVID-19.

Introduction: SARS-CoV-2 has established itself as one of the main etiological agents of instability of pulmonary function and repercussions in the respiratory tract. Due to the need for prolonged ventilatory support, an increased demand for tracheostomy indication. Objective: to verify the available evidence on the speech therapy management of tracheostomy in patients with COVID-19, through a brief review of current knowledge. Method: Searches were carried out in the databases of Pubmed, Lilacs, Scielo, Web of Science, Scopus and Google Scholar, in the period of August 2020, using the descriptors "tracheostomy and COVID-19", extracted from the Medical Subject Headings (MeSH) and Health Sciences Descriptors (DeCS). Results: six studies were selected, according to the eligibility criteria. The process of weaning the cuff or changing the tracheostomy cannula was suggested after a negative result for COVID-19. Studies suggest clinical evaluation of swallowing, the use of cannulas without fenestra, with inflated cuff. The use of personal protective equipment was strongly recommended during the procedures. There is no consensus regarding speech therapy for patients with tracheostomy with COVID-19. Conclusion:This review did not show any scientific evidence on the speech therapy management of tracheostomy in patients with COVID-19.

Introducción: El SARS-CoV-2 se ha consolidado como uno de los principales agentes etiológicos de inestabilidad de la función pulmonar y repercusiones en el tracto respiratorio. Debido a la necesidad de soporte ventilatorio prolongado, una mayor demanda de indicación de traqueotomia. Objetivo: verificar la evidencia disponible sobre el manejo logopédico de la traqueotomía en pacientes con COVID-19, a través de una breve revisión de los conocimientos actuales. Método: Se realizaron búsquedas en las bases de datos de Pubmed, Lilacs, Scielo, Web of Science, Scopus y Google Scholar, en el período de agosto de 2020, utilizando los descriptores "traqueotomía y COVID-19", extraídos de Medical Subject Headings ( MeSH) y Descriptores de Ciencias de la Salud (DeCS). Resultados: se seleccionaron seis estudios, según los criterios de elegibilidad. El proceso de destete del manguito o cambio de cánula de traqueotomía se sugirió después de un resultado negativo para COVID-19. Los estudios sugieren una evaluación clínica de la deglución, el uso de cánulas sin fenestra, con manguito inflado. Se recomienda encarecidamente el uso de equipo de protección personal durante los procedimientos. No existe consenso con respecto a la terapia del habla para pacientes con traqueotomía con COVID-19. Conclusión: Esta revisión no mostró evidencia científica sobre el manejo logopédico de la traqueotomía en pacientes con COVID-19.

Nurse Practitioner-Led Telehealth to Improve Outpatient Pediatric Tracheostomy Management in South Texas.

INTRODUCTION: Pediatric tracheostomy patients are a medically complex population with increased incidence of emergency room use, hospital readmission, tracheostomy-associated complications, and caregiver anxiety, especially within 30 days after discharge. METHOD: The specific aims of this quality improvement initiative include using a nurse-led, interprofessional care team to improve access to care with creation and implementation of a hospital-based discharge protocol and adoption of telehealth follow-up care for newly placed tracheostomy tubes. RESULTS: Telehealth was accessible for patients living more than 150 miles from the primary clinical site. Caregiver knowledge, satisfaction, self-efficacy, and competence in tracheostomy skills increased after protocol implementation. Outcomes included no tracheostomy-associated complications, emergency room visits, or unnecessary hospitalizations. DISCUSSION: Evaluation of this initiative showed promise telehealth was effective in supporting caregivers and refining proficiency caring for tracheostomy-dependent children. This facility's experience with nurse-led telehealth found it to be an accessible, affordable, and valuable health-care service .

A Quasi-experimental Study to Explore the Effect of Barrier Cream on the Peristomal Skin of Patients With a Tracheostomy.

Peristomal skin problems represent one of the most common complications of a tracheostomy. A quasi-experimental study was conducted among patients ages 18 to 65 years hospitalized in a Turkish university hospital ear-nose-throat clinic between August 15, 2013, and December 15, 2013, to compare the effect of using or not using a barrier cream on the peristomal skin with regard to pH, moisture, temperature, color, odor, turgor, infections, and lesions after tracheostomy surgery. Patients were selected using a purposeful sampling method and included if they had not undergone another operation for a complication (eg, pneumothorax, tube misplacement, hemorrhage) within 24 hours following the tracheostomy operation. In phase 1 of the study, 9 registered nurses were observed 3 times each by the researcher, who completed an observation form. From these observations and related nursing textbooks, the researcher developed a protocol entitled "Nursing Care Steps for Patients with a Tracheostomy." This protocol was followed during phase 2 of the study during which participants were alternately assigned to either the intervention (a barrier cream containing dimethicone, acrylate terpolymer, oils, paraffin, water, dicapryladipate, isopropyl palmitate, and PPG-15 stearyl ether followed by gauze) or control (gauze only) group (n = 30 each) and observed for 7 days. Demographic characteristics were gathered for each patient upon admission to the study. Peristomal skin was assessed in terms of pH, temperature, and moisture (relative humidity [RH]) using a surface pH meter, surface thermometer, and digital skin moisture tester, as well as for lesions, infection, and maceration. Findings were documented on a skin condition assessment form. Twenty-four (24) hours post surgery, the barrier cream plus gauze was applied over peristomal area in the study group and gauze dressing only in the control group. Peristomal skin pH, moisture, and temperature were within the normal range for both groups during all observations throughout the study but closer to normal ranges in the intervention group. Mean peristomal skin pH in the intervention group was significantly higher (5.452 ± 0.043) than in the control group (5.123 ± 0.057; P &.001), mean peristomal skin moisture in the control group (46.90 ± 0.132 RH) was significantly greater than in the intervention group (41.71 ± 0.774 RH; P &.001), and mean peristomal skin temperature in the control group (33.59 ± 1.3˚ C) was significantly higher than in the intervention group (31.64 ± 0.607˚ C; P &.001). In both groups, Staphylococcus epidermidis was the most commonly cultured microorganism, and S aureus was the most cultured pathological microorganism in addition to the normal skin flora. Peristomal skin condition was maintained for both the intervention and control groups. Use of a barrier cream to protect tracheostomy peristomal skin beneath absorbent dressings (eg, gauze) is recommended, but additional short-term and long-term studies are needed.

Standardizing Care and Parental Training to Improve Training Duration, Referral Frequency, and Length of Stay: Our Quality Improvement Project Experience.

OBJECTIVES: At our institution, there is a six bed Pediatric Respiratory Care Unit for technology dependent infants and children with a tracheostomy tube. A lack of consistency in patient care and parent/guardian education prompted our group to critically evaluate the services we provided by revisiting our teaching protocol and instituting a new model of care in the Unit. The aims of this quality improvement (QI) project were to standardize care and skills proficiency training to parents of infants with a tracheostomy tube in preparation for discharge to home. METHODS: After conducting a current state survey of key unit stakeholders, we initiated a multidisciplinary, QI project to answer the question: 'could a standardized approach to care and training lead to a decrease in parental/guardian training time, a decrease in length of stay, and/or an increase in developmental interventions for infants with tracheostomy tubes'? A convenience sample of infants with a tracheostomy tube admitted to the Pediatric Respiratory Care Unit were included in the study. Descriptive statistics were used to analyze the results. RESULTS: Through this QI approach, we were able to decrease the time required by parents to achieve proficiency in the care of a technology dependent infant, the length of stay for these infants, and increase referral of the infants for developmental assessment. CONCLUSIONS: These outcomes have implications for how to approach deficiencies in patient care and make changes that lead to sustained improvements.

O cuidado da família à criança em uso de cânula de traqueostomia no domicílio: as vozes dos familiares cuidadores / The care of the family to the child that uses a tracheostomy tube at home: the voices of the family caregivers

A criança portadora de cânula de traqueostomia apresenta uma inerente fragilidade oriunda da exposição das vias aéreas inferiores através do estoma e a presença constante da cânula, e quando no domicílio exige vigilância continuada e principalmente cuidados específicos por parte dos familiares cuidadores a fim de preservar a vida e propiciar o bem-estar de seus filhos. Com os objetivos de descrever os cuidados de manutenção da vida realizados pelos familiares cuidadores as crianças portadoras de cânula de traqueostomia no domicílio; identificar os desafios enfrentados pelos familiares para cuidar da criança em uso de cânula de traqueostomia; analisar as estratégias utilizadas pelos familiares cuidadores para superar esses desafios. Trata-se de um estudo descritivo com abordagem qualitativa. O cenário foi um ambulatório pediátrico que atende crianças em condições crônicas no município do Rio de Janeiro e os participantes, 8 familiares cuidadores de crianças portadoras de cânula de traqueostomia com idade entre 3 e 9 anos de idade. A coleta de dados foi realizada através de entrevista semiestruturada, no período de janeiro de 2015 a maio de 2016. Utilizada a análise de conteúdo proposta por Bardin sob a ótica das concepções sobre cuidado de Collière. Como resultados, emergiram duas categorias: Os cuidados desenvolvidos pelos familiares cuidadores a criança portadora da cânula de traqueostomia e os desafios e estratégias dos familiares cuidadores frente ao cuidado da criança portadora de cânula de traqueostomia. A primeira categoria abrange: cuidados durante o banho; cuidados relacionados com a manutenção da cânula de traqueostomia e cuidados realizados para a aspiração das vias aéreas. E a segunda compreende três categorias: desafios de lidar com o novo; desafios e estratégias no cuidar da criança; desafios e estratégias relacionados à aquisição de materiais e desafios relacionados ao lazer. As demandas de cuidado à criança portadora de cânula de traqueostomia são complexas, com repercussões significativas na rotina familiar, mas que possibilitam a preservação da permeabilidade das vias aéreas de suas crianças, impedindo possíveis obstruções e lesões causadas pela umidade constante da pele com presença de muco pulmonar em contato com o cadarço fixador. Quanto aos desafios, eram relativos a nova condição da criança e o manejo do dispositivo, a falta de estrutura para o desenvolvimento dos cuidados, a presença frequente de secreção traqueal, a preocupação com a descanulação, principalmente no momento de troca do cadarço fixador bem como o receio da obstrução da cânula de traqueostomia. Para o enfretamento dos desafios no ambiente domiciliar, os familiares cuidadores reinventam as estratégias de cuidado a fim de preservar a vida da criança. Entretanto, por vezes as ações cuidativas se mostram inadequadas, colocando em risco a saúde de seus filhos. Conclui-se que o enfermeiro se torna imprescindível no acompanhamento dessas crianças no domicílio, amenizando a transição do ambiente hospitalar para o domiciliar, identificando as reais necessidades vivenciadas, sobretudo mediando a instrumentalização dos familiares cuidadores para a manutenção adequada e segura das vias aéreas neste ambiente.

The child with a tracheostomy tube shows an inherent fragility originated from the exposure of the lower airways through the stoma and the constant presence of the tube, and when, at home, requires continued monitoring and, above all, specific care on the part of the family caregivers with the purpose of preserving life and providing welfare for their children. Study object: the care of the family to the child with a tracheostomy tube at home. Objectives: to describe the care related to the maintenance of life held by the family caregivers to the children with tracheostomy tubes at home; to identify the challenges faced by relatives to care for the child with a tracheostomy tube; to analyze the strategies used by the family caregivers to overcome these challenges. Methodology: it is a descriptive study with a qualitative approach. The scenario was a pediatric outpatient facility that assists children in chronic conditions in the city of Rio de Janeiro, and the participants were 8 family caregivers of children with tracheostomy tubes, aged between 3 and 9. Data were collected through semi-structured interviews, from January 2015 to May 2016, analyzed according to the content analysis proposed by Bardin, and then interpreted in the perspective of the conceptions of care prescribed by Collière. The results gave rise to two categories: "The care developed by the family caregivers to the child with a tracheostomy tube" and "The challenges and strategies of the family caregivers in relation to the care of the child with a tracheostomy tube". The first category includes: the care during bath; the care related to the maintenance of the tracheostomy tube and the care held for the aspiration of the airways. The second encompasses: the challenges of dealing with the new; in the care of the child; in the acquisition of materials and challenges related to leisure. The demands for care of the child with a tracheostomy tube are complex, with significant repercussions on the family routine, but they enable the preservation of the permeability of the airways of their children, thereby avoiding possible obstructions and injuries caused by the constant moisture of the skin with presence of pulmonary mucus in contact with the fixative lace. As for the challenges, these were related to the new condition of the child, the handling of the device, the lack of structure for the development of care, the frequent presence of tracheal secretion, the concern about the tube removal, mainly at the time to switch the fixative lace, as well as the fear of obstruction of the tracheostomy tube. In order to confront the challenges in the home environment, the family caregivers reinvent the care strategies with the purpose of preserving the life of the child. Nevertheless, the care actions are sometimes inappropriate, which jeopardizes the health of their children. Conclusion: the nursing staff needs to rethink and articulate its daily practice in order to redirect its praxis and actions, in the holistic sense, where the health of the child is seen in the family and community environment, thereby developing educational actions appropriate to the actual needs of the child and of its family and involving it in the care process

Inpatient Nursing and Parental Comfort in Managing Pediatric Tracheostomy Care and Emergencies.

IMPORTANCE: Tracheostomy is a critical and often life-saving intervention, but associated risks are not negligible. The vulnerability of the pediatric population underlies the importance of caregiver comfort and competence in tracheostomy care. OBJECTIVE: To assess inpatient nursing staff and parental perspectives in managing tracheostomy care. DESIGN, SETTING, AND PARTICIPANTS: Cross-sectional analysis of survey data from (1) a volunteer sample of inpatient nurses in a tertiary care, freestanding pediatric hospital in the Midwest, assigned to clinical wards that provide care for children with tracheostomy tubes and (2) a consecutive sample of families whose child underwent tracheostomy tube placement at the same institution between March 1 and December 31, 2013. MAIN OUTCOMES AND MEASURES: Nurse and parental comfort in managing acute and established tracheostomy tubes. Nursing data were analyzed with attention to years' experience and primary unit of practice. RESULTS: Respondents included 129 of 820 nurses (16% response rate) and family members of 19 of 38 children (50% response rate). When queried about changing established tracheostomies, 59 of 128 nurses (46%) reported being "totally comfortable," including 46 of 82 intensive care unit (ICU) nurses (56%) vs 13 of 46 floor nurses (28%) (P = .002) and 48 of 80 nurses with at least 5 years' experience (60%) vs 12 of 49 less experienced nurses (24%) (P < .001). For managing accidental decannulation of a fresh tracheostomy, 61 nurses (47%) described being completely uncomfortable, including 27 of 83 ICU nurses (33%) vs 34 of 46 floor nurses (73%) (P = .006), and 33 of 80 nurses with at least 5 years' experience (41% ) vs 28 of 49 less experienced nurses (57%) (P = .03). Most families felt prepared for discharge (16 of 17 [94%]) and found the health care team accessible (16 of 17 [94%]), although only 5 of 18 families (28%) indicated that tracheostomy teaching was consistent. CONCLUSIONS AND RELEVANCE: Nurses' comfort with tracheostomy was higher among nurses with at least 5 years' experience and primary ICU location. Whereas parental comfort with tracheostomy care was high, lack of consistent instruction highlights the role for standardized education in tracheostomy care.

Patient safety and the prevention of skin and mucosal lesions associated with airway invasive devices / La seguridad del paciente y la prevención de lesiones cutáneo-mucosas asociadas con los dispositivos invasivos en las vías aéreas / Segurança do paciente e a prevenção de lesões cutâneo-mucosas associadas aos dispositivos invasivos nas vias aéreas

AbstractOBJECTIVETo analyze the care implemented by the nursing team to promote the safety of adult patients and prevention of skin and mucosal lesions associated with the presence of lower airways invasive devices.METHODStudy with qualitative and quantitative approach, descriptive and exploratory type, whose investigative scenarios were adult inpatient units of a hospital in the West Frontier of Rio Grande do Sul. The study subjects consisted of nurses, nursing technicians and nursing assistants.RESULTSA total of 118 professionals were interviewed. We highlight the observed specific care with endotracheal tube and tracheostomy, management and assessment of the cuff and the criteria used to secretion aspiration.CONCLUSIONThere is a superficial nursing work in the patient direct care and a differentiation in relation to the perception of nurse technicians, especially those working in the intensive care unit, who presented major property and view of the patient's clinical status.

ResumenOBJETIVOAnalizar los cuidados implantados por el equipo de Enfermería para la promoción de la seguridad del paciente adulto y la prevención de lesiones cutáneo-mucosas asociadas con la presencia de dispositivos invasivos en las vías aéreas inferiores.MÉTODOEstudio con abordaje cualitativo y cuantitativo, del tipo descriptivo y exploratorio, cuyos escenarios investigativos fueron las unidades de estancia hospitalaria de adultos en un hospital de Fronteira Oeste, Rio Grande do Sul. Los sujetos investigados se constituyeron de enfermeros, técnicos y auxiliares de Enfermería.RESULTADOSFueron entrevistados 118 profesionales. Se evidenciaron los cuidados específicos con el tubo orotraqueal y la traqueotomía, con el manejo y la evaluación del cuff y los criterios utilizados para la aspiración de secreciones.ConclusiónExiste una superficialidad de la actuación del enfermero en el cuidado directo al paciente y una diferenciación con respecto a la percepción de los técnicos de Enfermería, en especial los actuantes en la unidad de terapia intensiva, que presentaron mayor propiedad y visión clínica del paciente.

ResumoOBJETIVOAnalisar os cuidados implementados pela equipe de Enfermagem para a promoção da segurança do paciente adulto e a prevenção de lesões cutâneo-mucosas associadas à presença de dispositivos invasivos nas vias aéreas inferiores.MÉTODOEstudo com abordagem qualitativa e quantitativa, do tipo descritivo e exploratório, cujos cenários investigativos foram as unidades de internação adulto de um hospital da Fronteira Oeste do Rio Grande do Sul. Os sujeitos pesquisados constituíram-se de enfermeiros, técnicos e auxiliares de Enfermagem.RESULTADOSForam entrevistados 118 profissionais. Evidenciaram-se os cuidados específicos com o tubo orotraqueal e traqueostomia, com o manejo e avaliação do cuff e os critérios utilizados para a aspiração de secreções.CONCLUSÃOHá uma superficialidade da atuação do enfermeiro no cuidado direto ao paciente e uma diferenciação em relação à percepção dos técnicos de Enfermagem, em especial os atuantes na unidade de terapia intensiva, que apresentaram maior propriedade e visão da clínica do paciente.

[Nursing care for tracheotomy and tracheostomy patients]. / Les soins infirmiers aux patients trachéotomisés et trachéostomisés.

Nursing care is specific in otorhinolaryngology, particularly in oncology. The three dimensions of the care, technical, relational and educational, are essential and reflect the quality of the patient management which must be multi-disciplinary.

Life after Tracheostomy: Patient and Family Perspectives on Teaching, Transitions, and Multidisciplinary Teams.

OBJECTIVE: To report patient/family experiences and outcomes after tracheostomy STUDY DESIGN: International survey of patients and families with tracheostomy. SETTING: Collaboration of the Patient Safety and Quality Improvement Committee of the American Academy of Otolaryngology-Head and Neck Surgery and the Global Tracheostomy Collaborative. METHODS: A 50-item survey was developed with multistakeholder collaboration. The survey was disseminated via international social networks used by patients with a tracheostomy and their families. Qualitative and quantitative data were analyzed. RESULTS: Of 220 respondents, 90% cared for a pediatric patient with a tracheostomy. Only 48% of respondents felt "very prepared" at time of discharge, and 11% did not receive emergency preparedness training prior to discharge. Home nursing needs were inadequately met in 17% of families, with resulting difficulties shortly after discharge; 14% sought emergent care within 1 week of discharge. Nearly half of respondents indicated a desire to have met with a patient with a tracheostomy prior to surgery but were not offered that opportunity. Fragmented care or limited teamwork was reported by 32% of respondents, whereas tracheotomy care was described as "integrated" or "maximally integrated" for 67%. CONCLUSION: While many families report satisfaction with tracheostomy care, opportunities remain for improving care. This study highlights the importance of teaching, teamwork, and smoothing transition from the hospital. Potential quality improvement areas include standardizing tracheostomy teaching for routine and emergency needs and optimizing postdischarge support and coordination. Prior to surgery, connecting families to people with a tracheostomy may also be beneficial.

Mentoring the next generation of neuroscience nurses: a pilot study of mentor engagement within an academic-service partnership.

Resulting from a system-wide launch of an academic-service partnership that united a research-intensive School of Nursing and a tertiary healthcare system, neuroscience nurses used a team-based approach in mentoring undergraduate nursing students in neuroscience nursing. They linked their team approach to the Institute of Medicine's Future of Nursing report and American Association of Neuroscience Nurses' (2012) strategic plan to prepare neuroscience nurses for the future. Using case reports containing both the mentors' and students' perspective, we showcase sophomore nursing students' development in neuroscience nursing with focus on their developing skills in competency, leadership, and collaboration. Results from this implementation phase include improved reliability in performing undergraduate neurological assessments; developing competency in collaborating with the health team using a culturally sensitive approach; beginning leadership in managing a patient with seizures; and collaborating with families in patient-family-focused care. Evaluation of the effectiveness of this mentored approach to clinical undergraduate nursing education will focus on confidence building for students and mentors.

Effects of a multidisciplinary care program on disability, autonomy, and nursing needs in subjects recovering from acute respiratory failure in a chronic ventilator facility.

BACKGROUND: The aim of this study was to analyze the effects of a multidisciplinary program carried out in a chronic ventilator facility on disability, autonomy, and nursing needs of patients after a prolonged ICU stay. Secondary outcome measures were survival, weaning rate, chronic ventilator facility stay, and discharge destination. METHODS: Multidisciplinary assessment, clinical stabilization, weaning attempts, and a new Disabled Patients Autonomy Planning tool to assess daily care needs were investigated in 240 subjects in a chronic ventilator facility (52 subjects after cardiovascular surgery, 60 subjects with acute respiratory failure, 71 subjects with COPD, and 57 subjects with neurological disease). RESULTS: At admission, nursing needs, disability, and autonomy differed according to diagnosis (P < .001); weaned subjects had greater nursing needs (P < .001) and disability (P = .0014) than unweaned subjects. During the stay, 13.8% of the subjects died irrespective of diagnosis (P = .12); 47% (P < .001) were weaned with significant differences (P <.007) by diagnosis. In the 207 surviving subjects, nursing needs increased as disability increased (r = 0.59, P < .001) and autonomy decreased (r = -0.66, P < .001); disability and autonomy were inter-related (r = 0.61, P < .001). Oxygen saturation, hypercapnia, dyspnea, disability, autonomy, and nursing needs significantly improved (all, P < .001). Fifty-nine percent of the subjects were discharged home. Subjects discharged to nursing homes presented mainly neurological diseases, being more disabled and less autonomous, with higher nursing needs (all, P < .04). Mechanical ventilation use and tracheostomy increased the probability of being discharged to a nursing home (odds ratio [OR] of 1.84, P = .04; OR 2.47, P = .003, respectively). Mortality was higher in subjects who were ventilated (OR 8.44, P < .001), male (OR 2.64, P = .01), elderly (P < .001), or malnourished (P = .01) and in subjects with low autonomy (P < .001), greater nursing needs (P = .002), and more severe disabilities (P = .04). CONCLUSIONS: A specialized tailored multidisciplinary program in subjects after an ICU stay contributed to recovery from disability, autonomy, and fewer nursing needs irrespective of diagnosis. Subjects discharged to a nursing home were the most severely disabled.

Understanding the challenges during transitions of care for children with critical airway conditions.

PURPOSE: The specific aim of this qualitative descriptive study was to gain an understanding of the challenges occurring during transitions of care between two institutions for children with critical airway conditions. METHODS: Qualitative descriptive methodology was utilized to analyze data from two focus groups conducted with nurses from two adjacent institutions. RESULTS: The focus groups were composed of 19 staff nurses, three case managers, one clinical nurse specialist and two nurse directors. Three themes emerged from the nurses' focus groups: Uncertainty with Diagnosis, Communication Between Healthcare Facilities and Family Members, and Parental Acceptance/Readiness to Learn. CONCLUSION: Nurses are in a unique position to improve both the quality and coordination of care to these children and their family members. An effort to improve transfer of care between institutions and nurses could reduce the combined length of stay for patients and reduce avoidable readmissions. Nurses are in a key position to enhance the competence, confidence, and comfort for family members and caretakers to exercise their post-discharge responsibilities. IMPLICATIONS FOR PRACTICE: Consistent, clear communication among health care providers and family members can improve care in this vulnerable population. These data identified need for further education of nurses.

Tracheostomy in infants: parent education for home care.

Children with tracheostomies are increasingly discharged home for continued care by their parents. Nurses are responsible for providing these parents with the extensive education required for a smooth and successful transition to home care. This article is intended to help neonatal and pediatric nurses to effectively prepare the parents of an infant with a tracheostomy to provide safe, quality care to their child after being discharged from an acute care setting to their home. This article discusses the knowledge, attitudes, and skills the parents are required to acquire prior to the infant's discharge. Home ventilation, airway management, suctioning, tracheostomy care, emergency management, safe home environment, equipment for continuous or intermittent ventilation, and supplies necessary for care are some of the topics discussed.

Tracheostomized patients care: efficacy of a brief theoretical education program for nursing personnel.

INTRODUCTION: Tracheostomized cancer patients require a special nursing care involving specifically related procedures. The goal of this study was to evaluate the results of a brief theoretical education program on tracheostomized patients care for nursing personnel. MATERIALS AND METHODS: One hundred and ten professionals have participated in this before and after-intervention one group study, and the program was carried out in a Brazilian hospital, a national reference center in oncology treatment. The questionnaire outcomes were compared to assess the theoretical knowledge level of the participants. RESULTS AND DISCUSSION: Statistical analysis showed that this program was efficient to enhance knowledge skills on specific nursing procedures related to care of the traqueostomized cancer patients. The low costs and simple structure required in the program may encourage the spread of similar practices to improve quality of nursing assistance in the hospital environment.