A Study to Assess the Effectiveness of Structured Teaching Programme on Knowledge regarding Tracheostomy Care among 2nd year GNM Students of selected Nursing Schools at Bangalore

 

Asha Sajji¹*, Angel K Jose², Arpita Paul², H. Tika Devi Sharma², Midhun Jose²,

Sairoj Thapa², Soorya Kiran. S.²

¹Ph.D. (N), Professor, Department of Medical Surgical Nursing,

Raja Rajeswari College of Nursing, Bengaluru, Karnataka, India.

²B. Sc. (N) students, Raja Rajeswari College of Nursing, Bengaluru, Karnataka, India.

 

 

ABSTRACT:

Background of the study: Tracheostomy is a surgical procedure of making an incision into the trachea so that a tube can be inserted into the opening to assist breathing for the patient requiring respiratory support. Tracheostomy care includes a multidisciplinary approach, mainly involving nursing care. Good tracheostomy care consists of consistent suctioning, stoma care, nutrition, speech therapy, and periodic changing of the tracheostomy tube.⁵ Objectives: To assess pre-test and post test knowledge regarding tracheostomy care among student nurses. 2. To evaluate the effectiveness of structured teaching programme on knowledge regarding tracheostomy care among student nurses. 3. To find out the association between post-test knowledge scores regarding tracheostomy care among student nurses with their selected demographic variables. Design: Pre-experimental one group pre test post test design was selected for the study. Fifty 2 nd year GNM students were selected through non-probability convenience sampling technique. Data was collected using a self-structured knowledge questionnaire. Results: Findings revealed that, in pre-test, 33(66%) participants had inadequate knowledge, 16(32%) had moderately adequate knowledge and only 1(2%) had adequate knowledge. In post test, 30(60%) participants had adequate knowledge and 20(40%) had moderately adequate knowledge. The mean score of post-test knowledge 20.7±2.697 was higher than mean score of pre-test knowledge 11.12± 5.149. The calculated t-value 11.65 was found to be significant at p<0.05 level. Conclusion: Teaching programmes are effective in enhancing the knowledge regarding tracheostomy care and hence must be conducted at regular intervals.

 

 

 

INTRODUCTION:

Tracheostomy is a surgical procedure commonly performed in intensive care units. It involves making an incision into the trachea so that a tube can be inserted into the opening to assist breathing for the patient requiring respiratory support.¹

 

 

It can be performed as emergency or elective procedure.² Traditionally it was confined to emergency management of upper airway obstruction but now more recently indications have extended to include prolonged mechanical ventilation, chronic respiratory insufficiency, and management of excessive secretions.¹ Alexander the Great, legend has it, performed a surgical tracheostomy in the fourth century BCE, using the tip of his sword to open the windpipe of a choking soldier.²

 

Tracheostomy is performed to bypass upper airway obstruction. 10– 24% of patients in ICU require tracheostomy for prolonged respiratory support or weaning. Critically ill patients tolerate short-term tracheal intubation with few complications where as prolonged tracheal intubation is associated with major complications. Tracheostomy is also considered in patients predicted to require prolonged artificial clearance to minimize or avoid laryngeal injury secondary to an extended period of translaryngeal intubation. This can also avoid the undesirable side-effects of ongoing sedation allowing for increased patient comfort, cough, respiratory drive, mobility and gut function.³

 

The complications of tracheostomy can be either early or late. The early complications include hemorrhage, tube dislodgement, pneumothorax, and wound infection, while late complications include tracheal stenosis, tracheo-esophageal fistula and laryngeal stenosis.⁴ Care of tracheostomy includes a multidisciplinary approach, mainly involving nursing care. Good tracheostomy care consists of consistent suctioning, stoma care, nutrition, speech therapy, and periodic changing of the tracheostomy tube.⁵

 

While providing tracheostomy care, the nurse must ensure that the tube is free of secretions, maintain a patent airway, provide wound care, assess the patient, and secure tracheostomy tubes in place. Decannulation may occure due to the movement of tube that may cause irritation and coughing. Keeping the tube secure while changing the ties or holder to prevent accidental decannulation is critical.⁶

 

The patient with new tracheostomy will face many problems like management of excess secretions, risk of infections, body image disturbances and impaired vocalization. Health care providers must ensure the patient safety while they are moved from hospital to home. Patient and the family must understand all the aspects of tracheostomy care. They should be able to recognize any signs and symptoms of infection or tube displacement that should be reported to the physician and have adequate support at home. Nurses can help a patient successfully manage these problems through comprehensive discharge planning.⁷

 

OBJECTIVES:

Objectives of the study were as follows:

1.     To assess pre-test and post test knowledge regarding tracheostomy care among student nurses.

2.     To evaluate the effectiveness of structured teaching programme on knowledge regarding tracheostomy care among student nurses.

3.     To find out the association between post-test knowledge scores regarding tracheostomy care among student nurses with their selected demographic variables.

 

MATERIALS AND METHODS:

Current study was conducted using a pre-experimental one group pre-test post-test design. 50 2^nd year GNM students were selected by non-probability convenience sampling technique. A pre tested structured knowledge questionnaire consisting 30 items was used to collect data. Validity of the tool was established under the expert guidance from medical surgical nursing. Reliability of the tool was established using test- retest method and feasibility was checked by conducting a pilot study. Informed consent from the study participants and also institutional ethical clearance from the concerned authority was obtained before proceeding for data collection. Descriptive and inferential statistics was used to analyze the data.

 

RESULTS AND INTERPRETATION:

Table 1: Frequency and percentage distribution of subjects according their Socio-demographic variables                             n=50

 

Table 1 depicts the socio-demographic characteristics of student nurses. Majority of the subjects, 24(48%) were in the age group of 20-21 years, 38(76%) were females, 42(84%) belonged to Hindu community, 30(60%) subjects never had clinical posting in ICU/CCU and 28(56%) gained information from books.

 

Graph 1: Comparison of level of knowledge between pre test and post test                                                                             n=50

Graph 1 shows the comparison of level of knowledge between pre test and post test. In pre test, 33(66%) subjects had inadequate knowledge, 16(32%) had moderately adequate knowledge and only 1(2%) had adequate knowledge. In post test, 30(60%) subjects had adequate knowledge, 20(40%) had moderately adequate knowledge and no one had inadequate knowledge.

 

Table 2: Comparison of Pre-test and Post-test Knowledge Score regarding Tracheostomy Care                                                            n=50

*Significant at p<0.05, df=49

 

Table 2 depicts the comparison of pre-test and post-test knowledge scores regarding tracheostomy care among student nurses. Data reveals that the mean score of post-test knowledge 20.7±2.697 was higher than mean score of pre-test knowledge 11.12±5.149. The calculated t-value 11.65 is significant at p<0.05 level.

 

Table 3: Factors associated with knowledge of student nurses regarding tracheostomy care with demographic variables       n=50

S-Significant at p<0.05, NS- Not significant at p<0.05

 

Table 3: depicts that there is a significant association of knowledge with gender and no association was found with age, religion, duration of clinical posting in ICU/CCU and source of information.

 

DISCUSSION:

Findings of the current study shows that, 24(48%) subjects were in the age group of 20-21 years and majority 38(76%) being females. These findings were consistent with the findings reported by Kaur K. who used the same sample size and found that 70% participants in the study were between 21-25 years age group and 96% participants were females.¹ Similarly a study conducted by Shiyamala P., et al reported that 90% of the subjects in their study were females.¹⁰ 42(84%) participants in this study belonged to Hindu community which were similar to the findings a study carried out by Kanakalmath, R. C., et al, where the authors stated that majority of the participants were hindus.⁸ 30(60%) subjects in this study never had clinical posting in ICU/CCU. Similarly, according to the findings reported by Kanakalmath, R. C., et al, 88% subjects did not have earlier exposure to tracheostomy care.⁸ In present study it was found that 28(56%) gained information from books which was consistent with findings of a study conducted by Kaur K. stating 70% subjects gained information from books.¹ 68% subjects gained information from books and journals according a study conducted by Kanakalmath, R. C., et al.⁸

 

In present study it was found that, 33(66%) subjects had inadequate knowledge, 16(32%) had moderately adequate knowledge and only 1(2%) had adequate knowledge in pre test. In post test, 30(60%) subjects had adequate knowledge, 20(40%) had moderately adequate knowledge and no one had inadequate knowledge. Present study findings were consistent with the study findings reported by Kaur. K. which showed that knowledge scores in posttest 20.26±2.89 was higher than pre-test 13.58±2.65 regarding tracheostomy care among staff nurses.  And with regard to practice, post-test score 20.2±4 was higher than pre-test score 17.36± 4.39 regarding tracheostomy care indicating the effectiveness of structured teaching programme in improving the knowledge and practice of staff nurses regarding tracheostomy care.¹ A study conducted by Kanakalmath, R. C., et al. reported that the pretest mean knowledge score was 10.96 with standard deviation 2.74 and the post test mean knowledge score was 22.64 with standard deviation 3.98. it was also found that 52% subject had average knowledge, 28% had good knowledge and 24% had poor knowledge in pre test which was enhanced to 84% subjects had good knowledge, 16% had average knowledge with no one having poor knowledge in post test.⁸ Dhaliwal, M. K, et al  conducted a study on staff nurses to assess their knowledge and skills on tracheostomy care and found that 57% and 43% subjects had average and good knowledge respectively with 44% and 56% subjects having fair and good skills respectively.⁹ A study conducted by Singh. R. reported that 40% subjects had poor knowledge, 46% had average knowledge and only 14% subjects had good knowledge in pre test. After attending video assisted teaching programme on tracheostomy care 46% subjects had excellent knowledge and 44% had good knowledge demonstrating the effectiveness of teaching programme.³ Shiyamala P., et al conducted a study on undergraduate nursing students to assess the effect of IEC package on knowledge regarding tracheostomy care and found that pre test mean knowledge score was 8.06 and post test mean knowledge score was 13.75. It was also noted that 28.45% gain in post test knowledge score after attending teaching programme.¹⁰ A study conducted by Gaterega, T., et al. demonstrated that 71% subjects had moderate knowledge with 97.5% exhibiting low level of practice regarding tracheostomy care.¹¹ Malk. N. R., et al stated that majority of the study subjects had unsatisfactory knowledge and practice regarding tracheostomy care before the training programme and a significant improvement in knowledge and practice was observed after the training programme.¹²

 

CONCLUSION:

Findings of this study showed that GNM students have inadequate knowledge regarding tracheostomy care. Structured teaching programme was found to be effective in improving the knowledge of study participants about tracheostomy care which will be useful when they start practicing their nursing career in future.

 

CONFLICT OF INTEREST:

There is no conflict of interest in this study.

 

ACKNOWLEDGEMENT:

I would like to express my sincere gratitude to the participants of study who had spent their valuable time for giving the information.

 

ETHICAL CLEARANCE: 

A formal written permission was obtained from the institutional ethical committee and also informed consent was taken from the study participants.

 

REFERENCES:

1.      Kaur. K. A Pre-Experimental Study to Assess the Effectiveness of Structured Teaching Programme on Knowledge and Practice regarding Tracheostomy Care among Staff Nurses at Selected Hospitals of Punjab. International Journal of Science and Research.  2019; 8(3): 593-598.

2.      Trubuhovich. R. V. Primary sources and the tracheostomy legend about Alexander the Great. J Anesth Hist. 2018; 4: 38.

3.      Singh. R., Raghavendran. M., Singh. R. A study to assess the effectiveness of video assisted teaching module on knowledge regarding tracheostomy care among B. Sc. Nursing students in selected colleges in Kanpur. IOSR Journal of Nursing and Health Science. 2020; 9(6): 40-44.

4.      Khanum. T., Zia. S., Khan. T., Kamal. S., Khoso. M. N., Alvi. J., Ali. A. Assessment of knowledge regarding tracheostomy care and management of early complications among healthcare professionals. Braz J Otorhinolaryngol. 2022; 88(2): 251–256.

5.      Berman, A., and Snyder, S. Fundamentals of nursing concepts, Process and practice. Company of John Wiley and Sons, Inc., New York. 2012; 9^th ed. 1604-16010.

6.      Ignatavicius, D.D., Workman, M. LRebar, C. R., & Heimgartner, N. M. Medical- surgical nursing concept of interprofessional collaborative care. Saunders, an imprint of Elsevier Inc. 2020; 9^th ed. 576.

7.      Wilson. E. B., Malley. N. Discharge planning for the patient with a new tracheostomy. Crit Care Nurse. 1990; 10: 73-9

8.      Kanakalmath. R. C., Pinnapati. S. S., Patali. C. S., Ronad. S. K. A Study to Evaluate the Effectiveness of Planned Teaching Programme on Knowledge Regarding Tracheostomy Care Among Final Year GNM Students in Selected Schools of Nursing at Bagalkot, Karnataka. International Journal of Innovative Science and Research Technology. 2018; 3(11): 129-137.

9.      Dhaliwal. M. K., Choudhary. R., Sharma. P. A Descriptive Study to assess the knowledge and skills on tracheostomy care among staff nurses working in selected hospitals of district Mohali, Punjab. Asian Journal of Nursing Education and Research. 2018; 8(2): 242-246.

10.   Shiyamala. P., Suseelal. T., Kanniammal. C. Effect of IEC package regarding knowledge on tracheostomy care among undergraduate students in SRM college of nursing, Kattankulathur, Chengalpet district. Journal of Pharmaceutical Negative Results. 2022; 13(9): 1927-1929.

11.   Gaterega. T., Mwiseneza. M. J., Chironda. G. Nurses knowledge and practices regarding tracheostomy care at a selected referral hospital in Rwanda – A descriptive cross-sectional study. International Journal of Africa Nursing Sciences. 2021; 15: 2-7.

12.   Malk. R. N., Fahem. E. M., Soultan. A. A. A. Effectiveness of Training Program regarding Tracheostomy Care on Nurses Performance at Intensive Care Unit. Egyptian Journal of Health Care. 2022; 13(1): 267- 279.

 

 

 

 

 

 

 

 

 

 

 

Received on 16.09.2023           Modified on 07.11.2023

Accepted on 17.01.2024          © A&V Publications all right reserved