INTRODUCTION:

“It is not how much you do, but how much love you put in doing”.

(Mother Teressa)¹

Tracheostomy is a surgical procedure to create an opening in the neck at front of the windpipe (trachea). A surgical procedure which consist of making an incision on the anterior aspect of the neck and opening a direct airway through an incision in the trachea. The resulting stoma can serve independently as an airway or as a site for tracheostomy tube to be inserted. This tube allows a person to breathe without a use of his or her nose or mouth. Tracheostomy can also be stated as an opening into trachea through neck, with the tracheal nervosa into continuity of the skin, also the opening being created. Tracheostomy is performed by making an incision in the lower neck.It can be performed as an emergency elective procedure.²

The types of tracheostomy includes: Emergency Tracheostomy in which laryngeal obstruction is acute and demanding an urgent relief. Elective tracheostomy in which the incision is given as prophylactic, therapeutic. Permanent Tracheostomy is required for the patients with bilateral abductor paralysis, laryngeal stenosis, laryngectomy, or laryngopharyngectomy, lower tracheal slump and is being stitched to the skin³.

In the acute setting, indications for tracheostomy include conditions such as, severe facial trauma ,head and neck cancers, large congenital tumours of head and neck e.g. (brachial cleft cyst),and acute angioedema and inflammation of head and neck⁴.

In the chronic setting indications for tracheostomy include need for long term mechanical ventilation and tracheal toilet, e.g. (comatose patients or extensive surgery involving the head and neck) this procedure may be indicated for severe obstructive sleep apnoea seen in patients intolerant of continuous posterior airway pressure (CPAP) therapy. Similarly, in case of tracheobronchial injury which can result from the blunt or penetrating trauma to the neck, and respiratory insufficiency⁵.

For the clients with tracheostomy, the nurse reinforces education provided by the physician or respiratory therapist. The clients understanding of the tracheostomy tube may be enhanced by looking at and touching a tube. The changes in the ability to speak and eat should also be explained .If it is expected that the tracheostoma will be permanent information about living a productive life with modifications in clothing can be provided. The nurse should monitor the vital signs and assess for the indications of shock haemorrhage or complications from the patient’s general condition or the surgical interventions⁴.

Respiratory distress and tube obstruction: mucus plug is the most common cause of respiratory distress, this complications includes bleeding, a very small amount of bleeding (pink or red streaked mucus) often occurs as a result of routine suctioning ,infection tracheaitis in which there is infection due to inadequate humidification of the trachea, tracheal stenosis where in scar tissue accumulate at the site of tracheostomy tube, tracheoesophageal fistula; an abnormal connection between the trachea and the oesophagus, formation of inflammatory growth of tissue, and pressure necrosis; a sore skin and soft tissues around the tracheal site are the late complications of tracheostomy. Similarly early complications includes bleeding, Pneumothorax, Pneumomediastinum, and subcutaneous emphysema. Other complications includes; accidental decannulation, severe infection, damage to the windpipe, tracheomalacia and collapse or narrowing of the airway.⁵

NEED FOR THE STUDY:

A creation of an opening into trachea through neck being brought into continuity and its creation is called tracheostomy; the insertion of annual for airway management and is performed for the client with potential or present airway obstruction, for ventilator assistance, to provide pulmonary hygiene and to decrease the anatomic death. Most of the tracheostomies are designed to exert a low pressure against the tracheal wall through use of an easily distensible cuff that accepts a high volume of air without generating excessive force. Tracheostomy can be performed as an emergency procedure or as an elective procedure, depending on the indication. A component provider can perform a percutaneous tracheostomy at the bedside in critical care units. This method is cost-effective as it avoids the operating room cost saves time and avoids transporting critically ill clients to the operating room. The surgical approach, done as an open procedure in the operating room, includes removal of a portion of a tracheal ring to facilitate creation of stoma for the tube placement. Historically, tracheostomy was associated with a high risk of complications and a significant

mortality rate.

The reported complication rates in adults undergoing tracheostomy vary considerably but it is generally held that complications are more frequent after emergency tracheostomy for airway obstruction. Complications of tracheostomy includes Intra operative i.e Bleeding, Damage to adjacent structures, False passage, Post procedural i.e Cuff leak, Tube occlusion, Tube dislodgement, Tracheo-esophageal fistula, Tracheo-innominate fistula, Tracheal stenosis. The prevalence of tracheostomy was 10% in the long-term ventilated patients (defined as > 24 h), or 1.3% of all patients. Most tracheostomies were performed during the 2nd week of ventilation. An overall complication rate of 13 % was reported, bleeding and infections being at the top of the scale. Tracheostomy is one of the most frequently performed surgical procedures on critically ill patients required prolonged mechanical ventilation in the intensive care unit. It is performed in about 24% of all patients in intensive care units1.Nurses are the care providers and play a central role in providing quality of care. They must be aware of modified and advanced techqnics and versions in medical terms. It is important for nurses working in the ICU set up regarding the knowledge of tracheostomy care as this will improve their professional skills and get to know about abreast of knowledge regarding tracheostomy and develop deep interest to study this significant, researchable and feasible problem.

STATEMENT OF THE PROBLEM:

A study to assess the knowledge regarding tracheostomy care among the staff nurses working in KLES Dr. Prabhakar Kore Hospital & MRC Belagavi with view to develop information booklet on tracheostomy care.

OBJECTIVE OF THE STUDY:

· To assess the knowledge of staff nurses regarding Tracheostomy care.

· To developed information booklet on Tracheostomy care.

OPERATIONAL DEFINITIONS:

1) Assess: In this study assess refers to examine knowledge of staff nurses regarding Tracheostomy care.

2) Knowledge: In this study knowledge refers as to appropriate response from the staff nurses about Tracheostomy care.

3) Tracheostomy Care: It is a care provided to the patient undergone tracheostomy with an aim of maintaining patent airway so as to receive oxygen humidity as the patient can be hemodynamically stable and thus can increase breathing workload.

4) Staff Nurses: Qualified or registered nursing personnel working at intensive care units

5) Booklet: A booklet is a small book that has paper cover and that gives information about Tracheostomy care.

DELIMITATION:

This study is delimited to staff nurses working at intensive care units of KLES Dr. Prabhakar Kore Hospital and MRC, Belagavi, Karnataka

ASSUMPTION:

It is assumed that staff nurses have some knowledge regarding Tracheostomy care.

RESEARCH METHODOLOGY:

Research methods are the techniques used by researchers to structure a study and to gather and analyses information relevant to the research questions.

RESEARCH APPROACH:

Selection of an appropriate research approach that involves a general set of orderly, disciplined procedures to acquire information is of utmost importance in a research study.

Focusing on the nature of the research problem for the present study and the objectives to be fulfilled, a descriptive research was considered as a benefit approach to carry out the study.

RESEARCH DESIGN:

A descriptive survey research design was used.

VARIABLES:

The research variables are factors that can be manipulated and measured.

1. RESEARCH VARIABLES: Staff nurses working at intensive care units of K.L.E’s Dr. Prabhakar Kore Hospital and MRC, Belgaum.

2. DEMOGRAPHIC VARIABLES: Selected demographic variables such as Sex, Age, Education, Work experience, and Source of information.

RESEARCH SETTING:

The research setting is the environment within which the studies are conducted. Setting is the most specific place where data collection occurs based on nature of the research questions. The present study will be conducted at Intensive care units (ICU’s), KLES Dr. Prabhakar Kore Hospital and MRC, Belgaum, Karnataka.

POPULATION:

A population is the entire aggregation of cases in which a researcher is interested. In the present study population comprises of staff nurses working in Intensive Care Units (ICU’s) of KLE’S Dr. Prabhakar Kore Hospital and MRC, Belgaum, Karnataka.

SAMPLE:

Sample is a portion of population that represents the entire population. The sample chosen for the present study were Staff nurses working in Intensive care units(ICU’s) of KLE’S Dr. Prabhakar Kore Hospital and MRC, Belgaum, Karnataka.

SAMPLE SIZE:

The sample size comprised of 50 staff nurses working at ICU’s of KLES Dr. Prbhakar Kore Hospital & MRC, Belgaum, Karnataka.

SAMPLING TECHNIQUE:

The non probability purposive sampling technique was used for the present study.

CRITERIA FOR SAMPLE SELECTION:

The criteria that specify population characteristics are referred to as eligibility criteria or inclusion criteria. A population may be defined in terms of characteristics that people must not possess i.e., the exclusion criteria. The eligibility criteria may reflect the ability to participate in a study. The criteria used to define a population for a research project have implication for both the interpretation of the results and the generalizability of the findings.

INCLUSION CRITERIA:

Staff nurses working at intensive care units

EXCLUSION CRITERIA:

· Staff nurses who are not willing to participate.

· Staff nurses who are on leave on the day of data collection.

SAMPLE CHARACTERISTICS:

The data option to describe the sample characteristics included gender, age, educational status, work experiences and source of information.

PROCEDURE FOR DATA COLLECTION:

The formal permission from the principal of KLEU’S Institute of Nursing Sciences, Belgaum, Karnataka and Medical Director of Dr.Prabhakar Kore Hospital and MRC Belgaum was obtained to conduct research study.

DATA COLLECTION TOOLS:

Data collection tools are the given instrument used by the researcher to observe or measure the key variables in the research problem.

STEPS FOR DATA COLLECTION:

Step I: The investigator will obtain permission from respective authority to conduct the study.

StepII: Selection of subjects (staff nurses working in intensive care units by using non-probability convenient sampling technique based on inclusion criteria.)

Step III: Self introduction of the investigator.

Step IV: Permission from the staff nurses

Step V: The level of knowledge will be assessed with the help of questionnaire before intervention.

Step VI: Giving information booklet about adverse effects of heparin.

Step VII: Data collected will be tabulated and analyzed by using statistical and inferential tests.

DATA ANALYSIS:

Data analysis is the systemic organization and synthesis of research data and testing of research hypothesis by using the collected data.

The analysis of data is the most skilled task in the research process. For the present study the data obtained were analyzed in respect to the objectives of the study by using descriptive statistics. The plan of data analysis was worked out with experts in the field of statistics and nursing. The plan of analysis was as follows:

a) Organization of data in the master sheet.

b) Tabulation of data in terms of frequencies, percentage, mean, median, mode and standard deviation was done

TOOLS AND TECHNIQUES:

The structured questionnaire was prepared for assessing the knowledge.

DEVELOPMENT OF TOOLS:

The structured questionnaire was the tracheostomy care among staff nurses working at intensive care units (ICU’S) of K L E’S Dr. Prabhakar Kore Hospital and MRC Belgaum, Karnataka. Various review of literature was carried out in preparing the tool and the necessary correction had been made by experts.

LITERATURE REVIEW:

Literature review from journals Published, Various books, Unpublished Research, and articles and website were referred to develop the research tool.

DESCRIPTION OF THE TOOL:

PART I: It comprises of demographic variables such as gender, age, educational status, work experiences and source of information.

PART II: Knowledge questionnaires regarding tracheostomy care.

For 20 items on knowledge, a score of ‘1’was awarded to the correct response, while a score of ‘0’was awarded to the incorrect response.

PLAN FOR DATA ANALYSIS:

The data obtained was analyzed in terms of the objectives of the study using descriptive statistics. The plan of data analysis was worked out with experts in the field of statistics and nursing. The plan of analysis was as follows:

a) Organization of data in the master sheet.

b) Tabulation of data in terms of frequencies, percentage, mean, median, mode and standard deviation and range to describe the data.

c) Classifying Knowledge score using mean and standard deviation as follows:

Mean + standard deviation = Good

(Mean + standard deviation) x (Mean - standard deviation) = Average

Mean - standard deviation = Poor

For 20 items on knowledge, a score of ‘1’was awarded to the correct response, while a score of ‘0’was awarded to the incorrect response.

RESULTS:

This chapter presents the analysis and interpretation of the data collected to evaluate the knowledge regarding the tracheostomy care. In this study descriptive statistics are used to describe the data and to identify the factors. The statistics was used to find out the association between the selected socio demographic variables and identified factors.

Analysis is the process of organizing and synthesizing data .The investigator collected the data for analysis and interpretation, using a structured knowledge questionnaire. In order to examine the proposed association the data was tabulated, analyzed and interpreted, using descriptive and inferential statistics.

The data was organized and analyzed under the following headings.

1 Distribution of subjects according to socio demographic variables.

2 Frequency and percentage to identify the factors

Table 1: Frequency and percentage distribution of patient profile according to Gender, Age factors, Qualification, Years of experience, Source of Information, Areas of work n=50

Sl. No

Socio Demographic Variables

Frequency

(f)

Percentage (%)

Gender

a)Male

b)Female

Age factors

a)20-25

b)25-30

c) 30-35

c)30-35

Qualification

a) GNM(N)

b) BSc(N)

c) P B. BSc(N)

d) MSc(N)

Years of experience

a) 0-5yrs

b) 5-10yrs

c) 10-15yrs

Source of Information

a) Continuing Nursing Education

b) Through Books

c) Workshop/Conference

d) Others

Areas of work

a) SICU

b) MICU

c) NSICU

d) Other ICU

The data presented in Table no. 1 indicates that in this section the researcher analyzed and categorized the subjects of study to various groups based on the demographic variables

Majority of the staff nurses were female (62%), and (38%) were male, 52% staff nurses belonged to the age group between 20 -25 years and 56% staff nurses were B.Sc. (N). Majority of the staff nurses have 0-5 years of work experience that is (86%). More than 5 year is (12%), 24.99% of the staff nurses got information through continuing education, 20% through books, 16.2% through workshops and 20% through mass media and others.

Graph 1: Distribution of staff nurses according to gender

Graph 2: Distribution of staff nurses according to age factors.

Graph 3: Distribution of staff nurses according to qualification

Graph 4: Distribution of staff nurses according to years of experience

Graph 5: Distribution according to sources of information

Graph 6: Distribution according to Area of work

Table2: Mean, Median, Mode, Standard deviation and Range of knowledge.

Item	Mean	Median	Mode	Standard Deviation	Range
Knowledge	11.8	12	12	3.52	13

Table 2 represents the distribution of knowledge. The knowledge was distributed with mean of 11.8, median of 12, mode of 12, and standard deviation of 3.53 and range of 13.

TABLE3: Showing frequency and percentage distribution of knowledge.

Knowledge Score	Frequency (f)	Percentage (%)
Good(16 -20)	8	16%
Average(12-15)	26	52%
Poor(0-11)	16	32%

Table 3 reveals that majority of staff nurses 26 (52%) had average knowledge, and the remaining 8(16%) had good knowledge and 16(32%) had poor knowledge.

DISCUSSION:

Tracheostomy Care is a major health issue in various parts of the world. The number of patients with tracheostomy is increasing in both developed and developing countries. Many times the patients die due to lack of knowledge of nurses about tracheostomy Care.

Thus the main aim of the study is to assess the knowledge, regarding the tracheostomy care among the Staff nurses.

In the connection with the above, descriptive study was undertaken with the aim purpose of assessing the level of knowledge regarding tracheostomy care among the staff nurses. To achieve the set of the study, 50 staff nurses were studied. Such was the selection that the maximum of staff nurses were distributed on different sample characteristics as follows.

Table 1 revealed distribution of staff nurses with gender, age, education, work, experience, and source of information. Majority of the staff nurses were female 62%, and 38% were male, 52% staff nurses belonged to the age group between 20 -25 years and 56% staff nurses were B.Sc. (N). Majority of the staff nurses have 0-5 years of work experience that is (86%). More than 5 year is (12%), 24.99% of the staff nurses got information through continuing education, 20% through books, 16.2% through workshops and 20% through mass media and others.

KNOWLEDGE:

To achieve the objectives of this study, the staff nurses were assessed on the knowledge about tracheostomy care among the staff nurses.

Table 2 represents the distribution of knowledge. The knowledge was distributed with the mean of 13.8, mode of 14, median of 14 and standard deviation of 3.52 and the range is 14

Table 3 reveals that majority of the staff nurses 26(52%) had average knowledge and the remaining 16(32%) had good knowledge and 8(16%) had poor knowledge regarding tracheostomy care.

CONCLUSION:

Based on the analysis of the findings the following interference was drawn. There was evident increase in the knowledge of scores in all the areas included in the study, after giving information about tracheostomy care.

Thus it was proved that simple information booklet was effective teaching method for creating awareness regarding tracheostomy care among the staff nurses working at Dr Prabhakar Kore Hopsital Belagavi, Karnataka.

NURSING IMPLICTAIONS:

The findings of the study have implications in the area of nesting education , nursing practice, nursing administration and nursing research.

NURSING EDUCATION:

The educational background of a nurse should have necessary skills and knowledge to function as a health educator. Health education is the major key to improve knowledge as well as a modify practice among the general population. Booklet can be used as a reference material by the researcher to provide and aid the staff nurses to know regarding tracheostomy care.This study will enable the researchers to prepare information booklet for the staff nurses regarding tracheostomy care. Thus the researcher will build good knowledge of the staff nurses by providing information booklet which will lard to decrease the adverse effects of tracheostomy care.

NURSING PRACTICE:

This study will help the nurses to gain the knowledge regarding the tracheostomy care . Nurses enhance people ability to deal with the multiple factors that influences their health status and health care needs. The goal of nursing is to promote health, prevent illness and to restore health and alleviate suffering.

NURSING ADMINISTRATION:

Nurses as an administrator can influence the quality of nursing care in heath care organization but planning different health education program, in service education programs and supervising care at different levels and should plan outreach activity in collaboration with other agencies.

This study emphasizes the need for in – service education, seminars, regarding tracheostomy care . And booklets by nursing superintendent and in charges to provide guidelines to the staff nurses and nursing students.

NURSING RESEARCH:

Nurses need to be actively engaged in all phases of research process, to address ongoing questions of interest to continue, to improve client care. The present study information must be used by others researchers or modified for reuse. The present study can be the sources of review of literature for others who are conducting studies in similar topics.

LIMITATIONS:

1. The present study was limited to KLEU’S Dr. Prabhakar Kore Hospital Belgaum.

2. The present study was limited to only 50 staff nurses working in ICU’S.

3. No broad generalization could be made due to small size of the samples.

RECOMMENDATIONS:

1. Similar study on large and wider sample for longer period of time would be more pertinent in making broad generalization.

2. A descriptive study can be conducted on knowledge regarding tracheostomy care.

An experimental study can be undertaken using a control group for effective comparison of the result.

SUMMARY:

This study was proposed to describe the levels of knowledge of adverse effects of tracheostomy care among staff nurses. The knowledge was assessed by using questionnaires with the options of yes or no. The study was conducted on staff nurses of the ICU’S of DR Prabhakar Kore Hospital and MRC, Belgaum. This study revealed certain facts regarding knowledge. The average percentage of the overall knowledge was 63.33%.

The structured knowledge questionnaires was conducted by preparing blue print and reviewing literature.

In order to fulfill objective data was analyzed using descriptive statistics. The descriptive statistic used were frequency and percentage distribution of samples characteristics and computation of mean , mode, median, standard deviation and range of knowledge scores.

THE OBJECTIVES OF STUDY WERE:

· To assess the knowledge of staff nurses regarding the adverse effects of tracheostomy care.

· To develop the information booklet on tracheostomy care.

RESULTS:

Majority of the staff nurses 26(52%) had average knowledge and the remaining 16(32%) had good knowledge and 8(16%) had poor knowledge regarding tracheostomy care.

REFERENCE:

1 Tracheostomy Care Quotes ( www.quotes.co.in)

2 Daniels Rick, Nursing Fundamentals Caring and Clinical Decision Making, 7^th edition. Page No: 1265-1271

3 Ferell BR, Dahlin C , Nurses Perception on Tracheostomy Care. www.quaker co.in

4 www. Web Crawler .com Tracheostomy Care [online] 2013 Nov (cited 2014 Jan)

5 Interdisciplinary ICU Ratisches Kantons http:// www.Waent.org.

Received on 23.03.2016 Modified on 30.03.2016

Int. J. Adv. Nur. Management. 2016; 4(3): 299-306.

DOI: 10.5958/2454-2660.2016.00054.5