Developing seamless clinical nursing practice guidelines to prevent complications in adult patients with tracheostomy tubes at home

Abstract

This study aimed to develop clinical nursing practice guidelines for the seamless prevention of complications in adult patients with home tracheostomy tubes, employing a research and development process comprising three phases: 1) examining complications experienced by patients, 2) developing the nursing practice guidelines, and 3) evaluating the implementation of the guidelines. The sample consisted of six nurses and twenty-five patients. The research instruments included: 1) a structured interview guide, 2) a questionnaire on complications among home tracheostomy patients, 3) a knowledge assessment on complication prevention, 4) a home self-care skills assessment, and 5) satisfaction questionnaires for both patients and professional nurses. Content validity was established by three experts, yielding an Index of Objective Congruence (IOC) ranging from 0.67 to 1.00, with reliability coefficients of 0.86, 0.72, 0.78, 0.74, and 0.85, respectively.

            The findings revealed that the most frequently encountered complications were bleeding at the tracheostomy wound site (24%) and respiratory difficulty due to sputum obstruction (16%). The developed guidelines comprised six core components: self-assessment and informational support, equipment and environmental management, self-care skill development, emergency communication, follow-up by healthcare personnel, and psychological support. Evaluation of the guidelines' effectiveness demonstrated a statistically significant increase in knowledge regarding complication prevention (p < .05), with mean scores rising from 51.80% to 76.60% following training. Overall tracheostomy care skills yielded a mean score of 72.06%, which was significantly higher than the established threshold of 60%. Satisfaction with the guidelines among both nurses and patients was rated at a high level.