Original articleMore than nothing: The lived experience of tracheostomy while acutely ill
Introduction
Patients require the insertion of tracheostomy tube for a variety of reasons including the facilitation of weaning from mechanical ventilation within the intensive care unit (ICU). There is unconvincing evidence (Griffiths et al., 2005) that early tracheostomy tube placement may markedly reduce duration of ventilation and shorter stays in critical care and the advent of the Tracman trial (2008) explores this further. This completed multicentre, unblended, randomised controlled trial investigated early versus late tracheostomy tube placement in the critically ill and is to be published imminently.
While it can be argued that reduction in ICU length of stay has clear advantages for the cost of and quality of care, it is uncertain what impact this intervention has on the whole patient, their experience of being critically ill and any issues during recovery. This illustrates an imperative to investigate peoples’ experience of these tubes so that they may be represented in parallel with the findings of the above studies to gain a human understanding of what has become widespread use of these artificial airways. Nursing staff on the ward and critical care areas are exposed to these tubes currently yet there is little information available regarding the lived experience of tracheostomy.
This information is critical for nursing knowledge given the understanding that the heart of nursing people with any illness is consideration of their needs based on the effect that the illness has on them (Cronin and Rawlings-Anderson, 2004). Therefore investigating a nursing concern, what people have to say about their tracheostomy, permits us to better understand these patients needs and provides a cornerstone for their holistic care along with the practical skills required to care for these people to a high standard.
Section snippets
Literature review
An integrated search for literature was undertaken to determine what is already known about tracheostomy and, in particular the patient experience of these artificial airways. An electronic search was performed of the following databases:
- •
CINAHL—Cumulative Index to Nursing and Allied Health Literature
- •
Medline
- •
BNI—British Nursing Index
- •
EMBASE Psychiatry
Secondary references were investigated as well as networking with colleagues within the multi disciplinary team and a nationally acclaimed expert in
Methodology
This study concerns itself with gaining descriptions from the experience of the tracheostomy tube rather than quantifying the experience through measurement or searching for explanations. I share van Manen's understanding (1990) that from a human scientific perspective, methodology refers to a philosophical framework and the fundamental assumptions and principles of a particular perspective. The philosophy of phenomenology offers such a framework. Phenomenology tries to give a direct
A rigorous phenomenological approach
The trustworthiness of this study may in part be determined through the use of criteria for qualitative data (Lincoln and Guba, 1985):
- •
Credibility. Participants with specific experience of tracheostomy tube were chosen and a rigorous phenomenological approach used to gain descriptions of their experience. The term rigor is understood here to pertain to a robust and systematic approach used within the epistemological and theoretical principles of phenomenological inquiry, a convincing argument
Findings and discussion
Six broad themes were derived from the data analysis and these convey an understanding of what it is like to live and breathe with a tracheostomy tube.
Implications for future research and care
The findings regarding communication, normality and relationships with staff have similarities with those who have described the experience of mechanical ventilation although these studies are inconsistent or not explicit when mentioning tracheostomy within their sample characteristics. Future research could use similar methods to explore the experience of communication in people with tracheostomy on the ward environment further and this may shed light on this particular theme to add to others
Conclusion
Nurses in both critical care and ward environments can be influential in determining how people with these tubes are cared for effectively in the holistic sense. Adequate communication as a minimum can involve a creative, consistent, patient centred approach that involves the patient choosing the best approach for them. Demonstrating proficiency with common skills such as suction and stoma care can engender confidence from the patient and this is seen as crucial when one considers that the
Limitations
This study formed the dissertation module of a recent M.Sc. (Nursing). Recruitment was limited to time constraints, availability of potential participants willing to take part and therefore the number was small.
References (59)
- et al.
Memories of intensive care and experiences of survivors of a critical illness: an interview study
Intensive & Critical Care Nursing
(2004) - et al.
Pain related to tracheal suctioning in awake acutely and critically ill adults: a descriptive study
Intensive & Critical Care Nursing
(2008) - et al.
The lived experience of survivors of prolonged mechanical ventilation: a phenomenological study
Heart & Lung
(2003) - et al.
Suctioning: a review of current research recommendations
Intensive & Critical Care Nursing
(2002) From Husserl to van Manen. A review of different phenomenological approaches
International Journal of Nursing Studies
(2007)- et al.
Patients’ experience of being critically ill or severely injured and cared for in an intensive care unit in relation to the ICU syndrome, Part I
Intensive & Critical Care Nursing
(1998) - et al.
Acute confusion and unreal experiences in intensive care patients in relation to the ICU syndrome, Part II
Intensive & Critical Care Nursing
(1999) An exploratory study of patients’ memory recall of their stay in an adult intensive therapy unit
Intensive & Critical Care Nursing
(1996)Reclaiming the everyday world: how long-term ventilated patients in critical care seek to gain aspects of power and control over their environment
Intensive & Critical Care Nursing
(2004)- et al.
Researching the experience of being critically ill: some methodological difficulties
Intensive & Critical Care Nursing
(2003)
Severely ill ICU patients recall of factual events and unreal experiences of hospital admission and ICU stay-3 and 12 months after discharge
Intensive & Critical Care Nursing
Psychosocial recovery following ICU: experiences and influences upon discharge to the community
Intensive & Critical Care Nursing
‘Fishing with the dead’—recall of memories from the ICU
Intensive & Critical Care Nursing
Communication interaction in ICU—patient and staff experiences and perceptions
Intensive & Critical Care Nursing
Leaving the intensive care unit: a phenomenological study of the patients’ experience
Intensive & Critical Care Nursing
Assessment of patients’ experience of discomforts during respirator therapy
Critical Care Medicine
Best Practice in the care of patients with a tracheostomy
Nursing Times
Tracheostomy care: tracheal suctioning and humidification
British Journal of Nursing
Sampling in qualitative research. Purposeful and theoretical sampling; merging or clear boundaries?
Journal of Advanced Nursing
Knowledge for contemporary nursing practice
Tracheostomy management for patients in general ward settings
Professional Nurse
The lived experience of a tracheostomy tube change: a phenomenological study
Journal of Clinical Nursing
The good, the bad and the relative, Part Two: Goodness and the criterion problem in qualitative research
International Journal of Nursing Practice
The theory, practice, and evaluation of the phenomenological method as a qualitative research procedure
Journal of Phenomenological Psychology
Concerning the application of phenomenology to caring research
The Scandinavian Journal of Caring Sciences
The phenomenological movement and research in the human sciences
Nursing Science Quarterly
Systematic review and meta-analysis of studies of the timing of tracheostomy in adult patients undergoing artificial ventilation
British Medical Journal
Tracheostomy: suctioning and humidification
Nursing Standard
Patient's experiences of communication during the respirator treatment period
Intensive & Critical Care Nursing
Cited by (41)
What matters most to adults with a tracheostomy in ICU and the implications for clinical practice: a qualitative systematic review and metasynthesis
2022, Journal of Critical CareCitation Excerpt :Their compromised ability to communicate resulted in feelings of frustration, vulnerability, isolation, and a diminished sense of self’ (author quote) [44]. Perceptions of staff not making an effort to communicate with voiceless patients, not attempting to correct misunderstandings, or jumping to conclusions about a message [42,43,45,46,49,51,53], were deeply upsetting to patients, and can be seen as dehumanising . In contrast, Flinterud and Andershed's (2015) [48] study highlighted the value of caring, attentive staff who acknowledged communication difficulties, took time to try to understand, were present at the bedside and communicated through verbal and non-verbal means.
Adaptation and validation into Spanish of a specific questionnaire on quality of life in patients with tracheostomy (TQOL)
2022, Acta Otorrinolaringologica EspanolaDetermining the Prevalence, Implementation Approaches, and Opinions of Above Cuff Vocalization: A Survey of Health Care Professionals
2022, Archives of Physical Medicine and RehabilitationThe communication experience of tracheostomy patients with nurses in the intensive care unit: A phenomenological study
2018, Intensive and Critical Care Nursing