Original article
More than nothing: The lived experience of tracheostomy while acutely ill

https://doi.org/10.1016/j.iccn.2009.09.004Get rights and content

Summary

While the physical sensations surrounding tracheostomy tube insertion have been reported within nursing and allied healthcare literature, the lived experience of these sensations is poorly described. This appears relevant given the imminent results of the Tracman study (2008).

A purposive sample of three participants who had tracheostomy tubes previously within a critical care area or still in situ were recruited. They described their experiences in a face-to-face semi-structured interview that were audio taped. The interviews were transcribed verbatim and analysed using Giorgi's 5 concrete steps of the human scientific phenomenological method (1997).

Findings revealed themes that drew attention to the fundamental aspects of the experience. These were:

  • 1.

    Necessity of communication

  • 2.

    Retaining normality

  • 3.

    Psychosocial discomfort

  • 4.

    Painful procedures

  • 5.

    Fear of the unknown

  • 6.

    Relationships with staff

Practical recommendations draw attention to the organisational support required for staff expected to care for these patients in the ward environment. This involves the introduction of evidence based guidelines and competency based care to promote the acquisition of skills required to perform those essential tasks such as suction and stoma care to a high standard. Protected, formalised skills based teaching is seen as fundamental in this process. Patients’ felt confident in nursing staff that were able to demonstrate proficiency with such tasks and this is seen as crucial when one considers that the tracheostomy tube is a new experience for patients.

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.

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