Introduction
Using the introduction of the term “tracheostomy” that will be the key term applied throughout the current paper, it is necessary to state that tracheostomy is defined as “the insertion of a tube through the neck tissues, into the trachea, leaving the whole of the larynx intact” (Feber, 2006, p. 186). There can be emergencies which demand tracheostomy or this can be an elective procedure as well under the circumstances demanding the anastomosis of the trachea. However, whether a tracheostomy is an emergency measure or a carefully prepared one, whether it will be permanent or temporary therapy, the ultimate goal of tracheostomy care remains the same: “to ensure airway patency by keeping the tube free from mucus buildup” (Lippincott Williams & Wilkins, 2007, p. 359). Besides, Frace (2010) mentions that the care of the patients with tracheostomies belongs to “the most challenging and stressful nursing care situations” (p. 58). Tracheostomy care training will enable the students to show less stress while providing care for patients with tracheostomy and it will reduce the risks connected with the procedure.
Aim of Teaching Tracheostomy Care
The main aims of teaching tracheostomy are the basic principles, characteristics, and stages of care of a patient with tracheostomy. Melat Ziegler (2005) mentions “refusal to perform tracheostomy care related to dysfunctional anxiety” (p. 33), and the teaching session aims to eliminate such possibility among the students. The process of tracheostomy care instruction demands the development of the skill of critical thinking as the students should be able to make rational and responsible decisions (Bradshaw & Lowenstein, 2007, p. 57). The process of tracheostomy care should be focused on the caregiver, as well as, on the treatment.
Teacher’s Objective
It is possible to define the main objectives an instructor should set during the teaching session on tracheostomy care. They can be briefly summarized as follows: to acquaint the students with two main techniques that are used to perform a tracheostomy: a surgical tracheostomy and a percutaneous dictational tracheostomy or PRT (Russel, 2005, p. 429). The students should get basic knowledge of the types of tubes for tracheostomy, the benefits of tracheostomy, and the processes of suctioning, cleaning of the inner tube, and the equipment required for and the procedure of changing a tube (Feber, 2006).
Teaching Strategies
Since nursing is the profession that deals with human life and its hazards directly, and tracheostomy care also has its specificity that has been described in the above sections, it is necessary to provide solid theoretical background for the process of planning tracheostomy care training. Nursing demands moving from cognitivism to constructivism that is more learner-focused (Bosher & Pharris, 2008, p. 186). Adherence to constructivism as the theory in the basis of training will provide students with the environment that will enable them to think critically, practice reflectively, cooperate in the groups of fellow students and get at and effectively use the information they are provided with to support their practical tasks (Young and Paterson, 2007, p. 6).
Kolb’s model of experiential learning corresponds to a constructive theoretical base. As for the instrument used to measure the learning styles of nursing students, it will be the Kolb Learning Style Inventory that is reported to be the most commonly used one with nursing students (McGovern Billings & Halstead, 2005, p. 29). On defining the ratio of learning styles in the group of students, it is necessary to direct the instruction towards prevalent learning styles though those that constitute the minority should not be omitted. Thus, the types of activities during tracheostomy care instruction suitable for accommodators will be group work, discussion, open-ended problems, simulations, etc. (Nilson, 2010, p. 231). Divergers will benefit from discussion, interactive lectures, simulations, while convergence is successful when demonstrations, case studies, and simulations are used (Nilson, 2010, p. 232). Thus, the use of Kolb’s learning styles accounts for the choice of the teaching techniques mentioned below because tracheostomy care instruction should be treated as a multidimensional teaching process and this fact accounts for the necessity of the application of several teaching techniques in complex or in natural succession as established by the instructor.
First of all, it is necessary to form a theoretical basis for the students. This can be best achieved with the help of the application of a traditional teaching method, a lecture. The main peculiarities of the lecture about tracheostomy and tracheostomy care should be a clear and logical plan, the support of the lecture with schemes and other kinds of visual aids, the best choice will be to provide the students with concise notes about the flow of the lecture (Carpen, 2005, p. 4). The flow of the lecture should be logical, with a smooth but clear transition to the succeeding items. The manner of the presentation should be accessible; it is not necessary and even not desirable to overload the lecture with terminology, though the introduction of the necessary terminology is essential. Though the students perform a passive role during a lecture, the lecture can be modified so that a student could become an active participant in the instructional process during a lecture. An instructor should encourage students’ feedback, students should ask questions in the course of the lecture.
Besides a lecture, it is advisable to use the teaching strategies that would focus on active learning and critical thinking of the students. It can be the discussion of the material that has been delivered in the lecture. In the case of tracheostomy care, the discussion can be built around the benefits of tracheostomy or patient assessment.
The analysis of a case study can be a perfect strategy to use during the instruction of students on tracheostomy care as it can be “valuable for applying concepts from lecture to clinical practice” (Young & Paterson, 2007, p. 288). British Journal of Nursing (1999) offers a perfect case study involving a nurse who did not follow init guidelines concerning tracheostomy care. Also, it is possible to build the discussion based on one-minute web-based videos that “reinforce the management of the tracheostomy emergencies” (Tanner, 2006, p. 483).
Moving from the most passive to the active teaching and learning strategies, it is necessary to mention the use of a simulation lab that “provides an opportunity to practice the management of spontaneous decannulation, and to demonstrate skills in cannulation” (Tanner, 2006, p. 483).
Learning Outcomes
Learning outcomes should demonstrate a sufficient theoretical basis of the students’ knowledge and their acquisition of practical skills necessary for adequate provision of tracheostomy care. They should demonstrate that skills connected with the processes of suctioning, cleaning of the inner tube, and changing of the tube.
Evaluation Strategies
Since the tracheostomy care instruction is directed in two basic ways: theoretical one and practical one, it is necessary to evaluate the student’s knowledge in both spheres. The assessment of theoretical competence can be performed based on oral or written examination according to the choice of the examiner. It is possible to check theoretical knowledge with the help of the analysis of the case studies as it has been done during the process of instruction.
However, there is the necessity of the assessment of the development of practical skills of tracheostomy care. Students can be assessed in the simulation lab where they received the instruction and practical training. They should demonstrate their skills of suctioning, cleaning the inner tube, and changing the tube.
Conclusion
In conclusion, special attention of an instructor teaching a tracheostomy care course is caused by significant risk factors associated with caring for a patient that has been given or should be given a tracheostomy (tube obstruction, misplacement), as their possible consequences may result in respiratory and cardiac arrest threatening the patient’s health (Russel, 2005). It is necessary to provide the students with an adequate understanding of the basic principles, characteristics, and stages of care of a patient with tracheostomy. Since a solid theoretical ground is needed for the planning of tracheostomy care instruction, constructivism has been chosen as a suitable educational theory and the choice of the teaching techniques is made based on Kolb’s learning styles. By the end of the tracheostomy care course, students should be able to demonstrate sufficient theoretical knowledge and adequate practical skills of care of a patient with a tracheostomy.
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