Experience of Adult Patients with Tracheotomy in Situ

1.0 Executive Summary

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The systematic review seeks to find the best available evidence of the experience faced by adult patients with tracheotomy students in situ. The evidence is collected through the findings of four main articles that investigate the experiences of adult patients with tracheotomy tubes in situ. The findings show four dominant experiences in adult patients with tracheotomy tubes, which include physical sensation, communication, psychological discomfort, and fear of the unknown. The four experiences are broad and the findings further subdivide into smaller experiences, which can be easily recorded in the findings. The paper concludes that the community (friends and relatives) of tracheotomy patients can help them cope with the experiences. Various recommendations are made towards helping adult patients with tracheotomy patients to cope with their experience. The recommendations include training nurses and other professionals appropriately, community awareness, individualized cognitive behavioral therapy, proper clinical care, and creation of forums through which tracheotomy students meet up and exchange experiences

1.1 Context

The reviews context involves the patients who are adults and have had the tracheotomy tube inserted in them. The review captures the positive, negative, and neutral experiences that the patient experience. The review also looks at the general performance of experience among the patients.

1.2 Objectives

The objectives of the systematic review was to obtain first hand information of the experience that the patients of tracheotomy. Subsequently, the review summarizes the findings of all the relevant studies conducted on the same. The review thereby seeks to answers the following question: What is/are the experience of adult patients with a Tracheotomy tube in situ?

1.3 Methods

The study includes adult patients with tracheotomy tubes in situ drawn from four papers on the same topic. The method for data collection was semi-structured interviews. Some questions were open ended to enable the participants give their feelings on their experience while other that needed straight answers were closed. Some of the interviews were videotaped for a better analysis.

1.4 Results

The participants reported diverse experiences while having the tracheotomy tube in Situ. Physical sensations and high emotions come in as a main theme in the results section. The Tracheotomy tube in situ is also reported to inhibit many activities that would otherwise be conducted by the participants were they free from the tube. The analysis also showed that there was a communication breakdown between the adult patients with the tracheotomy tubes and the surrounding people. Despite the negative experiences, the patients still regard the tracheotomy tube highly.

1.5 Conclusion

The importance of understanding the experiences of the adult patients with tracheotomy tubes in situ sums up the study. This ensures that the right practices are put in place to ensure that the patients experience a better life. Patients perception on the tube should be inclined to the better for improved lifestyles and normalcy among the patients using the tube.

2.0 INTRODUCTION

Critically ill patients, especially in the ICU usually have trouble in breathing, to enable them to breathe, it is necessary for the doctors to find the appropriate breathing mechanisms. The difficulty in breathing may come in as a result of mechanical ventilation, sedation and an entire body weakness according to Fisher et al. (2009). Prolonged breathing complications for the critically ill patients warrants the insertion of a tracheotomy tube as an aide to the breathing system (Durbin, 2010). The tracheotomy tube reduces the strain of the vocal chords, thereby acting as an efficient breathing system.

The tracheotomy tube introduces the patient to a new life and experiences since it requires the patient to learn the coping strategy of the new lifestyle irrespective of whether the tube is permanent or temporary. The tracheotomy tube presents new challenges to the patient especially in communication through speech (Hess, 2005). Communication among the patients can however be achieved through specialized gadgets such as the tracheotomy speaking valves, letter pointers, picture boards as well as communication apps (Hess 2005, Patak et al. 2006 & Dikeman and Kazandjian 2008). However, even with the aid of such devices, communication might still pose a challenge to the patient.

Apart from communication challenges, adult patients with tracheotomy tubes in situ go through different experiences, which should be understood, by the medical practitioners and the people around them to enhance the patients quality of life the patients go through (Condon, 2010). Factors that as the physical sensations, pain during the insertion and changing of the tubes and the feelings of inferiority are among other experiences that the tracheotomised patients go through.

3.0 BACKGROUND

The use of tracheotomy in hospitals has increased. This is in response to increase in respiratory illnesses that make it necessary for patients to have an alternative breathing system apart from the mouth or nose albeit temporarily. While Tracheotomy is in the clinical practice has been of great success, the patients who experience it have deemed it as having many disadvantages. The disadvantages range from the physical challenges, psychological complications, and emotional discomfort (Freeman 2011). Newly tracheotomised patients find it hard to transit from their normal state to a life where they have to use the tracheotomy tube for breathing. In the medical practice, patient transitions from one condition to the next should be considered (Ludin et al 2013). Similarly, tracheotomy tube insertion in adult patients involves a transition, which affects the life of an individual to a great extent. Critically ill patients experience extreme transitions in their lives. As such, the transitions of the patients lives takes place in three aspects; the health illness transition (from health to critical illness), developmental transition where the illness affects the patient and his or her family and situational transition which involves the patients role changing due to the illness. Therefore, critically ill patients may experience different transitions, which may at times overwhelm them if not handled appropriately (Meleis, 2010).

Tracheotomised adult patients face different types of transitions. They not only experience changes in their breathing system but also in the way they communicate, the roles they perform, their relationships with their families and friends and the perceptions other people have on them. The experiences of the patient changes as they embark on developing appropriate coping strategies to their new lifestyle. It is therefore important to consider the experiences that the tracheotomised patients experience in their daily interactions in order to devise ways through which the medical practice, family, and friends can be involved in providing assistance towards the patients adaptation to the new lifestyle.

The rationale for the systematic review emanates from the increasing cases of adult patients with tracheotomy tubes in situ. Tracheotomised patients go through many experiences and it is necessary to determine the prevalent experiences for appropriate recommendations.

Systematic Review Purpose or Question

What are the experienced faced by adult patients with Tracheotomy tube in situ?

3.1 Inclusion Criteria

The population included in the review includes adult patients with tracheotomy in situ. To attain the objectives of the research, face-to-face interviews were conducted to get first hand information from the participants. Studies that included the adult patients with tracheotomy tubes in situ were included in the study. The review aims at finding out the true experiences each adult patient with the tracheotomy tube in situ faces, which will then be reported in the findings section. Non-adults who had tracheotomy tubes in situ were excluded from the review, as they did not meet the entire threshold.

3.2 Types of studies

The type of studies used to compile the review was mostly qualitative research articles. The pilot qualitative studies were the most preferred in the review since they contain primary data from the workers and collected by the reviewers. In general qualitative studies, phenomenology grounded theories, ethnography, focus groups, hermeneutics phenomenology and action research were used. The interviews in the studies were semi-structured thereby allowing the participants to give individual experiences and feelings towards tracheotomy tube insertion into their breathing system. In the study, four main articles have been used for the data synthesis and supplemented with other relevant sources.

3.3 Search Criteria

In order to capture as many related publications as possible, searches were conducted on different research and medical databases. The searches aimed at finding the primary studies on the experience of adult patients with tracheotomy in situ. The search was limited to publications covering the topic of patients experience having tracheotomy. The search language was English, Arabic as my mother language and a third language familiar with the second reviewer. While the databases presented vast information of the study, four articles fit the inclusion criteria after the critical appraisal thereby forming the basis of the review. An appropriate search strategy was applied: an electronic search in the different databases as well as hand searching of the published and grey literature. English is the preferred language of search since it most of the studies are in the language. The review topic was considered when choosing the database. The electronic databases used in this review are CINAHL, Cochrane, MEDLINE (PubMed) and Google Scholars. On commencement, the CINAHL is used, as there are many comprehensive nursing research studies on the topic of interest. MEDLINE is used via PubMed and using MeSh terminology to find different terms related to the topic. The research also uses sources ranging from nursing literature, allied health, and literature involving databases such as Google scholar, which has easy to access documents. The keywords were searched in the heading, abstract, and topic descriptors. In addition, the reference list was used for additional research subsequently leading to more articles related to the topic.

3.4 Method of the review

The methodology of the study involved qualitative study such as Methods phenomenology, hermeneutic phenomenology, ethnography, qualitative method, grounded theory, qualitative inquiry, focus group, content analysis, and action research. Thematic analysis was then applied where data from all the sources was examined, classified, and used to draw patterns on the experience of adult patients with Tracheotomy. The details were critically appraised to determine their effectiveness in the review. The critical appraisal is as follows

3.5 Data extraction

In the extraction of the data, the JBI data extraction form was used to determine the...