Special trainers provide time-intensive education
Lessons are repeated until checklist is complete
Not all teaching is equal. Some is time - and labor-intensive. That is the case with training on equipment that many premature babies and other children must use to survive.
At the technology-dependent intensive care unit on the Scottish Rite campus of Children's Healthcare of Atlanta, teaching parents about tracheostomy tubes, ventilators, and feeding tubes is an everyday event. Usually, caregivers for at least 10 patients are being trained at any point in time on the 11-bed unit.
"Most of the patients are babies. We do have the occasional older child that has muscular dystrophy and cerebral palsy. We have a child now with central hypoventilation syndrome, and she will have to have a trach and vent for the rest of her life," says Amy Robinson, RN, BSN, CPN, a TICU educator.
While some education is done informally at the bedside, much of what must be learned is completed in scheduled sessions. Education must often be arranged according to work schedules, because some children are hospitalized for so long that parents often have had to return to their job.
Language barriers make training more difficult as well. When families are not fluent in English an interpreter must be scheduled for each training session.
However, the biggest barrier to education is denial, and parents must come to terms with their child's health problems, realizing that the use of the equipment is not for a few weeks but for several years and sometimes a lifetime. Once they accept the situation, they can learn about their child's care.
They have to realize that although the situation is not what they expected, it is going to be okay, says Robinson.
Most of the patients on the TICU are babies born prematurely at 21 to 27 weeks. The majority of the babies on a ventilator will get strong enough to be weaned from its use between age two and four and breathe on their own, according to Robinson.
Intensive training needed
Education begins simply with the nurse educators encouraging parents to watch them take care of the tubes. They are also given booklets to look over and invited to watch a video on trach care.
While nurses will teach simple tasks as the parents watch, the actual training for the care of the tracheostomy equipment and ventilators is completed by one of two trainers who work with parents and other caregivers. The trainers go through a two-page checklist teaching item by item over a six-week time period. Skill training is a slow process, and each step is repeated several times to ensure understanding.
A primary and secondary caregiver must complete the training. Often, it is the mother and father, but it can be a sibling over the age of 18, a relative or friend. This makes it possible for the main caregiver to get a break. It is also a safety issue, because someone has to care for the child 24 hours a day seven days a week.
"If they have five people they want trained we will train them. The minimum is two people, and the maximum whatever they feel is necessary," says Robinson.
Once the checklist is complete, each trained caregiver must stay with the child 24 hours doing all the care. A nurse observes each step in the caregiving process to make sure it is done correctly.
If caregivers are unable to complete the tasks correctly, they go back through the training process and try the one-on-one observed care again, says Robinson.
Regular nurse educators provide instruction on feeding tubes, and the homecare company that brings the feeding pump will go over its use with the caregiver.
Robinson says another important part of the educational process is to provide information on services the family will need when they take their child home. This would include daycare facilities for children with special needs.
"Any kind of community help and support is really good," says Robinson.
Source
For more information on educating children on special equipment contact:
- Amy Robinson, RN, BSN, CPN, TICU Educator, Children's Healthcare of Atlanta, Scottish Rite campus. Telephone: (404) 785-5285. E-mail: [email protected].
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