Outpatient vs Inpatient Tracheostomy Care

mdiada · Jan 29, 2017

Please? :-)

verene, MSN · Jan 29, 2017

What do you know about trach care already? What are some areas that might be different in care when comparing in-patient and out-patient? Think on it a little bit, and I bet you can come up with at least a couple things that might be different between the two to start exploring.

Areas to start researching: Check the policies on trach care in your clinical settings. Use a research data base like CINAHL to search for journal articles and research studies. It may help to do a more general google search on trach care in-patient and out-patient to find general background knowledge and terminology before you start delving into the more focused data bases. If you are feeling really lost on how to access health-care journal articles and databases talk to your librarians at school - they should be able to help you come up with appropriate search strings, and are generally a great resources for learning how to research effectively.

mdiada · Jan 29, 2017

Thank you for the help! I appreciate it so much! But to be honest, I've already done the Google search with inpatient vs outpatient, and like I said, I may just well be overthinking this (which always seems to happen!), and I've found nothing. Literally nothing. The only thing I can think of is that in outpatient setting, trach care may not be as sterile as it should be, like it is in the inpatient setting. Thing is, my teacher requires references for all this information, and as of yet, I've found not a single thing that really states any differences between the two, not even when using the databases. About to pull my hair out, haha!

AliNajaCat · Jan 29, 2017

I find it hard to believe that you can't search nursing journals for info on trach care. I just searched "nursing care tracheostomy" and got over four hundred thousand returns in a click.

Ask your librarian for help using CINAHL, the Cumulative Index of Nursing and Allied Health Literature. Honest. You'll learn a useful skill AND you'll have the citations your faculty wants you to learn how to find.

No, you may not find THE ONE ARTICLE that you can totally paraphrase for your paper and be done with it. You'll have to read maybe a dozen before you learn what you need to learn.

verene, MSN · Jan 30, 2017

Thank you for the help! I appreciate it so much! But to be honest, I've already done the Google search with inpatient vs outpatient, and like I said, I may just well be overthinking this (which always seems to happen!), and I've found nothing. Literally nothing. The only thing I can think of is that in outpatient setting, trach care may not be as sterile as it should be, like it is in the inpatient setting. Thing is, my teacher requires references for all this information, and as of yet, I've found not a single thing that really states any differences between the two, not even when using the databases. About to pull my hair out, haha!

I think you might be getting too bogged down in the specific question of "difference between in-patient and out-patient trach care." I doubt you will find a single source which will break everything down for you. So you need to take a step back and look at more of the general issues tracheotomy care. You've identified sterility as one issue, that is a good place to start. Think about some of the issues you might encounter: who might be managing the care in the different settings? What resources for trach management might differ between an in-patient setting and an out-patient setting? Also think about different kinds of trachs you might see in each setting (not all tracheotomies are the same!) and how this might affect care. Which types are you more likely to see in each setting? What stage of healing are they likely to be at? How would different healing stages affect care needs?

It may still take some refining to find good search terms (this is why librarians are your friend - I can't believe sometimes how much faster they are at finding things), but I think if you go in with the expectation of searching several different points of care, and types of trachs, that you'll find some good articles. It will then be up to you to analyze those articles and synthesize that knowledge into your paper where in you will be the one providing the concise explanation of the differences in care.

LilyRN99 · Jan 30, 2017

I have worked in home care. Things are less sterile in a home environment. We clean the stoma sometimes with just soap and water with wash cloths. Suction catheters are used more than once and once the sterile gloves from the kit are used we just use clean gloves. Medical equipment is expensive and sometimes limited in a home. We don't have the luxury to be wasteful with supplies since there isn't a central supply closet. We often clean supplies with hot soapy water (not the trach cannula itself). We also have to be careful about animal hair/pet dander, cleanliness of the home (dust, mold), filters in AC/heat units, allergens from an open window or being outside (public places and parks expose a person to a lot more pathogens than a clean hospital room) ,be strict about infection control. I care for children so how clean are their toys? Think about how a home environment is different than a hospital. The trach person in a home can't avoid sick family members. If they have home care nurses each nurse brings in pathogens and allergens (even if they are being careful), can be contagious before symptoms arise. What is the mom or wife is the primary care giver and that person is ill. Is the family providing safe and clean care, do they have a adequate diet? Do they have all the equipment that they need available esp a back up trach and ambu bag. Education will be very important. Do they know signs of resp problems and when to call 911. Hope this helps.

HouTx, BSN, MSN, EdD · Jan 30, 2017

OP may also want to consider the age of the trach. Fresh trachs are generally only found in inpatient settings & they are associated with a particular protocol, including the stand-by equipment that has to be at the bedside.

AliNajaCat · Jan 30, 2017

I have worked in home care. Things are less sterile in a home environment. We clean the stoma sometimes with just soap and water with wash cloths. Suction catheters are used more than once and once the sterile gloves from the kit are used we just use clean gloves. Medical equipment is expensive and sometimes limited in a home. We don't have the luxury to be wasteful with supplies since there isn't a central supply closet. We often clean supplies with hot soapy water (not the trach cannula itself). We also have to be careful about animal hair/pet dander, cleanliness of the home (dust, mold), filters in AC/heat units, allergens from an open window or being outside (public places and parks expose a person to a lot more pathogens than a clean hospital room) ,be strict about infection control. I care for children so how clean are their toys? Think about how a home environment is different than a hospital. The trach person in a home can't avoid sick family members. If they have home care nurses each nurse brings in pathogens and allergens (even if they are being careful), can be contagious before symptoms arise. What is the mom or wife is the primary care giver and that person is ill. Is the family providing safe and clean care, do they have a adequate diet? Do they have all the equipment that they need available esp a back up trach and ambu bag. Education will be very important. Do they know signs of resp problems and when to call 911. Hope this helps.

Nice information and generous of you to write it all for her, but not something this student can cite when she writes her homework paper.