Factors Associated with Adherence to Tracheostomy Care Guidelines among Critical Care Nurses at Kenyatta National Hospital

Abstract

Tracheostomy care should be undertaken using evidence based guidelines. Failure to use these guidelines leads to a higher risk of poor prognosis, which causes burden to the patient, patient’s family and to healthcare workers including nurses. Several factors affect adherence to tracheostomy care guidelines among nurses in critical care units. The objective of this study is to establish factors associated with adherence to tracheostomy care guidelines among critical care nurses in Kenyatta National Hospital. An analytical cross-sectional study was carried out at the critical care unit. A total of 79 nurses were recruited into the study through a census method. An observational checklist was used to collect data on adherence level while performing tracheostomy care on a single observation. A self-administered questionnaire was then used to collect data on reported adherence and nursing and health system factors affecting adherence. Data was analyzed using R studio version 1.4.1103. Descriptive statistics was used to describe data. Pearson’s Chi square test and Fishers exact test was used to identify significant factors for binary logistic regression in the multivariate analysis. Significant factors were those with a P value of less than 0.05 with a 95% confidence interval. Mean age of the nurses was 39.1 years with females 56 (70.9%) being the majority. On observation of tracheostomy care 18(22.8%) nurses adhered to tracheostomy care guidelines while 61(77.2%) did not. On filling a self-reporting tool on adherence those who adhered were 41(51.9%) while 38(48.1%) did not adhere. Among the nursing factors affecting adherence, knowledge of the nurses on tracheostomy care guidelines was significantly associated with adherence in the multivariate analysis (AOR= 4.29; 95%CI= 1.19-17.90; P=0.031). In the bivariate analysis of health system factors, status of critical care unit workload (OR=3.47; 95%CI= 1.18-10.8 P= 0.025) and awareness of hospital management strategies and activities regarding tracheostomy care guidelines (OR= 0.01; 95%CI: 0.05-0.73; P=0.016) were significantly associated with adherence. In the multivariate analysis, hospital management strategies and activities regarding tracheostomy care guidelines was the only health system factor significantly associated with adherence (AOR= 0.21; 95%CI= 0.05-0.73; P=0.019). In conclusion, majority of the nurses did not adhere to tracheostomy care guidelines on observation compared to their self-reports in the questionnaire. Knowledge of tracheostomy care guidelines and awareness of hospital management strategies and activities regarding tracheostomy care guidelines were the factors affecting adherence to the guidelines. This study therefore recommends nurses in the unit to increase adherence to tracheostomy care guidelines through problem-based learning. Nurse managers in the hospital should also ensure nurses are informed of hospital policies regarding application of new tracheostomy care guidelines in the unit to increase adherence to the guidelines.