Date of Award

2025

Document Type

Doctor of Nursing Practice (DNP)

Degree Name

Doctor of Nursing Practice (DNP)

Department

Nursing

Committee Chair

Tracy Lakin

Subject(s)

Tracheotomy--Nursing, Nursing--Education, Nursing care plans

Abstract

In intensive care unit patients, tracheostomy tubes are frequently utilized as an adjunct to facilitate weaning from mechanically-assisted ventilation. Tracheostomy placement represents a high-risk intervention within a high-acuity population where complication rates can range from 10% to 15% and sometimes with life-threatening consequences. Amidst shifts in the nursing workforce, bedside nurses demonstrate reduced hands-on experience in managing tracheostomy care and often lack the knowledge, training, and confidence to prevent or effectively manage airway emergencies. To reinforce hospital-based education and policy, the use of nursing checklists modeled after Kamishibai cards and nursing coaching was explored as a strategy to improve nurses’ knowledge and comfort in caring for patients with high-risk surgical airways. Kamishibai cards function as visual cue cards designed to prompt evidence-based care delivery. This project implemented a tracheostomy-specific checklist, designed as a Kamishibai card, within a neurological/neurosurgical intensive care unit (NCU) and stepdown unit. The checklist was completed by the bedside nurse and reviewed by the shift leader to identify areas requiring additional support or informal coaching. The intervention aimed to reduce the incidence of tracheostomy-related emergencies through enhanced nurse preparedness and structured, real-time education. After project implementation, the incidence rate of tracheostomy emergencies in the NCU dropped from 17.2% to a rate of 9.3% during the six-month study period, resulting in a 46% reduction rate.

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