International Journal of Africa Nursing Sciences 15 (2021) 100350

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International Journal of Africa Nursing Sciences

journal homepage: www.elsevier.com/locate/ijans

Nurses knowledge and practices regarding tracheostomy care at a selected

referral hospital in Rwanda – A descriptive cross-sectional study
Tony Gaterega a, Marie-Josee Mwiseneza a, Geldine Chironda a, b, c, *
a
School of Nursing and Midwifery, University of Rwanda, College of Medicine and Health Sciences, Kigali, Rwanda
b
Human Resources for Health (HRH), New York University, Rory Meyers College of Nursing, USA
c
University of KwaZulu Natal, College of Health Sciences. School of Nursing and Public Health, Durban, South Africa

A R T I C L E I N F O A B S T R A C T

Keywords: Introduction: Airway Obstruction is a medical emergency that provides an artificial airway support such as the use
Tracheostomy care of endotracheal tubes or creating tracheostomy. To sustain the patency of the airway, a competent nurse is
Nurses required to deliver care for such kind of patients.
Knowledge
Aim: The aim of the study was to assess nurses’ knowledge and practices regarding tracheostomy care among
Practice
patients with tracheostomy tube.
Methodology: A quantitative approach, using a cross sectional descriptive study design was used. A convenient
sample of 80 nurses working in internal medicine, surgical ward and intensive care units at (RMH) was selected.
An adapted structured questionnaire was used to collect data. Descriptive and Inferential statistics were used to
analyzed the data.
Results: The majority of nurses (71%) had moderate knowledge, 26.5% lower knowledge and Only 2(2,5%) of
nurses had high knowledge on tracheostomy definition, types and care. Regarding practice of nurses, a greater
number [78(97.5%)] exhibited low levels and only 2(2.5%) with high level of practice regarding the tracheos­
tomy care. There were no significant demographic factors associated with knowledge and practice of nurses.
Conclusion: The level of knowledge and practice was limited. Therefore, in-service continuous professional
development for registered nurses working in the internal medicine, surgical ward and ICU is highly recom­
mended for further research to elicit the major contributory factors that led to inadequate knowledge and
practice.

1. Introduction a big health problem. Most of the time, the patients die from compli­
cations related to poor tracheostomy care and poor practices (Freeman
Airway obstruction is a medical emergency and a threat to life that & Morris, 2012).
always require providing artificial airway support such as the use of Tracheostomy care needs a multidisciplinary approach which
endotracheal tubes or creating tracheostomy (Welton, Morrison, Cata­ particularly involves nurses to prevent complications such as tube
lig, Chris, & Pataki, 2016). To sustain the patency of the airways, a blockage, infection, and bleeding (Sodhi, Shrivastava, & Singla, 2014).
competent nurse is required to help in provision of care, education of A study conducted in Germany in regards to management of tracheos­
patients, their relatives and any other person involved in the care (Onah tomy showed that tracheostomy guidelines were lacking in the wards
et al., 2014). Tracheostomy is one of the oldest known surgical pro­ leading to malpractice of nurses (Veelo et al., 2008). Another study
cedures where an individual natural air way is compromised and require conducted on the role of the multidisplinary team care of the trache­
long term ventilation (Padma, Arundath, Latha, Indira, & Sreelakshmi, ostomy patient revealed an increasingly incidents associated with poor
2016). High risk of morbidity and mortality including the potential for management of tracheostomy patients as evidenced by a number of
litigation are usually associated complications of tracheostomies (Farida high-profile reports from registries of reported patient self-incidents.
et al., 2016) hence malpractice around the tracheostomy care constitute The reasons for failed tracheostomy included inadequacies in staff

* Corresponding author at: School of Nursing and Midwifery, College of Medicine and Health Sciences, University of Rwanda, Remera Campus, 11KG47 Kigali city,
Rwanda.
E-mail address: gerrychironda@yahoo.co.uk (G. Chironda).

https://doi.org/10.1016/j.ijans.2021.100350
Received 24 October 2019; Received in revised form 16 November 2020; Accepted 11 August 2021
Available online 18 August 2021
2214-1391/© 2021 The Author(s). Published by Elsevier Ltd. This is an open access article under the CC BY-NC-ND license
(http://creativecommons.org/licenses/by-nc-nd/4.0/).
T. Gaterega et al. International Journal of Africa Nursing Sciences 15 (2021) 100350

education ,equipment provision as well as poor monitoring and response internal medicine. However, 80 nurses consented and participated in the
to clinical incidents so when a clinical incident occurs relating to a study by filling in the questionnaires, hence the sample size for the study
tracheostomy (Bonvento, Wallace, Lynch, Coe, & McGrath, 2017). was 80. Convenient sampling strategy was used to select the
Patients with tracheostomy are high risk for hemorrhage, subcu­ participants.
taneous emphysema, infection as well as other life-threatening compli­
cation like impaired ventilation and airway obstruction (Morris, 4.5. Data collection instruments
Whitmer, & McIntosh, 2013). Poor knowledge and practices regarding
tracheostomy care by bedside nurses can led to the aforementioned A tool that was used to collect data for this study was an adopted
complications that are life threatening to the patient (Qadir, 2018). questionnaire (Nwakaego, 2016). The data collection tool consisted of
Nurses plays an important role in positive outcome in patients with three sections namely demographic data, knowledge and practices
tracheostomy as nurses spend more time with patients providing tra­ regarding tracheostomy care among nurses. The knowledge questions
cheostomy care. Despite this reality, nurses’ knowledge and practices in were on Tracheostomy definition & types (9 items) and Tracheostomy
regards to tracheostomy care was found to be very low (Yelverton et al., Tube (4 items). Variables relation were relating to practice of nurses on
2015) thus negatively impacting the clients’ outcomes. According to the tracheostomy care (16 items) and suctioning (4 items). The question­
researcher’s anecdotal observation, in Rwanda, little is known about naire was self-administered and completed at working place of
knowledge and practices regarding tracheostomy care among nurses, participants.
yet this care is mostly being provided by nurses.
4.6. Validity and reliability of the data collection instrument
2. Purpose of the study
The researcher evaluated the validity and reliability of this instru­
The aim of this study is to assess nurses knowledge and practices ment. The use of adopted instrument and adding some aspects from in-
regarding tracheostomy care at a selected referral hospital in Rwanda. depth literature review enhanced content of the tool. Further, the tool
was given to the clinical experts (anesthetists, intensive care specialists,
3. Specific objectives ENT surgeons) and academic experts in order to assess whether all
contents to be measured have been included. Content validity ration of
1. To determine the level of knowledge regarding tracheostomy care the instrument was considered in this study after being rated by the
among nurses working in selected Referral Hospital. experts using the formulae Content validity ratio (CVR) = [(E – (N/2))/
2. To establish the level of practice regarding tracheostomy care among (N/2)] where (N) stand for the total number of experts and (E) Stand for
nurses working in selected Referral Hospital. the number of experts who rated the instrument as essential. The CVR
3. To determine the socio- demographic factors associated with from the instrument of this study was 0.8. It was closer to 1.0 hence the
knowledge and practice of nurses regarding tracheostomy care at instrument was considered more essential.
Selected Referral Hospital. Pretesting the instrument was carried out on ten nurses who works in
ICU and Surgical wards at the same hospital setting to evaluate if the tool
4. Methodology is understandable and does not contain ambiguities. There were no
changes were made to the instrument after the pretesting and these
4.1. Study design nurses were excluded from the final study. During data collection, all
participants used the same questionnaire which was explained in the
This study used a descriptive cross-sectional design. This research same manner before starting answering the questionnaire. Cronbach’s
design is appropriate for this study as it helped to understand the alpha was calculated which is a statistical procedure used for calculating
knowledge and practice of nurses regarding Tracheostomy care at internal consistency of the instrument. The Cronbach’s alpha for the
selected referral hospital. present study instrument was above 0.5. This means that the instrument
was a good measure of knowledge and practice of nurses.
4.2. Study setting
4.7. Data analysis
The study was done in one referral hospitals located in Kigali city.
This setting receives all patients from the Eastern provinces and Kigali Before analyzing the data, data grouped and classified according to
city. the variables. Those quantitative data were analyzed descriptively using
tables, graphs and presentation in the form of frequencies and per­
4.3. Study population centages (%). Inferential statistics (chi-square) was used to establish an
association between demographic data and nurse’s knowledge and
The study population consisted of nurses working at the selected practices regarding tracheostomy care.
study site in intensive care units (ICU), surgical ward and internal
medicine. These wards were chosen because patients with tracheostomy 4.8. Ethical considerations
are mostly nursed in these specific wards. An approximate of 10 to 15
patients with tracheostomies are admitted in the selected wards on Before data collection ethical clearance was obtained from Univer­
monthly basis. sity of Rwanda College of Medicine and Health Sciences institutional
review board (Ref: CMHS/IRB/033/2019) and Ethical Committee of
4.4. Sample size Hospital 1 (Ref: RMH/IRB/010/2019) was obtained. Participant rights
to confidentiality, to privacy, to self-determination, to fair treatment
The total number of nurses working at the study site in the selected were observed. Written informed consent was obtained from partici­
study units was 150. The current study used the method of Taro Yamane pants after full explanation of the interest of the study.
which is n = N/1 + N (e) 2(Mora & Kloet 2010) to calculate the sample
size. Where n = sample size, N = population size, e = sampling error. N 5. Results
= 150, e = 0.05 N = 150/1 + 150 × 0.0025 = 109. Therefore, the
calculated sample size was 109. The researchers targeted registered The findings include a description of sample demographics, knowl­
nurses working at the study site in intensive care unit, surgical ward and edge and practice of nurses regarding tracheostomy care.

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T. Gaterega et al. International Journal of Africa Nursing Sciences 15 (2021) 100350

5.1. Demographics Table 2

Knowledge of nurses regarding Tracheostomy (N = 80).
Table 1 shows the results of age groups, sex, educational status, Variables Correct Incorrect
working departments and working experience of the participants. The
Freq % Freq %
sample was 80 nurses working in three different selected departments at
the study site. In terms of age, 29(36.3%) were between 20 and 30 years, Knowledge of nurses regarding Tracheostomy definition & types
Trachea is known as the wind pipe 59 73.8% 21 26.3%
36(45%) between 31 and 40 years, 11(13.8%) in the age range of 41–50 Trachea extends downward to level of the 6th 16 20% 64 80%
years and with only 4(5%) above 50 years. In terms of sex 37(46.3%) thoracic
was male and 43(53.8%) was females. According to educational level, 6 Trachea approximately measure 10 to 11cm 47 58.8% 33 41.1%
(7.5) were A1 registered nurse, 26(47%) Advanced diploma registered Number of hyaline cartilages that present in 23 28.8% 57 71.3%
trachea are 16 to 20
nurses, 47(58.8%) bachelor degree registered nurses while 1(1.3%) had
Important function of trachea is cough reflex 47 58.8% 33 41.3%
master’s degree. With regards to working department, 24(30%) of the Tracheostomy refers to indwelling tube 71 88.8% 9 11.3%
participants were working in internal medicine, 32(40%) intensive care inserted into the trachea
unit while 24(30%) in surgical ward. Regarding working experience, 34 Types of tracheostomy are permanent and 71 88.8% 9 11.3%
(42.5%) ranged from 0 to 5 years of experience, 32(40%) between 6 and temporary
For long term disease, the type of tracheostomy 52 65.0% 28 35.0%
10 years of experience, 11(13.8%) between 11 and 15 years and only 3 used is long term
(3.8%) worked for more than 16 years. Tracheostomy is indicated severe burn, 16 20% 64 80%
laryngeal obstruction and when Endo-
tracheal tube cannot insert.
5.2. Knowledge of nurses regarding tracheostomy care Knowledge of nurses regarding Tracheostomy Tube
The appropriate size of tracheostomy tube for 35 43.8% 45 56%
The Table 2 below displays knowledge of the participants about adults is 10 to 12mm.
Length and inner diameter in millimeters are 38 47.5% 42 52.5%
tracheostomy, trachea and tracheostomy tube. About 59(73.8%) of the
the criteria you base on while choosing a
participants responds correctly to the definition of trachea while 21 tracheostomy tube
(26.35) failed to the question. There were 16(20%) knowing the Parts of tracheostomy tube are cuff, inner and 53 66.3% 27 33.8%
extension level of trachea while 64(80%) did not know. More than half outer cannula.
[47(58.8%)] of the participants responds correctly to the measure of The normal measurements of tracheostomy 47 58.8% 33 41.3%
tube cuff pressure are 20–25 mm of Hg.
trachea while 33(41.1) gave an incorrect answer. A fewer number [23
(28.8%)] of the participants correctly identified the number of hyaline
cartilages while the majority [57(71.3%)] failed. About 47(58.8) knew eight (47.5%) were able to identify the criteria of choosing tracheos­
the function of trachea while 33(41.3) % did not know. tomy tube while 42(52.5) did not. A greater number [53(66.3%)] of the
Regarding definition of tracheostomy, 71(88.8%) of the participants participant responds correctly to parts of tracheostomy and 27(33.8%)
responds correctly to the definition of tracheostomy while 9(11.3%) incorrectly. More than half [47(58%)] knew the tracheostomy cuff
failed. A greater number [71(88.8%)] knew the types of tracheostomy pressure while 33(41.3) did not know (Refer to Table 2).
while 9(11.3%) did not know. About 52(65%) responds correctly to the
types of tracheostomy used in long term disease while 28(35%) gave
incorrect answer. While the minority, [16(20%)] gave the correct in­ 5.3. Practice of nurses regarding tracheostomy care
dications for tracheostomy, the majority [64(80%)] failed the question
(Refer to Table 2). Table 3 below displays information on practice of nurses regarding
Concerning the tracheostomy tube, 35(43.8%) responds correctly to tracheostomy care. Fifty-five (68.8%) agree with comprehensive family
appropriate size of tracheostomy tube while 45(56%) failed. Thirty- support and explanation about the complication of tracheostomy care
while 25(31.3%) did not. The majority [62(77.5%)] agree with supine
Table 1 position & head extended as the suitable position given the patient
Demographic Data (N = 80). during tracheostomy care while 18(22.5%) disagree. A greater number
Demographic Variables Frequency % Frequency [69(86.3%)] agree with precaution of administering narcotics and
analgesia and 48(60%) agree with the condition of stoma to be assessed
Age
20–30 years 29 36.3% for redness before tracheostomy care. Nearly 48(60%) agreed with clean
31–40 years 36 45.0% technique used in tracheostomy care. Whilst 31(38.8) agree to Sodium
41–50 years 11 13.8% chloride as solution used in tracheostomy care, 49(61.3%) disagreed.
51–60 years 4 5.0% More than half [46(57.5%)] agree to be at loose two fingers used while
Sex fixing tracheostomy tape with 33(41.3%) disagreeing. 38(47.5) agreed
Male 37 46.3% to fresh stoma to be performed every 24 h while 42(52.5%) disagreed.
Female 43 53.8%
While 33(41.3%) agreed to the essentiality of hand washing before
Educational level and after the tracheostomy procedure, more than half [47 (58.8%)]
A2 6 7.5% disagreed. There were 33(41.3%) who agreed to the indication for res­
A1 26 32.5%
piratory difficulty as nasal breath, restlessness cyanosis and Intercostal
A0 47 58.8%
Masters 1 1.3% retraction whilst the majority [47(58.8%)] disagreed. Above half [47
(58.8%)] agreed that to the best position given to the patient with tra­
Department
Internal medicine 24 30.0%
cheostomy to breath better as Fowler’s position while 33(41.3%) dis­
Intensive care unit 32 40.0% agreed with the position.
Surgical ward 24 30.0% Approximately 44(55%) agree to constantly observe patient with
Working Experience tracheostomy while 36(45%) disagreed. Moreover, 41(51.3%) agreed to
0–5 years 34 42.5% take special precautions of the nurse while feeding patient with tra­
6–10 years 32 40.0% cheostomy tube. Less than half [32(40%)] agree with the monitoring of
11–15 years 11 13.8% tracheostomy cuff pressure while the majority [48(60%)] disagreed.
16 and above years 3 3.8%
Less than half [32(40%)] agreed that tracheostomy should be suctioned

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T. Gaterega et al. International Journal of Africa Nursing Sciences 15 (2021) 100350

Table 3 Table 4
Practice of nurses regarding tracheostomy(N = 80). Knowledge and Practice scores of Nurses Regarding Tracheostomy Care (N =
Variables Agree Disagree
80).
Perceived knowledge Knowledge score Frequency% Level of
Freq % Freq %
scores (13) (%) Knowledge
Practice of nurses regarding tracheostomy care
4 30.7% 4(5%) Low
For a comprehensive and family support the 55 68.8% 25 31.3%
5 38.4% 7(8.8%)
patient relatives should be explained about
6 46.1% 10(12.5%)
possible complications of tracheostomy such
7 53.8% 24(30%) Moderate
as inability to laugh
8 61.5% 21(26.3%)
Supine position & head extended is the position 62 77.5% 18 22.5%
9 69.2% 12(15%)
given to the patient during tracheostomy care
10 76% 2(2%) High
Administer narcotics and analgesic drugs with 69 86.3% 11 13.8%
precaution because it will cause Hypoxemia Perceived practice scores Practice score Frequency Level of practice
Redness of stoma should be assessed before 48 60% 32 40% out of 20 (%) (%)
tracheostomy care 6 30% 2(2.5%) Low
Clean technique is used in tracheostomy care 48 60% 32 40% 7 35% 1(1.3%)
Sodium chloride is used to clean tracheostomy 31 38.8% 49 61.3% 8 40% 4(5%)
site 9 45% 10(12.5%)
While fixing tracheostomy tape it 46 57.5% 33 41.3% 10 50% 12(15.5%)
recommended to be loose at least 2 fingers. 11 55% 19(23.8%)
fresh stoma should be performed every 24 38 47.5% 42 52.5% 12 60% 16(20%)
hoursday 13 65% 8(10%)
14 70% 6(7.5%)
Practice of nurses regarding tracheostomy suction tube
15 75% 1(1.3%) High
Size of suction catheter used for adult is 12 to 44 55.0% 36 45%
16 80% 1(1.3%)
18 Fr
Suctioning should not be continued for more 43 53.8% 37 46.3%
than15 seconds
Purpose of suctioning is to Maintain patent 58 72.5% 22 27.5%
Table 5
airway
Bleeding is the early complication of 32 40.0% 48 60.0%
Factors associated with knowledge and practice of nurse’s regarding tracheos­
tracheostomy procedure in most patient tomy care (N = 80).

Practice of nurses during tracheostomy care Factors associated with Factors Associated with
Hand washing is essential and should be done 33 41.3% 47 58.8% knowledge practice
before and after tracheostomy procedure to Variables Mean (95% CI) p value Mean (95% CI) p value
reduce risk of infection to patient
Indication to watch for respiratory difficulty are 33 41.3% 47 58.85 Age
nasal breath, restlessness cyanosis and 20–30 years 7.24(7.24–7.80) .794 11.0(10.3–11.8) .937
Intercostal retraction 31–40 years 7.16(6.65–7.68) 10.8(10.1–11.5)
Fowler’s position is the best position given 47 58.8% 33 41.3% 41–50 years 7.18(6.34–8.02) 11.4(10.3–12.5)
patient with tracheostomy to breath better 51–60 years 10.7(8.03–13.4) 10.7(8.03–13.4)
Observe constantly patient with tracheostomy 44 55.0% 36 45% Educational status
to avoid tube displacement A1 7.50(5.77–9.22) .497 11.5(13.6–9.32) .928
Inflating the cuff for at least 1 hr. after feeding 41 51.3% 39 48.8% A2 7.23(6.70–7.75) 11.2(10.5–11.9)
is the special precaution by the nurse while A0 7.12(6.69–7.56) 10.8(10.2–11.4)
giving tube feeding to the patient with Masters
tracheostomy
Tracheostomy tube cuff pressure should be 32 40.0% 48 60% Sex
monitored every 12 hours Male 7.37(6.89–7.86) .587 11.2(10.6–11.7) .533
During the first days of tracheostomy, the 39 48.8% 41 51.3% Female 7.20(6.60–7.44) 10.8(10.1–11.4)
trachea should be suctioned every two hours
Departiments
Obturator is the instrument should be kept 36 45% 44 55%
I.M 7.37(7.0–7.74) .794 10.2(9.36–11.0) .492
ready during tracheostomy decannulation
ICU 7.18(6.577–7.80) 11.4(10.7–12.1)
Surgical Ward 7.0(6.39–7.16) 11.2(10.4–11.9)

every 2 h during first days while a significant number [48(60%)] dis­ Working experience
agreed. Lastly, 36(45%) agreed to an obturator instrument kept ready 0–5 years 7.47(6.98–7.95) .554 10.7(9.98–11.4) .904
6–10 years 6.78(6.27–7.28) 11.3(10.6–12)
during tracheostomy decannulation while more than half of participants 11–15 years 7.54(6.53–8.55) 11.1(10–12.2)
[44(55%)] disagreed. 16 years and above

5.4. Knowledge scores of nurses regarding tracheostomy care

because the P value is above 0.5.
Referring to Table 4, only 2(2,5%) of nurses had high knowledge, the
6. Discussion
majority (71%) moderate and 26.5% has relatively lower knowledge
regarding tracheostomy care. Regarding practice of nurses, only 2
6.1. Demographic variables
(2.5%) had high level of practice and a greater number [78(97.5%)]
exhibited low levels of practice regarding the tracheostomy care.
The sample size in this study was 80 with the majority (53.8%) of
participants being females and this confirms the study conducted by
5.5. Factors associated with knowledge and practice of nurse’s regarding
Nwakaego (2016) who used the same sample size with females consti­
tracheostomy care
tuting 80% of the sample. Another study conducted by Mungan et al.
(2019) used a sample size of 138 with approximately 88% on nurses
Table 5 revealed the factors associated with knowledge and practice
being females. A study conducted by Pradhan, Neupane, Sah, Kuwar,
of nurses regarding tracheostomy care. Generally, there are no signifi­
and Shah (2018) used a sample size of 80 nurses’ students but a greater
cant demographic factors associated with knowledge and practice

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T. Gaterega et al. International Journal of Africa Nursing Sciences 15 (2021) 100350

number (62%) of participants being females. On contrary, Patil (2016) knowledge for pretest while the posttest after the intervention of edu­
used a sample size of 50 staff nurses but with 62% female participants. cation highlighted excellent knowledge in 80% of the study population.
These findings highlight an important aspect of gender where female Nevertheless, none had fallen in the category of inadequate knowledge
dominance continues in nursing profession. level regarding tracheostomy care. Hence the need to necessitate and
In terms of age group, most of the participants [36(45%)] were aged implement continual education of nurses on tracheostomy care.
in range of 31–40 years with few between 51 and 60 years and this
complement the results by Nwakaego (2016) where 52.5% were in the 6.3. Level of practice regarding tracheostomy care.
age range of aged between 30 and 40 years and only 10% were over 50
years. Further, 52% of staff nurses were in the age group of 20–25 years Whilst Dhaliwal et al. (2018) revealed good and fair skills regarding
according to the study done by Patil (2016). In contrarily to results of tracheostomy care in 56% and 44% of nurses respectively, the current
Pradhan et al. (2018), half of student nurses (50%) were aged between findings found only 2(2.5%) with high level of practice. Moreover, a
15 and 18 years and the other half aged 19 to 22 years. This is possible greater number [78(97.5%)] exhibited low levels of practice regarding
since the study was done on students’ nurses who were still young and in the tracheostomy care. In a study done by Sardesai et al. (2016), nurses
their training phase. reported receiving adequate training, being satisfied with the training
Findings on educational status highlighted an approximate 59% with they have received coupled with longer work experience on tracheos­
bachelor’s degree, thus confirming the findings of Mungan et al. (2019) tomy care. However, some nurses were doubting their capabilities and
and Patil (2016). This result is different from the results by Nwakaego practice skills in specific routines of tracheostomy care which include
(2016) were less than half (37.5%) of the participants were at bachelor’s changing trach ties, managing mucus and changing the inner cannula of
level. Moreover, minority of nurses (1.3%) had master’s degree and this the tracheotomy appliance (Sardesai et al., 2016), thus indicating
is agreeing to the study of Nwakaego (2016) with only 6.25% with post diminished levels of practice. However, the findings of Zeb et al. (2017)
graduate studies. The study findings on the working experiences shows revealed the mean practice level of 80.37%±18.37% indicating good
that most of the participants working experience ranges from 0 to 5 practices.
years (42.5%) and 6–10 years (40%) respectively while few numbers A recent systematic review of literature identifies handwashing
(3.8%) above 16 years, similarly to the findings of Mungan et al. (2019) compliance prior to suctioning in only 62% of the nurses (Pinto et al.,
and Patil (2016) where 52.2% and 86% of the nurses have provided care 2020) while in the current study, it was highlighted in approximately
for tracheostomized patients for less than 5 years respectively. On the 41% of the study participants. Change in respiration as an indication for
other hand, the study by Nwakaego (2016) highlighted an experience of initiating suctioning to clear the patient’s airway rather had low score as
11 to 20 years for nurses in the selected study wards. only 41% of nurses were aware of this indication in the current study,
and this calls for measures in assessing the practical learning needs of
6.2. Level of knowledge regarding tracheostomy care the nurses. Different study conducted by Mcdonough et al. (2016)
revealed poor self-efficacy with tracheostomy and laryngectomy care
Regarding nurse’s knowledge about Tracheostomy care, the results that under-mines a nurse’s ability to successfully manage these patients.
of the current study revealed that majority of nurses having moderate Survey data from Mcdonough et al. (2016) indicated that 19% of
knowledge (71%) confirming the findings by a study conducted in India respondents doubt their ability to perform routine tracheostomy care
which shows inadequate knowledge for majority (81.67%)] of nurses and 50% of respondents doubt their ability to perform routine laryn­
(Qadir, 2018). Moreover, Dhaliwal, Choudhary, and Sharma (2018) gectomy care. Furthermore, 40% of respondents doubt their ability to
revealed more than half of the study participants with average knowl­ perform emergency tracheostomy care and 62% of respondents doubt
edge. Furthermore, in a study done by Mungan et al. (2019), the level of their ability to perform emergency laryngectomy care. In contrary, a
knowledge on tracheostomy care among nurses was low as only 46.4% study conducted by Alanazi, Saud, Fa, King, Qureshi, and Saud (2014)
answered ≥ 7 questions correctly. There were only 2,5% with high on use of endotracheal tubes in continuous aspiration shows that most of
knowledge on tracheostomy care in the current study and this contrast the nurses (74.5%) displayed using endotracheal tubes properly on pa­
the findings of Dhaliwal et al. (2018) were 43% of nurses exhibited good tient with tracheostomy care. Additionally, 79% of nurses apply
knowledge. continuously suctioning as recommended. Another study by Sardesai
In the current study, approximately 44% of nurses were able to et al. (2016) revealed the majority of nurses being comfortable with
identify size of the suctioning catheter and this is almost similar to suctioning (77.1% of nurses) and cleaning the tracheotomy site (71.2%
findings of Pinto, D’silva, and Sanil (2020) where only 36% had of nurses).
knowledge regarding this. Whilst 46% were aware of the appropriate
suction pressure to be used for endotracheal suctioning tube (Pinto et al., 6.4. Factors associated with knowledge and practice of nurse’s regarding
2020), the current study reveals better knowledge in nearly 59% of tracheostomy care.
nurses. Another study conducted in 2016 in India showed 53.3% of staff
nurses and 40% student nurses exhibiting moderately adequate knowl­ Generally, there are no significant demographic factors associated
edge regarding tracheostomy care (Padma et al., 2016). The study with knowledge and practice because the P value is above 0.5 from the
conducted by Zeb, Ali, Hussain, Shah, and Faisal (2017) on tracheos­ current study. The findings of Mungan et al. (2019) also indicated no
tomy suctioning revealed majority of nurses with average knowledge on significant association of knowledge with all the demographic charac­
endotracheal suctioning, 83.5% and about 72.1% knew the use of teristics of the study population. In contrary, another study revealed
adequately sterile approach in trachea aspiration. Another different non gender as the only demographic factor significantly associated with
experimental descriptive research conducted by Hor, Hospital, and knowledge (p = 0.043) and practice (p = 0.043) regarding endotracheal
Hospital (2017) on the post-operative tracheostomy care in intensive suctioning (Zeb et al., 2017).
care unit highlighted 52% of nurses with average knowledge, 32% good Whilst Dhaliwal et al. (2018) highlighted a significant association
knowledge and 16% had poor knowledge regarding Tracheostomy care. among the demographics of age, total work experience, present area of
However, studies have revealed improvement in knowledge after work and educational program attended on tracheostomy care and
implementing of education content on tracheostomy care. The post test knowledge, there was no significant association with skills of the
results for the study of Qadir (2018) reveals adequate knowledge in acquisition of tracheostomy care. A study done to assess the effect of
majority of nurses and even highly adequate knowledge in nearly 47% of video-assisted teaching module regarding Tracheostomy care on
study participants. According to Jacob and Ramesh (2015), 52 % of knowledge and practices revealed a highly significant difference be­
nurses revealed good level of knowledge with none at excellent level of tween pre-test and post knowledge with paired t-test while the Chi-

5
T. Gaterega et al. International Journal of Africa Nursing Sciences 15 (2021) 100350

square test showed no significant association between knowledge and Acknowledgement

practices with demographic variables (Tyagi, 2019).
We would like to thank the study site and participants.
7. Limitations to the study
Appendix A. Supplementary data
In this study generalizability was applied on nurses working at RMH
are not applied in nurses working at CHUK or other Referral hospital in Supplementary data to this article can be found online at https://doi.
Rwanda. The results of the study on practice of nurses regarding tra­ org/10.1016/j.ijans.2021.100350.
cheostomy care was obtained through self-report thus introducing the
aspect of information and recall bias. Actual practice of nurses could References
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the work reported in this paper.

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