Tracheal suctioning: an exploration of nurses' knowledge and competence in acute and high dependency ward areas

With an increasing demand for intensive care beds more nurses in acute and high dependency wards will be expected to care competently for patients with tracheostomy tubes. Tracheal suctioning is an essential aspect of effective airway management. However, this has many associated risks and complications, ranging from trauma and hypoxaemia to, in extreme cases, cardiac arrest and death. It is imperative that nurses are aware of these risks and are able to practice according to current research recommendations. Aims. This study was designed to explore nurses' knowledge and competence in performing tracheal suctioning in acute and high dependency ward areas and to investigate discrepancies between knowledge and practice using method triangulation.

Twenty-eight nurses were observed using nonparticipant observation and a structured observation schedule. Each subject was interviewed and questioned about their tracheal suctioning practices, and subsequently completed a knowledge-based questionnaire. Scores were allocated for knowledge and practice.

The findings demonstrated a poor level of knowledge for many subjects. This was also reflected in practice, as suctioning was performed against many of the research recommendations. Many nurses were unaware of recommended practice and a number demonstrated potentially unsafe practice. In addition, there was no significant relationship between knowledge and practice. However, during the interviews, many nurses were able to provide a rationale for specific aspects of practice that were perhaps not based on current research recommendations.

The study raised concern about all aspects of tracheal suctioning and has highlighted the need for changes in practice, clinical guidelines and focused practice-based education.