Loerzel, V.W., Crosby, W.W., Reising, E., & Sole, M.L. (2014). Developing the Tracheostomy Care Anxiety Relief through Education and Support (T-CARES) Program. Clinical Journal of Oncology Nursing, 18, 522–527. 

To evaluate the effectiveness of thee Tracheostomy Care Anxiety Relief through Education and Support (T-CARES) educational program for decreasing caregiver anxiety and increasing caregiver competence with tracheostomy suctioning

T-CARES is a one-hour course for caregivers about caring for a tracheostomy. The course is offered once a week in the hospital unit in a group setting. It involves an 18-minute video, group discussion, hands-on practice, and a return demonstration of tracheostomy care. The course covers the following topics: the introduction to airway anatomy, components of a tracheostomy tube, tracheostomy suctioning, stoma care, changing the ties securing the tracheostomy, cleaning the inner cannula, preparing for the unexpected, reinsertion of the tracheostomy tube after accidental decannulation, how to handle a mucous plug, when to call the doctor, and self-care. Evaluations were done at baseline and postintervention.

• N = 11  
• MEDIAN AGE = 50. 8 years (range = 31–69 years)
• MALES: 64%, FEMALES: 36%
• KEY DISEASE CHARACTERISTICS: Caregivers of patients with head and neck cancer with new tracheostomies
• OTHER KEY SAMPLE CHARACTERISTICS: 90% Caucasian; 81% had a high school education or above; and 90% had no prior tracheostomy experience

• SITE: Single site    
• SETTING TYPE: Inpatient  
• LOCATION: Central Florida

• PHASE OF CARE: Multiple phases of care

Nonexperimental, self-selected to receive the intervention pre- and post-test pilot study

• State-Trait Anxiety Inventory (STAI)
• Suctioning competency checklist
• Course evaluation

Mean STAI scores dropped from 50.5 to 34.3 after the intervention (p = 0.008). All participants were able to perform nine of the 14 skills needed for tracheostomy suctioning. Course evaluations were positive.

T-CARES is an effective intervention for reducing caregiver anxiety and increasing caregiver competency of tracheostomy care.

• Small sample (< 30)
• Risk of bias (no control group)
• Risk of bias (no blinding) 
• Risk of bias (no random assignment) 
• Risk of bias (no appropriate attentional control condition)  
• Risk of bias (sample characteristics)
• Questionable protocol fidelity
• Other limitations/explanation: No mention of how these registered nurses and trainers were calibrated as trainers although the protocol was standardized in its content and delivery; no mention of how the registered nurses and trainers who helped caregivers learn were trained in a standardized way themselves

Nurse-developed caregiver educational programs may be useful in decreasing anxiety and increasing competency for the development of new caregiver skills required for quality patient care. Additional research in this area is indicated.