Preparation, Clinical Support, and Confidence of Speech-Language Pathologists Managing Clients With a Tracheostomy in Australia Purpose: To describe the preparation and training, clinical support, and confidence of speech-language pathologists (SLPs) in relation to tracheostomy client care in Australia. Method: A survey was sent to 90 SLPs involved in tracheostomy management across Australia. The survey contained questions relating to preparation and ... Research
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Research  |   August 2008
Preparation, Clinical Support, and Confidence of Speech-Language Pathologists Managing Clients With a Tracheostomy in Australia
 
Author Affiliations & Notes
  • Elizabeth Ward
    The University of Queensland, Australia
  • Emma Agius
    The University of Queensland, Australia
  • Maura Solley
    Princess Alexandra Hospital, Queensland, Australia
  • Petrea Cornwell
    The University of Queensland, and Princess Alexandra Hospital
  • Claire Jones
    The University of Queensland
  • Contact author: Elizabeth Ward, Division of Speech Pathology, Therapies Building, The University of Queensland, St. Lucia, 4072 Australia. E-mail: liz.ward@uq.edu.au.
  • © 2008 American Speech-Language-Hearing AssociationAmerican Speech-Language-Hearing Association
Article Information
Swallowing, Dysphagia & Feeding Disorders / International & Global
Research   |   August 2008
Preparation, Clinical Support, and Confidence of Speech-Language Pathologists Managing Clients With a Tracheostomy in Australia
American Journal of Speech-Language Pathology, August 2008, Vol. 17, 265-276. doi:10.1044/1058-0360(2008/024)
History: Received February 28, 2006 , Revised June 11, 2007 , Accepted January 14, 2008
 
American Journal of Speech-Language Pathology, August 2008, Vol. 17, 265-276. doi:10.1044/1058-0360(2008/024)
History: Received February 28, 2006; Revised June 11, 2007; Accepted January 14, 2008
Web of Science® Times Cited: 4

Purpose: To describe the preparation and training, clinical support, and confidence of speech-language pathologists (SLPs) in relation to tracheostomy client care in Australia.

Method: A survey was sent to 90 SLPs involved in tracheostomy management across Australia. The survey contained questions relating to preparation and training, clinical support, and confidence.

Results: The response rate was high (76%). The majority of SLPs were pursuing a range of professional development activities, had clinical support available, and felt confident providing care of clients with tracheostomies. Despite these findings, 45% of SLPs were not up-to-date with evidence-based practice, less than 30% were knowledgeable of the advances in tracheostomy tube technology, and only 16% felt they worked as part of an optimal team. Only half were confident and had clinical support for managing clients who were ventilated. Most (88%) believed additional training opportunities would be beneficial.

Conclusions: The current data highlight issues for health care facilities and education providers to address regarding the training and support needs of SLPs providing tracheostomy client care.

Clients with a tracheostomy tube present with complex clinical needs (Hyland & Lee, 2003). Unfortunately, numerous authors have commented that health care professionals often lack sufficient knowledge (Choate, Barbetti, & Sandford, 2003; Day, Farnell, Haynes, Wainwright, & Wilson-Barnett, 2002; Heafield, Rogers, & Karnik, 1999; Lewis & Oliver, 2005; Manley, Frank, & Melvin, 1999), confidence (Lewis & Oliver, 2005; Manley et al., 1999), and training (Heafield et al., 1999; Manley et al., 1999) in various areas of tracheostomy management. Research has also highlighted that within institutions the skills, knowledge levels (Choate et al., 2003; Hyland & Lee, 2003), and practices (Day et al., 2002) demonstrated by health professionals who care for clients with a tracheostomy tube can vary widely. It is recognized that such deficits and inconsistency of practice could prevent clients from receiving optimal care and may place them at risk of serious complications (Heafield et al., 1999; Norwood, Spiers, Bailiss, & Sayers, 2004). It is important, therefore, that health professionals who manage clients with a tracheostomy tube ensure they have adequate, ongoing education and training to enable them to implement client care in a confident and consistent manner (Heafield et al., 1999; Lewis & Oliver, 2005; Norwood et al., 2004).
In relation to speech-language pathology, Manley et al. (1999)  completed the only systematic study to date that examined the preparation and knowledge base of speech-language pathologists (SLPs) with respect to tracheostomy care and levels of confidence to provide such care. They surveyed 228 SLPs who were managing the tracheostomized population across the United States and found that SLPs had completed varying levels of preparation and training to care for clients with a tracheostomy. Furthermore, they noted that many SLPs (42%) achieved less than 75% accuracy on a series of questions regarding core aspects of tracheostomy care, indicating that they required further education and training. In addition, they found approximately half of the cohort felt underconfident of their ability to manage clients with a tracheostomy (Manley et al., 1999). Manley et al. concluded that these findings highlighted the need for the profession to monitor, encourage, and assist SLPs to ensure they have acquired sufficient skills and knowledge before providing services to clients with a tracheostomy.
Within the discipline of speech-language pathology in Australia, the management of clients who have a tracheostomy tube is regarded as a specialist skill. Hence, it is not a competency required of Australian new graduates and is an area unsuitable for them to undertake without supervision from a senior SLP (Speech Pathology Australia, 2001). The Tracheostomy Management Position Paper (Speech Pathology Australia, 2005) presents the national guidelines for managing clients with a tracheostomy and those clients also requiring ventilator assistance in Australia. According to this document, prior to independently managing the tracheostomized population, it is the practicing SLP’s responsibility to expand on the basic information he or she gained at university to obtain competency in tracheostomy care. Furthermore, it is recommended that when working with clients with a tracheostomy, SLPs should routinely update their knowledge and clinical skills in order to maintain competency (Speech Pathology Australia, 2005). However, although both the prior (Speech Pathology Australia, 1996) and current (Speech Pathology Australia, 2005) national guidelines advocate for ongoing training and education, there has been no systematic investigation of the preparation SLPs have undertaken to provide tracheostomy management (encompassing assessment and management of dysphagia, voice, and communication) here in Australia. Hence, there is no evidence available to support whether the national recommendations are being followed.
In addition to obtaining adequate clinical knowledge and training, it is acknowledged that health professionals caring for clients with a tracheostomy tube need to have access to clinical support (discipline-specific and multidisciplinary), in order to provide safe and efficient services (Choate et al., 2003; Dikeman & Kazandjian, 2003; Hughson & Foulsum, 2000; Lewis & Oliver, 2005). Management of this population requires the SLP to seek assistance and coordinated involvement from a number of team members, including the nurse, physiotherapist, and treating physician (Dikeman & Kazandjian, 2003; Hales, 2004; Higgins & Maclean, 1997; Schwartz Cowley, Swanson, Chapman, Kitik, & Mackay, 1994; Woodnorth, 2004). It is recognized that when such teams function optimally, not only are team members supported, but complications are prevented (Goldsmith, 2000), goals are accomplished efficiently, and the quality of care for the client is improved (Dikeman & Kazandjian, 2003; Hyland & Lee, 2003; Murray & Brzozowski, 1998).
When investigating clinical support, Manley et al. (1999)  found that only half (51.7%) of their American SLPs used a multidisciplinary team approach. Thus, it could be interpreted that many of the SLPs were caring for this client population with minimal support from other professionals. Recently, Hyland and Lee (2003)  commented that within the Australian health setting they examined, there was inadequate communication and poor role awareness among health professionals involved in tracheostomy care. It could be suggested, therefore, that these health professionals were not working as a coordinated team and, hence, also lacked team support while managing the tracheostomized population. Even though the recent national position paper highlights the importance of team support (Speech Pathology Australia, 2005), there are currently no national data available to determine to what extent SLPs in Australia work within a team-based, supported, clinical environment.
It is recognized that after appropriate training and preparation, and when well supported, SLPs become more confident of their ability to manage clients with a tracheostomy tube (Manley et al., 1999). Not surprisingly, considering the poor knowledge base and lack of team support demonstrated by a majority of SLPs, Manley et al. (1999)  found only half (47.3%) of their cohort felt confident of their ability to assess and treat clients with a tracheostomy. Further investigation of confidence levels, according to the year SLPs graduated from university, revealed that confidence was not purely gained from academic training or clinical exposure with the tracheostomized population, but rather a combination of the two (Manley et al., 1999). It could be presumed then, that if SLPs in Australia are adhering to the national guidelines for tracheostomy management, particularly the recommendations for preparation and clinical support, they should feel confident to provide clinical care to the tracheostomized population. However, as no studies of this issue have been conducted, the confidence levels of Australian SLPs working with this population remain unknown.
Presently, the literature regarding the education and training, clinical support, and confidence levels of SLPs providing tracheostomy care is extremely limited, with the main study on this issue geographically specific to the practices and perceptions of SLPs within the United States. Consequently, the purpose of the current study was to describe the preparation and training, extent of clinical support, and confidence of SLPs in relation to tracheostomy management in Australia. In light of the directions for best practice in tracheostomy management highlighted in both the prior and current national position papers, it was hypothesized that SLPs in Australia would actively seek to maintain ongoing professional development, work in a supported clinical environment, and, in turn, feel confident to manage clients with a tracheostomy. Through the identification of either strengths or weaknesses in current practice, the findings of the present investigation will inform SLPs, education providers, and health care facilities regarding the preparation, training, and clinical support needs of SLPs. In turn, this will provide specific directions to optimize the quality of care for clients with a tracheostomy.
Method
Questionnaire
A questionnaire was developed for the purpose of investigating two separate topics in tracheostomy management: (a) clinical consistency relating to dysphagia management and decannulation (these results are published elsewhere; see Ward, Jones, Solley, & Cornwell, 2007) and (b) preparation, training, clinical support, and confidence—the focus of the current investigation. The questionnaire consisted of a total of 51 questions of which only 21 questions related to clinician education and training, clinical support, and clinician confidence levels (see Appendix). The design and development of the survey tool have been outlined previously in Ward et al. (2007) . All questions followed either a multichoice or dichotomous format, allowing the responses to be quantified and compared. Additional open-ended comment sections were provided on a number of items to allow for further extrapolation if required. For the purposes of this investigation, the term tracheostomy management refers to the assessment and management of dysphagia (including decisions relating to decannulation), voice, and communication.
Participants
The nature of the study was to examine preparation and training, clinical support, and confidence of SLPs working with clients with a tracheostomy. Therefore only SLPs with greater than 1 year clinical experience and some prior experience with this population were invited to complete the questionnaire. SLPs were primarily recruited from the Tracheostomy Interest Group of Australia (TIGA), a nationwide, voluntary, nonfunded organization designed to link SLPs interested in the management of clients with a tracheostomy. Additional experienced SLPs were recruited via snowball sampling instigated by TIGA members. Ethical approval was sought and gained from the University of Queensland. Initial recruitment identified 90 SLPs willing to participate in the current study. The surveys were sent in 2004, with a high response rate of 75.6% (68/90) obtained.
Analysis
All data were entered directly into a Microsoft Access database. The data for Questions 6 and 8 were collapsed as per Ward et al. (2007)  to allow for examination of basic trends in the demographics of the respondents. This involved the “all” and “most” options being combined and the “some” and “none” options combined, resulting in three main responses: “most to all,” “half,” and “some to none.” The quantitative data were analyzed using descriptive statistical methods including frequencies and percentages. Content analysis of qualitative responses was undertaken by two clinical researchers with experience in tracheostomy management who individually reviewed the comments for each question, identified the main themes, and subsequently coded them within each response (Fink, 2003). They subsequently compared their analyses, and where discrepancies occurred they reached a consensus. The response rate for individual questions ranged from 88.2% (60/68) to 100% (68/68). Percentages for each question were calculated using a consistent sample size of 68, including a percentage nonresponse.
Results
Respondent Demographic Information
Most respondents had received a bachelor’s degree in speech-language pathology within Australia, and the majority completed their bachelor’s degree in Queensland (see Table 1).1  The mean number of years after graduation with a bachelor’s degree was 11 (range = 1–30). Most had been working for more than 6 years, and 82% indicated that they were currently working more than 4 days a week. Responses were received from SLPs working in all states and territories of Australia. The majority worked with the adult population (adults/seniors), and most managed clients with a tracheostomy in acute care settings (see Table 2). The majority (78%) of respondents spent less than 25% of their total clinical time with clients with a tracheostomy (47%: 1%–9% of their time; 31%: 10%–24% of their time; 10%: 25%–49% of their time; 12%: >50% of their time). Only a few respondents (7.4%) had no prior experience with ventilated clients, with over half the group reporting experience with more than 10 clients (33.8%: 1–10 clients; 30.9%: 11–50 clients; 27%: >50 clients).
TABLE 1 Demographic information.
Demographic information.×
Topic Parameter % respondents
Qualification Bachelor’s 92.5
Higher degree (Australia + overseas) 6
No response 1.5
Years since graduation 1–5 28
6–10 35
11–15 13
>15 24
Employed hours/week 1–9 3
10–19 8.8
20–29 4.4
30–39 54.4
>40 27.9
No response 1.5
Location of employment in Australia Queensland 39.7
New South Wales 16.2
Victoria 17.6
Western Australia 5.9
Northern Territory 5.9
South Australia 4.4
Australian Capital Territory 4.4
Tasmania 1.5
No response 4.4
TABLE 1 Demographic information.
Demographic information.×
Topic Parameter % respondents
Qualification Bachelor’s 92.5
Higher degree (Australia + overseas) 6
No response 1.5
Years since graduation 1–5 28
6–10 35
11–15 13
>15 24
Employed hours/week 1–9 3
10–19 8.8
20–29 4.4
30–39 54.4
>40 27.9
No response 1.5
Location of employment in Australia Queensland 39.7
New South Wales 16.2
Victoria 17.6
Western Australia 5.9
Northern Territory 5.9
South Australia 4.4
Australian Capital Territory 4.4
Tasmania 1.5
No response 4.4
×
TABLE 2 Patient populations, job setting, and primary reason for referral.
Patient populations, job setting, and primary reason for referral.×
Question Response categories
No response All/most Usually/always Half the time Some/none Seldom/never
n % n % n % n %
What proportion of active clinical time is spent with the following patient populations?
  Children (0–11 years) 1 1.5 5 7.4 2 2.9 60 88.2
  Adolescents (12–17 years) 0 0 0 0 0 0 68 100
  Adults (18–65 years) 0 0 27 39.7 23 33.8 18 26.5
  Seniors (65+ years) 0 0 20 29.4 23 33.8 25 36.8
In which of the listed job setting(s) do you currently manage patients with a tracheostomy?
  Acute care 0 0 52 76.5 3 4.4 13 19.1
  Slow stream rehabilitation/nursing care 0 0 0 0 0 0 68 100
  Inpatient rehabilitation 0 0 9 13.3 2 2.9 57 83.8
  Outpatient rehabilitation 0 0 0 0 4 5.9 64 94.1
  Education facility 0 0 0 0 0 0 68 100
  Community outreach 0 0 1 1.5 0 0 67 98.5
TABLE 2 Patient populations, job setting, and primary reason for referral.
Patient populations, job setting, and primary reason for referral.×
Question Response categories
No response All/most Usually/always Half the time Some/none Seldom/never
n % n % n % n %
What proportion of active clinical time is spent with the following patient populations?
  Children (0–11 years) 1 1.5 5 7.4 2 2.9 60 88.2
  Adolescents (12–17 years) 0 0 0 0 0 0 68 100
  Adults (18–65 years) 0 0 27 39.7 23 33.8 18 26.5
  Seniors (65+ years) 0 0 20 29.4 23 33.8 25 36.8
In which of the listed job setting(s) do you currently manage patients with a tracheostomy?
  Acute care 0 0 52 76.5 3 4.4 13 19.1
  Slow stream rehabilitation/nursing care 0 0 0 0 0 0 68 100
  Inpatient rehabilitation 0 0 9 13.3 2 2.9 57 83.8
  Outpatient rehabilitation 0 0 0 0 4 5.9 64 94.1
  Education facility 0 0 0 0 0 0 68 100
  Community outreach 0 0 1 1.5 0 0 67 98.5
×
Preparation and Training
Prior to independently managing clients with a tracheostomy, approximately half (51.4%) of the respondents received 1–5 hr of undergraduate lectures on tracheostomy, while a quarter (25.0%) reported that they received no undergraduate lectures (see Table 3). Those respondents who received no lectures indicated that they had all graduated from university more than 5 years prior to the study. Regarding clinical supervision during university practicum and/or on-the-job (see Table 3), 39.7% of the respondents experienced up to 5 hr of supervision before independently managing clients with a tracheostomy, and half (50.0%) of the group reported having had more than 5 hr. As shown in Table 3, approximately half (51.5%) of the respondents indicated that their department did not have a formal tracheostomy competency training program (Question 12).
TABLE 3 Clinical preparation and presence of formal training programs (N = 68).
Clinical preparation and presence of formal training programs (N = 68).×
Question n %
10. Prior to treating patients independently, approximately how many hours training (i.e., undergraduate lectures) did you receive in tracheostomy management?
 None 17 25.0
 1–5 hr 35 51.4
 6–10 hr 8 11.8
 11–20 hr 4 5.9
 More than 20 hr 4 5.9
11. Prior to treating patients independently, how many hours of clinical supervision did you gain in tracheostomy management (during university practicum and/or on-the-job)?
 None 6 8.8
 1–5 hr 27 39.7
 6–10 hr 18 26.5
 11–20 hr 10 14.7
 More than 20 hr 6 8.8
 Nonresponse 1 1.5
12. Does your speech pathology department have a formal tracheostomy competency training program?
 Yes 19 27.9
 Currently developing one 13 19.1
 No 35 51.5
 Nonresponse 1 1.5
TABLE 3 Clinical preparation and presence of formal training programs (N = 68).
Clinical preparation and presence of formal training programs (N = 68).×
Question n %
10. Prior to treating patients independently, approximately how many hours training (i.e., undergraduate lectures) did you receive in tracheostomy management?
 None 17 25.0
 1–5 hr 35 51.4
 6–10 hr 8 11.8
 11–20 hr 4 5.9
 More than 20 hr 4 5.9
11. Prior to treating patients independently, how many hours of clinical supervision did you gain in tracheostomy management (during university practicum and/or on-the-job)?
 None 6 8.8
 1–5 hr 27 39.7
 6–10 hr 18 26.5
 11–20 hr 10 14.7
 More than 20 hr 6 8.8
 Nonresponse 1 1.5
12. Does your speech pathology department have a formal tracheostomy competency training program?
 Yes 19 27.9
 Currently developing one 13 19.1
 No 35 51.5
 Nonresponse 1 1.5
×
Responses to Question 13 revealed that all respondents had participated in at least one type of tracheostomy-related professional development activity, with a total of 70.6% having participated in at least four. Aside from being a member of an interest group such as TIGA or the New South Wales Tracheostomy Interest Group, the most popular form of professional development was attendance at workshops (72.1%) hosted by the national association (Speech Pathology Australia), followed by attendance at forums or in-services within the workplace (66.2%; see Table 4). Two respondents reported that they had completed formal suctioning competency training programs at their institutions to enable them to perform tracheal suctioning.
TABLE 4 Professional development activities (N = 68).
Professional development activities (N = 68).×
Question n %
13. Please indicate what tracheostomy-related professional development activities you have undertaken?
 Becoming a member of an interest group (e.g., TIGA, NSW Tracheostomy Interest Group) 53 77.9
 Speech Pathology Australia (SPA) workshops 49 72.1
 Speech pathology forums/in-services within workplace 45 66.2
 Teleconferences 39 57.4
 Multidisciplinary forums/in-services within workplace 36 52.9
 Conference presentations (SPA, other) 32 47.1
 Non-SPA workshops 21 30.9
 Visited specialist center(s) where expert speech pathologists treat patients who are tracheostomized and ventilator assisted 19 27.9
 Other
  Research and self-study 10 14.7
  Mentoring 5 7.4
  Formal suctioning competency training programs 2 2.9
Note. TIGA = Tracheostomy Interest Group of Australia; NSW = New South Wales.
Note. TIGA = Tracheostomy Interest Group of Australia; NSW = New South Wales.×
TABLE 4 Professional development activities (N = 68).
Professional development activities (N = 68).×
Question n %
13. Please indicate what tracheostomy-related professional development activities you have undertaken?
 Becoming a member of an interest group (e.g., TIGA, NSW Tracheostomy Interest Group) 53 77.9
 Speech Pathology Australia (SPA) workshops 49 72.1
 Speech pathology forums/in-services within workplace 45 66.2
 Teleconferences 39 57.4
 Multidisciplinary forums/in-services within workplace 36 52.9
 Conference presentations (SPA, other) 32 47.1
 Non-SPA workshops 21 30.9
 Visited specialist center(s) where expert speech pathologists treat patients who are tracheostomized and ventilator assisted 19 27.9
 Other
  Research and self-study 10 14.7
  Mentoring 5 7.4
  Formal suctioning competency training programs 2 2.9
Note. TIGA = Tracheostomy Interest Group of Australia; NSW = New South Wales.
Note. TIGA = Tracheostomy Interest Group of Australia; NSW = New South Wales.×
×
Responses to Question 14 revealed that just over half (54.4%) of the respondents felt up-to-date, 17.7% did not feel up-to-date, and 27.9% were not sure if they felt up-to-date with evidence-based practice relating to tracheostomy management. Respondents who did not feel up-to-date highlighted in their comments that this was because they had insufficient time to review the literature or poor access to the literature, and/or because managing clients with a tracheostomy constituted only a small part of their caseload. Regarding the advances in tracheostomy technology, including the specialized tracheostomy tube options available (Question 15), most respondents (47.0%) reported that they sometimes felt up-to-date, 26.5% felt up-to-date, and 26.5% did not feel up-to-date.
When asked to consider the training, if any, that they would find beneficial regarding the management of clients with a tracheostomy (Question 16), a total of 60 (88.2%) respondents provided comments. Responses commonly highlighted a need for both basic and advanced level training delivered through a range of means including mentoring, work shadowing, lectures, practical workshops, and workplace competency training programs. Responses also revealed that respondents sought training opportunities that would provide them with access to the latest research. With regard to the focus of training, many respondents identified a need for training opportunities that cover the management of clients who have a tracheostomy and require ventilator support. Additionally, some respondents felt they would benefit from training regarding tracheostomy-related equipment including the various types of tracheostomy tubes and ventilator equipment. Two respondents recognized a need for pediatric-focused training, noting that training opportunities tend to focus predominately on the adult population.
Clinical Support
Within their multidisciplinary team, the majority (79.4%) of the respondents felt they had a defined role in the management of dysphagia in clients with a tracheostomy tube, and a further 10.3% believed their role was defined on some hospital wards though not on others (Question 17; see Table 5). The wards in which respondents identified themselves as having a defined role are listed, in order of decreasing frequency, in Table 5. Respondents commented that they lacked a defined role across some of the wards and/or units in which they worked because ward and/or medical staff did not recognize the need for an SLP to be involved in the management of dysphagia in clients with a tracheostomy. Regarding the availability of expert clinical support (Question 18; see Table 5), almost three quarters (73.5%) of the group felt they had expert support available within their multidisciplinary team for the management of clients with a tracheostomy. Half (52.9%) of the respondents felt the same type of support was available for the management of clients with a tracheostomy who also require ventilator assistance. Responses to Question 19 revealed that a minority (16.2%) of respondents worked as part of an optimal team approach while managing the tracheostomized population (see Table 5). Generally, comments accompanying “sometimes” responses highlighted that within many hospitals an optimal team approach was used on only some of the wards and/or units in which clients with a tracheostomy were managed, and such wards and/or units varied between hospitals. Some respondents reported that not having a defined role and/or the paucity of formal tracheostomy management protocols contributed to the absence or inconsistent presence of an optimal team approach, within certain settings.
TABLE 5 Clinical roles, expert support, and working in an optimal team (N = 68).
Clinical roles, expert support, and working in an optimal team (N = 68).×
Question n %
17. Overall, do you have a defined role within the multidisciplinary team working with patients who are dysphagic and require a tracheostomy?
  Yes 54 79.4
  Yes and No 7 10.3
  No 7 10.3
Wards in which respondents have a defined role:
  Neurological/Neurosurgery 34 50.0
  Intensive Care Unit 30 44.1
  Ear Nose Throat 25 36.8
  Respiratory 17 25.0
  General Medical 17 25.0
  General Surgical 10 14.7
  Other wards <6 <8.8
18. Do you feel you have expert clinical support within your multidisciplinary team for the management of patients with a tracheostomy and those patients requiring ventilator assistance?
 Tracheostomy only
  Yes 50 73.5
  No 14 20.6
  Nonresponse 4 5.9
 Tracheostomy and requiring ventilator assistance
  Yes 36 52.9
  No 31 45.6
  Nonresponse 1 1.5
19. Does the setting in which you work have an optimal team approach for the management of patients with a tracheostomy?
  Yes 11 16.2
  Sometimes 30 44.1
  No 27 39.7
TABLE 5 Clinical roles, expert support, and working in an optimal team (N = 68).
Clinical roles, expert support, and working in an optimal team (N = 68).×
Question n %
17. Overall, do you have a defined role within the multidisciplinary team working with patients who are dysphagic and require a tracheostomy?
  Yes 54 79.4
  Yes and No 7 10.3
  No 7 10.3
Wards in which respondents have a defined role:
  Neurological/Neurosurgery 34 50.0
  Intensive Care Unit 30 44.1
  Ear Nose Throat 25 36.8
  Respiratory 17 25.0
  General Medical 17 25.0
  General Surgical 10 14.7
  Other wards <6 <8.8
18. Do you feel you have expert clinical support within your multidisciplinary team for the management of patients with a tracheostomy and those patients requiring ventilator assistance?
 Tracheostomy only
  Yes 50 73.5
  No 14 20.6
  Nonresponse 4 5.9
 Tracheostomy and requiring ventilator assistance
  Yes 36 52.9
  No 31 45.6
  Nonresponse 1 1.5
19. Does the setting in which you work have an optimal team approach for the management of patients with a tracheostomy?
  Yes 11 16.2
  Sometimes 30 44.1
  No 27 39.7
×
Clinician Confidence
Over three quarters (76.5%, n = 52) of the cohort felt confident to manage clients with a tracheostomy within their current multidisciplinary team (Question 20). Comments made by the 22% (n = 15) of respondents who “sometimes” felt confident highlighted that their confidence fluctuated because only a small part of their caseload was spent working with the tracheostomized population. Only one respondent felt underconfident. In regard to managing clients who have a tracheostomy and require ventilator support within a multidisciplinary team (Question 21), approximately half (51.5%, n = 35) of the respondents felt confident. Of the respondents who felt underconfident (48.5%, n = 33), many commented that this was because they have had limited exposure to the ventilator-assisted population, and some reported that this was because they have had limited training and/or clinical supervision regarding this management area.
Discussion
The purpose of the current investigation was to describe the preparation and training, extent of clinical support, and confidence of SLPs involved in the care of clients with a tracheostomy tube in Australia. Consistent with the initial project hypothesis, the present data demonstrated that the majority of SLPs are pursuing ways to enhance their preparation for managing the tracheostomized population, are working in supported clinical environments, and feel confident to provide the clinical management of clients with a tracheostomy tube. Nevertheless, the results also indicated that only a minority of SLPs work consistently as part of an optimal team approach while managing this clinical population, and the majority feel they would benefit from additional clinical training and education opportunities. In relation to clients with a tracheostomy who require ventilator support, current data revealed that fewer SLPs feel confident to care for such clients than the nonventilated population and that their preparation and support for this area of management need to be enhanced. The specific issues raised by this study in relation to preparation and training, clinical support, and confidence will be discussed further in the sections below. Where relevant, consideration of any possible bias created by the nature of the responding population is highlighted.
Preparation and Training
The results of the current study revealed that the majority of the SLPs had received training related specifically to tracheostomy management at university, typically between 1 and 5 hr. This amount of undergraduate training is consistent with recognition in the recent Tracheostomy Management Position Paper (Speech Pathology Australia, 2005) that Australian university programs now cover tracheostomy management, although in limited detail, which is a reflection of the fact that tracheostomy management is regarded as a specialist skill and is not expected to be within the skill set of a newly graduated clinician (Speech Pathology Australia, 2001). However, Australian university programs do include course work that will enable entry-level SLPs to demonstrate competence in the areas of speech, language, fluency, voice, and dysphagia (Speech Pathology Australia, 2001), with the latter two areas precursors to managing the tracheostomized population (Speech Pathology Australia, 2005). Therefore, undergraduate training programs provide the fundamentals for the development of core competencies essential for providing care to this specialized population.
As tracheostomy management is considered a specialist skill, the recent national position paper states that practicing SLPs are responsible for obtaining competency in tracheostomy management before treating the clinical population independently and are obliged to routinely update their knowledge and clinical skills (Manley et al., 1999; Speech Pathology Australia, 2005). Up until now, the preparation SLPs have undertaken in order to obtain and maintain competency in this specialized area has not been described. Direct clinical supervision is noted as one of the various methods through which competency should be obtained (Speech Pathology Australia, 2005), and over 90% of the current surveyed SLPs had used direct supervision, either through clinical supervision at a university or on-the-job. In addition to direct clinical supervision, the national position paper has advised organizations to develop tracheostomy competency training programs for staff members to facilitate training. Current data revealed that less than a third of the SLPs reported that their department had a formal tracheostomy competency training program, though a considerable number were currently developing one. Given these findings, departments are encouraged to implement competency training programs, in line with national practice recommendations, to enhance the preparation of SLPs involved in tracheostomy management.
In recent studies conducted in the United States, SLPs have been reported to use a range of resources to further their knowledge and skills in relation to other clinical specialty areas such as complex dysphagic clients (Davis & Conti, 2003) and clients with a tracheoesophageal voice prosthesis (Melvin, Frank, & Robinson, 2001). Similarly, SLPs in the present study pursued a range of clinical training and education activities to better prepare themselves for managing the tracheostomized population. The most popular form of professional development was membership in a tracheostomy interest group, though this was an anticipated bias of the current sample, given that a tracheostomy interest group was used as the primary means of recruitment. The second and third most frequently reported professional development activities were attending workshops and discipline forums/in-services within the workplace, respectively. Of particular interest was that two SLPs in the present study had completed formal suctioning competency training programs to provide them with the skills to carry out tracheal suctioning. This type of suctioning is currently considered to be outside the scope of practice for SLPs in Australia; however, by completing appropriate training, these SLPs have complied with recommendations for SLPs undertaking roles outside their scope of practice (Speech Pathology Australia, 2005).
It has been noted that as part of their preparation for managing the tracheostomized population, SLPs need to keep current with the literature on tracheostomy care in order to achieve and maintain competency and expand their expertise (Dikeman & Kazandjian, 2003; Speech Pathology Australia, 2005). There is, however, only a small body of literature (Hughson & Foulsum, 2000), little consensus regarding clinical practice (Speech Pathology Australia, 2005), and a deficiency of high-quality evidence (Russell & Matta, 2004) regarding tracheostomy management. The current investigation revealed that only half of the SLPs felt up-to-date with the research evidence. Contributing to this were issues such as insufficient time to review, poor access to the literature, and/or clients with a tracheostomy forming only a small part of their caseload. Although there have been no studies specifically exploring the use of evidence to guide SLPs' tracheostomy management, a recent article by Brener, Vallino-Napoli, Reid, and Reilly (2003)  found that few SLPs were using research evidence to guide their dysphagia practice. The authors cited similar issues to those observed in the current study as reasons why SLPs were not guided by evidence-based practice. In response, Reilly (2004)  encouraged SLPs to negotiate with their case managers for time in which to research and review the evidence. Indeed, this suggestion appears equally applicable to SLPs involved in tracheostomy management.
SLPs need to be knowledgeable regarding the various types of tracheostomy tubes available in order for them to effectively manage their clients (Dikeman & Kazandjian, 2003; Speech Pathology Australia, 2005). The current study found that the majority of the SLP cohort considered themselves to have partial or limited knowledge of the advances in tracheostomy technology. Choate et al. (2003)  also identified this as an area of inadequate knowledge. Such data would appear to indicate that many Australian SLPs need to actively address this aspect of their knowledge base.
A high level of consensus exists across the United States that SLPs working in medical settings need additional training and education regarding the management of clients with a tracheostomy with and without ventilator (Shadden, Toner, & McCarthy, 1997). Similarly, in the present study, the majority (88.2%) of the cohort indicated that they would benefit from further training. In particular, SLPs requested both basic and advanced level training delivered through a variety of means including mentoring, work shadowing, lectures, practical workshops, and workplace competency training programs. SLPs thought that useful topics for training opportunities included the management of ventilated clients, management of pediatric clients with a tracheostomy, and correct use of tracheostomy-related equipment, including the different types of tracheostomy tubes and ventilator equipment. The current results highlight that Australian SLPs want additional training opportunities; therefore, there needs to be an active drive within professional associations and clinical settings to provide these training opportunities. While these results are drawn solely from an Australian context, it is plausible to conclude that professionals within other countries may face similar needs.
Clinical Support
It is acknowledged that SLPs caring for the tracheostomized population and/or the tracheostomized and ventilator-assisted population should seek support and advice from professionals experienced in those respective areas of management (Manley et al., 1999; Speech Pathology Australia, 2005; Woodnorth, 2004). Hence, it was a positive finding that most of the SLPs in the current study felt they had access to support from colleagues within their team. However, SLPs indicated that the same level of expert clinical support was often not available within their team for the management of clients with a tracheostomy and requiring ventilator support. Considering the complexity of management for clients who are tracheostomized and ventilator assisted (Dikeman & Kazandjian, 2003), and given that it is an area in which SLPs are fulfilling an increasingly greater role (Davis & Stanton, 2004; Speech Pathology Australia, 2005), there is a need for expert clinical support to be made available for SLPs managing this more specialized population.
It is documented that dysphagia management is a key role of the SLP working with the tracheostomized population (Dikeman & Kazandjian, 2003; Hales, 2004; Hauck, 1999; Higgins & Maclean, 1997; Kasper, Stubbs, Barton, & Pierson, 1996). In the present study, a large proportion of the cohort felt they had a defined role within their multidisciplinary team for the management of dysphagia in clients with a tracheostomy. For a number of the SLPs, however, this role was not recognized on some of the wards and/or units in which clients with a tracheostomy were managed within their respective workplaces. This finding would suggest these SLPs need to conduct hospitalwide education in order to raise other health professionals' awareness of the role of the SLP in managing dysphagia among the tracheostomized population (Dikeman & Kazandjian, 2003).
Although the current study set out to determine whether SLPs worked as part of an optimal team approach with the tracheostomized population, rather than whether they worked as part of a team, the results also indicated that many Australian SLPs were lacking optimal team support while providing tracheostomy care. This result reflects little change from the data reported previously by Manley et al. (1999), who found that 40% of their SLPs provided clinical care to the client population without team support. Specifically, the present data revealed that only a minority of the cohort felt they consistently worked as part of an optimal team approach when managing clients with a tracheostomy. SLPs noted that an optimal team approach was used on only some of the wards and/or units in which they managed clients with a tracheostomy, and these wards and/or units varied between respective workplaces. This finding suggests that the extent to which SLPs work within a team-based, supported clinical environment varies according to both the hospital and the ward/unit in which they are providing tracheostomy care.
Overall, the present results regarding role definition (in relation to dysphagia management) and teamwork indicate that while many Australian SLPs have a defined role in the management of dysphagia in clients with a tracheostomy, when engaged in such clinical care most are either sometimes or never well supported by an optimal clinical team. In light of the existing literature which advocates that effective teamwork enhances the care of the complex client (Goldsmith, 2000; Murray & Brzozowski, 1998; Schwartz Cowley et al., 1994) and enables health professionals to receive support (Firth-Cozens, 2001; Hyland & Lee, 2003; Risser et al., 1999), the current findings suggest that institutions should implement strategies to optimize teamwork and ensure SLPs and other health professionals providing tracheostomy care are adequately supported.
Clinician Confidence
Results from the current study revealed that a high proportion of Australian SLPs felt confident of their ability to manage the tracheostomized population. Specifically, 76.5% of the SLPs in the present investigation felt confident to care for clients with a tracheostomy. Despite the majority findings, several SLPs in the current study reported they only felt confident of their ability to provide tracheostomy care some of the time. They argued that this was because they spent only a small proportion of their caseload caring for this clinical population. This perception is congruent with Manley et al.'s (1999)  statement that SLPs gain confidence in their ability to manage clients with a tracheostomy from a combination of both academic training and clinical exposure to clients. In light of this relationship, it is even more important that SLPs with limited access to clients ensure they have established clinical guidelines within their practice setting, as well as other experienced team members to call on to facilitate optimal client care.
Although a high proportion of SLPs felt confident to care for clients with a tracheostomy tube, only half of the current cohort felt confident of their ability to manage those clients with a tracheostomy and requiring ventilator support within their team. A finding such as this was anticipated given that the management of the tracheostomized and ventilator-assisted population, as mentioned earlier, is more challenging than the management of the nonventilated population (Dikeman & Kazandjian, 2003) and, hence, is regarded as an advanced skill (Speech Pathology Australia, 2005). The discrepancy between clinician confidence for ventilated and nonventilated clients was also anticipated, considering that many of the cohort had little prior exposure to the tracheostomized and ventilator-assisted population within their career. Indeed, of the SLPs who felt underconfident, many attributed their reduced confidence to their limited exposure to the tracheostomized and ventilator-assisted population and recognized this area as one needing improvement, training opportunities, and professional education activities, specifically regarding the management of the ventilated client.
Limitations and Further Research
The present study has provided insight into the preparation and training, clinical support, and confidence of SLPs working with the tracheostomized population in Australia; however, there are acknowledged limitations in the current research. The data were obtained using a questionnaire format that has inherent weaknesses, including its inability to prove causal relationships (Alreck & Settle, 2004) and the potential for respondents to omit individual items and misinterpret questions or response choices (Mangione, 1995). Hence, in order to fully understand the training and support needs of SLPs working with the tracheostomized population, direct assessment of the knowledge base of SLPs regarding core aspects of tracheostomy management, such as dysphagia management, decannulation procedures, and communication management, is needed.
The nonrepresentative nature of the current clinical sample is another key limitation. Potential sample bias must be considered, as SLPs surveyed were predominantly members of a tracheostomy interest group and hence more inclined to participate in professional development activities and/or advocate for the provision of additional education and training opportunities. In future studies, both these sources of bias may be avoided by recruiting participants directly from health care facilities across Australia. While all attempts were made to obtain data that reflected national practice, it is also recognized that the results may not be representative of the national population of SLPs, given that the SLP demographics revealed a large group of respondents from one state not in keeping with national population data. Finally, it is acknowledged that the current data predominantly reflect the practices and perceptions of SLPs who manage adult clients with a tracheostomy. Consequently, little information is currently available regarding the clinical training, support, and confidence of SLPs working with the pediatric population. Hence, it is recommended that future studies investigate the practices and perceptions of SLPs managing pediatric clients with a tracheostomy, an area in which Australian SLPs are fulfilling an increasingly greater role (Speech Pathology Australia, 2005).
Conclusion
The present study was the first to document the preparation and training, clinical support, and confidence of SLPs providing clinical care to clients with a tracheostomy tube in Australia. The data demonstrated that the majority of SLPs are pursuing clinical training and education to enhance their clinical practice, working in supported clinical environments, and feel confident to manage clients with a tracheostomy. Despite these encouraging findings, results also revealed areas of clinician preparation and support that require attention, as well as a number of barriers that prevent SLPs from accessing the research evidence. The majority of SLPs felt they would benefit from additional clinical training and education opportunities, and although most worked in teams, few felt they worked in an optimal clinical team. The profession, health care facilities, and SLPs are encouraged to attend to these areas in order to further enhance their preparation, support, and confidence.
Acknowledgments
We are grateful to the members of the Tracheostomy Interest Group of Australia and all other SLPs involved for their participation in this study.
References
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Appendix
Questionnaire of Tracheostomy Management Practices in Australia
1) From which University did you receive your degree in speech pathology?
  a) Bachelor’s_____________, Master’s_____________, PhD_____________
2) Please indicate what year you graduated from university?
  a) Bachelor’s_____________, Master’s_____________, PhD_____________
3) How many years have you been practicing speech pathology?
  a) 1–5_____________   b) 6–10_____________
  c) 11–15_____________  d) more than 15 years_____________
4) How many paid hours per week do you work as a speech pathologist?
  a) 1–9  b) 10–19  c) 20–29  d) 30–39  e) 40+
5) Please indicate which state or territory you are currently working in.
  _________________________________________________________
6) What proportion of your active clinical time is spent working with the following populations? (N.B. this does NOT include time dedicated to administrative tasks such as teaching, research, clinical service management, etc.)
All Most Half Some None
Children (0–11 years) 1 2 3 4 5
Adolescents (12–17 years) 1 2 3 4 5
Adults (18–65 years) 1 2 3 4 5
Seniors (65+ years) 1 2 3 4 5
7) Within the last year what percentage of your active clinical time consisted of the management of patients with a tracheostomy?
  a) None  b) 1%–9%  c) 10%–24%  d) 25%–49%  e) 50%+
8) In which of the listed job setting(s) do you currently manage patients with a tracheostomy? If you work in more than one setting, please estimate the percentage of time you currently work in each.
Job Setting All Most Half Some None
Acute Care 1 2 3 4 5
Slow Stream Rehabilitation/Nursing Facility 1 2 3 4 5
In-Patient Rehabilitation 1 2 3 4 5
Out-Patient Rehabilitation 1 2 3 4 5
Education Facility 1 2 3 4 5
Community Outreach 1 2 3 4 5
Other:___________________________ 1 2 3 4 5
9) Please indicate how many patients you have worked with who are tracheostomized and ventilator assisted?
  a) None b) 1–10 c) 11–50 d) More than 50
10) Prior to treating patients independently, approximately how many hours training (i.e., undergraduate lectures) did you receive in tracheostomy management?
  a) None  b) 1–5  c) 6–10  d) 11–20  e) More than 20
11) Prior to treating patients independently, how many hours of clinical supervision did you gain in tracheostomy management (during university practicum and/or on-the-job)?
  a) None  b) 1–5  c) 6–10  d) 11–20  e) More than 20
12) Does your speech pathology department have a formal tracheostomy competency training program?
  a) Yes  b) Currently developing one  c) No
13) Please indicate what tracheostomy-related professional development activities you have undertaken? (please tick)
  ❑ Speech Pathology Australia (SPA) workshops
  ❑ Non-SPA workshops
  ❑ Conference presentations (SPA, other)
  ❑ Visited specialist center(s) where patients who are tracheostomized and ventilator assisted are treated by expert speech pathologists
  ❑ Teleconferences
  ❑ Multidisciplinary forums/inservices within my workplace
  ❑ Speech pathology forums/inservices within my workplace
  ❑ Becoming a member of an interest group (e.g., TIGA, NSW Tracheostomy Interest Group)
  ❑ Other:___________________________________________________
14) Do you feel up-to-date with the available evidence-based practice in tracheostomy management?
  a) Yes  b) Not sure  c) No
  Comments:_________________________________________________
15) Do you feel up-to-date with the advances in tracheostomy technology including the specialized tracheostomy tube options available (e.g., “talking” traches, double cuffed tubes, foam cuffs, metal tubes, extra long cuffs)?
  a) Yes  b) Sometimes  c) No
  Comments:_________________________________________________
16) What training, if any, would you find beneficial regarding patients who are tracheostomized? If possible, please make suggestions as to why.
  Comments:____________________________________________________
17) Overall, do you have a defined role within the multidisciplinary team working with patients who are dysphagic and require a tracheostomy?
  a) Yes. Which ward(s)____________________________________________
  b) No. Which ward(s)____________________________________________
  Comments:____________________________________________________
18) Do you feel you have expert clinical support within your multidisciplinary team for the management of patients with a tracheostomy and those patients requiring ventilator assistance?
  a) Tracheostomy only……..……………………………………………Yes/No
  b) Tracheostomy and requiring ventilator assistance………………Yes/No
19) Does the setting in which you work have an optimal team approach for the management of patients with a tracheostomy?
  a) Yes  b) Sometimes  c) No
  Comments:____________________________________________________
20) Do you feel confident to manage patients with a tracheostomy within your multidisciplinary team?
  a) Yes  b) Sometimes  c) No
  Comments:__________________________________________________
21) Within your multidisciplinary team, do you feel confident in managing patients with a tracheostomy who require ventilator assistance?
  a) Yes  b) No
  Comments:__________________________________________________
                   Thank-you for your participation in this research project
1 Within the Australian context, certification as an SLP is predominantly achieved through a 4-year profession-specific bachelor’s program.
Within the Australian context, certification as an SLP is predominantly achieved through a 4-year profession-specific bachelor’s program.×
TABLE 1 Demographic information.
Demographic information.×
Topic Parameter % respondents
Qualification Bachelor’s 92.5
Higher degree (Australia + overseas) 6
No response 1.5
Years since graduation 1–5 28
6–10 35
11–15 13
>15 24
Employed hours/week 1–9 3
10–19 8.8
20–29 4.4
30–39 54.4
>40 27.9
No response 1.5
Location of employment in Australia Queensland 39.7
New South Wales 16.2
Victoria 17.6
Western Australia 5.9
Northern Territory 5.9
South Australia 4.4
Australian Capital Territory 4.4
Tasmania 1.5
No response 4.4
TABLE 1 Demographic information.
Demographic information.×
Topic Parameter % respondents
Qualification Bachelor’s 92.5
Higher degree (Australia + overseas) 6
No response 1.5
Years since graduation 1–5 28
6–10 35
11–15 13
>15 24
Employed hours/week 1–9 3
10–19 8.8
20–29 4.4
30–39 54.4
>40 27.9
No response 1.5
Location of employment in Australia Queensland 39.7
New South Wales 16.2
Victoria 17.6
Western Australia 5.9
Northern Territory 5.9
South Australia 4.4
Australian Capital Territory 4.4
Tasmania 1.5
No response 4.4
×
TABLE 2 Patient populations, job setting, and primary reason for referral.
Patient populations, job setting, and primary reason for referral.×
Question Response categories
No response All/most Usually/always Half the time Some/none Seldom/never
n % n % n % n %
What proportion of active clinical time is spent with the following patient populations?
  Children (0–11 years) 1 1.5 5 7.4 2 2.9 60 88.2
  Adolescents (12–17 years) 0 0 0 0 0 0 68 100
  Adults (18–65 years) 0 0 27 39.7 23 33.8 18 26.5
  Seniors (65+ years) 0 0 20 29.4 23 33.8 25 36.8
In which of the listed job setting(s) do you currently manage patients with a tracheostomy?
  Acute care 0 0 52 76.5 3 4.4 13 19.1
  Slow stream rehabilitation/nursing care 0 0 0 0 0 0 68 100
  Inpatient rehabilitation 0 0 9 13.3 2 2.9 57 83.8
  Outpatient rehabilitation 0 0 0 0 4 5.9 64 94.1
  Education facility 0 0 0 0 0 0 68 100
  Community outreach 0 0 1 1.5 0 0 67 98.5
TABLE 2 Patient populations, job setting, and primary reason for referral.
Patient populations, job setting, and primary reason for referral.×
Question Response categories
No response All/most Usually/always Half the time Some/none Seldom/never
n % n % n % n %
What proportion of active clinical time is spent with the following patient populations?
  Children (0–11 years) 1 1.5 5 7.4 2 2.9 60 88.2
  Adolescents (12–17 years) 0 0 0 0 0 0 68 100
  Adults (18–65 years) 0 0 27 39.7 23 33.8 18 26.5
  Seniors (65+ years) 0 0 20 29.4 23 33.8 25 36.8
In which of the listed job setting(s) do you currently manage patients with a tracheostomy?
  Acute care 0 0 52 76.5 3 4.4 13 19.1
  Slow stream rehabilitation/nursing care 0 0 0 0 0 0 68 100
  Inpatient rehabilitation 0 0 9 13.3 2 2.9 57 83.8
  Outpatient rehabilitation 0 0 0 0 4 5.9 64 94.1
  Education facility 0 0 0 0 0 0 68 100
  Community outreach 0 0 1 1.5 0 0 67 98.5
×
TABLE 3 Clinical preparation and presence of formal training programs (N = 68).
Clinical preparation and presence of formal training programs (N = 68).×
Question n %
10. Prior to treating patients independently, approximately how many hours training (i.e., undergraduate lectures) did you receive in tracheostomy management?
 None 17 25.0
 1–5 hr 35 51.4
 6–10 hr 8 11.8
 11–20 hr 4 5.9
 More than 20 hr 4 5.9
11. Prior to treating patients independently, how many hours of clinical supervision did you gain in tracheostomy management (during university practicum and/or on-the-job)?
 None 6 8.8
 1–5 hr 27 39.7
 6–10 hr 18 26.5
 11–20 hr 10 14.7
 More than 20 hr 6 8.8
 Nonresponse 1 1.5
12. Does your speech pathology department have a formal tracheostomy competency training program?
 Yes 19 27.9
 Currently developing one 13 19.1
 No 35 51.5
 Nonresponse 1 1.5
TABLE 3 Clinical preparation and presence of formal training programs (N = 68).
Clinical preparation and presence of formal training programs (N = 68).×
Question n %
10. Prior to treating patients independently, approximately how many hours training (i.e., undergraduate lectures) did you receive in tracheostomy management?
 None 17 25.0
 1–5 hr 35 51.4
 6–10 hr 8 11.8
 11–20 hr 4 5.9
 More than 20 hr 4 5.9
11. Prior to treating patients independently, how many hours of clinical supervision did you gain in tracheostomy management (during university practicum and/or on-the-job)?
 None 6 8.8
 1–5 hr 27 39.7
 6–10 hr 18 26.5
 11–20 hr 10 14.7
 More than 20 hr 6 8.8
 Nonresponse 1 1.5
12. Does your speech pathology department have a formal tracheostomy competency training program?
 Yes 19 27.9
 Currently developing one 13 19.1
 No 35 51.5
 Nonresponse 1 1.5
×
TABLE 4 Professional development activities (N = 68).
Professional development activities (N = 68).×
Question n %
13. Please indicate what tracheostomy-related professional development activities you have undertaken?
 Becoming a member of an interest group (e.g., TIGA, NSW Tracheostomy Interest Group) 53 77.9
 Speech Pathology Australia (SPA) workshops 49 72.1
 Speech pathology forums/in-services within workplace 45 66.2
 Teleconferences 39 57.4
 Multidisciplinary forums/in-services within workplace 36 52.9
 Conference presentations (SPA, other) 32 47.1
 Non-SPA workshops 21 30.9
 Visited specialist center(s) where expert speech pathologists treat patients who are tracheostomized and ventilator assisted 19 27.9
 Other
  Research and self-study 10 14.7
  Mentoring 5 7.4
  Formal suctioning competency training programs 2 2.9
Note. TIGA = Tracheostomy Interest Group of Australia; NSW = New South Wales.
Note. TIGA = Tracheostomy Interest Group of Australia; NSW = New South Wales.×
TABLE 4 Professional development activities (N = 68).
Professional development activities (N = 68).×
Question n %
13. Please indicate what tracheostomy-related professional development activities you have undertaken?
 Becoming a member of an interest group (e.g., TIGA, NSW Tracheostomy Interest Group) 53 77.9
 Speech Pathology Australia (SPA) workshops 49 72.1
 Speech pathology forums/in-services within workplace 45 66.2
 Teleconferences 39 57.4
 Multidisciplinary forums/in-services within workplace 36 52.9
 Conference presentations (SPA, other) 32 47.1
 Non-SPA workshops 21 30.9
 Visited specialist center(s) where expert speech pathologists treat patients who are tracheostomized and ventilator assisted 19 27.9
 Other
  Research and self-study 10 14.7
  Mentoring 5 7.4
  Formal suctioning competency training programs 2 2.9
Note. TIGA = Tracheostomy Interest Group of Australia; NSW = New South Wales.
Note. TIGA = Tracheostomy Interest Group of Australia; NSW = New South Wales.×
×
TABLE 5 Clinical roles, expert support, and working in an optimal team (N = 68).
Clinical roles, expert support, and working in an optimal team (N = 68).×
Question n %
17. Overall, do you have a defined role within the multidisciplinary team working with patients who are dysphagic and require a tracheostomy?
  Yes 54 79.4
  Yes and No 7 10.3
  No 7 10.3
Wards in which respondents have a defined role:
  Neurological/Neurosurgery 34 50.0
  Intensive Care Unit 30 44.1
  Ear Nose Throat 25 36.8
  Respiratory 17 25.0
  General Medical 17 25.0
  General Surgical 10 14.7
  Other wards <6 <8.8
18. Do you feel you have expert clinical support within your multidisciplinary team for the management of patients with a tracheostomy and those patients requiring ventilator assistance?
 Tracheostomy only
  Yes 50 73.5
  No 14 20.6
  Nonresponse 4 5.9
 Tracheostomy and requiring ventilator assistance
  Yes 36 52.9
  No 31 45.6
  Nonresponse 1 1.5
19. Does the setting in which you work have an optimal team approach for the management of patients with a tracheostomy?
  Yes 11 16.2
  Sometimes 30 44.1
  No 27 39.7
TABLE 5 Clinical roles, expert support, and working in an optimal team (N = 68).
Clinical roles, expert support, and working in an optimal team (N = 68).×
Question n %
17. Overall, do you have a defined role within the multidisciplinary team working with patients who are dysphagic and require a tracheostomy?
  Yes 54 79.4
  Yes and No 7 10.3
  No 7 10.3
Wards in which respondents have a defined role:
  Neurological/Neurosurgery 34 50.0
  Intensive Care Unit 30 44.1
  Ear Nose Throat 25 36.8
  Respiratory 17 25.0
  General Medical 17 25.0
  General Surgical 10 14.7
  Other wards <6 <8.8
18. Do you feel you have expert clinical support within your multidisciplinary team for the management of patients with a tracheostomy and those patients requiring ventilator assistance?
 Tracheostomy only
  Yes 50 73.5
  No 14 20.6
  Nonresponse 4 5.9
 Tracheostomy and requiring ventilator assistance
  Yes 36 52.9
  No 31 45.6
  Nonresponse 1 1.5
19. Does the setting in which you work have an optimal team approach for the management of patients with a tracheostomy?
  Yes 11 16.2
  Sometimes 30 44.1
  No 27 39.7
×