The Experiences of School-Age Children with a Tracheostomy The Individuals with Disabilities Act ensures that all children have access to their education in the least restrictive environment (U.S. Department of Education, n.d.). This law has made attending school easier for medically fragile children. Adults recognize the value of schools being places of inclusion. However, there has been minimal research presented on how these children feel about being in a school-setting. A review of a research study published by Spratling, Minick, and Carmon (2012), is able to highlight the perspective of one group of medically-fragile children. The purpose of this paper is to review the background of this issue, the methods used, the researcher’s findings, ethical considerations, and the impact this study may have on nursing practice in schools.
Background
This research study focused on children who have tracheostomies and what their experience has been in the school setting. The researchers identified that most previous research focused on the child’s experience as interpreted by the parents or a child’s caregiver (Spratling et al., 2012). With the increase of the number of children who are able to attend school with medical conditions, it is important to understand their perspective to see if there are ways to improve their experience.
Methods
This study was qualitative design and used interpretive phenomenology to describe the experiences of school-age children who have a tracheostomy. The sample was made up of children ages 6 through 12; both males and females were included. The ethnicity of the participants included two White, two African American, and one Hispanic child. Three of the children require mechanical ventilation or continuous positive airway pressure at night only. The subject pool was drawn from a large pulmonary clinic. The children have all had a tracheostomy for at least one year or were deccanulated within the last year. The researchers also used a criteria of including only those children who could answer questions without parental assistance. The result was five subjects who were able/willing to participate. Questions were developed to establish rapport with the children and then moved on to more specific questions regarding their school experience. Parents could choose to be present during the interview (Spratling et al., 2012).
Analysis
The researchers identified three common themes in the participant’s responses. The first theme that the researchers identified is, “I’m the only one”. The children identified themselves as being the only one they knew with a tracheostomy (Spratling et al., 2012). This theme demonstrates the feeling of isolation that may come from the inability to share their experience with someone who would understand. Children want to fit in and by having a tracheostomy they are instantly recognized as being different. The reactions of other children may impact the development of their self-esteem and may impact their feelings about school. The second theme that was identified by the researchers is, “Just tell them”. Sharing information with their peers and with school staff helps to alleviate isolation. One of the children reported that being proactive in talking about her tracheostomy helped to answer questions before they were asked and allowed for interaction with other students (Spratling et al., 2012). Helping other students to understand their experience can remove the fear that the other children may fear.
Tracheostomies seem scary because they relate to the child’s ability to breathe. Most children can understand how important that is and understand what if feels like when you can’t breathe. Having the child with a tracheostomy explain how it works and demonstrate that they still like to do the activities that other kids do, can be helpful for another child to see that they are just like them. The final theme that the researchers identified is, “Friends are helpful.” All of the participants reported that their friends were the ones that helped them at school the most both with specific tasks and overall supportive presence (Spratling et al., 2012). The children recognized the value of having a friend who they could play with and share things with. Learning social skills and building friendships are both skills that the school environment helps to support. It is important for children with tracheostomies to learn how to communicate and how to interact with their peers. These skills will aid them as they grow and develop. Friendships and support at school may encourage regular school attendance and help establish the value of education (Spratling et al., 2012).
The findings of this research can be used to support school nursing practice. The experiences of these participants provides valuable information. The school nurse is the point of contact for the family and the link between the family and school. When the school nurse develops the child’s care plan, one of the areas to assess might be the child’s connections with other students. Social isolation can be a nursing diagnosis for some of these children. The nurse should develop interventions that would support the child by brainstorming activities that the child might do to establish relationships with other students. Activities may include presenting information to their classmates, having a guest speaker who can talk about the reason the child has the tracheostomy, inviting an older student with a tracheostomy to come visit and share their experience or writing a story to share with their classmates. This writer has observed that when children are given the information that answers their questions honestly and openly they become able to accept the disabled child for who they are. With an increasing number of medically fragile children in the regular education setting, it is more common to see children with health issues and it is not seen as a big deal to the students (Spratling et al., 2012). Ethical considerations
The researchers ensured that the parents and children were fully informed of the study. Confidentiality was accomplished by giving each child a number; all identifying information was concealed. The researchers videotaped the interviews. The data was evaluated in a team approach in order to prevent misinterpretation of the data (Spratling et al., 2012). One of the identified possible concerns is that the primary investigator had established relationships with the children and their families through the clinic. However, because the families were fully informed this writer does not see any breech of ethics. The other area where ethics may be a concern is in the school setting. Families may not want to disclose any of their child’s history or experience for fear it may be shared with the school (Spratling et al., 2012). If the researchers shared the results with the school, this would cause harm to the student and the family; this would go against the nurse’s duty to prevent no harm to the student.
This research study provides the opportunity for school nurses to enhance their practice with medically fragile students. This writer sees the benefit of future studies on how medically fragile children integrate into the school environment. The ideal would be for students to identify for themselves, ways in which they might feel included and accepted in the school environment. There is also opportunity for able bodied students to learn more about the medical challenges that their peers face. Another area that could be studied is to evaluate how accommodating the school environment is for children with medical needs. Are buildings, classrooms, and bathrooms really accessible for everyone? Students with medical needs should be given the opportunity to provide feedback on the environment. This writer believes that knowledge gained from this information may be beneficially in supporting all student’s needs.

References
Spratling, R., Minick, P., & Carmon, M. (2012). The experiences of school-age children with a tracheostomy. Journal of Pediatric Health Care, 26 (2), 118-125. Retrieved from http://www.sciencedirect.com.library.gcu.edu:2048/science/article/pii/S0891524510002014
U.S. Department of Education (n.d.). Retrieved from http://idea.ed.gov/explore/view/p/%2Croot%2Cdynamic%2CTopicalArea%2C3%2C