{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T13:58:03Z","timestamp":1790776683754,"version":"4.1.0"},"reference-count":40,"publisher":"Wiley","issue":"10","license":[{"start":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T00:00:00Z","timestamp":1790726400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T00:00:00Z","timestamp":1790726400000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Nursing Open"],"published-print":{"date-parts":[[2026,10]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Aim<\/jats:title>\n                    <jats:p>To evaluate the impact of a 12\u2010element nurse\u2010led tracheostomy care bundle, compared with routine care, on stoma integrity, respiratory distress, and pneumonia\u2010related outcomes among patients with tracheostomies.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>A quasi\u2010experimental study was conducted among 80 critically ill patients with tracheostomies admitted to Mansoura University Hospital. Participants were allocated into a study group receiving a 12\u2010element nurse\u2010led tracheostomy care bundle and a control group receiving routine care (40 patients per group). Patients were followed for 15\u2009days. Data were collected using stoma\u2010site assessment, the National Early Warning Score (NEWS), the Respiratory Distress Observation Scale (RDOS), and the modified Clinical Pulmonary Infection Score (CPIS). Statistical analyses included chi\u2010squared tests, Friedman tests for repeated measurements, and effect size estimation using partial eta squared.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Baseline demographic and clinical characteristics were comparable between groups (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&gt;\u20090.05). Primary longitudinal repeated\u2010measures models revealed significant Group \u00d7 Time interaction effects favouring the nurse\u2010led bundle for physiological stability (NEWS:\n                      <jats:italic>F<\/jats:italic>\n                      \u2009=\u20097.838,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001, partial eta squared\u2009=\u20090.086), stoma integrity composite scores (\n                      <jats:italic>F<\/jats:italic>\n                      \u2009=\u20095.849,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001, partial eta squared\u2009=\u20090.048), and respiratory distress trajectories (RDOS:\n                      <jats:italic>F<\/jats:italic>\n                      \u2009=\u20094.382,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.014, partial eta squared\u2009=\u20090.036). Secondary day\u2010specific analyses showed lower stoma\u2010site infection signs (swelling, purulent discharge, skin breakdown, redness, warmth, and foul drainage) in the intervention cohort during follow\u2010up. Regarding pneumonia\u2010related outcomes, CPIS\u2010indicated suspected respiratory infection occurred less frequently in the study group (1\u2010week: 10.0% vs. 20.0%; 2\u2010week: 5.0% vs. 10.0%), though the difference was not statistically significant (Chi\u2010square\u2009=\u20093.710,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.168).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>A 12\u2010element nurse\u2010led tracheostomy care bundle was associated with improved stoma integrity, reduced observed respiratory distress, and favourable changes in physiological stability among patients with tracheostomies. Although lower proportions of CPIS\u2010indicated suspected respiratory infection were observed in the bundle group, the difference was not statistically significant. Further multicentre controlled studies are required to determine the effect of standardized tracheostomy care bundles on pneumonia\u2010related outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Implications for the Profession and Patient Care<\/jats:title>\n                    <jats:p>Standardizing tracheostomy management via a nurse\u2010led bundle provides a structured, evidence\u2010informed framework for ICU practice. For nurses, it ensures consistent airway management, stoma assessment, suctioning, humidification, cuff pressure monitoring, and documentation, enhancing procedural fidelity and patient safety. For patients, bundle adherence supports stoma integrity, reduces respiratory distress, and promotes physiological stability. These improvements may optimize ICU workflows, guide timely interventions, and support care transitions such as decannulation and discharge. Implementation should include staff training, standardized checklists, and monitoring to ensure fidelity and adaptability. While preliminary results are promising, further evaluation in diverse clinical settings is recommended before broad adoption.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Patient or Public Contribution<\/jats:title>\n                    <jats:p>No patient or public contribution.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/nop2.70861","type":"journal-article","created":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T13:15:33Z","timestamp":1790774133000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Impact of a 12\u2010Element Nurse\u2010Led Tracheostomy Care Bundle on Stoma Integrity, Respiratory Distress and Suspected Pneumonia\u2010Related Outcomes Among Patients With Tracheostomies: A Quasi\u2010Experimental Study"],"prefix":"10.1002","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5571-7162","authenticated-orcid":false,"given":"Eman Yasser","family":"Hammouda","sequence":"first","affiliation":[{"name":"Faculty of Nursing, Critical Care and Emergency Nursing Mansoura University  Mansoura Egypt"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4244-1459","authenticated-orcid":false,"given":"Mohammed Elsayed","family":"Zaky","sequence":"additional","affiliation":[{"name":"Faculty of Nursing, Medical Surgical Nursing Department Cairo University  Cairo Egypt"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0958-9109","authenticated-orcid":false,"given":"Mona Saad Abdelwareth","family":"Ahmed","sequence":"additional","affiliation":[{"name":"Department of Medical and Surgical Nursing, College of Nursing Princess Nourah bint Abdulrahman University  Riyadh Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1293-5140","authenticated-orcid":false,"given":"Walaa El\u2010Khanany","family":"Zahran","sequence":"additional","affiliation":[{"name":"Faculty of Nursing, Medical Surgical Nursing Department Damietta University  Damietta City Egypt"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0755-890X","authenticated-orcid":false,"given":"Hend El\u2010Sayed","family":"Mansour","sequence":"additional","affiliation":[{"name":"Faculty of Nursing, Critical Care and Emergency Nursing Mansoura University  Mansoura Egypt"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,9,30]]},"reference":[{"issue":"2","key":"e_1_2_16_2_1","doi-asserted-by":"crossref","first-page":"17","DOI":"10.37506\/ijone.v13i2.14618","article-title":"Effect of an Educational Training Program in Tracheostomy Care on Nurses' Knowledge and Skills","volume":"13","author":"Abdulrahman E.","year":"2021","journal-title":"International Journal of Nursing Education"},{"key":"e_1_2_16_3_1","doi-asserted-by":"publisher","DOI":"10.1186\/s13054\u2010018\u20102126\u20106"},{"key":"e_1_2_16_4_1","doi-asserted-by":"publisher","DOI":"10.1097\/CCE.0000000000000523"},{"key":"e_1_2_16_5_1","unstructured":"ACI\u2010ICCMU Tracheostomy Expert Group.2013.\u201cCare of Adult Patients in Acute Care Facilities With a Tracheostomy: Clinical Practice Guideline.\u201dhttps:\/\/www.aci.health.nsw.gov.au\/__data\/assets\/pdf_file\/0005\/181454\/ACI_Tracheostomy_CPG.pdf."},{"key":"e_1_2_16_6_1","doi-asserted-by":"publisher","DOI":"10.1111\/jocn.15840"},{"key":"e_1_2_16_7_1","doi-asserted-by":"publisher","DOI":"10.21608\/jnsbu.2024.354365"},{"issue":"1","key":"e_1_2_16_8_1","doi-asserted-by":"crossref","DOI":"10.21608\/tsnj.2025.414142","article-title":"Effect of Implementing Tracheostomy Care Guidelines on Patients' Clinical Outcomes at the Intensive Care Units","volume":"36","author":"Al\u2010Metyazidy H. 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