Simulation-based training is increasingly used to prepare family caregivers of children with tracheostomies for the complex demands of home care. This scoping review synthesized 11 United States-based studies published between 2013 and 2024, examining simulation program components, instructional strategies, and reported outcomes. Most programs incorporated high-fidelity simulations before discharge and focused on emergency preparedness and routine care. Reported outcomes included improvements in caregiver confidence, knowledge, and satisfaction, though few studies used validated tools or assessed long-term competency. Gaps in demographic reporting, theoretical grounding, outcome measures, and equitable access were common. Findings underscore the need for standardized, theory-informed, and inclusive simulation curricula that reflect caregiver diversity and real-world challenges. Future research should explore sustained postdischarge education, develop validated outcome measures, and inform national guidelines that promote safe, effective, and equitable caregiver training for children with tracheostomies.
CohenE, KuoDZ, AgrawalR, et al.Children with medical complexity: An emerging population for clinical and research initiatives. Pediatrics, 2011; 127(3):529–538; doi: 10.1542/peds.2010-0910
2.
Oztek CelebiFZ, SenelS. Patients with chronic conditions and their complex care needs in a tertiary care hospital. Arch Pediatr, 2021; 28(6):470–474; doi: 10.1016/j.arcped.2021.05.001
3.
ChandranA, SikkaK, ThakarA, et al.The impact of pediatric tracheostomy on the quality of life of caregivers. Int J Pediatr Otorhinolaryngol, 2021; 149:110854; doi: 10.1016/j.ijporl.2021.110854
4.
FriesenTL, ZamoraSM, RahmanianR, et al.Predictors of pediatric tracheostomy outcomes in the United States. Otolaryngol Head Neck Surg, 2020; 163(3):591–599; doi: 10.1177/0194599820917620
Pettitt-SchieberB, MahendranG, TeyCS, et al.Risk factors for return visits in children discharged with tracheostomy. Int J Pediatr Otorhinolaryngol, 2021; 150:110860; doi: 10.1016/j.ijporl.2021.110860
7.
WestwoodEL, HutchinsJV, ThevasagayamR. Quality of life in paediatric tracheostomy patients and their caregivers – A cross-sectional study. Int J Pediatr Otorhinolaryngol, 2019; 127:109606; doi: 10.1016/j.ijporl.2019.109606
8.
PrietoV, RozmusC, CohenE, et al.Caregiver burden, caregiving satisfaction, and health-related quality of life among caregivers of children with medical complexity. PNJ, 2022; 48(3):111–121; doi: 10.62116/PNJ.2022.48.3.111
9.
YuJA, HendersonC, CookS, et al.Family caregivers of children with medical complexity: Health-related quality of life and experiences of care coordination. Acad Pediatr, 2020; 20(8):1116–1123; doi: 10.1016/j.acap.2020.06.014
10.
FosterCC, AgrawalRK, DavisMM. Home health care for children with medical complexity: Workforce gaps, policy, and future directions. Health Aff (Millwood), 2019; 38(6):987–993; doi: 10.1377/hlthaff.2018.05531
11.
TofilNM, RutledgeC, ZinkanJL, et al.Ventilator caregiver education through the use of high-fidelity pediatric simulators: A pilot study. Clin Pediatr (Phila), 2013; 52(11):1038–1043; doi: 10.1177/0009922813505901
12.
StefanidisD, CookD, Kalantar-MotamediSM, et al.Society for Simulation in Healthcare Guidelines for Simulation Training. Simul Healthc, 2024; 19(1S):S4–S22; doi: 10.1097/SIH.0000000000000776
13.
WattsPI, McDermottDS, AlinierG, et al.Healthcare simulation standards of best practice simulation design. Clin Simul Nurs, 2021; 58:14–21; doi: 10.1016/j.ecns.2021.08.009
14.
McCoyJL, WilliamsKA, SenkincJL, et al.Pediatric tracheostomy care simulation: Real-life scenarios in a safe learning environment. Respir Care, 2022; 67(1):40–47; doi: 10.4187/respcare.09201
15.
PrickettK, DeshpandeA, PaschalH, et al.Simulation-based education to improve emergency management skills in caregivers of tracheostomy patients. Int J Pediatr Otorhinolaryngol, 2019; 120:157–161; doi: 10.1016/j.ijporl.2019.01.020
16.
YuenA, RodriguezN, OsorioSN, et al.Simulation-based discharge education program for caregivers of children with tracheostomies. Hosp Pediatr, 2021; 11(6):571–578; doi: 10.1542/hpeds.2020-000984
17.
MaiK, DavisRK, HamiltonS, et al.Identifying caregiver needs for children with a tracheostomy living at home. Clin Pediatr (Phila), 2020; 59(13):1169–1181; doi: 10.1177/0009922820941209
18.
PetersMDJ, MarnieC, TriccoAC, et al.Updated methodological guidance for the conduct of scoping reviews. JBI Evid Synth, 2020; 18(10):2119–2126; doi: 10.11124/JBIES-20-00167
19.
PetersMDJ, GodfreyC, McInerneyP, et al.Scoping reviews. In: JBI Manual for Evidence Synthesis. (AromatarisE, eds.) JBI; 2024. https://synthesismanual.jbi.global
20.
TriccoAC, LillieE, ZarinW, et al.PRISMA extension for scoping reviews (PRISMA-ScR): Checklist and explanation. Ann Intern Med, 2018; 169(7):467–473; doi: 10.7326/M18-0850
21.
Van OrneJ, BrooksM, VirginB, et al.Use of simulation in educating caregivers of children with tracheostomies: A scoping review protocol. OSF. 2025. https://osf.io/728un [Last accessed: Jul26, 2025].
22.
SinghM, RestivoA. Task trainers in procedural skills acquisition in medical simulation. StatPearls. Treasure Island, Florida: StatPearls Publishing; 2024. In: https://www.ncbi.nlm.nih.gov/books/NBK558925/
23.
ThomasJ, HardenA. Methods for the thematic synthesis of qualitative research in systematic reviews. BMC Med Res Methodol, 2008; 8:45; doi: 10.1186/1471-2288-8-45
24.
AromatarisE, LockwoodC, PorrittK, et al.JBI manual for evidence synthesis. JBI, 2024; doi: 10.46658/JBIMES-24-01
25.
BergmanCM, ThomasC, ClapperT, et al.Sim-based home tracheostomy care: A mixed methods study on outcomes and parental preparedness. Hosp Pediatr, 2024; 14(4):251–257; doi: 10.1542/hpeds.2023-007539
26.
BrooksM, JacobsL, CazzellM. Impact of emergency management in a simulated home environment for caregivers of children who are tracheostomy dependent. J Spec Pediatr Nurs, 2022; 27(2):e12366; doi: 10.1111/jspn.12366
27.
StanleyT, BattlesM, BezruczkoN, et al.Efficacy of simulation for caregivers of children with a tracheostomy. Clin Simul Nurs, 2019; 31:9–16; doi: 10.1016/j.ecns.2019.03.005
28.
ThrasherJ, BakerJ, VentreKM, et al.Hospital to home: A quality improvement initiative to implement high-fidelity simulation training for caregivers of children requiring long-term mechanical ventilation. J Pediatr Nurs, 2018; 38:114–121; doi: 10.1016/j.pedn.2017.08.028
29.
TofilNM, SchierS, BenningfieldB, et al.Tracheostomy education for parents utilizing simulation: A new paradigm in parental education. Pediatr Nurs, 2018; 44(3):111–115.
30.
WhalenM, AebersoldM, NelsonK, et al.The feasibility and use of simulation to assess parent learning. Clin Simul Nurs, 2020; 38:23–26; doi: 10.1016/j.ecns.2019.10.003
31.
WooldridgeAL, CarterKF. Pediatric and neonatal tracheostomy caregiver education with phased simulation to increase competency and enhance coping. J Pediatr Nurs, 2021; 60:247–251; doi: 10.1016/j.pedn.2021.07.011
32.
KolbDA. Experiential Learning: Experience as the Source of Learning and Development. Englewood Cliffs, New Jersey: Prentice Hall; 1984.
33.
NicksonCP, PetrosoniakA, BarwickS, et al.Translational simulation: From description to action. Adv Simul (Lond), 2021; 6(1):6; doi: 10.1186/s41077-021-00160-6
34.
AcordaDE, Van OrneJ. Pediatric tracheostomy education program structures, barriers, and support: A nationwide survey of children’s hospitals. Otolaryngol Head Neck Surg, 2025; 172(1):283–291; doi: 10.1002/ohn.1020
35.
HighMS, JulionW, HeigelS, et al.Parent education programs for children assisted by invasive mechanical ventilation: A scoping review. J Pediatr Nurs, 2022; 66:160–170; doi: 10.1016/j.pedn.2022.06.009
36.
ChengA, MagidDJ, AuerbachM, et al.Part 6: Resuscitation education science: 2020 American heart association guidelines for cardiopulmonary resuscitation and emergency cardiovascular care. Circulation, 2020; 142(16_suppl_2):S551–S579; doi: 10.1161/CIR.0000000000000903
37.
BerroEA, DaneFC, KnoeselJ. Exploring the relationships among realism, engagement, and competency in simulation. Teach Learn Nurs, 2023; 18(4):e241–e245; doi: 10.1016/j.teln.2023.07.010
38.
CareyJM, RosslerK. The how, when, why of high fidelity simulation. StatPearls. Treasure Island, Florida: StatPearls Publishing; 2023. In: https://www.ncbi.nlm.nih.gov/books/NBK559313/
39.
NeunhoefferF, Miarka-MautheC, HarnischmacherC, et al.Severe adverse events in children with tracheostomy and home mechanical ventilation—Comparison of pediatric home care and a specialized pediatric nursing care facility. Respir Med, 2022; 191:106392; doi: 10.1016/j.rmed.2021.106392
40.
OngT, LiuCC, ElderL, et al.The trach safe initiative: A quality improvement initiative to reduce mortality among pediatric tracheostomy patients. Otolaryngol Head Neck Surg, 2020; 163(2):221–231; doi: 10.1177/0194599820911728
41.
MazanecSR, SandstromK, ColettaD, et al.Building family caregiver skills using a simulation-based intervention: A randomized pilot trial. Oncol Nurs Forum, 2019; 46(4):419–427; doi: 10.1188/19.onf.419-427
42.
JossbergerH, BreckwoldtJ, GruberH. Promoting expertise through simulation (PETS): A conceptual framework. Learn Instr, 2022; 82:101686; doi: 10.1016/j.learninstruc.2022.101686
Think Cultural Health. National standards for culturally and linguistically appropriate services (CLAS) in health and health care. Rockville, Maryland: U.S. Department of Health & Human Services, Office of Minority Health; 2025. https://thinkculturalhealth.hhs.gov/clas/standards
45.
YuJA, BayerND, BeachSR, et al.A national profile of families and caregivers of children with disabilities and/or medical complexity. Acad Pediatr, 2022; 22(8):1489–1498; doi: 10.1016/j.acap.2022.08.004
46.
PalaganasJC, CharnetskiM, DowellS, et al.Cultural considerations in debriefing: A systematic review of the literature. BMJ Simul Technol Enhanc Learn, 2021; 7(6):605–610; doi: 10.1136/bmjstel-2020-000857
47.
HurY, HickmanRLJr. Use and impact of simulation in family caregiver education: A systematic review. West J Nurs Res, 2024; 46(2):143–151; doi: 10.1177/01939459231218956
StoneKP, RutmanL, CalhounAW, et al.; And for the International Network in Simulation-Based Innovation, Research and Education (INSPIRE) SQUIRE-SIM Reporting Guidelines Investigators. SQUIRE-SIM (standards for quality improvement reporting excellence for SIMulation): Publication guidelines for simulation-based quality improvement projects. Simul Healthc, 2024; doi: 10.1097/SIH.0000000000000819
Supplementary Material
Please find the following supplemental material available below.
For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.
For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.
