Enteral feeding is a long established practice across pediatric and adult populations, to enhance nutritional intake and prevent malnutrition. Despite recognition of the importance of nutrition within the modern health agenda, evaluation of the efficacy of how such feeds are delivered is more limited. The accuracy, safety, and consistency with which enteral feed pump systems dispense nutritional formulae are important determinants of their use and acceptability. Enteral feed pump safety has received increased interest in recent years as enteral pumps are used across hospital and home settings. Four areas of enteral feed pump safety have emerged: the consistent and accurate delivery of formula; the minimization of errors associated with tube misconnection; the impact of continuous feed delivery itself (via an enteral feed pump); and the chemical composition of the casing used in enteral feed pump manufacture. The daily use of pumps in delivery of enteral feeds in a home setting predominantly falls to the hands of parents and caregivers. Their understanding of the use and function of their pump is necessary to ensure appropriate, safe, and accurate delivery of enteral nutrition; their experience with this is important in informing clinicians and manufacturers of the emerging needs and requirements of this diverse patient population. The review highlights current practice and areas of concern and establishes our current knowledge in this field.
Background/context
Simulated Practice (SP) has occurred more predominately within the nursing profession,1,2 where the response to the NMC simulated practice project has allowed incorporation of SP hours as part of the nurse programme. Evidence looking at the use and impact of SP in other areas such as dietetics is limited. This is an evaluation of a SP assessment with dietetic students and perceived impact on clinical placement experience where there is a current evidence.3,4
Methodology
Students were randomly allocated a simulated patient were service users were employed as a patient with a specific clinical condition. Standard module evaluations were collected for module review and comments specifically related to the assessment were extracted. A 6 question survey was e-mailed to the students during their placement year approximately 1 year later to gain further feedback and evaluation in relation the their clinical placement setting.
Results
17 students completed module evaluations and 9 responded to the survey. Students felt the SP assessment was theoretically good but felt ill prepared for the experience, wanting more support and guidance around the SP. Responses 1 year later showed 55.6% of students felt prepared for the assessment, and found it ‘similar to practice’. The realistic nature of the assessment and the practical hands on approach was positive. 89% found it stressful but have used the skills in their clinical placement and 100% of the respondents would like more SP experiences.
Conclusions/recommendations
Although initially students felt pressured and ill-prepared for the SP, one year on it was highly valued, the skills were used in practice and all wanted more SP throughout the course. Feedback and evaluation comments will inform further development of the SP assessment for the Applied Nutrition Support module at Leeds Metropolitan University.
References
Valler-Jones T, Meechan R, Jones H. Simulated practice - a panacea for health education? British Journal of Nursing 2011;20:10
Ricketts B, Merriman C, Stayt L. Simulated practice learning in a preregistration programme. British Journal of Nursing 2012;21:7
Handley R, Dodge N. Can simulated practice learning improve clinical competence? British Journal of Nursing 2013;22:9
Edgecombe K, Seaton P, Monahan K, et al. Clinical Simulation in Nursing: A literature review and guidelines for practice. National Centre for Tertiary Teaching Excellence 2013; Ako Aetearoa [internet],
requirements and 6%(n¼2) met estimated energy and protein requirements. Patients on GICU had a mean cumulative deficit of 3439 kCal, 169 g protein and patients on CICU had a mean cumulative deficit of 2173 kCal, 203 g protein. Feed was stopped for a mean of 48 hours per patient (range 8e101 hours), which equated to 15% of total feed time for GICU patients and 19% of total feed time for CICU patients. The primary cause of interruptions to feeding was airway procedures, followed by surgical procedures. The cause for 230 hours of stoppage could not be identified.
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