Development of a Competency Model for Placement and Verification of Nasogastric and Nasoenteric Feeding Tubes for Adult Hospitalized Patients

Powers, Jan; Brown, Britta; Lyman, Beth; Escuro, Arlene A.; Linford, Lorraine; Gorsuch, Kim; Mogensen, Kris M.; Engelbrecht, Jessica; Chaney, Amanda; McGinnis, Carol; Quatrara, Beth; Leonard, Jennifer; Guenter, Peggi

doi:10.1002/ncp.10671

Cited by 20 publications

(30 citation statements)

References 90 publications

(118 reference statements)

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“…Moreover, quick judgement is required for learners to make decisions when facing different clinical situations. In this way, complications and harm that may be caused to patients during the implementation of complex medical skills can be prevented (Henriksen et al, 2018; Powers et al, 2021). However, many physicians do not gain sufficient technical practice during school, which easily results in a lack of confidence in their independent practice in clinical settings (von Cranach et al, 2019; Yu et al, 2021).…”

Section: Introductionmentioning

confidence: 99%

Fostering complex professional skills with interactive simulation technology: A virtual reality‐based flipped learning approach

Lin

Hwang

Chou

et al. 2022

Brit J Educational Tech

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It has always been a challenging issue to develop complex professional skills accompanied with sufficient professional knowledge and correct judgement. Previous studies have indicated that students have more opportunities for practice in flipped learning contexts. Basically, complex professional skills training is often risky in different real-world applications. Therefore, most medical training lessons are done through case discussions, interpretation of mannequins, and watching videos. Such learning models are, however, not only ineffective, but students fail to solve real problems without sufficient drills. The advanced progress of 3D simulation technology provides good opportunities to solve these problems. Virtual reality (VR) provides simulations for real clinical scenarios, offering medical students the chance to practice standard complex medical skills repeatedly, as well as thinking about and responding to clinical problems in VR, where they can obtain immediate feedback from VR learning systems. Thus, to enhance medical students' complex medical skills, the study proposes a virtual reality-based flipped learning approach. To investigate the effectiveness of the proposed approach, a quasi-experimental design was conducted with two groups in a lumbar puncture course for postgraduate year (PGY) residents of a hospital The experimental group with 39 students was conducted with virtual reality-based flipped learning (VR-FL), while the control group with 37 students was managed by traditional flipped learning (T-FL).

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Section: Introductionmentioning

confidence: 99%

Fostering complex professional skills with interactive simulation technology: A virtual reality‐based flipped learning approach

Lin

Hwang

Chou

et al. 2022

Brit J Educational Tech

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“…The use of direct visualization is an optional step in the placement procedure, which gives the ability to visualize the internal anatomy and the ability to change the tube direction as indicated/needed. NG tubes placed using direct visualization show an overall placement time in the five to 11-minute range with 90% gastric placement [ 4 ]. Radiographs to confirm Dobhoff placement are currently the gold standard in practice [ 4 ].…”

Section: Methodsmentioning

confidence: 99%

“…NG tubes placed using direct visualization show an overall placement time in the five to 11-minute range with 90% gastric placement [ 4 ]. Radiographs to confirm Dobhoff placement are currently the gold standard in practice [ 4 ]. An optimal Dobhoff securement technique is imperative for successful continued use and the prevention of dislodgement/interruption of nutrition.…”

Section: Methodsmentioning

confidence: 99%

Nasogastric Feeding Tube/Dobhoff Placement: A Multidisciplinary Approach to the Management of Malnutrition During Radiation Therapy in Patients With Head and Neck Cancer

Coke¹,

Gilbert²,

Hill³

et al. 2022

Cureus

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Background Radiation therapy (RT)-associated oral mucositis, xerostomia, thick mucoid saliva, nausea/vomiting, and loss of taste may result in significantly compromised oral intake in patients undergoing treatment for head and neck cancers (HNC). Feeding tube placement allows patients to receive enteral nutrition and continue the planned course of treatment. Objectives RT-associated oral mucositis, xerostomia, and loss of taste may result in significantly compromised oral intake in patients undergoing treatment for head and neck cancers. We sought to determine if reactive nasogastric (NG) tube placement was an effective strategy for nutritional support in these patients and if invasive percutaneous endoscopic gastrostomy (PEG) tube insertion could be avoided. Methods This is an institutional review board (IRB)-approved study of patients treated for head and neck cancer using definitive or adjuvant RT with or without concurrent chemotherapy between June 2017 and December 2020. We evaluated the indications for NG tube (Dobhoff) placement, time of placement during the course of RT, patient tolerance of NG tube, and median duration of NG tube placement. In addition, we followed weight loss during treatment, treatment interruptions, and treatment-related toxicities. Complications associated with having the NG tube, if the NG tube needed to be replaced during treatment, and if the patient had any hospitalization during the course of treatment were tracked. Results Of the 441 patients treated for head and neck cancer during the time period of this study, 47 required reactive NG tube placement for nutritional support. Patients included 40 with primary oropharynx, three with oral cavity, two with larynx, one with nasopharyngeal, and one was unknown. Chemotherapy was given concurrently with radiation in 87.2% (n=41) patients. The median time of NG tube placement was during Week 5 of the six to seven-week course of RT. The median percentage of weight loss from baseline to the date of NG tube placement was 12.9% (range, -0.9% to 25.9%). The median rate of weight loss decreased by 8.7% from the date of NG tube placement to the end of treatment. The median duration of NG tube placement was 29 days (range, 5 to 151 days). There were no serious medical complications associated with having the NG tube in place during treatment. Twenty-seven point six percent (27.6%; n=13) of patients had the NG tube dislodged or displaced and needed replacement. Thirty-eight point three percent (38.3%; n=18) of patients with an NG tube had to be hospitalized during the course of RT, with the predominant symptoms being failure to thrive (22.2%; n=4) and nausea/vomiting 22.2% (n=4). Six point four percent (6.4%; n=3) of patients requested the removal of the NG tube due to local irritation. Seventy-six point six percent (76.6%; n=36) of patients did not require further nutritional support with the placement of a percutaneous endoscopic gastrostomy (PEG) tube. ...

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“…Some of the risks in ENT are related to the different steps by which it is composed sequentially, such as medical and dietary indication and prescription, preparation, conservation, storage, transport, administration, clinical laboratory monitoring, and evaluation (Kozeniecki & Fritzshall, 2015). From this perspective, hospital care in ENT implies a combination of knowledge and practices from different specialties, various professionals, and processes, in an interdependent way, in a team, making it a complex procedure with a high risk for adverse events (AE) and incidents (M. C. Paiva, Paiva & Berti, 2010;Powers et al, 2021). At the national level, RDC 503 of the National Health Surveillance Agency established the minimum technical requirements for enteral nutrition therapy.…”

Section: Introductionmentioning

confidence: 99%

Safety in enteral nutritional therapy: knowledge of patients and caregivers

Paiva¹,

Lima²,

Paiva³

et al. 2023

Rev. Uningá

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This study aimed to examine the knowledge of patients and companions about enteral nutritional therapy (ENT) and compare similarities. This descriptive, prospective, quantitative study was conducted in a university hospital in the interior of the state of São Paulo. The study population consisted of 13 hospitalized patients and 47 companions who were interviewed over 7 months. Data regarding medical, nutritional, and nursing care were verified using electronic patient records. Data about the patients ENT was obtained through a structured questionnaire, and were compiled for this study based on the minimum requirements for ENT care in the RDC Nº 503. The statistical analysis used average and pattern deviation, median and 25-75th percentile, and number of cases and percentage. To compare proportions and agreements of the answers, the chi-square test and agreement of Kappa were used. The following was verified for patients and companions: lower correct answer frequencies in relation to the nutritional state, probe positioning test, type and quantity of prescribed diet, hand hygiene, prevention of distention/diarrhea/constipation, and different answers regarding the assessment of body weight, and knowledge of the position of the bed for feeding and hydration. It was concluded that the knowledge of patients and companions about ENT proved to be insufficient to promote patient safety. Information from companions, with few differences, is similar and in agreement with that of patients.

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Development of a Competency Model for Placement and Verification of Nasogastric and Nasoenteric Feeding Tubes for Adult Hospitalized Patients

Cited by 20 publications

References 90 publications

Fostering complex professional skills with interactive simulation technology: A virtual reality‐based flipped learning approach

Fostering complex professional skills with interactive simulation technology: A virtual reality‐based flipped learning approach

Nasogastric Feeding Tube/Dobhoff Placement: A Multidisciplinary Approach to the Management of Malnutrition During Radiation Therapy in Patients With Head and Neck Cancer

Safety in enteral nutritional therapy: knowledge of patients and caregivers

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