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Managing nasogastric tube feeding and keeping nutrition

Health is defined by WORLD HEALTH Business(WHO) as a "state of complete physical, mental and communal well being and not merely the lack of any disease or infirmity". Health is a confident quality which emphasizing physical, cultural, intellectual, emotional and religious well-being.

Maslow's hierarchy theory claims that basic individuals needs are necessary for human survival and health. The most basic or first level include physiological needs such as air, food and water. Matching to Maslow, the amount to which basic needs are fulfilled is a significant factor determining individuals level of health.

Food is anything that can be employed by your body to sustain progress and bodily operations and energy. Each individual food has its own unique set of nutrients that meet the varying requirements of the human body. This is why it is so important to eat a wide variety of food to ensure that the body gets all the diverse and essential nutrition.

Nutrients will be the components of food that help to nourish the body. The basic classes of nutrients are carbohydrates, lipids(fat), protein, vitamin supplements, minerals and water. All nutrition, both in kind and amount, are the cornerstone of good health and provides the cutting edge for protection of diseases.

These nutrition are supplied to the body cells by gastro intestinal system. This is accomplished through the procedure of ingestion(taking food), digestion(breakdown of food), absorption(transfer of food product into flow).

Good nutritional status refers to the consumption of a sensible diet that supplies all the fundamental nutrition in right percentage to meet the requirements of your body. Such a person may be reported to be receiving optimum nourishment.

Optimum nutritional position can be influenced by many factors such as insufficient diet or consuming food which consists of less nutrients, food patterns and monetary insufficiencies etc.

In sickness the ability to eat and drink effectively can get modified. The disease impacting on central anxious system, gastrointestinal system plus some surgical conditions can alter the patients capability to take the food through the mouth. In these conditions patients are in high risk of under nourishment.

There are man-made feeding methods open to keep the risk patients clear of under diet through enteral and parenteral feeding. When gastro digestive tract cannot be used for the ingestion, digestion and absorption of nutrients parenteral diet may be substituted. Parenteral nutrition refers to the supervision of nutrients by way of a route other than the GI tract(Bloodstream).

When the gastro intestinal tract is useful but patient cannot be provided with high calorie supplements orally, pipe feeding can be provided with nasogastric pipe, nasointestinal pipe, gastrostomy and jejunostomy.

A nasogastric tube is commonly used for short-term nourishing problems, usually bought for an individual who has an operating GI tract but unable to take any or enough oral nourishment. Nasogastric tube feeding is a technique of giving food in patients, who are not able to swallow the food through mouth, by making use of a long soft plastic pipe which is put through the nose area via throat straight into the abdomen.

The record of enteral feeding goes back about 3500 years back to the historical Greeks & Egyptians, who infused nutrient requirement solutions into the rectum to take care of various bowel disorders. The early Egyptians used reeds and animal bladders to provide patients with a variety of wine, poultry broth and uncooked eggs. In 1793, an early healer delivered jelly, eggs, milk, sugar and wine beverage to an individual by having a hollow whale bone protected with eel skin, which was pressed down the throat to the tummy. In 1800, Philip Phisik, a plastic surgeon from Philadelphia, created the use of the stomach tube as a kind of abdomen pump (Paine, 1934). This is used for poisoned patients for the intended purpose of cleansing out their belly.

In the 1930s, nurses trained in Australia and the uk utilized a words entitled Modern Professional Medical (Scott, c1930). It included dialogue of using a tube placed via the nasal area into the tummy, apparently for the sole occasional purpose of administering bolus artificial feeding. Furthermore to diet delivery in the 1930s, nasogatric tubes also were used to relieve pressure in the tummy brought on by gas and gastrointestinal secretions (decompression).

Today nasogastric tube feeding is a very common procedure observed in the medical and surgical products of the nursing homes. The tube is constructed of superior plastics like polyethylene, polyvinyl or polyurethane (Clevenger & Rodriguez, 1995). This pipe is inserted through the nose area or mouth and placed directly into the stomach. The need of tube feeding includes delivery of nutrition, administration of medications, gastric irrigation, and gastric decompression before and after surgery or intestinal blockage. Patients with nasogastric tubes currently receive care and attention in a multitude of adjustments, such as extensive medical and operative care units, crisis rooms, , basic and specialized acute and chronic attention areas, extended health care facilities, and home care and attention settings(Susan C Dewit, 2006).

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The supply provided through the nasogastric pipe should be in liquid or semi-liquid form and given in room or body's temperature. Blenderized foods from a normal diet or commercial formulas are usually provided. Feedings are given by gravity drip method or by feeding pump or by intermittent feeding. A maximum amount of 300-400 ml of give food to can be provided at the same time sent at an interval of 2-3 hrs depending after the patients tolerance and physicians advice. . A number of feeds should be provided though nasogastric pipe in order to ensure the optimum nutritional status.

Caring of the patients acquiring nasogastric tube feeding is a major nursing responsibility that requires lots of interventions like delivering feeds, assessing correct keeping the tube, maintaining the tube's patency, ensuring adequate nutrition, protecting the tube set up, and appointment patient comfort and other basic needs. The weight of the patient should be inspected daily and maintain an accurate consumption and end result record. Blood glucose level also should supervised at distinct intervals. When the patient is a permanent feeding keeping the diet and health and wellness is an important and nurse's responsibility. To be able to maintain the nutritional position the nurse should compute patients requirements and choose diet accordingly.

Emma L(1983) highlights enteral feeding is associated with greater risk of problems, around 11. 7%. Her research uncovers that tube-related issues are normal in patients obtaining long-term home enteral diet. Even though different feeding modalities can be found, unfortunately no method of enteral feeding is without risk. aspiration pneumonia, high gastric residuals, constipation, diarrhea, belly distention, vomiting, regurgitation, erosion of esophageal, nose and oropharyngeal mucosa and infections are the difficulties of pipe feeding.

Initially only nurses were carried out this process. However, over years caregivers of the patient are also involved in feeding the patient through the pipe. Now the duty of feeding the patient through the tube is distributed by the caregivers both in clinic and home options. Since the family are also involved in feeding patients they must be instructed about nourishing, importance of wholesome diet, signs and symptoms and importance of reporting them to the doctor or nurse.

Ellet. M L, A. Expresses enteral feeding is advisable because it allows better use of nutrition, is safer, and more cost effective than parenteral nutrition. Tube feeding permits maintenance of muscle metabolism even though patient cannot ingest anything through mouth. The potential good thing about pipe feeding includes providing nourishment to the patient prolonging life and improving comfort and standard of living(WONG 2002). Current situation shows enteral pipe feeding is a common medical procedure in lots of the hospital, long-term and home care setting.

NEED OF THIS STUDY

. Handling nasogastric tube feeding and retaining the diet are a nurse's responsibility. In the beginning only nurses were carried out this procedure but over years caregivers of the individual also shared the duty of feeding the patient through the pipe. Now Family members are participating in feeding the patient through N. G Pipe both clinic and home settings. Caregivers regarding in feeding is a good aspect of patient care but when they are participating they must be properly trained and educated. However in many adjustments the caregivers are feeding the individual without proper understanding about any of it. Researcher also observed the faulty nourishing techniques of the caregivers while he was working in the medical and operative departments. Even though no problems were reported so far, the patients are in high risk to getting complications.

STATEMENT

A Analysis TO MEASURE THE Efficiency OF STRUCTURED Coaching ON KNOWLEDGE AND TECHNIQUES OF NASOGASTRIC Pipe FEEDING BECAUSE OF THE CAREGIVERS OF PATIENTS RECEIVING TUBE FEEDING WITHIN A SELECTED HOSPITAL AT ALAPPUZHA, KERALA

SPECIFIC OBJECTIVE

1)To determine and compare the amount of knowledge regarding nasogastric feeding, between control and experimental group before and after treatment.

. 2)Assess and compare the amount of strategy of nasogastric pipe nourishing between control and experimental group before and after involvement.

3)To associate the decided on demographic variables(age, education, job and source of training) with knowledge and techniques of feeding among experimental group.

AIM OF THE STUDY

The goal of the analysis is to judge whether structured teaching about NG pipe feeding made any difference in the data and techniques of caregivers in nourishing patients through nasogastric pipe compared to those who did not receive the organized teaching.

HYPOTHESIS

There is a factor between experimental and control group of caregivers with regard to the data and technique of nasogastric tube feeding.

SUB HYPOTHESIS

H1-There will be a significant difference in the mean knowledge score on tube nourishing among caregivers of the experimental and control group following the intervention no significant difference before involvement.

H2- You will see a significant difference in the scores of techniques of feeding between the control and experimental group after involvement no difference before treatment.

OPERATIONAL DEFINITION

EFFECTIVENESS : On this study effectiveness identifies the data gained by the caregiver consequently of selected aspect of nasogastric tube feeding and the capability to perform the tube nourishing with correct approach.

KNOWLEDGE : knowledge identifies ideas, information, factual knowledge presented by a person from various resources. In this review knowledge identifies the factual information gained by the members regarding naogastric pipe feeding through the teaching learning experience which is assessed by using structured interview timetable.

TECHNIQUE

Technique is just how of carrying out an activity step-by-step and systematically. On this study technique refers to the correct method of undertaking N. G Pipe feeding with the correct application of medical principles of pipe feeding

STRUCTURED TEACHING

Structured teaching refers to planned events, group of studies &lectures with a view to boost knowledge. On this study it identifies a formal instruction which is preplanned with definite, objectives, contents, teaching, learning experience and AV supports to impart essential knowledge on pipe feeding and how to give feeding securely to the patients.

CAREGIVERS

Caregivers will be the family of the patients who stay with the patient most of the time and participates in patient care and attention including feeding patients through nasal tube and assume obligations in the individual care activities

NASOGASTRIC Pipe FEEDING

Naogastric pipe feeding is a method of supplying nourishment to patients who weren't able to swallow the meals through mouth by the assistance of along very soft plastic pipe which is inserted through the nasal area via throat directly into the stomach

ASSUMPTIONS

N. G Pipe feeding is an extremely prevalent and common process in both inpatient and home adjustments. Patients relatives are also taking part in feeding the individual. The family members are undertaking the task with or without satisfactory knowledge, training, and supervision regarding nasogastric pipe feeding and hence this brings about a whole lot of negative effects on the relative-dependent patient.

LIMITATION

The analysis is conducted in mere one hospital. Therefore the result cannot be generalized.

Because of the restrictions from a healthcare facility and anticipated to limitations owing to age guidelines, the sample might not exactly be a representative one.

For an education programme to work, continuous follow-up is essential. But in this instance, due to limited time availability, it might not be possible.

DELIMITTION

The study is delimited to,

Three observations.

Only one medical center.

An generation of 20-60yrs.

SCOPE OF STUDY

Through this study the researcher can determine the data and techniques of the caregivers about nasogastric tube feeding by examining the knowing of tube feeding in several aspects. Regions of less knowledge can be centered.

The understanding about the correct knowledge and approach of tube feeding will help those to provide feeding by using appropriate techniques, avoid potential issues and promote patient's basic safety.

These findings can help the health care and attention providers to give necessary attention to provide sufficient training to the family of the patients who need to feed through nasogastric pipe both in home and hospital settings.

RESEARCH FRAMEWORK

A shape work is the foundation of a theory, talking about mental image of a phenomena which can be abstract or concrete.

A theory is a set of interrelated concepts, designed for a clinical purpose, meanings and propositions, that present a organized view of phenomena by specifying relations among parameters with the goal of detailing predicting the phenomena (Kerlinger 1986).

A conceptual construction provides structural basis to the study study which provides rationale for predictions about romance among the parameters in the study. Conceptual framework sorts the base for observations, explanations of ideas, research design, interpretation etc. Conceptual platform gives meaning to the condition and study findings by summarizing existing knowledge in field of inquiry and discovering linkage between concepts.

For this research the Conceptual framework adopted is nursing process model predicated on Dorothy. E. jhonson's behavioural system theory(1980). The analysis focus on evaluating the potency of providing structured teaching programme on the knowledge and techniques of nasogastric tube feeding among the list of caregivers of the individual.

According to Jhonson, nursing views the individual as a couple of interconnected or unbiased parts operating as a built-in entire. Humans seek encounters which could disturb balance and require action modifications to re-establish balance. The behavioral system are crucial and reveal adaptations that are successful. Jhonson discovered seven sub systems. The sub systems are affiliative, aggressive, dependency, eliminative, ingestive, restorative and intimate. These sub systems carryout special function for the system all together. Disturbances in any subsystem usually affects the other. The steps of the medical process is offered with Dorothy Jhonson's behavioural system model. Nursing process is a deliberate activity where the practice of nursing is conducted in a organized order. Dorothy Jhonson presents a three step nursing process. The steps are entitled nursing medical diagnosis which is parallel to the evaluation and diagnostic stage, the next step nursing goal equals the execution and third step is analysis. This study focuses on the caregivers of the individual and the dependency subsystems.

Assessment

Assessment is the procedure of collecting data regarding each sub-system. In this study assessment was done in the dependency subsystem. Data on the demographic characteristics of the caregivers(age, gender, education, profession, experience in nourishing, instructions and source of instructions received on pipe feeding) were gathered. The data of caregivers regarding various aspect of nasogastric pipe feeding were assessed by an interview agenda and an observational List of guidelines was used to assess

the technique of feeding.

Diagnosis

Through diagnosis of the subsystem problems are discovered and diagnosed which supply the basis for intervention. In this study the data's were gathered through observational List of guidelines and interview plan was examined and the identification was made on knowledge and technique of caregivers and grouped into excellent, good, average and poor.

Nursing goals(planning)

After diagnosis is made the target is to maintain or repair the dependency subsystem balance and balance through planning interventions. In such a study the target was to improve the caregivers level of knowledge and approach of pipe feeding.

Intervention

Nursing activity as an exterior regulatory force facilitates the individual to regain equilibrium. Predicated on diagnosis, nursing actions can be designed in terms of teaching or providing resources needed. With this study the nursing activity was a set up teaching including demonstration on different facets of tube feeding.

Evaluation

Evaluation refers to reassessment the subsystem which is discovered as difficult for balance previously. With this review the investigator likened knowledge and technique of experimental group with control group by using criteria and evaluated the potency of the treatment.

Figure-1 High signals the conceptual construction on modified nursing process based on Dorothy. E. Jhonson's behavioural system model

Implementation

Evaluation

No changes observed in the level of knowledge and strategy.

Patients at risky to getting complications

-Caregivers demonstrate improved degrees of knowledge and techniques of feeding.

-patient less risk of getting complications

Control group

-No teaching programs.

experimental group

-A Structured teaching regarding ding different facets of pipe feeding and demonstration of the strategy of pipe feeding

Assessment

Diagnosis

goal

FIGURE 1. MODIFIED NURSING PROCESS PREDICATED ON DOROTHY JHONSON'S BEHAVIOURAL SYSTEM MODEL(1980)

Improve the caregivers degree of knowledge and technique of pipe feeding

Level of knowledge and techniques of tube feeding

-excellent

-good

-average

-poor

Caregiver's demographic variables

-Age

-Sex

-Education

-Occupation

-Experience in feeding

-instruction and supervision received

-source of instruction

-attitude

-Lack of seriousness

-Fear and anxiety

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