Improving Patient Experience In The Area Of NGT Sample

METHODOLOGY

Various approaches have been taken as a part of research methodology. A thorough exploration of the literature has been carried out which is in form secondary sources of literature. It involved for studying the journal articles, research papers, books that have been written on the topic of Nasogastric Tube Feeding. There has also been a study of policy documents as well as guidelines on Nasogastric Tube Feeding. This is a must so as to assist in the process of Improving the Patient and Service Experience that has been provided to service users. This form of methodology has been used for many reasons.

The methodology is most relevant as study of secondary literature sources will assist in getting a brief review about the topic of Nasogastric Tube Feeding. Many recent issues have also been observed in provision of a well defined patient care in the area of Nasogastric Tube Feeding. Hence, it is only by studying the secondary sources of literature a brief outline can be created on the issues followed by which a manner in which patient care can be improved. In this regard, the required audience that has been selected happens to be the manager of neuro ward as well as the health care team that is involved in the provision of Nasogastric Tube Feeding to the patients. The managers are responsible for complying with the policy norms so that they can provide for proper training in the area of nasogastric feeding. All Trust employees should ensure is an audience so as to make them competent in the procedures used for delivery of practice.

RATIONALE

The given topic of Nasogastric Tube Feeding is an important area as thousands of individuals have been undertaking this technique on a daily basis. Families that are caring for loved ones who have been chronically ill are often required to decide on whether they should use feeding tubes when the patient is no longer able to chew and swallow his or her food . Hence, the requirement happens to be proper as well as in-depth provision of enhancement in the services provided to patient who are being fed by NGT instruments. This is a must so as to provide proper as well as good care to patient in all accords.

LITERATURE REVIEW

Nasogastric Tube Feeding

As per the view points of Acton, 2012, “Nasogastric Tube Feeding is given to a patient when a person cannot eat or drink enough so as to complete the requirement of getting adequate amount of nutrition” (Acton, 2012). This kind of Tube Feeding is usually recommended if a person wishes to get nutritional support for a short duration of time (Brousseau and Kost, 2006). It may also be must if a person who are having radiotherapy towards mouth, throat as well as gullet and is difficult for them to undergo swallowing as a result of swelling that is present due to the radiotherapy.

As the researcher has been working in the neurology ward, where it has been found out that as any kind of progression is observed in neurological illnesses then there is a situation when muscles of the throat cease to work properly on a gradual basis (Reising and Neal, 2005). This leads to many kinds of issues in terms of swallowing, gagging, choking and coughing followed by loss in voice and an inability to catch breath. This leads to a chance by which a person starts to eat less (Gallagher, 2004).  Good nutrition is often a key to heal the body in all accords. Fluid intake is also a major requirement to prevent the body from getting dried off. This kind of a Nutritional support is a must for patients who are not able to eat or even drink in a usual manner. This is a requirement so as to;

• Prevent overall loss of weight. 
• Help people who wish to put on more weight.
• Overcoming of weakness as well as tiredness found in patients who have been suffering from long illness like cancer .
• Making sure that the fluid intake of patients has been attained in a proper manner. 
• Easing the problems faced by patients who find it difficult to eat on account of swallowing issues . 

According to Lewis and McKenna, 2009, “a nasogastric (NG) tube is a long and narrow feeding tube that passes through the nose and reaches down the stomach. It is very soft as well as bendable in nature” (Lewis and McKenna, 2009). The equipment for this consists of a 60cc syringe, liquid that has been prescribed by doctor, a measuring cup, clean container of food as well as IV pole or wall hook so as to hang the container while feeding activity is being performed (Rao and et. al., 2011). The Nasogastric Tube Feeding is a common practice that is observed in all groups of patients which begin from neonatal to older years. Thousands of nasogastric feeding tubes are found to be inserted.

Nasogastric tubes are added so as to deliver the food directly into stomach. It also aids in removal of substances from the stomach and sometimes as a means for testing of contents in stomach. The most common purpose happens to be insertion of a nasogastric tube so as to deliver feedings to patients who are not able to eat (Kunstman and et.al. 2013). Patients in need of a nasogastric tube are the ones who are in coma, have undergone surgery or are on mechanical ventilation. Other than food there is also a delivery of various substances like stopping the bleeding in stomach as well as medication so as to neutralize the effect of poisons that have been swallowed. According to Jeffery and Grant, 2012, “placing a Nasogastric tube thus helps in prevention of nausea and vomiting for removal of stomach contents, prevention of distention in stomach when the patient had ulcer bleeds, obstruction in bowel or other kinds of gastrointestinal diseases” .

Procedure for nasogastric feeding

Procedure for nasogastric feeding is required to be followed in all accords so that a proper management of the patient can be carried out in a proper manner. This is required to be ensured so that a proper kind of service experience can be delivered to patients.

• Assessment and Preparation of the Client - The clients chart is required to be checked followed by confirming of physicians order towards NGT feeding. This is done so as to make sure that right process is given to right client. 
• Preparation - This involves for washing hands followed by preparing of materials in the correct amount. 
• Positioning of patient - It is essential to place the patient in a right manner like in bed or proper sitting on chair (Acton, 2012). This is required so as to enhance gravitational flow and prevent the chances of aspiration from lungs in all possible accords. A disposable pad can also be kept so as to void the area from getting messy. 
• Positioning of instrument - This involves an essential role from the service providers where there is a requirement to assess the Patency of Tubing as well Contents of Residual Feeding.

Administer the Feeding - This is one of the major steps and required for undertaking a proper care on part of service providers. The requirement happens to be cleaning of tube so as to facilitate smooth flow of solution (Gallagher, 2004). The feeding must be made to flow in a smooth and slow fashion followed by adjustment of syringe in order to make the flow easier. The service providers are required to remain alert so that the patient does not feel discomfort and if this happens then it is best to stop the flow for a minute. Administration of feedings must be done properly in order to avoid vomiting, pain and flatus. This is followed by removal of tube along with ensuring of comfort and safety of patient.

Issues in nasogastric feeding

Many issues have been noted on part of health care professionals when they are undertaking the process of nasogastric feeding on patients. One such issue that has been observed in the area of providing for a well defined patient service experience happens to be the delay that is caused in schedule feeds due to busy time plan of nurses. The unavailability of careers who are responsible for nasogastric feeding is also a crucial issue that is being faced by most of the staff members and patients (Nasogastric (NG) Tube Feeding: Common Problems, 2013). This results towards lack of consistency in the process of Nasogastric Tube Feeding that has been scheduled to be provided for the patient. Other issues can be in form of blockage in tubes if it is not flushed before and after the intake of medicines. Sometimes the lack of time on part of heath care professionals may lead to feeding without putting the Patient in upright position. This can led to an increased chance of vomiting. A faster rate of feeding can also led to issues. There can also be development of difficulty in breathing during or immediately after feeding if proper position is not set by the care giver. Issues can also occur if care is not given to the amount and time span of food that is kept in feeding bag which should not be for more than eight hours.

Management of patient on NGT delay in schedule feeds

Patient and the caregivers can be regarded as important team members who are required to play a key role in the effective management of nasogastric tube feeding.  Management can only take place when health practitioners and nurses involved in the area of Nasogastric Tube Feeding encourage the patients as well as the caregivers to be an active participant in the area of tube feeding (Acton, 2012). Management can only take place when there is a development of a suitable action plan that is consistent with the goals of patients who is undertaking nasogastric feeding.

CONCLUSION

It can be concluded that there is often a need to improve patient or service enhancement in the area of NGT feeding. This is a must so as to make the life of chronically ill patient a healthy one by giving them nutrient amount in the best possible amount. There can be a usage of a suitable action plan by which the overall service and patient experience that is provided to service user of nasogastric feeding can be improved. In this regard, a proper service plan can only be provided if clinical management practices have been followed by the staff members. It has been discussed in the appendix section.

Research Proposal for Medical Department

Development of Targets for Self-improvement

REFERENCES

• Acton, A. Q., 2012. Issues in Drug Management, Toxicology, Monitoring, Resistance, and Safety. Scholarly Editions. 
• Bowling, T., and et.al., 2010. Nutrition and the Cancer Patient. Oxford University Press. 
• Brousseau, V.J., and Kost, K.M., 2006. A rare but serious entity:  nasogastric tube syndrome. Otolaryngol Head Neck Surg.
• Daryaei, P., and et al., 2009. Omission of nasogastric tube application inpostoperative care of esophagectomy. World J Surg.
• Gallagher, E.J., 2004. Nasogastric tubes: hard to swallow. Ann Emerg Med.

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