The Feasibility Study of a Revised Standard Care Procedure on the Capacity of Nasogastric Tube Placement Verification Among Critical Care Nurses

10.1097/jnr.0000000000000302

Feng-Huang YANG；Feng-Yu LIN；Yueh-Juen HWU

critical care ； intervention study ； nasogastric tube ； placement verification

The Journal of Nursing Research

27卷4期（2019 / 08 / 01）

1 - 8-003

英文

Background: Evidence-based studies propose that the aspirate pH test may be easily and reliably conducted to verify the proper placement of nasogastric tubes (NGTs). Nurses rarely implement this procedure because of the lack of related knowledge. Purpose: The purpose of this study was to explore the feasibility of implementing a revised standard care procedure to enhance nurses' ability to verify placement of the NGT. Methods: his study used a quasi-experimental, longitudinal research design. Nurses from two intensive care units were randomly assigned to the experimental group (n = 35) and the control group (n = 31). A revised standard-of-care procedure to confirm the proper placement of an NGT was incorporated into a slideshow presentation, a printed leaflet, and an audit checklist. The experimental group received continuous education and individual teaching on the revised standard-of-care procedure, whereas the control group did not receive additional education and continued to provide conventional care. The study gathered data using scales designed to address knowledge of and attitudes toward verification of NGT placement and the checklist for auditing the NGT care procedure. Scales were implemented before and after the practice program was conducted, in Months 1, 2, and 3, to evaluate the feasibility of the developed improvement measures. Results: This study found significant improvements in the experimental group in terms of knowledge regarding NGT placement verification and the NGT care auditing procedure. The positive improvement of the intervention on the NGT care auditing procedure remained for at least 3 months after the end of the intervention. Conclusions: The findings suggest that using an aspirate pH test is a feasible approach to verify NGT placement in critical care units, a crucial aspect of care necessary to promote patient safety and quality of care.

1. Lin, Y. L.,Liao, C. C.,Yu, W. P.,Chu, T. L.,Ho, L. H.(2018).A multidisciplinary program reduces over 24 hours of physical restraint in neurological intensive care unit.The Journal of Nursing Research,26(4),288-296.
   連結：
2. American Association of Critical-Care Nurses(2016).AACN practice alert: Initial and ongoing verification of feeding tube placement in adults.Critical Care Nurse,36(2),e8-e13.
3. Boeykens, K.,Steeman, E.,Duysburgh, I.(2014).Reliability of pH measurement and the auscultatorymethod to confirm the position of a nasogastric tube.International Journal of Nursing Studies,51(11),1427-1433.
4. Bourgault, A. M.,Heath, J.,Hooper, V.,Sole, M. L.,Waller, J. L.,Nesmith, E. G.(2014).Factors influencing critical care nurses' adoption of the AACN practice alert on verification of feeding tube placement.American Journal of Critical Care,23(2),134-143.
5. Chan, E. Y.,Ng, I. H.,Tan, S. L.,Jabin, K.,Lee, L. N.,Ang, C. C.(2012).Nasogastric feeding practices: A survey using clinical scenarios.International Journal of Nursing Studies,49(3),310-319.
6. Cohen, J.(1992).A power primer.PsychologicalBulletin,112(1),155-159.
7. DiBardino, D. M.,Wunderink, R. G.(2015).Aspiration pneumonia: A review of modern trend.Journal of Critical Care,30(1),40-48.
8. Eveleigh, M.,Law, R.,Pullyblank, A.,Bennett, J.(2011).Nasogastric feeding tube placement: Changing culture.Nursing Time,107(41),14-16.
9. Fan, E. M.,Tan, S. B.,Ang, S. Y.(2017).Nasogastric tube placement confirmation: Where we are and where we should be heading.Proceedings of Singapore Healthcare,26(3),189-195.
10. Faul, F.,Erdfelder, E.,Lang, A. G.,Buchner, A.(2007).G* power 3: A flexible statistical power analysis program for the social, behavioral, and biomedical sciences.Behavior Research Methods,39(2),175-191.
11. French, S. D.,Green, S. E.,O’Connor, D. A,McKenzie, J. E.,Francis, J. J.,Michie, S.,Grimshaw, J. M.(2012).Developing theory-informed behaviour change interventions to implement evidence into practice: A systematic approach using the theoretical domains framework.Implementation Science,7,38-40.
12. Jiang, Y. X.,Lin, F. Y.,Kao, M. C.,Lin, R. A.,Wu, S. J.(2013)。A systematic review of methods for detecting nasogastric tube misplacement after insertion。The Journal of Long-Term Care，17(2)，105-124。
13. Ke, S. C.,Lin, F. Y.,Hsieh, Y. H.,Hwu, Y. J.,Chang, C. N.(2014)。Project to increase the nasogastric tube verification practice。Show Chwan Medical Journal，13(3–4)，63-72。
14. Kunis, K.(2007).Confirmation of nasogastric tube placement.American Journal of Critical Care,16(1),19.
15. Metheny, N. A.,Titler, M. G.(2010).Assessing placement of feeding tubes.The American Journal of Nursing,101(5),36-45.
16. Peter, S.,Gill, F.(2009).Development of a clinical practice guideline for testing nasogastric tube placement.Journal for Specialists in Pediatric Nursing,14(1),3-11.
17. Schunk, D. H.(2007).Learning theories: An educational perspective.Upper Saddle River, NJ:Prentice Hall.
18. Stepter, C. R.(2012).Maintaining placement of temporary enteral feeding tubes in adults: A critical appraisal of the evidence.Medsurg Nursing,21(2),61-68.
19. Stewart, M. L.,Biddle, M.,Thomas, T.(2017).Evaluation of current feeding practices in the critically ill: A retrospective chart review.Intensive and Critical Care Nursing,38,24-30.
20. Tan, L.,Chang, L.,Wu, H. P.(2012)。Measuring the pH of gastric aspirate to determine nasogastric tube placement: A systematic review。Chinese Journal of Practical Nursing，31，57-59。
21. Tu, C. T.(Ed.)(2017).Experimental research methods and analysis of covariance.Taipei City, Taiwan, ROC:Wu-Nan Book.
22. Wu, S. J.,Lin, F. Y.,Hwu, Y. J.,Ke, S. C.,Chang, C. N.(2016)。Evidence utilization of NG tube care in the intensive care units。Resuscitation & Intensive Care Medicine，1(3)，130-141。
23. Yang, F. H.,Lin, F. Y.,Hwu, Y. J.(2017)。Knowledge, attitude, and behavior of Taiwan nurses toward nasogastric tube placement verification。Cheng Ching Medical Journal，13(1)，55-63。

1. 胡月娟,呂哲維(2020)。機構住民軟食餐點的創新研發。護理雜誌，67(4)，33-38。
2. 宋惠娟,余佳倫,王琬詳(2022)。跨團隊鼻胃管照護三部曲。護理雜誌，69(1)，33-40。