VOL: 97, ISSUE: 16, PAGE NO: 52
Rebecca George, BSc, RGN, is nutrition support nurse, Torbay Hospital, DevonBoth administration of medication and aseptic technique are taught and assessed as defined skills (Shaw, 1994). However, enteral tube-feeding skills are predominantly acquired according to the 'see one, do one, teach one' ethos and so do not always share the same clinical importance.
Both administration of medication and aseptic technique are taught and assessed as defined skills (Shaw, 1994). However, enteral tube-feeding skills are predominantly acquired according to the 'see one, do one, teach one' ethos and so do not always share the same clinical importance.
Despite the availability of local and national guidelines (Colagiovanni, 1999; Burnham, 2000) a need for greater understanding of placement techniques and devices, accessible to everyone needing to develop enteral feeding skills, was evident in our trust.
The nutrition support team monitors and provides enteral and parenteral nutrition support trustwide. I am involved in raising awareness of malnutrition, and a major component of my practice involves the education of health care professionals, patients and carers.
I applied for an educational grant to develop a clinical skills station for enteral feeding and to purchase a training mannequin for the insertion and care of nasogastric and gastrostomy tubes.
We are based in a resource room in the endoscopy department of the hospital, which has given us the perfect place to set the station up, along with a video recorder, internet access and audiovisual links to the endoscopy rooms to allow endoscopic tube placement to be watched. Our skills station is a trolley (pictured above) complete with training videos, information and current research material. Each drawer contains practice kits for the various routes of nutrition, along with laminated problem-solving cards.
A member of the nutrition team takes responsibility for updating and modifying the station frequently in the light of new research or changing skill needs.
The benefit for health care professionals
The skills station was designed to promote a learning environment in which it is safe for all individuals to practise skills and also provides a range of support information and research material. In addition it offers an opportunity to improve and review individual techniques. It is flexible enough to use for one-to-one sessions or for individuals to visit the station and work through procedures alone, for reading and self-instruction, experiential learning and for tutorials, thereby encompassing a range of teaching approaches suitable to various individual learning styles.
We anticipate that the skills station will reduce training costs and staff time away from the clinical area, as the station can be made available for ward-based sessions as required. It can be easily transported from one clinical area to another and be available trustwide for pre-and post-registration students on the various university courses linked with the trust.
As a nurse-led team we run outpatient clinics and provide home visits, and we look forward to being able to give greater support in the community. This can be achieved by offering training in community hospitals and medical centres and to nurses working in residential and nursing homes.
The benefit for patients and carers
Malnutrition complicates many adult and childhood diseases. Increasingly patients are being discharged into the community from hospital requiring ongoing nutritional support. For home enteral nutrition to be safe, families and carers need appropriate education and the skills to manage tubes, thereby gaining a greater sense of control. Current training with modified dolls means that passing tubes is difficult, unrealistic and anatomically incorrect.
The mannequin training model was developed and studied by the nutrition team at the Princess of Wales Children's Hospital in Birmingham. Their results showed that the model made patients and carers feel more in control and gave confidence and insight into tube displacement and misplacement (Sexton and Holden, 2000).
The skills station offers patients and carers a stressfree environment where they can practise skills as much as they need to. There is plenty of time for questions and discussion to help allay fears as well as offer support to develop practical skills.
As yet a functional anatomically correct mannequin model is still in the manufacturing process, but when it is available it will provide a valuable addition to the skills station. Despite a lack of knowledge in enteral feeding practices, nurses are expected to educate each other, patients, carers and community nurses into whose care the patient is discharged. We aim to provide support to enable them to do this safely and effectively, and the skills station provides flexibility in learning opportunities and accessibility to all.
In the future we hope to develop a skills package whereby competency at placement and replacement of enteral feeding tubes can be formally assessed. In the meantime, we keep a record of every visitor to the skills station and complete an evaluation form that will later be used for audit purposes.