Evaluation Nurses’ Practices for Medication Administration via Enteral Feeding Tube

Title 

The article’s title is ‘ Evaluation Nurses’ Practices for Medication Administration via Enteral Feeding Tube ’. The title is informative as the reader knows that it is the practices of evaluation nurses when they administer medications using the enteral tube that are under review. However, the title fails to reveal some of the key information pertaining to the study such as the population being studied and the location ( Polit & Beck, 2014) . It also fails to highlight some of the variables that will be used. However, the title guides the reader as it leaves no doubt that it is the practices of the evaluation nurses that are being evaluated. 

Abstract 

The abstract should provide an overview of the entire paper. It should ne formatted into sections containing the Aim, Background, Design, Methods, Results, Conclusion, and Relevance of the study to clinical practice (Uysal, Sari, Gok & Maslak, 2016). The abstract in the article contains the background, objectives, methodology, results and conclusion. The detailed information in each of the sections enhances an easier grasp by the reader of the information contained in the article. For instance, at the background section, the article explains the need for care by nurses when they are administering medications to patients using the enteral tube. 

The nurses should demonstrate various skills as any mistakes can be life-threatening. The objectives section also acts as the aims section while the methodology section contains both the design and methods sections. However, the abstract lacks a section on the relevance of the study to clinical practice. The lack of this section is, however, not of much relevance as the reader can contemplate the relevance of the study since other sections have stated the implications of the nurses not adhering to procedures or lacking adequate skills in using the enteral tube on patients. 

Researchers’ Credentials 

One of the authors of this article is Nurcan Uysal who is a registered nurse and holds a PhD. The author is an assistant professor in Gediz University in the Faculty of Health Science. The other author is Hatice Yildirim Sari who is also a registered nurse and a holder of PhD. He is an Associate Professor in Katip Çelebi University in the Faculty of Health Science, Department of Pediatric Nursing. The third author is Derya Demir Gok who is also a registered nurse and works in the nursing department in Dr. Behcet Uz Children's Hospital. The fourth author is Oznur Ozsoy Maslak who works in the nursing department at the Menemen Government Hospital. 

The credentials of the authors reveal they are experts in the health sector thereby ascertaining their suitability to conduct the research. 

Problem Statement 

The problem statement indicates the issue at hand that needs to be addressed. The problem being addressed in the article is explicitly stated in the introduction section. The authors emphasize that the use of enteral tube is ubiquitous amongst patients that are critically ill. It is, therefore, necessary for nurses to have the suitable skills of using the enteral tube while administering drugs to patients. The problem being addressed is assessing whether the nurses in the selected hospital have the requisite skills in using the tube to meet the care needs of the patients. The problem statement in the introduction section develops a persuasive argument as the lack of the necessary skills amongst nurses can lead to respiratory problems, diarrhea and other complications like aspiration pneumonia not to mention death (Bhola & Ranjeeta, 2017). 

Further, the lack of the necessary skills can cause the occlusion of the tube that leads to the ‘upsetting of the patient’ and can cause stomach problems leading to increased length of stay in hospital ((Uysal, Sari, Gok & Maslak, 2016, p. 1059). The problem statement emphasizes the need for nurses to possess the required skills as the enteral tube serves a critical role in administering medications to patients when they are critically ill. The skills required include verification of the tube placement, conducting flushing of the tube and preparing and administering the drugs, especially when they are in the form of tablets. 

The study will facilitate the determination of whether the nurses possess these skills and if not, it will demonstrate to the management of the hospital the need to train and equip the nurses with such skills to enhance the safety of the patients and shorten their stay in hospital. 

Purpose of the Study 

The purpose of this study is found in the ‘aim’ section of the article. It seeks to reveal why the study is being conducted. The statement is explicit and leaves the reader in no doubt on the intentions of the authors. They have clearly and concisely stated that they seek to evaluate whether the recommended procedures in the administration of medications through an enteral tube are being followed (Uysal, Sari, Gok & Maslak, 2016). The identity of the issues that will be addressed in the article in this section enhances the level of focus by the reader. The wording is easily understood as it reveals the focus of the article is the behavior and actions of nurses when administering medications to patients through an enteral tube. They emphasize that ‘any mistake by nurses during the medication administration can constitute a life threat’ (Uysal, Sari, Gok & Maslak, 2016, p. 1059). 

Hypothesis 

The hypothesis of the article is located in the first three sentences in the introduction section. The hypothesis is drawn from standards in the health industry where the authors state that after professionals like physicians prescribe medications to patients, it is the role of nurses to administer the medications. The authors then elaborate on the need for nurses to administer the medications professionally when using enteral tube as it errors can be fatal. The hypothesis is easy to depict and it becomes easy to identify relationships between the need for professionalism by nurses on one hand and the safety of the patient on the other. The two variables i.e. professionalism by nurses and the safety of the patient are the core focus of the article. 

Data Collection Methods 

The methods used to collect the data for this study are explained in the ‘data collection tools’ section of the article. The data for the study was collected through a survey and questionnaire methods from the sample that consisted of nurses from two state hospitals. The nurses selected are those working in the bed treatment sections in the hospitals as they are the ones most likely to use the enteral tube on patients that are admitted. The sample size was 184 nurses. 

The survey contained 26 questions that centered on inquiring the various procedures performed by nurses when they are handling patients and using an enteral tube to administer medications. The questions were aimed at revealing whether the nurses have the required skills and competencies in using the enteral tube on patients. The questions touched on areas like placement of the tube, preparing and administering medications and the flushing of the tube before and after the medications have been administered. The collected data was then analyzed by calculating the percentages of responses for the specific questions contained in the survey. 

The methods used to collect the data are optimal as the responses of the nurses to the individual questions demonstrated their competencies in each of the competence areas being addressed in the study. It was easy for the researchers to draw inferences from such data based on the nature of the revelations made by the nurses in the survey. 

However, it would have been suitable for the researchers to include statistical analysis of the data to determine aspects such as the levels of significance. For instance, it would have been prudent for the researchers to conduct analysis of variance to determine whether there are significant differences between the means of the data collected in the study and that of evidence-based standards. Also, t-tests should have been conducted to assess the significance of the differences in responses received by the nurses from the two hospitals. 

Ethical Considerations 

The researchers obtained permission to conduct the study from the Non-invasive Clinic Research Studies Ethics Board of the Izmir Kâtip Çelebi University. They also obtained permission from the administration of the two hospitals that were involved in the study. Further, the nurses involved in the study also approved it after getting verbal information on what it entails and the nature of information that it seeks to collect. 

The explanation of the details of the study to stakeholders such as nurses is vital as the informed consent enhances the willingness of the nurses to participate in the study. It enhances the objectivity of the data collected as none of the members of the sample was ‘forced to participate under duress or through coercion’ (Lancaster, 2017, p. 96). However, it would have been prudent for the researchers to also inform the participants like the nurses how the collected data will be used. 

Also, the researchers should have assured the nurses that the information they provide will be treated confidentially and cannot be used against them. They should also have assured the members of the sample that their personal details such as the name and personal contacts will not be revealed to unauthorized parties. 

Such information is crucial as it reduces the likelihood of bias where nurses provide skewed information due to the fear of reprisals from the management of the hospitals in case the information they provide reveals lack of professionalism and complacency. The researchers should have prepared an informed consent form that contains such assurances to enhance the willingness and motivation of the nurses to participate and the provision of objective and factual answers. 

Also, it is not clear whether the participants of the study were informed that participation in the study is voluntary. The information is crucial in ensuring those selected to be members of the sample and do not wish to participate in the study are identified. Ensuring that the participants in the study are willing and enthusiastic to participate is essential in enhancing the quality of the collected data. Those that participate unwillingly after their inclusion in the sample can provide unreliable data due to issues like representation bias where they request their friends to fill the survey questionnaires on their behalf or ‘leave some questions partly answered or unanswered’ (Rashid, 2015. P. 72). Such possibilities are eliminated through informed consent where the guidelines of the study are exhaustively provided in the informed consent forms. 

Statistical Analysis Methods Used 

The only statistical method used in this study is the calculation of percentages for the various responses to the survey questions. The percentages reveal the level of professionalism and adherence by the nursing personnel to required standards and procedures in the use of the enteral tube on patients when administering medications. As mentioned earlier, it would have been necessary for the researchers to consider using various statistical measures such as analysis of variance and the t-test. For instance, the t-test would have been used to determine whether there are any significant differences between the two groups of nurses from the two hospitals involved in the study. 

The researchers also use inferential statistics to draw conclusions from the responses received from the members of the sample. The conclusions were made after the results obtained were compared with the recommendations from evidence-based practice. 

Results 

The results section contains different sets of data. First, the characteristics of the participants in the study are enumerated in terms of demographic data such as age, education and the number of years worked. Then, the results of the survey are tabulated based on the practices of nurses when they are administering medication to patients through the enteral tube. Some of the main areas that were assessed in the survey include verification of the tube placement before administering the medication, dilution and crushing of medication, flushing, medical administration and tube occlusion. The responses and percentages for each of the areas under assessment are listed in tabular format. 

The listing of the responses and the percentages in a tabular format is necessary in enhancing the visibility of the data. The results are then explained separately making it easier to determine whether the revelations by the nurses align with the recommendations of evidence-based practice. It is easier for the reader to follow the documented results and link these results to the inferences and conclusions that are made by the authors. 

Discussion 

The discussion section is presented in a clear and coherent manner. On the outset, the researchers are categorical that the results of the study reveal that the actions of the nurses when handling patients using the enteral tube are incompatible with the recommendations of evidence-based practice. For example, they emphasize that the auscultation method that the nurses use to check the placement of the tube is unreliable. The authors relate their inferences with other study that made similar observations. 

They also cite professional entities such as The National Patient Safety Agency to further demonstrate the unreliability of the auscultation method as most bodies advocate for the checking of the pH value of the aspirated fluid to check the placement of the tube. 

The ability of the researchers to cite other studies on the topic enhances the quality of their opinions based on the results of the study. It also makes such opinions credible and authentic. The researchers also include the Enteral Feeding Practice Recommendations that are published by the American Society for Parenteral and Enteral Nutrition to further demonstrate the credibility of their inferences from the results of the study. 

Limitations of the Study 

The article does not have a section on the limitations of the study. It would have been prudent for the researchers to highlight the limitations of the study to facilitate further research and also reveal constraints that could have impacted on the conclusions made in the study. For example, the study involved only two hospitals in Turkey and, therefore, its findings cannot be generalized in the entire healthcare fraternity in the country. It means the failure by the researchers to enumerate the limitations of their study hinders the identity of some of the challenges they experienced during the various stages of the research. The failure to include the limitations of the study also impedes the ability to make recommendations for further research. Any further research usually seeks to overcome some of the limitations experienced in a previous study. 

Recommendations for Further Research 

The article lacks this section. The lack of the section leaves the reader unaware of the possible approaches that can be used when conducting subsequent studies in this area. The researchers should have included this section to inform the reader and other researchers on the main areas of focus when conducting research studies on the topic ( Polit & Beck, 2014) . For instance, the authors should have highlighted areas where further research should be conducted to determine the source of the gaps identified where most nurses do not adhere to evidence-based practices when handling patients that are using enteral tubes. 

For example, one of the areas that should be researched further on the topic is the quality of training received by nurses, and whether such training involves hands-on activities in the handling of patients that require the use of enteral tubes to administer medications. Other areas is the nature of regulations in the hospitals and whether there are disciplinary mechanisms for nursing professionals that are found to be complacent when administering medications to patients using the enteral tubes. The research can also be extended to determine whether hospitals have any training and development programs for nurses where they can be taught and refreshed on the skills needed to optimally handle patients that require the use of enteral tubes. 

Implications for Nursing Practice 

The section is titled ‘implications’ and is found at the end of the article. The researchers observe that there are risks to patient safety when nurses administer medications to patients using enteral tubes. Based on the findings of the researchers that most nurses rely on unreliable methods when administering medications to the patients using enteral tubes, the authors are categorical in highlighting the need for further training of nurses. The training ensures the nurses have the requisite skills and competencies in handling such patients thereby eliminating the risks in patient safety. 

Also, the researchers affirm the need for hospitals to have published guidelines to offer insights to nurses when handling the patient categories that require medications to be administered enterally. Such an implication is crucial as hospital establishments have diverse professionals like physicians that can monitor the activities of nurses and adherence to the guidelines. It will also be easier for nurses to seek the guidance of such professionals and minimize the exposure of patients to safety risks. However, such guidelines should be updated periodically to capture any new trends and changes in the evidence-based practices. Also, the guidelines should be placed in conspicuous places for easier visibility by the nurses. 

References 

Bhola, N. & Ranjeeta, K. (2017). Perceived barriers and effect of knowledge-based intervention on the competencies of medical faculty members towards conducting research. Journal of Medical Education, 16 (2): 17-35. 

Lancaster, K. (2017). Confidentiality, anonymity and power relations in elite interviewing: Conducting qualitative policy research in a politicised domain. International Journal of Social Research Methodology , 20 (1): 93-103. 

Polit, D. & Beck, C. (2014). Essentials of nursing research: Appraising evidence for nursing practice (8 th ed). Philadelphia. Lippincott, Williams, and Wilkins. 

Rashid, A. (2015). Conducting research in organizations on ethical matters while focusing on challenges, issues and other aspects . New York. Pearson. 

Uysal, N., Sari, H., Gok, D. & Maslak, O. (2016). Evaluation nurses’ practices for medication administration via enteral feeding tube. International Journal of Caring Sciences , 9 (3): 1058-1065.