Nursing
Part one
Write a 3-page paper that includes the following:
• A summary of your area of interest, an identification of the problem that you have selected, and an explanation of the significance of this problem for nursing practice
• The 5 questions you have generated and a description of how you analyzed them for feasibility
• Your preliminary PICOT question and a description of each PICOT variable relevant to your question
• At least 10 possible keywords that could be used when conducting a literature search for your PICOT question and a rationale for your selections
Part 2
Write a 3-page literature review that includes the following:
• A synthesis of what the studies reveal about the current state of knowledge on the question that you developed
• Point out inconsistencies and contradictions in the literature and offer possible explanations for inconsistencies.
• Preliminary conclusions on whether the evidence provides strong support for a change in practice or whether further research is needed to adequately address your inquiry
• Your literature review summary table with all references formatted in correct APA style
Part 3
3 pages
• Restate your PICOT question and its significance to nursing practice.
• Summarize the findings from the articles you selected for your literature review. Describe at least one nursing practice that is supported by the evidence in the articles. Justify your response with specific references to at least 2 of the articles.
• Explain how the evidence-based practice that you identified contributes to better outcomes. In addition, identify potential negative outcomes that could result from failing to use the evidence-based practice.
• Outline the strategy for disseminating the evidence-based practice that you identified throughout your practice setting. Explain how you would communicate the importance of the practice to your colleagues. Describe how you would move from disseminating the information to implementing the evidence-based practice within your organization. How would you address concerns and opposition to the change in practice?
In addition, include a 1-page summary of your project
Correct Placement of a Nasogastric Tube and Verification
This a version of the paper I started
According to Polit & Beck, “Evidence based practice relies on meticulous integration of research evidence on a topic. The emphasis on best evidence in EBP implies that evidence about a clinical problem has gathered, evaluated, and synthesized so that conclusions can be drawn about the most effective practices” (pg. 30 ). The literature and evidence I reviewed on the correct placement of a NG tube discussed similar instructions on how to insert an NG tube correctly.
In majority of the literature reviewed highlights were placed on standard precautions, teaching and patient’s cooperation during the procedure. Prior to the procedure the nurse should always review the facility policy and procedure regarding inserting a NG tube. The benefits and risk should also be discussed with the patient/family. According the article, Nasogastric Feeding Tube, “The primary risk of inserting a NG tube if it’s not properly inserted, it can injure the tissue inside the sinuses, throat, esophagus, or stomach. Tubes can also mistakenly be placed into the lungs: food and medicine may pass into the lungs if this were to occur” (Medline, 2012). In order to prevent these complications from occurring, prior to using the tube the placement should be confirmed by x-ray.
The literature provided different pros and cons through evidence when assessing the correct placement of an NG Tube. Similarities in literature noted verification can vary depending on hospital protocol. For example, some of the literature suggest assessing the abdomen and listening for air better known as the auscultation method but this method alone should not be used for confirmation of NG Tube. Other methods such as aspirating the gastric contents and testing the Ph to confirmed placement is not always a reliable confirmation as well. More studies could be performed to best understand how to prevent pH testing mistakes to adequately measure and test the contents. And lastly a method involves observing bubbles when the end of the feeding tube is placed under water. This method is also unreliable. “the appearance of bubbles is thought to indicate that the feeding tube is misplaced in the respiratory tract. However, bubbling can also occur when feeding tubes are placed in the gastrointestinal tract.10 Also, the absence of bubbles does not rule out respiratory placement if the tube’s ports are occluded by the respiratory mucosa” ( Lemyze, 2010). These following methods have traditionally been used to verify feeding tube placement at the bedside.
Evidence based practice supports that the best method for confirmation is taking an x-ray to confirm placement. Performing an x-ray will allow the image of the tube to be viewed and determine the exact location of the tube. Although, literature mention that ordering an x-ray can be time consuming and having to move the patient to radiology can be bothersome for patients. At the hospital that I work prn, the physicians has standard orders when inserting an NG Tube. An x-ray have to be done after initially inserting a tube to confirm placement. The x-ray image will allow the radiologist to visualize where the tube is located. Having the ability to order radiology at the patient’s bedside decrease the amount of time and pain to the patient.
In one of the study I reviewed the study designed used was systemic review. “The study was using the bedside method of confirming correct placement using the PH indicator. The study on 46 patients (78 nasogastric intubations), Neumann et al. found that pH≤4.0 accurately confirmed correct position (P=0.0005) but gastric aspiration was successful in 85% of patients only [2]. Furthermore, a pH value of >4 was not very helpful in predicting malposition (37%) especially when pH-altering medications were used. The study concluded that when the pH of the nasogastric tube aspirate is <4.0, X-ray films are not needed to prove the accuracy of tube placement. In other situations, a film is required. Radiographic examination as initial assessment to confirm proper placement of nasogastric tubes is widely practiced “(NPSA, 2012). In conclusion, the evidence provides strong support for a change in some hospital methods of correct placement of an NG Tubes. Implementing a specialized team of nurses to ensure that nurses are competent in correct placement of feeding tubes to reduce complications associated with improper tube placement would be a great asset to invest in. Reference: Polit, D. F., & Beck, C. T. (2012). Nursing research: Generating and assessing evidence for nursing practice (Laureate Education, Inc., custom Ed.). Philadelphia, PA: Lippincott Williams & Wilkins. Medline Plus. (2012, October 8). Nasogastric Feeding Tube. Retrieved June 6, 2013, from http://www.nlm.nih.gov/medlineplus/ency/patientinstructions/000182.htm. National Patient Safety Agency UK, Patient Safety Alert “Reducing the harm by misplaced nasogastric feeding tubes in adults, children and infants,” March 2011. Retrieved on February 26 2013 http://www.nrls.npsa.nhs.uk/resources/?EntryId45=129640 Lemyze, M. (2010) The placement of nasogastric tubes. CMAJ. anadian Medical Association Journal, 182(8), 802. Walden University Library. (2012). Levels of evidence. Retrieved mfromhttp://libraryguides.waldenu.edu/evidencepyramid Correct Placement of a Nasogastric Tube and Verification Reference: Polit, D. F., & Beck, C. T. (2012). Nursing research: Generating and assessing evidence for nursing practice (Laureate Education, Inc., custom Ed.). Philadelphia, PA: Lippincott Williams & Wilkins. Medline Plus. (2012, October 8). Nasogastric Feeding Tube. Retrieved June 6, 2013, from http://www.nlm.nih.gov/medlineplus/ency/patientinstructions/000182.htm. National Patient Safety Agency UK, Patient Safety Alert “Reducing the harm by misplaced nasogastric feeding tubes in adults, children and infants,” March 2011. Retrieved on February 26 2013 http://www.nrls.npsa.nhs.uk/resources/?EntryId45=129640 Lemyze, M. (2010) The placement of nasogastric tubes. CMAJ. anadian Medical Association Journal, 182(8), 802. Walden University Library. (2012). Levels of evidence. Retrieved mfromhttp://libraryguides.waldenu.edu/evidencepyramid Correct Placement of a Nasogastric Tube and Verification Evidence Synthesis According to Polit & Beck, “Evidence based practice relies on meticulous integration of research evidence on a topic. The emphasis on best evidence in EBP implies that evidence about a clinical problem has gathered, evaluated, and synthesized so that conclusions can be drawn about the most effective practices” (pg. 30 ). The literature and evidence I reviewed on the correct placement of a NG tube discussed similar instructions on how to insert an NG tube correctly. In majority of the literature reviewed highlights were placed on standard precautions, teaching and patient’s cooperation during the procedure. Prior to the procedure the nurse should always review the facility policy and procedure regarding inserting a NG tube. The benefits and risk should also be discussed with the patient/family. According the article, Nasogastric Feeding Tube, “The primary risk of inserting a NG tube if it’s not properly inserted, it can injure the tissue inside the sinuses, throat, esophagus, or stomach. Tubes can also mistakenly be placed into the lungs: food and medicine may pass into the lungs if this were to occur” (Medline, 2012). In order to prevent these complications from occurring, prior to using the tube the placement should be confirmed by x-ray. The literature provided different pros and cons through evidence when assessing the correct placement of an NG Tube. Similarities in literature noted verification can vary depending on hospital protocol. For example, some of the literature suggest assessing the abdomen and listening for air better known as the auscultation method but this method alone should not be used for confirmation of NG Tube. Other methods such as aspirating the gastric contents and testing the Ph to confirmed placement is not always a reliable confirmation as well. More studies could be performed to best understand how to prevent pH testing mistakes to adequately measure and test the contents. And lastly a method involves observing bubbles when the end of the feeding tube is placed under water. This method is also unreliable. “the appearance of bubbles is thought to indicate that the feeding tube is misplaced in the respiratory tract. However, bubbling can also occur when feeding tubes are placed in the gastrointestinal tract.10 Also, the absence of bubbles does not rule out respiratory placement if the tube’s ports are occluded by the respiratory mucosa” ( Lemyze, 2010). These following methods have traditionally been used to verify feeding tube placement at the bedside. Evidence based practice supports that the best method for confirmation is taking an x-ray to confirm placement. Performing an x-ray will allow the image of the tube to be viewed and determine the exact location of the tube. Although, literature mention that ordering an x-ray can be time consuming and having to move the patient to radiology can be bothersome for patients. At the hospital that I work prn, the physicians has standard orders when inserting an NG Tube. An x-ray have to be done after initially inserting a tube to confirm placement. The x-ray image will allow the radiologist to visualize where the tube is located. Having the ability to order radiology at the patient’s bedside decrease the amount of time and pain to the patient. In one of the study I reviewed the study designed used was systemic review. “The study was using the bedside method of confirming correct placement using the PH indicator. The study on 46 patients (78 nasogastric intubations), Neumann et al. found that pH≤4.0 accurately confirmed correct position (P=0.0005) but gastric aspiration was successful in 85% of patients only [2]. Furthermore, a pH value of >4 was not very helpful in predicting malposition (37%) especially when pH-altering medications were used. The study concluded that when the pH of the nasogastric tube aspirate is <4.0, X-ray films are not needed to prove the accuracy of tube placement. In other situations, a film is required. Radiographic examination as initial assessment to confirm proper placement of nasogastric tubes is widely practiced “(NPSA, 2012).
In conclusion, the evidence provides strong support for a change in some hospital methods of correct placement of an NG Tubes. Implementing a specialized team of nurses to ensure that nurses are competent in correct placement of feeding tubes to reduce complications associated with improper tube placement would be a great asset to invest in.
Reference:
Polit, D. F., & Beck, C. T. (2012). Nursing research: Generating and assessing evidence for nursing practice (Laureate Education, Inc., custom Ed.). Philadelphia, PA: Lippincott Williams & Wilkins.
Medline Plus. (2012, October 8). Nasogastric Feeding Tube. Retrieved June 6, 2013, from http://www.nlm.nih.gov/medlineplus/ency/patientinstructions/000182.htm.
National Patient Safety Agency UK, Patient Safety Alert “Reducing the harm by misplaced nasogastric feeding tubes in adults, children and infants,” March 2011. Retrieved on February 26 2013 http://www.nrls.npsa.nhs.uk/resources/?EntryId45=129640
Lemyze, M. (2010) The placement of nasogastric tubes. CMAJ. anadian Medical Association Journal, 182(8), 802.
Walden University Library. (2012). Levels of evidence. Retrieved mfromhttp://libraryguides.waldenu.edu/evidencepyramid
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