Scenario: You begin your career in an acute care hospital as a newly licensed RN

Question

Scenario: You begin your career in an acute care hospital as a newly licensed RN. During your orientation, you observe your preceptor checking gastric feeding tube placement by injecting air and auscultating the abdomen, stopping continuous enteral tube feedings before a patient is turned or repositioned, and routinely inserting rectal tubes for patients with diarrhea. You know that ALL three (3) of these practices are currently NOT supported by nursing evidence. When asked, your preceptor responds, “This is the way we have always cared for patients with tube feedings and diarrhea.” You prepare to talk to this peer about necessary changes in nursing practice. Initial Discussion Post: Address the following: Choose ONE (1) of the practices described in the scenario. Describe how you will address this gap in nursing practice with your preceptor. Write out exactly what you might say to this RN to professionally address the current evidence for the nursing care of patients. Include when and where you would communicate this information Consider any additional information you might provide to your preceptor to support changing nursing practice Base your initial post on your readings and research of this topic. Your initial post must contain a minimum of 250 words. References, citations, and repeating the question do not count towards the 250 word minimum.

Explanation / Answer

I would like to address the practice gastric feeding tube placement by injecting air and auscultating the abdomen.

The auscultating method of determining the location for feeding tubes is considered to be ineffective and unreliable.

The alternative recommended method can be used is  Aspiration of contents and pH testing.

I will try to address the nursing gap with my preceptor by showing the effective alternate method.

I would aspirate Gastric contents constantly with a vacuum pump or intermittently, manually by a syringe. After aspiration, the acidity of the gastric acid can be calculated by titration to a pH 7 using an alkaline solution and chemical indicators or pH meters

The correct position of the gastric tube in the most appropriate part of the stomach can be confirmed either radiologically or by a water recovery test. In the water recovery test, the subject drinks 20 mL of water and if 16–20 mL of it can be aspirated via the gastric tube, it can be taken as a marker that the tube is in a satisfactory position.

I will discuss this gap in nursing practice with the supervisor and will take it for the further discussion in the department meeting . Will further conduct a discussion with senior staffs and if necessary will demand for a visit of another world class Hospital visit for further practical study on the recommended method.

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