Caring for patients with PEG feeding Essay

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Caring for patients with PEG feeding Essay

ccording to Boud et al. (1985),”Reflection is a form of response of the learner to experience”. Reflection helps to recall about an experience, makes us think about it and finally helps us to evaluate it. I feel reflecting back on our experience can broaden our knowledge and skills by making us conscious of our strengths and shortcomings and thus in the long run help us to excel in that particular task. Since nursing concepts and practices are changing day by day, reflection is of much importance to provide effective and competent care in nursing.

Among the various models of reflection I have chosen Gibbs model of reflection (1988) to reflect my experience in achieving the learning outcome, care of patients with PEG feeding. This model of reflection consists of six stages as seen in diagram.

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PEG feeding is the most common form of enteral feeding in people requiring artificial nutritional support for longer than 4-6 weeks. According to a study among stroke patients conducted by Cummins C, Marshall T, Burls A (2002) to ascertain whether endoscopic feeding is more effective than nasogastric tube feeding (NGT), concluded that PEG feeding was more efficient than NGT feeding, and also when compared with NGT feeding, PEG feeding of dysphagic stroke patients was associated with small increases in patient well-being’. Caring for patients with PEG feeding Essay.

Since I am working in an acute stroke ward, we get many clients with enteral feeding. Dysphagia secondary to acute stroke is an appropriate referral for PEG-feeding rather than nasogastric feeding (Norton et al, 1996 as cited by Chapman, W. and Ditchburn, L., 2005). Even though I have cared for patients with nasogastric tube during my previous working experiences, I have never got a chance to care for a patient with PEG feeding. So I selected this learning objective to get acquainted with it to provide effective care for those clients. I read books and journals to acquire knowledge and also browsed the internet to gather related information. I also observed meticulously senior colleagues caring for patients with PEG feeding and administering the feed. I also read the active hospital policy to comply with it. Then, I undertook care of patients under supervision, my mentor and other colleagues gave me feedback on my performance and I was able to make corrections based on it.

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Initially I was anxious and tense in undertaking care of a client with PEG feeding. Undertaking care under supervision helped me to clarify doubts regarding the procedure and build my confidence. As the patients are nil by mouth, oral care was provided which is an inevitable component while caring for a client with PEG as well as cleaning the site of tube insertion after healing with mild soap and water daily and drying thoroughly (Arrowsmith, 1996 as cited by Chapman, W. and Ditchburn, L., 2005). Also, I made a point to flush the tube with sterile water before and after feeds or administering medications (NICE, 2003) and to rotate gastrostomy tube to prevent blockage (Stroud, H., Duncan, H., and Nightingale, J., 2003)

Refreshing my knowledge and working under supervision enabled me to build my confidence. Guidance and feedback given to me by my mentor and colleagues helped me to perform better each time. My mentor has assessed me competent in caring for a client with PEG.

I feel by selecting this learning outcome I was able to achieve an important skill essential for my placement area. By reading journals and active hospital policy I was able to understand the rationale behind each of my action.  Caring for patients with PEG feeding Essay.This has helped me build my confidence immensely as well as to expand my knowledge on the same. I also ensured documentation in enteral checklist was completed regarding the time the feed started, volume, rate per hour recorded in a consistent, concise manner, which fulfils the principles of record-keeping as laid down by the NMC, 2008.

I believe that by taking this learning objective I was able to gain knowledge and skills for safe and effective practice when working without direct supervision (NMC, 2008). Working along with my mentor and colleagues gave me opportunity to clarify doubts and achieve this skill which expanded my skills and knowledge and made me familiar with another method of maintaining nutritional status. Learning new skills and keeping knowledge up to date helps one to develop professionally. By accomplishing the learning objective I am able to care for patients with PEG feeding and this will benefit me to provide efficient care.

In order to provide proficient care in forthcoming days, I should keep myself aware of the policies and procedures followed in the trust and must keep my knowledge and skills up to date (NMC, 2008) to function better. Also, I must consult and take advice from colleagues when appropriate (NMC, 2008).

This essay discusses a clinical skill in which I have become competent during my placement in care home. I will use a reflective model to discuss how I achieved the necessary level of competence. Reflection can make a sense of the familiar and taken for granted situations and is an important human activity, in which people capture their experience, think about it and evaluate it (Driscoll, 1994). Here I have used the Gibbs model of reflection which includes description, feeling, evaluation, analysis, conclusion and action plan of a learning experience (Gibbs 1988). The clinical skill I have learned is PEG feeding. Percutanious endoscopic gastrostomy (PEG) feeding introduced into clinical practice in…show more content…
Initially I was not able to administer medication or feed through the peg feed due to the lack of knowledge and skills on how to do it properly. I had to ask for the help of senior staff to help with feeding. I was desperate to achieve the skill to peg feed which I must possess to administer medication to that client. I asked one of the senior staff who was looking after that client to teach me how to do PEG feeding. She demonstrated it to me and I discussed the matter with my mentor. Caring for patients with PEG feeding Essay. My mentor put me through PEG feed training that gave me all the necessary information about the proper use and management of PEG tube. The next time I had the chance to do it I could relate the theory to practice by continuously performing the feeding, I gained competence in performing that skill. Feeling I was interested in learning about PEG feeding from the very first time I saw it in the care home. I was eager to learn the skill. By observing my colleague doing it and by attending training I learned the procedure clearly and gained necessary confidence to perform it. I obtained consent and maintained privacy before carrying out the procedure. I was nervous whilst doing it for the first time but with the support of my colleagues I overcame the stress and mastered the skill. Evaluation Though I was unaware of the correct procedure of PEG feeding and was unable to perform the

This reflective essay describes my experience in achieving my learning outcomes pertaining to care of percutaneous endoscopic gastrostomy (PEG), giving feed through PEG and administration of medicines through PEG that I have taken as part of the Overseas Nurse Program. It flows as a reflective practise as it incorporates the concept of learning. According to Bolton (2010) reflective practise involves utilising practical values and theories which influence everyday actions, by examining contemplatively and unreceptively geared towards developmental insight. Therefore, experience only does not lead to learning but deliberate reflection on the experience is essential.

Consequently, to further discourse my understanding and involvement with this concept, I have adapted on a certain framework of reflection. I have chosen David Schon’s Model of Reflective Practise to reflect on my experience. I directed this framework on my experience because it enables me to recapture the events in a manner where learning occurs during the process of experiencing handling patients with PEG, gaining insights from them with the application of the theories and concepts I know and building new perspectives and understanding of doing things in relation to PEG. Schon’s model (1983) is focused on two major concepts, reflection-in-action and reflection-on-action. In the reflection-in action activity, reflection happens while in the act of doing the task (cited by Killion and Todnem, 1991). Reflecting-in-action requires me to think on my feet, be able to work instinctively by drawing on similar experiences to solve problems or make necessary decisions. Caring for patients with PEG feeding Essay. It involved looking to my experiences, connecting with my feelings, and attending to the theories and principles in use. It entailed building new understandings to inform my actions in the situations that were unfolding. Whereas in reflection-on-action, it requires looking back on what one has accomplished and reviewing the actions, thoughts, and product (cited by Killion and Todnem, 1991).

As I am working in the medical unit, I was assigned together with my mentor in one of the patients in the unit who has percutaneous endoscopic gastrostomy (PEG) surgically clasped on her abdominal area. As we entered the room to do PEG care, specifically changing the PEG dressing on a new one I was confronted with a different practise from what I used to do back in my home country. She told me that in United Kingdom normal saline is used to cleanse the PEG site instead of antiseptic solution. And now this is where the reflection-in-action came into play. Instead of insisting what I think was the best practise for me (using antiseptic solution for disinfection), I stood up and followed what my mentor told me believing that what she knows is within the standard of practice within United Kingdom. When I tried to engage myself in performing changing the PEG dressing, I tried to think on my feet and did the principle of disinfection using normal saline. I needed to reflect to ensure that this will not happen again.Caring for patients with PEG feeding Essay.

In another incident where reflection-in-action occurred that became my second learning outcome happened when we have to give a feed through PEG. All the while I was expecting an asepto syringe to be used to deliver the feed to the patient but to my surprise my mentor got this special set attached on what she called a Kangaroo pump to deliver the feed at a desired rate and paced time (at that time for 12 hours). It was my first time to encounter this method of administering a PEG feed to a patient. What I did was to stand back and observe how my mentor did all the attachments from the Kangaroo pump up to the PEG tube, but rather than just standing I offered my mentor if she can supervise me on how to enter the transcript (total volume, rate and running hours) on the pump which she gladly did to me. I was really surprised with the whole process and needed a reflection to establish my competence with this new process of giving PEG feed to patients.

In the last incident that happened that became my third learning outcome transpired during administering medicines via PEG. I was caught off guard with regards to the preparation of medicines to be given to the same patient who got a PEG. We are giving an Aspirin dose for this patient and all we’ve got in the medicines cupboard is an enteric-coated form of this medication. Knowing that enteric-coated tablets should not be crushed when administered, I immediately asked my mentor if we can request to the pharmacy an effervescent form of Aspirin. And that’s where reflection-in-action occurred wherein I have to think of a solution on how not to breach the standards of safe medicines administration in the United Kingdom. Instead of crushing and giving it to the patient, I asked my mentor about an alternative solution to address our needs for the medicines administration. In that way I was able to think on my feet and learned something out of the experience.

According to Schon’s model what I felt when those incidents happened was part of the learning process. Schon (1983) gives further information that the practitioner allows himself to be surprised, puzzle or confused in a certain situation which is unique or uncertain to him.Caring for patients with PEG feeding Essay.  He reflects on the event before him, and on the prior considerations which have been imbedded in his attitude. He conducts an experiment which allows him to formulate both a new understanding of the situation and a change in the situation. After all the incidents that transpired during my clinical placement in relation to my three learning outcomes, I have done a reflection-on-action in every learning outcome that I have identified. I made researches on them and took my time to recall the series of events that transpired and based the lapses I made on evidences I have come across during my reflection process. In this way, reflection-on-action was evident.

On the first learning outcome, I have observed a different practise back in my home country cleansing the PEG site. We use chlorhexidine in cleansing the PEG site instead of just plain normal saline but after finding evidences about which is safe and efficient in usage, I was fully convinced that normal saline has a better concept ground than chlorhexidine. Sibbald et al (2000) emphasises that although chlorhexidine has been identified as less harmful to tissues and have effective antibacterial activity against both gram-negative and gram-positive bacteria causes damage to new tissues and should not come close to meninges and mucous membranes for it will cause permanent damage. This concept is applicable with my patient as there is an open mucous membrane where the PEG was inserted and exposure to chlorhexidine would increase the risk of microbial invasion and growth, which may precede to sepsis. Furthermore, the work of Sibbald was strengthened by Edmonds et al (2004a) and Jacobson that physiological saline is a widely recommended in irrigating and wound dressing solution since it is found to be compatible with human tissue. Thus, the practice of using normal saline in cleansing the PEG site was evidence-based practice and I have fully get an excellent grasp of why normal saline is used for PEG care. In this way, I am ensuring patient safety and embracing better understanding of evidence-based practise. Caring for patients with PEG feeding Essay.

On the second learning outcome, I have also witnessed a different way of giving PEG feed to our patients in our home country. We have bolus tube feeding rather than continuous tube feeding using a Kangaroo pump. Aside from observing each time a PEG feed will be given to the patient during my clinical placement, I also did researches on the efficacy of continuous feeding via pump and differences of using a pump from bolus feeding. I have done this in order to develop my competency in using the Kangaroo pump and giving continuous PEG feed to patients. Abbott Laboratories NZ Ltd (2011) gives further information that pumps continue to use microprocessors that allow the delivery of controlled enteral feeding. Its array of flow rate selection gives incremental increases in delivery which is very essential in critical care settings where low infusion rates are vital in maintaining the integrity of the gut and where maximising the feeding volume are fairly balanced. On the contrary, Bankhead et (2009) matched that gravity feeding is considered as the first-line delivery of enteral feeding in some countries but the Dieticians Association of Australia (2011) slashed the idea of Bankhead et al and proved that the usage of enteral feed pumps is now known as the most accurate way of enteral feeding provision across all healthcare settings and patients. Also, I have found out that using Kangaroo pumps instead of asepto syringe in delivering feed to patients lessen complications associated with giving feed to patients via abdominal ostomy tube. Niv et al (2009) found out that established benefits have been shown to prevent aspiration in critically ill patients. Furthermore, the jejunum produces fluid in conjunction to hyperosmolar solutions, and rapid delivery of a hyperosmolar formula will lead in hyperperisitalsis, diarrhoea and abdominal distention. Thus, a more controlled delivery to the intestine via continuous pump infusions can lessen or prevent these symptoms.

On my third learning outcome, medicines administration via PEG has many aspects but the one that got me on my feet was about my competency in giving the right drug, specifically its form and preparation. According to Nursing and Midwifery Council (2008) ‘As a Registered Nurse or Midwife you are accountable for your actions and omissions. In administering medication you should think through issues and apply your professional expertise and judgment in the best interests of patients.’Caring for patients with PEG feeding Essay.  As I have recalled what I did when the incident happened wherein I immediately asked my mentor if we can request to the pharmacy an effervescent form of Aspirin since enteric-coated tablets should not be crushed when administered, I considered the best interest of the patient. As a professional nurse I have a duty of care to my patients in ensuring their safety under the sphere of my care. I need to follow what is appropriate and right for the patient. Also, my mentor was able to practise within the scope of her practise as she was able to directly supervise me in everything that I did with the patient. The Department of Health (2005) stressed that as a Registered Nurse you have a duty of care and are professionally and legally accountable for the care you provide. In line with the administration of the appropriate form of medications to be given to the patient, the Nursing and Midwifery Council (2008) has developed protocols for medicine management on the area of tablet crushing. It stipulates in the policy that nurses should not crush any medicines or break capsules that are not specifically indicated for that purpose and by so will alter the chemical properties of the medicine. Thus, as I have reflected with what I and my mentor have done is fitting and legally right.

The reflection-on-action that happened to me on the three learning outcomes gave me the opportunity to evaluate my competency and efficiency as an overseas nurse on adaptation program. Prior to my reflection, I have never realised how crucial it is to do PEG care, administering medicines through PEG and giving feed through PEG until I experienced the three incidents that changed of how I do and view things in the clinical field. According to Schon (1983) when a practitioner becomes aware of a situation he sees to be unique, he perceives it as something already found in his range. The familiar situation acts as a standard for the unfamiliar one. Caring for patients with PEG feeding Essay.

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With regards to strengths and areas of development, I believe I was able to achieve a certain level of competency in carrying out procedures related to PEG. The learning outcomes I and my mentor identified have helped me to improve myself in terms of skills, knowledge and attitude. After the reflection process happened, I was able to build my confidence in performing procedures related to PEG. I also need to be at ease with operating the Kangaroo pump although I was able to familiarise myself with the process of hooking the PEG feed on the pump and setting the rate and dosing of the feed in the equipment. It was complicated at first but after the reflection process and supervision of my mentor, I was able to get through and learned operating the pump appropriately. Medication administration through PEG has provided me with new perspectives on how to establish a process in checking the medicines to be given and how critical thinking will help me in my decision-making and if I was able to observe the six rights of medication administration.

As a future plan, I need to project competency, professionalism and efficiency in everything that I do be it with the patients or other allied healthcare workers who are part of the organization. It is essential for me to maintain the standards of my profession as it will mould me into a competent registered nurse of United Kingdom. Nursing and Midwifery Council (2010) highlighted that ‘All nurses must act first and foremost to care for and safeguard the public. They must practise autonomously and be responsible and accountable for safe, compassionate, person-centred, evidence-based nursing that respects and maintains dignity and human rights. They must show professionalism and integrity and work within recognised professional, ethical and legal frameworks.’

In a nutshell, reflective practice became the backbone of my learning outcomes in relation to PEG. It provided me with basis in which area needs to be improved and enhanced. Reflection-in-action and reflection-on-action are learning processes that guided me to evaluate my decisions before and after the incidents happened. These incidents gave birth to learning and turned to acquisition of new knowledge and concept that became an enriching experience for me.  Caring for patients with PEG feeding Essay.

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