Patients and home carers' experience and perceptions of different modalities of enteral feeding.

AIMS AND OBJECTIVES: To explore patients and carers' experience and perceptions of different modalities of long-term enteral feeding. BACKGROUND: With an ageing population in Singapore, there is a concomitant increase in number of patients with dysphagia and hence increase in prevalence of enteral feeding. It is essential to understand experiences of patients and home carers with long-term home enteral feeding and perceptions of different modalities to better provide support. DESIGN: A qualitative descriptive approach fulfilling the COREQ checklist criteria (See File S1). Nine patients who were receiving long-term enteral feeding and nine carers were recruited over the period of August to December 2017. One-to-one interviews were conducted and audio-recorded. An inductive content analysis approach, with open coding, creation of categories and abstraction of data, was adopted. RESULTS: Three themes were generated: (a) factors influencing choice of mode of enteral feeding; respondents narrated factors such as need to "conceal" illness, need to be independent and previous bad experience with alternative modality (b) identified informational, emotional and physical needs. Respondents reported the need for support in terms of information on the different modalities, and training on how to self-care or provide care and (c) individual perception and attitude towards life with enteral feeding. Most respondents portrayed a positive outlook to life, despite that they could no longer participate in communal eating. CONCLUSION AND RELEVANCE TO CLINICAL PRACTICE: Understanding patients and carers' experience and perceptions will inform the development of strategies to empower future patients and carers in choice of modality for enteral feeding. Patients with percutaneous endoscopic gastrostomy (PEG) found it easier to integrate enteral tube feeding into daily lives. Carers played a pivotal role in choice of modality, as well as in care of patients on enteral feeding.

Caring for patients on home enteral nutrition: Reported complications by home carers and perspectives of community nurses.

AIMS AND OBJECTIVES: To explore the experiences of community nurses and home carers, in caring for patients on home enteral nutrition. BACKGROUND: The number of patients on home enteral nutrition is on the increase due to advancement in technology and shift in focus of providing care from acute to community care settings. METHODS: A mixed-method approach was adopted. (i) A face-to-face survey design was used to elicit experience of carers of patients on home enteral nutrition. (ii) Focus group interviews were conducted with community nurses. RESULTS: Ninety-nine carers (n = 99) were recruited. Patient's mean age that they cared for was aged 77.7 years (SD = 11.2), and they had been on enteral feeding for a mean of 29 months (SD = 23.0). Most were bed-bound (90%) and required full assistance with their feeding (99%). Most were not on follow-up with dietitians (91%) and dentists (96%). The three most common reported gastrointestinal complications were constipation (31%), abdominal distension (28%) and vomiting (22%). Twenty community nurses (n = 20) were recruited for the focus group interviews. Four main themes emerged from the analysis: (i) challenge of accessing allied health services in the community; (ii) shorter length of stay in the acute care setting led to challenges in carers' learning and adaptation; (iii) transition gaps between hospital and home care services; and (iv) managing expectations of family. CONCLUSION: To facilitate a better transition of care for patients, adequate training for carers, standardising clinical practice in managing patients with home enteral nutrition and improving communication between home care services and the acute care hospitals are needed. RELEVANCE TO CLINICAL PRACTICE: This study highlighted the challenges faced by community home care nurses and carers. Results of this study would help to inform future policies and practice changes that would improve the quality of care received by patients on home enteral nutrition.

Harnessing power of simulation training effectiveness with Kirkpatrick model in emergency surgical airway procedures.

Objectives: Training effectiveness indicates how good a program has met pre-set training objectives or organizational goals for the best benefit of healthcare professionals and service users in the community. The study aimed to evaluate training effectiveness following implementation of new training curriculum of emergency surgical airway procedures (Cricothyroidotomy) organized by the Queen Elizabeth Hospital. Design: This training evaluation relied on observational descriptive study design. Timed task on Cricothyroidotomy procedures and standardized post-training questionnaire were applied to assess the first 3 levels of Kirkpatrick's model: (Level-1) Reaction by training satisfaction; (Level-2) Learning by acquisition of knowledge and skills assessment passing rate; (Level-3) Behavior by personal strengths. Setting: This program was operated in the Multi-Disciplinary Simulation and Skills Centre, a hospital-based high-fidelity simulation training center accredited by the Society for Simulation in Healthcare. Participants: The study recruited 80 trauma service providers, including 35 general surgeons, 15 emergency physicians, 10 anesthesiologists or intensivists, 6 neurosurgeons, 4 orthopedic surgeons, and 10 emergency nurses from five trauma centers under the Hospital Authority. All underwent the Advanced Trauma Life Support training in advance. Results: Compared with reference score from previous training sessions, the result of program using new training curriculum and simulator demonstrated significant training satisfaction of participants (Level-1), and high level of assertiveness, mental preparedness, self-efficacy, and internal locus of control and responsibility (p < .01, for all in Level-3). All participants (N = 80) completed entire Cricothyroidotomy procedure in 2 min without technical errors (Assessment passing rate = 100%) (Level-2). Conclusions: Under Kirkpatrick model, simulation training in Cricothyroidotomy procedure using new curriculum and simulators has been proven to be useful for healthcare professionals involved in trauma service management. The result suggests that application of a state-of-the-art training tools to advanced surgical skills training could improve training satisfaction, knowledge and skills acquisition, and personal strengths transferable to clinical practice. ACGME competencies: Practice Based Learning and Improvement.

A Descriptive Study of enteral tube feeding among adults in an acute care tertiary hospital-patient selection, characteristics and complications.

BACKGROUND: It is vital to develop a better understanding of the use of different modalities for enteral feeding and its associated complications, given differences in funding support, community resources and infrastructure available to support home enteral feeding in an acute care tertiary hospital. AIM: To provide a description of the clinical characteristics of patients on long-term enteral feeding and incidence of associated complications. METHODS: A retrospective case records review study design was adopted. Medical records of patients discharged from a tertiary hospital with long-term nasogastric tube (NGT) or percutaneous endoscopic gastrostomy (PEG) feeding for the first time during the period of January 2010 to June 2017 were reviewed. Data collected include patient's demographics, reason for enteral feeding, morbidity and nutritional status upon initiation of NGT and PEG feeding, readmission episodes and documented complications (associated with enteral feeding) within one-year post discharge. RESULTS: Records of 120 NGT and 118 PEG patients were analysed. Significant age and gender differences were found with older patients being more likely to be placed on NGT [NGT (Mean 79.1, SD 11.3) vs. PEG (Mean 67.1, SD 12.6)] and higher number of females in the NGT group as compared to the PEG group (NGT 59.2% vs. PEG 31.4%). Majority of patients were fed by caregivers in the NGT (99.2%) as compared to the PEG (51.7%) group. Patients with cancer were more likely to be on PEG feeding (NGT 5%, PEG 70.3%), whereas patients with stroke-related diagnoses were more likely to be on NGT feeding (NGT 48% vs. PEG 8.5%). The total Charlson Comorbidity score was also significantly different between the NGT (mean = 5.7; SD = 1.5) and PEG (mean = 4.5; SD = 2.0) groups. A higher number of patients with PEG feeding had no complications (47.5%) as compared to the NGT group (8.3%). Patients who received NGT feeding were more likely experience tube blockage [OR 0.03, 95% CI (0.001-0.72), p = 0.03], secondary displacement of tube [OR 0.04, 95% CI (0.002-0.72), p = 0.03] and accidental tube removal [OR 0.03, 95% CI (0.004-0.21), p < 0.001]. CONCLUSION: Overall, patients who received NGT feeding experienced more complications than those who had PEG feeding. The choice for NGT or PEG feeding may be influenced by patient related factors as well as the presence of caregivers, which need to be considered in the improvement of enteral nutrition services in the local context.

Effectiveness of a workplace training programme in improving social, communication and emotional skills for adults with autism and intellectual disability in Hong Kong--a pilot study.

This pilot study explored the effectiveness of workplace training programme that aimed to enhance the work-related behaviours in individuals with autism and intellectual disabilities. Fourteen participants with autism and mild to moderate intellectual disability (mean age = 24.6 years) were recruited. The workplace training programme included practices in work context and group educational sessions. A pre-test-post-test design was used with the Work Personality Profile, the Scale of Independent Behaviour Revised and the Observational Emotional Inventory Revised to evaluate the targeted behaviours. Improvement in social and communication skills specific to the workplace was achieved. For emotional control, participants became less confused and had a better self-concept. However, improvement in other general emotional behaviours, such as impulse control, was limited. The results indicated that a structured workplace training programme aimed at improving social, communication and emotional behaviours can be helpful for people with autism and intellectual disability. Further study with a larger sample size and a control group is recommended. The development of specific programme to cater for the emotional control needs at workplace for people with autism is also suggested.