PROFORMA FOR REGISTRATION OF SUBJECTS FOR

DISSERTATION

MS.G. SATHYAVATHY

FIRST YEAR M.SC (NURSING)

MEDICAL SURGICAL NURSING

YEAR 2009-2010.

IKON NURSING COLLEGE

BHEEMANAHALLI

RAMANAGAR (DIST)

B.M. MAIN ROAD, BIDADI

BANGALORE.
 RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES
BANGALORE, KARNATAKA.
SYNOPSIS PROFORMA FOR REGISTRATION OF SUBJECTS FOR
DISSERTATION

1. NAME OF THE CANDIDATE MS.G.SATHYAVATHY

IKON NURSING COLLEGE
AND ADDRESS BHEEMANA HALLI,
RAMANAGAR ( DIST )
B.M.MAIN ROAD,BIDADI
BANGALORE.

2. NAME OF THE IKON COLLEGE OF NURSING

INSTITUTION BHEEMANA HALLI,
RAMANAGAR ( DIST )
B.M.MAIN ROAD,BIDADI
BANGALORE.

3. COURSE OF STUDY AND 1 YEAR- M .SC. (NURSING)

SUBJECT MEDICAL AND SURGICAL NURSING.

4. DATE AND ADMISSION TO 12.06.2009

COURSE
5. TITTLE OF THE TOPIC :- A STUDY TO ASSESS THE
EFFCTIVENESS OF STRUCTURE
TEACHING PROGRAMME ON
KNOWLEDGE AND PRACTICE OF NASO
GASTRIC TUBE FEEDING TO ADULT
PATIENT AMONG NURSING
PERSONNEL WORKING IN SELECTED
HOSPITAL, BANGALORE.

1
6. BRIEF RESUME OF THE INTENDED WORK:

6.1. INTRODUCTION:
 THE ADMINISTRATION OF LIQUID FOODS INTO STOMACH BY A TUBE

INSERTED THROUGH THE NOSTRIL IS CALLED NASO GASTRIC TUBE

FEEDING OR NASAL GAVAGE .

NG tube feeding widely preferred over parenteral nutrition in adult and

children while nurses inserting NG tube this important to determine the correct

insertion distance for placing nasogastric/ orogastric (NG/OG) tube and to

determine the internal position after the tube has been placed. There is a need to

change practices of insertion and determining placement, according to the most

up-to-date evidence, in order to increase the safety of inserting NG tube feeding. 1

There is no doubt that they are too common and that tubes misplaced on

insertion can lead to serious complication, such as aspiration pneumonia and

malabsorption, which lead to diarrhea and failure to gain weight. There are

different methods of tube insertion placement in choices are available for the

patient were suffering with different disease condition. Example, stroke and

unconscious patient.

Tube feedings are essential when a patient is unable to chew or swallow, such as

after oral surgery or facial trauma. When a person has no appetite or refuses to eat;

in terms of great nutritional need, such as the burn or trauma patient ; in the

comatose patient, or during periods of moderate mal absorption or diarrhea they

also added that, tube feedings should be used only when all or at least part of the

gastro intestinal tract is functioning 2.

 Enteral nutrition has become widely preferred over parenteral nutrition in

adults and children with functioning gastrointestinal tracts when the need for tube

feeding is expected to be 6 weeks or less. It is estimated that between 750,000 and

1,000,000 nasogastric tubes are used in adults and children per year (National

Patient Safety Agency, 2005). In a cross-sectional study done in 2005-2006 in a large

Midwestern childrens hospital, 44 percent of the children had enteral tubes in

place. Of the 1,206 enteral tubes identified, 2/3rds were nasogastric/orogastric

(NG/OG) tubes (Chin, unpublished manuscript).3

6.2. NEED FOR THE STUDY :

Naso gastric tube feeding is given to meet the nutritional requirements when

oral intake is inadequate or not possible as long as gastro intestinal tract is

functioning normally.

A study conducted in SJMCH in the year 1997-98, 800 patients were

admitted in medical ICU. It was observed from the investigators experience that

approximately 80 percent of the patients were on Naso gastric tube feeding.

While preparing NG tube feeding it is necessary to maintain cleanliness the

temperature of feed and the volume of feed and flow rate moreover the feed should

meet caloric and nutritive requirement of the patient.

 Surgical patients may be unable or unwilling to feed normally, owing to

mechanical obstruction to ingestion because of nausea or anorexia or secondary to

neurologic abnormality. Such patients the NG tube has been the standard method of

feeding. NG tube feeding are generally easier to manage and more esthetically

pleasing them.

NG tube feeding with existing practices among nursing personnel in relation

to the technique of Naso gastric tube feeding and the quality of nutrients provided to

patients with Naso gastric tube feeding. In turn it will help to improve quality of

care in relation to meeting nutritional need of these patients by nurses. It could also

help to augment steps of naso gastric tube feeding.4

The FOOD study early feeding via a NG tube is usually recommended as safe

way of supplying nutrition in acute stroke patients.

A study were to determine the methods used by nurses to determine the correct

insertion distance for placing nasogastric/ orogastric (NG/OG) tubes and to

determine the internal position after the tube has been placed. There is a need to

change practices of insertion and determining placement, according to the most up-

to-date evidence, in order to increase the safety of clients receiving enteral tube

feedings.

3
 Esophageal cancer - General approaches. The treatment is determined by the

cellular type of cancer (adenocarcinoma or squamous cell carcinoma vs. other types),

the stage of the disease, the general condition of the patient and other diseases

present. On the whole, adequate nutrition needs to be assured, and adequate dental

care is vital. If the patient cannot swallow at all, a stent may be inserted to keep the

esophagus patent; stents may also assist in occluding fistulas. A nasogastric tube

may be necessary.5

Nasogastric tubes are increasingly used in the management of a diverse group of

patients who generally require short-term enteral feeding. NG intubation in head

and neck cancer patients may be especially difficult following radiotherapy due to

difficulties in swallowing secondary to edema, mucositis, abnormal anatomy and

altered sensation. We describe a simple technique that evolved from experience of

passing NG tubes in head and neck cancer patients. The feeding tube is inserted

through the appropriate nasal cavity, and at 21 cm (8 inches) from the anterior

nares in the average adult (corresponding to a few millimeters above the

arytenoids), the patient is asked to vocalize by saying eeeee in a high pitched tone.

The tube is then advanced into the esophagus while the patient is vocalizing. This

technique has been successfully carried out in 22 consecutive patients, thereby

avoiding the use of more invasive methods.6

 Department of dietetics and clinical nutrition, san Giovanni battista hospital,

turin, Italy. There report his experience with the use of NG feeding in a 39-year- old

women with chronic restricter anorexia nervosa treated in liaison psychiatry and

psychotherapy. On admission to psychiatry unit, the patient presented seriously

deteriorated general condition and a body mass index (BMI) of 10 [BMI= weight

kg/height m(2)]. She refused oral feeding, but eventually accepted NG feeding. In

preparation for her continuing long term (>1 month) NG feeding, During the follow-

up period, an overall improvement in nutritional status, general condition, mood

and cognitive functioning was observed. NG feeding interventions may be feasible in

the long-term treatment of selected anorexia nervosa patients when closely followed-

up by a multidisciplinary medical team.7

6.3 REVIEW OF LITERATURE :

REVIEW RELATED TO NASOGASTRIC TUBE FEEDING

 Reviewing of literature is important for developing a broad conceptual context

into which a problem will fit. It is only within such a context, that the findings of a

project can make a contribution to a body of knowledge. The more ones study is

linked with other research, the more of a contribution it is likely to make . a very

important role of the literature review, is to suggest ways of going about the

business of conducting a study on a topic of interest. 8

The literature reviewed for the present study has been organized under the

following heading:

1. Enteral nutrition

2. Naso gastric tube feeding technique

3. Complication of Naso gastric tube feeding.

1. ENTERAL NUTRITION:

A study was conducted on un intermittent schedule since stomach is normally a

reservoir for intermittently receiving food. Caloric delivery on an intermittent

schedule is determined by calculating the desired 24 hrs nutrient make and dividing

by the number of feedings per day .The average individual can tolerate between 240

and 400ml per feeding & A experimental study was conducted the tube feeding was

once and unpleasant and trouble some procedure both for the patient and the nurse.

The search for adaptable equipment to deliver the feeding and the frustration of

trying to handle complication, were ever present problems. But recent advances in

enteral nutrition are changing all that. Now tube feeding is an easy and safe

procedure. Physically more efficient, and less expensive than parenteral nutrition. 9

Diets used in tube feeding may be of three types: 1) High carbohydrate diet,
2) High carbohydrate- normal protein diet 3) High protein high calorie diet. An average

adult patient will require 1500-2000 kcal. After surgical operation or injury or

burns, or in severe protein- calorie malnutrition provision of 3000 kcal/day is

needed. If adequate calories are not supplied, wasting of body muscle will take place

recommended proportion of carbohydrate, fat and protein for a normal adult person

is as follows: carbohydrate-60-70 %, fat- 10-20 %, protein-10 %, of total calories. 10

5
 A study conducted in east Suffolk, England to find out the existence of hospital

NG tube feeding induced mal nutrition. In this survey of 92 patients from four

general medical wards 43 were male and 49 were female. She found that the

nutrient deficits were present in 84 patients, weight loss occurred in 90 % with a

mean loss since admission of 6.3 + 2.6 kg in one to two weeks. This data shows high

lights the nurses responsibility to maintain the nutritional status of patients. 11

A study attempted to determine the adequately in meeting the nutritional

requirements of tube feed adult patients in medical, surgical and neurological

wards of Christian medical college ( CMC ) hospital, Vellore, out of 45 patients,

observed, 11 (24.4 %) patients, had more than 40 % deficit in calories, 10 ( 22.2 %)

had more then 40 % deficit in protein and 38 (84.4 % ) had more then 40 % deficit in

protein and 38 ( 84.4 % ) had more then 40 % deficit in carbohydrate. This study

also revealed that 16 ( 35.6% ) of them had more that 40 % fat and 1 ( 2.2% ) had

excess in fluid intake.12

There are currently five evidence-based methods to measure the distance feeding

tubes should be inserted. The most commonly used method for measuring tube

insertion distance in hospitals is the noseearxiphoid (NEX) method. This is

obtained by measuring from the nose to the earlobe and then to the bottom of the

xiphoid process. This method was developed using an unreported number of infants

at autopsy. Ziemer and Carroll (1978) had previously reported the NEX method to

be too short, because gastric contents cannot usually be aspirated until the tubing

is advanced further (p. 1543). According to Tedeschi, Altimier, and Warner (2004),

when placing tubes based on the NEX measurement guideline, tubes were noted in

the lower esophagus on x-ray with unacceptable frequency. 13

2. NASOGASTRIC TUBE FEEDING TECHNIQUE:

 Tube feedings may be ordered for a patient who is unable to take oral

nourishment. A Naso gastric tube is most commonly used for short term feeding

problems.

Lewin ( 1985 ) reported that there should be there essential criteria for tube

feeding. First spontaneous nutritional intake should be shown to be inadequate,

second, using the gastro intestinal tract must be desirable and third it

gastrointestinal tract must be desirable and third it must be functional.

Lewins, collier and Heitkemper (1996) explained standards for the

administration of tube feeding procedure :

1) CLIENTS POSITION: - The client should be sitting or lying with head of bed

elevated 30-45 degrees to prevent aspiration.

2) PATENCY OF TUBE: - If feedings are intermittent, the tube should be irrigated with

water after each feeding to prevent blockage of the tube.

3) TUBE POSITION:- Proper placement of the tube in the stomach should be checked

before each feeding or every four hours with continuous feedings.

4) ADMINISTRATION OF FEEDINGS: He principle of gravity is used with the drip

method or with a blub or plunge type of syringe.

5) GENERAL NURSING CONSIDERATIONS:- The client should be weighed daily or

several times a week. An accurate intake and output should be maintained.

A study was stated that prior to giving an intermittent feeding, the care giver

should check for the presence of gastric residuals by aspirating stomach contents

through the feeding tube. If more then 100 ml can be withdrawn, the feeding should

be postponed. In the next scheduled time if the residuals are more then 100 ml, the

physician should be notified and feeding stopped and was recommended bedside

measures to test Naso gastric tube and naso intestinal feeding tube placement.

Among the methods discussed are:- aspiration of recognizable gastro intestinal

contents, auscultation of insufflated air, measurement of PH of gastrointestinal

secretions, and observing for coughing and choking, inability to speak, and the

appearance of bubbles from the end of the tube when it is held under water. 14
 A clinical study in st.louis to determine the extent to which sounds generated by

insufflations through feeding tube could be used to predict where the tube port

ended in the gastro intestinal tract( esophagus, stomach, or proximal small

intestine). The study was also done to differentiate between gastric and respiratory

placement. Sounds generated by a series of air insufflations through the tubes of 85

acutely- ill adult subjects were recorded. One hundred fifteen usable tape recordings

of sound sequences were obtained. The average percentage of correct classifications

of each tape was 34.4 %.

7
Three subjects with feeding tubes in advertently positioned in the respiratory tract. It

shows that nurses should not rely only on the auscultatory method to differentiate

gastric from intestinal placement, nor gastric from respiratory placement of feeding

tubes.15

A clinical study in Polit and hunger to evaluate the extent to which PH values of

aspirates from feeding tubes can be used to differentiate between gastric and

intestinal tube placement and gastric and respiratory tube placement. A sample of

405 aspirates from naso gastric tubes and 389 aspirates from naso intestinal tubes

were obtained 605 subjects. Eighty five percentage of the 405 PH meter readings

from gastric fluid were between 0 and 6.0,87% of the 389 PH meter measurements

performed on intestinal aspirates were greater than 6.0. and also recommended a

similar test to differentiate between gastric and intestinal tubes placement. If the

PH of the fluids less than 3.5 the is in the stomach, a PH gastric than 6.5 means the

tube is in the small intestinal. Before beginning feedings a through gastric- and

assessment is necessary. Listen for bowel sounds in all quadrants for at least 5 per

minutes, if bowel sounds are absent notify the physician, recheck tube placement

after an episode of coughing, retching or vomiting.16

A study conducted in Gaunter, Jones, Ericson to identify visual characteristics of

aspirates from feeding tubes as a method for predicting tube location, the 880

feeding tube aspirates were the sample selected for the study. Ninety percent of the

444 gastric aspirates were white, tan, bloody, brown, or colorless and 95 % were

clody.428 intestinal aspirates were recorded as yellow or bile 80 %. The appearance

of aspirates was helpful in distinguishing between gastric and intestinal placement

and the Three methods of administering feed have been recommended if the bolus

method is used the feed should be poured into the barrel of a large syringe attached

to the feeding tube, the barrel should be held about 12 inches above the patients

shoulder and 200 400 ml of formula should be given over a 5 minute period, or an

average of 40 80 ml per minute. The second method is the intermittent delivery

method which allows the formula to drip slowly over 20 30 minutes thereby

facilitating a lower rate per minute than the bolus method. The third delivery

method is continuous drip feedings over a 16 24 hour period. Patients on

continuous drip feedings can be turned from side to side, but the head of the bed

should be elevated at all times. 17

8
 A study described a safe method of handling and storage of formula for tube fed

Patients. the points to be kept in mind are as follows : 1) the hands must be washed

thoroughly before handling the formula thus lessening the chanced of food

contamination. 2 ) Temperature extremes when storing unopened formula should be

avoided. 3) The expiry date on formula containers should be checked and use of out

dated formula must be avoided. 4) the equipment and kitchen area must be chanced

before mixing or handing formula. (5) Tube feeding equipment must be rinsed

before and after each use. 6) new formula should not be added to formula already

hanging in the bag and he formula should hand for no more then 6-8 hours if

continuous drip method is used and The study compared the adequacy of care

provided in tube feeding procedure by different group of nursing personnel in CMC

hospital, vellore.19

The study was conducted on 68 nursing personnel on 34 Patients. the nursing

personnel were nine degree nurses , 24 diploma nurses and 35 student nurses. The

study revealed that adequate care was given by 72 % of the nursing students, 62.7 %

of the diploma nurses and 62.5 % of the degree nurses. Comparing the quality of the

care given by the different category of nursing personnel, the students nurses gave

significantly better care then the diploma nurses. This study also found that the

majority of experienced nursing personnel (58.1 % ) gave adequate care in meeting

the nutritional needs through naso gastric tube feeding .20

3. COMPLICATIONS OF NASO GASTRIC TUBE FEEDING :

The complications associated with tube feeding fall into three categories.

1) Mechanical, 2) Gastro intestinal , 3) Metabolic.

1) Mechanical complication included:- naso pharyngeal irritation ; luminal obstruction,

mucosal erosion, tube displacement and aspiration.

2) Gastro intestinal complications :- consisted of: cramping/ distention/ vomiting;

diarrhea.

3) Metabolic complications involved:- hypertonic dehydration; glucose intolerance; hyper

osmolar non ketotic coma; hepatic encephalopathy; renal failure; cardiac failure.

9
 A study stated that pulmonary complications are potentially the must dangerous

complications associated with enteral feeding and may even result in death. Young

and white (1992)asserted that patients at risk for aspiration are those who have

lowered level of consciousness, absent or diminished cough reflex and are non

communicative and recumbent most of the time. Other factors that can cause the

patients to aspirate are reduced oral or hypo pharyngeal sensation, dysphagia from

neurological or esophageal diseases, in competent upper or lower esophageal

sphincters, diminished esophageal peristalsis or a delayed gastric emptying. 21

According to the risk of aspiration can be avoided in conscious patients who should

be fed at all times in a sitting or semi- recumbent position. Reverse trendelenburg

position is recommended for unconscious patients. Gastric distension can be

avoided by the correct choice of tube feed and by measuring gastric residue as

feeding is initiated. Tube feeding rates should not be increased suddenly to meet

specified delivery volumes .

A surveyed the problems and benefits of different

practices related to entered feeding the administration of cold feeds has been

implicated as a possible cause of diarrhea, since it could act as an irritant to the

intestinal mucosa and increase gut mobility. Bolus feeding is largely responsible for

tube feeding related diarrhea, regurgitation of feed and abnormal cramps.22

 A study stated that nausea, vomiting and diarrhea from tube feeding could be

prevented or overcome by correcting the rapid infusion rates, osmolality of the

formula and preventing the bacterial contamination of the formula and feeding

equipments. According to constipation is more a patients and with previous history

of constipation or laxative use / abuse and in patients who are on long term tube

feeding regimens, especially in those given low-residue formulas. Constipation can

be prevented by ensuring that the patient receives adequate amount of fluid,

switching to a fiber- containing formula, administering a bulking agent, and

increasing physical activity to stimulate intestinal motility. A study reported that to

prevent problems with naso enteral tube, the nostrils have to be checked every eight

hours for signs of excessive pressure, such as erythema or a distorted shape and

they have to be cleaned and moistened every 4-8 hours. In some cases the tube

pressing against the nasal cartilage results in nasal septum abscess. Tube rupture

can be identified when there is no resistance to the flour of formula. or when you can

it withdraw residual volume.23

10
 A study described the nurses responsibility in dealing with complications of naso

gastric tube. They suggested that it gastric residual is grater than 150 ml, the

feeding has to be postponed until there is less residual. Any feed withdrawn from

the stomach has to be replaced immediately. The patient complains of diarrhea,

fullness, cramping, nausea or vomiting the nurse is directed to receive the feeding

technique and ask herself the following questions. Am I giving the correct amount of

feeding? is the feeding at room temperature? At the flour rate adjusted properly?

Have I checked gastric residual before each feeding? Am I positioning the patient

properly during the feeding? If the answer is yes to questions and problems still

exist the nurse should inform the doctor. Mechanical problems such as tube

blockage, breakage or displacement may also occur which should be checked by

nurses.24
11
6.4: STATEMENT OF THE PROBLEM:-

A study to assess the effectiveness of structure teaching programme on

knowledge and practice of Naso gastric tube feeding to adult patient among

nursing personnel working in selected hospital, Bangalore.

6.5: OBJECTIVES OF THE STUDY:

1. To determine the pre test knowledge on practice of nursing personnel

regarding

Naso gastric tube feeding

2. To administer structure teaching program regarding knowledge and

practice of Naso

gastric tube feeding

3. To assess the post test knowledge and practice of nursing personnel

regarding Naso

gastric tube feeding

4. To know the association between the pre test and post test knowledge and

practice of

nursing personnel with their selected socio demographic Variables

6.6: OPERATIONAL DEFINITIONS:-

EFFECTIVENESS:

It refers significant gain in knowledge on tube feeding as determined by

significant difference in pre test and post test score

STRUCTURED TEACHING PROGRAME:

 It refers to systematically organized teaching strategy regarding knowledge and

practice of Naso gastric tube feeding among nursing personnel.

KNOWLEDGE:

It refers to correct response of nursing personnel to items in knowledge

questionnaire on categories of Naso gastric tube feeding .

PRACTICE:

It refers to the activities performed by nursing personnel regarding Naso gastric

tube feeding.

12
ADULT:

In this study, it refers to the children whose age is 20 to 40 years.

NASO GASTRIC TUBE FEEDING :

It refers to the process of giving liquid nutrients to a patient through the tube into

the stomach.

NURSING PERSONNEL: It refers to :

Qualified a professional nursing personnel who is in practice in the particular

hospital.

6.7 : ASSUMPTION OF THE STUDY:

1. The nursing personnel have limited knowledge level about Naso gastric tube

feeding

2. Nursing personnel have the limited practice and knowledge level about Naso

gastric tube feeding.

3. Safe and successful tube feeding depends on choosing the right patient, formula,

route and techniques as well as on nurses expert vigilance and care.

6.8 : DELIMITAIONS OF THE STUDY:

1. The study is limited to the nursing personnel available during data collection

2. Staff nurses who are willing to participate in study

3. Staff nurses who are present at the time of data collection.

6.9 : HYPOTHESIS:

Ho1: There will be significance difference in the level of knowledge of nursing personnel

on Naso gastric tube feeding after administration of structured teaching

 programme.

Ho2: There will be significance difference in the level of practice of nursing personnel

on Naso gastric tube feeding before and after administration of structured

teaching programme.

Ho3: There will be significance association between the pre test and posttest knowledge

level of nursing personnel regarding Naso gastric tube feeding with their selected

social demographic variables.

13

HO4: There will be significance association of post test practice level of nursing

Personnel with their selected social demographic variables.

7 : MATERIALS AND METHODS:

The Study is designed to assess the effectiveness of structure teaching programme

on Naso gastric tube feeding to adult patient among nursing personnel working in

Selected hospital in Bangalore.

7.1 : SOURCE OF DATA:

Nursing personnel who are working in selected hospital, Bangalore.

7.2 : METHOD OF DATA COLLECTION:

The data will collected from the nursing personnel by structured knowledge

Questionnaire regarding nasogastric tube feeding.

i) RESEARCH DESIGN:

Quasi experimental one group pretest and post test design.

ii) RESEARCH VARIABLES :

1) Dependent variables : Knowledge of nursing personnel on nasogastric tube

 feeding

2) Independent variable: Structure teaching program on knowledge regarding

nasogastric tube feeding in a selected hospital at Bangalore.

iii) SETTING:

The study will conducted in selected hospital

iv) POPULATION:

Nursing personnel in selected hospital will be included in this study.

v) SAMPLE SIZE :

Based on the objectives of the study 50 samples will be selected for the study.

14

vi) SAMPLING CRITERIA :

INCLUSION CRITERIA :

1. Nursing personnel who are willing to participate in the study

2 . Nurses working in selected hospital

3. Nurses who give consent for the study.

EXCLUSION CRITERIA:

1. Nursing personnel those who are in leave on the day of assessment.

2. Nurses who are not willing to participate in the study.

vii) SAMPELLING TECHNIQUE

Convenient sampling technique will be used.

viii) TOOL FOR DATA COLLECTION :

Self administered knowledge and practice questionnaire will be developed

 and used for data collection.

ix) METHOD OF DATA COLLECTION :

The investigator will administer a structured interview schedule to collect data

from the subjects.

x ) METHOD OF DATA ANALYSIS:

The investigator will analyze the data obtained by using descriptive and

Inferential statistics. The plan of data analysis will be follows:

1. Organize the data in a master sheet / computer

2. Frequency and percentages for the analysis of socio demographic data

3. Mean standard deviation ( SD ), and paired t test to determine the significance.

4. Chi-squire to measure to measure the association.

xi) PROJECTED OUTCOME:

The structured teaching Programme on Naso gastric tube feeding will enhance

the knowledge of nursing personnel.. 15

7.3 : DOES THE STUDY REQUIRE ANY INVESTIGATION OR

INTERVENTION TO BE CONDUCTED ON PATIENTS OR OTHER

HUMANS OR ANIMALS? IF SO, PLEASE DESCRIBE BRIEFLY.

Yes, Structured teaching Programme the will be conducted on Naso gastric

tube feeding nurses in patients at selected hospital at bangalore .

7.4 : HAS EHETHICAL CLEARANCE BEEN OBTAINED FROM YOUR

INSTITUTION IN CASE OF 7 .3?

Yes, informed consent will be obtained from the institution authorities and
 subject, privacy, confidentiality and anonymity will be guarded, scientific

objectivity of the study will be maintained with honesty & impartiality.

16

8. LIST OF REFERENCES:

1. Bayer hind m, Deborah Evans Scholl and Eileen Guiden ford, 1983 tube feeding

at home American Faurnal of nursing, 83;1321-25.

2. Bockus, sherry, 1991, trouble shooting your tube feedings American journal of

nursing 91, 24-28.

3. Brown, Katrina 1991. Improwing intake nursing time 87;64-68 Bursztein simonet

energy metabolism . indirect Calarimetry and nutrition London: library of Congral

Catatoging in publication:1989, 266p,p

4. Chitras . the quality and colt of care probided by the nursing personnel in meetin

the nutritional needs of adult patient. (univerlity of m.g.r. madral 1995). p.48

5. Christensen: Barbara lauriteen and elaine oden kockrow, fondations of

nursing.chicago: more by co. 1995-p.1693.

6. Eilenberg put:1989 enteral nutritionnursing clinics of north America 24:315-37

7. Minerva gastroenteral dietol. 2006 dec; 52 (4) : 431-5.

8. Eilenberg putptli:G 1994 nasoenteral tubes page no:57:62-68.

9. Holmes sue. 1993 building blocks nursing Times 89:28-31

17

10. Eur Arch Otorhinolaryngol. 2005 May; 262 (5) ; 423-5. Epub 2004 nov 12.
11. J.S.Garrow.W.P.T.James and Anne Ralph. Human nutrition and dietetics Londan :

Lucy Gardiner publishers .1998. p.p. 847.

12. Jones.Sande 1984 simpler and safer tube feeding techniques page no 47:40-47.

13. Kemp.Brenda Biglow.Addele Pillitteri, Patricia B row fundamentals of nursing

London ;Scot foramen and co:1989.

14. Tedeschi, Altimier, and Warner gastric contents cannot usually be aspirated until

the tubing is advanced further (p. 1543). (2004),

15. Potter , patricia a and anne . Griffin perry fundamentals of nursing . st Louis

Baltimore: mosby co.1997. page no 1540.

16. Williame Gwyn,1992. Hard to swallow nursing times 88;63-67.

17. Rombeau .Jhon L.and Lenora R. Barot .1981;Enternal Nutrition therapy

surgical clinics of North America. 6:605-619.

18. www. Wikepidea.com

19.. Stoner , sherry, Trouble shooting your tube feedings American journal of nursing
2005.

20. Konstenttinides and shronts- fundamental of nursing, London: scot

foreman & co. 2008.

21. Livingstone, umapathy and saraswathy- 2008.

22. Perry, Nasogastric tube feeding RN 57:62-69. 2005.

18
23. Jones- sande simpler and safer tube feeding techniques RN47: 40-47.2005.

24. J clin gastroenterol . 1992 Mar; 14 (2 ) : 144-7.

19