Strategic management assignment help: Nasogastric tube – Hospitalized patients
Nasogastric tube insertion for unconscious patients, patients with swallowing difficulties and digestive system malfunctioning’s is a commonly used procedure for hospitalised patients. A nasogastric tube is used for feeding, administering drugs and removing stomach content using aspiration. However, patients fed via the tube while it is wrongly positioned, dehydration, aspiration pneumonia and sepsis are few health complications related to the procedure of nasogastric tube insertion and the nursing care for a clients with a nasogastric tubes.
In this report the author had identified and will focus on nasogastric tube insertion and the above complications in elderly patients and what are the rationales to overcome this problem.
Population:
The population used in this research is the elderly patients aged above 65 who live in long term health care facilities such as nursing homes or geriatric hospitals. The numbers of candidates are about 20 to 200 patients with naso gastric tube inserted. However in one research article, the population researched were a number of stroke patients who have the similar physical states as elderly patients.
Interventions:
Adequate oral hygiene and standard of care in residential aged care facilities and proper education about naso gastric tube management is considered as the best productive interventions
Comparison:
A high number of patients were identified with aspiration pneumonia that was fed through naso gastric tubes and this number was compared with patients who were oral fed.
Outcomes:
The patients who were fed via naso gastric tubes were identified as higher risk of getting aspiration pneumonia rather than the patients who were fed orally.
Importance of developing a clinical practice knowledge and research
It has been noted that elderly patients with dysphagia has a high mortality rate due to aspiration, especially the patients who live in nursing homes have a higher mortality rate of six months after inserting the naso gastric tube (Mamun, K & Lim, J, 2005) .Even though naso gastric provides solution for patients with swallowing difficulties, it significantly increase the number of deaths caused by aspiration pneumonia. However in some cases, patients who were fed orally had a better out come in the mortality rate rather than the patients who were fed with naso gastric tubes.
The more researches should be conducted to find a solution to prevent aspiration pneumonia for elderly patients with naso gastric tubes .This will potentially reduce the number of patients who die in complications related to aspiration pneumonia.
Methods
Inclusion and exclusion criteria (750 words)
Inclusion
In the above researchers regarding the relationship between naso gastric tubes and aspiration pneumonia, the population reviewed were patients over 65 years. This age group was chosen because it is evident that people who are over age 65 are more prone to get aspiration pneumonia while been treated with naso gastric tube incubation ( Marik, Paul, E,Kaplan, D, 2003). Patients who were incubated due to stroke have also been included to this study because their physical statues after the stoke is similar to many elderly patients (Dziewas, R, Ritter, M,et al, 2004). The intervention for the above studies will be mainly focused on the proper oral hygiene in elderly patients in nursing homes and the higher standard of care that will prevent potential complications related to pneumonia (Sarin, Jaya, et al, 2008). Studies were conducted on routine oral cares for the elderly patients with naso gastric tubes where the oral hygiene was done using one selective antiseptic cleaning compound. This was to identify wether the oropharyngeal microbial flora and other organisms cause aspiration pneumonia in elderly patients .The same study was performed on the patients who were not on naso gastric tubes and were orally fed (Chong Lin, C, 2004). The idea of this study is to compare the number of patients who suffered from aspiration pneumonia who were naso gastric fed and orally fed. The motility rate was also compared in these two categories. The outcome of this research was the patients who got proper oral hygiene care did not suffer from aspiration pneumonia. Poor oral hygiene, lack of standards of care, and insufficient attention paid to promote oral health care are the main reasons for aspiration pneumonia (Sjögren, Petteri, 2008). Nevertheless Patients who were fed orally had a better out come in the mortality rate rather than the patients with naso gastric tubes (Bullock, T et al, 2008).
Exclusion
Patients under the age of 65 were not included in these studies because people under this age are more tolerant to aspiration pneumonia. Due to the higher immunity level in their body system many people under the age of 65 do not suffer from aspiration pneumonia and related complications as much as the older adults (Marie, J, File, S, 2012). The study that was conducted to identify the relationship between the dehydration on patients, who were fed via naso gastric tube and orally fed, did not include patients with existing urinary tract infections. The results of the study was determined by testing the urine and blood samples hence the sodium and electrolyte levels in patients with urinal tract infections will be vary from the regular patients (Beetz, R,2003) . All the data for the research studies were gathered from patients who were admitted to geriatric hospitals or nursing home settings. The patients who were admitted to general medical wards were excluded. The reason for this is the standard of care in hospital settings and the standard of care in nursing home and geriatric hospital environment have many differences such as the patients nurse ratio, the care plans and pathways, government legislations, medication regimes and access to emergency and other allied health services (Kane, Robert L., et al, 2003).
Search strategy (Total 1250 words)
Two electronic data bases used for researching . (100 words)
Google scholar is one of the data bases used to collect information related to the assignment. Google scholar is a user friendly data base contains various articles written by many researches and expertise in various fields throughout the time. By using the ‘custom range’ setting of goggle scholar, the viewer can narrow down the articles and research papers according to the relevant times hence this helps the viewer to identify the most relevant information.
The library data base of the University of South Australia is also another electronic data based used to gather information. University library website contains many e books, research papers and articles that are relevant to the authors research topic .This data base is also very user friendly.
Key words used to identify appropriate publications (250 words)
Naso gastric tube: The research is about the relationship in between elderly patients with naso gastric tubes and aspiration pneumonia. There are many articles about procedures and complications related to naso gastric tubes, however the ‘customer range’ setting helps to narrow down the articles as per relevance.
Aspiration pneumonia: This is another key word used in the search for relevant articles. However ‘aspiration pneumonia’ gives a wide range of research articles.
Elderly patients: The research is based on aspiration pneumonia in elderly patients who are using naso gastric tubes for feeding. Elderly patients are one of the main key word that is related to this research. The goggle scholar and University of South Australia provides many articles about various to conditions or elderly patients however can be narrowed down.
Dehydration
A part of the research is to identify the hydration levels of elderly patients who have naso gastric tubes incubated. This keyword combined with other key words directly guides the viewer to the section where the information is about the hydration level of elderly patient with naso gastric tubes.
Oral hygiene
Proper oral hygiene is one of the key elements of preventing aspiration pneumonia for elderly patients with naos gastric tubes. The Google scholar and the university data base have many articles related to prevention of aspiration pneumonia by using adequate oral hygiene.
Nursing homes
The research is mainly focused on patients who live in nursing homes and geriatric hospital care. This key word combined with other key words will direct the viewer to the particular area of controlling aspiration pneumonia in nursing homes
Geriatric hospitals
A geriatric hospital is also another key word used to do the research. By using this key word combined with other main key words, the viewer can observe the articles and journals related to care for the patients with aspiration pneumonia who live in geriatric hospital setting.
Developing a simple search strategy string relevant to the research question
(500 words equivalent).
In relation to the following research the author used a search strategy string using subject searching, truncation, abbreviations, wildcards and Boolean operators.
Subject searching
The author used following key words ,statements and phrases in the ‘Google scholars’ and ‘Uni SA library’ search engines to identify the most relevant articles for the research. To narrow the search, the author also added a time period from 2003 to 2013. Then the author clicked view to collect the results (Pub med search strategies, 2013).
- Naso gastric tube incubation for older patients
- Management of naso gastric tube incubation in elderly patients
- Complications related to naso gastric tube incubation in elderly patients
- Possible interventions to prevent aspiration pneumonia in elderly patients
- Elderly patients with naso gastric tubes ,who live in nursing homes and geriatric hospitals
- Motility rate of elderly patients who are fed though naso gastric tubes
Truncation/wildcard
When a relevant document or a pdf file was downloaded for the research, the author used truncation search to identify the sections where the most relevant details, information, and terms were found. The author used following worlds for the truncation search (Pub med Search Strategies, 2013).
- Older adults*
- Elderly patients*
- Older people*
- Aged*
- Aging*
- Naso gastric*
- Naso gastric tube incubation*
- Orally fed*
- Tube fed*
- Hygiene*
- Pneumonia*
- Aspiration pneumonia*
- Motility rate*
- Deaths*
- Oral hygiene*
- Nursing homes*
- Geriatric hospitals*
- Geriatric*
- 2003*
- 2013*
- Sample*
- Population*
- Interventions*
Boolean operators
The author used the three concepts of Boolean operators to search articles for the research question.
The author used ‘AND’ to retrieve and search article s and records contain all of the key words but in separate (Pub med Health, 2012). This technique was used in creating the inclusion criteria for the report. For example
- Naso gastric tube incubation and aspiration pneumonia
- Aspiration pneumonia and elderly patients
- Aspiration pneumonia and nursing homes
- Standard of care in nursing homes and prevention of aspiration pneumonia
- Aspiration pneumonia and motility rate in elderly patients
- Naso gastric tube feeding and oral feeding
- Oral hygiene and aspiration pneumonia
- Causes of aspiration pneumonia in elderly patients and interventions
- The relationship between aspiration pneumonia and older patients
The author used ‘OR’ to gather and search any related information for the research topic. This technique was also used in creating the inclusion criteria for the report (Pub med Health, 2012). For example
- Aspiration pneumonia or common pneumonia in elderly patients
- Nursing home care or geriatric hospital care
- Orally fed or naso gastricly fed
- Patients with naso gastric tubes inserted or patients with aspiration pneumonia
- Elderly patients or stroke patients
- Oral care or naso gastric tube care
- Possible interventions or outcomes to prevent aspiration pneumonia in elderly patients
- Mortality rate in elderly patients with naso gastric tube fed or motility rate in patients who are orally fed
The author used ‘NOT’ to eliminate unwanted information in the research to identify the most relevant information (Pub med Health, 2012). This technique was preferably used in creating the exclusion criteria for the report .For example,
- Aspiration pneumonia in elderly patients with naso gastric tubes not children
- Nursing homes and geriatric hospitals not general hospitals
- Motility rate of patients naso gastricly fed not orally fed
- Elderly patients who are not under 65 years of age
- Aspiration pneumonia in older people not young adults
- Bacteria and germs that cause aspiration pneumonia not oral flora
How does the review process broaden the understanding of the selected research problem? (400 words)
PICO
The PICO method is a very useful tool in research projects. The use of problem/population section the author understood how to narrow down a research question by identifying the primary problem of the research question, the main concerns of the patients, the diseases and health states, the age , sex ,medication and accommodation as well as the number of candidates with similar kind of problems (Huang, Xiaoli et al,2006).
The second step of PICO which is the intervention helped the author to understand and identify possible interventions for the clients who suffer with aspiration pneumonia after inserting a naso gastric tube. The author also understood that interventions are the main considerations for the group of patients.
In the third section the author understood the use of comparison by using questions and debating the main alternative interventions for the problem. However For some of the research articles related to aspiration pneumonia in elderly patients with naso gastric tubes did not contain alternative interventions.
The final aspect of PICO which is the outcome helped the author to identify specific results of what the researchers were planning to accomplish and improve. In this particular report the outcomes were to understand and identify the main causes of aspiration pneumonia in elderly patients with naso gastric tubes and the increasing motility rate.
Inclusion and exclusion criteria
By using the inclusion and exclusion criteria’s the author understood means of establishing precision in this particular study of naso gastric tubes and elderly patients with aspiration pneumonia. According to the inclusion criteria the researchers used the best possible candidates for their study according to their age, health statues and the care provided. In the exclusion criteria, the researchers eliminated the candidates who are under the appropriate age, health statues, patients who are on particular medications and accommodation statues. By doing this filtration before the study, the researchers can collect the most accurate data and results as well as to identify the best possible outcomes.
Search strategies
The author understood the use of subject searching, truncations, abbreviations and Boolean operators helps the researches to find the most relevant details related to their research. The truncations help to find out key words in a large document while Boolean operator helps to identify articles and information that contains all the key words or any key words. These techniques also help to eliminate the information that is irrelevant or out of date.
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