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Rajiv Gandhi University of Health Sciences, Karnataka,

Bangalore

PROFORMA SYNOPSIS FOR REGISTRATION OF SUBJECT FOR DISSERTATION

DISSERTATION PROPOSAL

“A STUDY TO EVALUATE THE EFFECTIVENESS OF PLANNEDDEMONSTRATION AND COMPUTER ASSISSTED TEACHING ON KNOWLEDGE REGARDING PEDIATRIC NASOGASTRIC TUBE FEEDING AMONG THE 4th YEAR BSc NURSING STUDENTS OF SELECTED NURSING

COLLEGES IN BANGALORE ''

SUBMITTED BY,

MISS.SHIBY JOSE

1ST YEAR M.Sc. NURSING

BHAGATH COLLEGE OF NURSING

BANGALORE-61

0


BangalorePROFORMA SYNOSPSIS FOR REGISTRATION OF SUBJECT FOR DISSERTATION

1

1. Name of the Candidate and Address Miss. Shiby Jose, Bhagath college of nursing,no.60,uttarahalli main road,uttarahalli hobli,banglore 61

2. Name of the Institution Bhagath College Of Nursing Bangalore

3. Course of study 1st Year MSc. Nursing, Child Health Nursing

4. Date of admission to course 1/6/2012

5. Title of the topic :“A STUDY TO EVALUATE THE EFFECTIVENESS OF PLANNED DEMONSTRATION AND COMPUTER ASSISSTED TEACHING ON

KNOWLEDGE REGARDING PEDIATRIC NASOGASTRIC TUBE FEEDING AMONG THE 4th YEAR B.Sc NURSING STUDENTS OF SELECTED NURSING

COLLEGES IN BANGALORE ''

6. Brief resume of the intended work: 6.1 Need for the study 6.2 Review of literature 6.3 Objectives of the study 6.4 Operational definitions 6.5 Hypothesis of the study 6.6 Assumptions 6.7 Delimitations of the study 6.8 Pilot study 6.9 Variables

Enclosed Enclosed Enclosed Enclosed Enclosed Enclosed Enclosed Enclosed Enclosed

7. Materials and methods 7.1 sources of data- Data will be collected from fourth year B.Sc Nursing students studying at selected colleges in Bangalore.

7.2 Methods of data collection- Structured knowledge questionnaire 7.3 Does the study require any interventions or investigation to the patients or other human being or animals? Yes 7.4 Has ethical clearance been obtained from your institution? Yes, ethical committee’s report is here with enclosed.

List of references Enclosed


Bangalore

PROFORMA SYNOPSIS FOR REGISTRATION OF SUBJECT FOR DISSERTATION

1. Name of the Candidate and Address Miss. Shiby Jose,

Bhagath college of nursing ,uttarahalli

main road,uttarahalli hobli,Bangalore-560

061

2. Name of the Institution Bhagath College Of Nursing

3. Course of study and subject 1st Year M.Sc. Nursing

Child Health Nursing

4. Date of admission to course 1/6/2012

5. Title of the Topic:

“A STUDY TO EVALUATE THE EFFECTIVENESS OF PLANNED

DEMONSTRATION AND COMPUTER ASSISSTED TEACHING

ON KNOWLEDGE REGARDING PEDIATRIC NASOGASTRIC

TUBE FEEDING AMONG THE 4th YEAR B.Sc NURSING

STUDENTS OF SELECTED NURSING COLLEGES IN

BANGALORE ''

2

6. BRIEF RESUME OF THE INTENDED WORK:

INTRODUCTION

“Relying Solely upon Auscultation to verify nasally inserted Feeding tube placement may lead to tragic

consequence”

- by Norma Metheny, Ph.D, RN

Good nutrition in children fosters optimal growth and development. Health supervision of children

requires knowledge of their nutritional needs. Nutrition as a new field of study is about one hundred years old.

Even though Hippocrates had recognized diet on a component of health as early as 300BC, only in the past one

hundred years people began to realize the importance of carbohydrates, lipids and proteins for normal growth

and development. Good nutrition maintains health as well as promotes normal growth and development.1

Nasogastric feeding is a way to deliver nutrients and medications through a tube when a child cannot take

food or drink through the mouth. Possible reason for tube feedings are central nervous system problems, severe

cerebral palsy, burns, head injury, after surgery, inherited metabolic disorders gastrointestinal diseases, severe

gastro oesophageal reflux, failure to thrive, disorders of the oesophagus, abnormalities in the anatomy of the

gastrointestinal tract, severe cleft lip/cleft palate and cancer of oesophagus etc.2

Nasogastric feeding is done via a small tube that is inserted through the nose and runs to the stomach.

Some children receive all nutrition from NG feedings, while others get supplementary feedings via the tube. NG

feedings do not require surgery for tube placement and are favoured for short-term tube feedings. Nasogastric

tube feeding is one of the safe means of meeting nutritional requirement of infants less than 32 weeks or those

whose weight is less than 1500gms and critically ill children. Minor complications can be a sore throat, nose

bleeds and sinusitis, severe mid face trauma.2

Nursing management of new-borns receiving enteral feedings encompasses, tube insertion and placement

confirmation, securing the tube, monitoring the patient during administration of enteral feedings and maintaining

tube function, providing oral and nasal hygiene, assessing and preventing complications, maintain intake output,

calculate bodyweight and tube removal . The nurse must follow asepsis technique in the time of oral feeding to

prevent the cross infection.

Nasogastric tube feeding is one of the safe means of meeting nutritional requirement of infants less than

32 weeks or those whose weight is less than 1500gms and critically ill children. Nasogastric tube feeding

provides adequate nutrition and is an essential component of critical care. Nurses have to decrease the gap

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between theory and practice by performing proper clinical bed side procedure. A better understanding of nursing

practice related to tube feeding is required for providing a better care. A successful Nasogastric tube feeding

performance requires an expert skilled procedure and monitoring the child efficiently.

Numerous studies demonstrated that nursing professionals are still following so many errors during their

Nasogastric tube feed practice. The nurses need to be moulded from their educational period itself with accurate

theoretical and practical knowledge of procedures. The healths of the future nation exist upon the well being of

the children over there. Hence the researcher felt to conduct a research study to improve the knowledge of

students regarding Nasogastric feeding.

6.1 NEED FOR THE STUDY

“The doctor of the future will no longer treat the human frame with drugs, but rather will cure and

prevent disease with nutrition.”

~Thomas Edison

Children are very important and vulnerable group of overall population and constitute almost 1/3rd of

the overall population, and they also have some rights such as protection, security, social identification, basic

needs like air, water, food, clothes, shelter etc. Neonatal morbidity & mortality is increasing day by day due to

the lack of the available resources in developing countries. For better neonatal care and prevention of the

preventable causes of neonatal morbidity & mortality, audit of the neonatal admission should be reported

continuously all over the country.3

Infants born prematurely and other congenital or acquired medical conditions or who have extended stays

in the neonatal intensive care unit are at risk of developing feeding and nutritional problems than are full term,

healthy new-borns. Because of the complex nature of feeding, it is necessary to have a thorough understanding of

the developmental nature for this skill. Intervention strategies to promote stability leading to successful feeding

are also described. Premature babies have special nutritional needs because they grow at a faster rate than full

term babies and their digestive systems are immature. Deontologists measure their weight in grams. Breast milk

is an excellent source of nutrition, but they are too immature to feed directly from the breast or bottle until they

are 32 -34 weeks gestational age. Therefore they have to be fed on Nasogastric feeding.4

Nasogastric tube feeding is an essential component of the treatment of severe and persistent diarrhoea. It

helps the gut to recover, replaces the nutrients lost in the stool and prevents malnutrition. Often the normal diet

of a child with persistent diarrhoea is inadequate and this is a good opportunity to advice the nurses how to feed

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and improve the nutrition of the child. So, it is very necessary for the nurses to have theoretical as well as

practical knowledge. It has suggested in recent studies that there are benefits of early introduction of small

amounts of Nasogastric tube feeding in metabolically stable preterm infants. These “minimal enteral feedings”

have shown to stimulate the infant’s gastrointestinal tract, preventing mucosal atrophy and subsequent enteral

feeding with as little as 0.1ml to 4ml/kg formula.5

A study was conducted in New Delhi to describe recent reports of feeding Nasogastric tube placement

problems and to examine possible solutions. Multiple case reports of complications of malpositioned feeding

tubes continue to surface; most are due to inadvertent placement in the respiratory tract. A tube with feeding

ports in the oesophagus, and the displacement of a small bowel tube into the stomach of a patient with

significantly slowed gastric motility significantly increased the risk for aspiration. Isolated reports of a nasally

placed tube entering the brain following head injury also identified as per the reports, of oesophageal and gastric

perforation in neonates. A recent study showed that malpositioned tubes are not routinely recorded in risk

management databases; it further demonstrated that a comprehensive intervention to reduce complications from

small-bore Nasogastric feeding tubes was effective. The study concluded that, complications related to

malpositioned feeding tubes were usually preventable if effective protocols were adodted.6

A study was conducted by Dr. S Leonard who was the head of paediatrics nursing in cork University,

New Zealand, among the staff nurses to find out the complication of Nasogastric tube placement. He found that

the staff nurse inserted tube and position confirmed by the air in sufflation and feeding was recommended after

one hour patient become agitated an chest radiography was performed .the feeding tube was seen in the right

bronchus and the patient having pneumothorax as a result of air in sufflation of Nasogastric tube placed next to

pleural space. The death of the child occurred due to this complication.7

The errors during the Nasogastric tube feeding include pulmonary aspiration. Diarrhoea, constipation,

tube occlusion, displacement of the tube, abdominal cramping, nausea and vomiting, delayed gastric emptying,

serum electrolyte imbalance, increased respiratory quotient, fluid overload, hyper osmolar dehydration etc.

Nursing students must have adequate knowledge and good practice technique to minimize the complications. So

nursing students need the demonstration and adequate training regarding Nasogastric tube feeding.

When the researcher was working in a hospital as a NICU staff, researcher observed that many of the

nursing personnel’s were following improper methods of oral feeding, tube insertion, and placement. Hence the

researcher felt to conduct a research study to improve the knowledge of students regarding Nasogastric feeding.

5

6.2 REVIEW OF LITERATURE

6

A review of literature related research and theory on a topic has become a standard and virtually essential

activity of scientific research projects “Literature review is a critical summary of research on a topic of interest,

often prepared to put a research problem in contact or as the basis for an implementation project.” Review of

literature was undertaken to gain in depth knowledge on various aspects of the problem under study.

Simmons - Stern N R conducted London, a retrospective study on feeding dysfunctions in infants with

severe chronic renal failure among 15 patients. The result showed that 13 patients had significant and persistent

eating difficulty, with difficulty in chewing and swallowing in 7 and food refusal in 6. For 2 patients panic

attacks from swallowing were repeatedly reported. These problems persisted for more than year in 5 patients and

between 1 and 6 months in 4. The researcher concluded that a possible means of overcoming the difficulties that

may follow Nasogastric tube feeding might include: encouraging the use of a pacifier, proposing water for

spontaneous consumption, leaving the child the possibility of eating food spontaneously during the day time, and

increased support for the parents during weaning 8

Kolanowski conducted a retrospective study in China, on complication associated with enteral nutrition

by Nasogastric tube in an internal medicine unit among 64 newborns who were fed by Nasogastric tube. The

result showed several kinds of complications such as diarrhoea, vomiting, constipation, lung aspiration, tube

dislodgement, tube clogging, hyperglycaemia and electrolytic alteration. Hence the researcher suggested that

need of nursing intervention by checking the gastric residue periodically, attempting to place the tube in the

duodenum in the unconscious patients and the use of protective mittens in disturbed patients.9

Grassel E conducted a study in German for identifying non-invasive techniques and criteria for

predicting the proper length for insertion of Nasogastric tube such that the tube would be located in the fundus of

the stomach. A revive of literature and existing practices revealed unsubstantiated and discrepant methods

currently in use and justified the need for the research. The study involved relating several external body

measurements from the tip of the nose to the lower oesophageal sphincter, via the oesophagus. A variety of

analysis including stepwise multiple regression, were used and are presented. A formula is presented and stated

to provide 91% confidence level of tube tip placement in the stomach between 1 and 10 cm. this is compared to a

confidence level of 72% using the traditional nose to ear to xiphoid measurement. The formula is ((NEX-

50cm)/2)+50cm where NEX is the distance from the tip of the earlobe to the xiphoid. Thus complications can be

prevented by proper placement of the tube.10

Carpenter B D conducted a study in Department of Podiatric Critical Care, USA to determine the Oral

and nasal enteral tube placement errors and complications in a neonatal intensive care unit. Five cases of enteral

7

tube placement errors occurred in our combined medical-surgical neonatal care unit within the past year. All five

resulted in placement of the feeding tube in the respiratory tract, four occurred despite the presence of cuffed

endotracheal tubes. Three of the five patients had subsequent worsening of their respiratory status. One

developed a pneumothorax, one developed pulmonary haemorrhage, and one developed an increased oxygen

requirement. Patients in the neonatal intensive care unit may have characteristics that place them at an increased

risk for misplacement of oral or nasal enteral tubes into the respiratory tract. Placement of enteral tubes into the

respiratory tract may cause serious morbidity and possibly mortality. Checking the placement of enteral tubes

with traditional methods does not prevent misplacement in the respiratory tree, and new techniques should be

considered.11

Haung H conducted a retrospective study in the Department of Gastroenterology, Peking University

Third Hospital, Beijing, China, to evaluate the feasibility and efficacy of small-caliber trans nasal Oesophago

gastro duodenoscopy for the placement of nasoenteric feeding tubes (NET) in patients with severe upper

gastrointestinal (GI) diseases.51 patients underwent transnasal endoscopy for the placement of NET in Peking

University Third Hospital. Indications for NET included oesophageal stricture or gastric outlet obstruction

because of corrosive Oesophagitis or gastritis, partial obstruction due to malignancy, stenosis in stoma or efferent

loop, gastro paresis, metallic stent in upper GI tract, tracheoesophageal fistula, severe acute pancreatitis, anorexia

nervosa and intensive care patients. The position of the tube was confirmed by the immediate second endoscopy

or abdominal X-ray. If the initiate placement was not correct, an adjustment or a second placement was

conducted immediately. The researcher concluded that the transnasal endoscopic placement of NET was feasible

in patients with upper GI diseases, especially in those with changed anatomy.12

Dr. Jabin J conducted a retrospective study in Tan Tock Seng Hospital, Singapore to evaluate nurses'

practices on bolus Nasogastric feeding relating to verification of tube placement, and response to complications

during feeding. The survey participation rate was 99.5% (1203 nurses). Seventy-six percent would choose two or

more methods to verify placement when they were in doubt. Percentage of hydrogen (pH) testing was the most

common first method of checking tube placement. The second and third self-reported methods were auscultation

and the bubble test. Few chose radiography to confirm tube placement. When the aspirate was pH 7, and in the

presence of positive auscultation, most participants would take further steps to confirm placement. Most nurses

lacked the knowledge to effectively manage patients' distress during tube feeding. The findings showed that the

majority of participants reported that they would exercise due caution by taking additional measures to

check tube placement when in doubt13.

Smith BJ conducted a retrospective study in Australia to relate Nasogastric tube position and intragastric

air collection in a neonatal intensive care population, reviewed 326 radiographs and classified Nasogastric tube

8

position and gastric air. Descriptive statistics were used to describe demographic data. Kendal's tau statistic was

applied to explore the relationship between Nasogastric tube position and amount of gastric air. A Mann-

Whitney U test was performed to confirm the differences in gastric air in neonates with Ch5 and Ch6 gastric

tubes and neonates with Ch8 gastric tubes. One or both orifices of Nasogastric tubes were in the oesophagus in

7.1% of cases, tubes were curled up in the stomach in 35.3% of cases, and tube tips were beyond the pyloric

sphincter in 5.5% of cases. Substantial or excessive air was found in 37.7% of cases. Kendal's tau value indicated

that there was no significant correlation between Nasogastric tube position and gastric air. The Mann-Whitney U

value indicated that children with Ch5 and Ch6 gastric tubes had significantly more gastric air than children with

Ch8 gastric tubes. Nasogastric tubes were malpositioned in nearly half of cases, and substantial or excessive air

was found in more than one-third of cases. The hypothesis-the better the position of the tube, the smaller the

amount of gastric air-was not confirmed by the data. However, a significant relationship was found between tube

size and gastric air.15

Cannaby AM conducted a retrospective study in U K to survey the views and practices of nutrition

specialist nurses in acute trusts. Nasogastric tubes are commonly used for patients as a short-term method of

providing continuous, pre-packed liquid feed. In order to explore how evidence-based practice is being

incorporated into care, a postal questionnaire comprising 35 questions considered the role of the nutrition

specialist nurse, care of children with Nasogastric tubes, and training and education of nurses in the care of these

children. Results of this small study indicate differences in the education and practice of nursing care for children

with Nasogastric tubes. Nurses also need support in practising their skills to ensure they feel confident in caring

for children’s with Nasogastric tubes.16

Kuhn D study was conducted in Nepal on mechanical problem with small diameter Nasogastric feeding

tubes. They have suggested that the use of Nasogastric feeding for nutritional support of hospitalised and home

bound chronically ill individuals has been expanding during the past ten years. Nasogastric and naso enteral

dimension is safer and more cost effective than total parenteral nutrition. Mechanical problem related to slowing

of the formula and/or clogging of the tube have been reported, but have received little attention in the research

literature. This explanatory survey was designed to determine the extend of mechanical problems and the

procedures used to care for enteral feeding tubes. 58% of 91 hospitals reported a significant occurrence of

mechanical problems with small diameter enteral feeding tubes, and only 31% had written procedure for care of

the tube.17

Anita Karp conducted a study in China, on evidenced based feeding guidelines of very low-birth weight

infants, and focused on development of research based enteral feeding CPG (Clinical Practice Guidelines) on

infants weighing <1500gms. The CPG was based on an extensive literature review and was developed through a

9

process of consensus decision made by a team of clinical researchers. Infants who weigh less than 1000gms

initiate minimal enteral nutrition at 48hrs, whereas nutritional feeding begins in 5-6 days of life. For infants

between 1000 and 1500gms, nutritional feeding begins at 48hrs and is advanced a rate of less than 30ml/kg/day.

The benefit of intermittent tube feeding is founded at the end of the study.18

Mota M L conducted a study Korea, to evaluate the knowledge of nurses working in intensive care units

concerning recommendations for the proper administration of medication through Nasogastric and enteral tubes.

This exploratory-descriptive study with a quantitative approach was carried out with 49 nurses in an intensive

care unit of a tertiary hospital in Brazil. A total of 36.7% of nurses reported they disregard the dosage forms

provided by the pharmacy at the time of administering the medication through tubes. Metal, wood, or a plastic

mortar is the method most frequently reported (42.86%) for crushing prescribed solid forms; 32.65% leave the

drugs in 20 ml of water until dissolved; 65.3% place the responsibility for choosing the pharmaceutical

formulation and its correlation with the tube site, either into the stomach or into the intestine, on the physician.

The results indicate there is a gap between specific literature on medication administered through tubes and

knowledge of nurses on the subject.20

Clemente N A conducted a study in USA to describe recent reports of feeding tube placement problems

and to examine possible solutions. Multiple case reports of complications of malpositioned feeding tubes

continue to surface; most are due to inadvertent placement in the respiratory tract. A tube with feeding ports in

the oesophagus, and the displacement of a small bowel tube into the stomach of a patient with significantly

slowed gastric motility significantly increased the risk for aspiration. Isolated reports of a nasally placed tube

entering the brain following head injury also identified as per the reports, of oesophageal and gastric perforation

in neonates. A recent study showed that malpositioned tubes are not routinely recorded in risk management

databases; it further demonstrated that a comprehensive intervention to reduce complications from small-bore

Nasogastric feeding tubes was effective. The study concluded that, complications related to malpositioned

feeding tubes were usually preventable if effective protocols were adopted21

Wilkes-Homes C conducted a study in Britain to evaluate the safe placement of Nasogastric tube.

Insertion of Nasogastric tubes is a common nursing procedure but practice rituals and unfounded assumptions

can compromise safety. Current methods for checking the position of Nasogastric tubes are not always suitable

in children but there is limited guidance on how to proceed when gastric placement cannot be determined. As a

result of a local adverse incident, a working party challenged the assumptions and rituals of practice using an

evidence-based framework. A Nasogastric tube algorithm was developed using a risk assessment approach to

improve the safety 22

10

Williams TA, Leslie GD conducted a study in Australia to evaluate the nursing care of enteral tube

feeding in critically ill child. Evidence to support alternate methods of tube placement assessment other than

abdominal X-ray was inconclusive. The study recommended that continuous rather than intermittent feeding,

semi-recumbent positioning to reduce the risk of airway aspiration and diligent artificial airway cuff

management. Contamination of feeds can be minimised by minimal, meticulous handling and the use of closed

rather than open systems. Generally, there was little high quality evidence to support practice recommendations

leaving significant scope for further research by nurses in the management of patients with enteral tubes.23

Huffman conducted a study in German, to demonstrate a method to confirm feeding tube placement.

Auscultation after insufflations of air over the stomach and other less common practices used to verify proper

tube position have been shown to be ineffective in predicting correct tube position. Checking pH of aspirate has

be recommended as a better method to confirm feeding tube position at the bedside. Careful review of the

literature and appropriate application of research findings can lead to change in time-honoured nursing practices.

Although change is often difficult, a coordinated effort by nurses across organizational lines may facilitate the

process.14

6.3 OBJECTIVES OF THE STUDY:

1. To assess existing knowledge of fourth year B.Sc nursing students regarding paediatric Nasogastric tube

feeding by administering a pre test.

2. To conduct a planned demonstration and computer assisted teaching regarding paediatric Nasogastric

tube feeding to fourth year B.Sc nursing students.

11

3. To find out the effectiveness of planned demonstration and computer assisted teaching regarding

paediatric Nasogastric tube feeding by comparing pre test and post test knowledge scores of 4 th year B.Sc

nursing student.

4. To find out the association between the knowledge of fourth year B.Sc nursing students regarding

paediatric Nasogastric tube feeding and selected demographic variables.

6.4 OPERATIONAL DEFINITIONS:

• Evaluate:- - Evaluate refers to a process of judging and validating the quality of planned demonstration

and computer assisted teaching on the knowledge regarding paediatric Nasogastric tube feeding among

fourth year nursing students

• Effectiveness: - Effectiveness refers to gain in knowledge regarding paediatric Nasogastric tube feeding

through the planned demonstration and computer assisted teaching. It is determined by difference

between pre and post test knowledge scores.

• Planned Demonstration: - It is the pre-planned act of teaching through visualized explanation of

paediatric Nasogastric tube feeding among fourth year nursing students.

• Computer assisted teaching: - It is a structured systematic information, instruction, or training given to

a person or group with the help of computer. In this study this is administered to 4 thyear BSc nursing

students regarding paediatric Nasogastric tube feeding.

• Knowledge: - It is the students’ intellectual ability to answer correctly for the questions related to

paediatric Nasogastric tube feeding.

• Paediatric Nasogastric tube feeding - It is a method of feeding consisting of delivering liquid nutrients

through a tube passing through the nose into the stomach of the child.

• Fourth year B.Sc nursing students:-Students who have passed 3rd year BSc nursing and studying in

final year B.Sc nursing in the selected colleges of nursing, Bangalore.

• Nursing college:-An organization that provides baccalaureate and higher degree programme in nursing

which is recognized by the Karnataka state nursing council, Government of Karnataka and Indian nursing

council.

6.5 HYPOTHESIS OF THE STUDY

H1:- There will be statistically significant difference between pre and post test knowledge scores of the 4th year

BSc nursing students regarding paediatric Nasogastric tube feeding.

H2:-There will be statistically significant association between students’ knowledge regarding paediatric

Nasogastric tube feeding and selected demographic variables.

12

6.5 ASSUMPTIONS:

• Fourth year B.Sc nursing students may possess some knowledge regarding paediatric Nasogastric

tube feeding.

• Knowledge of students regarding paediatric Nasogastric tube feeding can be measured by

administering with the help of a structured knowledge questionnaire.

• The planned demonstration and computer assisted teaching may enhance the knowledge of students

regarding Nasogastric tube feeding.

• Effectiveness of planned demonstration and computer assisted teaching can be measured by

comparing pre-test and post test.

6.6 DELIMITATIONS OF THE STUDY:

• The study will be limited to selected Colleges of nursing in Bangalore city.

• The study is limited to 60 4th year B.Sc nursing Students who are studying at the selected nursing

colleges in Bangalore city.

6.7 PILOT STUDY:

The study will be conducted with 10 samples. The purpose to conduct the pilot study is to find out the

feasibility for conducting the study and design on plan of statistical analysis.

6.8 VARIABLES:

Variables are qualities, properties, or characteristic of persons, things, or situations that change or vary

and are manipulated or measured in research.

• Dependent variable:

Knowledge of 4thyear BSc nursing Students regarding paediatric Nasogastric tube feeding.

• Independent variable:

Planned demonstration and computer assisted teaching regarding paediatric Nasogastric tube

feeding.

• Extraneous Variable:

The demographic variables of students like age, sex, additional sources of information, previous

academic performance of students.

13

7. MATERIALS AND METHODS:

7.1 SOURCE OF DATA:

The data will be collected from the 4thyear BSc nursing Students studying at selected Colleges in

Bangalore.

7.1.1 RESEARCH DESIGN:

Pre experimental Design.

The design adopted for this study is Pre experimental in nature. One group pre test post test design.

7.1.2 RESEARCH APPROACH:

Evaluative research approach.

7.1.3 SETTINGS OF THE STUDY:

The study will be conducted at selected nursing Colleges, Bangalore.

7.1.4 POPULATION:

All Students who meet the inclusion criteria in selected Colleges, Bangalore.

7.2 METHODS OF COLLECTION OF DATA (INCLUDING SAMPLING PROCEDURE)

The data collection procedure will be carried out for a period of one month. The study will be

conducted after obtaining permission from concerned authorities. The investigator will collect data from

Students by using structured questionnaire to assess knowledge regarding paediatric Nasogastric tube feeding of

newborn babies.

Data collection instruments consist of the following sections:

Section ‘A’: Demographic data

Section ‘B’: Questions to assess the knowledge of Students regarding paediatric Nasogastric tube

feeding.

14

7.2.1 SAMPLING TECHNIQUE:

Sampling technique adopted for the selection of sample is non-probability convenience sampling.

7.2.2 SAMPLE SIZE:

The sample consists of, 60 4th year BSc nursing Students at selected Colleges of nursing in Bangalore.

SAMPLING CRITERIA:

7.2.3 INCLUSION CRITERIA:

• Students who are between the age group of 21 -25 years.

• Students who are studying in 4thyear BSc nursing at selected nursing Colleges, Bangalore.

7.2.4 EXCLUSIVE CRITERIA:

• Students who are not available at the time of study.

• Students who are selected for pilot study.

7.2.5 TOOL FOR DATA COLLECTION:

Structured knowledge questionnaire is used to collect data from the Students.

7.2.6 DATA ANALYSIS METHOD:

The data collected will be analysed by using descriptive and inferential statistics.

• DESCRIPTIVE STATISTICS:

Frequency and percentage for analysis of demographic data and mean, mean percentage and standard

deviation will be used for assessing the level of knowledge.

• INFERENTIAL STATISTICS:

15

Chi-square test will be used to find out the association between knowledge and selected

demographic variables. And paired t' test will be used for assessing the effectiveness of planned

demonstration and computer assisted teaching.

7.3 DOES THE STUDY REQUIRE ANY INVESTIGATIONS OR INTERVENTION TO BE

CONDUCTED ON PATIENTS OR OTHER HUMAN OR ANIMALS?

Since the study design is Pre experimental in nature, investigation and interventions are required.

7.4 HAS ETHICAL CLEARENCE BEEN OBTAINED FROM YOUR INSTITUTION?

Yes, ethical committee’s report is here with enclosed.

The main study will be conducted after the approval of research Committee of the college. Permission

will be obtained from the Head of the Institution. The purpose and details of the study will be explained to the

study subjects and assurance will be given regarding the confidentiality of the data collected.

8. LIST OF THE REFERENCE (VANCOUVER STYLE FOLLOWED):

• Anthikad J. Nutrition and biochemistry for nurses. New Delhi: Jaypee Brothers Medical Publishers;

2009.

• Wikipedia the free encyclopaedia. Article related to Tube feeding. [Online] . 2000 [cited 2000 July 25].

Available from URL: http://www.en.wikipedia.org

16

• Dr. S Leonard ,Nursing care of children[online] 2005 [cited2005jan15].Available from:

http://www.ncbi.nlm.gov/pubmed.com

• Article related to nursing care in critical care unit. [online]2010 [cited 2010 Jun 5] Available from: URL:

http://ecritical nursing.com

• Article related to Intervention strategies of premature children. [ homepage on the Internet]. 2010 [cited

2010 sep 2] Available from: URL: http://www.e-medicinespot.com

• Patole and De Klerk. Standardised feeding regimens in Indian paediatrics, First edition Paras medical

publication, Hydrabad, 1998.

• Fiţa IG, Enciu AM, Stănoiu BP. Recent reports of feeding Nasogastric tube placement [homepage on the

Internet]. 2011 [cited 2011 Dec 12].;52(3) Available from: http://www.ncbi.nlm.gov/pubmed.co

• Simmons-stern NR, Budson AE, Ally BA. Feeding dysfunctions in infants with severe chronic renal

failure among 15 patients [homepage on the Internet]. 2011 [cited 2011 Dec 18].;48(10) Available from:


• Yu F, Kolanowski A. Complication associated with enteral nutrition by nasogastric tube [homepage on

the Internet]. 2009 [cited 2011 Nov 4].;30(4) Available from: http://www.ncbi.nlm.gov/pubmed.com

• Graessel E, Stemmer R, Eichenseer B. Non-invasive techniques and criteria for predicting the proper

length for insertion of Nasogastric tube [homepage on the Internet]. 2011 [cited 2011 Dec 7].;9(1)

Available from: http://www.ncbi.nlm.gov/pubmed.com

• Carpenter BD, Zoller SM, Balsis S. Oral and nasal enteral tube placement errors. [homepage on the

Internet]. 2011 [cited 2011 Nov 5].;26(2) Available from: http://www.ncbi.nlm.gov/pubmed.com

• Huang Y H. Placement of Nasoenteric feeding tubes in patients with severe upper gastrointestinal

diseases [homepage on the Internet]2012June:13(6) Available from:


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9. Signature of the candidate

10. Remarks of the guide

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11. Names and designation of

11.1 Guide

11.2 Signature

11.3 Co- guide

11.4 Signature

11.5 Head of the department

11.6 Signature

Mrs Metilda

12. 12.1 Remarks of the chairman and

principal

12.2 Signature

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