الفهرس 
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Abstract
Summary
Nasogastric tube feeding has been a common practice in all groups of patients, from neonates to older people, for many years. Thousands of nasogastric feeding tubes are inserted daily without incident. However, there is a small risk that nasogastric feeding tubes can be misplaced in the lungs during insertion, or can migrate out of the stomach at a later stage (Stirland, 2020).
Optimal nutrition is very important in the care of critically ill patients. Furthermore, malnutrition has been associated with a longer length of stay in the intensive care unit (ICU) and with higher risk-adjusted mortality .Nutrition is one of the most important principles in treating many diseases and directly intervenes in pathophysiological changes and critical results of the disease. Most patients including ICU inpatients fail to intake the required nutrition like normal people. These patients are exposed to critical conditions and life-threatening diseases and unable to self-care, particularly in oral intake (Zeb et al., 2022).
Gastric intubation is a common procedure that gives access to the stomach through the nasal entry for diagnostic and therapeutic purposes. By inserting a nasogastric tube, you are gaining access to the stomach and its contents. While generally considered a basic medical procedure, it frequently includes some level of uneasiness for the patient, if he isn’t adequately prepared with anesthesia to the nasal passages and explicit guidelines on how to participate with the administration during the procedure(Abdelrahman et al., 2020).
Aim of the study
The aim of this study is to assess nurses’ performance in nasogastric tube use among patients in critical care units.
Research Question
The current study was formulated to answer the following questions:
• What is the level of nurses’ knowledge regarding feeding and administration of medications via nasogastric tube?
• What is the level of nurses’ practice regarding feeding and administration of medications via nasogastric tube?
• What is the level of nurses’ attitude regarding feeding and administration of medications via nasogastric tube?
Setting:
The study was conducted in intensive care units at Ain-Shams University Medicine Hospital. The general intensive care unit is located on the ground floor and divided into two parts; intensive care unit(A), and intensive care unit(B). Each ICU consisted of 15 beds and two isolation rooms. The blood disorders intensive care unit is located on the second floor and consists of 11 beds separated by curtains with no isolation rooms. The thoracic intensive care unit is located on the first floor and consists of 12 beds including 2 isolation beds.
Subject:
A convenience sample of (80) staff nurses from the above-mentioned setting. Convenience sampling (also known as Haphazard Sampling or Accidental Sampling) is a type of nonprobability or nonrandom sampling where members of the target nurses that meet certain practical criteria, such as easy accessibility, availability at a given time, or the willingness to participate are included for the purpose of the study. It also refers to the research subjects of nurses that are easily accessible to the researcher (Etikan, 2016). Convenience sampling is a non-probability sampling that is often used for clinical and qualitative research. This sampling technique often selects clinical cases or participants that are available around a location (such as a hospital), medical records database, Internet site, or customer-membership list (Stratton, 2021).
Tools of data collection:
Data were collected through using the following two tools to achieve the aim of the study:
Tool I: Structured Self-administered Interview Questionnaire Form(Appendix I).
This tool was adopted from (Babapour et al., 2016; Metwaly, Mohammed& Mohammed, 2013). It developed into two parts. It aimed to assess nurses’ knowledge regarding nasogastric tubes.
Part (1)Nurses’ demographic data: This part is concerned with assessment of nurses’ demographic characteristics.
Part (2) Nurses’ Knowledge Questionnaire sheet: this part designed to assess nurses’ knowledge regarding nasogastric tubes.
Scoring system: The score is distributed as one mark for each correct answer and zero for each incorrect answer. The total score is converted into a percentage. The total score of the questionnaire was (39) grades. knowledge was considered an unsatisfactory level of knowledge if the total percent score was below 75% (below 29 grades) and a satisfactory level of knowledge if the total percent score was equaled as above ≥75% (above ≥29 grades) (Attia et al., 2021).
Tool II: Observational Checklist for nurses’ practice
This tool was adopted from (Abdullah, Mohammed & Ismai, 2014; Willihnganz & Clayton, 2016; Cooper & Gosnell, 2018). It aimed to assess nurses’ practice during caring for patients with nasogastric tubes. It consisted of two parts: -
Part one: Aimed to assess routine nursing care as Nasogastric tube feeding administration and medication administration.
Part two: Aimed to assess nursing care during nasogastric tube complications.
Scoring system: The score is distributed as one mark for each step correctly done, and zero for incorrectly done & not done the total score is converted into percentages and graded as the following: - Below 85% is considered an unsatisfactory level of practice. 85% and above considered as satisfactory level of practice (Attia et al., 2021). Total score of nasogastric tube feeding administration and medication administration checklist 94 grades. The total score of the nasogastric tube complications checklist was 193 grades.
Tool III: Nurses’ Attitude Likert scale: (Appendix III)
This tool was developed by Mohamed et al.,(2022) and modified by the researcher. It aimed to assess nurses’ attitudes regarding the care of patients with a nasogastric tube.
Scoring system: scoring each statement was as the following; agree response was given one grade while disagree/neutral responses were given zero for positive statements and the opposite score for negative statements (numbers 2,9). The total score was classified as the following; ≥80% was considered positive attitude, and <80 % was considered negative attitude (Mohamed et al., 2022).
The present study revealed the following main results:
- The study shows that (75%) of the staff nurses have an unsatisfactory level of knowledge regarding feeding and administration of medications via nasogastric tube. While (25%) of them have a satisfactory level of knowledge regarding feeding and administration of medications via nasogastric tube.
- from the study indicates that (57.5%) of the staff nurses are between 25-35 years old, (58.8%) of them are female, As well as (45%) of them have a bachelor of nursing, As well (51.2%) have more than 10 years of experience in ICU, and (52.5%) are attended training courses on the nasogastric tube and its complications. As well as (57.5%) of them attended one course.
- As regarded the study shows that (82.5%) of the studied staff nurses have an unsatisfactory level of knowledge regarding feeding and administration of medications via nasogastric tube.
- As regarded the study shows that (69%) of the studied staff nurses have an unsatisfactory practice level regarding total practice levels among staff nurses regarding nasogastric tube mechanical complications.
- The study shows that (56.2%) of the studied staff nurses have an unsatisfactory practice level regarding nasogastric tube infectious complications. While (43.8%) of them have a satisfactory practice level regarding nasogastric tube infectious complications.
- The study shows that (61.2%) of the studied staff nurses have an unsatisfactory practice level regarding nasogastric tube metabolic complications.
- As regarded the study shows that (73%) of the studied staff nurses have an unsatisfactory practice level regarding feeding and administration of medications via nasogastric and nursing care during nasogastric tube complications tube.
- The study shows that (34. %) of the staff nurses have a positive attitude level regarding feeding and administration of medications via nasogastric tube. While (66%) of them have a negative attitude level regarding feeding and administration of medications via nasogastric tube.
- As regarded the study shows that there was a highly statistically significant relation between total staff nurses’ knowledge level and their demographic characteristics at (P= < 0.01).
- The study shows that there was a highly statistically significant relation between total staff nurses’ practice level and their demographic characteristics at (P= < 0.01).
- As regarded the study shows that there was a highly statistically significant relation between total attitude level and their staff nurses’ demographic characteristics at (P= < 0.01).
- Reveals that there was a highly significant positive correlation between total level of knowledge, total practice, and total attitude among staff nurses regarding nasogastric tube use among patients in critical care units at (P= < 0.01).
The important recommendations inferred from the study results were:
- In-service training programs must be developed based on nurses’ performance regarding the care of patients with nasogastric tubes in critical care units.
- A simplified & comprehensive manual Arabic booklet including the suggested nurse guidelines for caring of patients with nasogastric tubes.
- Knowledge and performance of nursing staff should be periodically evaluated, documented, and up to date if necessary.
Future research
- Further study is recommended to evaluate and good physical assessment for the patients who received nasogastric tube feeding.
- Factors Affecting Clinical Outcomes for Patients with Nasogastric Tube Feeding at Critical Care Unit.