Overcrowding in emergency departments is a worldwide problem. The non-urgent utilization of the emergency service is considered a serious threat to the quality of care delivered. Patients in stable condition admitted for nasogastric tube dislodgement is one of the typical examples observed in Hong Kong. According to the triage protocol, the waiting time for consultation is estimated to be at least 120 minutes for patients triaged into non-urgent categories, with the total length of stay possibly prolonged in cases of resuscitation. Consequently, these patients are at risks of feeding regime disturbance and altered nutrition. Nasogastric tube insertion is a basic nursing procedure in most clinical settings in Hong Kong. However, under current practice, nurses in the emergency department are not allowed to initiate the procedure unless a medical consultation has been performed, not even for patients in stable condition. In order to reduce the length of stay of these patients and minimize possible complications resulted from the delayed treatment, it is suggested to switch the practice from physician-led to nurse-led. This translational nursing research project was i) to explore and evaluate the effectiveness of nurse-led care for stable patients in various healthcare settings through a systematic literature review, ii) to develop an evidence-based protocol of nurse-initiated nasogastric tube replacement, iii) to assess its feasibility and applicability in a local emergency department, as well as iv) to develop strategies for the implementation and evaluation of the new practice. A systematic literature review was undertaken using four electronic databases, namely MEDLINE, CINAHL, Cochrane Library and British Nursing Index. Search terms “nurse-led”, “nurse-initiated”, “training”, “effect$” were used. A total of 1,994 relevant citations were retrieved. Ten randomized controlled trials met the inclusion criteria and were finally selected. Extracted data and methodological qualities of the included studies were assessed using a structured appraisal instrument. All studies generated high level of evidence on the effectiveness of nurse-initiated interventions provided to stable patients in various healthcare settings, which included the improvement of patients’ health outcomes, reduction of waiting time for consultations, increased level of patient satisfaction. The quality of nurse-led practice was of the same standard as the usual practice led by doctors. The nurse- initiated intervention was further enhanced by the provision of training and collaboration with medical staff. Six evidence-based recommendations were devised for the nurse-initiated nasogastric tube replacement protocol. It included i) provision of training, ii) development of patient assessment form for the protocol, iii) initiation of baseline assessment for eligible patients and iv) radiographic verification by nurses, v) collaboration with medical staff, and vi) ongoing evaluation of the implementation. The nurse-initiated nasogastric tube replacement for stable patients is an effective solution to the problem of overcrowding in emergency department. Further development of non-urgent treatments and services led by emergency nurses should be considered. / published_or_final_version / Nursing Studies / Master / Master of Nursing

The purpose of this study was to examine the effect that the patient's level of consciousness and the degree of nasogastric tube flexibility would have on the ease of insertion of the tube in patients with an endotracheal tube in place. The statistical hypotheses tested were: 1. The Degree of nasogastric tube flexibility will not influence the ease with which the tube is inserted. 2. The level of consciousness of the patient will not influence the ease with which the nasogastric tube is inserted. 3. There will be no interaction between the degree of flexibility of the nasogastric tube to be inserted and the level of consciousness of the patient in whom the tube is placed. The sample from whom data was collected for the study consisted of 121 patients admitted to the respiratory intensive care unit of a large teaching hospital who required endotrachea intubation and subsequent placement of a nasogastric tube. The number of attempts per patient for successful placement of each tube were recorded over a four month period and the data analysed using a 2 X 3 factorial design. The two independent variables were degree of nasogastric tube flexibility with two levels: flexible and rigid, and level of consciousness with three levels: conscious, obtunded and unconscious. The data collected from the study indicate that the degree of nasogastric tube flexibility significantly affects the ease with which a tube can be inserted in an intubated patient (α=.05) the rigid tube requiring a statistically fewer number of attempts than the flexible tube. The difference among levels of patient consciousness were not found to be statistically significant in this investigation but the interaction between the degree of tube flexibility and level of patient consciousness revealed statistical significance. / Applied Science, Faculty of / Nursing, School of / Graduate