ABSTRACT
The Trust provides cancer services for patients across the region. Approximately 300 patients each year receive radiotherapy for head and neck cancer, approximately 50% of these patients have enteral feeding tubes placed. Historically, Dietitians provided support for all patients with enteral feeding tubes receiving radiotherapy treatment and the local nursing service provided by the enteral tube feeding contract provider provided community clinical support. Due to increasing patient numbers and increased Dietetic workload, a new “enteral feeding tube nurse clinic” was introduced, run by the local enteral tube feeding homecare nurse, with the intention of supporting patients with enteral feeding tubes. This clinic has been running since 2019 and is a “drop-in clinic” which both staff and patients’ can access for support, including troubleshooting advice on feeding tubes, moving patients from bolus feeding to pump feeding or even giving patients reassurance that they are caring for their enteral feeding tube correctly. This is a unique service built in conjunction with the Dietetic team, designed to meet local patient’s needs. In 2020 a review took place to evaluate the level of patient satisfaction of care from the enteral feeding tube nurse clinic, to establish the confidence of patients in caring for their feeding tubes and to explore feedback from patients to develop the service further. The review took the form of a patient questionnaire, given to patients during the last week of their radiotherapy treatment. Survey questionnaire forms assessing: the patient’s satisfaction with the support and service (5-point scale: 1 not at all satisfied -5 very satisfied);how confident they felt after receiving the support (5-point scale: 1 not at all satisfied -5 very satisfied), and;about their experience overall (free text), were handed out to patients in clinic over a 6-week period. The questionnaire was completed by 12 patients. For satisfaction with the support and service 10/12 (83%) of patients scored 5: very satisfied, with the remaining 2 patients scoring 3: neutral. Comments from patients included: “nurses always willing to help”, “excellent nurses, great, quick, professional job-no fuss”, “help available whenever it is needed”, “very happy with the care provided”, “every time I have requested their help, I have had a prompt reply and always each problem has been addressed”. For confidence with enteral tube feeding procedures, 100% of patients scored 5: very confident. Comments from patients included: “I feel much happier with the tube”, “very confident in cleaning and rotation, and excellent instructions from nurses”. When asked about their experience overall, patient comments included “Thank you for all your support”, “expert care, friendly, informative”, “fantastic prompt treatment”, “grateful that I have had the support”, “friendly, professional staff are always willing to help and always have said ‘if you need me, just ask, at any time”. Due to Covid-19 the clinics had to temporarily stop, however the Dietitians and Consultants missed the instant and direct access to the homecare nurse for enteral feeding tube support, suggesting that the clinic was also highly valued by the healthcare professionals working at the clinic. In August 2021 the clinics started again and there are plans to expand the service later this year. In summary, the enteral feeding tube nurse clinic was positively evaluated by the patients attending the radiotherapy clinic. The overwhelming feedback was that having contact with an enteral tube feeding homecare nurse at least weekly throughout their radiotherapy treatment allowed them to have rapid access to support, advice, reassurance, and training if their feeding requirements changed. Due to the success of this clinic, development of similar clinics in other areas should be considered.
ABSTRACT
Education is increasingly being accessed digitally, as demonstrated by the success of e-Learning for Healthcare or e-LfH, a health education England programme developed in partnership with the NHS and professional bodies1. Within digital learning, e-learning is a popular medium as it offers users an opportunity to learn at one’s own pace, at a convenient time and place, revisiting as often as required, giving flexibility, and freedom to continue a professional development journey. A plan was therefore formed to develop e-learning to provide important support for enteral tube feeding for care home staff in a simple, convenient, and easily accessible format. Before development of the e-learning, qualitative and quantitative research was undertaken with key stakeholders to assess the acceptability of e-learning for care home staff in the field of enteral tube feeding. Following launch of the e-learning, views and feedback were analysed. Qualitative interviews were conducted with six care home managers across the UK to understand the challenges faced in providing education on enteral tube feeding for care home staff. Difficulties identified included: releasing staff from day-to-day activities;high turn-over of staff resulting in frequent training required for new employees;access to workplace digital devices, and;staff unable to complete their full duties until training was completed and documented. An online survey was conducted to gain quantitative information from an enteral tube feed companies’ homecare nurse team to evaluate the concept of online e-learning for care home staff. 13 homecare nurses responded, (approx. 10%) and 80% felt online training would be valuable for care home staff. Using these learnings an enteral tube feeding e-learning course was developed by the company’s homecare nurse team consisting of six, short interactive modules. Six Dietitians across the UK in both acute and community settings were consulted on the content, which they reviewed and refined ensuring a balanced view of practices and procedures were included. COVID-19 accelerated the requirement for online learning as face-to-face activity and care home access was restricted and the modules were launched earlier than planned in March 2020. A simple registration process granted access to the modules through a variety of electronic devices such as tablets and laptops. Between March 2020 to July 2021, 5,152 individuals registered and completed at least one module, with 3,661 (71%) completing the introductory course and the first 3 modules. Several NHS Trusts have added the e-learning link to their intranet sites as mandatory training for new starters. Feedback has been positive: “E-learning is going down a treat at the moment”;“11 of my staff completed the training. We found it really useful, the system was easy to navigate, gave us information that we didn’t know and helped us to understand the different types of feeding systems available. I would recommend this training as we all felt it gave us more confidence in supporting a person using a feeding system”. The high uptake of the e-learning and positive feedback demonstrate that these e-learning modules are a popular and acceptable form of education for care home staff and are suitable to be used across a variety of settings. The initial research helped to ensure that the e-learning modules which were developed, fully met the needs of care home staff and therefore provide important support in a simple, convenient, and easily accessible format. References 1. e-Learning for Healthcare.