ABSTRACT
PURPOSE/OBJECTIVES: To determine the difference in the incidence of diarrhea among subjects given one of three formulas with varying fiber concentrations administered by nasogastric (NG) tube, variables affecting incidence of diarrhea, discomforts other than diarrhea associated with NG tube feedings, and effects of changing from continuous to interval feedings on incidence of diarrhea and discomforts. DESIGN: Prospective, double-blind, randomized study. SETTING: Midwestern tertiary care center otolaryngology nursing unit. SAMPLE: Eighty randomized subjects who were 18 years or older, English-speaking, and undergoing head and neck cancer surgery that required an NG tube postoperatively and who had no gastrointestinal (GI) illness within two weeks prior to surgery. METHODS: Subjects received continuous administration of formula containing no fiber, 7 gms/L of fiber, or 14 gms/L of fiber until they reached the caloric intake goal and then were advanced to interval feedings. Patients' medical records provided past medical history and information on medication administration. A bedside flow sheet was used for documenting incidence of diarrhea and other GI discomforts. MAIN RESEARCH VARIABLES: Amount of fiber in the formula administered, patient's genders and prior food aversions, and antibiotics' effect on diarrhea and other GI discomforts. FINDINGS: Multiple logistic regression showed significant odds ratios (ORs) for developing diarrhea in female subjects (OR = 7.96), subjects who had prior food aversions (OR = 2.67), and subjects receiving broad spectrum antibiotics (OR = 3.22). Diarrhea was four times more likely to occur in males who received fiber-free formula. Of all subjects, 70% experienced GI discomforts with continuous feedings, and 50% experienced discomforts when advanced to interval feedings. CONCLUSIONS: Fiber formulas reduced the incidence of diarrhea in male subjects but not in female subjects. Antibiotics' effect on diarrhea paralleled the findings of other studies. IMPLICATIONS FOR NURSING PRACTICE: Use formulas with fiber for males. Liquid stools do not require interruption of tube feeding; GI discomforts warrant interruption. Interval feeding schedules require monitoring similar to continuous feeding schedules.
Subject(s)
Diarrhea/etiology , Dietary Fiber/adverse effects , Enteral Nutrition/adverse effects , Antibiotic Prophylaxis , Diarrhea/epidemiology , Double-Blind Method , Enteral Nutrition/methods , Enteral Nutrition/nursing , Female , Food Preferences , Head and Neck Neoplasms/surgery , Humans , Incidence , Isotonic Solutions/administration & dosage , Isotonic Solutions/adverse effects , Logistic Models , Male , Middle Aged , Odds Ratio , Prospective Studies , Sex FactorsABSTRACT
Diarrhea following tube feedings in postoperative head and neck oncology patients is a significant problem. The existing tube feeding protocol was evaluated and clarified. A study was also undertaken to reduce the incidence of diarrhea in this patient population.
Subject(s)
Enteral Nutrition/nursing , Patient Care Planning , Diarrhea/etiology , Diarrhea/prevention & control , Enteral Nutrition/adverse effects , Enteral Nutrition/methods , Head and Neck Neoplasms/surgery , HumansABSTRACT
This descriptive, non-experimental study using the Delphi survey process identified basic holistic health principles for which holistic nurse practitioners agreed guide their healing practice. Seventeen expert holistic nurse practitioners (and AHNA leaders) comprised the respondent group. On the average these practitioners have been nurses for 25 years and holistic practitioners for 11 years. Seventy percent of the group completed all three Delphi rounds indicating their agreement regarding 25 principles of holistic health, their applicability to practice, and care goals related to each principle. A high level of consensus was reached regarding 17 principles. In addition to affirming principles related to unity, interdependence, evolution, energy fields, and interactions, the AHNA expert nurse practitioners strongly emphasized spirituality. The group addressed reality as a unified whole, not limited by the material universe, supporting a practice model based on holographic perspectives.
Subject(s)
Holistic Health , Models, Nursing , Nursing Care/organization & administration , Delphi Technique , Humans , Nurse Practitioners , Organizational ObjectivesABSTRACT
Maximizing the normal healing processes reduces costs, time, and the adverse social and psychological effects on the patient. The success of any corrective procedure rests on wound healing and restoration of function. The condition of the host, the surgical technique, and the nursing care all contribute to a satisfactory outcome.
Subject(s)
Nursing Care , Surgery, Plastic , Wound Healing , Humans , Monitoring, Physiologic/nursing , Postoperative Care/methods , Skin Transplantation/nursing , Surgery, Plastic/methods , SuturesABSTRACT
This manuscript describes the concerns of a 15-member faculty group in a team-taught undergraduate nursing course regarding the quality of its classroom tests. A process of systematic evaluation spanning several semesters resulted in changes both in testing and, subsequently, in the grading policy. The primary goal of the changes was to strengthen the validity and reliability of tests which, in turn, would increase test fairness for the students. Discussion areas include 1) reliability and validity; 2) difficulty and discrimination indices; 3) effects of poor-item elimination; and 4) determination of cut scores. Explanations of how testing and measurement principles were applied occurs in each area.
