Practical aspects of teaching home parenteral nutrition therapy.

With the implementation of the prospective pricing system there has been a greater emphasis on discharging patients on home health care therapy. Home parenteral nutrition (HPN) has been a successful method of treating patients with compromised gastrointestinal tracts. The key to the success of these programs remains patient and family training. Adequate knowledge and skills must be demonstrated and documented in the areas of aseptic technique, procedures of catheter care, complications, and equipment, prior to discharge. This paper describes the various aspects of identifying and training patients for HPN, and some of the problems and complications that may occur.

Nutrition education in schools of nursing in the United States. Part 2: The status of nutrition education in schools of nursing.

To explore whether nurses in academic institutions are being adequately educated to care for patients' nutritional needs, we conducted a survey of National League for Nursing accredited baccalaureate programs in the United States and their associated graduate programs. Data indicate that nutrition content is an integral part of baccalaureate nursing programs. Less emphasis is reported on nutrition content at the graduate level. Recommendations include revision of the substantive nutritive content and increased clinical experience in nutrition in both undergraduate and graduate nursing education.

Calculating parenteral feedings: a programmed instruction.

A programmed learning tool on how to calculate and use parenteral feedings is presented. The format includes a brief text (frame), then questions and answers about the text. The 42 frames provide the reader a step-by-step explanation of (a) when parenteral feedings are used; (b) the differences between central and peripheral administration; (c) the calculation of nutrient needs, including calories, protein, carbohydrate, fat, fluids, vitamins, and minerals; (d) the percent solutions of those nutrients available and their caloric value; (e) the calculation of the solution osmolarity; and (f) the integration of the nutrients needed into the composition of the parenteral solution for the patient. The programmed instruction gives readers the basic framework for beginning their use of parenteral nutrition.

Cost of a home parenteral nutrition program.

We analyzed the costs to a hospital of providing complete home parenteral nutrition (HPN) services for eight patients. Identified cost components include patient training, equipment, supplies, and follow-up. The average annual cost of maintaining parenteral nutrition at home was 73% lower than it would have been in the hospital. The establishment of private companies to provide patients with HPN supplies and services will reduce the financial burden of HPN programs for hospitals.

Preparing patients for home parenteral nutrition.

A comprehensive, interdisciplinary program for patients requiring home parenteral nutrition (HPN) is described. This program begins with an initial patient assessment, which includes medical prerequisites and evaluation of patient motivation and learning abilities, family supports, emotional status, and individual life-styles. The teaching phase involves instructing the patient in the tasks necessary to self-administer parenteral nutrition at home. Problems that can arise are presented, and patient self-monitoring for adverse reactions and problem solving is emphasized. Outpatient follow-up is provided by the interdisciplinary Nutrition Support Service in a clinic setting. Specific components of these visits in relation to physical and emotional adjustment to HPN are discussed. The Nutrition Support Service recognizes a long-term commitment to patients receiving HPN, and members of the team are available to assist patients when problems occur.

Self-instructional program on pediatric parenteral nutrition.

A self-instructional package on pediatric parenteral nutrition was designed and its effectiveness in educating health-care practitioners was studied. Participants included eight medical students, 10 pediatricians, 10 pharmacists and 10 pharmacy students at a teaching hospital. Each participant reviewed the program and completed 25-point pre- and posttests. Participants consistently scored higher on the posttest than on the pretest. Further, participants felt that they better understood parenteral nutrition therapy and that they better understood how to write or check orders as a result of their participation in the program. It is suggested that a self-instructional package is an effective method of educating practitioners and students in total parenteral nutrition.