Quantitative Research Critique
 Any adult patient who is alert and oriented during the passing of a nasogastric tube for enteral feeding would likely state that although it is necessary in providing adequate nutrition, the initial passing can be quite uncomfortable at best. In children and teens however, a nasogastric tube can be utterly traumatic. In pediatric nursing it has long been proven that in order to provide necessary medical interventions children fare much better when prepped via play therapy or role-play prior to initiation. Older children and teens tend to comply better when they are given an opportunity to have some sort of control over the situation and even in some cases administer the treatment themselves. The authors of “Psychological Preparation for Nasogastric Feeding in Children” set out to provide a quantitative research study of two different age groups of pediatric patients receiving enteral nutrition in the home via nasogastric tubing. Although the sample size is small and there continues to remain a lack of literature of the subject overall, the authors were clearly able to prove the benefits of psychological preparation in nasogastric tubing initiation as well utilizing the same preparation in other interventions.
In “Psychological Preparation for Nasogastric Feeding in Children”, Holden et al clearly state that while there is plenty of evidence available on enteral feeding in various settings, very few studies have explored how the experience effects children psychologically. The article also states, “ while children are often prepared for the practical aspects of nasogastric feeding, some studies suggest that the information is often inappropriate to the child’s level of cognitive development (Eider, 1984; Pass and Pass, 1987).” The reader is clearly able to draw the conclusion that the cognitive level of development is the independent variable and the understanding of the need for the nasogastric tube and possibly being able to tolerate it is the dependent variable. For example, if you have two children of the same preschool age and same level of cognition requiring the same procedure, the child who is prepared first by receiving a demonstration on a doll and then given a chance to act out how the doll might feel after would potentially tolerate the procedure better than the child who was told that the tube would help put food in their belly even if they didn’t feel like eating. Assessing a patient’s level of understanding and tailoring explanations and demonstrations accordingly can be utilized in all age ranges of patients and in any medical procedure. It can be argued that this would be the basis of individual patient centered care.
The authors of this study used experimental, cross-sectional design to test their hypothesis that children who are given a detailed preparation and supportive measures prior to the start of feeding are generally less traumatized by the intervention than those who received the standard preparation and minimal support (Holden et al, 1997). A questionnaire was administered by blinded dietetic staff to the families and older children who had undergone the procedure that enabled the researchers to minimize the chance of bias within the study. The questionnaire was broken down into three sections and asked the families/patient to rate how they felt the feeding affected their home life on a numerical scale, an open ended portion to describe how they felt regarding the preparation time given and what was their understanding of the advantages and disadvantages in their own words. The last sections asked the families what advice they would give to others new to the procedure, how helpful they felt the teaching aides were on a numerical scale and parents/older teens were asked to assess the level of play/normal activities at the start of the feeds, then at approximately two months later and again at the end. Comparisons were then drawn between those who received the in-depth teaching and those who received the standard teaching. The data collection points enabled the researchers to provide a rigorous design because the participants were able to use numerical scales and open-ended questions giving insight into their personal experience in their own words. Furthermore, since the research also asked the parents/families to give their personal advice to others undergoing the procedure they also gave the researchers avenues in which to pursue further studies of the subject material. The sample size also remained constant through out the study thus minimizing the chance of attrition and distortion of outcomes.
The population for this study was acquired through The Children’s Hospital, Birmingham NHS Trust. They were chosen at random because of their need for enteral feeding by nasogastric tubing at home. The researchers then used a sample size of forty-eight children which where then broken down into two groups. Group A consisted of 32 children (20 girls and 12 boys; mean age 4 years) and group B consisted of 16 children and adolescents (8 females and 8 males; mean age 12 years) (Holden et al, 1997). Only those who were new to nasogastric tube feedings and were without any history of psychiatric disorders were eligible. Though the sample was chosen at random it is not without weaknesses noted. Group A is double the amount of group B which could have possibly distorted some statistical significance of the study. Another possible bias is that the uneven number of samples within each group. Also group A’s mean age is 4 and group B’s mean age is 12, the subjects in group A who answered the questionnaire were from the parents perspective while group B’s subjects were able to answer the questionnaires themselves. Within each group there are also a larger number of females then males which can also present bias or weakness within the study. In addition to the contrasting ages and sexes within the study, there is also a lack of literature of this subject within the field of nursing research so although the researchers may have attempted to minimize bias within their research there is very little to compare this study to. However, the research does support external validity because it can be utilized in other procedures within the medical field and in other regions geographically.
In conclusion, although there is still a lack of literature on psychological support in enteral feeds by nasogastric tubing the study does present valid statistical support. Statistically, those children from group A showed no difference in their response regardless of which type of prep they received. In group B the statistics shows that those who received the more in depth explanation reported less distress during tube placement even though they may have felt discomfort. The subjects were also able to report the advantages and disadvantages of the feeding and demonstrate an understanding for the need. Finally, nurses can utilize this information by learning how to assess their patient’s cognition level and provide explanations accordingly in everyday practice.
Booth, IW. Psychological preparation for nasogastric feeding in children. (1997) British Journal of Nursing,6 (7). 376-385
Coughlan, M., Cronin, P., Ryan, F. Step-by-step guide to critiquing research. Part 1:Â Quantitative research. (2007) British Journal of Nursing, 16 (11). 658-653
Holden CE., MacDonald, A., Ward, M., Ford, K., Patchel,C., Handy D., Chell, M., Brown, GB.,
Polit, D., & Beck, C.T. (2013). Essentials of nursing research (8th ed.) Philadelphia: Lippencott
Williams & Wilkins.
