The effect of an information brochure on patients undergoing gastrointestinal endoscopy: a randomized controlled study

OBJECTIVE

The aim of the present study was to test the potential beneficial effects of an information brochure on undergoing a gastrointestinal endoscopy for the first time. The information provided was based on self-regulation theory, and patients could restrict themselves to reading the summary only.

METHODS

Patients were randomly assigned to an experimental group receiving the brochure at least 1 day before the gastroscopy (N=47), or to a control group not receiving the brochure (N=48).

RESULTS

The results show that all experimental subjects, except one, fully read the brochure. Those receiving the brochure experienced less anxiety before the gastroscopy and, afterwards, they reported greater satisfaction with the preparation for it. With regard to coping style there were some small moderating effects into the direction expected: low blunters (those not seeking distraction under impending threat) as compared to high blunters showed extra reduced anxiety after reading the brochure. They also tended to read the brochure more often. High monitors (those seeking information under impending threat) receiving the brochure showed reduced anxiety during the gastroscopy as compared to low monitors (tendency).

CONCLUSION

We conclude that providing patients with the developed brochure constitutes an efficient, beneficial intervention.

PRACTICE IMPLICATIONS

The brochure could easily be implemented in standard practice without the necessity to take the patient's coping style into account.

Joint primary-secondary care design of PEG care pathways

The use of PEG feeding has increased over the past decade. This article describes the development of a care pathway to support patients and maintain standards of care in PEG feeding.

Percutaneous endoscopic gastrostomy (PEG): the role and perspective of nurses

AIMS AND OBJECTIVES

To study the perspectives of nurses on (i) the process of decision-making regarding the placement of feeding gastrostomies, (ii) their role in the process, (iii) the impact this participation has on them personally and (iv) gastrostomy placement in general.

BACKGROUND

The decision to commit patients to long-term feeding using a gastrostomy tube can be very difficult, particularly when the anticipated benefits are uncertain. Strategies to improve such decision-making are required. Nurses are in an excellent position to provide valuable insights regarding this decision-making and their increased participation in this process might substantially improve it.

DESIGN

A cross-sectional, exploratory design using in-depth semi-structured interviews and a self-administered questionnaire.

METHODS

In-depth semi-structured interviews with 17 nurses experienced in percutaneous endoscopic gastrostomy decision-making were undertaken and analysed.

RESULTS

Individuals making decisions regarding feeding gastrostomy placement were observed to be insufficiently informed regarding the device and the ramifications of its placement. Nurses were perceived to play an important, although underused, role in decisions to commit patients to long-term feeding. Participation in the making of these decisions may be stressful to nurses, particularly when the only result anticipated is the sustaining of a life of poor quality. Sixteen nurses reported that they would not want to have a gastrostomy for themselves if they were unable to maintain some quality of life. Strategies that could improve decision-making were suggested.

CONCLUSIONS

Decision-making could be improved by providing better information to decision makers. A team-orientated approach and more active dialogue with regard to care planning among health professionals, especially between doctors and nurses is needed. Effective decisions regarding feeding gastrostomy placement require adequate resources, especially sufficient time for caregivers to communicate effectively with those who must make these decisions.

RELEVANCE TO CLINICAL PRACTICE

The role of nurses in decision-making regarding commitments to long-term feeding using gastrostomy tubes could be effectively augmented.

The correct positioning and role of an external fixation device on a PEG

A percutaneous endoscopic gastrostomy tube (PEG) is the means by which long-term artificial enteral nutrition can be provided to patients. PEGs differ in design and length of use but have one device common to all--the external fixation device or boister. This is a small piece of polyurethane or silicone that is usually circular or triangular in shape. It encircles the PEG and is designed to anchor the PEG externally and 'prevent it from being pulled into the stomach' (Colagiovanni, 2001) (Fig 1).

Enteral feeding and percutaneous endoscopic gastrostomy

Many patients are unable to eat and others are malnourished. Such patients need nutritional support, and enteral feeding offers one way of providing such support. It may be needed for a short time during acute or critical illness or for prolonged periods in chronic illness. Short-term feeding is usually given through a nasogastric tube, while permanent feeding access is indicated for long-term feeding, most commonly through a gastrostomy. Percutaneous endoscopic gastrostomy (PEG) is a minimally invasive technique for placing a feeding tube and causing minimal discomfort. This article reviews enteral feeding focusing on PEG and considers the after care and complications of this method of feeding.

Managing bowel obstruction in ovarian cancer using a percutaneous endoscopic gastrostomy (PEG) tube

An estimated 2,500 women were diagnosed with and 1,500 died from ovarian cancer in Canada in 2002. Up to 42% of patients in the palliative phase develop a malignant bowel obstruction. Options for management include medical therapy, surgery, and/or a percutaneous endoscopic gastrostomy (PEG) tube. The objective of this quality improvement study was to: 1) examine if successful palliation was achieved using a PEG tube, and 2) identify opportunities to improve the quality of nursing care provided. A retrospective review of 24 patient records revealed that 75% did not have nausea/vomiting by time of discharge; 92% resumed a clear fluid diet; 83% were discharged from the acute care setting; and 70% did not require re-admission. A PEG tube may effectively palliate women with non-operable bowel obstruction in advanced/recurrent cancer of the ovary. Opportunities for improving care are presented.

Do nurses know enough about percutaneous endoscopic gastrostomy?

An audit of nurses in a district general hospital found that there were gaps in their knowledge about the management of percutaneous endoscopic gastrostomy. The author suggests ways in which their knowledge could be updated and patient care improved.

Audit of a nurse endoscopist based one stop dyspepsia clinic

As a response to the UK Health Department's "two week cancer wait" initiative a one stop dyspepsia clinic based on a nurse endoscopist was introduced, and the first 100 cases attending this clinic have been audited. After referral on a purpose designed form, patients were assessed by a gastroenterologist and then investigated at the same visit--where possible and appropriate--by endoscopy or ultrasound scan. All endoscopies were performed by a trained nurse specialist. Of the 100 patients, 84 were gastroscoped the same day and 11 had an ultrasound scan. Inappropriate tests were avoided in 16% of referrals. The commonest endoscopic diagnoses were minor oesophageal or gastroduodenal inflammation (64% of gastroscopies). Only six oesophageal or gastric cancers were found--all at an advanced stage--and three further malignancies were diagnosed. Only a minority (12%) of the patients with "alarm symptoms" had cancer. The waiting time for an appointment rose progressively during the first six months of the clinic. The system was popular with patients as most of them (70%) were dealt with at a single hospital attendance. Basing the endoscopy practice on a trained nurse specialist not only facilitated the creation of the service by maximising the use of scarce resources, but also improved communication and overall management of patients.

Care of the laparoscopic Nissen fundoplication patient

Gastroesophageal reflux disease can usually be successfully managed with conservative medical treatment. Anti-reflux surgery is a safe alternative when treatment fails or patients desire a more definitive treatment option. Through a case study approach, this article describes the indications for surgery, the essentials of the authors' multi-disciplinary approach to care and the components of a well-designed education plan for a patient undergoing laparoscopic Nissen fundoplication. Although most patients do well after surgery, diligent nursing care is required before and after surgery to prevent or manage complications and ensure patients have a rapid recovery and successful outcome.

Education for the gastroenterology cancer patient

Education for the adult gastroenterology cancer patient requires incorporation of standards of care from both an oncology and a gastroenterology focus. In addition, standards of oncology education and role delineations for the gastroenterology/endoscopy nurse provide optimal support for the nurse-teacher working with patients with cancer of the gastrointestinal (GI) tract. The development of a teaching plan and a philosophy for teaching provide the basis for the delivery of care relative to the learning needs of this patient population.

PEGS in children: nursing considerations

The nursing care of children with a percutaneous endoscopic gastrostomy (PEG) means caring for the whole of the child with a PEG. Even in the highly technical and specialized field of PEG, the main themes that characterize pediatric nursing are used as a reference guide (Dall'Oglio, 1996).

Patient education: pre- and post-procedure upper endoscopy

In this article, the author describes the responsibility of the admitting nurse to inform the patient about the procedure before the consent form is signed. The importance of an informed patient in relation to the legal implications and also the increased comfort level that the patient will experience are described. Results of a research program on pre-procedure patient education will be referenced.

An investigation into the information obtained by patients undergoing gastroscopy investigations

The benefits of informing patients before undergoing surgery or other investigative procedures are clearly demonstrated in the literature. This study aimed to determine the amount and type of information given to patients before, during and after undergoing gastroscopy investigations. A survey approach incorporating structured interviews and structured observation was utilized. There were statistically significant differences between the information acquired by younger and older patients prior to, but not during or after, the procedure. Nurses appear to be the most important source of information for older patients while the information leaflet was perceived as the most important source of information for younger patients.

Percutaneous endoscopic gastrostomy (PEG)

In the form of a case study that illustrates the procedure of percutaneous endoscopic gastrostomy (PEG), this article examines the implications of feeding patients by identifying the professional, legal, and moral issues that are involved.

Percutaneous endoscopic gastrostomy: evaluation of insertion by an endoscopy nurse practitioner

OBJECTIVE

To evaluate the success rate and complications of percutaneous endoscopic gastrostomy (PEG) insertion performed with an endoscopy nurse practitioner, rather than a second doctor, carrying out percutaneous gastric puncture.

DESIGN

A prospective evaluation of one nurse'e performance.

SETTING

The endoscopy unit in a district general hospital.

METHODS

An experienced endoscopy nurse, who had undergone a specific training course in PEG insertion, participated in PEG placement in 50 unselected patients over a one year period. The outcome and complications were compared with 50 PEGs inserted over the same period by medical personnel. A standard 'pull' technique was used to insert a 15Fr tube under sedation and local anaesthetic.

RESULTS

The nurse was successful in PEG placement in all patients. Immediate complications from the procedure occurred in two cases in both the nurse-assisted and doctor-assisted groups. These were directly related to the gastric puncture in only one patient in each group; the others were respiratory complications related to the gastroscopy (resulting in the death of one patient). Thirty-day mortality was 8% in the nurse-assisted group and 12% following doctor-assisted PEG (mainly due to progression of the underlying condition). Outcome at 3 months was similar in the two groups, except for a slightly lower incidence of stomal infection in the nurse-assisted group.

CONCLUSION

The participation of an endoscopy nurse practitioner in the gastric puncture for PEG insertion appeared to be safe and effective and offered advantages in terms of the efficient provision of a PEG placement service, increased continuity of care for the patients and an enhanced professional role for the nurse involved.

The first assistant role in PEG tube insertion

Nurses are under pressure to take on junior doctors' tasks. Expansion of the nurse's role should be of benefit to patients and professionally appropriate. The development of the first assistant role in PEG may be an avenue for expanding nursing.

Catch 22: manipulative family members

When a Medicare patient from another state, who is not deemed mentally incompetent, vehemently demands treatment but then defers all procedures and treatment to her questionably competent son who, in turn, curtails any progress toward diagnosis, what are the hospital's and attending physicians' rights to continue basic care to the tune of $90,000 and beyond? Such multifaceted and complex dilemmas are illustrated by this case study which outlines the challenges and restraints encountered in dealing with an unusual situation. Also, it offers guidelines as a framework for action when a manipulative family member or patient is encountered.

[Percutaneous endoscopic gastrostomy. The technic and the indications for a new methodology]

Percutaneous endoscopic gastrostomy (PEG) is a worldwide accepted non surgical technique for enteral feeding in patients with prolonged swallowing difficulties or inabilities. PEG was recently introduced in Italy, and experience confirmed that such a technique is easy to perform, cheap, safe, well accepted by patients and carries a very low incidence of complications. In the present work technical procedure and our personal experience are reported; thirteen PEGs were performed our centre and no short nor long-term complications were observed.