‘Percutaneous endoscopic gastronomy (PEG) is a procedure in which a flexible feeding tube is inserted through the abdominal wall and into the stomach’ (Asge.org, 2017). In this assignment, I will identify the science of a PEG feed, discuss the ethical challenges of carrying out the procedure, describe key features of personal knowledge of carrying out the procedure and debating what artistry is in nursing.
It has clearly been evidenced with the worldwide population trends, that in today’s society there are many health problems in which lead to malnutrition, this is because of, dementia, stroke, and malignancy which are common within the elderly society and dysphagia is associated with these. (Chen et al., 2011) Malnutrition is a deficiency in which a person’s intake of energy and/or nutrients is imbalanced. This can either be ‘undernutrition’ or be overweight/obesity. (World Health Organization, 2016)
Bapen says ‘It has also been estimated that malnutrition affects over 3 million people in the UK and about 1.3 million of these are over the age of 65 and 93% of these are living in the community.’ (Bapen.org.uk, 2017) The ‘Malnutrition Universal Screening Tool’ (‘MUST’) was launched in 2003 and has had been reviewed regularly. It was developed by the Malnutrition Advisory Group. ‘MUST’ is a five-step screening tool, the aim of the tool is to identify adults who are malnourished, are at the risk of malnutrition, or obese. (Bapen.org.uk, 2016) Alternative feeding then becomes considered when an individual is unable to ingest any food. The most appropriate method for long-term enteral feeding is gastronomy. This procedure can be used for allowing the individual to receive their nutritional needs, their fluids ,and medicines which goes directly into the stomach. Patients who suffer from swallowing complications and can’t provide adequate nutrition. (Asge.org, 2017) There are many different reasons as to why somebody isn’t receiving the adequate nutrition. Such as, obstruction of the oesophagus, loss of swallowing reflexes, postoperatively for patients who have ad some types of oral surgery.
A PEG is more appropriate than a nasogastric tube if the feeding is going to last more than 4 weeks, therefore it avoids delays in feeding and discomfort when the tube is displaced.
PEG feeding is considered as a medical treatment; therefore, it raises ethical and legal considerations, to carry out the procedure it requires valid consent of the individual before the procedure is carried out. The individual must have the capacity to give consent after receiving the correct information about the procedure. If the patient has the capacity and they wish to refuse treatment, whether their decision may lead to death or not, their decision must be granted. However, if the individual lacks capacity, healthcare professions must help somebody who can represent them such as a family member and aid them to act in their best interest and based on their family members values and not their own. (Kurien et al., 2017)
Some people base their decisions on religious beliefs, some religions may believe that life is too special and valuable. Therefore, they will continue with PEG feeding as without food and drink they will die. However, some religions believe that they are lacking sufficient quality of life, therefore they are prolonging their suffering and will choose not to have eternal feeding. (The Doctor Will See You Now, 2002) When a PEG is being inserted, the physiological and social factors must be involved as eternal feeding can be very distressing. Although it’s not visible, individuals may feel as though they’re social activities are limited as they may feel embarrassed. Also, individuals usually link eternal feeding to ill health which means it can have an impact on their mood. Upon insertion, these factors must be discussed with the individual. (Dougherty and Lister, 2015, p.279.)
There are potential hazards when dealing with a PEG, there is an increased risk of infection and a source for the growth of micro-organisms. Liquid nutrients create an increased risk of bacteria and cross contamination to the feeding system during the procedure. According to the ‘Trust Hand Hygiene Policy’, whoever is dealing with it must wash their hands thoroughly before handling feeds and different components. Through the author’s experience, when handling equipment and cleaning the area, the non-touch aseptic technique must be used. A Nurse must have the knowledge how and when a PEG should be flushed. The Nurse should know that the tube should be flushed with 30ml of tap water and using a 50ml syringe. After this is done, it should then be documented. During the day, flushes should be given every 4-6 hours, before and after feeding and before and after medication.
Nursing can be seen as, a science and an art. Science is more apparent, for example, understanding disease management, medications and what to do in emergencies. Nurses also need to be up to date with policies and procedures and how to use different equipment and when to use them, which is science-based.
However, the art of nursing comes holistically depending on the Nurse, it’s more than just knowing things, it’s what you do and going above and beyond for your patients. The art of nursing blends the science of nursing with the holistic approach and treating patients as a whole. (Dr. Rachel Danford, 2017)
Within nursing, you apply the art of communication to reach to your patients and allow you to focus on the science of your nursing skills and abilities. Smiling more and making jokes at the appropriate time makes the day a little bit brighter for the patients. Taking the time out of the nurses’ routine to sit with their patients and taking time to connect with them is an art. Learning about their past lives and their families, makes a huge difference to the patient’s experience as it can be easy to miss out the person as a whole and just focus on the scientific tasks needed to be carried out. The Art of Noticing is essential to the everyday practice of nurses. It enables the nurse to make clinical reasoning, make appropriate judgments and carry out the basics of care. By being able to notice things, then the nurse can possibly rule out any possible risks and they ,therefore, can make changes towards recovery. Failure to notice can have serious consequences, such as harm or death to a patient.