Peg Feeding

This essay discusses a clinical skill in which I have become competent during my placement in care home. I will use a reflective model to discuss how I achieved the necessary level of competence. Reflection can make a sense of the familiar and taken for granted situations and is an important human activity, in which people capture their experience, think about it and evaluate it (Driscoll, 1994). Here I have used the Gibbs model of reflection which includes description, feeling, evaluation, analysis, conclusion and action plan of a learning experience (Gibbs 1988). The clinical skill I have learned is PEG feeding. Percutanious endoscopic gastrostomy (PEG) feeding introduced into clinical practice in 1980, is now established as an effective way of providing internal feeding to patients who have functionally normal gastro intestinal tract but who cannot meet their nutritional needs because of inadequate oral intake (kurien M, 2010). It is mainly used when an individual is unable to maintain nutrition by eating or drinking.

Today, an increasing number of patients cared for at hospital or at home have Percutanious gastrostomy feeding tubes (Jones et al, 2006). Dysphagia is the most common reason for initiating gastrostomy tube feeding commonly as a result of cerebro vascular accident, multiple sclerosis, motor neurone disease and cerebral trauma (Parker et al, 2006). There are two types of peg tubes, those that last 18 months to two years and balloon retained gastrostomy tubes which require replacement every 2-3 months (Collier, 2007). One of the most important responsibilities whilst PEG feeding is flushing the tube correctly with water after a feed or medication. Description

During my training in the care home, we have a resident who has a PEG feed. He suffers from Huntington’s disease. Since it is a congenital motor neural disorder, he is at high risk of aspirating oral foods due to the involuntary movements whilst feeding. He was the first patient I cared for with a PEG feed. Though I studied PEG feeding I did not have an opportunity to care for a patient with PEG tube during my experience in home country. Initially I was not able to administer medication or feed through the peg feed due to the lack of knowledge and skills on how to do it properly. I had to ask for the help of senior staff to help with feeding. I was desperate to achieve the skill to peg feed which I must possess to administer medication to that client. I asked one of the senior staff who was looking after that client to teach me how to do PEG feeding. She demonstrated it to me and I discussed the matter with my mentor. My mentor put me through PEG feed training that gave me all the necessary information about the proper use and management of PEG tube. The next time I had the chance to do it I could relate the theory to practice by continuously performing the feeding, I gained competence in performing that skill. Feeling

I was interested in learning about PEG feeding from the very first time I saw it in the care home. I was eager to learn the skill. By observing my colleague doing it and by attending training I learned the procedure clearly and gained necessary confidence to perform it. I obtained consent and maintained privacy before carrying out the procedure. I was nervous whilst doing it for the first time but with the support of my colleagues I overcame the stress and mastered the skill. Evaluation

Though I was unaware of the correct procedure of PEG feeding and was unable to perform the PEG feed, my mentor’s help and proper training put me on track and helped me to perform the feed using the correct technique and procedure. The positive aspects of the learning outcome were:

* Learning a new skill
* Gaining confidence in myself
* Eagerness to learn more new skills
The negative aspects of the learning outcome were:
* Feeling of stress and tension
* Fear of making mistakes

Analysis
This experience helped me so much in gaining a new skill and encouraged me to learn more skills. Even though I did not know about the procedure initially, observation and training helped me to identify the safe practice and made me confident that I could perform well. The continuous support from my mentor and the positive evaluations from my colleagues gave me confidence to develop my skills and knowledge. Conclusion

In conclusion, learning about PEG feeding and developing skills for safe administration of PEG feed made me confident as a student nurse to look forward to practice safely as a registered nurse in the future. I realise the importance of updating clinical skills and knowledge. Using a reflective model has helped me to realise that my learning is something which I must be pro-active in.

Action plan
In future, I will not be hesitant to ask for help in learning a skill that I am not familiar with. I will update my clinical skills and knowledge by attending more training sessions which will help me to deliver safe and effective care to the clients in my care.

References

* CollierJ(2007) Enteral feeding: An overview http://www.dietetics.co.uk/article _ enteral_feeding.asp (accessed on 18/4/12) * Gibbs, G. (1988). Learning by doing. A guide to teaching and learning methods. London: Further Education unit. * Department of Health (2001) Reference Guide to Consent for Examination or Treatment. Department of Health, London * Desimone, R., Werner, J, Harris, D. (2002) Human Resource Development. Fort Worth Texas: Harcourt College Publishers, p. 655, glossary. * Driscoll J (1994) Reflective practice for practice. Senior nurse10(10)26-8 * Jones B , Holden C, Dalzell M, Micklewright A, Glencorse C(2006) Artificial Nutrition Support in the U.K 2005: A Report by the British Artificial Nutrition Survey(BANS), a Committee of BAPEN(The British Association for Parenteral and Enteral Nutrition) * Kurien.M (2010) Percutaneous endoscopic gastrostomy (PEG) feeding, http://www.bmj.com/content/340/bmj.c2414.extract (accessed on 12/04/12) * Parker T, Neale G, Cottee S, et al (1996) Management of Artificial Nutrition in East Anglia: a community study. J R Coll Physicians Lond 30(1): 27-32. * Rollins H (1998) Managing Enteral Feeding Tubes at Home. Clinical Nutrition Update 3(2): 3-4. * The code, standards of conducts performance and ethics for nurses and midwifes, NMC, London