BAOJ Clinical Trials
Nicanor M Domingo, et al., Clinical Trials 2015, 1: 1
1: 005
Research Article
Interventional Capability of an Instructional Video in the Performance of Nasogastric
Tube Feeding: Improving Knowledge in the Rehabilitative Phase of Care
Nicanor M Domingo1*, Ellyson Ryan C Paa2 and Kay Ann Tongol3
1.3
Assistant Professor, College of Nursing and Allied Medical Sciences, Wesleyan University-Philippines, Cabanatuan City 3100
Medical Officer, Luis Tirso M. Rivilla General Hospital, Paniqui, Tarlac
2
Abstract
Feeding via nasogastric tube (NGT) poses risks to clients under the
rehabilitative phase, since they require nutrition solely by enteric
tube approach. This study sought to determine the effectiveness of
an instructional video about nasogastric tube feeding. There were
90-purposively selected, grouped participants from a medical ward
and Outpatient Department (OPD) of a tertiary care setting. They
were asked for a return demonstration using a dummy with NGT
inserted on its nostril. The subjects performed the steps to the doll
as seen in the instructional video. Concomitantly, the researchers
scored the subjects according to the number of their correctlyexecuted steps.
Majority of the subjects are young adults and attended school for
7-10 years. Those who belong to the group with video and written
instruction (Group C) obtained the highest frequency of properlyexecuted steps than those who had solely seen the video without
instruction (Group A) and those who have watched the videos and
practiced the steps alone. It also showed noticeable improvements
after the second video-watching; t-test revealed: Group A (5.24);
Group B (7.93) and Group C (8.32), showing that significant
difference exists on their initial and final scores. Further, Group
C obtained the highest significance; but there is no significant
difference between their second scores (X2 = 3.29).
Instructional video serves as a teaching enhancement tool, so as
it provides better knowledge, skills and the reassurance to execute
tube feeding more effectively and efficiently especially for caregiver
and relatives whose patients were discharged from the hospital.
Keywords: Nasogastric tube; Quantitative; Instructional Video;
Tube Feeding; Enteral Feeding
Introduction
Enteral nutrition is offered to clients who are unable to ingest food
via upper gastrointestinal tract, whether it is impaired or there is
an interruption of transport of food to the small intestines. Enteral
feedings in the hospital setting are done through administration
per nasogastric tube (NGT) and small-bore feeding tubes, by
means of a gastrostomy (Percutaneous Endoscopic Gastrostomy)
or jejunostomy tubes. One method of achieving enteral access
is by nasogastric tubes. An NGT is inserted through one of the
nares, to the nasopharynx, down to the alimentary tract. Enteral
nutrition by nasogastric tubes is used for those who have intact
gag and cough reflex, adequate gastric emptying, and those who
Clinical Trials, an open access journal
require short-term feedings. NGT feeding is not always seen in
the hospitals, in the rehabilitative phase of care, client’s family
and/or significant other may conduct feeding and medication
administration through enteral tube (gavage) in the rehabilitative
phase of care (community setting).
Nasogastric tube feeding may look simple but there are
complications if done in a wrong manner. Risks for wrong feeding
include aspiration pneumonia, hypoxic encephalopathy and death
due to hypoxia. Therefore, correct nasogastric tube feeding is
inculcated so that nutritional therapy is promoted, reversing its
possible complications.
Nurses usually are the frontline workers in guiding and instructing
relatives or caregiver the proper way of tube feeding. However,
in a locality in which patients are numerous, and instructors are
busy with so much workload, some vital data or skills might be
overlooked or missed by the instructor. With this awareness, the
researchers thought of doing instructional video, as a teaching tool
to impart knowledge to nurses, relatives and caregiver on the proper
way of doing nasogastric tube feeding and to minimize possible
complication brought about by the faulty tube feeding when clients
are at their homes. Nowadays, videos become an effective medium
in the field of teaching and learning. It can communicate complex
information and, if used creatively, can become a powerful and
expressive tool.
The study determined the effectiveness of an instructional video in
nasogastric tube feeding. This is useful in the community setting
in which patients are at home for rehabilitation and their relatives
are the ones performing NGT feeding. Instructional video, return
*Corresponding author: Nicanor M Domingo, Assistant Professor,
College of Nursing and Allied Medical Sciences, Wesleyan UniversityPhilippines, Cabanatuan City 3100, E-mail: nmdomingo@gmail.com
Rec Date: November 27, 2015, Acc Date: December 15, 2015, Pub
Date: December 18, 2015.
Citation: Nicanor M Domingo, Ellyson Ryan C Paa and Kay Ann Tongol
(2015) Interventional Capability of an Instructional Video in the
Performance of Nasogastric Tube Feeding: Improving Knowledge in the
Rehabilitative Phase of Care. Clinical Trials 1: 005.
Copyright: © 2015 Nicanor M Domingo, et al. This is an open-access
article distributed under the terms of the Creative Commons Attribution
License, which permits unrestricted use, distribution, and reproduction
in any medium, provided the original author and source are credited.
Volume 1; Issue 1; 005
Citation: Nicanor M Domingo, Ellyson Ryan C Paa and Kay Ann Tongol (2015) Interventional Capability of an Instructional Video in
the Performance of Nasogastric Tube Feeding: Improving Knowledge in the Rehabilitative Phase of Care. Clinical Trials 1: 005.
demonstration by using dolls, and on actual patients are vital keys
to hasten the retention of memory of an individual in a particular
skill during teaching.
Methodology
Selection and Consent Process
The study used 90-purposively selected participants from the
Outpatient Department (OPD) of one of the government hospitals
in Cabanatuan City. Relatives of patients who do not know NGT
feeding waiting in OPD were approached and if consented if they
can participate in the research.
After obtaining a written consent from the subjects, researchers
explained the purpose of research, as well as their privacy, anonymity,
confidentiality and rights. Additionally, they were asked to fill-out
a form for their initials, age, sex and years in school. After which,
they were instructed on the procedure. The researchers assigned
the subjects into either Groups A, B, or C; the selection was done
according to the order or recruitment: 1st recruit as Group A; 2nd
recruit as Group B and 3rd recruit as Group C. Each group has 30
subjects.
Exclusion Criteria
The exclusion criteria were persons less than 18 years of age
and inability to communicate, understand and comply with the
requirements of the study such as language (Tagalog and English).
Application of Instructional Material
All subjects were made to watch a short instructional video about
NGT feeding wherein there were eight steps in doing so. The
subjects were asked for a return demonstration using a dummy
with NGT tube inserted in its nostril. The subjects performed the
steps to the doll as seen in the instructional video. Concomitantly,
the researcher scores the subjects according to the number of their
correctly executed step(s), these are:
1. Do hand washing before touching the NGT or food.
2. Do check the placement of your feeding tube by aspirating gastric
contents or feel air bubbles after introduction of air.
3. It is important to sit up during feeding and remain in that
position for 30-60 minutes.
The subjects were made to watch the same video again:
Those in Group A and C were made to watch the video (plain video
watching).While Group B was instructed to follow the instruction
and practice it on the doll while watching the video.
For the second return demonstration (after the second video
watching):
Group A and B were scored by the researchers after watching the
instructional video. While Group C was given a written instruction
of the eight (8) steps; they were instructed that they can look at it
as they perform the return demonstration. The researchers scored
them according to the number of steps correctly-executed.
Thus:
Group A – Video only (twice done)
Group B – Video with practice
Group C – Video with written instruction
Statistical Analysis
Data were subjected to statistical analysis, description of such
includes:
Frequency distribution. It is the arrangement of the values that one
or more variables take in a sample. It is a systematic way to list
series of observation of variables. This was done by categorizing
and tabulating the frequency of each occurrence.
Percentage. This was utilized to get the proportion of a part of the
whole.
Independent Samples T-test. A method of testing procedure which
compares means for two groups of cases to find any significant
difference between the two groups compared.
Chi Square statistic compares the tallies or counts of categorical
responses between two (or more) independent groups. A chi
square (X2) statistic is used to investigate whether distributions of
categorical variables differ from one another.
Results
A.Socio-demographic profile
Table 1: Age and sex distribution
4. Insert the tip of the tube from your food container into your
feeding tube.
Gender
5. Release the clamp slowly to adjust the speed of the feeding. Your
meal should last 45 minutes to an hour (if the patient has difficulty
of breathing during a feeding, stop the feeding and call your doctor
immediately).
6. When the feeding is done, fill the food container with the amount
of water your doctor prescribes, usually 30ml of water.
7. After the water is given, roll the clamp down to turn off and
disconnect the food container.
8. Wash out the food container after each use.
Clinical Trials, an open access journal
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18-29
years
30-39
years
40-49
years
50-59
years
≥60 years
Total
male
21
18
11
3
0
53
female
15
9
9
3
1
37
n=90
Table 1. conveys that majority (40%) of the subjects’ age range from 1829 years old which comprise the young adult group. There are 27 subjects
(30%) with age range from 30-39. Twenty (22%) belongs to 40-49; 6 or 7%
are middle-aged, and lastly, 1% is under the elderly group.
Table 1 also shows that there are 53 male and 37 female subjects. The
mean age range for both male and female is 18-29 years old. Therefore,
majority of the respondents are males within the age of 18-29 years old.
Volume 1; Issue 1; 005
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Citation: Nicanor M Domingo, Ellyson Ryan C Paa and Kay Ann Tongol (2015) Interventional Capability of an Instructional Video in
the Performance of Nasogastric Tube Feeding: Improving Knowledge in the Rehabilitative Phase of Care. Clinical Trials 1: 005.
Frequency
Percentage
6 years and below
9
10
It shows that upon dependent t-test in table 5, Group A obtained 5.24;
Group B (7.93) and Group C (8.32) denoting that all groups in the study
have significant difference on their initial and final scores. Further, Group
C obtained the highest significance (t value = 8.32).
7-10 years
54
60
Table 6: Significant difference on the scores between three groups
More than 10 years
27
30
Table 2: Educational attainment
Actual Frequency
Number of steps correctly executed A
B
C
total
n=30
5 and below
18
15
11
44
Table 2 shows that majority (60%) of the subjects attended school for 7-10
years. The group comprised of high school graduates and undergraduates.
There are 27 (30%) subjects who went to college and the remaining 9
(10%) were elementary graduates.
6 and above
12
15
19
46
30
30
30
90
100%
Table 3: Steps properly executed after 2 video watching
nd
Number of steps properly
executed after 2nd video
watching
Group A
Group B
Group C
Expected Frequency
Number of steps correctly executed
A
B
C
total
5 and below
15
15
15
45
6 and above
15
15
15
45
30
30
30
90
5 and below
18
15
11
6 and above
12
15
19
α = 0.05
r = 2
Total
30
30
30
N = 90
c=3
df = 2
Based on the data from the table, Group C (video with written instruction)
obtained the highest frequency of 19 in more than 6 properly executed
steps. Group A obtained 12 while Group B obtained 15. It means that
Group C answered more than 6 steps correctly compared to Group A and B.
X2 (0.005, 2) = 5.99
Table 4: Increase in scores among three groups
Significant differences on the scores between three groups show that
Group C has obtained the highest number of correctly-executed steps.
The alpha is set at 0.05 and degree of freedom is 2. With computed
chi square test of 3.29, the result fell below the area of critical value;
hence, the null hypothesis is accepted. Therefore, there is no significant
difference between the scores of samples on their second scores.
points improved
Group A
Group B
Group C
0
2
2
0
1
7
8
4
2
10
7
7
3
9
7
6
4
2
5
9
5
0
0
3
6
0
0
2
7
0
0
0
8
0
0
0
Table 4 denotes the improvement of groups after the second video
watching. Although increase in points does not clearly show which
teaching tool the subjects significantly improved.
It shows that Group C obtained the highest increase from initial to final
score with frequency of 3 and 2 to 5-point increase and 6-point increase,
respectively.
B.Statistical results
Table 5: Significant difference between the initial and final scores
t value
Decision
Interpretation
Group A
5.24
Reject H0
Significant
Group B
7.93
Reject H0
Significant
Group C
8.32
Reject H0
Significant
*significance level is at ≤0.05
Clinical Trials, an open access journal
X2 (0.01, 2) = 9.21
X2 computed = 3.29
Discussion
The number of patients receiving home enteral feeding has
increased considerably in recent years. In the Philippine culture,
Filipinos have close family ties. When a family member gets sick,
they prefer to provide the utmost care personally, an example of
which is tube feeding. With this instructional video, it seems that
it could help provide better knowledge, skills, and the reassurance
to initiate and execute tube feeding more effectively. Mastering the
techniques of basic medical procedures such as NGT feeding using
an instructional video in a technologically-changing environment
is a must. Indications, contraindications, and complications
are explained in an easy to understand fashion because several
conditions might occur such as hypoglycemia, electrolyte
disturbances, and bone marrow depression [1].
Nasogastric tubes are used for nourishing clients who have
adequate gastric emptying in a short-term feeding approach.
Some of the indications of inserting an NGT or providing such
include Cerebrovascular accident (CVA), severe burn, head and
neck tumors, tumors or cancers of the GI tract. Furthermore, it
can be used for clients with acute failure of the liver and kidneys,
surgery cases, pancreatitis, and psychologically such as in the case
of anorexia nervosa [2].
Volume 1; Issue 1; 005
Citation: Nicanor M Domingo, Ellyson Ryan C Paa and Kay Ann Tongol (2015) Interventional Capability of an Instructional Video in
the Performance of Nasogastric Tube Feeding: Improving Knowledge in the Rehabilitative Phase of Care. Clinical Trials 1: 005.
Nasogastric tube feeding has many therapeutic effects to some who
requires it, but contraindications or complications may arise when
improper feeding is done such as gastroesophageal aspiration
pneumonia of NGT formula in a neurologically-impaired gag
reflex seen to clients suffering from CVAs; this may lead to hypoxic
encephalopathy, other morbidity and if not, a mortality. Other
conditions may include Refeeding Syndrome to clients who are
nutritionally-unmonitored with high carbohydrate loads which
may lead to cardiac arrhythmias.[3] Further complications are
abdominal cramping due to large NGT feed volume, loose stools,
constipation, nausea and vomiting and other complications in the
GI tract.[4]
Educational attainment of the subjects usually belongs to low
income to low middle class group. Thus, it implies that many of the
patients or relatives that seek care belong to low socio-economic
status because government hospital pursues to deliver quality
health service especially to poor and marginalized sectors of the
society.
In this study, the researchers wanted to know if using an instructional
video is effective in transferring knowledge to audiences without
knowledge regarding nasogastric tube feeding. Video nowadays
become an effective medium in the field of teaching and learning.
It can communicate complex information and, if used creatively,
can become a powerful, expressive tool [5].
We also aimed to determine if there is a difference on scores when
the video watching is done repeatedly, and when written procedure
is used as a supplementary material. A person’s memory is what
stores, or retains information that is seen, heard, learned or otherwise
experienced. The ability to recall and use that information is also
courtesy of one’s memory. There are different types of memory
that retain information in different ways. Two of the approaches
include constant repetition and practice tests. Repetition is a
method in which an individual memorizes what is being taught
by repeating it silently or verbally. Repeating information regularly
is a great way to cement the information. The human brain is
excellent in recognizing patterns. If facts come up multiple times,
the brain recognizes it as something that has more importance
than facts visited only once. Repetition is one of the most powerful
components affecting our memory [6]. Repetitive and practice
tests can greatly impact a person’s ability to deliver information
and help improve actual test scores relative to one’s memory. In
comparing the traditional and non-interactive teaching methods,
interactive videos or visualizations allows persons to adapt their
form and content to their individual cognitive skills and needs [7].
Provided that the interactive features allow for intuitive use without
increasing cognitive load, interactive videos should therefore lead
to more efficient forms of learning.
Learning new information is huge form learning the facts, but
being keen both the studying process and the actual testing process
Clinical Trials, an open access journal
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will create greater associations and allow the person to recall the
information more effectively during their test. Instructions explicate
the steps required for completing a task or series of tasks.
On the other hand, carefully and fundamentally-designed, wellwritten instructions enable users to get the procedures done
safely and efficiently. Together with instructional video, potential
complications of faulty nasogastric tube feeding will be prevented.
Conclusion
Enteral feeding is relatively safe, effective, rapid way of initiating,
improving nutritional status. The researcher concludes that the
instructional video serves as a teaching enhancement tool, so as
it provides better knowledge, skills and the reassurance to execute
tube feeding more effectively and efficiently especially for those
health caregiver and relatives whose patients were discharged from
the hospital.
Recommendations
The researchers recommend another study design to analyze
quantitatively the difference on the effectiveness of the variants of
teaching enhancement tools.
The value of written instruction is recommended with simple and
easy-to-follow steps in tube feeding to be given to health caregivers
and relatives of the patients.
Acknowledgment
We are grateful to be supported by Prof. Marietta Teaño, our
Research Director, Dr. Jovi Flauta-Orio, Dr. Samonte, Dr. E.
Buenaventura and Hon. Pacifico Aniag.
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