A systematic review entails a comprehensive evaluation of the behavioral social as well as policy frameworks that identify the related and relevant literature (Bowling 2005, p54-63). This paper uses the available information on Enteral feeding as a basis for the creation and development of a framework for conducting an extensive search on the psychological implications of this medical procedure.
Enteral feeding is a way of providing nutrition to those who have swallowing difficulties. It is of importance to me as minorities of patients I nurse are fed this way. The patients have a degree of dementia and are unable to convey compliance or distress due to incapacity. The psychological implications are rarely addressed.
Feeding can be considered as the final disability that is characteristically common among adults of advanced age (Watson 2002). The method is mostly employed where there is a cognitive impairment that causes an individual to fail to complete their motor tasks. As a result, the majority of individuals with these conditions especially those with signs of dementia refuse the assistance of caregivers in feeding. This process leads to possible psychological effects which are the subject of my study. I will investigate the effect that eternal feeding has on the adult’s willingness to eat, their appetite to eat, and the difficulties that they experience.
The keywords used in my search were feeding, the eating experience, dementia and eating, eating problems, and eternal feeding. These were used to collect information from two main sites and search engines, Cinhal and Medline. The words generated a very high number of results most of which were not relevant to the study and the objective of the search. Combining these phrases and words into short sentences narrowed down the search results to 2921 results from Cinhal and 23897 from Medline. These however were still too many and irrelevant to the thesis and objective of the search. I narrowed down the search to the keywords of the search to tube feeding, Enteral feeding PEG, and eternal nutrition. These were further reduced and condensed to articles published between 1990 and 2011. This search generated 245 articles from Cinhal and 435 articles from Medline. The number was further reduced by those that focused on the effects and difficulties of Enteral feeding which reduced the number to 80 relevant articles.
Results and discussion
Out of these research studies, the majority took a qualitative approach relating the various aspects of Enteral feeding to specific conditions and patients suffering from certain illnesses. The available literature suggests a general preference for a qualitative approach to the topic (Horwood, 1992). The quantitative approach engages in actual practical experiments that are used to gather information on the subject matter. The qualitative aspect of the study focuses on existing information on the topic and subject of research.
The standard use of the word Enteral and feeding is common among the majority of articles. They all use and to a common meaning of the terms that are in line with giving of food from other remand other than through the mouth(Lipman 2005). This has been consistently used across all the articles. The articles however differ in the explanation of the term eating since some explain it among infants as a combination of behaviors such as the visual and vocal expressions that are displayed in response to a caregiver’s attempt to provide food. Among the adults, eating is conceived as the process of allowing food into the mouth and swallowing
Feeding problems are common among the elderly and those with mental and feeding-related illnesses. The eminent lack of a clear definition of the consequences of eternal feeding is related to the suggestion that these consequences and effects are multifactorial and cannot be concretely associated with a single cause. It is therefore easy to confuse them with other social ethical and medical history related effects as opposed to the sole cause of enteral feeding. As it were, patients with different conditions display different effects after the engagement of enteral feeding. For instance patients, nay has a lot of difficulty in responding to a variety of food and the perception of the need to eat or feed. They, therefore, develop a plain instinct to feed regardless of the taste and quality of food (Grimble, Payne, and Silk 1992). Dementia patients face great difficulty in handling and completing the process of taking food into the mouth and swallowing as well as turning the food in the mouth. There are extreme medium and borderline cases of psychological effects among patients who are put under enteral feeding (Brotherton and Abbott 2006).
The extreme case of an elderly person showed that he was more distracted by noises outside and events at lunch hour and did not complain about whatever type of food he was given. There are moderate and related cases of psychological effects where some patients associate food with the equipment that is used to feed them and substitute them with the actual plates and spoons and therefore forget how to use these utensils.
Conclusion
The direct ability of an individual to respond to the thought of food, think and choose between food varieties and undertake the eating process is greatly affected by enteral feeding (Marshall and West 2004). This is a common aspect among the various studies that have been conducted. It is therefore high time that policymakers consider these effects in allowing for the use of Enteral feeding on patients (Körner, 2006).
Background
The background review combines the literature review and the introduction to the report. This section has an up-to-date series of references that provide a sequential narration of the available research and information on nursing care maintaining a close margin of relevance to nursing care relationships. It has no subheadings and therefore makes it quite difficult to follow (Gerrish and Lacey 2006 p 345-360). It however constructs a logical argument that leads to a justification of the study and a basis of the research question. It gives an adequate academic account of the available evidence on the nursing care relationship (Bowling 2005). It also provides a balanced account by sampling studies and references from both nurses and patients themselves. It however would have done the research more justice if it had more subheadings.
Research Question
The aim of the research is categorically stated with clear terms that allow its meaning to come out clearly. This objective statement forms the foundation and basis of the research and report (Newell and Burnard 2006).
It falls in line with the title of the research that is justified and supported by the literature review and background.
Research design and methodology
The methodology is introduced by a replica of the abstract but in more detail as far as the sampling approach and technique that would be used in the research. Being a qualitative study a purposive sampling design was appropriate in ensuring that the research received a maximum contribution from the participants. The researchers obtained permission from the ethics committee to conduct the research. The sampling method and design generate a concrete sample that is used to generate the results of the study. The nurses for instance were sampled based on their potential to contribute to the study. This ensures that the study maintains an objective tone and keeps to the hypothesis. The results and discussion also contain only the relevant information for the
Sample
Purposive sampling has been used and successfully implemented in previous research. It provides the research with a concrete sample that represents all the objectives and hypotheses in the population. It gives the researcher enough evidence on qualitative aspects of the research topic. The manner of choosing the sample is adequately described and laid out in the introduction of the data collection section. The sample was made of 19 nurses among whom, 5 were qualified nurses while 9 were registered nurses and 2 auxiliary nurses. The research also engaged 13 elderly people of whom 2 were male and the rest were female. It does not have an inclusion-exclusion criterion but the purposive sampling technique in itself has an inclusion, criteria. The sample is a fair representation of the population because it is just enough to represent the population as a whole. The sample size is rather small giving more room for bias and inaccuracy. It is however big enough to allow for the deduction of a firm conclusion for the research (Hamersley and Atkinson 1995). The research also employs structured and semi-structured interviews. This gave the research advantage of structural and procedural reference by allowing the discussion and data analysis to make direct reference to the interviewees’ responses (Gold1958, pp 217-223). It allows the users of the report to understand and make supported conclusions from the recommendations and propositions of the research using it as a point of reference (Bowling 2005).
Ethical issues
The nature of the research required the researcher to obtain authorization since the views of the interviewees had serious implications on patients, nurses, and other related users of the research. it is therefore of utmost importance that all ethical and professional standards be employed in the development and conduct of the research The researcher therefore sought and obtained permission from the ethics committee. The research has abided by the rules by granting anonymity and confidentiality in as far as specific names and personalities of the interviewees in concerned. The interviews were conducted at the convenience of the interviewees and therefore ensured that there was informed consent for participating in the survey. This might have improved the response rate of the research and assured accuracy(Greenhalgh 2010). It also may have played a big role in increasing the number of respondents who were willing and able to participate in the research.
Data collection
There was no pilot study and in effect, there were few changes in the research design. There were however minor changes in the sample structure to allow a follow-up procedure for the structured interviews. The interviews were conducted for an average of 60 minutes per interview was done through structured questionnaires that contained a combination of demographic qualitative quantitative and open-ended questions that were administered to the interviewees. The place of the interviews was set at the convenience of the interviewees. This ensured that they are comfortable. The data collection approach differs and departs from the research design by employing a strategy that allows the researcher to evaluate and review the collected data and data transcripts at different stages of the research (Hamersley and Atkinson1995 p 300 -320). The review of these sources at each stage allows for the development of new themes and theories that were investigated in consequent stages. The use of this tool has diversified the research findings increasing the reliability and relevance of the research in the contemporary context. This approach however suffers the lack of objectivity since the themes that arise in a stage-based analysis have an element of bias. The data collecting strategy is fairly described and would have been better if more detail were incorporated.
Data analysis
The results are presented in the chronology of collecting. The research design allows for a stage-based analysis of data and therefore the data analysis is layer out in subheadings of the stage-based review. The method of data analysis is well explained as all the data was collected and documented through tape records and notes made from observation. The researcher employs the analytical hierarchy model and approach in analyzing the data. The stage-based analysis in the research design allowed for the identification of data gaps in the research. The data gaps were then interrogated in subsequent interviews and observations (Bowling 2005, p54-63). The research is mainly analytical and has little quantitative value as far as inferential statistics is concerned. It has no tables nor graphs an element that limits the presentation of the demographic aspect of the research (Crookes and Davies 2006, p23-35). The thematic approach of data analysis allows the data analysis to benefit from actual extracts of data as citations to the thematic claims.
Discussion
The discussion offers a balanced review of the research and the implicating of the results. It maintains a slim margin between previous research and the relevance and application of the present research. The research has covered the majority of data gaps but still goes on to acknowledge the pertinent weaknesses and failures in the research (Ritchie and Lewis 2003, p 200-209). It acknowledges s that the research was done on a small-scale basis a factor that limits the conclusions and application of the results. It also maintains a slim margin between the issues relevant to the study and those that are related but irrelevant to ensure that the reader maintains a clear picture of exactly what the research is about. The ethical value of the research is fairly acknowledged to support the recommendation for larger and more diverse research into the topic (Craig and Smyth 2007, p 145-157).
Conclusion and recommendation
The research discusses its conclusion by referring to previous research. The conclusion provides a fair record of accomplishment of the existing data and static of the topic placing the current research at the end of the chronology. It also discusses the criticisms that have been made in the previous research and whether or not these criticisms have been responded to. This, therefore, identifies the aspects covered by the research and those that still need to be interrogated and researched on.
The reference list
The references are fairly up-to-date and fall within the spectrum of the research topic. However, some of these were too old some dating back up to 50 years from the date the research was conducted. This however remains in the procedural aspects of the research since procedures remain the same over the years. The research also employs tools from different previous researches that are appropriately referenced. The report has over 50 references an aspect that draws from the researcher’s academic background and history.
References
Bowling, A. (2005) Handbook of Health Research Methods: Investigation, measurement and analysis. Berkshire: Open University Press, McGraw Hill Education.
Brotherton, A. and. Abbott, P. (2006) The impact of percutaneous endoscopic gastrostomy feeding upon daily life in adults. Journal of Human Nutrition and Dietetics. Volume19, issue 5 p355–367,
Craig, J.V.and Smyth, R. (2007) The evidence-based practice manual for nurses. Edinburgh: Churchill Livingstone.
Crookes, P. A., and Davies, S. (2006) Research into Practice; Essential skills for reading and applying research in nursing. Edinburgh; Balliere Tindall.
Gerrish, K.,and Lacey, A. (2006) The Research Process in Nursing. Oxford; Blackwell Science.
Gold,R. (1958) Roles in sociological field investigation. Social Forces 36,217–223.
Greenhalgh, T. (2010) How to Read a Paper: the basics of evidence based medicine. London. Wiley Blackwell, BMJ Books.
Grimble, GK. Payne J and Silk, DBA. (1992) Advances in nutrition in the critically ill Baillière’s Clinical Anaesthesiology, Volume 6, Issue 2, June, Pages 213-252.
Hamersley, M. & Atkinson P. (1995) Ethnography: Principles in Practice. London Tavistock.
Horwood A. (1992) A literature review of recent advances in enteral feeding and the increased understanding of the gut Intensive and Critical Care Nursing, Volume 8, Issue 3, , Pages 185-188.
Körner,U. (2006) Ethical and Legal Aspects of Enteral Nutrition. Clinical Nutrition, Volume 25, Issue 2, P 196-202.
Lipman, O. (2005) Enteral Nutrition Encyclopedia of Gastroenterology. Pages 698-701.
Marshall, A.,and West, S.(2004) Nutritional intake in the critically ill: Improving practice through research Australian Critical Care, Volume 17, Issue 1, Pages 6-15.
Newell, R.,and Burnard, P. (2006) Research for Evidence Based Practice. Oxford: Blackwell.
Parahoo, K. (2006) Nursing Research: principles, process and issues. London.Palgrave Macmillan.
Ritchie, J. & Lewis J. (2003) Qualitative Research Practice: A Guide for Social Science Students and Researchers. London.Sage.
Watson, R. (2002) Eating difficulty in older people with dementia. Nursing and Older People 14, 21–25.