Enteral Feeding Tube Recommendations for Nurses | Case Study

NSWOCC, percutaneous-enteral feeding tube, OpencityInc, case study

Food plays a vital role in human development, culture, and interactions. Nutritional demands can still be met for those unable to consume food normally. The enteral route bypasses the nose and mouth and passes directly through the skin of the abdomen to reach the digestive system. This is termed percutaneous enteral feeding. 

In this case study, we explore the development and launch of these feeding tube best practice recommendations by Nurses Specialized in Wound, Ostomy and Continence Canada.

Leading the way in French

Until now, each of the NSWOCC best practice recommendations projects has been developed in English and translated after the fact into French. The development of these percutaneous enteral feeding tube best practice recommendations, therefore, reflected a first for NSWOCC. A French-speaking committee of seventeen from Canada developed the best practice recommendations, which were simultaneously translated into English. The Delphi consensus process was conducted in French. The peer review was conducted concurrently in French and English. Adjustments resulting from the peer review were discussed and applied to both languages.

More and more patients are rapidly discharged after such [a percutaneous enteral feeding tube] procedure, and the need for instructions to manage and care is vast. Nurses in communities, families, and remote areas still need a document focusing on the nursing aspects. The French-speaking task force comprised NSWOCs from Quebec, Ontario, and New Brunswick. It has significantly improved the engagement of the French-speaking NSWOCs in the association, making them part of the active force, not just there as users.

Valérie Chaplain, BScN, RN, NSWOC, WOCC(C)

Only a few randomized controlled studies are available on the subject. The evidence base for the care of people using feeding tubes is generally weak. These best practice recommendations aim to equip nurses and any other health care professional offering support in the context of enteral feeding. It is recognized that increasing the knowledge of health care professionals facilitates an individual’s transition through the continuum of services.

The document is divided into several principal sections.

  • 54 best practice recommendations
  • Section 1–General Principles
  • Section 2–Preoperative Care
  • Section 3–Care
  • Section 4–Complications

Simultaneous translation

Developing best practice recommendations simultaneously in French and English was just one aspect that took this project to new levels of complexity. The initial literature searches generated 1,685 titles. Four task members independently screened the titles/abstracts to arrive at 243 relevant to the project for retrieval and full-text review; 207 were retained after the scoping review.

  • There are 54 recommendations–more than in other comparable projects and whittled down to separate recommendations from procedural steps or tips–each of the 54 statements achieved more than an 80% consensus for inclusion after multiple rounds.
  • The document is 102 pages in French and 94 pages in English.
  • The document includes 39 figures, 11 tables, and 5 checklists–the task force supplied many original photographs from clinical practice. Our medical illustrator supplied five figures, and two pathways were also developed.
  • The documents contain 189 references formatted in French and English – transposing references between English and French or vice-versa is time-consuming. We create a single file with side-by-side references in English and French.
  • There were fifteen peer reviewers in French and English.
Figure 1 percutaneous enteral feeding tube French case study

There are some tricky elements to the production of publications in French. Compared to English, the French language has spaces before periods, colons, question marks or exclamation points. In Word, it is possible to use nonbreaking spaces. However, in producing artwork in French care is needed to check that new lines of text don’t start with punctuation.

Working with this seventeen-member expert panel led by Valérie Chaplain was again a pleasure. We appreciate the educational grant from Cardinal Health Canada.

The simultaneous publication in English and French would not have been possible without the attention to detail of Josée Sénéchal and Valérie Chaplain. Thank you again to Véronique Synnett from Institut du Savoir Montford for conducting the literature searches and article retrieval. Thanks again to Natasha Wilson for the document production and Lisa Moulton for help with reference formatting. Layal Bou Abdo assigned the level of evidence for each reference supporting one of the recommendations.

The next best practice recommendations pending publication will be the malignant cutaneous wounds in spring 2024. Valérie has already volunteered to translate those into French too, as well as signing up for the latest best practice project on harm reduction in wound care.

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