Aims To explore nurses and guardians views, fears and knowledge about nasogastric tubes (NGT) use in children in a large African teaching hospital and to analyse the effect of interventions, an illustrated poster and nursing checklist.
Background NGTs are inserted regularly, particularly in cases of cerebral malaria and severe respiratory distress. Following insertion of NGT, it is the guardian’s responsibility for care of the tube and NG feeding.
Method 50 guardians, 25 caring for children with NGT’s and 25 without, were interviewed using an interpreter and standardised questionnaire. We subsequently introduced two interventions in the form of illustrated posters in multiple areas and a nursing checklist of competencies. Following interventions, a further 20 guardians were similarly interviewed. Nurse’s views of NGTs were also gathered in the form of a standardised questionnaire.
Results Overall, 88% of guardians were aware that a NGT was a tube used for feeding.
Pre-intervention, 68% of guardians thought NGTs were only used in very sick children compared with 10% in post-intervention group, suggesting cultural fear towards NGTs. Amongst those guardians caring for children with NGTs, awareness of tube placement improved post intervention, with 70% knowing it goes to the stomach, compared with 28% pre-intervention.
Following the interventions, 100% of guardians of children with NGT displayed positive attitudes compared with 68% pre-intervention. Despite interventions highlighting need to check NGT position before feeding, only one guardian in the post-intervention group described this. No guardians read the poster, despite all having seen it.
Nurses displayed good technical knowledge of indication and risks of NGTs, but 40% demonstrated negative feelings towards the therapy, for example, ‘I feel like I’m choking the child’. Majority also perceived that guardians felt negatively about NGTs, with 40% of nurses thinking parents thought the NGT resulted in death.
Conclusions There is a culture fear of NGT use, even amongst trained nurses. The intervention of a poster was of limited benefit. Education of guardians is essential to improve compliance with treatment, and the nursing checklist appeared more effective at this.