Traditional Poster Round
Context: : Parents report having a baby on NICU is stressful and they may feel inadequate and unable to help their child. However, if staff can work with parents to explain equipment and overcome fears about performing cares, parents are empowered to be involved in physically caring for their baby. This is hugely important in promoting bonding between parent and baby, and should be supported in every way possible.
With that in mind, our unit wished to promote parental involvement in nasogastric tube (NGT) feeding. Feeding your child is such a basic parental urge and empowering parents to do this is hugely satisfying for staff and parents.
However, parents may find the thought of feeding through the NGT intimidating. We have modified our simulation dolls to give a realistic model for parents to practice and build their confidence.
Description: : We have lots of photos and a video to help illustrate.
Our nurse education team have frequent parent education sessions which discuss NGT feeding. However, these sessions were not practical and therefore do not engage parents motor memory.
On review of our manikins it became clear that unless I significantly modified the models there was not one model that could be used to both insert an NGT and test aspirates. However, parents could realistically practice measuring and inserting the NGT on the PremiHal (Gaumard). However, this model would not easily give an aspirate.
I modified our extreme preterm manikin (from Laerdal) to allow NG aspiration and pH testing. I inserted the NGT through the mannikin’s nose and then pulled the tip of the NGT through to the chest cavity via intubation of the trachea. This allowed the tip of the NGT to sit outside the manikin through the chest. The NGT tip could then be inserted into various prefilled syringes and can use blue-tac to create a seal to avoid leaks.
I used water, formula, baby food and lemon juice to create solutions that could yield different pH’s.
• Water with a drop of lemon to give pH of approx. 5.0.
• Formula milk with lemon to give semi-digested milk with acidic pH
• Baby food (diluted with water) and lemon juice to give acidic pH to simulate mucky aspirates, when parents should consult with staff prior to feeding.
Observation/Evaluation: : This model was then used in conjunction with verbal discussion and explanation of NGT feeding with parents. The feedback from parents was positive, with many citing that they “loved” that they could practice.
• “Wow, that’s amazing!”
• “I didn’t think it would give different aspirates”
• “Love being able to practice, and not on our baby”
Staff performing the parent education sessions also had very positive attitude toward the manikin, reporting that they felt it made the session more realistic and was a helpful aid to support parental education and confidence.
Discussion: : The exercise was interesting to see how simple, low-tech and reversible modifications of our existing simulation manikins have facilitated improved parental education. Having a model that can easily be setup and is easily portable for parental education sessions is fantastic in making the education more real, relevant and engaging their motor memory. Anecdotally this translates into increased parental confidence and motivation to be involved in NGT feeding, which can only be a good thing for our parents and babies alike.
Our next step will be to develop a more formal parental questionnaire to see if this training translates into sustained learning for parents.