Building Capacity to Manage Enteral Feeding Tube Issues at the Bedside: A Nursing Champion Program
Summary
Within the past several years, there have been multiple serious safety events (SSEs) at SickKids related to the mismanagement of enteral feeding tubes at Sick Kids. A review led to the creation of an official G Tube Feeding Program, of which I am the G Tube Resource Nurse. Over a three-month period, I conducted a needs assessment with nurses on the inpatient units to identify the gaps in care that were perceived to contribute to the SSEs and, generally, a significant number of consultations for tube and stoma related challenges. It was identified that there are significant knowledge gaps around the management of G/GJ/J tubes, including skin assessment, basic knowledge about the different types of tubes used at SickKids and how to manage the associated challenges. However, there was a general consensus that these nurses were interested in providing more specialized care for patients with G/GJ/J tubes. With this, the idea for the fellowship project was born. With the overall learning goals to develop leadership and coaching skills within myself and my peers, the development of a G Tube Nurse Champion program aimed to increase staff knowledge and confidence in managing enteral feeding tubes independently and, ultimately, increase timely access to consistent care and decrease the number of safety events related to enteral feeding tube mismanagement. There is a future goal to pilot this champion program on an inpatient unit at SickKids.
My learning goals focused on gaining knowledge in the topics of adult learning and teaching, knowledge translation, mentorship and nursing championship. Interestingly, the path my learning took me on changed one of my learning goals halfway through the fellowship experience. Where I initially set out to create an implementation plan for the nurse champion program, ongoing reflection and support from an incredible mentor team led me to realize that my learning would be better applied in developing a solid education plan and the subsequent learning activities that would support eventual nurse champions. In true spirit of the fellowship, we made sure my learning was at the center and, in refocusing the learning objectives, the experience was much more valuable.
My learning objectives were met through comprehensive literature reviews, close consultation and collaboration with my mentorship team, subject matter experts and key stakeholders throughout the organization and reflective practice. As well, the fellowship provided the opportunity to complete many formal SickKids education sessions that directly impacted my learning objectives including a mentor bootcamp and the simulation development and instructor workshops, as well as acceptance into the Teaching Scholars Program, a collaborative program between SickKids and U of T. These activities have not only given me access to subject matter experts who have graciously shared their exceptional breadth of knowledge and experience but have also given me the tools I can practically apply on a daily basis. I have more confidence in my ability to manage adult learners in a complex healthcare teaching environment including identifying learning needs, collaboratively making supportive learning plans and providing appropriate feedback. As I currently interact and support staff and families regularly and am directly involved in the development of policy and education materials, the principles I have learned through the fellowship will be intertwined into my everyday practice.
This experience has been very fulfilling. Without the fellowship opportunity, I would not have had the opportunity to do such a deep dive into these topics and join sessions that have highlighted my strengths and given me areas to further develop.
Outcomes
At SickKids, over 200 children per year receive an enteral feeding tube. These patients are medically fragile with increasingly complex needs and access the health care system regularly due to their complexity. These visits are often directly related to tube or skin issues, and while in our organization, families rely on health care providers to be knowledgeable and competent in order to manage tube issues but to also to create and sustain processes that support their children. The completion of this fellowship has allowed me to apply my advanced knowledge of adult learning and knowledge transfer principles to the creation of a solid education plan and subsequent resources. This plan and the associated resources will build the capacity of inpatient unit nurses so families will have increased access to timely, safe and competent G/GJ tube care while admitted. There will be decreased delays in assessment and intervention since they will not have to wait on the G Tube Nursing team and nursing staff will have the ability to build competence in families’ skills prior to discharge. The increased confidence and capability of nurses and families is the most important outcome of this fellowship experience.
The work accomplished during the fellowship will positively impact the more than 1600 Sick Kids nurses by increasing capacity and building confidence around managing G/GJ/J tubes. The development of a nurse champion program that incorporates education opportunities based on the knowledge and resource gaps nurses identified during a hospital-wide needs assessment will directly impact their ability to provide safe, competent care. Increased capacity of frontline staff to manage basic G/GJ/J tube issues will lead to increased capacity of G Tube Feeding Program nursing team to support other practice and quality initiatives. Decreased consults to the G Tube Resource Nurse regarding basic G/GJ/J tube issues and decreased incidences of safety events, including SSEs, related to G/GJ/J tubes are outcomes to continue to evaluate.
In general, knowledge gained around adult learning and teaching, through my own literature review and participating in the Teaching Scholar’s Program, will be invaluable to G Tube Feeding Program. My new expertise will change the way we approach planning for and executing education activities. In particular, the use of simulation as an education tool will a gamechanger for our program, where hands-on learning is key to practicing and retaining the skills. Our program is better off for me having done this fellowship and that is really exciting.
Overall experience
Due to its very specific nature, there are unique challenges in backfilling my role. The impact was stressful at times but ultimately brought out the best in my team, helping us redefine our roles and how those roles interact. As I progressed through my fellowship experience, I was able to immediately apply my learning around adult education to this training scenario. It was gratifying to see improvements in my performance as a teacher/mentor and a positive response from my learner.
As well, as I accomplished my learning objectives, I was able to explore my personal preferences for learning and teaching. There were times when working independently with minimal structure was challenging, however, the opportunity to reflect on this process and connect it to the literature and theory has helped me gain a deeper understanding of my strengths and weaknesses. I have learned that there is so much more to adult learning and teaching, mentorship and knowledge translation. It is far easier to jump ahead to the solution and hope it all works out, but I have learned that forward-thinking, planning and evaluation are necessary for success. This was a valuable and practical lesson that will follow me onwards.
Due to the COVID-19 pandemic, interactions and learning opportunities were all managed virtually. While there was a less personal tone to everything, it also meant that I was able to see how experienced teachers adapted to a different learning environment and worked to incorporate the theories of adult learning virtually. This firsthand observation was vital to my learning.
The most satisfying part about this fellowship experience has been discovering new topics, practices and approaches that I was not familiar with but turns out I am actually very interested in. For example, the development of a simulation event to support nurse champion development was brand new area of learning for me. Having the opportunity to attend focused education sessions about simulation and connect with experts in this area has sparked my excitement and I look forward to learning more about this and being a resource for my team while using simulation to change our approach to education.
