Date of Graduation

Spring 5-14-2020

Document Type

Project

Degree Name

Doctor of Nursing Practice (DNP)

College/School

School of Nursing and Health Professions

Department/Program

Nursing

Program

Family Nurse Practitioner

First Advisor

Jo Loomis, DNP, FNP-C, CHSE, CLC, ANLC, NCMP, CNL

Second Advisor

Dena Cuyjet, DNP, PNP, MSN, BSN, RN, IBCLC

Abstract

Abstract

Problem. Patients with percutaneous endoscopic gastrostomy (PEG) tubes and their families report physical and psychosocial changes associated with complications after gastrointestinal surgeries. They are at particular risk for tube dislodgement, leakage, infection, poor fit, and skin irritation. The lack of specialization and fundamental stoma care knowledge among community health care providers potentially results in unintended consequences, leaving the system inefficient with fundamental inequities of stoma care delivery. While there is an increasing amount of accessibility to specialty centers for other types of wound care, stoma care support resources are scarce and not readily available to patients.

Context: This Doctor of Nursing Practice project focused on conducting a stoma care education workshop to primary care providers in outpatient clinics within the community. There is a need to enhance the quality of care for patients and families caring for stomas at home and improve barriers in access to specialized care, especially in rural communities. Utilization of trained primary care providers has the potential to reduce the costs associated with emergency room visits and hospital admissions.

Intervention. Emphasis of this project was placed on providing comprehensive education for wound and stoma care focused on gastrostomy tubes to providers at the California Association of Nurse Practitioners for the 43rd Annual Educational Conference. However, due to the current covid-19 pandemic the conference was cancelled and the project was implemented with a small group of nurse practitioners at Lucile Packard Children’s Hospital.

Outcome Measures. Outcome measures for evaluation of this project consisted of data collected from pre/post training assessment surveys to evaluate change in provider knowledge and confidence in implementing evidence-based wound and stoma care.

Results. Data analysis revealed an increase in overall provider knowledge with providing wound and stoma care by 25%. Of the participants, 66.67% (4 of 6) considered themselves as experts in gastrostomy tube care, while two participants indicated a proficient level of knowledge on the self-assessment questionnaire prior to the workshop. Significant changes were seen in provider recognition of common mechanical feeding tube complications and methods for treating peristomal hyper granulation tissue with a 33% increase, followed by a 25% increase in identifying risk factors for complications, and 22% improvement pertaining to treatment and causes of minor and major wound complications.

Limitations. Due to competing provider priorities focused on the novel covid-19 pandemic and social distancing considerations, only a small volume of providers were available to participate in the education workshop. Participants indicated that they were either an expert or proficient in gastrostomy tube care, therefore leading to bias.

Conclusions. Despite provider knowledge level pertaining to wound and stoma care, continuing education is an effective approach to enhance clinical skills and knowledge. Written educational materials are helpful tools for both providers and patients, especially in rural areas where access to specialized providers are limited.

Keywords: PEG, feeding tubes, complications, hospital readmission, emergency room visits, wounds, and stoma.

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