Australasian Emergency Nursing Journal (2013) 16, 136—143
Available online at www.sciencedirect.com
ScienceDirect
journal homepage: www.elsevier.com/locate/aenj
RESEARCH PAPER
Nurse initiated reinsertion of nasogastric
tubes in the Emergency Department: A
randomised controlled trial
Crystal Hiu Yan Ho, BSc (Hons), MSc, RN a,∗
Timothy Hudson Rainer, MD a,b
Colin Alexander Graham, MD, MPH a,b
a
b
Trauma & Emergency Center, Accident & Emergency Department, Prince of Wales Hospital, Hong Kong
Accident & Emergency Medicine Academic Unit, Chinese University of Hong Kong, Hong Kong
Received 22 June 2013 ; received in revised form 30 August 2013; accepted 31 August 2013
KEYWORDS
Enteral nutrition;
Emergency service,
hospital;
Emergency nursing;
Nurse practitioner;
Professional
autonomy;
Randomised
controlled trial
Summary
Background: Patients sometimes present to the Emergency Department (ED) for reinsertion of
nasogastric tubes (NGT) because of tube dislodgement. They usually need to wait for a long
time to see a doctor before the NGT can be reinserted. This study aimed at investigating
the feasibility of nurse initiated NGT insertion for these patients in order to improve patient
outcome.
Methods: This is a prospective randomised controlled trial. Patients requiring NGT reinsertion
were randomised to receive treatment by either nurse initiated reinsertion of NGT (NIRNGT)
or the standard NGT insertion protocol. Questionnaires were given to both groups of patients,
relatives and ED nurses afterwards. Outcome measures included door-to-treatment time, total
length of stay (LoS) in the ED and the satisfaction of patients, relatives and nurses.
Results: Twenty-two patients were recruited to the study and randomised: 12 in the standard
NGT insertion protocol and 10 in the NIRNGT protocol. The door-to-treatment time of the
NIRNGT group (mean = 45.6 min) was significantly shorter than the standard NGT insertion group
(mean = 123.08 min; p = 0.003). No statistically significant difference was detected between the
total ED LoS (p = 0.575). Patients, relatives and nurses were generally satisfied with the new
treatment protocol.
Conclusion: Patients can undergo NGT reinsertion significantly faster by adopting a nurse initiated reinsertion of NGT (NIRNGT) protocol.
© 2013 College of Emergency Nursing Australasia Ltd. Published by Elsevier Ltd. All rights
reserved.
∗ Corresponding author at: Trauma & Emergency Center, Accident & Emergency Department, Prince of Wales Hospital, New Territories,
Hong Kong. Tel.: +852 93133012; fax: +852 26324513.
E-mail address: chococrystal@gmail.com (C.H.Y. Ho).
1574-6267/$ — see front matter © 2013 College of Emergency Nursing Australasia Ltd. Published by Elsevier Ltd. All rights reserved.
http://dx.doi.org/10.1016/j.aenj.2013.08.005
Can NG tube reinsertion be faster in the ED?
What is known?
• Patients presenting to Emergency Department for
nasogastric tube reinsertion are commonly seen and
they usually need to wait for a long time to see a
doctor before getting the tube reinserted.
• The long waiting time of nasogastric tube reinsertion in Emergency Department correlates with poor
patient outcomes.
• While nurses initiate nasogastric tube reinsertion
in ward and community settings, the author query
about the possibilities to initiate nasogastric tube
reinsertion in Emergency Department.
What this paper adds?
• Nurses initiated reinsertion of nasogastric tube in
Emergency Department is highly recommended to
put into practice as patient could benefit and autonomy of nurses increased.
• In view of the advocacy of nurse practitioner worldwide, new nursing initiatives are encouraged and
nurses are able to take up the role independently
under the guidance of departmental protocol.
Introduction
Home enteral nutrition is becoming more common1,2 and
nasogastric tubes (NGT) are one of the commonly used
routes for enteral feeding. The most common indications
for home enteral feeding include chronic neurological problems (usually stroke) and cancer.3—5 Despite much evidence
proving the safety of percutaneous endoscopic gastrostomy
(PEG)6 (another type of enteral feeding), many community
dwelling adults with swallowing difficulties still have a NGT
inserted for enteral nutrition. Although there are no local
statistics available to indicate the actual population requiring home enteral feeding, it appears that more patients
are requiring enteral feeding as mortality from stroke and
cancer falls progressively.
Long-term enteral feeding patients are usually taken care
of by community nurses.3 However, sometimes they present
to the Emergency Department (ED) for reinsertion of the
NGT when community nurses are not available, especially
during non-office hours, as feeding is a basic need for the
patient, although a short period of fasting is unlikely to be
life threatening. In Prince of Wales Hospital (PWH), both the
average door-to-treatment time for NGT reinsertion and the
average length of stay in the ED overall are very prolonged,
as these patients are a relatively low priority as they do not
have an immediate threat to life.
Long waiting times not only correlate with patients
dissatisfaction7 and crowding,8 but also cause conflicts
between patients and health care professionals which may
lead to a higher chance of workplace violence.9—12 The
potential risks of acquiring infection in the ED13 and pressure
sore development within hours14 are very relevant for these
patients. Poor patient outcomes,8,10,15,16 increased costs16
and poor ED efficiency8,17 are likely to result.
137
While the responsibility for NGT insertion lies mainly with
nurses18 and nurse initiated care like NGT insertion is done
independently in the ward setting19 and community settings,
it is standard practice in the ED at PWH to wait until the
patient has been seen by a doctor and the order to reinsert the NGT has been given. We wondered whether nurse
initiated reinsertion of the NGT (NIRNGT) in the ED would
be feasible to improve the effectiveness of our service and
improve patient care for this vulnerable group. The independent role of nursing care has been shown to be effective
as demonstrated by the increasing trend of nurse practitioners in emergency care settings20 and the positive outcomes
of reductions in waiting time and length of stay in the ED.21
Review of NGT insertion procedure
A nasogastric tube is a tube inserted through the nose
into stomach. All registered nurses are trained to perform
this procedure independently. The placement of the NGT is
firstly checked by testing gastric aspirate with pH indicator strips.18,19,22 Radiography is used to confirm the position
whenever there is any doubt.18,23 In the ED of Prince of Wales
Hospital, doctors will order NGT insertion and/or subsequent
X-ray in writing after seeing the patient. Nurses will then
insert the NGT with a placement check. The aim of this study
was to investigate the possibility of shortening the waiting
time to improve the effectiveness of the ED service by trialling nurse initiated reinsertion of nasogastric tubes (NGT)
for long-term enteral feeding patients presenting to the ED.
Methods
Design
The study was a prospective randomised controlled clinical
trial comparing the effectiveness and waiting time of nurse
initiated reinsertion of NGT (NIRNGT) and traditional doctor
prescribed reinsertion of NGT in patients presenting to the
ED. A flowchart of the study designed is presented in Fig. 1.
Setting
This study was conducted in the Emergency Department of
Prince of Wales Hospital (PWH) in Shatin. It is a 1400-bed
university teaching hospital in the New Territories of Hong
Kong and is the regional trauma centre. The ED serves a
population of approximately 1.5 million and has an annual
census of about 150,000 new patients, with 30% admission
rate. There are approximately 6—8 patients visiting the ED
per month requiring reinsertion of NG tube because of tube
dislodgement.
Patients
All patients older than 18 years old presenting to the ED
with dislodgement of NGT requesting reinsertion or requiring a tube placement check during designated periods from 1
October 2009 to 28 February 2010 were considered for study
enrolment. Patients with acute variceal bleeding or basal
skull fracture19,24 within one week were excluded. Patients
138
C.H.Y. Ho et al.
Figure 1
Flowchart of the study design.
with oesophageal carcinoma or nasopharyngeal carcinoma,
patients with vomiting, fever, tachypnea or other signs of
pulmonary complication of NGT feeding, and patients in
an unstable clinical condition were also excluded. Patients
requiring Entriflex® reinsertion were excluded as Entriflex®
is not routinely inserted by nurses in Hong Kong. Entriflex®
is a small-bore feeding tube with a metal stylet to facilitate
passage. During insertion, if the tube is blindly advanced to
the airway or the lung, the stylet provides enough rigidity to
perforate the lung and cause pneumothorax.22 In addition,
a single patient will be included once.
Randomisation
Patients were allocated with a random-number generated by computer. The random allocation sequence was
implemented with numbered sealed envelopes so that the
sequence was concealed until interventions were assigned.
The triage nurse would obtain written informed consent
before randomisation. All recruited patients would receive
treatment by either nurse initiated reinsertion of NGT
(NIRNGT) protocol (intervention group) or standard NGT
insertion protocol (control group). It was not possible to
blind the patients or the nurses who carried out the intervention. However, we did try to perform single blinding as
data entry was completed by the principal investigator who
was not involved in the clinical interventions.
Interventions
In the intervention group (NIRNGT protocol), the nurse
would reinsert the NGT before the patient was seen by the
medical officer. Placement was confirmed by aspiration of
gastric content with pH ≤ 5.18 The nurse would initiate a
check chest X-ray for the patient whenever placement was
in doubt. The patient then awaited the medical officer’s
assessment for discharge. In the control group (standard NGT
insertion protocol), the patient would be in the standard
queue for the medical officer’s assessment. The ED nurse
would then reinsert the NGT after medical officer’s written
Can NG tube reinsertion be faster in the ED?
prescription. The patient then waited for the medical officer’s reassessment before discharge. A short questionnaire
was completed by patients and relatives after reinsertion
of the NGT in both groups. Another short questionnaire was
distributed to the ED nurses at the conclusion of the study.
139
Ethical considerations
Ethical approval was obtained from the joint university and
local institutional ethical committee. Informed written consent was obtained from each patient or his/her relative (see
below) before voluntary participation.
Training of nurses
Prior consent
As every nurse in ED performs NGT insertions and more than
half of the eligible patients visit the ED out-of-office-hours,
including weekends and midnights, investigators included all
ED nurses on duty. In order to standardise the procedure, a
leaflet was distributed to all nurses as a treatment guideline.
With the support of Emergency Department senior staff, a
few briefing sessions were arranged to inform the nurses
about the flow of the study and the NGT insertion procedure. By having nurses as investigators instead of having
small number of investigators, the generalisability of the
study was increased.
Sample size calculation
The current mean door-to-treatment time of standard NGT
reinsertion protocol was calculated by retrieving the previous 6 months’ data; it was 120 min. We assumed NIRNGT
could shorten door-to-treatment time by half. Using an
effect size of 60 min (half of the current waiting time for NGT
reinsertion), we used an online tool (http://department.
obg.cuhk.edu.hk/researchsupport/Sample size CompMean
Independent.asp) to derive the sample size for this study.
Based on the anticipated difference in means between two
groups of 60 min and an anticipated standard deviation of
45 min, with a ratio of 1:1 between the two groups, the estimated sample size was 10 in each group in order to detect a
significant difference with an alpha error of 0.05 and power
of 80%. In view of the possibility that some patients may
not agree to enter the study and others may withdraw, we
aimed to recruit an extra 30%, i.e. 13 patients per group.
Data collection and outcomes
The principal investigator reviewed the ED records after
NGT reinsertion. Data collected included patient characteristics, time of registration, time of NGT insertion and
time of ED departure. The primary outcome was the doorto-treatment time of each patient (i.e. waiting time for
treatment) of each patient. The secondary outcomes were
the total LoS, patients’/relatives’ satisfaction and nurses’
satisfaction (Questionnaires were shown in appendices 1 and
2). The endpoint of the study was patient discharge from the
ED. We used total LoS as a secondary outcome because from
the patients’ perspective, the time staying in ED after treatment was regarded as ‘waiting time’ and the total time in
the ED is a critical variable.
Definitions:
1. Door-to-treatment time: from the time of registration to
the time of successful NGT insertion.
2. Total LoS: from the time of registration to the time of
leaving the ED.
Most of the patients requiring long term enteral feeding live
in local homes for the elderly. When dislodgement of an NGT
occurs, they usually present to the ED with an ‘old age home’
(OAH) staff member who cannot sign the consent form. With
the help of the Shatin Community Geriatric Assessment Team
(CGAT), the principal investigator visited 19 private OAHs in
Shatin. The study was explained to the managers of these
homes. The consent forms together with a letter explaining
the study were given to the relatives who had family members requiring NGT feeding by the OAH staff on behalf of the
principal investigator. The contact number of the principal
investigator was printed on the consent form so that the
relatives could ask for further explanation if they had any
enquiries. Whenever a patient needed to visit the ED for
NGT reinsertion, OAH staff would bring the signed consent
form to the ED.
Data analysis
Data were analysed using SPSS version 17.0 (SPSS Inc.,
Chicago, IL, USA). P < 0.05 was considered as statistically significant. As the time data did not conform to
a Gaussian distribution, non-parametric tests were used.
Door-to-treatment time and total LoS were analysed using
the Mann—Whitney U test. Demographic data were summarised using means or presented in percentage.
Results
During the study period, 26 patients presented to the ED
requiring NG tube reinsertion, of whom one was excluded
because of a past history of nasopharyngeal carcinoma. The
remaining 25 patients were randomised; three were later
excluded because they had entered the study twice. Twelve
patients were randomised into the control group (standard
NGT reinsertion protocol) and 10 patients were randomised
into the intervention group (NIRNGT) (CONSORT diagram,
Fig. 2). No patients withdrew from the study. All patients
were discharged home and there were no immediate complications in either group.
Of the 22 recruited patients, 12 were female and 10
were male with a mean age of 81.7 years. The mean age
of the control group and intervention group were 82.8 and
81.5 years respectively. Twelve patients (54.5%) were OAH
residents and 10 (45.5%) were living at home.
The median door-to-treatment time of the intervention group was 32.5 min (25th percentile 23.8 min, 75th
percentile 67.5 min and interquartile range [IQR] 44 min).
The median door-to-treatment time of the control group
was 111 min (25th percentile 55.8 min, 75th percentile
177.8 min and IQR 122 min) (Fig. 3). There was a significant
140
C.H.Y. Ho et al.
Figure 2 CONSORT diagram of the study. One subject was excluded before randomisation because of past history of nasopharyngeal
carcinoma. Three subjects were excluded after randomisation because of entering the study twice.
difference (p = 0.003) between the door-to-treatment
times of two groups. The majority of patients in the
intervention group (n = 7, 70%) received treatment (nurse
initiated reinsertion of NGT) within 20—45 min after registration, with five patients (50%) receiving treatment
within 30 min. The remaining three patients (30%) in the
intervention group received treatment within 60—100 min
(Fig. 4).
On the other hand, most patients in the control group
(n = 9, 75%) received treatment within 50—150 min after registration. Two patients (17%) in the control group received
treatment within 200 min and one patient who came on a
Sunday received treatment within 35 min.
However, there was no significant difference (p = 0.575)
between the total LoS of the two groups. The median
total LoS of the intervention group and control group were
173.5 min and 174 min respectively, with IQR of 953 min
(25th percentile 143 min; 75th percentile 1095.8 min) and
569 min (25th percentile 108 min; 75th percentile 677 min).
The longest total LoS in the intervention group was 1317 min
(22 h) and 979 min (16 h) in the control group. Of the 22
patients, six had a total LoS of more than 720 min (12 h)
and five of them were OAH residents.
Figure 3
groups.
Questionnaires were given to all patients and relatives (n = 22); 12 questionnaires were collected afterwards
(response rate 54.5%). Of the 12 respondents, half of them
had visited the ED for NGT reinsertion more than once. All
of them (n = 12) wanted the service of nurse initiated reinsertion of NG tube (NIRNGT). Of these 12 participants who
wanted the service of NIRNGT, 3 of them preferred to see
a doctor before NG tube reinsertion at the same time. The
remaining 9 respondents did not express a preference to see
a doctor before treatment. All respondents (n = 11, 1 participant did not answer this question) thought that NIRNGT
could shorten waiting times.
Forty questionnaires were given to ED nurses and 30 were
collected (response rate 75%). The 30 nurses were divided
into 3 subgroups: 22 were registered nurses (RN), 5 were
nursing officers (NO) and 3 were advanced practice nurses
(APN). Average years of clinical experience were 12.8 years,
and average years of clinical experience of the 3 subgroups
(APN, NO and RN) were 18.3 years, 24.6 years and 9.4 years
respectively.
Overall, the nurses were comfortable in performing
NIRNGT (26 out of 30 strongly agree or agree). Three participants (3 RN) did not agree that they were comfortable to
Box plot showing door-to-treatment time of both
Figure 4
Box plot showing total LoS of both groups.
Can NG tube reinsertion be faster in the ED?
give the treatment before medical officer’s assessment and 1
participant was neutral. Seven nurses (2 APN, 5 RN) strongly
agreed and 19 nurses (5 NO, 1 APN, 13 RN) agreed (87%,
n = 26) that they were comfortable to carry out this procedure, while 1 RN was neutral. Twenty-eight participants
(93%) strongly agreed or agreed (1 did not answer and 1 neutral) that NIRNGT could increase the autonomy of nurses and
all nurses believed that NIRNGT could shorten waiting times
for the patients.
Discussion
This is the first prospective clinical randomised controlled
study evaluating the effectiveness of a nurse initiated procedure for patients who visit the ED requiring reinsertion of
NGT in Hong Kong. Our results revealed that the door-totreatment time in the NIRNGT protocol was much shorter
than traditional NGT insertion protocol, i.e. patients could
get NG tube reinserted faster in NIRNGT protocol. However,
both groups stayed equally long in the ED as there was no
significant difference in total LoS.
In the NIRNGT protocol, the mean door-to-treatment
time was 45.6 min and the mean total LoS was 472.6 min.
The waiting time for the Non Emergency Ambulance Transport Service (NEATS) accounted for the long total LoS in
both groups. Six patients went home using NEATS, and five
of these patients had a total LoS of more than 12 h. Three
patients who were in the NIRNGT protocol had a door-totreatment time within 30 min but a total LoS more than
1000 min (>16 h) because of the wait for the NEATS service.
Patients who were waiting for the NEATS service for transport to their homes often needed to wait overnight as they
usually came during the ‘out-of-office hour’ period, and the
NEATS service was unavailable. Although they were usually
relatively clinically stable, having to care for these patients
in the ED increases the workload of the health care professionals. Bedside care and basic needs like vital signs
monitoring, NG tube feeding and napkin changing are usually
provided. It represents a further burden on the busy ED in
addition to the large number of attendances, resuscitations
and access block patients.
To avoid patients waiting in the ED overnight for NEATS,
the NEATS service hours could be extended. In our study, 11
patients (50%) registered from 1630 h to 1900 h; if the NEATS
service hours were extended to 2100 h, all these patients
could be discharged if the NIRNGT protocol was followed.
Written information could be given to the OAHs advising
them not to bring these patients to the ED during out-ofoffice hours unless they can manage to transfer them back
after treatment.
In our study, there were patients with a total LoS of
>1000 min a prolonged wait for NEATS to get back home;
these three cases were all in the intervention group. This
may account for the lack of significance in the difference
in total LoS between the intervention group and control
group. A very significant difference was detected (p = 0.003)
in the door-to-treatment time between the two groups. It is
well known that waiting times in all Emergency Departments
have been rising for many years.25,26 The long waiting time
not only impedes individual access to ED care,27 but also
leads to negative outcomes. Poor patient outcomes, patients
141
dissatisfaction, crowding, conflicts between patients and
health care professionals, higher chances of workplace violence, increased costs and poor professional ED efficacy are
caused.7—17 On the contrary, a short waiting time to have
treatment is a great benefit for patients because nutrition
can be resumed as quickly as possible. From a nursing perspective, maintaining a patient’s hydration and nutrition
is our concern and responsibility. Therefore, the authors
believe that nurse initiated reinsertion of NG tubes should
become routine clinical practice. This is also supported by
patients, relatives and nurses on the basis of the questionnaire done in the study.
In Hong Kong, nurses do not usually do extended procedures independently. This new initiative of treatment
by nurses also parallels the increasing worldwide trend
of introducing nurse practitioners to emergency care
settings.20,25,28 Because of the increasing demand, workload
and working hours of medical residents,29 nurse practitioners are not only rising in number,25 but also expanding
and becoming more and more important in the healthcare
system.28 The role and function of nursing has ushered in
a new era,30,31 and it is now recognised that the nurse is
a knowledgeable professional and appropriately skilled to
perform many roles that were traditionally performed by
doctors.30
In our questionnaire of nurses’ satisfaction, 87% of the
ED nurses felt comfortable to carry out the procedure
before medical officer’s assessment and 93% of the nurses
strongly agreed or agreed that this initiative of treatment
could increase autonomy. Autonomy is a vital ingredient for professionalism and an essential element for full
recognition.32 It also plays a fundamental role for emergency nurse practitioners (ENP).28 Autonomy in practice
has a positive relationship between nurses’ job satisfaction, working environment, nurse retention and quality of
care.28,33
Feedback from patients and relatives also provided support for this nurse treatment initiative. All participants
stated they would like to receive nurse initiated care and
all of them believed that waiting times could be shortened.
Not only is the nursing perspective changing, the patient’s
perspective is changing too. Patients are accepting nurse
initiated care and nurse practitioners more than expected.
A study carried out in this ED in 200734 showed that many
(59.3%) younger patients (<65 years old) would rather choose
an ENP for treatment if the waiting time for a medical officer’s consultation was longer. A similar study from the US
showed that the majority (65%) of patients were willing to
be seen by an ENP.29 Patients were even more satisfied with
the treatment provided by ENPs than with that from junior
doctors.25
Although we believe that NIRNGT is worth implementing,
70% of ED nurses thought that difficulties exist because of
external factors. The very busy environment may be one
of the reasons contributing to the hesitation of the nurses.
However, any new initiative in clinical practice is challenging as people are generally fearful of change. According to
the three-stage unfreezing, moving and freezing model of
change theorised by Lewin,35 some external forces might
be needed for these steps. Encouragement from managers
and senior staff, group discussions and continuous evaluation
may facilitate the change process. The nursing role could
142
then evolve and the effectiveness of the service could be
improved.
C.H.Y. Ho et al.
public, commercial, or not-for-profit sectors. This paper was
not commissioned.
Study limitations
Acknowledgements
One limitation of this study was the small sample size, with
only 22 subjects recruited in the study. There is no similar
study in the literature available for reference. The comparatively small sample size was due to the limited data
collection time. It is possible that some eligible subjects
may have been missed because of external factors like the
busy ED environment or the non-availability of a written
consent form. However, the small sample size can be justified by its ability to detect a significant difference in the
study. Also, the cognitive state of the patient may affect
the outcome as the insertion procedure might be easier for
co-operative patients. In addition, the study was conducted
in a single centre, which may limit the generalisability of
the results. Our questionnaires had not been validated prior
to use, which is not ideal, but we believe they have face
validity. The response rates for the relative’s questionnaire
could have been better but the low response rate probably reflects the reality of long patient waiting times and the
desire to leave the ED as soon as treatment is complete and
transport is available.
Conclusion
This study demonstrated a shorter waiting time for patients
receiving treatment by nurse initiated reinsertion of NGT.
Although the total time for the patient stay in the ED was the
same for both the nurse initiated treatment protocol or traditional NG tube reinsertion protocol, this new initiative was
still worthwhile putting into practice. It was supported by
the patients/relatives and nurse satisfaction questionnaire,
and the increasing scope of practice of emergency nurses.
The quality of care, effectiveness of clinical services and the
autonomy of the nurse could be improved by this initiative.
Future research on a larger scale in Hong Kong and in other
countries could confirm our findings and encourage other
emergency providers to set up similar services to improve
patient care.
We thank Mr. Stones Wong, Departmental Operational Manager, Miss. Celestina Luk and Miss. Chan Yee Ming, Ward
Managers of the Emergency Department at the Prince of
Wales Hospital for their full support to carry out the study.
We also thank the nursing staff of the Emergency Department at Prince of Wales Hospital for their great help as
investigators and for data collection despite the very busy
working environment. We thank the Shatin Community Geriatric Assessment Team (CGAT) for their help in obtaining
prior consent. We also thank Miss. Josephine Chung, Nurse
Consultant in the Emergency Department at Prince of Wales
Hospital for her help and valuable opinion for the study.
Appendix 1. Short questionnaire on
patient’s/relative’s satisfaction
Questionnaire on patient’s/relative’s satisfaction of nurse
initiating reinsertion of NGT in the Emergency Department.
Date:
Please circle either ‘‘Yes’’ or ‘‘No’’ for each question.
1. Is this your first time coming/accompanying someone to
the Emergency Department with dislodged NG tube?
Yes
No
2. Do you want a service of nurse initiating reinsertion of
NG tube in the Emergency Department before a doctor’s
assessment?
Yes
No
3. Do you prefer a doctor’s assessment before reinsertion
of NG tube?
Yes
No
4. Do you think that the waiting time will be shortened if
nurses reinsert NG tube before doctor’s assessment?
Human research ethics approval
Ethical approval was obtained from the joint university and
local institutional ethical committee (Joint Chinese University of Hong Kong — New Territories East Cluster Clinical
Research Ethics Committee) CRE-2009.295-T.
Yes
No
Appendix 2. Short questionnaire on nurses’
satisfaction
Funding
This study received no specific grant from any funding
agency in the public, commercial, or not-for-profit sectors.
Provenance and conflicts of interest
We are unaware of any conflict of interest, and the study
received no specific grant from any funding agency in the
Questionnaire on nurses’ feedback of nurse initiating reinsertion of NGT in the Emergency Department.
Date:
Rank:
Year of clinical experience:
√
Please put a ‘‘ ’’ in the appropriate box below.
SA = Strongly agree
D = Disagree
A = Agree
SD = Strongly disagree
N = Neutral
Can NG tube reinsertion be faster in the ED?
1.
2.
3.
4.
143
I am comfortable to carry out the procedure (reinsertion of NG
tube) before medical officer’s assessment.
I think this procedure (nurse initiating reinsertion of NG tube)
increases the autonomy of nurses.
I think this procedure can help patient in terms of waiting
time and quality of nursing care.
I think difficulties exist for nurse initiating reinsertion of NG
tube because of the external factors, e.g. the busy
environment.
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