Nasogastric tube feeding under restraint: practical guidance for children’s nurses

Abstract

SINCE THE start of the coronavirus disease 2019 (COVID-19) pandemic, children's wards in the UK have seen a significant increase in the number of admissions of children and young people with an eating disorder (Broomfield et al 2021, Solmi et al 2021, Hudson et al 2022. A small number of these patients will be so severely malnourished that they will need to be fed via a nasogastric tube without their consent. Children's nurses working on hospital wards may therefore care for children and young people who need to receive nasogastric tube feeding under physical restraint, a distressing but potentially lifesaving intervention. This article explains the physical and psychological effects of eating disorders and provides practical guidance on nasogastric tube feeding under restraint. For convenience, the article uses the term 'young people', but children can also develop eating disorders and the article applies equally to them. Eating disorders Definition, types and risk factorsEating disorders are serious mental health conditions that are driven by an overevaluation of one's body weight and body shape and characterised by abnormal eating patterns -either strict control or lack of control of eating (American Psychiatric Association (APA) 2013). There are various types of eating disorder (Box 1), one of which is anorexia nervosa. An individual with this condition has an intense fear of gaining weight and severely restricts their food intake, which often leads to severe malnutrition (APA 2013).Research has suggested that in the UK the incidence of anorexia nervosa peaks at the Citation Fuller SJ, Thomson S, Tan J (2022) Nasogastric tube feeding under restraint: practical guidance for children's nurses. Nursing Children and Young People.

Decision-making and best practice when nasogastric tube feeding under restraint: multi-informant qualitative study

“…and J.T.) using specific examples; (4) manual coding of transcripts; (5) triangulation between different types of participant; (6) validation within the steering group.…”

“…To date there is little research regarding how to implement this intervention, although there is guidance regarding dietetic aspects, 2,3 the ethical and legal principles of NGT feeding under restraint on paediatric wards 4 and how to modify children's nursing practice. 5 There is also research into the patient and parent experience of this intervention 6 and a qualitative paper exploring the experience of nursing assistants built on this work. 7 This study is part of a larger programme of work exploring participants' experiences of NGT feeding under restraint, which includes a cross-sectional survey across England regarding the prevalence of the intervention and the characteristics of patients requiring it in in-patient mental health settings.…”

“…To date there is little research regarding how to implement this intervention, although there is guidance regarding dietetic aspects, 2 , 3 the ethical and legal principles of NGT feeding under restraint on paediatric wards 4 and how to modify children's nursing practice. 5 There is also research into the patient and parent experience of this intervention 6 and a qualitative paper exploring the experience of nursing assistants built on this work. 7 …”

Nasogastric tube feeding under physical restraint of children and young people with mental disorders: a comprehensive audit and case series across paediatric wards in England

“…If oral nutritional rehabilitation is unsuccessful and there is medical compromise, a treating team may consider passing a nasogastric tube (NGT) 5 6. Research suggests that supportive NGT feeding not only improves nutritional intake and promotes weight restoration but can also reduce drive for thinness and body dissatisfaction 7.…”

The importance of individualised care, good communication and trust for reducing nasogastric tube feeding under physical restraint: qualitative multi-informant study

“… 7 However, there is some practical guidance on how to amend traditional dietetic practice to ensure that when this intervention is needed, it is delivered as quickly and safely as possible, 8 , 9 and on clinical practice when this intervention is required on paediatric wards. 10 , 11 To further complicate a complex issue, there is some suggestion that coexisting conditions such as autism and emerging personality issues may increase duration of NGT feeding under restraint, with greater difficulty in re-establishing normal eating. 12 There is variation across eating disorder in-patient units in the UK regarding policies of when to initiate NGT under restraint, and how and when to discontinue it, with some units not delivering this intervention at all whereas others have patients receiving the intervention for over a year.…”