Nasogastric Tube InsertionAimsThe goals of the lesson are:1. to provide students with knowledge of the correct procedures for safe insertion of the NG tube2. to demonstrate to students the uses and benefits of the NG tube3.
to give students an understanding of the risks associated with this procedure and4. to dispel any myths about the NG tube insertion procedure.Learning objectivesStudents will be able to:Highlight at least three (3) indications and one (1) contraindication for using the NG tube.List all the equipment needed when performing a NG tube insertion.
Correctly arrange steps in preparing for and performing the procedure in order.Describe each step in detail.Outline and discuss precautions that must be taken to ensure proper and safe NG tube is insertion.Describe the correct position of the NG tube relative to the internal anatomyDiscuss possible complications associated with the NG tube.
Prepare a checklist for use during a NG tube insertion procedure.Discuss two advantages and two disadvantages to the use of the NG tube.Correctly demonstrate the safe insertion of a NG tube.Teaching strategiesPowerPoint® assisted lecture.
small-group discussionsone-minute paperquestion and answervisual demonstrationProcedure1. Teacher introduces lesson and objectives2. PowerPoint ® presentation interspersed with questions directed to individuals or entire class.3.
At the end of presentation each student asked to write a one-minute paper containing three points reflecting on the presentation and one question.4. Five students with varying reflective points and questions volunteer to present their paper to entire class.5.
Teacher demonstrates procedure for entire class and students observe.6. Students placed in pairs and instructed to create a checklist with precise steps and procedures to be used during an actual procedure (Teacher rotates between pairs clarifying any issues). The checklists are interchanged and peer-reviewed.
7. Each pair then takes turn performing procedure. One member orally narrates the procedure as it occurs for the rest of the class (e.g now she is putting on non-sterile gloves; now he is examining the nostrils for obstructions etc).
Outcome criteriaStudents will demonstrate knowledge of the performance procedures, risks and precautions related to the insertion of a NG tube by producing a one-minute reflective paper, actively participating in group discussions, verbally articulating their views, formulating reflective questions and comments, collaborating in the creation of a detailed explanatory checklist/guide on how to perform the procedure and in carrying out a demonstration of the procedure. Evaluation of teachingIn groups students will successfully complete a procedural checklist/guide and then demonstrate the procedure following the checklist meeting the following criteria:A. Note made of all material needed for the procedure.B.
Procedure for preparing the environment and the patient for the NG tube insertion described and performed satisfactorily.C. Each step for NG tube insertion outlined and followed, in PRECISE order, and with correct technique.D.
All necessary checks and appropriate precautions required during and at the end of the procedure are made and reasonable justification given for why such precautions were necessary.E. Detail made of two scenarios that may be presented (e.g.
ph above 6) and alternate steps or procedures that should be followed. RationaleThe teaching plan for the delivery of the topic ‘Nasogastric tube insertion’ functions on the basis of a combination of learning theories as well as incorporating best-practice teaching strategies and assessment and evaluation procedures. As noted by Stanberry and Azria-Evans (2001) teaching strategies, educational goals, content, learning styles and learning environment must all be considered in design learning programs in order for those programs to be effective and to adequate meet the needs of the learners as well as serve the purpose of the facilitators. The approach taken in this teaching plan subscribes to this philosophy.
Due consideration is taken, first and foremost, of the learners to whom the instructional content is delivered. Several theorists have posited that learners in any setting are at different developmental stages and have different ways of learning and these impact the effectiveness of learning. Piaget places learners into four developmental stages based on age and maturity. Newborns up to age two are in the sensorimotor stage where learning takes places via their innate senses and motor skills.
Children two to seven years are in the pre-operational stage where they are able to mentally represent objects within their environment. From age seven to eleven, children are now at the concrete operational stage and can therefore perform logical reasoning. At formal operational stage, children from eleven years up to adulthood are able to perform more abstract and logical reasoning (Slavin 33-38). Despite the age stratification not everyone goes through the stages at the same time or the same rate but definitely in the same order.
Benjamin Bloom’s taxonomy of instructional objectives reflects this hierarchical view of cognitive development where intelligence progresses from knowledge abilities to comprehension, application, analysis, synthesis and evaluation. Maturity, as facilitated by aging, facilitates the development of these cognitive skills.In a similar vein Honey and Mumford propose that each individual has one of four learning styles. Activists learn by being actively involved in new experiences getting bored easily, reflectors learn primarily through observing events from different perspectives, theorists tend to analyze experiences and come to decided conclusions on their meaning and relevance and pragmatists are experimental, usually preferring to learn through problem solving (Mumford & Honey).
More recently Howard Gardner presented a theory in 1983 that there at least seven types of intelligences and he lists these as being linguistic, logical-mathematical, spatial, bodily-kinesthetic, musical, interpersonal and intrapersonal (Klein 1997). An eighth, naturalist, was later added to the list. The first is able to master language, the second can utilize logical processes of thought, the third is able to construct excellent mental images, the fourth can manipulate their bodies skillfully, the fifth has an excellent perception of and ability to manipulate and create sounds and the symbols associated with them, the fifth is able to gauge other people’s emotions and feelings, the sixth is able to understand his internal feelings and emotions and the sixth has an understanding and care for aspects of nature (Nolen 2003).The teaching plan draws on all these theories of learning.
The target group is a set of students undertaking their Masters degree and they are therefore developmentally advanced and can perform thought processes at the higher scales of the cognitive domain. The learning objectives sample all cognitive domain levels much more emphasis is placed on higher order thinking because of the maturity of the learners. The one-minute writing task targets comprehension while creating the checklist requires application, analysis and synthesis.The method of presentation is quite differentiated so as to address the various learning styles and intelligences that may present among the learners.
The PowerPoint® presentation contains both text and photographs and will be used in conjunction with an oral lecture. This multimodality caters for Honey and Mumford’s learning styles. The teacher demonstration, individual presentations and the pair creative and performance task meet the needs of several learners of different intelligences including the interpersonal, intrapersonal, bodily-kinesthetic, linguistic spatial and logical-mathematician.The main concerns in creating an effective learning environment are not necessarily material, in terms of seating arrangement and other such concerns.
Adult learners are often very easily adaptable to a variety of settings once those arrangements are comfortable. Amerson advises that effective learning environments are created by actively engaging learners in the learning process. She recommends that classroom activities be designed based on the several intelligences so as to provide an interactive learning environment.Within this teaching plan learners are permitted to interact actively with the lesson by being involved in meaningful activities that cater to their different intelligences.
Intrapersonal learners, for example, may feel more comfortable with the individual one-minute reflections, interpersonal learners may feel at ease working in the groups while the spatial learners may be better able to conceptualize the NG tube insertion procedure when it is being described and the bodily-kinesthetic would benefit more from actually performing the procedure. The classroom environment thus caters for the needs of all learners ensuring that they are cognitively engaged through the delivery.The content of this lesson is specifically chosen because of its interest to the learners. Nasogastric tube insertions have had a bad reputation on the parts of clinicians and patients.
The press has reported instances of injury or death caused by incorrect insertions. Knowledge of the uses, indications and contraindications, and correct procedures to follow during the insertion is therefore essential. The content is pitched at the level that the learners are able to understand. Additionally the PowerPoint presentation gives the material visual appeal as most modern learners seem to prefer multimedia presentations as opposed to chalk and talk lectures (Rice, Filak and Short).
Students are able to interact with the information at the individual, small group and whole class levels thus aiding comprehension and retention.The teaching strategies used to deliver the content therefore take into consideration the needs of the learners as it pertains to style and interest. Consideration is also given to methods that are conducive to an engaging, vibrant and energized learning environment. Lectures are well suited to mature learners as they have larger attention and retention spans than younger children.
The session therefore takes the form of a type of lecture. According to Stanberry and Azuria-Evans lectures are transmission modes of learning and are suitable for passing on facts, essential knowledge and skills. The procedures for inserting the NG tube are very specific and needed to be adhered to strictly. It is therefore necessary that exact information is passed on accurately and therefore a lecturing modality is optimal to achieve this.
Bearing in mind, however, the diverse needs of the learners, the lecture method is used in conjunction with other methods. Question and answers sessions, peer discussions, individual reflection and a physical demonstration are all used to diversify the learning environment to accommodate the diverse group of learners.Evaluation procedures also follow logically from all these elements. Since learning is facilitated in a way that allows learners to actively interact and participate, evaluation procedures also adopt this perspective.
Informally during the lecture the presenter faces the students and estimate any instance of confusion or querying while material is being presented and use this as a guide for clarifying, expanding or rephrasing points. Subsequently students’ initial reflections on the content are assessed to determine how well material was grasped. At this stage it is easy to review information to ensure accuracy as this is a major objective. Later oversight of pair discussions should give some information as to how well students are analyzing, synthesizing and applying the information.
The more formal assessments are the checklists/guidelines produced by the group. Each student would have been observed to participate in creating the guidelines under the supervision of the facilitator thus the guidelines will reflect what each member understands individually.Performance assessment is also integral to this lesson and is the primary means of assessment. Students demonstrate understanding of the procedure by applying the necessary techniques.
Even though only one of each pair will be physically performing the insertion, the partner still demonstrates the same skill by narrating for the observers each step that the performer takes. As noted by Slavin, performance assessments are useful for assessing learning objectives requiring students to apply their knowledge and skills as they perform something.Overall evaluation of the entire learning session takes the form of peer reviews where individuals make comments on each other’s procedure commending good technique and highlighting errors or oversights. Presenter also makes appropriate general comments on the group’s performance of the procedure making any further clarifications.
Finally the guest students will complete a feedback evaluation of the lesson.As a result of all these considerations the overall goals of the lesson would be achieved. Learners are provided with optimal opportunity, given their learning preferences, the learning environment and the content as delivered by the teaching method, to demonstrate competence in the insertion of the NG tube, understand of its usefulness, risks and disadvantages, and reflect on their own performance.ReferencesAmerson, Roxanne.
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Filak and, James Short. “Does a High Tech (Computerized, Animated, Powerpoint) Presentation Increase Retention of Material Compared to a Low Tech (Black on Clear Overheads) Presentation?” Teaching and Learning in Medicine 17.2 (2005): 107-111.Slavin, Robert.
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