Nowadays, from 2002-2004 due to incorrect positioning

Nowadays, more elderly are residing in nursing homes due to the rapid aging population in Singapore and limited resources provided in homes. Hence, to further enhance the quality of care, the increasing number indicates that they require specialised healthcare services. According to Lotus Eldercare (2015), in homes, because the insertion of feeding tubes was done blindly, nursing home residents need to receive appropriate treatment. With the use of advanced medical technology life could be prolonged remarkably (Quadagno & Stahl, 2003). Evidence has shown that residents would likely to experience rapid decline in their health condition if they continue to provide inappropriate or insufficient treatment and medical care (Quadagno & Stahl, 2003).      

Therefore, this essay will discuss the evidence to change practice in nursing home setting with the use of x-ray, the gold standard in confirming NGT placement due to better visualization but has its own consequences (Fan, Tan & Ang, 2017).

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The objective of this essay is to implement the evidence retrieved from research studies regarding the use of x-ray to check NGT placement to change clinical practice in nursing homes. The writer will discuss the barriers that may be faced when implementing the evidence strategies to overcome those barriers.





According to Earley (2005), there were 11 deaths consecutively from 2002-2004 due to incorrect positioning of NGT with the use of blue litmus paper which is said to be inaccurate and redundant therefore adding on to the rise of mortality rate. It has been reported that NGT is dislodged although the external length of the tubing is anchored by the tape itself (Fan, Tan & Ang, 2017). Thus, checking of tube placement via x-rays is the precise and reliable method due to its ability to visualize the course of the NGT (Walsh & Schub 2016).

However, identifying the placement by inexperienced healthcare professionals may lead to serious complications such as lung perforation, pneumothorax and bronchial misplacement (Gachabayov, Kubachev & Neronov, 2016). The key to ensure correct tubing placement is assured by the marking on the tube which is aligned together with the opening of the nostrils.  Thus, this will reduce NGT complications in nursing homes.

The effectiveness of x-ray services in nursing home setting

Unlike acute hospital’s standard protocol, post intubation placements are confirmed through conventional methods such as inflating air, auscultation, aspiration of gastric contents and oral trial with sips of water with oxygen saturation monitoring (Lotus Eldercare, 2015).

Since x-ray examination is by far the reference standard for initial confirmation of all blindly inserted nasogastric tubes (Bourgault et al., 2015) Thus, I would like to implement this evidence to nursing homes.     




The IOWA model will be a suitable one as it focuses on the holistic healthcare system. It facilitates by implementing the evidence change in clinical setting. Furthermore, it consists of a set of methods to guide us through the change process (Brown, 2014).

Firstly, provide a holistic care for the residents involving the healthcare team such as staff nurses, doctors and radiographers regarding this implementation change. Next, gather all the healthcare teams in a multidisciplinary meeting to discuss about the implementation plan regarding the efficacy of x-ray usage in nursing homes. Set clear objectives in mind and cultivate a team dynamic in developing the desired outcome to implement the change. Team need to gain trust and mutual respect from one another so as to work towards the goal to be achieved as a whole (Gesme & Wiseman, 2010).

Secondly, gather all viewpoints among the healthcare team and come to a conclusion of the desired change by providing support to one another as individual efforts in providing input should be seen so that team will have a sense of goal-directed behaviour (Gesme & Wiseman, 2010). Express individual’s thoughts as well regarding the implementation changes considering they could adapt to the new change which may benefit them in the long run or whether they are still used to the current clinical practice.

In view of the change, collaboration of the healthcare team should take place during the change process to increase team’s understanding about the change to enhance the process of decision making (Hughes, 2008). For instance, assign a group of radiographers to a particular hospital ward and conduct an audit session. Purpose of an audit is to enhance the quality of care of patients at present and therefore, make further improvements in patient care. Moreover, it serves as a powerful tool to monitor patient outcomes so as to improve the hospital’s performance in delivering care to the patients (Yorston & Wormald, 2010). Prior to the audit, provide a checklist on areas to improve the ward’s usual practice.

In view of the ongoing process, communication takes place as there are step by step levels to achieve in order for the team have a clearer picture about what is expected and team should voice out their concerns or questions regarding the change process in order for a smooth workflow as a team (Gesme & Wiseman, 2010).

POSSIBLE BARRIERS & how to overcome  

Lack of confidence. Nurses in nursing homes may experience difficulty in adapting to the new intervention as they are used to the current clinical practice. Thus, they might feel unfamiliar with the new change to check for tube placement.

Ways to overcome this barrier is to motivate the nurses to be a proactive team player and communication among team members is important so as to establish a trust relationship. To keep this motivation drive in process hence, one will be motivated to make changes when they realised the importance of it (Pohankova, 2010).

Lack of manpower and resources. Understaffing can be identified as the biggest contributing factors in nursing homes thus the number of resources available at the moment may not be adequate to cater to all patients in homes (Quadagno & Stahl, 2003). For example in this new change, bulky x-ray equipment may be a challenge in terms of space and lack of radiographers is due to the overwhelming number of patients hence, nursing homes could not cater a handful of radiographers as other acute care sectors include polyclinic and general hospitals are in need of radiographers as well (Channel NewsAsia, 2016).

Ways to overcome this barrier is to equipped nurses with sufficient resources to encourage EBP implementation and divide the number of radiographers fairly when assigned to a particular ward.


Patients. By checking the tube placement via x-ray, which is known to be a non-invasive and painless procedure and therefore patient will experience no pain and this aid in their comfort during the x-ray process (U.S. Department of Health and Human Services, 2017).   

Stakeholders (healthcare). In view of the current modern technology nowadays, x-ray imaging is now gaining popularity in the medical community. Thus, there is collaboration within the healthcare team such that the radiographers, mainly the x-ray professionals whom interpret x-ray images will then liaise the findings with the doctors, allowing them to and manage their patients’ diseases safely and accurately. (University of California, 2017).


In conclusion, confirming nasogastric tube placement through x-rays is still considered the efficient method. Due to the increase aging population and the number of residents residing in nursing homes, residents’ quality of care may be neglected through receiving inappropriate and insufficient treatment hence, implementing the use of x-ray and radiographers in nursing home could improve the quality of care thus, minimizing the risks of NGT misplacement.                                                                                                                         


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