The Nursing Assistant's Scope of Practice
Caring for a person with a feeding tube, also known as enteral nutrition, requires a team effort, with each member of the healthcare staff having a distinct role. A Certified Nursing Assistant (CNA) or nursing assistant (NA) provides direct care under the supervision of a licensed nurse, such as a Registered Nurse (RN) or Licensed Practical Nurse (LPN). It is critical to understand that while an NA's tasks are vital, they differ significantly from those of licensed personnel. The NA's role is to perform supportive duties, while the licensed nurse is responsible for clinical assessments, administering medications and formula, and overall care planning.
Core Responsibilities of the Nursing Assistant
When assisting a patient with a feeding tube, an NA’s duties are focused on providing comfort, ensuring safety, and assisting the licensed nurse. These responsibilities are paramount for the patient's well-being and preventing serious complications.
Patient Positioning
One of the most important responsibilities for an NA is proper patient positioning during and after feeding. This is a key safety measure to prevent aspiration, which is when stomach contents enter the lungs.
- Before a feeding, elevate the head of the bed to at least 30-45 degrees, or as directed by the nurse.
- Keep the patient's head elevated for 30-60 minutes after the feeding is complete to help with digestion.
- Ensure the patient is comfortable and supported with pillows if necessary.
Monitoring and Observation
NAs are the first line of observation for changes in a patient's condition. Their reports are essential for the licensed nurse to provide timely interventions. NAs should be diligent in observing and immediately reporting the following issues:
- Patient Distress: Signs of discomfort, pain, nausea, or vomiting during or after feeding.
- Tube Issues: The tube is kinked, dislodged, or appears to be leaking.
- Tube Site Condition: Redness, swelling, warmth, pain, or unusual discharge around the tube insertion site.
- Abdominal Symptoms: Distension or complaints of cramping, which can indicate poor tolerance of the feeding.
- Respiratory Changes: Difficulty breathing, coughing, or other signs of potential aspiration.
Oral and Nasal Care
Patients with feeding tubes often do not eat or drink by mouth, making meticulous oral and nasal care crucial for comfort and hygiene.
- Provide regular oral care, including brushing teeth, cleaning the tongue, and moisturizing lips.
- Perform nasal care for patients with nasogastric tubes, which includes gently cleaning the area and ensuring the tube is not causing pressure on the nostril.
Assisting with Site Care
Under the direction and supervision of a licensed nurse, the NA may assist with keeping the skin around the tube site clean and dry. They must strictly follow the facility's procedures for this task.
- Gently clean the site with warm, soapy water or saline as directed.
- Pat the area dry completely with a clean towel.
- Change dressings if instructed and observe the site for any changes to report to the nurse.
Documentation
Accurate and timely documentation is a key part of the NA’s role. Following facility policy, they may be responsible for recording information related to the feeding tube.
- Logging feeding intake and duration if applicable.
- Recording the patient's tolerance of the feeding.
- Documenting any issues or observations reported to the licensed nurse.
Comparison of Nursing Roles in Feeding Tube Care
| Task | Nursing Assistant (NA) | Licensed Nurse (RN/LPN) |
|---|---|---|
| Inserting/Removing Tube | Absolutely NOT allowed. This is a licensed medical procedure. | Inserts and removes the tube, confirms placement via proper methods (e.g., pH test, X-ray verification). |
| Administering Feed/Medications | Does NOT administer formula or medications through the tube. | Prepares and administers prescribed formula and medications via the tube. |
| Patient Positioning | Positions the patient properly (e.g., elevated head of bed) for feeding safety. | Directs the NA on proper positioning and monitors for aspiration risk. |
| Monitoring | Observes and reports signs of complications or distress to the nurse immediately. | Assesses all patient systems, interprets NA's observations, and intervenes as needed. |
| Oral/Nasal Care | Provides regular oral and nasal hygiene to ensure patient comfort and prevent infection. | Oversees and directs oral hygiene plan. |
| Flushing Tube | NOT typically allowed to flush the tube unless explicitly trained and delegated by a licensed nurse for a specific patient under strict protocol. | Flushes the tube before and after feeds/medications to prevent clogging. |
| Site Care | Assists with cleaning the insertion site under supervision. | Assesses the insertion site for infection or breakdown. |
Ethical and Safety Considerations
Beyond the specific tasks, the NA plays a vital role in the patient's emotional and psychological well-being. Having a feeding tube can be a distressing experience for patients and their families. The NA can provide comfort and support by being present, attentive, and communicative.
Communication and Reporting
An NA must maintain a constant flow of communication with the licensed nurse. Any observation, no matter how small it may seem, must be reported promptly. A change in skin color, a new cough, or a complaint of nausea could indicate a serious problem that requires immediate attention from the licensed nurse.
Respecting Patient Dignity
Providing care with compassion is essential. The NA should always treat the patient with dignity and respect, explaining procedures simply and clearly, even if the patient is unable to respond verbally. Maintaining privacy during personal care and ensuring the patient is clean and comfortable contributes greatly to their quality of life.
Conclusion
While a Quizlet might offer a quick answer, the true role of a nursing assistant when caring for a person with a feeding tube is complex, dynamic, and essential to the patient's care team. The NA is the eyes and ears on the ground, carrying out critical supportive tasks like positioning and hygiene, and constantly monitoring the patient for complications. Their close supervision and immediate reporting to the licensed nurse ensure that patients with feeding tubes receive safe, compassionate, and effective care. For further in-depth knowledge on enteral tube management, authoritative resources are invaluable, such as the guidelines provided by the National Center for Biotechnology Information at https://www.ncbi.nlm.nih.gov/books/NBK593216/.
