الفهرس 
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Abstract
Since optimizing nutrition early in life is essential to improve PTNs survival and promote their growth and development, great attention must be paid to their nutrition. Unfortunately, many PTNs are liable to different health problems that impact negatively their feeding. So, some of them have to be fed enteraly via the OGT. This depends mainly on their medical condition. Delivering nutrition safely to those neonates requires competencies on part of the neonatal nurse. Nurse’s competencies could be achieved by application of recent comprehensive EBGs about OGTF. Implementation of EBGs concerning this route of administration is extremely important to make sure that nurses are capable of delivering feeding in an appropriate manner. Therefore, the current study was carried out to assess nurses’ application of evidence based guidelines on feeding PTNs via OGTF.
The study was conducted in the Neonatal Intensive Care Unit affiliated to the Maternity University Hospital at El-Shatby in Alexandria. All nurses responsible for providing OGTF for PTNs admitted to the previously mentioned setting comprised the study subjects. Their number was 50 nurses. Nurses’ application of EBGs on feeding PTNs via OGT observation checklist was the tool used to collect the necessary data. The tool was developed by the researcher guided by the BNHS and the AAP. It included five parts namely EBGs before, during and after OGTF as well as guidelines related to tube removal and documentation. Every nurse was observed three times while providing OGTF during the morning and afternoon shifts.
The main results of the present study revealed the following:
• More than half of the nurses (54.0%) were 20 to less than 30 years old with a mean age of 25.614± 1.22.
• Fifty two percent of them have completed their university education.
• Experiences of more than half of the nurses (58.0%) were five years or more.
• Eighty percent of the nurses attended training programs about PTNs’ feeding.
• All observations reflected that nurses washed their hands using soap and water and disinfected them using alcohol based sensitizer before OGT insertion (100% each).
• To carry out the procedure, observations clarified that all nurses prepared appropriate size of the tube, soft adhesive tape, latex gloves, and 5 ml syringe (100% each).
• Throughout 88.7% of the observations, it was clear that nurses have measured the length of the tube that has to be inserted from the corner of the mouth to the ear lobe and from the ear lobe to a point midway between the xiphoid process and umbilicus.
• Around two thirds of the observations (60.7%) revealed that nurses marked the measured length either with permanent marker or adhesive tape.
• Observations also showed that 94.0% of the nurses did not measure the distal part of the tube.
• The vast majority of the observations showed that nurses placed the neonate in the semi-sitting position with the head slightly raised before tube insertion as well as during feeding (98.7% and 94.0% respectively).
• Sixty four percent of the observations indicated that nurses did not lubricate the tube with sterile or distilled water prior to insertion.
• All observations reflected that nurses placed the stethoscope below the rib cage on the left side of neonate’s abdomen, injected 0.5 to 1 ml of air into the tube and heard gurgling sound. They aspirated stomach contents with syringe as well (100% each).
• Through the three observations, it was clear that all nurses secured tube on neonate’s cheek with adhesive tape.
• Observations displayed that nurses measured the circumference of the neonate’s abdomen before and after feeding (70.0% and 56.0% respectively).
• Slightly higher than three quarters of the observations (76.0%) indicated that nurses were not keen to offer neonates a pacifier during feeding to help them learn feeding skills.
• More than four fifths of the observations (84.7%) reflected that nurses held the syringe 25cm above the level of the neonate’s stomach.
• Also the highest percentage of the observations (98.0%) illustrated that nurses removed the plunger of the syringe and allowed the formula to flow by gravity.
• All observations (100.0%) reflected that nurses kept adding more milk before the syringe is empty.
• The majority of the observations (82.7%) clarified that the studied nurses fed neonates within a period of 20-30 minutes.
• All observations (100.0%) illustrated that nurses flushed the OGT by 1-2ml of sterile water after feeding.
• Burping the neonates, placing them on their right side and elevating the head of the bed by 20cm for 30 minutes were also practiced by the nurses throughout the observations (84.7%, 91.3% and 96.7% respectively).
• Regarding tube removal, the three observations reflected that nurses kept the tube pinched while withdrawing it gently (100% and 94.0% respectively).
• It was recognized that washing neonates’ cheeks and lips as well as drying neonates’ skin was practiced by nurses throughout the observations (66.0% and 58.0% respectively).
• Aspirated residuals confirming tube placement as well as residuals obtained following each feed was recorded by nurses as recognized in 78.7% and 53.3% of the observations respectively.
• All observations revealed that nurses recorded type and amount of feeding administered (100% each).
• More than three quarters of the same observations (76.7%) showed that nurses recorded complications encountering feeding such as signs of distress.
• Almost three quarters of the three observations (77.3%) showed that nurses did not document any management of the arising complications.
• Time of tube removal was documented throughout 96.7 % of the observations.
• Regarding different procedure steps it was clear that nurses’ performance before OGTF was fair among 86.0% of the nurses. While, during OGTF it was either fair or good among 48.0% and 40.0% of them respectively. They obtained good performance not only after OGTF but also while removing the tube and in documentation (100.0%, 98.0% and 84.0 respectively).
• The total performance among 88.0% of the nurses throughout all steps of OGTF was good.
• No statistical significant relations were found between nurses’ age, level of education, years of experience and their total practices score in the application of EBGs on feeding PTNs via OGT.
• Statistical significant difference was only found between nurses’ total practices score in the application of EBGs on feeding PTNs via OGT and their attendance of training program about feeding PTNs.