G-tube patient education (for use in any education that is part of a skill the patient will need to perform)

I recently was educating a patient about caring for their g-tube, which is a feeding tube surgically placed through the abdomen to the stomach in order to bypass the mouth and esophagus. 

Recently, I was told by a doctor that the tube had to be in place for a minimum of 6 weeks.

However, some patients regain their swallowing ability and, in turn, lose the need for the tube before the time when it is medically safe to remove.  The tube still needs to be maintained to prevent pathogens from forming inside the tube as well as from the opening in the abdomen.

Something that I did well: showed the patient the materials, then explained the procedure.

Materials:

• foam non-stick pad to place between the plastic circle that keeps the tube from retracting into the abdomen
• wet and dry washcloths
• basin with soap and water
• 2 washcloths (one for wet, one to dry)
• scissors
• marker
• graduated cylinder filled with at least 50 mL tap water
• piston syringe

Processes:

• date the foam barrier and cut out a hole for the tube and a slit to slide it into place
• how to clean and dry around the hole in the abdomen
• how much water to suck into the piston
• How to kink the tube to prevent backflow
• Insert the piston syringe and flush the tube.
• Put everything back in place

The patient was uncomfortable with looking at the hole where the tube is.

Didn't want to touch or clean it.

Didn't want to flush the tube.

What I should have done:

Give the patient duplicate supplies to handle as I'm handling each

Ask after each step if they wanted to perform the task on themself. No judgment if declined.

One of the challenges is that the patient does not know what it will feel like to push water out of the piston, or if the hole cut in the foam barrier is the right size and they don't want to mess up on themself (just like we, as nurses, don't want to make a mistake on a patient.)

The other challenge is disturbed body image. By exposing the patient to the change slowly and non-judgmentally several times, the patient has time to get used to the change and gain comfort and confidence. Then, adding repeated exposure to the materials for maintenance, the patient will eventually be capable - if not enthusiastic - about performing the task on their own.

We can apply the same principles to any number of skills that a patient may require; injections and wound care are two other skills that come to mind.

The goal, after all, is to promote the patient's independence and autonomy.