INTRODUCTION:

Nutrition is a fundamental pillar for human growth, development, and physiological maintenance. While the act of eating is a source of enjoyment and sustenance, a significant number of individuals are unable to meet their nutritional requirements orally due to various medical conditions. Nasogastric (NG) tube feeding is a life-sustaining intervention for patients with a functional gastrointestinal tract who cannot consume adequate nutrition orally, often as a result of stroke, neurological impairments, head and neck cancers, or major surgeries^1,2.

The clinical management of NG tube feeding within hospital settings is standardized and provided by trained professionals. However, a global shift towards shorter hospital stays and increased home-based care has transferred the primary responsibility for this complex procedure to family caregivers ^3,4. These informal caregivers, who typically lack formal medical training, are tasked with a range of critical duties. These include the preparation and administration of enteral feeds, delivering medications, maintaining tube patency through regular flushing, and vigilantly monitoring for complications such as aspiration, diarrhea, and tube dislodgement ^5,. Consequently, the knowledge and practices of these caregivers become pivotal determinants of the patient's nutritional status, recovery, and overall quality of life ^6.

NEED AND SIGNIFICANCE OF THE STUDY:

The competence of caregivers in managing NG tube feeding is directly correlated with patient safety. The risk of iatrogenic complications is heightened by a lack of knowledge and skills, an area that can be significantly improved through structured education and support ^7. Inadequate understanding and incorrect practices can lead to severe, and sometimes fatal, complications. For instance, tube blockage, a frequently encountered issue, often stems from improper flushing techniques ^8. More critically, failure to verify tube placement or assess gastric residual volume can result in aspiration pneumonia, a leading cause of morbidity and mortality in tube-fed patients ^9,10.

Empirical evidence from various settings consistently reveals significant gaps in caregiver competence. A study conducted in India found that only a minority of caregivers demonstrated satisfactory practices in NG tube care^11. Similarly, other research has documented poor levels of knowledge among caregivers regarding the prevention and management of common feeding-related complications ¹²

Despite the high global prevalence of NG tube feeding—with over 790,000 tubes inserted annually in the National Health Service (NHS) alone ¹³—standardized and effective training for caregivers in many low-resource settings remains inconsistent or entirely absent^14,15. This discrepancy creates a critical and dangerous gap in the continuum of care upon patient discharge. Therefore, assessment of the current levels of knowledge and practice among caregivers managing NG tube feeding is an essential first step. The findings from such an inquiry are crucial for developing targeted, evidence-based educational interventions to safeguard patient well-being in the community setting.

STATEMENT OF THE PROBLEM:

Knowledge and practices of nasogastric tube feeding among caregivers of hospitalized patients: A Cross-sectional study from a tertiary care hospital in Kerala

OBJECTIVES:

1. To assess the level of knowledge regarding nasogastric tube feeding among caregivers of hospitalised patients

2. To assess the level of practice regarding nasogastric tube feeding among caregivers of hospitalised patients

3. To determine the association between the knowledge levels and practice levels of nasogastric tube feeding among caregivers of hospitalised patients

OPERATIONAL DEFINITIONS:

· Knowledge: Understanding of caregivers regarding the purposes, type of food, time interval, complications and its prevention of nasogastric tube feeding measured by a structured questionnaire.

· Practice: The procedure or way of doing nasogastric tube feeding by caregivers of hospitalised patients measured by an observational check list.

· Nasogastric tube feeding: It is the process of giving liquid nutrients or medications through a tube into the stomach when the oral intake is inadequate or impossible.

· Caregivers of hospitalized patients: A family member, friend or paid helper who regularly look after a sick who admitted with nasogastric tube feeding for more than one week.

Assumptions:

The study is based on the following assumptions:

· Each caregiver has unique knowledge.

· Caregiver practices often deviate from guidelines.

· Better knowledge leads to better practice.

HYPOTHESES:

The following hypothesis was tested in the study:

H1: There is a significant association between the knowledge levels and practice levels of caregivers of hospitalised patients regarding nasogastric tube feeding.

Theoretical Framework:

Based on the Health Promotion Model (Pender, 1987), this study's conceptual framework posits that a caregiver's engagement in safe nasogastric (NGT) tube feeding practices is a health-promoting behavior influenced by cognitive-perceptual and modifying factors. The primary motivational mechanisms—including the caregiver's knowledge of NGT feeding, their perception of its importance for patient wellbeing, their perceived self-efficacy, and the perceived benefits and barriers to action—constitute the decision-making phase. These cognitive factors are shaped by modifying variables such as the caregiver's income, education, occupation, interpersonal interactions with family and health personnel, and exposure to situational cues like mass media. In the subsequent action phase, these factors collectively influence the caregiver's actual practices. An information guide on NGT feeding serves as a critical "cue to action," designed to address knowledge deficits, overcome perceived barriers, and ultimately trigger the adoption of correct, health-promoting behaviors to prevent complications^16,17,18.

MATERIALS AND METHODS:

Research Approach:

A quantitative research approach was adopted for this study to objectively and systematically assess the knowledge and practice levels of caregivers regarding the nasogastric tube feeding of hospitalised patients. This approach enables the statistical analysis of numerical data to identify patterns, relationships, and associations between variables.

Research Design:

A descriptive cross-sectional research design was employed, as it is well-suited for collecting data on a population at a single point in time to examine relationships between variables without manipulating them¹⁹.This approach allowed for the collection of quantitative data that were subsequently analyzed using statistical methods to identify associations.

Setting of the Study:

The study was conducted at a tertiary care centre managed by the state government of Kerala. The rationale for selecting the setting is feasibility and availability of subjects.

Population and Sample:

The target population for this study comprised all caregivers of hospitalised patients on NGT feeding in a tertiary care centre. The sample consists of 50 caregivers of hospitalised patients on nasogastric tube feeding for more than one week. The convenient sampling technique was employed.

Sample size:

50 caregivers of patients with nasogastric tube for more than one week will be included in the study.

For calculating the sample size, prevalence of NG tube insertion was taken from a study conducted in Tamilnadu and the formula used were N=4Pq/d2

Inclusion criteria:

· The caregivers who are available at the time of data collection.

· The caregivers who are willing to take part in the study.

· The caregivers of patient with nasogastric tube more than one week.

· Caregivers who are family members, friends or paid helpers of the patient.

· Are able to comprehend Malayalam.

Exclusion criteria:

· The person who has previous knowledge regarding nasogastric tube feeding.

· The caregiver who is working at medical care settings.

Variables:

Qualities, properties or characteristics of persons, things or situations that change or vary and are manipulated or measured in research are called variables²⁰.

Dependent variables: The knowledge score and practice score of caregivers regarding the nasogastric tube feeding among caregivers of hospitalised patients.

Study Tools:

Three structured tools were used for data collection:

Tool I: It consists of two sections.

Section A: Socio personal data sheet of caregivers contained 8 items to gather information on age, gender, educational status, occupation, type of family, relationship with the family, monthly family income, medical facilities available near home, and previous knowledge.

Section B: Clinical data sheet of patient consisted of 7 items

Tool II: Structured Knowledge Questionnaire: Comprised 16 multiple-choice questions assessing knowledge about the purposes, forms of food, time interval, complications and its prevention of nasogastric tube

Tool III: Observational Checklist: Consisted of 12 yes/no items evaluating the practice of nasogastric tube feeding among caregivers of hospitalised patients

Development and Validation of Tools:

The development of the research instruments began with a comprehensive review of the existing literature and consultations with nursing specialists from diverse areas, including medical, surgical, community health, paediatrics, and psychiatry. An initial version was assessed for relevance and appropriateness by a panel of five subject-matter experts. After receiving ethical approval, a separate group of six experts performed a content validation. Their recommendations were incorporated into the tools to improve their clarity and comprehensiveness, resulting in the final versions.

Pilot Study:

A pilot study was conducted with five caregivers of hospitalised patients on NGT feeding to assess the feasibility, clarity, and practicality of the data collection tools and procedures. Data from the pilot study were analyzed using descriptive statistics, which confirmed the suitability of the tools and the data collection process. No major changes were required, so the data were included in the main study.

Data Collection Procedure:

Data collection for the main study was conducted over a period of two weeks. All caregivers provided their written consent to participate only after being fully informed about the study's goals, what it would involve, and its potential risks and benefits. The socio personal and clinical data were collected by the researcher. The structured knowledge questionnaire was administered to the caregivers in the medical and surgical wards. Practice of caregivers was assessed by observational check list.

Plan for Data Analysis:

The data were analyzed using both descriptive and inferential statistics with SPSS software (version XX.0). Descriptive statistics, including frequency, percentage, mean, and standard deviation, were used to summarize the socio-personal and clinical characteristics of the caregivers and their knowledge and practice scores. Inferential statistics were applied to test the study hypotheses. The Chi-square test was used to determine the association between knowledge levels and practice levels, as well as associations between knowledge/practice levels and selected socio-demographic variables. A p-value of < 0.05 was considered statistically significant.

RESULTS:

Table 1: Socio-Demographic Characteristics of Caregivers (n = 50)

Variable	Category	Frequency	Percentage (%)
Age (years)	25 - 35	10	20
	36 - 45	15	30
	46 - 55	18	36
	Above 55	7	14
Gender	Male	11	22
Gender	Female	39	78
Education	Informal	1	2
	Primary	19	38
	Higher Secondary	23	46
	Degree	7	14
Employment	Employed	49
Employment	Unemployed	1
Monthly family income	Below 5000	29	58
	5001 -10000	9	18
	10001-15000	6	12
	Above15001	6	12
Type of family	Nuclear family	40	80
	Joint family	9	18
	Extended family	1	2
Relationship with the caregiver	Parents	21	42
	Siblings	8	16
	Relatives	2	4
	Husband/wife	14	28
	Others	5	10
Prior knowledge on nasogastric tube feeding	Yes	24	48
Prior knowledge on nasogastric tube feeding	N	26	56

The socio-demographic profile of the 50 caregivers is presented in Tables 1. Among the caregivers of patients on nasogastric tube feeding, 20% were in the age group of 25–35 years, 30% between 36–45 years, 36% between 46–55 years, and only 14% were above 55 years of age. A larger proportion of caregivers were women (78%), while men accounted for 22%.

With respect to education, 46% had completed high school, 38% had primary level education, 14% were degree holders, and 2% were illiterate. In terms of occupation, 40% of caregivers were homemakers. A majority (58%) belonged to families with a monthly income below ₹5,000. Regarding family type, 80% were from nuclear families, followed by 18% from joint families and 2% from extended families.

In relation to their role, 42% were parents of patients, 28% were spouses, 16% siblings, 10% others, and 4% relatives. More than half (52%) had no prior information about tube feeding, while 48% reported some previous knowledge.

Table 2: clinical characteristics of the patient with NGT feeding (n = 50)

Variable	Category	Frequency	Percentage (%)
Clinical diagnosis	Digestive conditions	3	6
	Neurological conditions	18	36
	Oncological conditions	2	4
	Others	27	54
Duration of illness (months)	<1 months
	1-3
	>3
Type of nasogastric tube feeding	Temporary	47	94
Type of nasogastric tube feeding	Permanent	3	6
Duration of tube feeding	For the past 1 week	39	78
	For the past 15 days	6	12
	More than 15 days	5	10
Number of feeds per day.	3-4	23	46
	5-6	14	26
	7-8	13	28

The Clinical Profile of the 50 patients is presented in Tables 2. Less than half of the patients presented with digestive (6%), neurological (34%), and oncological (4%) conditions, while 54% were diagnosed with other illnesses. Over half (54%) had illness duration of less than one month, 38% between one and three months, and 8% for more than three months. A vast majority (94%) were receiving temporary nasogastric tube feeding. Most patients (78%) had the feeding tube inserted for less than one week. In terms of feeding frequency, 46% required more than three to four feeds per day.

Table 3: Distribution of caregivers according to knowledge and practice regarding the nasogastric tube feeding among caregivers of hospitalised patients. (n=50)

Variable	Category / Score	Frequency (n)	Percentage (%)
Knowledge	Good (>75%)	12	24
	Average (50–75%)	30	60
	Poor (<50%)	8	16
Practice	Good (>75%)	32	64
	Average (50–75%)	10	20
	Poor (<50%)	8	16

Table 3 reveals that among the 50 participants, the majority (60%) demonstrated an average level of knowledge, while 24% showed good knowledge and 16% exhibited poor knowledge. In terms of practice, 32 participants (64%) performed well, 10 participants (20%) had an average level of practice, and 8 participants (16%) reflected poor practice.

Table 4: Relationship between knowledge and practice regarding the nasogastric tube feeding among caregivers of hospitalised patients.

Knowledge	Practice: Good	Practice: Poor	df	χ² value
Good	10	0	1	5.578
Average	18	7	5
Poor	4	3	2

The table 4 shows the cross-distribution of caregivers’ knowledge and their corresponding practice on nasogastric tube feeding. Among those with good knowledge, 10 had good practice and 1 had poor practice, while none fell in the average practice category. Caregivers with average knowledge mostly demonstrated good practice (18), followed by 7 with average practice and 5 with poor practice. In contrast, those with poor knowledge showed relatively weaker outcomes: 4 had good practice, 3 had average practice, and 2 had poor practice

DISCUSSION:

The present study intended to assess the knowledge and practice regarding nasogastric tube feeding among caregivers of patients admitted in a tertiary care centre, Thrissur. Among the 50 participants, the majority (60%) demonstrated an average level of knowledge, while 24% showed good knowledge and 16% exhibited poor knowledge. In terms of practice, 32 participants (64%) performed well, 10 participants (20%) had an average level of practice, and 8 participants (16%) reflected poor practice. Among those with good knowledge, 10 had good practice and 1 had poor practice, while none fell in the average practice category. Caregivers with average knowledge mostly demonstrated good practice (18), followed by 7 with average practice and 5 with poor practice. In contrast, those with poor knowledge showed relatively weaker outcomes: 4 had good practice, 3 had average practice, and 2 had poor practice. The study says that there is no association existing between knowledge and practice regarding nasogastric tube feeding among caregivers of patients.

CONCLUSION AND IMPLICATION FOR NURSING PRACTICE:

The study highlights the crucial role of nursing education in enhancing caregivers’ knowledge and practice regarding nasogastric tube feeding. Nurse educators can serve as motivators, guiding caregivers to understand and perform safe feeding practices that directly impact patient health outcomes. In terms of administration, the findings can be applied to organize in-service education programs and structured awareness sessions for caregivers. Nurse administrators can play a vital role in coordinating these programs to ensure consistency and effectiveness. From a research perspective, the study emphasizes the need for further investigations on caregivers’ awareness and practices across different hospital settings. Overall, the findings provide a strong foundation for educational, administrative, and research initiatives to improve the quality of care and reduce complications associated with nasogastric tube feeding.

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Received on 03.10.2025 Revised on 25.10.2025

Accepted on 10.11.2025 Published on 30.04.2026

Available online from May 02, 2026

Int. J. Nursing Education and Research. 2026;14(2):147-152.

DOI: 10.52711/2454-2660.2026.00029

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