Document Type : Original Article


1 The Department of Medical Surgical Nursing, School of Nursing and Midwifery, Tehran University of Medical Sciences

2 Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran

3 Cancer Control Research Center, Cancer Sciences, Tehran, Iran


BACKGROUND: Percutaneous endoscopic gastrostomy (PEG) is one of the most suitable methods
for long‑term nutritional support. In this study, the empowerment of intensive care nurses is examined
by a simulation technique to control the short‑term complications of PEG.
METHODS: A two‑group clinical trial study will be conducted on eighty intensive care nurses in
a teaching hospital in Tehran. The study participants will be randomly assigned to one of the two
control and intervention groups based on the inclusion criteria. A pretest will be given to both groups
using a researcher‑made tool. Then, the empowerment package developed by the researcher will
be provided to the intervention group in two stages. Next, a posttest will be administered. After this
stage, patients’ complications with PEG will be observed using a researcher‑made checklist. Nurses’
performances in both control and intervention groups will be evaluated in terms of preventing and
controlling short‑term complications up to 1 week after PEG insertion. All of the data collected in this
research will be analyzed with statistic tests such as independent t‑test, standard deviation, T pair,
ANOVA, and mean based on the SPSS 16 software.
RESULTS: At present, the research team is designing an empowerment package for nurses and
tools needed to evaluate the nurses’ empowerment.
CONCLUSION: This study will attempt to design and evaluate the empowerment package of graduate
nurses with a cognitive empowerment approach and using a simulation technique to care for patients
with PEG and to control their short‑term complications.


1. Shabanpur M, Nachvak SM, Moradi S, Hedayati S, Hosseinikia M,
Pasdar Y, et al. Nutritional Care in Iranian Intensive Care Units.
Clin Nutr Res 2018;7:136‑45.
2. Brown K, Cai C, Barreto A, Shoemaker P, Woellner J, Vu K, et al.
Predictors of percutaneous endoscopic gastrostomy placement in
acute ischemic stroke. J Stroke Cerebrovasc Dis 2018;27:3200‑7.
3. Almasi Z, Mohammadian‑Hafshejani A, Salehiniya H. Incidence,
mortality, and epidemiological aspects of cancers in Iran;
differences with the world data. J BUON 2016;21:994‑1004.
4. Hansen CC, Dissanaike S. Nutrition in the intensive care unit.
Southwest Respir Crit Care Chron 2015;3:18‑25.
5. Sharada M, Vadivelan M. Nutrition in critically ill patients.
J Indian Acad Clin Med 2014;15:205‑6.
6. Vallejo KP, Martínez CM, Adames AA, Fuchs‑Tarlovsky V,
Nogales GC, Paz RE, et al. Current clinical nutrition practices
incritically ill patients in Latin America: A multinational
observational study. Crit Care 2017;21 (1):1‑11.
7. Chaudhry R, Batra S, Mancillas OL, Wegner R, Grewal N,
Williams GW. In‑hospital mortality with use of percutaneous
endoscopic gastrostomy in traumatic brain injury patients:
Results of a nationwide population‑based study. Neurocrit Care
8. Robertsen A, Førde R, Skaga NO, Helseth E. Treatment‑limiting
decisions in patients with severe traumatic brain injury in a
Norwegian regional trauma center. Scand J Trauma Resusc Emerg
Med 2017;25:44.
9. Lucendo AJ, Friginal‑Ruiz AB. Percutaneous endoscopic
gastrostomy: An update on its indications, management,
complications, and care. Rev Esp Enferm Dig 2014;106:529‑39.
10. Amrendra Mandal PK, Sidhu JS, Hassan M, Gayam V.
A Successful Percutaneous Endoscopic Gastrostomy Tube
Feeding over Two Decades with No Complication: A Rare Case
Report. Cureus. 2019 Aug; 11 (8).
11. Barati M, Khaleghi S, Motamed Rastgar H. Evaluation of
percutaneous endoscopic gasterostomy in Hazrat Rasoul Akram
hospital. Razi J Med Sci 2013;20:49-54.
12. Lyons N, McQueen DA. A clinician’s guide: Caring for people
with gastrostomy tubes and devices. New Agency Clin Innov
2015;110 (20): 49‑54.
13. Tanaka T, Ueda T, Yokoyama T, Sadamitsu T, Yoshimura
A, Hazuki H, et al. Laparoscopic percutaneous endoscopic
gastrostomy is useful for elderly. Soc Laparoendosc Surg
14. Tobase L, Peres HH, Tomazini EA, Teodoro SV, Ramos MB,
Polastri TF. Basic life support: Evaluation of learning using
simulation and immediate feedback devices1. Rev Lat Am
Enfermagem 2017;25:e2942.
15. Hossein SM, Leili M, Hossein AM. Acceptability and outcomes
of percutaneous endoscopic gastrostomy (PEG) tube placement
and patient quality of life. Turk J Gastroenterol 2011;22:128‑33.
16. Enestvedt BK, Jorgensen J, Sedlack RE, Coyle WJ, Obstein KL,
Al‑Haddad MA, Christie JA, Davila RE, Mullady DK, Kubiliun N,
Kwon RS Endoscopic approaches to enteral feeding and nutrition
core curriculum. Gastrointest Endosc 2014;80:34‑41.
17. MoorheadS, JohnsonM, MaasML, SwansonE. Nursing Outcomes
Classification (NOC)‑E‑Book: Measurement of Health Outcomes.
Elsevier Health Sciences; 2018.
18. Yaman Aktaş Y, Karabulut N. The effects of music therapy in
endotracheal suctioning of mechanically ventilated patients. Nurs
Crit Care 2016;21:44‑52.
19. Nikravan mofrad M, Zahri Anbohi S. The effect of simulation training method on enabling student nurses in advanced
pre‑hospital operation. Cardiovasc Nurs J 2012;1:32‑8.
20. Ravaghi H, Goshtaei M, Olyaee Manesh A, Abolhassani N,
Arabloo J. Stakeholders’ perspective on health equity and its
indicators in Iran: A qualitative study. Med J Islam Repub Iran
21. Shah Ghelyan K, Naderi S. A model of empowerment to improve
employees, performance in auto parts industries of Iran. Iranian
journal of management sciences, 2009;4:149-69.
22. Chen R, Kanzaki H, Chiba M, Nishimura M, Kanzaki R,
Igarashi K. Local osteoprotegerin gene transfer to periodontal
tissue inhibits lipopolysaccharide‑induced alveolar bone
resorption. J Periodontal Res 2008;43:237‑45.
23. Fotoukian Z, Mohammadi Shahboulaghi F, Fallahi Khoshknab M,
Mohammadi E. Barriers to and factors facilitating empowerment
in elderly with COPD. Med J Islam Repub Iran 2014;28:155.
24. Bakhtiari H, Sofi A. The empowerment pattern of personnel.
Supervision and Inspection Quarterly 2009;1388:1-21.
25. Chaghari M, Saffari M, Ebadi A, Ameryoun A. Empowering
education: A new model for in‑service training of nursing staff.
J Adv Med Educ Prof 2017;5:26‑32.
26. Sajadi SA, Farsi Z. Simulation‑based education. J Educ Stud AJA
Univ Med Sci 2014;3:888‑94.
27. Pazargadi M, Sadeghi R. Simulation in nursing education. Iran
Q Educ Strateg 2011;3:161‑7.
28. Rahmani Beilondi R, Rahmani M. The evaluation of effectiveness
for training simulation method in the frank breech presentation
on knowledge and clinical skills of midwifery students. Educ
Strateg Med Sci 2017;9:351‑6.
29. Ahmad M, Aqel A. Comparison between clinical simulation and
traditional teaching for cardiopulmonary knowledge and skills.
Int J Educ Res Inf Sci 2015;2:83.
30. Bayoumy HM, Al Jadaani MA. The effect of PEG tube feeding
simulation on nursing students’ knowledge, competence,
self‑reported confidence and satisfaction with learning. Athens J
Health 2015;2 (4):297‑312.