COMMENTARY Commentary on Lin LC, Li MH & Watson R (2011) A survey of the reasons patients do not choose percutaneous endoscopic gastrostomy/ jejunostomy (PEG/PEJ) as a route for long-term feeding. Journal of Clinical Nursing 20, 802–810 Mahmoud Al Kalaldeh Although the advancement in technology of nutritional care is still increasing, health education provided by nurses still remains important. The study by Lin et al. (2011) discusses the issues around percutaneous endoscopic gastrostomy/ jejunostomy (PEG/PEJ) among patients in a home care agency and hospitals-based home care in Taiwan. It explores the reasons why many patients refuse this type of nutritional support. It was interesting to note from the data that the majority of patients were not familiar with nutritional care via PEG/PEJ and 58Æ4% of those who were aware of PEG/PEJ refused to use them. This highlights an essential issue concerning the nursing role, not only in the home care settings, but also in hospitals during the delivery of secondary and tertiary health care. Most of the patients who need artificial nutrition have had a stroke or are experiencing some form of cognitive deterioration, meaning that health care decision regarding the use of artificial nutrition might be discussed with the relatives as well as the patients if they are conscious and oriented. However, patients often make their decision regarding the initiation of artificial nutrition based on nurses’ suggestions and recommendations about feeding strategies. Inaccurate information about any specific route of feeding may require extra efforts from nurses to convince patients to change their attitude about such feeding strategy. In a study by Persenius et al. (2009), patients were highly dependent on the professional care services where nurses enhanced patients’ ability to comprehend their nutritional needs after recovery. This means that nurses are the most influential professionals and are best placed to intervene after understanding the patients’ needs of nutritional supplement. Therefore, nurses can enhance patients’ comprehension of various feeding routes and strategies. Similarly, Cornock (1998) stressed the importance of patients’ motivation and desire to adapt effectively with the changes in their nutritional pattern. Poor nutritional adaptation is seen as a major obstacle to successful nutrition among vulnerable patients. Therefore, nurses have a key role in alleviating and preventing these distressing changes through strengthening patients’ abilities to handle the situation through providing sufficient information (Stroud et al. 2003). Persenius et al. (2009) developed a theoretical understanding for nursing nutritional care services regarding the strategies used in managing patients’ nutrition. This study revealed that nurses’ competences in nutritional care depend on their knowledge of patients’ nutritional needs, history and preferences in combination with professional confidence (appropriate knowledge, experience) which should link with an understanding of the patients’ perspectives and their relatives’ involvement in decision-making regarding nutritional strategies. Lin et al. (2011) found that fear of wound infection, leakage and preserving body integrity were the main reasons of refusing PEG/PEJ. However, whatever the reasons, patients may make alternative choices if they are fully aware of the advantages and disadvantages of each routes of feeding, for example, the disadvantages of using nasogastric tube feeding over PEG/PEJ tubes in terms of tube dislodgement, obstruction, the prospect of aspiration and the limitations of physical movement. Author: Mahmoud Al Kalaldeh, RN, MSN, CNS, PhD Student, The University of Sheffield, School of Nursing, Sheffield, UK Correspondence: Mahmoud Al Kalaldeh, PhD Student, The University of Sheffield, School of Nursing, Samuel Fox House, Herries Road, Sheffield S5 7AU, UK. Telephone: +44 114 222 2076. E-mail: kalaldeh82@yahoo.com 288 Ó 2011 Blackwell Publishing Ltd, Journal of Clinical Nursing, 21, 288–289 doi: 10.1111/j.1365-2702.2011.04010.x Commentary Commentary References Cornock MA (1998) Stress and the intensive care patient: perceptions of patients and nurses. Journal of Advanced Nursing 27, 518–527. Lin LC, Li MH & Watson R (2011) A survey of the reasons patients do not choose percutaneous endoscopic gastrostomy/jejunostomy (PEG/PEJ) as a route for long-term feeding. Journal of Clinical Nursing 20, 802–810. Persenius MW, Hall-lord ML & WildeLarsson B (2009) Grasping the nutritional situation: a grounded theory study of patients’ experiences in intensive care. Nursing in Critical Care 14, 166–174. Stroud M, Duncan H & Nightingale J (2003) Guidelines for enteral feeding in adult hospital patients. Gut 52, vii1– vii427. Ó 2011 Blackwell Publishing Ltd, Journal of Clinical Nursing, 21, 288–289 Wentzel Persenius M, Wilde-Larsson B & Hall-lord ML (2009) To have and to hold nutritional control: balancing between individual and routine care: a grounded theory study. Intensive and Critical Care Nursing 25, 155–162. 289