| Course | NURS 500 Research (NURS500) |
|---|---|
| Module/Week | 4 |
| Assignment | Research Proposal Part 2, Literature Review |
| Paper type | Research proposal section (literature review with a summary table) |
| Length | about 1,193 words, 4 double-spaced pages plus title page and references. Course guide: Parts 1 to 4 together run 9 to 16 pages with 10 to 15 references |
| Format | APA 7 student paper |
| Points | 100 |
| School | Liberty University Online |
| Program | MSN |
| Where it sits | Module/Week 4 in Liberty's published NURS 500 course guide; current sections can differ |
| Updated | October 2026 |
Free sample paper for NURS 500 Week 4
Caregiver Teach-Back Before Discharge and Tube-Related Emergency Visits After a New Gastrostomy, Part 2: Review of the Literature
[Student Name]
School of Nursing, Liberty University
NURS 500: Research
Research Proposal: Part 2
[Instructor Name]
[Date]
This part continues the composite proposal begun in Part 1; every finding reported here comes from the source cited.
Caregiver Teach-Back Before Discharge and Tube-Related Emergency Visits After a New Gastrostomy, Part 2: Review of the Literature
The questions posed in Part 1 ask whether structured teach-back for family caregivers reduces tube-related emergency visits after a new gastrostomy and whether it improves caregiver preparedness. This review examines the evidence on three themes that lie behind those questions: unplanned care after gastrostomy placement, the burden and preparedness of caregivers, and teach-back as a method of teaching.
Search Strategy
Three databases, CINAHL Complete, PubMed and Cochrane, were queried for studies in English from 2018 through 2026, pairing gastrostomy, enteral nutrition and home enteral tube feeding with caregiver, preparedness, discharge education, emergency department and teach-back. The bibliographies of the reviews that qualified were then scanned by hand for anything the database terms had missed, and one older study was kept because it introduced the preparedness concept and the scale this proposal uses. Studies were kept when they reported adult or caregiver outcomes relevant to home tube feeding or to teach-back education; case reports and studies of surgical technique were excluded.
Unplanned Care After a New Gastrostomy
The clearest message from this literature is that a gastrostomy changes the course of care after discharge. In an analysis of 8,911 commercially insured patients with stroke, Wilmskoetter et al. (2018) found that the 148 patients who received a gastrostomy during their stroke admission were more likely to be admitted to rehabilitation and skilled nursing facilities and that tube placement independently predicted unplanned readmission within a year. That study was retrospective and used claims data, so it shows association rather than cause, and it cannot separate the effect of the tube from the severity of the illness that required it.
What drives the return visits is less often the underlying disease than the tube itself. McGrath et al. (2026), in a narrative review of home gastrostomy care, described fragmented follow-up and inadequate education as leading to preventable complications such as infection, tube malfunction and dislodgement, along with avoidable emergency visits. The systematic review by Amaratunga et al. (2023) supports the first half of that argument: across 11 studies of adults, education and multimodal programs reduced infection, blockage and displacement. Unplanned hospital encounters, however, did not fall significantly in any of the pooled comparisons, and because of risk of bias the reviewers graded their confidence in these findings as low. The literature therefore shows that tube complications can be reduced but has not shown that reducing them keeps patients out of the emergency department. Most of the precise return-visit figures in the literature come from children; studies of pediatric laparoscopic gastrostomy, such as Brierley et al. (2026), report 30-day emergency visit rates of about 12% to 14%, which may not transfer to older adults cared for by aging spouses.
Caregiver Burden and Preparedness
Caregivers of people fed by tube carry a heavy and often hidden load. Folwarski et al. (2024) surveyed 90 caregivers at three home nutrition centers. More than half met the screening threshold for depression, nearly one in five described their quality of life as poor, and in the regression model satisfaction with finances and depression were the variables that predicted quality of life. Because the design was cross-sectional, it cannot show whether depression leads to poorer caregiving or the reverse, but it identifies caregivers as a group whose capacity to manage complications cannot be assumed.
How caregivers develop confidence is described in more depth by qualitative work. Santos et al. (2024) followed 15 caregivers through a four-stage educational intervention with telemonitoring after a new gastrostomy and found that early confusion gave way to mastery after hands-on training with feedback from nurses. Complications such as obstruction and accidental tube loss still occurred at home, but caregivers reported being able to manage them. The small sample from one Brazilian unit limits transfer, but the finding that feedback on practice, not information alone, built mastery is directly relevant to teach-back.
Preparedness is the concept that links these findings to measurable outcomes. In a study of 78 older adults and their family caregivers after discharge, Archbold et al. (1990) found that preparedness for caregiving and the quality of the relationship each reduced some, though not all, aspects of caregiver role strain after other variables were controlled. Their scale has since been tested in larger samples; Remr (2026) reported high internal consistency and a single-factor structure in 1,024 interviews from a population-based sample, which supports its use as the preparedness measure in this study.
The preparedness literature also suggests a timing problem that matters for this study. Caregivers are usually taught in the last day or two before discharge, when the patient's medical issues, the family's travel and the paperwork of leaving all compete for attention. Archbold et al. (1990) measured preparedness weeks after discharge, and Santos et al. (2024) found that confidence came only after repeated practice, which together suggest that a single teaching session on the day of discharge may leave caregivers less prepared than they appear. A teaching method that confirms skill before the caregiver leaves, and that spreads practice over at least two sessions, answers that problem more directly than adding pages to the booklet.
Teach-Back as a Teaching Method
Teach-back has a broad but uneven evidence base. Talevski et al. (2020) reviewed 20 studies and found teach-back effective in 19, but the studies differed widely in setting, population and outcome, only four earned a high quality rating, and just half described how teach-back was built into routine practice. A more recent meta-analysis by Vick et al. (2026) limited inclusion to 18 randomized trials with 1,985 adult patients or care partners and teach-back delivered in a single encounter. It found a large increase in self-efficacy across five trials, with a standardized mean difference of 2.40, but no clear pattern of effect on knowledge, and the certainty of evidence was very low throughout.
Only a few studies have taught caregivers rather than patients. Huang et al. (2023) assigned 78 caregivers of patients beginning hemodialysis to teach-back education or routine teaching by order of recruitment and reported lower anxiety, lower depression and better care ability in the teach-back group at discharge, three months and six months. The nonrandomized allocation, the extra telephone contact given only to the intervention group and the single site limit what the study can show, but it is the closest model for the intervention proposed here.
Summary of Key Evidence
The nine studies most central to the research questions are summarized below.
| Source | Design and sample | Main finding | Relevance |
|---|---|---|---|
| Amaratunga et al. (2023) | Systematic review, 11 studies of adults | Education and multimodal programs cut complications; unplanned encounters unchanged | Outcome gap for research question 1 |
| Archbold et al. (1990) | Longitudinal, 78 caregiver dyads | Preparedness eased some aspects of role strain | Defines the preparedness variable |
| Brierley et al. (2026) | Retrospective cohort, 916 children | About 12% to 14% had an emergency visit within 30 days | Benchmark from a different population |
| Folwarski et al. (2024) | Cross-sectional, 90 caregivers | 57% depressed; 19% poor quality of life | Caregiver burden |
| Huang et al. (2023) | Nonrandomized trial, 78 caregivers | Teach-back improved care ability and mood | Model for the intervention |
| Remr (2026) | Psychometric study, 1,024 interviews | Preparedness scale reliable, single factor | Supports the instrument |
| Santos et al. (2024) | Qualitative descriptive, 15 caregivers | Mastery came from practice with feedback | Mechanism of teach-back |
| Talevski et al. (2020) | Systematic review, 20 studies | Effective in 19 of 20, mostly moderate quality | Evidence for the method |
| Vick et al. (2026) | Meta-analysis, 18 trials | Large gain in self-efficacy, very low certainty | Strength of evidence |
Synthesis and Gap
Read together, the studies point in one direction but stop short of an answer. Home tube feeding produces preventable complications and unplanned care; caregivers are burdened, and their preparedness is linked to how strained they become; and teach-back, especially when it involves practice with feedback, builds confidence and self-efficacy. What no study has tested is whether nurse-delivered teach-back for family caregivers of adults with a new gastrostomy reduces tube-related emergency visits in the 30 days after discharge, the period when inexperience is greatest. The review by Amaratunga et al. (2023) found that even successful programs did not reduce unplanned encounters, which makes emergency visits the outcome most in need of study. The proposed study addresses this gap directly, and its two-group design, described in Part 3, responds to the reviewers' concern about the quality of earlier evidence by enrolling consecutive caregivers, standardizing the intervention and measuring outcomes the same way in both groups.
References
Amaratunga, H., Bostock, K., Cunich, M., Steffens, D., & Carey, S. (2023). Systematic review of service improvements for home enteral tube feeding in adults. Nutrition in Clinical Practice, 38(2), 329-339. https://doi.org/10.1002/ncp.10900
Archbold, P. G., Stewart, B. J., Greenlick, M. R., & Harvath, T. (1990). Mutuality and preparedness as predictors of caregiver role strain. Research in Nursing & Health, 13(6), 375-384. https://doi.org/10.1002/nur.4770130605
Brierley, S. F., Hare, R., Payne, R., Wang, C., Egan, C., Garvey, E. M., Hansen, E. N., Harris, J. C., Jamshidi, R., McGovern, P. E., McMahon, L. E., Molitor, M. S., Notrica, D. M., van Leeuwen, K., Padilla, B. E., & Fraser, J. D. (2026). Postoperative complications after laparoscopic gastrostomy tube placement: Does gastropexy suture technique matter? Journal of Pediatric Surgery. Advance online publication. https://doi.org/10.1016/j.jpedsurg.2026.163454
Folwarski, M., Maciejewska-Cebulak, M., Skonieczna-Żydecka, K., Sumlet, M., Kupiec, M., Jankowska, B., Kwella, B., Balul, G., Szafrański, W., & Kłęk, S. (2024). Quality of life of caregivers of patients on home enteral nutrition. Clinical Nutrition, 43(9), 1983-1990. https://doi.org/10.1016/j.clnu.2024.07.011
Huang, J., Lin, X., Xiong, D., Huang, K., Luo, X., Lin, Q., Li, M., & Zhang, P. (2023). Impact of the teach-back method on caregiver outcomes using the "Timing it Right" framework for hemodialysis patients. Frontiers in Public Health, 11, Article 1123006. https://doi.org/10.3389/fpubh.2023.1123006
McGrath, K., Schotz, K., Dobak, S., & Ziegler, J. (2026). Gastrostomy tube care, replacement, and removal: Expanding the registered dietitian nutritionist scope of practice to provide more comprehensive enteral nutrition support and ongoing patient-centered care. Nutrition in Clinical Practice, 41(4), 1007-1019. https://doi.org/10.1002/ncp.70152
Remr, J. (2026). Psychometric validation of the Caregiver Preparedness Scale in a population-based sample. Nursing Reports, 16(4), Article 115. https://doi.org/10.3390/nursrep16040115
Santos, J. M. D., Pedreira, L. C., Góes, R. P., Souza, M. A. A., Baixinho, C. R. S. L., Ortega, J., De La Rosa, R. N., Sousa, A. R., Silva, V. A. D., Pinto, I. S., Santos, J. L. P., Vivas, L. C., & Oliveira, L. M. S. (2024). Caregivers' mastery in handling gastrostomy at home after educational intervention: Qualitative descriptive study. Healthcare, 12(21), Article 2147. https://doi.org/10.3390/healthcare12212147
Talevski, J., Wong Shee, A., Rasmussen, B., Kemp, G., & Beauchamp, A. (2020). Teach-back: A systematic review of implementation and impacts. PLOS ONE, 15(4), Article e0231350. https://doi.org/10.1371/journal.pone.0231350
Vick, J. B., Pace, R., Klimek-Johnson, P., Rushton, S., Roberts, M., Lewinski, A., Neiman, J. H., Chen, D., Joseph, L., Der, T., Gordon, A. M., Jacobs, M., Crossgrove, R., Hoenig, H., Cantrell, S., Sims, C., Namasingh, N., Thornlow, D., Alishahi, A., . . . Goldstein, K. M. (2026). Teach-back in clinical communication: A systematic review and meta-analysis. Journal of General Internal Medicine. Advance online publication. https://doi.org/10.1007/s11606-026-10678-y
Wilmskoetter, J., Simpson, A. N., Logan, S. L., Simpson, K. N., & Bonilha, H. S. (2018). Impact of gastrostomy feeding tube placement on the 1-year trajectory of care in patients after stroke. Nutrition in Clinical Practice, 33(4), 553-566. https://doi.org/10.1002/ncp.10015
What the NURS 500 Week 4 instructions ask
Part 2 of the NURS 500 proposal is the literature review. The course guide sets it in Module/Week 4 at 100 points, inside a proposal of 9 to 16 pages and 10 to 15 references overall, so Part 2 usually carries most of those references. The review should explain how the search was done, organize the evidence by theme or variable, compare designs and findings across studies, and judge the strength of the evidence rather than only report it. It should end by showing the gap the proposed study fills and linking that gap to the research questions from Part 1. Many instructors also want a summary or evidence table, and sources published within roughly five years, with older work kept only for a landmark study or an instrument.
How this NURS 500 Week 4 example is built
A brief account of the databases, years and terms used comes first, so the reader can judge how complete the evidence base is. It then runs three themes in the order of the research questions: unplanned care after gastrostomy, caregiver burden and preparedness, and teach-back. Inside each theme the paper compares studies by design and sample, for example setting a 90-caregiver cross-sectional survey beside a 15-caregiver qualitative study, and states what each design can and cannot show. An APA-style table summarizes the nine core sources. The synthesis section pulls the themes together, and the gap statement repeats the population, intervention and outcome of research question one so the link to Part 1 is exact.
NURS 500 Week 4 grading rubric: where the points go
A literature review in NURS 500 is typically graded on synthesis, critical appraisal, organization, relevance to the research questions and APA 7 mechanics. Synthesis earns the most: the rubric rewards sentences that compare and contrast findings across studies over paragraphs that summarize one article at a time. Appraisal points come from naming design, sample size and limitations, and from noting when evidence is low in quality or comes from a different population. Organization means headings by theme with a clear order, and relevance means every theme ties back to a variable in Part 1. Mechanics cover citation accuracy, the reference list, table formatting and scholarly sources within the expected date range.
NURS 500 Week 4 help: mistakes that cost points
The mistake that costs the most points in Part 2 is the annotated-bibliography review, where each paragraph begins with an author's name and summarizes one study. Organize by theme instead and let several studies share a paragraph. Students also lose points when they accept every finding at face value; say when a study is cross-sectional, small, pediatric or rated low in quality. Another common problem is a review that drifts away from the research questions, such as a long section on tube placement techniques when the study is about caregiver teaching. Keep the search statement short but specific, avoid quoting long passages, and make sure the gap at the end matches the question you wrote in Part 1.
Related NURS 500 sample papers
Other NURS 500 weeks
- NURS 500 Week 1: Discussion Forum 1 Research and EBP
- NURS 500 Week 3: Research Proposal Part 1
- NURS 500 Week 5: Research Proposal Part 3 Methodology
- NURS 500 Week 6: Proposal Part 4 Measurement
- NURS 500 Week 7: Research Article Critique
- NURS 500 Week 8: Discussion Forum 2 Into Practice
NURS 500 Week 4 questions, answered
How do I organize the NURS 500 literature review?
Organize it by theme or by study variable, not by article. Each theme should compare several studies, judge the quality of the evidence and end with what is still unknown, and the themes should follow the order of your research questions.
Where can I find a free NURS 500 Week 4 sample paper?
The full Part 2 literature review on gastrostomy caregivers and teach-back is published on this page with its evidence table, reference list and margin notes, all free to read.
How many sources does the NURS 500 literature review need?
The course guide asks for 10 to 15 references across the whole proposal, and most of them appear in Part 2. Use peer-reviewed studies from the last five years plus any classic theory or instrument sources.
Should a NURS 500 literature review include a table?
A summary table is not always required, but it helps the reader compare design, sample and findings at a glance. Keep the narrative synthesis in the text and use the table as a supplement.
What is a gap statement in a literature review?
It is a short paragraph that names what the published evidence has not yet shown and explains how the proposed study will address it. It should repeat the population, variables and outcome of your main research question.
Use it as a model, or ask for your own
This paper is an original model written by our desk for study. It is not a submitted student paper and not an official Liberty University document. Read it for structure and reasoning, then write your own to the instructions in your Canvas course. If you want a version built to your exact prompt and rubric, the first custom sample is free and arrives in 24 to 48 hours.
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