Paper Type

Doctoral Dissertation


Brooks College of Health

Degree Name

Doctor of Clinical Nutrition (DCN)


Nutrition & Dietetics

NACO controlled Corporate Body

University of North Florida. Department of Nutrition & Dietetics

First Advisor

Dr. Lauri Wright, PhD, RDN, LD/N, FAND

Second Advisor

Dr. Andrea Y. Arikawa PhD, MPH, RDN, LD/N, FAND

Third Advisor

Dr. Sherri Lewis, DCN, RDN, LDN, FAND

Fourth Advisor

Dr. Casey Colin, DCN, RDN, LD/N, FAND


A Home Enteral Nutrition (HEN) case manager position was implemented within the Tampa Veteran’s Health System (VHS) to coordinate and ensure that the transition process from the hospital into the home setting with a new feeding tube transpires smoothly. The Knowledgeto-Action (KTA) theoretical framework was used in this quality improvement project to incorporate a systematic step-by-step process to transition evidence into practice, and assess the effectiveness as well as the sustainability of maintaining a HEN case manager position within the Tampa VHS. 1 In a repeated cross-sectional study design, HEN case management data Pre-Case Management, Post-Case Management with 1-RD case manager, and Post-Case Management with multiple registered dietitian (RD) case managers within the Tampa VHS was collected and analyzed. The results revealed that having one or more RD HEN case managers have a positive impact on tube feeding complications as the number of cases with tube feeding complications, and the total number of tube-feeding complications decreased post case management. The predictors of tube feeding complications within the Tampa VHS included having a J-tube, GJtube, if the RD is notified prior to discharge, and when the RD follow up 7-days post discharge. These factors reflect that staffing and involving the RD for the care and management of new feeding tubes is essential. This will help minimize tube-feeding complications and challenges patients may experience as they transition from the hospital to home with a new feeding tube.

This study will help healthcare providers learn more about the contributors and/or predictors of tube feeding (TF) complications that Veterans experience with newly placed feeding tubes. This study revealed the impact the HEN RD case management position had on TF complications as well as which model was most effective for Tampa VHS hospital system.

Available for download on Monday, July 21, 2025