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Turan M, Cengiz Z, Olmaz D. Evidence-Based Investigation of Nurses' Nutrition Interventions in Intensive Care Patients Regarding Enteral Nutrition. Dimens Crit Care Nurs 2024; 43:123-129. [PMID: 38564454 DOI: 10.1097/dcc.0000000000000639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2024] Open
Abstract
AIM The aim of this study was to examine the practices and knowledge levels of nurses regarding enteral nutrition interventions in intensive care unit patients in terms of evidence. METHOD This cross-sectional study was conducted in 2 hospitals between May and August 2021. A total of 136 nurses working in the intensive care units of the hospitals completed online questionnaires including demographic characteristics and questions about enteral nutrition. RESULTS According to the nurses' knowledge level about the indication of enteral nutrition formulas, the following were incorrect or incomplete: their knowledge about transition to parenteral nutrition in case of nutritional contraindications, what to do when the amount of gastric residual volume in tolerance is >500 mL every 6 hours, the conditions for starting enteral nutrition, and which formulas are appropriate to use. Regarding their knowledge about enteral feeding tubes/sets, their knowledge about radiologic imaging after tube placement, measurement of gastric pH level, and marking the tube location was insufficient. Differently, the correct answer percentages of the nurses in 11 of the 13 questions regarding the principles of enteral nutrition practice were above 70%. CONCLUSION Nurses had adequate knowledge of the principles of enteral nutrition practice, but their knowledge of the indication of enteral nutrition formulas and the evidence for enteral feeding tubes/sets varied. The results showed that nurses need to gain information about the indication of enteral nutrition formulas and evidence related to enteral feeding tubes/sets.
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Enteral Nutrition Practice and Associated Factors Among Intensive Care Unit Nurses in South Korea. TOP CLIN NUTR 2023. [DOI: 10.1097/tin.0000000000000295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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3
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Hamdan M, Zidan S, Badrasawi M, Shweikeh H, Al-Masri R, Al-Khateeb R. Palestinian nurses' knowledge, attitudes, and practices regarding enteral nutrition: Cross-sectional study. Appl Nurs Res 2022; 63:151545. [PMID: 35034702 DOI: 10.1016/j.apnr.2021.151545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 08/31/2021] [Accepted: 11/15/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND Enteral nutrition support plays a key role in minimizing malnutrition in critically-ill patients, and its provision is originally a nurse's responsibility. Thus, nurses need to have a sufficient knowledge and a positive attitude with regard to enteral nutrition. In Palestine, literature regarding nurses' knowledge, practices, and attitudes of enteral nutrition is rare. OBJECTIVE This study aimed to investigate Palestinian nurses' knowledge, practices, and attitudes regarding enteral nutrition. METHOD Interview based pre-tested questionnaire was used during data collection procedure. Cronbach Alpha was also used to determine the reliability of knowledge, attitude and practice questionnaire. Descriptive statistics, independent t-test, and ANOVA were performed. RESULTS A total of 325 registered nurses were involved in the final analysis. The mean of the knowledge score is (9.6 ± 2.8) out of 20. It was confirmed that sociodemographic characteristics has no influence on nutrition knowledge score among nurses. The findings also reveal that certain aspects of enteral nutrition practices were consistent with the current guidelines such as flushing the tube and backrest elevation. On the other hand, certain practices showed inconsistency and differences with international guidelines such as checking gastric residual volume. Results also showed that nurses attitudes were positive towards enteral nutrition. CONCLUSION It was found that nurses' have inadequate knowledge regarding enteral nutrition. The findings also showed that enteral nutrition practices among nurses were somewhat incongruent with best current evidence. However, it was noted that they have positive attitudes towards enteral nutrition. Promoting research utilization is highly needed as well as establishing evidence-based guidelines.
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Affiliation(s)
- May Hamdan
- Department of Healthy and Therapeutic Nutrition, Faculty of Medicine and Health Sciences, Palestine Polytechnic University, Hebron, West Bank, Palestine.
| | - Souzan Zidan
- Department of Nutrition and Food Technology, Faculty of Agriculture, Hebron University, Hebron, West Bank, Palestine
| | - Manal Badrasawi
- Department of Nutrition and Food Technology, Faculty of Agriculture and Veterinary Medicine, An-Najah National University, Nablus, West Bank, Palestine
| | - Hammam Shweikeh
- Department of Healthy and Therapeutic Nutrition, Faculty of Medicine and Health Sciences, Palestine Polytechnic University, Hebron, West Bank, Palestine
| | - Reem Al-Masri
- Department of Healthy and Therapeutic Nutrition, Faculty of Medicine and Health Sciences, Palestine Polytechnic University, Hebron, West Bank, Palestine
| | - Rana Al-Khateeb
- Department of Healthy and Therapeutic Nutrition, Faculty of Medicine and Health Sciences, Palestine Polytechnic University, Hebron, West Bank, Palestine
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Lyons GCE, Summers MJ, Marshall AP, Chapple LAS. Systematic review of clinicians' knowledge, attitudes, and beliefs about nutrition in intensive care. Nutr Clin Pract 2021; 37:825-842. [PMID: 34617630 DOI: 10.1002/ncp.10785] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Nutrition is a key component of care for critically ill patients; yet nutrition delivery is below international recommendations. In order to improve nutrition delivery to critically ill patients, an understanding of the barriers that prevent guideline adherence is required. It is known that clinicians' knowledge, attitudes, and beliefs of the role of nutrition may act as a potential barrier to nutrition delivery, but whether this remains true in critical care is unknown. The aim of this systematic scoping review was to summarize the literature exploring the knowledge, attitudes, and beliefs of clinicians around nutrition support in critically ill patients. A search of four online databases (MEDLINE via Ovid, Emcare via Ovid, PsycINFO, and CINAHL via EBSCOhost) was conducted on August 14, 2020, to identify literature that reported on clinicians' knowledge, attitudes, and beliefs of nutrition in adult intensive care patients. Data were extracted on study and participant characteristics, methodology, and key study outcomes related to nutrition. Eighteen articles met eligibility criteria and were included in the review. Key findings included the following: nutrition was seen as a priority that ranked below life-saving interventions; differences in perceived clinician responsibilities exist; common barriers to nutrition delivery included inadequate resourcing, lack of nutrition protocols, and gastrointestinal intolerance; and identified facilitators included nutrition education and the presence of a supportive multidisciplinary team. The implementation of nutrition protocols, enhanced clinical nutrition education, and further clarification of roles and responsibilities pertaining to nutrition may assist in improving nutrition delivery in critical care.
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Affiliation(s)
- Gemma C E Lyons
- College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia, Australia
| | - Matthew J Summers
- Adelaide Medical School, The University of Adelaide, Adelaide, South Australia, Australia
- Intensive Care Unit, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Andrea P Marshall
- Gold Coast University Hospital, Southport, Queensland, Australia
- Griffith University, Gold Coast Campus, Southport, Queensland, Australia
| | - Lee-Anne S Chapple
- Adelaide Medical School, The University of Adelaide, Adelaide, South Australia, Australia
- Intensive Care Unit, Royal Adelaide Hospital, Adelaide, South Australia, Australia
- Centre of Research Excellence in Translating Nutritional Science to Good Health, The University of Adelaide, Adelaide, Australia
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Heidarzadi E, Jalali R, Hemmatpoor B, Salari N. The comparison of capnography and epigastric auscultation to assess the accuracy of nasogastric tube placement in intensive care unit patients. BMC Gastroenterol 2020; 20:196. [PMID: 32571235 PMCID: PMC7306926 DOI: 10.1186/s12876-020-01353-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Accepted: 06/17/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Placement of nasogastric (NG) tubes is a common procedure for patients especially in intensive care units (ICUs). Thus, it is important to determine the correct placement of the tube to prevent misplacement in the airways. Accordingly, the aim of this study was to compare the epigastric auscultation and capnography in assessing the accuracy of NG tube insertion in ICU patients. METHODS In this descriptive comparative study, 60 patients were selected trough convenience sampling. After insertion of the NG tube in a standard method, the accuracy of placement of the tube with both epigastric auscultation and capnography was investigated. The NG tube insertion accuracy was then confirmed via radiography. Data analysis was performed using statistical software SPSS version 23. RESULTS The result showed that capnography had a sensitivity, specificity, and accuracy of 100, 92.5, and 95% respectively, but epigastric auscultation had 90, 80, and 83.4% respectively. The Kappa agreement coefficient between two methods was - 0.759. CONCLUSION The results revealed that the use of the capnography is preferable over the epigastric auscultation to confirm the correct insertion of the NG tube. It is recommended that more than one method be applied to detect and confirm the correct insertion of the NG tube.
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Affiliation(s)
- Elahe Heidarzadi
- Department of Nursing, Faculty of Nursing and Midwifery, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Rostam Jalali
- Department of Nursing, Faculty of Nursing and Midwifery, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Behzad Hemmatpoor
- Department of Nursing, Faculty of Nursing and Midwifery, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Nader Salari
- Department of Nursing, Faculty of Nursing and Midwifery, Kermanshah University of Medical Sciences, Kermanshah, Iran
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7
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What is curbside consultation for the nurse practitioner? J Am Assoc Nurse Pract 2019; 33:29-37. [PMID: 31738271 DOI: 10.1097/jxx.0000000000000322] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Accepted: 08/09/2019] [Indexed: 11/26/2022]
Abstract
BACKGROUND Curbside or informal consultations between clinicians regarding patient care occur frequently in clinical practice. Evaluation of curbside consultation (CC) among nurse practitioners (NPs) is limited. PURPOSE To develop an understanding of NP perceptions of the CC process. METHODOLOGICAL ORIENTATION A qualitative descriptive design was used to assess the context of CCs among NPs. Inductive content analysis was conducted, and Atlas.ti was used to organize the data. SAMPLE Purposive sampling was used to recruit 20 NPs within primary care and specialty settings. CONCLUSIONS Themes describing CC included the description of the CC process, advantages and disadvantages, documentation, legal liability, unspoken rules, and patient-centered engagement. There was a lack of consensus on the boundaries of the CC definition including difficulty in distinguishing a CC from a formal consultation. Generally, the NP acknowledges limitations and views the CC favorably as a helpful tool for receiving practical feedback and expanding learning, collegiality, and collaboration. IMPLICATIONS FOR PRACTICE Findings provide insight regarding the common practice of CC in management of patients at the point of care, what it means to the NP, and a description of the breadth of the CC use. Given its potentially substantial impact on patient care, further assessment of the context of CC among NPs is obligatory.
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Ozen N, Blot S, Ozen V, Arikan Donmez A, Gurun P, Cinar FI, Labeau S. Gastric residual volume measurement in the intensive care unit: an international survey reporting nursing practice. Nurs Crit Care 2018; 23:263-269. [PMID: 30039544 DOI: 10.1111/nicc.12378] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Revised: 06/17/2018] [Accepted: 06/20/2018] [Indexed: 12/15/2022]
Abstract
BACKGROUND Gastric residual volume measurement is routinely used to evaluate the feeding tolerance and gastro-oesophageal reflux in patients receiving enteral feeding therapy in the intensive care unit. However, little supportive evidence for this intervention is available as the usefulness of gastric residual volume measurements in patients receiving enteral feeding therapy in the intensive care is controversial. AIM The aim of this study was to assess the practice of intensive care unit nurses related to gastric residual volume measurement in patients receiving enteral nutrition. METHODS A survey was conducted among a sample of intensive care unit nurses (n = 832) from four hospitals in Turkey (n = 182) and attendees of the Annual Congress of the Flemish Society for Critical Care Nurses in Flanders, Belgium (n = 650). The survey instrument was developed by the researchers based on the related literature. RESULTS A total of 480 nurses completed the questionnaire (response rate = 73%). Gastric residual volume is measured by 98·0% of respondents, with wide variations in the frequency of measuring. A 50-200 mL gastric residual volume is considered problematic by 45·5% (n = 183) of the participants, and only 18·4% (n = 81) reported their practice to be based on a current guideline. Strikingly, more experienced intensive care unit nurses appear to perform gastric residual volume measurements more commonly than their less experienced colleagues (p = 0·004), while the practice is more often reported to be performed in Belgium than in Turkey (p < 0·001). CONCLUSION Gastric residual volume management could be improved by applying current evidence to daily nursing practice. RELEVANCE TO CLINICAL PRACTICE Our results show that increased awareness of these guidelines by nurses is needed to reduce inefficient use of working time and resources, streamline clinical practices and improve patient outcomes. Current gastric residual volume measurement guidelines and up-to-date, relevant training should be provided to nurses.
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Affiliation(s)
- Nurten Ozen
- Faculty of Health Sciences, Istinye University, Istanbul, Turkey
| | - Stijn Blot
- Ghent University, Department of Internal Medicine, Ghent, Belgium
| | - Volkan Ozen
- Okmeydani Training and Research Hospital Kasimpasa Building, Department of Anesthesiology and Reanimation, Istanbul, Turkey
| | | | - Pınar Gurun
- Hacettepe University Hospitals, Nursing Services Directorate of Adult Hospital University, Ankara, Turkey
| | - Fatma Ilknur Cinar
- University of Health Sciences, Gulhane School of Nursing, Ankara, Turkey
| | - Sonia Labeau
- University College Ghent, Faculty of Education, Health and Social Work, Ghent, Belgium
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Kim H, Chang SJ. Implementing an educational program to improve critical care nurses' enteral nutritional support. Aust Crit Care 2018; 32:218-222. [PMID: 29759596 DOI: 10.1016/j.aucc.2018.04.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2017] [Revised: 03/29/2018] [Accepted: 04/01/2018] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND Although international nutrition societies recommend enteral nutrition guidelines for patients in intensive care units (ICUs), large gaps exist between these recommendations and actual clinical practice. Education programs designed to improve nurses' knowledge about enteral nutrition are therefore required. In Korea, there are no educational intervention studies about evidence-based guidelines of enteral nutrition for critically ill patients. OBJECTIVES We aimed to evaluate the effects of an education program to improve critical care nurses' perceptions, knowledge, and practices towards providing enteral nutritional support for ICU patients. METHODS A quasi-experimental, one-group study with a pre- and post-test design was conducted from March to April 2015. Nurses (N = 205) were recruited from nine ICUs from four tertiary hospitals in South Korea. The education program comprised two sessions of didactic lectures. Data were collected before (pre-test) and 1 month after (post-test) the education program using questionnaires that addressed nurses' perceptions, knowledge, and practices relating to providing enteral nutritional support for ICU patients. RESULTS After the program, nurses showed a significant improvement in their perceptions and knowledge of enteral nutrition for ICU patients. There was a significant improvement in inspecting nostrils daily, flushing the feeding tube before administration, providing medication that needs to be crushed correctly, changing feeding sets, and adjusting feeding schedules. CONCLUSIONS The findings indicate that an enteral nutrition education program could be an effective strategy to increase critical care nurses' support for the critically ill. This education program can be incorporated into hospital education or in-service training for critical care nurses to strengthen their perceptions and knowledge of nutritional support in the ICU. This may improve the clinical outcomes of ICU patients.
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Affiliation(s)
- Hyunjung Kim
- Division of Nursing & Research Institute of Nursing Science, Hallym University, Chuncheon, South Korea.
| | - Sun Ju Chang
- College of Nursing & Research Institute of Nursing Science, Seoul National University, Seoul, South Korea.
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10
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Nurse's perceptions of barriers to optimal nutritional therapy for hospitalized patients. Clin Nutr ESPEN 2017; 22:92-96. [DOI: 10.1016/j.clnesp.2017.08.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2017] [Revised: 07/18/2017] [Accepted: 08/09/2017] [Indexed: 01/07/2023]
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11
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Papermaster A, Champion JD. The common practice of “curbside consultation”. J Am Assoc Nurse Pract 2017; 29:618-628. [DOI: 10.1002/2327-6924.12500] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2017] [Revised: 06/22/2017] [Accepted: 06/26/2017] [Indexed: 11/08/2022]
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Bloomer MJ, Clarke AB, Morphet J. Nurses' prioritization of enteral nutrition in intensive care units: a national survey. Nurs Crit Care 2017; 23:152-158. [DOI: 10.1111/nicc.12284] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2016] [Revised: 11/04/2016] [Accepted: 12/20/2016] [Indexed: 11/28/2022]
Affiliation(s)
- Melissa J Bloomer
- School of Nursing & Midwifery and Centre for Quality and Patient Safety; Deakin University; Burwood Victoria Australia
| | - Angelique B Clarke
- School of Nursing & Midwifery; Monash University; Frankston Victoria Australia
- Intensive Care Unit, Peninsula Health; Frankston Victoria Australia
| | - Julia Morphet
- School of Nursing and Midwifery; Monash University; Frankston Victoria Australia
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13
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Intensive care nurses' knowledge of enteral nutrition: A descriptive questionnaire. Intensive Crit Care Nurs 2016; 37:68-74. [PMID: 27554608 DOI: 10.1016/j.iccn.2016.07.001] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2016] [Revised: 05/25/2016] [Accepted: 07/27/2016] [Indexed: 11/23/2022]
Abstract
BACKGROUND Nurses have an important role in the delivery and management of enteral nutrition in critically ill patients, to prevent iatrogenic malnutrition. It is not clear how nurses source enteral nutrition information. OBJECTIVE This study aimed to explore Australian nurses' enteral nutrition knowledge and sources of information. DESIGN Data were collected from members of the Australian College of Critical Care Nurses in May 2014 using an online questionnaire. A combination of descriptive statistics and non-parametric analyses were undertaken to evaluate quantitative data. Content analysis was used to evaluate qualitative data. RESULTS 359 responses were included in data analysis. All respondents were Registered Nurses with experience working in an Australian intensive care unit or high dependency unit. Most respondents reported their enteral nutrition knowledge was good (n=205, 60.1%) or excellent (n=35, 10.3%), but many lacked knowledge regarding the effect of malnutrition on patient outcomes. Dietitians and hospital protocols were the most valuable sources of enteral nutrition information, but were not consistently utilised. CONCLUSION Significant knowledge deficits in relation to enteral nutrition were identified. Dietitians were the preferred source of nurses' enteral nutrition information, however their limited availability impacted their efficacy as an information resource. Educational opportunities for nurses need to be improved to enable appropriate nutritional care in critically ill patients.
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Montgomery K, Belongia M, Schulta C, Mulberry MH, Nugent ML, Simpson PM. Health Care Providers’ Perceptions of Nutrition Support in Pediatric Oncology and Hematopoietic Stem Cell Transplant Patients. J Pediatr Oncol Nurs 2015; 33:265-72. [DOI: 10.1177/1043454215616604] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Persenius M, Hall-Lord ML, Wilde-Larsson B, Carlsson E. Clinical nursing leaders' perceptions of nutrition quality indicators in Swedish stroke wards: a national survey. J Nurs Manag 2015; 23:705-15. [PMID: 26340320 DOI: 10.1111/jonm.12199] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/15/2013] [Indexed: 12/18/2022]
Abstract
AIM To describe nursing leaders' perceptions of nutrition quality in Swedish stroke wards. BACKGROUND A high risk of undernutrition places great demand on nutritional care in stroke wards. Evidence-based guidelines exist, but healthcare professionals have reported low interest in nutritional care. The Donabedian framework of structure, process and outcome is recommended to monitor and improve nutrition quality. METHOD Using a descriptive cross-sectional design, a web-based questionnaire regarding nutritional care quality was delivered to eligible participants. RESULT Most clinical nursing leaders reported structure indicators, e.g. access to dieticians. Among process indicators, regular assessment of patients' swallowing was most frequently reported in comprehensive stroke wards compared with other stroke wards. Use of outcomes to monitor nutrition quality was not routine. Wards using standard care plans showed significantly better results. CONCLUSION Using the structure, process and outcome framework to examine nutrition quality, quality-improvement needs became visible. To provide high-quality nutrition, all three structure, process and outcome components must be addressed. IMPLICATIONS FOR NURSING MANAGEMENT The use of care pathways, standard care plans, the Senior Alert registry, as well as systematic use of outcome measures could improve nutrition quality. To assist clinical nursing leaders in managing all aspects of quality, structure, process and outcome can be a valuable framework.
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Affiliation(s)
- Mona Persenius
- Faculty of Health, Science, and Technology, Department of Health Sciences, Karlstad University, Karlstad, Sweden
| | - Marie-Louise Hall-Lord
- Faculty of Health, Science, and Technology, Department of Health Sciences, Karlstad University, Karlstad, Sweden.,Department of Nursing, Gjøvik University College, Elverum, Norway
| | - Bodil Wilde-Larsson
- Faculty of Health, Science, and Technology, Department of Health Sciences, Karlstad University, Karlstad, Sweden.,Department of Nursing, Hedmark University College, Elverum, Norway
| | - Eva Carlsson
- Centre for Health Care Sciences, Örebro University Hospital, School of Health and Medical Sciences, Örebro University, Örebro, Sweden.,Department of Quality and Patient Safety, Lindesberg Hospital, Lindesberg, Sweden
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Williams-Hooker R, Adams M, Havrilla DA, Leung W, Roach RR, Mosby TT. Caregiver and health care provider preferences of nutritional support in a hematopoietic stem cell transplant unit. Pediatr Blood Cancer 2015; 62:1473-6. [PMID: 25809410 DOI: 10.1002/pbc.25473] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2014] [Accepted: 01/21/2015] [Indexed: 01/25/2023]
Abstract
BACKGROUND Many pediatric oncology patients undergoing hematopoietic stem cell transplantation (HSCT) require nutritional support (NS) because of their inability to consume adequate caloric intake enough calories orally. Although NS can be provided either enteraly (EN) or parenteraly (PN), EN is the preferred method of NS as long as if the gastrointestinal tract is functioning. In this qualitative study, we determined the type of NS preferences and the reservations of caregivers of pediatric HSCT patients undergoing hematopoietic stem cell transplantation (HSCT) as well as those of health care (HC) providers working on the HSCT unit. PROCEDURES A survey was developed and completed anonymously by HC providers and caregivers. The hypothesis was that HC providers and caregivers would prefer PN because it is convenient to use in patients who already have a central line in place. RESULTS Most caregivers preferred PN to EN, while most HC providers preferred EN to PN. The barrier between EN initiation and caregivers' approval was the caregivers' perception that EN was invasive and painful, most common obstacle for initiation of EN among caregivers was that it hurts/is invasive, while the barrier with HC providers was vomiting and/abdominal pain associated with EN. CONCLUSIONS If caregivers were better educated about NS and the advantages/disadvantages of the different forms of NS, their preferences may change. There have been policy changes at St. Jude have been implemented since this study, and an outpatient dietitian now provides education to caregivers about NS during the pre-evaluation for HSCT.
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Affiliation(s)
- Ruth Williams-Hooker
- Clinical Nutrition Masters/Dietetic Internship Program, The University of Memphis, Memphis, Tennessee
| | | | - David A Havrilla
- Department of Food and Nutrition, Region One Medical Center, Memphis, Tennessee
| | - Wing Leung
- Bone Marrow Transplantation and Cellular Therapy, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Robin R Roach
- Master's Program in Environmental Nutrition, The University of Memphis, Memphis, Tennessee
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Kalaldeh MA, Watson R, Hayter M. Jordanian intensive care nurses' perspectives on evidence-based practice in nutritional care. ACTA ACUST UNITED AC 2015; 23:1023-9. [PMID: 25345451 DOI: 10.12968/bjon.2014.23.19.1023] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
This study aimed to explore Jordanian nurses' perspectives on the implementation of evidence-based practice and team-working related to nutritional care in the critically ill. Poor adherence to evidence-based practice and poor collaboration may contribute to nutritional failure. Fourteen critical care nurses from three healthcare sectors in Jordan were selected purposively and interviewed using semi-structured interviews. The information obtained was subjected to a thematic analysis. Four themes emerged from the study: 'undertaking nutritional responsibilities', 'approaching evidence-based practice', 'multidisciplinary team working' and 'consequences of enteral nutrition care deficits'. Although evidence-based practice was emphasised by nurses, lack of evidence-based resources, and ineffective aspiration reduction measures were found to impede adherence to evidence-based practice. Multidisciplinary team working was introduced as means to improve practice. However, ineffective nursing involvement and poor interaction were obstacles to effective sharing.
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Darawad MW, Hammad S, Al-Hussami M, Haourani E, Aboshaiqah AE, Hamdan-Mansour AM. Investigating critical care nurses' perception regarding enteral nutrition. NURSE EDUCATION TODAY 2015; 35:414-419. [PMID: 25497040 DOI: 10.1016/j.nedt.2014.11.023] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/03/2014] [Revised: 11/07/2014] [Accepted: 11/25/2014] [Indexed: 06/04/2023]
Abstract
BACKGROUND Evidences showed that nurses lack the needed knowledge to administer nutritional care. Besides, nutritional information was found to be incomplete in patients' record, and nurses' responsibilities regarding EN were not well understood. In Jordan, literature regarding nurses' perceptions of EN is scarce. AIM To investigate critical care nurses' perceptions regarding enteral nutrition (EN) of critically-ill adult patients. METHODS A descriptive, cross-sectional, comparative design was used to collect data from 151 Jordanian critical care nurses utilizing the Nurses' Perception of Enteral Nutrition Questionnaire. RESULTS Nurses in private hospitals scored the highest in regard to responsibility and support from documentation. Education, internet, and nursing school were the primary sources of EN knowledge. Besides, female nurses differ significantly from male nurses in regard to the perception of responsibility of EN. CONCLUSION Awareness of responsibility, supportive documentation system, and implementation of the current evidences of EN in the actual daily practices can be used to improve EN practices.
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Affiliation(s)
| | - Sawsan Hammad
- Faculty of Nursing, The University of Jordan, Amman 11942, Jordan.
| | | | - Eman Haourani
- Faculty of Nursing, The University of Jordan, Amman 11942, Jordan.
| | | | - Ayman M Hamdan-Mansour
- Faculty of Nursing, The University of Jordan, Amman 11942, Jordan; Department of Nursing, Al Farabi College, Riyadh 11514, Saudi Arabia.
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Al Kalaldeh M, Watson R, Hayter M. Jordanian nurses' knowledge and responsibility for enteral nutrition in the critically ill. Nurs Crit Care 2013; 20:229-41. [PMID: 24279734 DOI: 10.1111/nicc.12065] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2012] [Revised: 08/02/2013] [Accepted: 09/30/2013] [Indexed: 01/04/2023]
Abstract
BACKGROUND Poor nursing adherence to evidence-based guidelines has negative consequences leading to higher mortality rates, delayed recovery and longer length of stay. Evidence-based practice has the potential to minimize complications and discrepancies between nurses. AIM This study aimed to assess nurses' practice and perception of their knowledge and responsibility in relation to enteral nutrition (EN) in the critically ill. DESIGN AND METHODS This descriptive correlational design was applied to nurses working in intensive care units (ICUs) from three health care sectors in Jordan (Governmental, Military and Private sectors). Nurses were recruited using a stratified sampling technique. A pre-prepared questionnaire focusing on nurses' practice and perception towards EN was used. RESULTS A total of 253 ICU nurses completed the questionnaire. Nurses revealed a tendency to undertake nutritional care despite the recognition clinical nutrition is a secondary role. In terms of nursing processes, nurses showed greater levels of knowledge and responsibility for 'preventing complications' and 'evaluation' more than 'assessment' and 'identifying goals'. Nurses inadequately assess both gastric residuals and tube placement before feeding. Diarrhoea was the most frequent complication followed by abdominal pain, vomiting, tube dislodgment and weight loss. However, nurses realized that the incidences of complications is less likely when applying evidence-based protocol. CONCLUSION It is necessary to establish a preliminary assessment for patients' nutritional needs prior to using EN. Aspiration reduction measures are still deficient and need further attention. An evidence-based protocol for EN should be adopted in the critically ill. RELEVANCE TO CLINICAL PRACTICE This article provides insight into the current practice of Jordanian intensive care nurses in different health care sectors. The study can contribute to redirect the perception of nurses towards nutrition in the critically ill in addition to enhance positive adherence to evidence base.
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Affiliation(s)
| | - Roger Watson
- Faculty of Health and Social Care, Professor of Nursing, University of Hull, Hull HU6 7RX, UK
| | - Mark Hayter
- Faculty of Health and Social Care, Professor of Nursing, University of Hull, Hull HU6 7RX, UK
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Bjerrum M, Tewes M, Pedersen P. Nurses’ self-reported knowledge about and attitude to nutrition - before and after a training programme. Scand J Caring Sci 2011; 26:81-9. [DOI: 10.1111/j.1471-6712.2011.00906.x] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Marshall AP, West SH, Aitken LM. Preferred information sources for clinical decision making: critical care nurses' perceptions of information accessibility and usefulness. Worldviews Evid Based Nurs 2011; 8:224-35. [PMID: 21649854 DOI: 10.1111/j.1741-6787.2011.00221.x] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Variability in clinical practice may result from the use of diverse information sources to guide clinical decisions. In routine clinical practice, nurses privilege information from colleagues over more formal information sources. It is not clear whether similar information-seeking behaviour is exhibited when critical care nurses make decisions about a specific clinical practice, where extensive practice variability exists alongside a developing research base. PURPOSE This study explored the preferred sources of information intensive care nurses used and their perceptions of the accessibility and usefulness of this information for making decisions in clinically uncertain situations specific to enteral feeding practice. METHODS An instrumental case study design, incorporating concurrent verbal protocols, Q methodology and focus groups, was used to determine intensive care nurses' perspectives of information use in the resolution of clinical uncertainty. FINDINGS A preference for information from colleagues to support clinical decisions was observed. People as information sources were considered most useful and most accessible in the clinical setting. Text and electronic information sources were seen as less accessible, mainly because of the time required to access the information within the documents. DISCUSSION When faced with clinical uncertainty, obtaining information from colleagues allows information to be quickly accessed and applied within the context of a specific clinical presentation. Seeking information from others also provides opportunities for shared decision-making and potential validation of clinical judgment, although differing views may exacerbate clinical uncertainty. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE The social exchange of clinical information may meet the needs of nurses working in a complex, time-pressured environment but the extent of the evidence base for information passed through verbal communication is unclear. The perceived usefulness and accessibility of information is premised on the ease of use and access and thus the variability in information may be contributing to clinical uncertainty.
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Affiliation(s)
- Andrea P Marshall
- Sydney Nursing School (MO2), The University of Sydney, Sydney, NSW, Australia.
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Ros C, McNeill L, Bennett P. Review: nurses can improve patient nutrition in intensive care. J Clin Nurs 2009; 18:2406-15. [DOI: 10.1111/j.1365-2702.2008.02765.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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To have and to hold nutritional control: balancing between individual and routine care. A grounded theory study. Intensive Crit Care Nurs 2009; 25:155-62. [PMID: 19395264 DOI: 10.1016/j.iccn.2009.03.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2008] [Revised: 03/16/2009] [Accepted: 03/17/2009] [Indexed: 01/15/2023]
Abstract
OBJECTIVES Gaining insight into nutritional processes can help nurses and other staff in their work. The aim was to provide a theoretical understanding of the concerns and strategies of nutritional nursing care for patients with enteral nutrition in intensive care units. DESIGN A grounded theory approach was used. Observations of patient's nutritional care and twelve interviews with eight registered nurses and four enrolled nurses were conducted. SETTING The study was carried out in one intensive care unit at a medium sized hospital in Sweden. RESULTS The substantive theory developed included the core category "To have and to hold nutritional control - balancing between individual care and routine care". The core category was reflected in and related to the categories "knowing the patient", "facilitating the patient's involvement", "being a nurse in a team", "having professional confidence" and "having a supportive organisation". Finding a balance between individual care and routine care was a way of enhancing the patient's well-being, security and quality of care. CONCLUSION To have and to hold nutritional control over the patient's nutrition was found to be a balancing act between individual care and routine care. Organisation and teamwork are both challenging and supporting the provision, maintenance and development of nutritional care.
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Miller CA, Grossman S, Hindley E, MacGarvie D, Madill J. Are Enterally Fed ICU Patients Meeting Clinical Practice Guidelines? Nutr Clin Pract 2008; 23:642-50. [DOI: 10.1177/0884533608326062] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Affiliation(s)
| | - Sari Grossman
- From Toronto General Hospital, University Health Network
| | - Erin Hindley
- From Toronto General Hospital, University Health Network
| | | | - Janet Madill
- From Toronto General Hospital, University Health Network
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Impact of energy deficit calculated by a predictive method on outcome in medical patients requiring prolonged acute mechanical ventilation. Br J Nutr 2008; 101:1079-87. [PMID: 18778528 DOI: 10.1017/s0007114508055669] [Citation(s) in RCA: 122] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
To assess energy balance in very sick medical patients requiring prolonged acute mechanical ventilation and its possible impact on outcome, we conducted an observational study of the first 14 d of intensive care unit (ICU) stay in thirty-eight consecutive adult patients intubated at least 7 d. Exclusive enteral nutrition (EN) was started within 24 h of ICU admission and progressively increased, in absence of gastrointestinal intolerance, to the recommended energy of 125.5 kJ/kg per d. Calculated energy balance was defined as energy delivered - resting energy expenditure estimated by a predictive method based on static and dynamic biometric parameters. Mean energy balance was - 5439 (sem 222) kJ per d. EN was interrupted 23 % of the time and situations limiting feeding administration reached 64 % of survey time. ICU mortality was 72 %. Non-survivors had higher mean energy deficit than ICU survivors (P = 0.004). Multivariate analysis identified mean energy deficit as independently associated with ICU death (P = 0.02). Higher ICU mortality was observed with higher energy deficit (P = 0.003 comparing quartiles). Using receiver operating characteristic curve analysis, the best deficit threshold for predicting ICU mortality was 5021 kJ per d. Kaplan-Meier analysis showed that patients with mean energy deficit > or =5021 kJ per d had a higher ICU mortality rate than patients with lower mean energy deficit after the 14th ICU day (P = 0.01). The study suggests that large negative energy balance seems to be an independent determinant of ICU mortality in a very sick medical population requiring prolonged acute mechanical ventilation, especially when energy deficit exceeds 5021 kJ per d.
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Persenius MW, Hall-Lord ML, Bååth C, Larsson BW. Assessment and documentation of patients’ nutritional status: perceptions of registered nurses and their chief nurses. J Clin Nurs 2008; 17:2125-36. [DOI: 10.1111/j.1365-2702.2007.02202.x] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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Roynette C, Bongers A, Fulbrook P, Albarran J, Hofman Z. Enteral feeding practices in European ICUs: A survey from the European federation of critical care nursing associations (EfCCNa). ACTA ACUST UNITED AC 2008. [DOI: 10.1016/j.eclnm.2007.10.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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Bourgault AM, Ipe L, Weaver J, Swartz S, O’Dea PJ. Development of Evidence-Based Guidelines and Critical Care Nurses ’ Knowledge of Enteral Feeding. Crit Care Nurse 2007. [DOI: 10.4037/ccn2007.27.4.17] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Affiliation(s)
- Annette M. Bourgault
- Annette M. Bourgault was employed as a clinical nurse specialist in cardiovascular and critical care at Saint Joseph Regional Medical Center at the South Bend and Mishawaka campuses in Indiana when this article was written
| | - Laura Ipe
- Laura Ipe is a clinical dietitian with Saint Joseph Regional Medical Center in South Bend
| | - Joanne Weaver
- Joanne Weaver is an education specialist with Saint Joseph Regional Medical Center in South Bend
| | - Sally Swartz
- Sally Swartz is a medical/surgical/rehabilitation clinical nurse specialist at Saint Joseph Regional Medical Center at the South Bend and Mishawaka campuses
| | - Patrick J. O’Dea
- Patrick J. O’Dea works with Michiana Gastroenterology Inc in South Bend and is a gastroenterologist at Saint Joseph Regional Medical Center in South Bend
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Abstract
PURPOSE OF REVIEW Blind placement of a feeding tube can result in serious complications. Given the widespread use of tube feedings, even a small percentage of such problems can affect a significant number of people. The purpose of this review is to describe recent reports of feeding tube placement problems and to examine possible solutions. RECENT FINDINGS Multiple case reports of complications of malpositioned feeding tubes continue to surface; most are due to inadvertent placement in the respiratory tract. A tube with feeding ports in the esophagus significantly increases risk for aspiration, as does the displacement of a small bowel tube into the stomach of a patient with significantly slowed gastric motility. Isolated reports of a nasally placed tube entering the brain following head injury continue to occur, as do reports of esophageal and gastric perforation in neonates. A recent study showed that malpositioned tubes are not routinely recorded in risk management databases; it further demonstrated that a comprehensive intervention to reduce complications from small-bore nasogastric feeding tubes was effective. SUMMARY Complications related to malpositioned feeding tubes are usually preventable. Poor reporting of feeding tube placement errors hinders the adoption of effective protocols to prevent such errors.
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Affiliation(s)
- Norma A Metheny
- Saint Louis University School of Nursing, St Louis, Missouri 63104, USA.
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