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Pan H, Zhang C, Yang R, Tian P, Song J, Zhang Z. Cognitive influencing factors of ICU nurses on enteral nutrition interruption: a mixed methods study. BMC Nurs 2024; 23:433. [PMID: 38918841 PMCID: PMC11201787 DOI: 10.1186/s12912-024-02098-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2024] [Accepted: 06/17/2024] [Indexed: 06/27/2024] Open
Abstract
BACKGROUND The incidence of clinically avoidable enteral nutrition interruptions is high. ICU nurses, as the implementers and monitors of enteral nutrition, have a close relationship between their cognitive level of enteral nutrition interruption and the incidence of enteral nutrition interruption. The level of ICU nurses' cognition of enteral nutrition interruption and the key factors influencing the level of ICU nurses' cognition of enteral nutrition interruption are not known. OBJECTIVES This study aims to explore the cognitive level of ICU nurses on enteral nutrition interruption and delve into the key factors that affect their cognitive level from the perspective of management. DESIGN A sequential explanatory mixed methods research design was used. METHODS With the convenience sampling method, an online survey questionnaire was distributed to ICU nurses in Chongqing, and 336 valid questionnaires were collected. After the survey, ICU managers were invited to participate in qualitative interviews, in which 10 participants from five hospitals completed face-to-face individual semi-structured interviews and were analyzed with thematic analysis. RESULTS The survey found that ICU nurses had a good level of cognition towards enteral nutrition interruption but poor knowledge about the definition, causes, and consequences of enteral nutrition interruption, as well as negative attitudes toward active learning, assessment, and communication. And the longer work time in the ICU, joining the nutrition team, receiving systematic training, and acquiring relevant knowledge from academic journals more frequently were favorable to improving ICU nurses' knowledge level of enteral nutrition interruption. Personal interviews further identified the key factors affecting their cognitive level, including (1) lack of knowledge, (2) lack of proactive thinking, (3) lack of enteral nutrition management programs, and (4) lack of quality management tools for enteral nutrition interruption. CONCLUSION Although ICU nurses demonstrate a relatively high level of cognition, there is still room for improvement. ICU administrators must take specific measures to improve the knowledge of ICU nurses, especially in non-tertiary hospitals, in order to prevent nurse-induced enteral nutrition interruption in all ICUs and improve medical quality. TRIAL REGISTRATION Not applicable.
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Affiliation(s)
- Huiling Pan
- Intensive Care Unit, The Second Affiliated Hospital of Chongqing Medical University, Yuzhong, Chongqing, People's Republic of China
- School of Nursing, Chongqing Medical University, Yuzhong, Chongqing, People's Republic of China
| | - Chuanlai Zhang
- Intensive Care Unit, The Second Affiliated Hospital of Chongqing Medical University, Yuzhong, Chongqing, People's Republic of China.
- School of Nursing, Chongqing Medical University, Yuzhong, Chongqing, People's Republic of China.
| | - Ruiqi Yang
- Intensive Care Unit, The Second Affiliated Hospital of Chongqing Medical University, Yuzhong, Chongqing, People's Republic of China
- School of Nursing, Chongqing Medical University, Yuzhong, Chongqing, People's Republic of China
| | - Peng Tian
- Intensive Care Unit, The Second Affiliated Hospital of Chongqing Medical University, Yuzhong, Chongqing, People's Republic of China
- School of Nursing, Chongqing Medical University, Yuzhong, Chongqing, People's Republic of China
| | - Jie Song
- Intensive Care Unit, The Second Affiliated Hospital of Chongqing Medical University, Yuzhong, Chongqing, People's Republic of China
- School of Nursing, Chongqing Medical University, Yuzhong, Chongqing, People's Republic of China
| | - Zonghong Zhang
- Intensive Care Unit, The Second Affiliated Hospital of Chongqing Medical University, Yuzhong, Chongqing, People's Republic of China
- School of Nursing, Chongqing Medical University, Yuzhong, Chongqing, People's Republic of China
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Zaher S, Sumairi FA, Ajabnoor SM. Understanding nursing perspective towards barriers to the optimal delivery of enteral nutrition in intensive care settings. BMC Nurs 2024; 23:42. [PMID: 38221619 PMCID: PMC10789044 DOI: 10.1186/s12912-024-01715-4] [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: 10/21/2023] [Accepted: 01/04/2024] [Indexed: 01/16/2024] Open
Abstract
BACKGROUND The management process of Enteral Nutrition (EN) typically involves the interaction between a team of health care practitioners. Nurses being the closest to the patients, have crucial responsibilities and play a major role in feeding delivery along with other medical treatments. This study was conducted to investigate the perception of the nurses working in adult and paediatric intensive care Units (ICUs) regarding the EN barriers and identify the factors that influenced their perception. METHODS The data in this cross-sectional study was collected via online survey between 15 October 2021 and January 2022. All nurses working in adult or paediatric ICUs across Saudi Arabia were eligible to participate. The tool used for the data collection was adapted from Cahill et al. (2016) and then reviewed and modified by the researchers. The survey collected information about the demographics of the nurses, and it included 24 potential EN barriers where the participants were asked to rate their importance on a scale from 1 to 5. Descriptive statistics were performed to describe the variables, univariant analysis were performed to compare the perceptions of the nurses regarding the EN barriers based on their characteristics followed by stepwise linear regression analysis. RESULTS A total of 136 nurses working in adult and paediatric ICUs were included in this study. The results showed that the most important barriers as perceived by the nurses was "Frequent displacement of feeding tube, requiring reinsertion" [3.29 ± 1.28], "Delays in initiating motility agents in patients not tolerating enteral nutrition" [3.27 ± 1.24] and "Enteral formula not available on the unit". [3.27 ± 1.24]. Our results showed that the responses of the participants statistically varied based on their work settings, gender, region, and educational level for some items in the survey (P-value ≤ 0.05). In the regression analysis, gender was the only variable statistically influenced the total Likert rating scores of the participants (r = -0.213, p-value = 0.013). CONCLUSION This study identified several barriers that exist in the nursing practice of EN in critical care settings. There are distinct differences in the perception of the nurses to these barriers based on their characteristics. Understanding such differences is important for implementing future strategies for units that needed the most help in prioritizing EN delivery.
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Affiliation(s)
- Sara Zaher
- Clinical Nutrition Department, Faculty of Applied Medical Sciences, Taibah University, P.O. Box 344, Madinah, 42353, Kingdom of Saudi Arabia.
| | - Futoon Al Sumairi
- Clinical Nutrition Department, Faculty of Applied Medical Sciences, Taibah University, P.O. Box 344, Madinah, 42353, Kingdom of Saudi Arabia
| | - Sarah M Ajabnoor
- Department of Clinical Nutrition, Faculty of Applied Medical Sciences, King Abdulaziz University, Jeddah, Saudi Arabia
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Amir Z, Maroof S, Haider S. A descriptive study on nursing practice environment among public sector nurses in Lahore. HEALTHCARE IN LOW-RESOURCE SETTINGS 2023. [DOI: 10.4081/hls.2023.10658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/11/2023] Open
Abstract
Pakistan is a country where the nursing profession still has to get a good working environment as it is directly related to improved patient care. The nursing practice environment is a key factor that contributes to retention. Bearing in mind the importance of the issue the present study is designed to know the current state of the nursing practice environment. The data were collected from the nurses working in the medical wards and critical care units in the Pakistan Institute of Neurosciences, Lahore. Convenience sampling was used to select the respondents and collect the data. A total of 150 questionnaires were distributed among the nurses and 110 questionnaires were used for the data analysis in Statistical Package for Social Sciences. Frequency, descriptive statistics, reliability, and validity analyses were performed. As per the results of the study, the questionnaire used in the study was reliable and valid. Additionally, the results of the study established that the nursing practice environment is poor asking for concrete steps to make it better for improved patient care delivery. Nurse leaders can dedicate their efforts to the improvement of the nursing practice environment to improve the nurse job outcomes. Further, they can also arrange the trainings for the professional development of the nurses to ensure the better healthcare services delivery. The perceptions of the good nursing practice environment can be fostered among the nurses by having their active participation in the hospital matters and decision making because they are also the key staff in the hospital environment.
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Kappel SS, Maastrup R, Sangild PT, Jakobsen KT, Christensen VB, Aunsholt L. Nurses' and Physicians' Rationale Behind Clinical Performance and Interpretation of Routine Prefeed Gastric Aspiration in Preterm Infants: A Cross-sectional Study. J Perinat Neonatal Nurs 2023; 37:77-83. [PMID: 36548337 DOI: 10.1097/jpn.0000000000000618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
This study aims at understanding the rationale behind performing prefeed gastric aspirations in preterm infants, how nurses and physicians interpret the gastric aspiration and variations between them, and illuminating potential barriers for omitting routine prefeed aspiration. Nurses and physicians from all Danish neonatal intensive care units completed a questionnaire. Of 682 participants, the majority (94%) indicated that they routinely performed prefeed aspiration, primarily to check the feeding tube placement (nurses: 88%, physicians: 46%). Nurses feared necrotizing enterocolitis when observing a large gastric residual (GR) volume (31%) and green-stained GR (63%). Fewer nurses relative to physicians had "no worries" related to large volumes (15% vs 34%) or green-stained GR (14% vs 24%, both P < .01). More nurses than physicians intended to pause enteral feeding when observing green-stained GR (31% vs 16%, P < .01) and more nurses were concerned of completely omitting routine gastric aspirations (90% vs 46%, P < .05). The rationale behind the clinical use of GR volume and color as markers of necrotizing enterocolitis and feeding intolerance differs markedly between nurses and physicians in Denmark. If routine prefeed gastric aspiration should be omitted, special focus on information about early signs of necrotizing enterocolitis and methods to check tube placement is needed.
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Affiliation(s)
- Susanne Soendergaard Kappel
- Departments of Neonatology (MScN Kappel and Drs Maastrup, Sangild, and Aunsholt) and Pediatrics and Adolescent Medicine (Dr Christensen), Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark; Comparative Pediatrics and Nutrition, University of Copenhagen, Copenhagen, Denmark (MScN Kappel and Drs Sangild and Aunsholt); Department of Pediatrics, Odense University Hospital, Odense, Denmark (Dr Sangild); and The Think Tank DEA, Copenhagen, Denmark (Dr Jakobsen)
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Effect of Early Low-Calorie Enteral Nutrition Support in Critically Ill Patients: A Systematic Review and Meta-analysis. BIOMED RESEARCH INTERNATIONAL 2022; 2022:7478373. [PMID: 35832844 PMCID: PMC9273443 DOI: 10.1155/2022/7478373] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Revised: 06/11/2022] [Accepted: 06/14/2022] [Indexed: 11/17/2022]
Abstract
Objective The purpose of this research was to rigorously assess the impact of early low-fever enteral feeding supplementation in critically sick patients. Methods PubMed, Embase, Web of Science, Cochrane Central Register of Controlled Trials, Cumulative Index to Nursing and Allied Health Literature, and Physiotherapy Evidence Database were searched for randomized controlled trials related to enteral nutrition support of critically ill patients (retrieval time was limited to June 30, 2021); data were extracted after screening the literature, and the quality of meta-analysis was evaluated. Results When compared to adequate caloric enteral nutrition support, early low caloric enteral nutrition support reduces the incidence of intolerance to nutrition support (MD = 0.60, 95 percent CI: -0.18 to 1.39, P = 0.13) and the insulin dose during enteral nutrition support (MD = -17.21, 95 percent CI: -19.91 to -14.51, P = 0.00001). However, it had no effect on intensive care unit (ICU) treatment duration (MD = 0.60, 95 percent CI: -0.18 to 1.39, P = 0.13), in-hospital mortality (MD = 0.60, 95 percent CI: -0.18 to 1.39, P = 0.13), or infection incidence (OR = 1.00, 95 percent CI: 0.85, 1.19, P = 0.98). Conclusion When compared to sufficient caloric enteral nutrition support, early low-calorie enteral nutrition support lowers the risk of severe illness. The rate of intolerance to nutritional assistance and the decrease in insulin dosage supplied had no effect on the length of ICU therapy, patient death, or infection incidence.
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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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Lyons GCE, Summers MJ, Schultz TJ, Lambell K, Ridley EJ, Fetterplace K, Yandell R, Chapple LS. Protein prescription and delivery practices in critically ill adults: A survey of Australian and New Zealand intensive care dietitians. Aust Crit Care 2021; 35:543-549. [PMID: 34556388 DOI: 10.1016/j.aucc.2021.08.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Revised: 08/10/2021] [Accepted: 08/11/2021] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Protein provision is thought to be integral to attenuating muscle wasting in critical illness, yet patients receive half of that prescribed. As international guidelines lack definitive evidence to support recommendations, understanding clinicians' views relating to protein practices is of importance. OBJECTIVES The objective of this study was to describe Australia and New Zealand intensive care unit (ICU) dietitians' protein prescription and perceived delivery practices in critically ill adults, including common barriers and associations between ICU clinical experience and protein prescriptions for different clinical conditions. METHODS A 42-item descriptive quantitative survey of Australian and New Zealand intensive care dietitians was disseminated through nutrition and ICU society e-mailing lists. Data were collected on respondent demographics and reported protein practices including questions related to a multitrauma case study. Data were analysed using descriptive and content analysis and reported as n (%). Fisher's exact tests were used to compare experience and protein prescriptions. RESULTS Of the 67 responses received (one excluded due to >50% missing data), more than 80% of respondents stated they would prescribe 1.2-1.5 g protein/kg bodyweight/day for most critically ill patients, most commonly using European Society of Clinical Nutrition and Metabolism (ESPEN) guidelines to support prescriptions (n = 61/66, 92%). Most respondents (n = 49/66, 74%) thought their practice achieved 61-80% of protein prescriptions, with frequently reported barriers including fasting periods (n = 59/66, 89%), avoiding energy overfeeding (n = 50/66, 76%), and gastrointestinal intolerance (n = 47/66, 71%). No associations between years of ICU experience and protein prescriptions for 14 of the 15 predefined clinical conditions were present. CONCLUSIONS Australian and New Zealand ICU dietitians use international guidelines to inform protein prescriptions of 1.2-1.5 g/kg/day for most clinical conditions, and protein prescriptions do not appear to be influenced by years of ICU experience. Key perceived barriers to protein delivery including avoidance of energy overfeeding and gastrointestinal intolerance could be explored to improve protein adequacy.
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Affiliation(s)
- G C E Lyons
- Nutrition and Dietetics, College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia, Australia
| | - M J Summers
- Adelaide Medical School, The University of Adelaide, Adelaide, South Australia, Australia; Intensive Care Unit, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - T J Schultz
- Flinders Health and Medical Research Institute, Flinders University, Adelaide, South Australia, Australia; Adelaide Nursing School, The University of Adelaide, Adelaide, South Australia, Australia
| | - K Lambell
- Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, Australia; Nutrition Department, Alfred Health, Melbourne, Australia
| | - E J Ridley
- Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, Australia; Nutrition Department, Alfred Health, Melbourne, Australia
| | - K Fetterplace
- Allied Health Department (Clinical Nutrition), Royal Melbourne Hospital, Melbourne, Australia; The University of Melbourne, Melbourne Medical School, Department of Medicine and Radiology, Royal Melbourne Hospital, Melbourne, Australia
| | - R Yandell
- Department of Clinical Dietetics, Royal Adelaide Hospital, Port Road, Adelaide, South Australia, Australia
| | - L 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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Malekahmadi M, Pahlavani N, Firouzi S, Clayton ZS, Islam SMS, Rezaei Zonooz S, Moradi Moghaddam O, Soltani S. Effect of enteral immunomodulatory nutrition formula on mortality and critical care parameters in critically ill patients: A systematic review with meta-analysis. Nurs Crit Care 2021; 27:838-848. [PMID: 34323346 DOI: 10.1111/nicc.12687] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Revised: 06/10/2021] [Accepted: 07/02/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Enteral immunomodulatory nutrition is recommended as an adjuvant therapy for patients in intensive care units (ICU), but its effectiveness is incompletely understood. AIM The aim of this review was to examine the effect of a commonly used immunomodulatory formula-omega-3 fatty acids, γ-linolenic acid, and antioxidants-on clinical outcomes and mortality risk in critically ill patients. DESIGN Systematic review and meta-analysis of randomized controlled trials (RCTs). METHOD PubMed, Scopus, and Institute for Scientific Information (ISI) Web of Knowledge databases were searched until 18 February 2021. RCTs that used the immunomodulatory formula in the ICU were included. RESULTS Ten RCTs (1166 participants) were included in the meta-analysis. The immunomodulatory formula reduced the duration of ICU stay weighted mean difference [(WMD): -2.97 days; 95%CI: -5.59, -0.35)], mechanical ventilation (WMD = -2.20 days, 95%CI: -4.29, -0.10), sequential organ failure assessment and multiple organ dysfunction scores (Hedge's g: -0.42 U/L; 95% CI: -0.74, -0.11), decreased 8-day overall mortality risk (RR = 0.74, 95% CI: 0.58, 0.91), and extended the ICU-free days (WMD: 4.06 days, 95% CI: 0.02, 8.09). The improvement in respiratory function and reduction in mortality risk was more in patients with acute lung injury (ALI) and acute respiratory distress syndrome (ARDS). Furthermore, the reduction in mechanical ventilation and mortality risk was more evident in older (>60 years) vs young adults. CONCLUSION AND RELEVANCE TO CLINICAL PRACTICE Taken together, the immunomodulatory formula may enhance clinical practice for critical care nurses, such that the prevalence and/or susceptibility to secondary conditions commonly encountered in the ICU (ie, ALI and ARDS) could be attenuated, ultimately allowing critical care nurses to focus their care on the primary reason for which a patient is in the ICU. The study protocol was registered in PROSPERO.
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Affiliation(s)
- Mahsa Malekahmadi
- Department of Clinical Nutrition, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran.,Department of Clinical Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, Iran
| | - Naseh Pahlavani
- Social Development and Health Promotion Research Center, Gonabad University of Medical Sciences, Gonabad, Iran.,Department of Nutrition and Biochemistry, School of Medicine, Gonabad University of Medical Sciences, Gonabad, Iran.,Department of Clinical Biochemistry and Nutrition, Faculty of Medicine, Kurdistan University of Medical Sciences, Sanandaj, Iran
| | - Safieh Firouzi
- Department of Nutrition, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Zachary S Clayton
- Department of Integrative Physiology, University of Colorado Boulder, Boulder, Colorado, USA
| | - Sheikh Mohammed Shariful Islam
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Melbourne, Victoria, Australia
| | - Sanaz Rezaei Zonooz
- Trauma and Injury Research Center, Critical Care Department, Rasoul-e-Akram Complex Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Omid Moradi Moghaddam
- Trauma and Injury Research Center, Critical Care Department, Rasoul-e-Akram Complex Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Sepideh Soltani
- Yazd Cardiovascular Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
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Abstract
OBJECTIVES To explore the perceived barriers by pediatric intensive care healthcare professionals (nurses, dieticians, and physicians) in delivering enteral nutrition to critically ill children across the world. DESIGN Cross-sectional international online survey adapted for use in pediatric settings. SETTING PICUs across the world. SUBJECTS PICU nurses, physicians, and dietitians. INTERVENTIONS The 20-item adult intensive care "Barriers to delivery of enteral nutrition" survey was modified for pediatric settings, tested, and translated into 10 languages. The survey was distributed online to pediatric intensive care nurses, physicians, and dieticians via professional networks in March 2019 to June 2019. Professionals were asked to rate each item indicating the degree to which they perceived it hinders the provision of enteral nutrition in their PICUs with a 7-point Likert scale from 0 "not at all a barrier" to 6 "an extreme amount." MEASUREMENT AND MAIN RESULTS Nine-hundred twenty pediatric intensive care professionals responded from 57 countries; 477 of 920 nurses (52%), 407 of 920 physicians (44%), and 36 of 920 dieticians (4%). Sixty-two percent had more than 5 years PICU experience and 49% worked in general PICUs, with 35% working in combined cardiac and general PICUs. The top three perceived barriers across all professional groups were as follows: 1) enteral feeds being withheld in advance of procedures or operating department visits, 2) none or not enough dietitian coverage on weekends or evenings, and 3) not enough time dedicated to education and training on how to optimally feed patients. CONCLUSIONS This is the largest survey that has explored perceived barriers to the delivery of enteral nutrition across the world by physicians, nurses, and dietitians. There were some similarities with adult intensive care barriers. In all professional groups, the perception of barriers reduced with years PICU experience. This survey highlights implications for PICU practice around more focused nutrition education for all PICU professional groups.
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Vincelette C, Thivierge-Southidara M, Rochefort CM. Conceptual and methodological challenges of studies examining the determinants and outcomes of omitted nursing care: A narrative review of the literature. Int J Nurs Stud 2019; 100:103403. [DOI: 10.1016/j.ijnurstu.2019.103403] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Revised: 07/30/2019] [Accepted: 08/19/2019] [Indexed: 10/26/2022]
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Abstract
Nutritional support is seen as a vital component in the battle to attenuate the extreme hypermetabolic response experienced by patients suffering from large thermal injuries. Protein catabolism precipitating protein malnutrition places patients at greater risk of wound infection and sepsis due to delayed wound healing. Underfeeding, aggressive feeding, feeding routes, timing of initiation of feeding and tight insulin control have all been explored extensively in the quest to understand what nutritional treatment will best attenuate the hypermetabolic response. Despite this it is suggested that the majority of patients with large thermal injuries do not receive adequate nutritional support immediately post injury. Nurses have a pivotal role to play in ensuring that thermal injury patients receive appropriate nutritional support based on the best available evidence.
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Affiliation(s)
- Christina Price
- Wound Care Nurse Specialist/Staff Trainer, Bethesda General Hospital, Serukam, Singkawang, West Borneo, Indonesia
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Parenteral Nutrition Administration by Critical Care Nurses in Iran: A Performance Evaluation. JOURNAL OF INFUSION NURSING 2019; 42:197-202. [PMID: 31283662 DOI: 10.1097/nan.0000000000000327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
In Iran, nurses are responsible for administering parenteral nutrition (PN) to hospitalized patients in intensive care units (ICUs). However, little information is available among nurses in Iran regarding best practices in PN administration. This study evaluates the performance of critical care nurses in Iran in the administration of PN. The performance of 50 nurses in the administration of PN in the ICU was observed 3 times during a 5-month period for a total of 150 observations. A researcher-developed checklist, "Critical Care Nurses' Performance in Parenteral Nutrition Administration," was used for data collection. The total score in this checklist ranged from 0 to 52. Based on the procedural steps in the checklist and whether the steps were performed appropriately, nurses' performance was scored as poor, moderate, or good. The mean score of nurses' performances in PN administration skills was 24.6 ± 2.5. This study found that 46 nurses had moderate skill levels in PN administration, and 3 demonstrated poor skills. Overall, the results indicated that critical care nurses in Iran have poor to moderate PN administration skills.
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Alhassan RK, Tsikata R, Tizaawaw RN, Tannor PA, Quaw PP, Awortwi CAA, Ayanore MA, Afaya A, Salia SM, Milipaak J, Mwini-Nyaledzigbor PP. Adherence to standard nursing protocols on nasogastric tube feeding in a secondary referral hospital in Ghana: comparing self-ratings by professional and auxiliary nurses. BMC Health Serv Res 2019; 19:119. [PMID: 30760260 PMCID: PMC6375159 DOI: 10.1186/s12913-019-3931-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2018] [Accepted: 01/28/2019] [Indexed: 11/22/2022] Open
Abstract
Background Data on nurses’ adherence to standard protocol on nasogastric (NG) tube feeding remain scanty in Ghana even though patients in critical medical conditions are routinely managed using this procedure. This study explored self-rated adherence to standard protocols on NG tube feeding among professional and auxiliary nurses and the perceived barriers impeding compliance to these standard protocols. Methods This is a descriptive analytical cross-sectional study among professional (n = 89) and auxiliary (n = 24) nurses in a major referral hospital in one of the ten administrative regions in Ghana. Four-point Likert scale was used to ascertain the level of adherence to standard guidelines on nasogastric tube, ranging from 4 “Very large extent” to 1 “Very little extent”. Wilcoxon Mann-Whitney test and univariate ordered logistic regression tests (proportional odds models) were performed to determine the odds of higher self-ratings among professional and auxiliary nurses. Results Overall, the odds of higher self-ratings on adherence to standard nursing protocols on NG tube feeding was higher among auxiliary nurses than professional nurses (OR = 2.76, p = 0.031) after adjusting for age, gender, education and years of work experience. Key barriers to adherence to standard protocols on NG tube feeding were: limited opportunities for in-service trainings and insufficiency of NG tube feeding protocols on the wards. Conclusion There is the need for more routine in-service trainings for nursing staff to update their knowledge on NG tube feeding. Hospital management should also make current nursing protocols available to nurses to guide their practice alongside routine onsite supervision of nurses. Electronic supplementary material The online version of this article (10.1186/s12913-019-3931-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Robert Kaba Alhassan
- Department of Public Health Nursing, School of Nursing and Midwifery, University of Health and Allied Sciences, Ho. PMB 31, Volta Region, Ho, Ghana.
| | - Richard Tsikata
- Department of Nursing, School of Nursing and Midwifery, University of Health and Allied Sciences, Ho, Ghana
| | - Richard Naatu Tizaawaw
- Department of Nursing, School of Nursing and Midwifery, University of Health and Allied Sciences, Ho, Ghana
| | - Prince Asante Tannor
- Department of Nursing, School of Nursing and Midwifery, University of Health and Allied Sciences, Ho, Ghana
| | - Perpetual Praba Quaw
- Department of Nursing, School of Nursing and Midwifery, University of Health and Allied Sciences, Ho, Ghana
| | - Cecilia Aba Ata Awortwi
- Department of Nursing, School of Nursing and Midwifery, University of Health and Allied Sciences, Ho, Ghana
| | | | - Agani Afaya
- Department of Nursing, School of Nursing and Midwifery, University of Health and Allied Sciences, Ho, Ghana
| | - Solomon Mohammed Salia
- Department of Nursing, School of Nursing and Midwifery, University of Health and Allied Sciences, Ho, Ghana
| | - Japiong Milipaak
- Department of Nursing, School of Nursing and Midwifery, University of Health and Allied Sciences, Ho, Ghana
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Albarran J, Walker W. What's in this issue. Nurs Crit Care 2018; 23:115-116. [PMID: 29689613 DOI: 10.1111/nicc.12353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- John Albarran
- Associate Professor in Critical and Cardiovascular Nursing, Co-Editor, Nursing in Critical Care
| | - Wendy Walker
- Reader in Acute and Critical Care Nursing, Editorial Intern, Nursing in Critical Care
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Li Y, Ye Y, Mei Y, Ruan H, Yu Y. Semi-automated ultrasound guidance applied to nasogastrojejunal tube replacement for enteral nutrition in critically ill adults. Biomed Eng Online 2018; 17:21. [PMID: 29415733 PMCID: PMC5803918 DOI: 10.1186/s12938-018-0452-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2017] [Accepted: 01/27/2018] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND AND OBJECTIVE At present, the enteral nutrition approaches via nose and duodenum (or nose and jejunum) are the preferred method of nutritional support in the medical engineering field, given the superiority of in line with physiological processes and no serious complication. In this study, the authors adopted saline as the acoustic window, and gave enteral nutrition support to critically ill patients, via the nasogastrojejunal approach guided by semi-automated ultrasound. These above patients benefited a lot from this kind of nutrition support treatment, and we aimed to report the detailed information. METHODS Critically ill patients (n = 41) who had been treated with hospitalized intestine nutrition were identified. The Apogee 1200 ultrasonic diagnostic apparatus, and nasogastrojejunal tubes were adopted to carry out intestine nutrition treatment guided by semi-automated ultrasound. In order to confirm the specific positions of cardia, gastric body, antrum of stomach, and pylorus, the semi-automated ultrasound was utilized to probe the stomach cavity. And then, the ultrasonic probe was placed in the cardia location, and the nasogastrojejunal tube was slowly inserted through the metal thread. After operation, the nursing service satisfaction of patients and mean operation time were calculated, respectively. RESULTS All the patients were treated with enteral nutrition via nasogastrojejunal tube, and the whole procedure was under the guidance of semi-automated ultrasonography. The end of the feeding tube is attached to the surface of the stomach with a greater curvature, which can be bent on account of a no gastric peristalsis squeeze function, and thereby were prevented from entering into the antrum and pylorus locations. After this procedure, the mental thread was taken out, and the tube was pushed forward by a "drift" approach in order to allow it to enter into the intestine. The total nursing service satisfaction of patients was 90.24%, and the total incidence of adverse reactions was 17.07%. CONCLUSIONS In summary, the application of saline can be taken as sound window, and the metal wire as the tracking target, the bedside nasogastrojejunal tube guided by semi-automated ultrasound is an effective feeding tube placement method, with relatively good clinical application value in medical engineering.
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Affiliation(s)
- Ying Li
- Department of Critical Care Medicine, Second People’s Hospital of Shenzhen, Shenzhen, 518035 People’s Republic of China
| | - Yu Ye
- Department of Neurosurgery, Longgang Central Hospital of Shenzhen, Shenzhen, 518116 People’s Republic of China
| | - Yang Mei
- Department of Critical Care Medicine, Second People’s Hospital of Shenzhen, Shenzhen, 518035 People’s Republic of China
| | - Haiying Ruan
- Department of Critical Care Medicine, Second People’s Hospital of Shenzhen, Shenzhen, 518035 People’s Republic of China
| | - Yuan Yu
- Department of Critical Care Medicine, Second People’s Hospital of Shenzhen, Shenzhen, 518035 People’s Republic of China
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