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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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Kebede EB, Biratu Terfa Y, Tiruneh A, Sehumehone E, Fekecha B. Enhancing nasogastric tube insertion skill performance by using updated checklist among nursing students. SAGE Open Med 2024; 12:20503121241255265. [PMID: 38826824 PMCID: PMC11143836 DOI: 10.1177/20503121241255265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Accepted: 04/30/2024] [Indexed: 06/04/2024] Open
Abstract
Background Nasogastric tube (NGT) insertion is one of the most commonly performed procedures for critically ill patients through the nostril or mouth into the stomach, which is indicated for multiple reasons. Objective This study is, therefore, aimed to enhance the NGT insertion skill performance of third-year nursing students using the updated checklist, 2021. Method A facility-based pre-post intervention study was conducted among third-year nursing students of the School of Nursing, Jimma University. An updated checklist and intervention package were used among 26 randomly selected nursing students. The collected data was entered into EpiData version 3.1, EpiData Association, Denmark and exported to SPSS version 23, IBM Corp, Armonk, NewYork for analysis. Descriptive statistics were made for each item and Paired T-test analysis was conducted to summarize the findings. Result The highest NGT skill insertion performance score from 40% before the intervention was 35; however, after the intervention, the score increased to 40.3. Their mean score in NGT skill performance was increased by 11 after the intervention of implementing the intervention package using the updated checklist from 26.5 ±5 0.3 the pre-intervention to 37.8 ±5 1.7 post-intervention. The finding indicated that the improvement was statistically significant at p < 0.001. Conclusion Implementing an intervention package and employing an updated NGT insertion checklist improved the performance of third-year nursing students' NGT insertion skills by an average of 11 points compared to their pre-test scores. A large-scale control randomized trial study was recommended to control for the effects of confounding factors on the implementation of intervention packages.
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Affiliation(s)
| | - Yonas Biratu Terfa
- School of Nursing, Institute of Health, Jimma University, Jimma, Ethiopia
| | - Abebaw Tiruneh
- School of Midwifery, Institute of Health, Jimma University, Jimma, Ethiopia
| | | | - Bekana Fekecha
- School of Medical Laboratory, Institute of Health, Jimma University, Jimma, Ethiopia
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de Oliveira LC, Rosa KSDC, Gaspar T, Paiva BSR, Paiva CE, Peres WAF. Clinical usefulness of the Patient-Generated Subjective Global Assessment and modified Glasgow Prognostic Score in decision making concerning the indication of enteral nutritional therapy in patients with incurable cancer receiving palliative care. Nutrition 2023; 112:112057. [PMID: 37224572 DOI: 10.1016/j.nut.2023.112057] [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: 02/09/2023] [Revised: 04/13/2023] [Accepted: 04/18/2023] [Indexed: 05/26/2023]
Abstract
OBJECTIVES This study aimed to identify the clinical usefulness of assessing nutritional status using validated tools for the indication of enteral nutrition for patients with incurable cancer in palliative care. METHODS In this prospective cohort study, patients were assessed for nutritional risk using the Patient-Generated Subjective Global Assessment and for cancer cachexia (CC) using the modified Glasgow Prognostic Score upon enrollment and after ∼30 d. The outcome was stable or improved Karnofsky Performance Status. Logistic regression models were used, providing the odds ratio (OR) and 95% confidence interval (CI). RESULTS A total of 180 patients participated. The only nutritional status parameter that was associated with function was CC. The less severe the CC, the more likely Karnofsky Performance Status was to remain stable or improve over 30 d (non-cachectic: OR = 1.95; 95% CI, 1.01-3.47; malnourished: OR = 1.06; 95% CI, 1.01-1.42). Furthermore, white skin color (OR = 1.79; 95% CI, 1.04-2.47), higher educational level (OR = 1.39; 95% CI, 1.13-2.78), and inadequate calorie intake (OR = 1.96; 95% CI, 1.02-2.81) were also associated with the outcome. CONCLUSIONS Using the modified Glasgow Prognostic Score to identify the existence and severity of CC, which is associated with function, has the potential to help clinical decision making concerning the indication of enteral nutrition in patients with incurable cancer receiving palliative care.
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Affiliation(s)
| | | | | | | | - Carlos Eduardo Paiva
- Research Group on Palliative Care and Quality of Life (GPQual), Barretos Cancer Hospital, Barretos, Brazil
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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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Hu M, Ling Y, Xiong FT, Xu JM. Construction of a three-level enteral nutrition nursing system under the "Internet + medical" mode and an evaluation of its effect in clinical application. Front Public Health 2022; 10:976276. [PMID: 36238248 PMCID: PMC9550871 DOI: 10.3389/fpubh.2022.976276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Accepted: 08/29/2022] [Indexed: 01/25/2023] Open
Abstract
Objective This study aimed to explore the construction of a three-level enteral nutrition nursing system under the "Internet + medical" mode and the clinical application effect. Methods A total of 40 nurses from four primary and secondary hospitals in Jiangxi Province and 100 patients treated with enteral nutrition between January 2020 and December 2021 were enrolled in this study. Patients in the control group received routine enteral nutrition nursing. In the study group, a three-level enteral nutrition nursing system was applied under the "Internet + medical" mode to train and guide the implementation of clinical enteral nutrition. The changes in nurses' cognition and behavior in enteral nutrition safety nursing, comprehensive core competence before and after training, and the effect of enteral nutrition nursing were compared between the two groups. Results After 3 months of training, nurses' cognition and behavior scores in enteral nutrition safety nursing were higher than those before training (t = 11.780, P < 0.05), and nurses' core competence scores were higher than before training (P < 0.05). After 1 week of nursing, the nutritional risk screening 2002 (NRS2002) score decreased, and the levels of albumin and hemoglobin increased in both groups (P < 0.05). However, after 1 week of nursing, the NRS2002 score of the study group (2.89 ± 0.75) was lower than that of the control group (3.25 ± 0.82), and the levels of albumin (39.89 ± 3.21) and hemoglobin (119.57 ± 8.78) were higher in the study group than in the control group (albumin 36.25 ± 3.45, hemoglobin 113.66 ± 9.55) (P < 0.05). Conclusion Three-level enteral nutrition nursing linkage assisted by the "Internet + medical" mode can improve the cognition and behavior of medical staff in enteral nutrition safety nursing, as well as the comprehensive core competence of nurses, achieving good clinical effects.
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Affiliation(s)
- Min Hu
- Department of Neurology, The Second Affiliated Hospital of Nanchang University, Nanchang, China,Min Hu
| | - Yan Ling
- Department of Neurology, The Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Fang-Ting Xiong
- Department of Neurology, The Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Jian-Mei Xu
- Department of Neurosurgery, The Second Affiliated Hospital of Nanchang University, Nanchang, China,*Correspondence: Jian-Mei Xu
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Preventive strategies for feeding intolerance among patients with severe traumatic brain injury: A cross-sectional survey. Int J Nurs Sci 2022; 9:278-285. [PMID: 35891911 PMCID: PMC9304998 DOI: 10.1016/j.ijnss.2022.06.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2022] [Revised: 05/26/2022] [Accepted: 06/13/2022] [Indexed: 11/25/2022] Open
Abstract
Objectives This study aimed to investigate the application status of preventive measures for feeding intolerance in patients with severe traumatic brain injury (STBI) in China and analysis the differences and their causes. Methods A cross-sectional survey was conducted. From December 2019 to January 2020, ICU nurses and physicians of 89 hospitals in China were surveyed by using a questionnaire on preventive strategies for feeding intolerance in patients with STBI. The questionnaire included two parts: the general information of participants (10 items) and application of preventive measures for feeding intolerance in STBI patients (18 items). Results Totally 996 nurses and physicians completed the questionnaire. Among various methods, gastrointestinal symptoms(85.0%) and injury severity (71.4%) were mostly used to assess gastrointestinal functions and risk of feeding intolerance among STBI patients, respectively. Initiating enteral nutrition (EN) within 24–48 h (61.5%), nasogastric tubes (91.2%), 30°–45° of head-of-bed elevation (89.5%), continuous feeding by pump (72.9%), EN solution temperature of 38–40 °C (65.5%), <500 ml initial volume of EN solution (50.0%), monitoring gastric residual volume with a syringe (93.7%), and assessing gastric residual volume every 4 h (51.5%) were mostly applied for EN delivery among STBI patients. Prokinetic agents (73.3%), enema (73.6%), probiotics (79.0%), antacid agents (84.1%), and non-nutritional preparations as initial EN formula (65.6%) were commonly used for preventing feeding intolerance among STBI patients. Conclusions The survey showed that nurses and clinicians in China have a positive attitude towards preventive strategies for feeding intolerance. However, some effective new technologies and methods have not been timely applied in clinical practice. We suggest that managers, researchers, clinicians, nurses, and other health professionals should collaborate to explore effective and standard preventive strategies for feeding intolerance among patients with STBI.
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Habib M, Murtaza HG, Kharadi N, Mehreen T, Ilyas A, Khan AH, Ahmed M. Interruptions to Enteral Nutrition in Critically Ill Patients in the Intensive Care Unit. Cureus 2022; 14:e22821. [PMID: 35382187 PMCID: PMC8976564 DOI: 10.7759/cureus.22821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/02/2022] [Indexed: 11/05/2022] Open
Abstract
Background Malnourishment has been linked with increased morbidity and mortality among critically ill patients. The current study aimed to assess the factors contributing to the interruption of enteral nutrition so that preventive measures can be formulated to avoid the malnourishment of critically ill patients. Methodology A prospective, observational study was conducted at the Department of Intensive Care Unit, Shifa International Hospital, Islamabad, between November 2020 and May 2021. All patients admitted in the intensive care unit (ICU) during the study period aged between 18 and 80 years, who remained admitted in the medical ICU for at least 72 hours were included in the study. Those who had ileostomy or colostomy were excluded from the study. Diagnostic categories were defined as surgical and medical. Data on clinical parameters including admitting diagnosis and airway-related issues were recorded in a predefined proforma. Results The mean duration of enteral nutrition interruption in males was 13.96 ± 13.12 days while that of females, 12.48 ± 12.43 days. Non-invasive ventilation dependency was significantly associated with an interruption in enteral nutrition (p=0.002). The mean duration of interruption of enteral nutrition was not correlated with airway issues (p=0.569). However, the mean duration of interruption of enteral nutrition was significantly lower in patients who underwent spontaneous breathing trials with T-piece (p = 0.032). Those who were advised nil per oral before surgery had a significantly longer duration of enteral nutrition interruption (p < 0.0001) with a mean length of 30.18 ± 5.83 days. The duration of enteral nutrition interruption was significantly longer in patients who had tracheostomy than those who did not have a tracheostomy (26.3 ± 6.34 vs. 9.54 ± 11.61 days) (p < 0.0001). Conclusion The present study revealed that at least three-forth of the patients admitted in ICUs had documented orders to the interruption of enteral nutrition. The most significant causes that correlated with interruptions to enteral nutrition were non-invasive ventilation dependency, tracheostomy, spontaneous breathing trials with T-piece, and orders of nil per oral before surgery.
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Syrmis M, Frederiksen N, Reilly C. Characterisation of hospital-produced guidelines regarding management of temporary tube feeding care in general paediatric patients. INTERNATIONAL JOURNAL OF THERAPY AND REHABILITATION 2021. [DOI: 10.12968/ijtr.2020.0002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Background/Aims There is significant variation in the implementation of temporary tube feeding management in children and a paucity of associated clinical practice guidelines covering all phases of care, from decision making regarding tube insertion through to tube weaning. Development of clinical practice guidelines should consider levels of evidence other than randomised control trials. Examining hospital-produced guidelines used by frontline health staff, for example, could distinguish areas of application of evidence-based recommendations, as well as domains of care in need of increased implementation. This article describes the content of existing hospital-produced guidelines relating to tube feeding care in a general paediatric population. Methods Hospital-produced guidelines were sought by mailing 200 health services worldwide and searching Queensland Health's Electronic Publishing Service in Australia and Google. A content analysis was then performed. Results The 13 collected hospital-produced guidelines from Australia, the UK and Canada generally comprehensively reported on processes related to the decision-making, tube placement and tube maintenance phases. However, reporting on oral feeding while tube feeding, tube feeding dependency, tube feeding exit planning, and the social and emotional aspects of tube feeding were areas within these phases that had limited coverage. Recommendations for the phase of tube weaning were also infrequently included. Conclusions Development of formal clinical practice guidelines covering all tube feeding phases should assist in optimising patient and health service outcomes.
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Affiliation(s)
- Maryanne Syrmis
- Speech Pathology Department, Queensland Children's Hospital, Brisbane, Australia
| | - Nadine Frederiksen
- Occupational Therapy Department, Queensland Children's Hospital, Brisbane, Australia
| | - Claire Reilly
- Dietetics Department, Queensland Children's Hospital, Brisbane, Australia
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Koontalay A, Suksatan W, Teranuch A. Early Enteral Nutrition Met Calories Goals Led by Nurse on Improve Clinical Outcome: A Systematic Scoping Review. IRANIAN JOURNAL OF NURSING AND MIDWIFERY RESEARCH 2021; 26:392-398. [PMID: 34703776 PMCID: PMC8491827 DOI: 10.4103/ijnmr.ijnmr_421_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 02/24/2021] [Accepted: 05/08/2021] [Indexed: 11/12/2022]
Abstract
BACKGROUND Critically ill patients face challenges in hypercatabolism due to crisis states, as it may lead to malnutrition. An early Enteral Nutrition (EN) within 24-48 h is recommended to use in order to improve clinical outcomes. This systematic scoping review is examined recently with the evidence of the early EN protocol led by nurses to drive and achieve the daily calorie target and improve clinical outcomes. MATERIALS AND METHODS The database of CINAHL, MEDLINE via PubMed and Scopus, Web of Science, and Embase through Ovid from January 2019 to September 2020, comprised of 221 articles which four articles are chosen and entered into the final analysis. RESULTS The findings show the benefits of the early EN to guide nurses to start the EN as soon as possible after admitted to the Intensive Care Unit or when hemodynamic is stable in order to achieve a daily calorie target regarding the reduced hospitalization, duration of mechanical ventilation, morbidity, and mortality. CONCLUSIONS The synthesized results show the early EN led by a nurse to address the specific needs and the vital role of nutritional support, and also drive the enteral feeding for critically ill patients to reach the calorie target goals in short times to enhance clinical outcomes.
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Affiliation(s)
| | - Wanich Suksatan
- Faculty of Nursing, HRH Princess Chulabron College of Medical Science, Chulaborn Royal Academy, Thailand
- Saint Louis University, Trudy Busch.Valentine School of Nursing, St.Louis, Missouri, USA
| | - Aumpornpun Teranuch
- Adult Nursing, Faculty of Nursing, Khon Kaen University, Acting Director, Research and Training Center for Enhancing Quality of Life of Working Age People, Thailand
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Danielis M, Destrebecq ALL, Terzoni S, Palese A. Nursing care factors influencing patients' outcomes in the intensive care unit: Findings from a rapid review. Int J Nurs Pract 2021; 28:e12962. [PMID: 34002435 PMCID: PMC9286446 DOI: 10.1111/ijn.12962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2020] [Revised: 03/17/2021] [Accepted: 04/25/2021] [Indexed: 11/30/2022]
Abstract
Aims To examine the nursing care factors investigated regarding their influence on outcomes of critically ill patients. Background A large number of studies have considered patients' outcomes as sensitive to nursing practice in intensive care unit environments. However, no summary of nursing factors influencing these outcomes has been provided. Design Rapid review, following the seven‐stage process outlined by Tricco and colleagues. Data Sources Articles published up to March 2020 were identified in MEDLINE (via PubMed), Cumulative Index to Nursing and Allied Health Literature (CINAHL) and Scopus databases. Review Methods Eligibility of studies was first assessed at the title and abstracts level. Study inclusion was then established by two researchers by analysing the full texts. Results A total of 93 studies were included, with a total of 21 nursing care factors documented. At the structural level, nursing factors have been investigated at the organizational and at the personnel level. At the process level, nurse‐led programmes, independent nursing interventions and nurse behaviours have been investigated to date. Conclusion The set of nursing factors that emerged can be used in future research to improve poorly developed areas and to accumulate further evidence through additional studies, both at managerial and practice levels. What is already known about this topic?
Thirty‐five nursing‐sensitive outcomes capable of being used to measure the quality of care in the intensive care unit have been identified to date. Several nursing care factors in structural and process dimensions have been documented as having an influence on the outcomes of critically ill patients.
What this paper adds:
Many interventions have been assessed in relation to nursing outcomes, more often at the process than at structural levels. Specifically, a total of 21 nursing factors have been studied to date in the context of intensive care units, divided into structure (organizational and personnel) and process (nurse‐led programmes, independent nursing interventions and behaviours) dimensions.
The implications of this paper
The set of nursing factors that emerged can be considered as a basis for further research, especially regarding poorly developed areas. Emergent nursing care factors can be used as a blueprint to design and develop educational programmes both at under‐ and postgraduate levels. At the managerial levels, both structure and process dimensions of nursing care are capable of affecting outcomes and could be used to inform decision‐making.
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Affiliation(s)
- Matteo Danielis
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy.,School of Nursing, Department of Medical and Biological Sciences, Udine University, Udine, Italy
| | | | | | - Alvisa Palese
- School of Nursing, Department of Medical and Biological Sciences, Udine University, Udine, Italy
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Crossfield CL, Russo PL, Bucknall TK. Enteral nutrition feeding practices by intensive care nurses: A retrospective evaluation. Nurs Crit Care 2021; 27:676-681. [PMID: 33605511 DOI: 10.1111/nicc.12609] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Revised: 02/04/2021] [Accepted: 02/05/2021] [Indexed: 12/13/2022]
Abstract
BACKGROUND Enteral nutrition (EN) is an integral component of standard management of critically ill patients in intensive care. However, achieving adequate nutrition in this environment continues to present many challenges. DESIGN A descriptive exploratory design using a retrospective review of medical records. AIMS AND OBJECTIVES The aims of this study were to describe nursing practice associated with EN feeding and identify barriers to optimal nutritional delivery in the intensive care unit (ICU). METHODS Patients admitted to a major Australian metropolitan health service ICU during a 6-month period, and who received EN for at least 72 hours, were eligible for inclusion. Documented text from patient medical records was analysed using content analysis. Numerical data were analysed using SPSS software (version 25.0). Descriptive and inferential statistics were calculated. RESULTS A total of 150 patients were included in the study. The mean time from admission to EN commencement was 12.6 hours, with 59.3% commenced within 12 hours of admission. Only 9.3% of patients commenced EN at the target rate. Of the 150 patients, 24 (16%) received 80% of nutrition targets within 72 hours of admission. Patients who had EN commenced within 12 hours of admission and at the target rate were significantly more likely to achieve nutritional requirements (P = <.01). Patients who received an initial dietitian review within 24 hours of admission were more likely to achieve nutrition requirements (P = <.01). CONCLUSIONS Commencing EN on time and meeting target volumes remains challenging in the ICU patient. Airway management, procedural requirements, and delayed dietitian review for prescribed hourly rate initiation provide barriers to optimal nutrition delivery to critically ill patients. Tackling these barriers may require interdisciplinary interventions. RELEVANCE TO CLINICAL PRACTICE Providing adequate nutrition to critically ill patients is challenging. This study provides evidence that day's one and two are problematic to EN delivery; particularly concerning airway management, procedural requirements, and delayed dietitian review for prescribed hourly rate initiation. Highlighting the need for further research into these aspects of nutrition management.
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Affiliation(s)
- Claire L Crossfield
- School of Nursing and Midwifery, Faculty of Health, Deakin University, Victoria, Geelong, Australia
| | - Philip L Russo
- Department of Nursing Research, Cabrini Monash University, Malvern, Victoria, Australia
| | - Tracey K Bucknall
- School of Nursing and Midwifery, Faculty of Health, Deakin University, Victoria, Geelong, Australia.,Centre for Quality and Patient Safety Research, Institute for Health Transformation, Deakin University, Victoria, Burwood, Australia
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Xu LC, Huang XJ, Lin BX, Zheng JY, Zhu HH. Clinical nurses' nasogastric feeding practices in adults: a multicenter cross-sectional survey in China. J Int Med Res 2021; 48:300060520920051. [PMID: 32349566 PMCID: PMC7218984 DOI: 10.1177/0300060520920051] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE We aimed to investigate practices of nasogastric tube (NGT) intubation and feeding for adults by clinical nurses in China. METHODS A self-designed and validated questionnaire comprising 30 questions was distributed to 560 clinical nurses in three comprehensive hospitals of Xiamen, China. The questionnaire covered participants' demographic characteristics, NGT placement, administration of enteral nutrition (EN), and monitoring or management of feeding intolerance. RESULTS A total 464 (82.9%) questionnaires were completed; 36.2% of nurses used nose-ear-xiphoid and 79.5% forehead-xiphoid measurement to define the internal length of the NGT. Many participants still used traditional methods to confirm NGT placement (auscultation of injected air 50.2%, bubble test 34.7% and observing feeding tube aspirate 34.3%). Bolus feeding was the most commonly used technique to administer EN. A total 97.0% of all nurses used syringes to measure gastric residual volume (GRV), and 62.7% measured GRV every 4-8 hours. The most frequently used GRV threshold values were 200 mL (44.6%) and 150 mL (25.2%). Most nurses stopped feeding immediately when encountering high GRV (84.3%) or diarrhea (45.0%). The nasogastric feeding practices of many clinical nurses were not consistent with international guidelines. CONCLUSIONS Our study can provide an impetus for nursing administrators to revise their nasogastric feeding procedures, to promote compliance with evidence-based guidelines.
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Affiliation(s)
- Li-Chun Xu
- Zhongshan Hospital, Xiamen University, Xiamen, Fujian, China
| | - Xiao-Jin Huang
- Zhongshan Hospital, Xiamen University, Xiamen, Fujian, China
| | - Bi-Xia Lin
- Xiamen Cardiovascular Hospital Xiamen University, Xiamen, Fujian, China
| | - Jun-Yi Zheng
- Nursing Department of Xiamen University, Xiamen, Fujian, China
| | - Hai-Hua Zhu
- The First Affiliated Hospital of Xiamen University, Xiamen, Fujian, China
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Cox J, Schallom M, Jung C. Identifying Risk Factors for Pressure Injury in Adult Critical Care Patients. Am J Crit Care 2020; 29:204-213. [PMID: 32355967 DOI: 10.4037/ajcc2020243] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
BACKGROUND Critically ill patients have a variety of unique risk factors for pressure injury. Identification of these risk factors is essential to prevent pressure injury in this population. OBJECTIVE To identify factors predicting the development of pressure injury in critical care patients using a large data set from the PhysioNet MIMIC-III (Medical Information Mart for Intensive Care) clinical database. METHODS Data for 1460 patients were extracted from the database. Variables that were significant in bivariate analyses were used in a final logistic regression model. A final set of significant variables from the logistic regression was used to develop a decision tree model. RESULTS In regression analysis, cardiovascular disease, peripheral vascular disease, pneumonia or influenza, cardiovascular surgery, hemodialysis, norepinephrine administration, hypotension, septic shock, moderate to severe malnutrition, sex, age, and Braden Scale score on admission to the intensive care unit were all predictive of pressure injury. Decision tree analysis revealed that patients who received norepinephrine, were older than 65 years, had a length of stay of 10 days or less, and had a Braden Scale score of 15 or less had a 63.6% risk of pressure injury. CONCLUSION Determining pressure injury risk in critically ill patients is complex and challenging. One common pathophysiological factor is impaired tissue oxygenation and perfusion, which may be nonmodifiable. Improved risk quantification is needed and may be realized in the near future by leveraging the clinical information available in the electronic medical record through the power of predictive analytics.
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Affiliation(s)
- Jill Cox
- Jill Cox is an associate clinical professor at Rutgers University School of Nursing, Newark, New Jersey, and an advanced practice nurse and certified wound, ostomy, and continence nurse at Englewood Health, Englewood, New Jersey
| | - Marilyn Schallom
- Marilyn Schallom is a clinical nurse specialist and research scientist in the Department of Research for Patient Care Services, Barnes-Jewish Hospital, St Louis, Missouri
| | - Christy Jung
- Christy Jung is a research analyst in the Office of Institutional Research and Assessment, Rutgers University School of Nursing
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14
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Danielis M, Palese A, Terzoni S, Destrebecq ALL. What nursing sensitive outcomes have been studied to-date among patients cared for in intensive care units? Findings from a scoping review. Int J Nurs Stud 2019; 102:103491. [PMID: 31862529 DOI: 10.1016/j.ijnurstu.2019.103491] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Revised: 10/18/2019] [Accepted: 11/22/2019] [Indexed: 12/27/2022]
Abstract
BACKGROUND Although many studies have considered mortality and adverse effects as outcomes sensitive to nursing practice, it seems that other outcomes of nursing care in intensive care units have been explored less commonly. OBJECTIVES To describe the state-of-science in research in the field of nursing sensitive outcomes in intensive care units and to synthesize outcomes that have been documented to date as being influenced by nursing care. DESIGN A scoping review study based on the framework proposed by Arksey and O'Malley, further refined by the Levac and Joanna Briggs Institute was performed in 2019. DATA SOURCES The Medline, Cumulative Index to Nursing and Allied Health Literature, Web of Science, Scopus, and Google Scholar electronic databases were searched. In addition, the reference list of included articles was screened. REVIEW METHODS Two researchers independently identified publications on the basis of the following criteria: (a) articles that reported nursing sensitive outcomes on critically-ill adult patients admitted to the intensive care unit, (b) as primary and secondary studies, (c) written in English, and (d) without any time frame limitation. RESULTS Of the 4,231 records, 112 fully met the inclusion criteria and were included. Publications were mainly authored in the US and Canada (n = 44, 39.2%), and the majority (n = 62, 55.3%) had an observational design. A total of 233 nursing sensitive outcomes emerged, categorized in 35 outcomes, with, on average, two per study included. The most often measured outcomes were pressure ulcers (20 studies) and ventilator-associated pneumonias (19 studies); the less studied outcomes were quality of life, secretion clearance, patient-ventilator dysynchrony, and post-extubation dysphagia. When categorizing outcomes, the ones concerning safety (n = 77, 33.1%) were represented the most, followed by those concerning the clinical (n = 72, 30.9%), functional (n = 70, 30.0%), and perceptual (n = 14, 6.0%) domains. The interdependent outcomes linked to multi-professional interventions (e.g., ventilator-associated pneumonias) were the most frequently studied nursing sensitive outcomes (n = 20, 57.1%), while independent outcomes resulting from autonomous interventions performed by nurses were less often studied (n = 8, 22.9%). CONCLUSIONS From a clinical point of view, a large heterogeneity of outcomes influenced by nursing care emerged. However, identified outcomes have been studied with different approaches and metrics, so that future efforts will need to establish homogeneous conceptual and operative definitions. Moreover, increasing efforts in establishing perceptual outcomes, or those close to the fundamentals of nursing care, are suggested in order to better depict the contribution of critical care nurses in the field.
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Affiliation(s)
- Matteo Danielis
- Department of Clinical Sciences and Community Health, University of Milan, Via Vanzetti 5, 20133 Milan, Italy; School of Nursing, Department of Medical Sciences, University of Udine, Udine, Italy.
| | - Alvisa Palese
- School of Nursing, Department of Medical Sciences, University of Udine, Udine, Italy
| | - Stefano Terzoni
- School of Nursing, San Paolo Hospital, ASST Santi Paolo e Carlo, Milan, Italy
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15
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Zampieri FG, Salluh JIF, Azevedo LCP, Kahn JM, Damiani LP, Borges LP, Viana WN, Costa R, Corrêa TD, Araya DES, Maia MO, Ferez MA, Carvalho AGR, Knibel MF, Melo UO, Santino MS, Lisboa T, Caser EB, Besen BAMP, Bozza FA, Angus DC, Soares M. ICU staffing feature phenotypes and their relationship with patients' outcomes: an unsupervised machine learning analysis. Intensive Care Med 2019; 45:1599-1607. [PMID: 31595349 DOI: 10.1007/s00134-019-05790-z] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Accepted: 09/17/2019] [Indexed: 01/09/2023]
Abstract
PURPOSE To study whether ICU staffing features are associated with improved hospital mortality, ICU length of stay (LOS) and duration of mechanical ventilation (MV) using cluster analysis directed by machine learning. METHODS The following variables were included in the analysis: average bed to nurse, physiotherapist and physician ratios, presence of 24/7 board-certified intensivists and dedicated pharmacists in the ICU, and nurse and physiotherapist autonomy scores. Clusters were defined using the partition around medoids method. We assessed the association between clusters and hospital mortality using logistic regression and with ICU LOS and MV duration using competing risk regression. RESULTS Analysis included data from 129,680 patients admitted to 93 ICUs (2014-2015). Three clusters were identified. The features distinguishing between the clusters were: the presence of board-certified intensivists in the ICU 24/7 (present in Cluster 3), dedicated pharmacists (present in Clusters 2 and 3) and the extent of nurse autonomy (which increased from Clusters 1 to 3). The patients in Cluster 3 exhibited the best outcomes, with lower adjusted hospital mortality [odds ratio 0.92 (95% confidence interval (CI), 0.87-0.98)], shorter ICU LOS [subhazard ratio (SHR) for patients surviving to ICU discharge 1.24 (95% CI 1.22-1.26)] and shorter durations of MV [SHR for undergoing extubation 1.61(95% CI 1.54-1.69)]. Cluster 1 had the worst outcomes. CONCLUSION Patients treated in ICUs combining 24/7 expert intensivist coverage, a dedicated pharmacist and nurses with greater autonomy had the best outcomes. All of these features represent achievable targets that should be considered by policy makers with an interest in promoting equal and optimal ICU care.
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Affiliation(s)
- Fernando G Zampieri
- Graduate Program in Translational Medicine, Department of Critical Care, D'Or Institute for Research and Education, Rua Diniz Cordeiro, 30. Botafogo, Rio De Janeiro, 22281-100, Brazil.,Research Institute, HCor-Hospital do Coração, São Paulo, Brazil
| | - Jorge I F Salluh
- Graduate Program in Translational Medicine, Department of Critical Care, D'Or Institute for Research and Education, Rua Diniz Cordeiro, 30. Botafogo, Rio De Janeiro, 22281-100, Brazil.,Department of Research and Development, Epimed Solutions, Rio De Janeiro, Brazil
| | | | - Jeremy M Kahn
- Clinical Research, Investigation, and Systems Modeling of Acute Illness (CRISMA) Center, Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.,Department of Health Policy & Management, University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA, USA
| | - Lucas P Damiani
- Research Institute, HCor-Hospital do Coração, São Paulo, Brazil
| | - Lunna P Borges
- Department of Research and Development, Epimed Solutions, Rio De Janeiro, Brazil
| | | | | | - Thiago D Corrêa
- Adult ICU, Hospital Israelita Albert Einstein, São Paulo, Brazil
| | | | - Marcelo O Maia
- ICU, Hospital Santa Luzia Rede D'Or São Luiz DF, Brasília, Brazil
| | | | | | | | - Ulisses O Melo
- ICU, Hospital Estadual Alberto Torres, São Gonçalo, Brazil
| | | | - Thiago Lisboa
- ICU, Hospital Santa Rita, Santa Casa de Misericórdia de Porto Alegre, Porto Alegre, Brazil
| | | | | | - Fernando A Bozza
- Graduate Program in Translational Medicine, Department of Critical Care, D'Or Institute for Research and Education, Rua Diniz Cordeiro, 30. Botafogo, Rio De Janeiro, 22281-100, Brazil.,Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio De Janeiro, Brazil
| | - Derek C Angus
- Clinical Research, Investigation, and Systems Modeling of Acute Illness (CRISMA) Center, Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.,Department of Health Policy & Management, University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA, USA
| | - Marcio Soares
- Graduate Program in Translational Medicine, Department of Critical Care, D'Or Institute for Research and Education, Rua Diniz Cordeiro, 30. Botafogo, Rio De Janeiro, 22281-100, Brazil.
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16
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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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