Enteral Nutrition Management in the Critical Care Patient: Intensive Care Nurses' Practices of Tube Feeding

Main Article Content

Nuri Seferoğlu
Pakize Özyürek
Öznur Gürlek Kisacik

Keywords

Enteral nutrition, Tube feeding, Intensive care, Critical patient, Nurse.

Abstract

Study Objectives: Maximizing the benefits of enteral nutrition (EN) and minimizing adverse events requires adequate training of the multidisciplinary team, especially nurses, and systematic practice of care practice. This study was aimed at determining the EN practices of intensive care unit (ICU) nurses in Turkey and the factors affecting these practices. Methods: “Nurse Information Form" and the "Enteral Nutrition Practice Form" were distributed to 196 intensive care unit nurses to investigate the EN. Results: The total score of the nurses on EN practice was 126.82 ± 16.18 (range, 35-175).  Only 34.6% (n = 68) of the participants were found to have an acceptable score of sufficiency for positive EN practices.  The highest practice score ICU nurses obtained subsections was the “Preventing Complications Related to EN” (4.19 ± 0.50) subsection, the lowest score was also "Gastro-Intestinal System (GIS) Tolerance Evaluation" (2.72 ± 0.68) subsection. While 50.5% of the nurses never paid attention to the amount of product that should be given to the patient at a meal, 23.0% of them never paid attention to the fact that medication that should not be crushed was not given through the feeding tube. Conclusion: It was concluded that ICU nurses do not follow the current guidelines on EN practice and have not received adequate training in EN. With a well-designed in-service training program and standard protocols, adherence to evidence-based guidelines can be increased; inconsistencies and errors in the EN practices can be reduced.

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References

1. Marshall AP, Takefala T, Williams LT, Spencer A, Grealish L, Roberts S. Health practitioner practices and their influence on nutritional intake of hospitalised patients. Int J Nurs Sci 2019; 6(2): 162-168.
2. Li PF, Wang YL, Fang YL, Nan L, Zhou J, Zhang D. Effect of early enteral nutrition on outcomes of trauma patients requiring intensive care. Chin J Traumato. 2020; 23(3): 163-167.
3. Darawad MW, Alfasfos N, Zaki I, Alnajar M, Hammad S, Samarkandi OA. ICU Nurses' perceived barriers to effective enteral nutrition practices: A multicenter survey study. Open Nurs J 2018; 12: 67-75.
4. Rattanachaiwong S, Zribi B, Kagan I, Theilla M, Heching M, Singer P. Comparison of nutritional screening and diagnostic tools in diagnosis of severe malnutrition in critically ill patients. Clinical Nutrition 2020; 39(11): 3419-3425.
5. Kang MC, Kim JH, Ryu SW, et al. Prevalence of malnutrition in hospitalized patients: A multicenter cross-sectional study. J Korean Med Sci 2018; 33(2): e10.
6. Shin BC, Chun IA, Ryu SY, Oh JE, Choi PK, Kang, HG. Association between indication for therapy by nutrition support team and nutritional status. Medicine (Baltimore) 2018; 97(52): e13932.
7. Mogensen KM, Lasky-Su J, Rogers AJ, et al. Metabolites associated with malnutrition in the intensive care unit are also associated with 28-day mortality: A prospective cohort study. J Parenter Enteral Nutr 2017; 41(2): 188-197.
8. Lin J, Ke L, Doig GD, et al. Nutritional practice in critically ill COVID-19 patients: A multicenter ambidirectional cohort study in Wuhan and Jingzhou. Asia Pac J Clin Nutr 2021; 30(1): 15-21. doi: 10.6133/apjcn.202103_30(1).0003
9. Lindqvist C, Slinde F, Majeed A, Bottai M, Wahlin S. Nutrition impact symptoms are related to malnutrition and quality of life - A cross-sectional study of patients with chronic liver disease. Clin Nutr 2020; 39(6): 1840-1848.
10. Curtis LJ, Bernier P, Jeejeebhoy K, et al. Costs of hospital malnutrition. Clin Nutr 2017; 36(5): 1391-1396.
11. Ceniccola GD, Araújo WMC, de Brito-Ashurst I, Abreu HB, Akutsu RC. Protected time for nutrition support teams: What are the benefits? Clin Nutr ESPEN 2016; 16: 36-41.
12. Rasmussen NML, Belqaid K, Lugnet K, Nielsen AL, Rasmussen HH, Beck AM. Effectiveness of multidisciplinary nutritional support in older hospitalised patients: A systematic review and meta-analyses. Clin Nutr ESPEN 2018; 27: 44-52.
13. Buitrago G, Vargas J, Sulo S, et al. Targeting malnutrition: Nutrition programs yield cost savings for hospitalized patients. Clin Nutr 2019; S0261-5614(19): 33213-3.
14. Vest MT, Kolm P, Bowen J, et al. Association between enteral feeding, weight status, and mortality in a medical ıntensive care unit. Am J Crit Care 2018; 27(2): 136-143.
15. Boullata JI, Carrera AL, Harvey L, Escuro AA, Hudson L, Mays A. ASPEN safe practices for enteral nutrition therapy. J Parenter Enteral Nutr 2017; 41(1): 15-103.
16. National Patient Safety Agency (NPSA). Patient safety alert NPSA/2011/PSA002. In: Reducing the harm caused by misplaced nasogas-tric feeding tubes in adults, Children and infants. NPSA, London, UK. Retrived from:file:///C:/Users/HP/Downloads/Nasogastric%20alert_final_2011%2003%2009%20(3).pdf
17. Singer P, Blaser AR, Berger MM, et al. ESPEN guideline on clinical nutrition in the intensive care unit. Clin Nutr 2019; 38(1): 48-79.
18. Bloomer MJ, Clarke AB, Morphet J. Nurses’ prioritization of enteral nutrition in intensive care units: a national survey. Nurs Crit Care 2018; 23(3): 152-158.
19. Xing J, Zhang Z, Ke L, Zhou J, Qin B, Liang H. Enteral nutrition feeding in Chinese intensive care units: a cross-sectional study involving 116 hospitals. Crit Care 2018; 22(1): 229.
20. Mula C. Nurses' competency and challenges in enteral feeding in the intensive care unit (ICU) and high dependency units (HDU) of a referral hospital, Malawi. Malawi Med J 2014; 3(26): 55-59.
21. Gupta B, Agrawal P, Soni KD, et al. Enteral nutrition practices in the intensive care unit: Understanding of nursing practices and perspectives. J Anaesthesiol Clin Pharmacol 2012; 28(1): 41-4.
22. Lane C, Wedlake LJ, Dougherty L, Shaw C. Attitudes towards and knowledge of nutrition support amongst health care professionals on London intensive care units. J Hum Nutr Diet 2014; 27(Suppl 2): 339-51.
23. Morphet J, Clarke AB, Bloomer MJ. Intensive care nurses' knowledge of enteral nutrition: A descriptive questionnaire. Intensive Crit Care Nurs 2016; 37: 68-74.
24. Al Kalaldeh M, Watson R, Hayter M. Jordanian nurses' knowledge and responsibility for enteral nutrition in the critically ill. Nurs Crit Care 2015; 20(5): 229-41.
25. Republic of Turkey Ministry of Health. Health Quality Standards 2015. Republic of Turkey Ministry of Health website. https://dosyamerkez.saglik.gov.tr/Eklenti/3460,skshastanesetiv5r1pdf.pdf?0. Accessed June 19, 2020.
26. Hemşirelik yönetmeliğinde değişiklik yapılmasına dair yönetmelik, 19 Nisan 2011. http://www.turkhemsirelerdernegi.org.tr/tr/yasa-ve-yonetmelikler/yonetmelikler/19-nisan 2011-hemsirelik-yonetmeliginde-degisiklik-yapilmasina-dair-yonetmelik.aspx. Accessed June 19, 2020.
27. Yılmaz DK, Sarkut P, Düzgün F, Kuzu C, Kılıçturgay S. Yatan hastaların nutrisyonel değerlendirme ve desteğine yönelik hemşirelerin görüşleri. (in Turkish) Hemşirelikte Eğitim ve Araştırma Dergisi 2017; 14(2): 139-43.
28. Özbaş N, Baykara ZG. Hemşirelerin tüple enteral beslenme konusunda bilgi düzeylerinin belirlenmesi (in Turkish). International Journal of Human Sciences 2018; 15(1): 359-367. 359-367.
29. Yalcin N, Cihan A, Gundogdu H, Ocakci A. Nutrition knowledge level of nurses. Health Science Journal 2013; 7(1): 99-108.
30. Uysal N, Eşer İ, Khorsid, L. Hemşirelerin enteral beslenme işlemine yönelik uygulama ve kayıtlarının incelenmesi. (in Turkish) Anadolu Hemşirelik ve Sağlık Bilimleri Dergisi 2011; 14(2): 1-9.
31. McClave SA, Taylor BE, Martindale RG, Warren MM, Johnson DR, Braunschweig C. Guidelines for the provision and assessment of nutrition support therapy in the adult critically ill patient: society of critical care medicine (SCCM) and American society for parenteral and enteral nutrition (A.S.P.E.N.). JPEN 2016; 40(2): 159-211.
32. Davis LL. Instrument review: getting the most from a panel of experts. Applied Nursing Research 1992; 5(4): 194-197.
33. Al-Qalah TAH, Alrubaiee GG. Intensive care nurses' knowledge of enteral nutrition at public hospitals in Sana'a, Yemen: A cross-sectional survey. F1000Research 2020; 9(759): 1-14. https://doi.org/10.12688/f1000research.25041.1
34. Mohammed SR, Ahmed Attia SM, Abdelrahman HA. Assessment of nurses' knowledge and practices about medications administration via nasogastric tube at emergency hospital. Mansoura Nursing Journal (MNJ). 2020; 7(2): 1-15.
35. Kılıç S. Cronbach’ın Alfa güvenirlik katsayısı. Journal of Mood Disorders (jMOOD). 2016; 6(1): 47-58.
36. Kim H, Chang SJ. Implementing an educational program to improve critical care nurses' enteral nutritional support. Aust Crit Care 2019; 32(3): 218-222.
37. Darawad MW, Hammad S, Al-Hussami M, Alnajar M, Hammad S, Samarkandi OA. Investigating critical care nurses' perception regarding enteral nutrition. Nurse Educ Today 2015; 35(2): 414-419.
38. Persenius MW, Larsson BW, Hall-Lord ML. Enteral nutrition in intensive care nurses' perceptions and bedside observations. Intensive Crit Care Nurs 2006; 22(2): 82-94.
39. Fulbrook P, Bongers A, Albarran JW. A European survey of enteral nutrition practices and procedures in adult intensive care units. J Clin Nurs 2007; 16(11): 2132-41.
40. Ozen N, Blot S, Ozen V, et al. Gastric residual volume measurement in the intensive care unit: an international survey reporting nursing practice. Nurs Crit Care 2018; 23(5): 263-269.
41. Ichimarua S, Amagai T. Intermittent and bolus methods of feeding in critical care. Diet and Nutrition in Critical Care. Media New York 2014, DOI 10.1007/978-1-4614-8503-2_139-1 Retrived from: https://www.researchgate.net/publication/273462801
42. Boeykens K, Steeman E, Duysburgh I. Reliability of pH measurement and the auscultatory method to confirm the position of a nasogastric tube. Int J Nurs Study 2014; 51(11): 1427-1433.
43. Verpleegkundigen & Verzorgenden Nederland. 2011; Landelijke multidisciplinaire richtlijn Neusmaagsonde.
44. Beghettoa MG, Anzilierob F, Leãesc DM, de Mellod ED. Feeding tube placement: auscultatory method and x-ray agreement. Rev Gaúcha Enferm 2015; 36(4): 98-103.
45. Alhashemi SH, Ghorbani R, Vazin A. Improving knowledge, attitudes, and practice of nurses in medication administration through enteral feeding tubes by clinical pharmacists: a case-control study. Adv Med Educ Pract 2019; 10: 493-500.
46. Sari D, Kadifeli D, Akbiyik A, Taşkiran N. Intensive care unit nurses’ knowledge of medication administration via enteral tubes. Nurs Crit Care 2018; 23(3): 141-146.
47. Theilla M, Cohen J, Singer P, Liebman C, Kagan I. The Assessment, knowledge and perceived quality of nutrition care amongst nurses. J Nutri Med Diet Care 2016; 2(1): 2-5.
48. Ramuada LG. Assessment of knowledge, attitude and practice of nurses regarding enteral nutrition at a military hospital. Thesis presented in partial fulfilment of the requirements for the degree Master of Nutrition at the University of Stellenbosch. 2017.
49. Bedier NA, EL-Ata ABA, Shehab MS. Effect of educational program on nurses’s knowledge related to care of patients undergoing nasogastric tube feding. Port Said Scientific Journal of Nursing 2014; 1(2): 11-129.