Current status and influencing factors of barriers to enteral feeding of critically ill patients: A multicenter study.

To investigate the barriers in administering enteral feeding to critically ill patients from the nursing perspective. Our objectives are to provide tailored interventions for addressing identified barriers and propose an optimal enteral nutrition (EN) practice in intensive care unit (ICU). Despite the availability of numerous verified clinical practice guidelines focusing on enteral feeding of critically ill patients, a wide gap remains between the guideline recommendations and actual nutrition performances. Underfeeding is also a global problem. Therefore, to further understand the reasons of the systemic iatrogenic underfeeding in ICUs, several potential issues are investigated. This research is a cross-sectional descriptive study. A total of 808 nurses were recruited from 10 comprehensive hospitals from different districts in China. The nursing staff demographic, the unit's EN management information and the Chinese version of barriers to enteral feeding critically ill patients questionnaire were the parameters used to collect data via WeChat app. Moreover, the collected data were analysed by descriptive and correlative statistical analysis methods. Results obtained by multiple linear regression showed that frequency of EN-related training, full-time ICU nutritionist, hospital level, specific protocols for enteral feeding and position were significantly influencing the enteral feeding of ICU patients. Enteral feeding barriers of ICU patients are at a moderate level and are influenced by multiple aspects. Hence, hospital departments should strengthen standardisation and systematic EN training, provide ICU full-time nutritionists and distribute medical resources and personnel rationally. Moreover, construction of a localised feeding process and exerting subjective initiative of clinical nurses from an evidence-based guideline are important. Multifaceted tailored interventions should be implemented to address these barriers. The findings of this study can be used to inform future intervention and guidelines aimed at addressing these barriers systematically and improving adherence to critical care nutrition guidelines for the provision of enteral nutrition.

Huang J ，Yang L ，Zhuang Y ，Qi H ，Chen X ，Lv K ... -  《-》

Barriers to feeding critically ill patients: a multicenter survey of critical care nurses.

The aims of this study were to describe the barriers to enterally feeding critically ill patients from a nursing perspective and to examine whether these barriers differ across centers. A cross-sectional survey was conducted in 5 hospitals in North America. A 45-item questionnaire was administered to critical care nurses to evaluate the barriers to enterally feeding patients. A total of 138 of 340 critical care nurses completed the questionnaire (response rate of 41%). The 5 most important barriers to nurses were as follows: (1) other aspects of patient care taking priority over nutrition, (2) not enough feeding pumps available, (3) enteral formula not available on the unit, (4) difficulties in obtaining small bowel access in patients not tolerating enteral nutrition, and (5) no or not enough dietitian coverage during weekends and holidays. For 18 (81%) of 22 potential barriers, the rated magnitude of importance was similar across the 5 intensive care units. Nurses in our multicenter survey identified important barriers to providing adequate enteral nutrition to their critically ill patients. The importance of these barriers does not appear to differ significantly across different clinical settings. Future research is required to evaluate if tailoring interventions to overcome these identified barriers is an effective strategy of improving nutrition practice.

Cahill NE ，Murch L ，Cook D ，Heyland DK ，Canadian Critical Care Trials Group ... -  《-》

Jordanian nurses' knowledge and responsibility for enteral nutrition in the critically ill.

Poor nursing adherence to evidence-based guidelines has negative consequences leading to higher mortality rates, delayed recovery and longer length of stay. Evidence-based practice has the potential to minimize complications and discrepancies between nurses. This study aimed to assess nurses' practice and perception of their knowledge and responsibility in relation to enteral nutrition (EN) in the critically ill. This descriptive correlational design was applied to nurses working in intensive care units (ICUs) from three health care sectors in Jordan (Governmental, Military and Private sectors). Nurses were recruited using a stratified sampling technique. A pre-prepared questionnaire focusing on nurses' practice and perception towards EN was used. A total of 253 ICU nurses completed the questionnaire. Nurses revealed a tendency to undertake nutritional care despite the recognition clinical nutrition is a secondary role. In terms of nursing processes, nurses showed greater levels of knowledge and responsibility for 'preventing complications' and 'evaluation' more than 'assessment' and 'identifying goals'. Nurses inadequately assess both gastric residuals and tube placement before feeding. Diarrhoea was the most frequent complication followed by abdominal pain, vomiting, tube dislodgment and weight loss. However, nurses realized that the incidences of complications is less likely when applying evidence-based protocol. It is necessary to establish a preliminary assessment for patients' nutritional needs prior to using EN. Aspiration reduction measures are still deficient and need further attention. An evidence-based protocol for EN should be adopted in the critically ill. This article provides insight into the current practice of Jordanian intensive care nurses in different health care sectors. The study can contribute to redirect the perception of nurses towards nutrition in the critically ill in addition to enhance positive adherence to evidence base.

Al Kalaldeh M ，Watson R ，Hayter M 《-》

Canadian clinical practice guidelines for nutrition support in mechanically ventilated, critically ill adult patients.

Heyland DK ，Dhaliwal R ，Drover JW ，Gramlich L ，Dodek P ，Canadian Critical Care Clinical Practice Guidelines Committee ... -  《JOURNAL OF PARENTERAL AND ENTERAL NUTRITION》

Development and psychometric properties of a questionnaire to assess barriers to feeding critically ill patients.

Cahill NE ，Day AG ，Cook D ，Heyland DK ，Canadian Critical Care Trials Group ... -  《-》