Effect of a Clinical Nursing Practice Guideline of Enteral Nutrition Care on the Duration of Mechanical Ventilator for Critically Ill Patients

Evidence-Based Investigation of Nurses' Nutrition Interventions in Intensive Care Patients Regarding Enteral Nutrition

AIM

The aim of this study was to examine the practices and knowledge levels of nurses regarding enteral nutrition interventions in intensive care unit patients in terms of evidence.

METHOD

This cross-sectional study was conducted in 2 hospitals between May and August 2021. A total of 136 nurses working in the intensive care units of the hospitals completed online questionnaires including demographic characteristics and questions about enteral nutrition.

RESULTS

According to the nurses' knowledge level about the indication of enteral nutrition formulas, the following were incorrect or incomplete: their knowledge about transition to parenteral nutrition in case of nutritional contraindications, what to do when the amount of gastric residual volume in tolerance is >500 mL every 6 hours, the conditions for starting enteral nutrition, and which formulas are appropriate to use. Regarding their knowledge about enteral feeding tubes/sets, their knowledge about radiologic imaging after tube placement, measurement of gastric pH level, and marking the tube location was insufficient. Differently, the correct answer percentages of the nurses in 11 of the 13 questions regarding the principles of enteral nutrition practice were above 70%.

CONCLUSION

Nurses had adequate knowledge of the principles of enteral nutrition practice, but their knowledge of the indication of enteral nutrition formulas and the evidence for enteral feeding tubes/sets varied. The results showed that nurses need to gain information about the indication of enteral nutrition formulas and evidence related to enteral feeding tubes/sets.

Understanding nursing perspective towards barriers to the optimal delivery of enteral nutrition in intensive care settings

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.

Nursing management of the critical thinking and care quality of ICU nurses: A cross-sectional study

AIM

To explore the effectiveness of a digital learning management system in enhancing intensive care unit nurses' critical care knowledge and critical thinking tendency.

BACKGROUND

Learning intensive care unit knowledge and skills is essential for the continuing education of nurses, and impacts patient health outcomes. Enhancing intensive care unit nurses' critical care abilities is a medical care quality concern in clinical practice.

METHODS

A cross-sectional study was conducted with 212 participants to investigate the effects of a digital learning system on care quality.

RESULTS

After the implementation of the digital learning system, intensive care unit nurses' critical care knowledge and critical thinking skills increased significantly. High-level nurses had higher critical thinking scores. All participants associated critical care knowledge with improved quality of care.

CONCLUSION

The digital learning management system enhanced intensive care unit nurses' critical care knowledge. Optimizing nursing care safety and quality requires that nursing staff to be at an adequate level, which improves their critical care ability.

IMPLICATIONS FOR NURSING MANAGEMENT

A well-designed digital learning management system with structured classes may allow intensive care unit nurses to learn effectively and can be used for continuing education. These results are of interest to nursing management staff who want to invest in the continued professional development of intensive care unit nurses to improve critical care knowledge, critical thinking skills, care quality, and health care value.

Early Enteral Nutrition Met Calories Goals Led by Nurse on Improve Clinical Outcome: A Systematic Scoping Review

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.

Optimal Nutritional Factors Influencing the Duration of Mechanical Ventilation Among Adult Patients with Critical Illnesses in an Intensive Care Unit

Objective

This study aims to identify the impact of nutritional factors on mechanical ventilation duration for critical patients.

Patients and Methods

The current study was a single-center, prospective observational design which enrolled one-hundred critically ill patients who were admitted to an intensive care unit (ICU). It demonstrates purposive sampling and also performs the descriptive nutritional factors influencing the mechanical ventilation duration. Daily calories target requirement scale (DCRS), subjective global assessment form (SGA), dyspnea assessment form, and APACHE II have been used as methods in the study along with time to initial enteral nutrition (EN) after 24-hour admission and daily calories target requirement over 7 days to assess patients. Data is analyzed using the multiple regressions.

Results

As a result, nutritional status monitoring, time to initial EN, calories and target requirements are statistically positive significance associated with the mechanical ventilation duration respectively (R = 0.54, R = 0.30, R= 0.40, p < 0.05). However, age, illness severity, and dyspnea scales are not associated with the mechanical ventilation duration (p> 0.05). Therefore, the nutritional status, malnutrition scores and calorie target requirements can be used to significantly predict the mechanical ventilation duration. The predictive power is 58 and 28.0% of variance. The most proper influencer to predict the mechanical ventilation duration is nutritional status or malnutrition scores.

Conclusion

The research findings show that the nutritional status, time to initial EN, and calorie target requirement within 7 days of admission are associated with the mechanical ventilation duration in the critical patients. Therefore, it can be used to develop guidelines reducing the mechanical ventilation duration and to promote the ventilator halting for critical patients.

Nursing care factors influencing patients' outcomes in the intensive care unit: Findings from a rapid review

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.