Oesophageal bezoar as a complication of enteral nutrition in critically ill patients. Two case studies

Compassion fatigue and stress related to cardiopulmonary resuscitation: a study of critical care nurses' experiences

BACKGROUND

Cardiopulmonary resuscitation (CPR) is considered one of the most stressful experiences in critical care nursing; it directly and indirectly leads to compassion fatigue and burnout.

AIM

Determine the levels of and relationship between postcode stress and compassion fatigue.

DESIGN AND METHODS

A descriptive-correlational study using 300 critical care nurses from five intensive care units in two hospitals was conducted.

TOOLS

Demographic and work-related data, the Postcode Stress Scale, and the Professional Quality of Life Scale: Compassion Fatigue subscale.

RESULTS

Nurses had moderate to high postcode stress and compassion fatigue (67.98 ± 16.39 and 65.40±14.34, respectively). Moreover, there was a significant positive correlation between postcode stress, burnout (r=0.350, p=<0.001), secondary traumatic stress (r=0.518, p=<0.001), and subsequently, compassion fatigue (r=0.449, p=<0.001). In addition, higher levels of postcode stress were associated with higher levels of compassion fatigue with its subscales: burnout and secondary traumatic stress, with a coefficient of determination for compassion fatigue (0.199), burnout subscale (0.121), and secondary traumatic stress (0.266).

CONCLUSION

Critical care nurses involved in resuscitation experiences are susceptible to postcode stress, burnout, secondary traumatic stress, and compassion fatigue. There is a significant relationship between these factors, with higher levels of postcode stress contributing to higher levels of compassion fatigue and its subscales: burnout and secondary traumatic stress. These results highlight the importance of addressing and managing the psychological well-being of nurses in resuscitation settings to mitigate the adverse effects of stress and promote their overall resilience and well-being.

Esophageal pharmacobezoar: a very unusual complication of enteral nutrition use

Enteral nutrition in intensive care has been a great advance in medicine, due to its benefit, cost-effectiveness and few complications. Bronchoaspiration, diarrhea, regurgitation or mechanical problems are the main adverse effects. Esophageal obstruction by bezoar is a very infrequent complication, and there are only a few cases described in the literature.

Oesophageal mucosal tears caused by suboptimal nasogastric tube insertion: a case study

Oesophageal bezoars are one of the many causes of nasogastric tube obstruction; however, they are extremely rare and, therefore, not often considered to be the cause of a blockage. A bezoar is a solid mass of indigestible material that accumulates in the digestive tract. After a blockage is identified, the nasogastric tube is usually removed and another one inserted. However, this can be dangerous and can easily cause tearing of the oesophageal mucosa, bleeding, and other serious complications. In this article, the authors present a case of nasogastric tube obstruction caused by oesophageal bezoars. After the nasogastric tube was replaced, the patient experienced two tears of the oesophageal mucosa. This article highlights the importance of the introduction of a procedure for nurses to follow in cases of nasogastric tube obstruction, bearing in mind the possibility of the presence of oesophageal bezoars. If necessary, a gastroscope should be used to ensure safe insertion of the nasogastric tube and prevent oesophageal mucosal tears.

Gastric residual volume measurement in the intensive care unit: an international survey reporting nursing practice

BACKGROUND

Gastric residual volume measurement is routinely used to evaluate the feeding tolerance and gastro-oesophageal reflux in patients receiving enteral feeding therapy in the intensive care unit. However, little supportive evidence for this intervention is available as the usefulness of gastric residual volume measurements in patients receiving enteral feeding therapy in the intensive care is controversial.

AIM

The aim of this study was to assess the practice of intensive care unit nurses related to gastric residual volume measurement in patients receiving enteral nutrition.

METHODS

A survey was conducted among a sample of intensive care unit nurses (n = 832) from four hospitals in Turkey (n = 182) and attendees of the Annual Congress of the Flemish Society for Critical Care Nurses in Flanders, Belgium (n = 650). The survey instrument was developed by the researchers based on the related literature.

RESULTS

A total of 480 nurses completed the questionnaire (response rate = 73%). Gastric residual volume is measured by 98·0% of respondents, with wide variations in the frequency of measuring. A 50-200 mL gastric residual volume is considered problematic by 45·5% (n = 183) of the participants, and only 18·4% (n = 81) reported their practice to be based on a current guideline. Strikingly, more experienced intensive care unit nurses appear to perform gastric residual volume measurements more commonly than their less experienced colleagues (p = 0·004), while the practice is more often reported to be performed in Belgium than in Turkey (p < 0·001).

CONCLUSION

Gastric residual volume management could be improved by applying current evidence to daily nursing practice.

RELEVANCE TO CLINICAL PRACTICE

Our results show that increased awareness of these guidelines by nurses is needed to reduce inefficient use of working time and resources, streamline clinical practices and improve patient outcomes. Current gastric residual volume measurement guidelines and up-to-date, relevant training should be provided to nurses.