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Terblanche E, Merriweather J, Bharal M, Lewis R, Wandrag L. Dietetic-led interventions in critically ill adults that influence outcome: A scoping review. JPEN J Parenter Enteral Nutr 2025; 49:165-179. [PMID: 39629684 DOI: 10.1002/jpen.2705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Revised: 10/22/2024] [Accepted: 10/24/2024] [Indexed: 02/06/2025]
Abstract
BACKGROUND Critically ill patients face malnutrition risks, making nutrition management challenging. Dietitians play a crucial role in the intensive care unit (ICU) by applying their expertise to address these challenges. This review examines dietitian-led interventions and their impact on patient outcomes. METHODS A scoping review of MEDLINE, Embase, CINAHL, EBSCO, Web of Science, and ProQuest databases from January 1995 to July 2023 was conducted. Studies involving dietitian-led interventions in adult critical care were included. Data extraction followed Joanna Briggs Institute methodology, focusing on study design, population, and interventions. RESULTS Of 751 studies, 39 met the inclusion criteria. Most studies were observational, with only three interventional trials. Dietitian-led interventions included (1) guideline development and implementation, (2) individualized nutrition treatment, and (3) enteral nutrition tube insertion. Outcomes were classified into (1) patient clinical outcomes (ICU stay duration, mechanical ventilation, infections, cost savings, readmissions, mortality, adverse effects, and glycemic control) and (2) nutrition-related outcomes (nutrition initiation, energy and protein delivery, gastrointestinal tolerance, parenteral nutrition use, and appropriate dietetic referral). CONCLUSION Dietitian-led interventions improved nutrition outcomes and may have contributed to better clinical outcomes. Future research should prioritize reporting core outcomes, including nutrition status and physical function, to further quantify the effectiveness of dietitians in ICU care and enhance their recognition within the multiprofessional team.
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Affiliation(s)
| | - Judith Merriweather
- Critical Care Department, Royal Infirmary of Edinburgh, Edinburgh, UK
- Nutrition and Dietetic Department, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Mina Bharal
- Nutrition and Dietetics Department, Northwick Park & St Mark's Hospitals, London North West Hospitals University Trust, Harrow, UK
| | - Rhiannon Lewis
- Cardiothoracics and Critical Care, Royal Brompton and Harefield Hospitals, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Liesl Wandrag
- Nutrition & Dietetic Department, Kings College Hospital NHS Foundation Trust, London, UK
- Critical Care Department, Kings College Hospital NHS Foundation Trust, London, UK
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Deng W, Yang X, Wang L, Luo W, Li J. A qualitative study on the life experiences and discharge planning of family caregivers for the elderly with nasal feeding. Am J Transl Res 2024; 16:3306-3315. [PMID: 39114715 PMCID: PMC11301494 DOI: 10.62347/butq7906] [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: 03/01/2024] [Accepted: 06/19/2024] [Indexed: 08/10/2024]
Abstract
OBJECTIVE To understand the discharge planning needs of family caregivers for the elderly with nasal feeding. METHODS From May to August in 2021, in-depth interviews were conducted with eleven family caregivers for elderly patients with nasal feeding at a tertiary hospital in Shenzhen. The interviews were analyzed using phenomenological research methods and the Knowledge, Awareness, and Practice (KAP) theory to identify and refine key themes. RESULTS The discharge planning needs of family caregivers for elderly with nasal feeding can be summarized into three themes: ① Learning needs related to nasal feeding knowledge and discharge planning (Knowledge), ② Factors affecting the family caregivers of elderly with nasal feeding (Awareness), and ③ Practical needs in caregiving (Practice). CONCLUSION Discharge planning for family caregivers of elderly individuals receiving nasal feeding should focus on the accurate assessment of tube placement and patient condition, operational skills, emergency response, and complication management. Medical professionals should evaluate these needs to develop personalized discharge readiness service plans, ensuring the quality of care for elderly patients with nasal feeding at home.
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Affiliation(s)
- Wuhong Deng
- Department of Geriatrics, Shenzhen People’s Hospital, 2nd Clinical Medical College of Jinan University, 1st Affiliated Hospital of Southern University of Science and TechnologyShenzhen 518020, Guangdong, China
| | - Xiufen Yang
- Department of Geriatrics, Shenzhen People’s Hospital, 2nd Clinical Medical College of Jinan University, 1st Affiliated Hospital of Southern University of Science and TechnologyShenzhen 518020, Guangdong, China
| | - Linying Wang
- Department of Geriatrics, Shenzhen People’s Hospital, 2nd Clinical Medical College of Jinan University, 1st Affiliated Hospital of Southern University of Science and TechnologyShenzhen 518020, Guangdong, China
| | - Weixiang Luo
- Department of Nursing, Shenzhen People’s Hospital, 2nd Clinical Medical College of Jinan University, 1st Affiliated Hospital of Southern University of Science and TechnologyShenzhen 518020, Guangdong, China
| | - Jinling Li
- Department of Geriatrics, Shenzhen People’s Hospital, 2nd Clinical Medical College of Jinan University, 1st Affiliated Hospital of Southern University of Science and TechnologyShenzhen 518020, Guangdong, China
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Occhiali E, Bernard B, Fraboulet M, Achamrah N, Clavier T. An evaluation of intensive care nurses' performance of indirect calorimetry measurements. Nurs Crit Care 2024; 29:307-312. [PMID: 38228360 DOI: 10.1111/nicc.13019] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 12/05/2023] [Accepted: 12/12/2023] [Indexed: 01/18/2024]
Abstract
BACKGROUND Indirect calorimetry (IC) is the gold standard to monitor energy expenditure in critically ill patients. In several intensive care units (ICUs), nurses are responsible for carrying out the measurements. AIM The aim of this study was to assess nurses' perception of their involvement in IC. STUDY DESIGN This was a prospective survey conducted in the surgical ICU of a French university hospital after 18 months of use of the Q-NRG + ® calorimeter (COSMED©, Italy). All nurses who have used the calorimeter in the previous 6 months in this ICU were questioned through a questionnaire about their theoretical and practical knowledge and experience in using it. RESULTS The participation rate was 93% (28/30 surveyed). All the respondents understood the objectives of performing an IC and 23 of them (82%) had used the device at least once in the previous 6 months. All the users thought it was pertinent that ICU nurses were in charge of the IC measurements, 16 of them (70%) reported having been formally trained, mostly by a colleague, and 17 (77%) felt comfortable with the device after 2 to 5 uses. The five non-users (8%) did not have the opportunity to do so. Theoretical and practical knowledge could be improved as only 5 of the users (22%) declared to know the main criteria of reliability of the IC measurement and 4 of them (18%) declared to know the maintenance and cleaning protocol of the device. CONCLUSION Nurses quickly felt comfortable with the Q-NRG + ® in this ICU. Formal initial and ongoing training of all staff completing IC is essential to perform IC measurements safely and to obtain reliable and interpretable results in practice. RELEVANCE TO CLINICAL PRACTICE Involving the nursing team in nutritional care, even if it is technical, seems to bring satisfaction in terms of overall patient care.
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Affiliation(s)
- Emilie Occhiali
- Department of Anesthesiology, Critical Care and Perioperative Medicine, Surgical Intensive Care Unit, Rouen University Hospital, Rouen, France
| | - Benedicte Bernard
- Department of Anesthesiology, Critical Care and Perioperative Medicine, Surgical Intensive Care Unit, Rouen University Hospital, Rouen, France
| | - Marion Fraboulet
- Department of Anesthesiology, Critical Care and Perioperative Medicine, Surgical Intensive Care Unit, Rouen University Hospital, Rouen, France
| | - Najate Achamrah
- Department of Nutrition, Rouen University Hospital, Rouen, France
| | - Thomas Clavier
- Department of Anesthesiology, Critical Care and Perioperative Medicine, Surgical Intensive Care Unit, Rouen University Hospital, Rouen, France
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Zaragoza-García I, Arias-Rivera S, Frade-Mera MJ, Martí JD, Gallart E, San José-Arribas A, Velasco-Sanz TR, Blazquez-Martínez E, Raurell-Torredà M. Enteral nutrition management in critically ill adult patients and its relationship with intensive care unit-acquired muscle weakness: A national cohort study. PLoS One 2023; 18:e0286598. [PMID: 37285356 DOI: 10.1371/journal.pone.0286598] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2023] [Accepted: 05/19/2023] [Indexed: 06/09/2023] Open
Abstract
OBJECTIVE To assess the incidence and determinants of ICU-acquired muscle weakness (ICUAW) in adult patients with enteral nutrition (EN) during the first 7 days in the ICU and mechanical ventilation for at least 48 hours. METHODS A prospective, nationwide, multicentre cohort study in a national ICU network of 80 ICUs. ICU patients receiving invasive mechanical ventilation for at least 48 hours and EN the first 7 days of their ICU stay were included. The primary outcome was incidence of ICUAW. The secondary outcome was analysed, during days 3-7 of ICU stay, the relationship between demographic and clinical data to contribute to the onset of ICUAW, identify whether energy and protein intake can contribute independently to the onset of ICUAW and degree of compliance guidelines for EN. RESULTS 319 patients were studied from 69 ICUs in our country. The incidence of ICUAW was 153/222 (68.9%; 95% CI [62.5%-74.7%]). Patients without ICUAW showed higher levels of active mobility (p = 0.018). The logistic regression analysis showed no effect on energy or protein intake on the onset of ICUAW. Overfeeding was observed on a significant proportion of patient-days, while more overfeeding (as per US guidelines) was found among patients with obesity than those without (42.9% vs 12.5%; p<0.001). Protein intake was deficient (as per US/European guidelines) during ICU days 3-7. CONCLUSIONS The incidence of ICUAW was high in this patient cohort. Early mobility was associated with a lower incidence of ICUAW. Significant overfeeding and deficient protein intake were observed. However, energy and protein intake alone were insufficient to explain ICUAW onset. RELEVANCE TO CLINICAL PRACTICE Low mobility, high incidence of ICUAW and low protein intake suggest the need to train, update and involve ICU professionals in nutritional care and the need for early mobilization of ICU patients.
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Affiliation(s)
- Ignacio Zaragoza-García
- Department of Nursing, Faculty of Nursing, Physiotherapy and Podology, University Complutense of Madrid, Madrid, Spain
- Invecuid, Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid, Spain
| | - Susana Arias-Rivera
- University Hospital of Getafe, CIBER Enfermedades Respiratorias, Instituto de Salud Carlos III, Getafe, Spain
| | - María Jesús Frade-Mera
- Department of Nursing, Faculty of Nursing, Physiotherapy and Podology, University Complutense of Madrid, Madrid, Spain
- Department of Critical Care, 12 Octubre University Hospital, Madrid, Spain
| | | | - Elisabet Gallart
- Department of Critical Care, Vall Hebron University Hospital, Barcelona, Spain
| | - Alicia San José-Arribas
- Escola Universitaria d'Infermeria Sant Pau, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Tamara Raquel Velasco-Sanz
- Department of Nursing, Faculty of Nursing, Physiotherapy and Podology, University Complutense of Madrid, Madrid, Spain
- Department of Critical Care, San Carlos University Hospital, Madrid, Spain
| | | | - Marta Raurell-Torredà
- Department d'Infermeria Fonamental i medicoquirúrgica, Facultat d'Infermeria, Universitat de Barcelona, Barcelona, Spain
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Maraş G, Ceyhan Ö, Delen N. Intensive care nurses' knowledge and use of a nursing checklist: A cross-sectional survey. J Nurs Manag 2022; 30:4442-4451. [PMID: 36257924 DOI: 10.1111/jonm.13874] [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: 05/14/2022] [Revised: 09/03/2022] [Accepted: 09/25/2022] [Indexed: 12/30/2022]
Abstract
AIM This descriptive study was conducted to determine the awareness of nurses working in intensive care units about the daily patient checklist. BACKGROUND Checklists are used in the daily follow-up and evaluation of patients admitted to the intensive care unit. METHOD The research was carried out with 180 nurses through the social media account of the Turkish Intensive Care Specialists Association Nurse Commission between July 2021 and March 2022. Data were collected with a descriptive information form and intensive care unit daily patient checklist. Necessary permissions were obtained before the study. RESULTS Among nurses, 45.0% of them got 15 full points from the Checklist. Moreover, 81.1% of the nurses stated that they knew that a checklist should be used to help eliminate the deficiencies of daily care and treatment in the intensive care unit, while 66.7% stated that they used a checklist. It was determined that nurses knew the most about parameters 'Check the daily infection parameters', 'Glycaemic control', 'Therapy', and the least about parameters 'Thromboprophylaxis', 'Ulcer prevention', 'Hypo-hyper delirium' and 'Use a daily checklist'. CONCLUSION It was determined that the level of awareness of intensive care unit nurses about some parameters that should be followed daily for patient care was low. IMPLICATIONS FOR NURSING MANAGEMENT Checklists can be used as a guide for health care professionals in the routine daily evaluation of intensive care unit patients. It is thought that these reminder abbreviations will provide efficiency in preventing the disruption of applications, reducing medical errors, reducing mortality and morbidity, and cost.
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Affiliation(s)
- Gülseren Maraş
- Faculty of Health Sciences, Surgery Nursing, Erciyes University, Kayseri, Turkey
| | - Özlem Ceyhan
- Faculty of Health Sciences, Internal Medicine Nursing, Erciyes University, Kayseri, Turkey
| | - Nuray Delen
- President of Turkish Internal and Surgical Sciences Intensive Care Association Nursing Commission, Ankara, Turkey
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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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Trapani J, Tume L. Spotlight on the first joint BACCN/IACCN conference. Nurs Crit Care 2022; 27:617-618. [PMID: 36017788 DOI: 10.1111/nicc.12836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Accepted: 07/20/2022] [Indexed: 11/29/2022]
Affiliation(s)
- Josef Trapani
- Faculty of Health Sciences, University of Malta, Msida, Malta
| | - Lyvonne Tume
- Faculty of Health, Social Care & Medicine, Edge Hill University, Ormskirk, UK
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