New Nutrition Guidelines: Promoting Enteral Nutrition via a Nutrition Bundle

Qualitative study on the ability of neurological nurses to manage patients with indwelling gastrointestinal canal

Aim and objectives

This study aims to assess the proficiency of nurses in the neurology department in managing patients with indwelling gastrointestinal canal.

Background

Many critically ill patients in neurology departments require the placement of nasoenteric tubes to provide enteral nutrition. However, in clinical practice, there exists considerable variability in nurses' competencies regarding the management of patients with nasoenteric tubes. A thorough understanding of the challenges nurses face throughout the entire process of nasoenteric tube care and the development of targeted improvement measures are crucial for delivering enhanced patient care and facilitating patient recovery.

Design

A qualitative interview study.

Methods

From August to October 2023, 11 neurological nurses were recruited offline in three hospitals for semi-structured and in-depth interviews. The data analysis uses the KJ method to summarize and classify the themes from the semi-structured interview results, and then organize the themes into a coherent visual and logical path. The COREQ list is used.

Results

The researchers conducted semi-structured interviews with 11 neurology nurses from three hospitals using a purposive sampling method, of which 64% of the participants were female and 36% were male; the average age was 38.27 ± 7.85 years; 27% from the Department of Neurology, 73% from the Department of Neurosurgery; junior professional titles accounted for 18%, intermediate professional titles accounted for 64%, senior professional titles accounted for 18%; 27% of the subjects were head nurses and 73% were nurses. The study identified 5 themes: (1) Preparation and evaluation before intubation; (2) Enhancement of intubation success rates; (3) Prevention of complications; (4) Management of complications and emergencies; (5) The acquisition of relevant knowledge and experience. In clinical practice, the bedside blind insertion technique is random and has not yet formed a unified standard, and the specific operation details and techniques need to be further improved.

Conclusion

Disparities exist in the nursing capabilities of neurology nurses due to variations in their knowledge and experience regarding gastrointestinal canal management.

Associated ICU nurses' characteristics to clinical enteral nutrition knowledge at public hospitals in Sana'a, Yemen: A basis for remodeling safety and quality of care standards

Background: Nurses have a pivotal role in initiating and managing enteral nutrition (EN) and monitoring any potential complications. Yet, it is unclear whether Yemeni nurses have adequate knowledge to deliver and manage enteral nutrition safely. Therefore, the aim of this study was to assess the level of ICU nurses' knowledge regarding the care of EN. Methods: A descriptive cross-sectional study was conducted from February 2019 to March 2019. A probability sampling method was used to recruit 174 nurses from four public hospitals in the capital city of Yemen. A self-administered 17-item questionnaire related to ICU nurses' knowledge regarding EN intervention was used to collect the data. Results: Based on our findings, only 10.9% of the respondents had an adequate level of knowledge about EN care, while 43.1% of them had a moderate level of knowledge, and 46.0% of them had an inadequate level of knowledge. Only 16.1% of the participants were knowledgeable of EN pre-administration care, whereas 5.80% of them were knowledgeable of EN administration care, and 9.20% were knowledgeable of EN post-administration care. There were significant associations between ICU nurses' level of knowledge of EN care and their level of education and knowledge sources. Conclusions: The significant gap in ICU nurses' knowledge regarding EN care identified implies the need to upgrade and refresh of the ICU nurses' knowledge by implementing a regular training program concerning EN care.

Critical Care Nurses’ Perceptions of Enteral Nutrition: A Descriptive Cross-Sectional Study

Background and Objective:

Nutritional support is an essential component of critical care with a significant effect on the outcomes of critically ill patients. Critical care nurses are in a central position to achieve nutritional goals and preserve the nutritional status of patients at best. This study aimed to investigate the critical care nurses’ perceptions of the responsibility, knowledge, and documentation system support regarding enteral nutrition.

Methods:

Data were collected from 292 critical care nurses in different healthcare sectors in Sana’a, the capital of Yemen, using a quantitative, descriptive, cross-sectional design. A self-administered questionnaire containing 50 items was used for data collection. The data were collected between March and June 2021. The Statistical Package for the Social Sciences (SPSS) version 16 was used for the data analysis.

Results:

The study found that most critical care units did not have guidelines, protocols, or a nutritional support team, and the physicians prescribed enteral nutrition. The critical care nurses perceived they had a low responsibility, insufficient knowledge, and moderate documentation support regarding enteral nutrition. The nurses in private hospitals had the highest responsibility, the nurses who received in-service education about enteral nutrition reported the highest level of knowledge, and the nurses in the Neuro critical care units had the best support from a documentation system. Scientific workshops and conferences were the main sources of knowledge regarding enteral nutrition. The nurses’ educational needs included the ability to evaluate the outcomes, goal setting, and nutritional assessment.

Conclusions:

The critical care nurses perceived a low responsibility, low level of knowledge, and moderate support from a documentation system regarding enteral nutrition. There is an urgent need to create or adopt enteral nutrition evidence-based guidelines and protocols and establish a multidisciplinary nutritional support team with clear roles and responsibilities. In-service education and training related to enteral nutrition are paramount.

Using Nurse-Driven Protocols to Eliminate Routine Gastric Residual Volume Measurements: A Retrospective Study

BACKGROUND

Multiple critical care guidelines support the elimination of routine gastric residual volume monitoring in patients receiving enteral nutrition. However, transitioning nursing practice away from routine gastric residual volume assessments has proved challenging.

OBJECTIVE

To evaluate outcomes after the elimination of routine gastric residual volume monitoring in a 14-bed adult intensive care unit at a large teaching hospital in the southeastern United States.

METHODS

Practice change was accomplished through in-service training and implementation of a validated protocol. Data were collected for 30 days before and 30 days after protocol implementation to determine effects on the total volume of enteral nutrition received as well as the rate of adverse events after elimination of routine gastric residual volume assessments (n = 22) as compared with previous standard practice (n = 25).

RESULTS

When gastric residual volume was not measured, the mean (SD) percentage of enteral nutrition delivery was 81% (12%) of the ordered volume, compared with 60% (18%) in the historic control group (P = .002). Eliminating gastric residual volume monitoring was not associated with an increased rate of adverse events (emesis, aspiration pneumonia) or a change in length of stay. Nursing staff demonstrated a high degree of compliance with this protocol change.

CONCLUSION

The findings of this study indicate that the elimination of routine gastric residual volume assessment does not increase the rate of adverse events and results in increased nutrition provision. Use of a protocol for practice change as well as mandatory in-service training may effect changes in nursing practice.

Enteral Nutrition: Based on the Combination of Nutrison Fibre and TPF-DM with A Marine Biological-Based Active Polysaccharide Preparation

Good nutrition is essential for human growth, wound healing, and spiritual vitality. However, some individuals are unable to eat or experience gastrointestinal problems such as severe diarrhea, vomiting, gastric retention, and even gastrointestinal bleeding for a variety of causes. Therefore, it has important clinical significance to provide patients with required nutrients and maintain the integrity of the body’s tissues and organs through enteral nutrition. Based on this, this work uses a dual carrier of polylactic acid (PLA) and polyvinyl alcohol (PVA) to carry marine biopolysaccharides combined with sodium alginate (PSS) and successfully obtains the intestinal tract based on marine bioactive polysaccharides. Nutritional oral biological preparations (PSS-PLA/PVA) also cooperate with enteral nutritional suspension (diabetes) (TPF-DM) and Nutrison fibre to provide enteral nutritional support for critically ill patients. PSS-PLA/PVA has been shown in clinical studies to increase the effect of enteral nutrition support, the function of intestinal T lymphatic tissue, and the ability to control immunological function, indicating that it is worthy of further clinical development.

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.

Enteral Nutrition in the Deployed Critical Care Ground and Air Transport Environment: A Narrative Review

INTRODUCTION

Early and adequate administration of enteral nutrition (EN) improves outcomes in critical care patients. However, the environment where Critical Care Air Transport teams provide patient care poses particular challenges to achieving the same standard of nutritional support readily administered in civilian intensive care units. Providing the highest standard of nutritional care in austere military environments remains the goal for all patients despite inherent challenges. Enteral nutrition, specifically, is not currently a standard of practice in-flight because of concerns for microaspiration and the associated risk of developing ventilator-associated pneumonia. Clinical concern for aspiration combines with the lack of an EN pump approved for use through Safe-to-Fly testing to further decrease the likelihood of initiating EN in trauma patients. Early EN significantly reduces morbidity and mortality risks; therefore, the lack of nutritional support is contrary to established standards of care in civilian intensive care units. Hence, this literature review proposes to provide a clearer understanding of current EN practices as well as any associated risks within the En Route Care system.

METHOD

A narrative review of literature related to EN in military and civilian flight settings using the PRISMA methodology.

RESULTS

A search using the key terms of critical care, air ambulance, EN, nutritional status, and aspiration returned a total of 51,990 articles. A title review followed by a more targeted abstract analysis by the research team generated 39 articles for full-text review. The full-text review then yielded a total of 10 relevant articles for inclusion in the final synthesis table.

CONCLUSIONS

Overall, the consensus of the literature supports that early evaluation and initiation of standard EN feeding protocols on the ground and during transport improves patient outcomes and enhances injury recovery. However, additional research will determine the current number of patients fed in-flight along with the actual risks and benefits of EN in this population.

Malnutrition and nutritional status in critically ill patients with enteral nutrition

BACKGROUND & OBJECTIVE: The prevention of malnutrition is an important factor in the survival of critically ill patients with enteral nutrition. The present study aims to assess the nutritional status and its association with some blood-related markers in critically ill patients with enteral nutrition during hospitalization in the intensive care units (ICUs). METHODS: Totally, 110 patients participated in this study from the time of admission to discharge at five ICUs. The patients’ nutritional status was assessed by subjective global assessment (SGA), Acute Physiology and Chronic Health Evaluation and Albumin, Total Iron Binding Capacity (TIBC), Hemoglobin (Hb), Hematocrit (HCT), Ferritin, and Feas biochemical indices and anthropometric parameters. RESULTS: Malnutrition prevalence increased significantly on the day of discharge (83.6%) compared to the day of admission (41.8%), according to SGA (P < 0.001). Hb, HCT, serum Fe decreased and ferritin, also TIBC were increased during hospitalization in ICU. The malnutrition risk predictors based on the logistic regression were low levels of Hb (OR = 0.6), HCT (OR = 0.9), Fe (OR = 0.9), Albumin (OR = 0.3) and High Ferritin level (OR = 1.006) on the admission day. Anemia of inflammation (AI) was observed during ICU stay. CONCLUSION: This study demonstrated that malnutrition is an increasing phenomenon in the ICU patients and the delay in patient’s enteral feeding had a direct influence in the prevalence of malnutrition on discharge day.

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

PURPOSE

Early enteral nutrition (EN) can improve clinical outcomes in critically ill patients. This study aimed to evaluate the effects of this clinical nursing practice guideline (CNPG) of EN care on the duration of mechanical ventilator in critically ill patients to investigate whether it was able to improve clinical outcomes.

METHODS

This study compares a pretest-posttest design for the two groups, which was done before and after to determine the effects of a CNPG of EN care on the duration of a mechanical ventilator in critically ill patients. This study was performed on 44 critically ill patients admitted to the intensive care unit (ICU). The patients were divided into two groups according to EN. For the intervention group, CNPG started within the first 48 hours of admission to the ICU, and for the control group, they received standard nursing care.

RESULTS

After the implementation, it showed significant associations between the duration of mechanical ventilator in ICU. The intervention group who received the CNPG had significantly shorter starting time of EN and a reduced duration of mechanical ventilator than those in the control group (p < .001).

CONCLUSION

A CNPG for EN care reduced the duration of mechanical ventilator. This could possibly improve the delivery of target calories when compared with current standard practice and improve the outcome of critically ill patients.