Enteral nutrition in the critically ill : a mixed-methods study of adherence to evidence-based protocols, nursing responsibility and teamwork

• Main Author: Al kalaldeh, Mahmoud
• Other Authors: Watson, Roger ; Hayter, Mark
• Published: University of Sheffield 2011
• Subjects: 615.5
• Online Access: http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.548638

Objectives: this study aimed to assess nurses' practice and perception of their knowledge, responsibility and documentation in relation to enteral nutrition in the critically ill and to explore nurses' attitudes towards establishing evidence-based practice and teamwork in three health care sectors in Jordan. Background: 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 and team working is the key to minimising complications and discrepancies between nurses. Design and methods: mixed-methods strategies were employed. A cluster randomised sample recruited 253 ICU nurse for the survey. Fourteen nurses were selected purposively for the interviews and fifty five patients were involved in bedside observations. Both statistical and thematic analysis findings were integrated and discussed together. Results: 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'. However, female nurses scored higher in taking responsibility for ‘assessment' and ‘planning' than male nurses. The internet and clinical experience were the most effective sources of knowledge along with university education and colleagues. Nurses showed inconsistency in assessment tasks such as controlling gastric residual volume and confirming tube placements. Diarrhoea was the most frequent complication followed by abdominal pain, vomiting, tube dislodgment, weight loss. However, nurses realised that the incidences of complications is less likely when applying such evidence-based protocol for enteral nutrition. Multidisciplinary team work was introduced as a source of evidence-based practice and establishing a nutritional team contributes to a greater nursing involvement in decision making. Poor cooperation and interaction within the team prohibits standardized care and increases the imparity in nursing practice. Conclusion: increased nursing awareness of nutritional assessment through providing training programs and surveillance of clinical performance is necessary. Management should be concerned with offering an accessible source of knowledge, the required equipment and documentation systems. Enhancing collaboration between health care providers and offering appropriate counselling should also be emphasized.