Investigation of intensive care nurses enteral nutrition practices

Introduction: It is of importance to give nutritional support to provide energy, protein and other nutrients for patients who cannot be orally fed in the intensive care unit. Enteral nutrition is the most preferred feeding method in critical patients who cannot be orally fed. The responsibility to monitor the care provided to patients who receive enteral nutrition and to monitor the effects of nutrition belongs to intensive care nurses. Identifying current enteral feeding practices of nurses and determining their competencies can improve health care quality. Objective: This descriptive and cross-sectional study was conducted to examine intensive care nurses' care practices related to enteral nutrition. Materials and Methods: This study was carried out at university and state hospitals in the province of Afyonkarahisar between March and August 2019. The population of the study consisted of 215 intensive care nurses working in the University Hospital and Afyonkarahisar State Hospital. The sample of the study consisted of 196 nurses who were not on leave at the time of the study and who agreed to participate in the study. 196 nurses represented 91.6% of the population. Written permission was taken from the administrations of the hospitals and the Clinical Research Ethics Committee to conduct the study. A questionnaire containing the recommendations of ESPEN and ESPEN guidelines was used to determine the enteral feeding practices of the nurses. The statistical analysis program (Statistical Package for Social Science - SPSS) 22.0 was used for the analysis of the data. Descriptive characteristics of the nurses demographics and enteral nutrition practice in intensive care units were given as number and percentage distributions. Each item in the enteral nutrition practice form was analyzed with the number, percentage, mean, and standard deviation statistics. In the comparison of variables with normal distribution, the t-test was used for the variables with two groups, variance analysis was used for the variables with three or more groups. The reliability of the internal consistency of the questionnaire was calculated with Cronbach's Alpha value. The content validity of the questions was evaluated by nine experts. In the interpretation of the findings, the significance level was taken as 0.05. Results: The reliability of the internal consistency of the questionnaire was found to be 0.824 and the content validity was found to be 0.96. The mean age of the nurses who participated in the study was 30±7.6 years; the mean working time was 99±77.6 months; the mean working time in the intensive care unit was 54±46 months. Of the nurses, 59.2% worked in a state hospital and 40.8% worked in a university hospital. Of the institutions, 46.4% had the nutrition follow-up form; 30.1% had the nutritional risk assessment form; 44.8% had a nutritional team of physicians, nurses, and dieticians. It was determined that the nutritional assessment of patients was made by the nurse by 44.4% and that the enteral nutritional product was determined by the physician by 60.7%. The most commonly enteral feeding route was the nasogastric tube by 93.4%. 67.7% of the nurses stated that they applied intermittent feeding and 43.9% of them stated that they used a enteral feeding pump. It was determined that the nurses most frequently encountered diarrhea, tube dislocation and hypo/hyperglycemia problems regarding enteral nutrition. Increasing the nutrient amount gradually to increase gastrointestinal tolerance, giving the patient a semi-fowler's position, performing daily oral care were among the care that nurses "always" showed. The enteral tube feeding caring practice mean score of the nurses was 126.87±16.18. A statistically significant difference was between the enteral feeding caring practice of the intensive care nurses of two hospitals (p<0.05). There was no significant difference found between internal diseases intensive care and surgical intensive care in terms of enteral feeding caring practice (p>0.05). Conclusion: With this study, the efficiency of nursing care practices regarding enteral nutrition in intensive care units was assessed from the nurses' perspective. However, it was found that the practices were not at a "very good" level but a moderate-good level when the enteral nutritional care recommended in the guidelines and the care practice of the nurses were compared. It was observed that nurses did not apply effective enteral feeding caring practice especially on taking responsibility, gastrointestinal tolerance/intolerance, enteral nutrition application and enteral nutrition of patients in the terminal period. Intensive care patients can receive adequate nutrition and the quality of care can be improved if intensive care nurses know their responsibilities and develop an awareness and if the obstacles to care are determined and prevented. Keywords: Enteral nutrition, care, tube feeding, nutritional assessment, intensive care nurse.