1Critical Care Nursing, Payambar Azam Hospital, Kerman, Iran
2Critical Care Nursing, Faculty of Nursing and Midwifery, Bam University of Medical Sciences, Bam, Iran
3Nursing Research Center, Faculty of Razi School of Nursing and Midwifery, Department of Critical Care Nursing, Kerman University of Medical Sciences, Kerman, Iran
4Razi Faculty of Nursing and Midwifery, Department of Critical Care Nursing, Kerman University of Medical Sciences, Kerman, Iran
Copyright © 2021 The Korean Society of Critical Care Medicine
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
CONFLICT OF INTEREST No potential conflict of interest relevant to this article was reported.
AUTHOR CONTRIBUTIONS
Conceptualization: MM, PMS. Data curation: MM, PMS. Formal analysis: PMS. Methodology: PMS. Project administration: MA. Visualization: MA . Writing–original draft: PMS. Writing–review & editing: MA, PMS.
Characteristics | Physician | Nurse | Chi-square test | P-value |
---|---|---|---|---|
Sex | 191.23 | 0.001 | ||
Female | 12 (11.5) | 230 (87.5) | ||
Male | 92 (88.5) | 33 (12.5) | ||
Age (yr) | 186.58 | 0.001 | ||
20–30 | 2 (1.9) | 103 (39.2) | ||
31–40 | 5 (4.8) | 109 (41.4) | ||
41–50 | 72 (69.2) | 21 (8.0) | ||
>50 | 25 (24.0) | 30 (11.4) | ||
Marital status | 26.22 | 0.001 | ||
Single | 2 (1.9) | 62 (23.6) | ||
Married | 102 (98.1) | 201 (76.4) | ||
Clinical work experience (yr) | 1.56 | 0.67 | ||
0–5 | 27 (26.0) | 86 (32.7) | ||
6–10 | 38 (36.5) | 88 (33.5) | ||
11–15 | 25 (24.0) | 57 (21.7) | ||
>15 | 14 (13.5) | 32 (12.2) | ||
Work experience in ICU (yr) | 15.56 | 0.001 | ||
1–5 | 32 (30.8) | 128 (48.7) | ||
6–10 | 36 (34.6) | 87 (33.1) | ||
11–15 | 21 (20.2) | 35 (13.3) | ||
>15 | 15 (14.4) | 13 (5.0) | ||
Educational course of nutrition for patients | 89.52 | 0.001 | ||
Yes | 88 (84.6) | 79 (30.0) | ||
No | 16 (15.4) | 184 (70.0) |
Subscale of enteral nutrition barriers | Nurse | Physician | t-test | P-value |
---|---|---|---|---|
Guideline recommendations and implementation strategies | 3.91±0.05 | 3.77±0.10 | 1.27 | 0.205 |
ICU resources | 3.80±0.05 | 3.98±0.11 | –1.39 | 0.026 |
Dietician support | 3.90±0.05 | 4.60±0.04 | –9.41 | <0.001 |
Delivery of enteral nutrition to the patient | 3.66±0.05 | 3.50±0.05 | 2.24 | 0.165 |
Critical care provider attitudes and behavior | 3.52±0.05 | 3.33±0.04 | 2.71 | 0.007 |
Total | 3.74±0.68 | 3.75±0.04 | –0.18 | 0.855 |
Subscale | Question of enteral nutrition barriers | Nurse | Physician | t-test | P-value |
---|---|---|---|---|---|
Guideline recommendations and implementation strategies | I am not familiar with our current guidelines for nutrition in the ICU. | 4.06±0.06 | 3.81±0.11 | 1.85 | 0.060 |
Current scientific evidence supporting some nutrition interventions is inadequate to inform practice. | 3.80±0.68 | 3.50±0.12 | 2.22 | 0.020 | |
The language of the recommendations of the current guidelines for nutrition are not easy to understand. | 3.65±0.07 | 3.22±0.11 | 3.24 | 0.001 | |
The current guidelines for nutrition are not readily accessible when I want to refer to them. | 3.95±0.06 | 4.31±0.12 | –2.77 | 0.006 | |
No feeding protocol in place to guide the initiation and progression of enteral nutrition | 4.04±0.06 | 4.34±0.12 | –2.27 | 0.023 | |
Current feeding protocol is outdated. | 3.94±0.06 | 3.46±0.13 | 3.62 | 0.001 | |
ICU resources | Not enough nursing staff to deliver adequate nutrition | 3.39±0.08 | 3.27±0.15 | 0.70 | 0.487 |
Enteral formula not available on the unit | 4.06±0.06 | 4.27±0.12 | –1.57 | 0.117 | |
No or not enough feeding pumps on the unit | 3.94±0.07 | 4.40±0.12 | –3.09 | 0.002 | |
Dietitian support | Waiting for the dietitian to assess the patient | 3.98±0.06 | 4.43±0.61 | –3.83 | 0.002 |
Dietitian not routinely present on weekday patient rounds | 3.95±0.06 | 4.60±0.05 | –5.87 | 0.001 | |
No or not enough dietitian coverage during evenings, weekends and holidays | 3.85±0.07 | 4.75±0.06 | –7.10 | 0.001 | |
Not enough time dedicated to education and training on how to optimally feed patients | 3.80±0.07 | 4.61±0.07 | –6.41 | 0.001 | |
Delivery of enteral nutrition to the patient | Delay in physicians ordering the initiation of enteral nutrition | 3.77±0.06 | 2.57±0.12 | 9.10 | 0.001 |
Waiting for physician/radiology to read X-ray and confirm tube placement | 3.41±0.08 | 2.63±0.08 | 5.67 | 0.001 | |
Frequent displacement of feeding tube, requiring reinsertion | 3.06±0.09 | 1.85±0.09 | 7.28 | 0.001 | |
Delays in initiating motility agents in patients not tolerating enteral nutrition (i.e., high gastric residual volumes) | 3.71±0.07 | 3.76±0.09 | –0.49 | 0.622 | |
Delays and difficulties in obtaining small bowel access in patients not tolerating enteral nutrition (i.e., high gastric residual volumes) | 3.97±0.06 | 4.64±0.07 | –6.86 | 0.001 | |
In resuscitated, hemodynamically stable patients, other aspects of patient care still take priority over | 3.88±0.07 | 4.58±0.07 | –6.61 | 0.001 | |
Nutrition therapy not routinely discussed on patient care rounds | 3.81±0.07 | 4.45±0.07 | –5.90 | 0.001 | |
Critical care provider attitudes and behavior | Non-ICU physicians (i.e., surgeons, gastroenterologists) requesting patients not be fed entirely | 3.39±0.07 | 2.15±0.14 | 7.55 | 0.001 |
Nurses failing to progress feeds as per the feeding protocol | 3.25±0.08 | 2.55±0.13 | 4.57 | 0.001 | |
Feeds being held due to diarrhea | 3.69±0.06 | 4.31±0.05 | –6.81 | 0.001 | |
Fear of adverse events due to aggressively feeding patients | 3.58±0.07 | 4.22±0.06 | –6.64 | 0.001 | |
Feeding being held too far in advance of procedures or operating room visits | 3.96±0.07 | 4.71±0.06 | –7.57 | 0.001 | |
General belief among ICU team that provision of adequate nutrition does not impact on patient outcome | 3.25±0.08 | 2.04±0.09 | 9.90 | 0.001 |
Values are presented as number (%). ICU: intensive care unit.
Values are presented as mean±standard deviation. ICU: intensive care unit.
Values are presented as mean±standard deviation. ICU: intensive care unit.