Implementing an educational program to improve critical care nurses' enteral nutritional support

Abstract

Background

Although international nutrition societies recommend enteral nutrition guidelines for patients in intensive care units (ICUs), large gaps exist between these recommendations and actual clinical practice. Education programs designed to improve nurses' knowledge about enteral nutrition are therefore required. In Korea, there are no educational intervention studies about evidence-based guidelines of enteral nutrition for critically ill patients.

Objectives

We aimed to evaluate the effects of an education program to improve critical care nurses' perceptions, knowledge, and practices towards providing enteral nutritional support for ICU patients.

Methods

A quasi-experimental, one-group study with a pre- and post-test design was conducted from March to April 2015. Nurses (N = 205) were recruited from nine ICUs from four tertiary hospitals in South Korea. The education program comprised two sessions of didactic lectures. Data were collected before (pre-test) and 1 month after (post-test) the education program using questionnaires that addressed nurses' perceptions, knowledge, and practices relating to providing enteral nutritional support for ICU patients.

Results

After the program, nurses showed a significant improvement in their perceptions and knowledge of enteral nutrition for ICU patients. There was a significant improvement in inspecting nostrils daily, flushing the feeding tube before administration, providing medication that needs to be crushed correctly, changing feeding sets, and adjusting feeding schedules.

Conclusions

The findings indicate that an enteral nutrition education program could be an effective strategy to increase critical care nurses' support for the critically ill. This education program can be incorporated into hospital education or in-service training for critical care nurses to strengthen their perceptions and knowledge of nutritional support in the ICU. This may improve the clinical outcomes of ICU patients.

Introduction

Enteral nutrition is the primary method to provide nutritional support for critically ill patients who cannot eat orally. Early enteral nutrition has effects on a reduction in infectious complications, length of stay in intensive care unit (ICU), and hospital cost in critically ill patients, compared to delayed nutrition.¹ Despite advancements in the techniques and equipment for enteral nutrition, inadequate nutritional intake is a significant issue for critically ill patients.[2], [3] Underfeeding has detrimental effects on ICU patients' clinical outcomes including delayed wound healing, prolonged mechanical ventilation, increased infectious complications, increased length of stay in ICU, and higher mortality.[4], [5]

Critical care nurses are responsible for assessing critically ill patients' nutritional status, initiating and managing enteral or parenteral nutrition, monitoring potential complications, and evaluating and revising nutrition goals.⁶ Evidence-based guidelines for nutritional support are intended to be the basis for the standardisation of nurses' practice and contribute to improvements in nutritional intake.⁷ Although some international nutrition societies recommend enteral nutrition guidelines for ICU patients, large gaps between these recommendations and actual clinical practice remain.⁸ Previous studies reported that lack of knowledge and perception of the importance of nutrition by nurses and placing a low priority on nutrition in the ICU may contribute to the inadequate translation of these guidelines to practice.[3], [6]

Critical care nurses' perceptions, knowledge, and practices towards enteral nutrition can impact patients' nutritional status by preventing insufficient provision of enteral nutrition.[9], [10] Previous studies described favourable perceptions of critical care nurses regarding the importance of enteral nutrition; however, nurses lack knowledge and understanding about enteral nutrition,[7], [11] suggesting a need for them to be provided with information about nutritional support.¹¹ It is possible that enhancing critical care nurses' knowledge may contribute to improved nursing practices relating to enteral nutrition.

Critical care nurses typically obtain enteral nutrition information from colleagues, rather than scientific articles or academic conferences.¹² Hospital education and in-service training may provide an alternative to more formal educational programs.⁹ To date, no study has been conducted on educational interventions using evidence-based guidelines for enteral nutrition of critically ill patients in Korea. This may be because the priority of enteral nutrition is lower than those of other treatments in the ICU.¹¹ Consequently, the development of a nutritional education program with up-to-date evidence is the first step to enhance critical care nurses' perceptions, knowledge, and practices.

Therefore, we developed an education program specific for enteral nutrition for critically ill patients. Our aims were to assess if a locally developed educational program improved Korean critical care nurses' perceptions, knowledge, and practices towards providing enteral nutritional support for critically ill patients. We developed the following research question: To-what extent does an education program about enteral nutrition improve the perceptions, knowledge, and practices of critical care nurses? The following hypotheses in the study were developed after participation in the education program: (i) critical care nurses will demonstrate improvement in perception of nutrition support for critically ill patients; (ii) critical care nurses will demonstrate improved knowledge about enteral nutrition; and (iii) critical care nurses will demonstrate improved clinical practices around enteral nutrition following participation in the enteral nutrition education program.