Exploring the Enteral Feeding Practices Used by Critical Care Nurses: A Dissertation
Authors
Emmons, Margaret M.Faculty Advisor
Carol BovaUMass Chan Affiliations
Graduate School of NursingDocument Type
Doctoral DissertationPublication Date
2014-12-01Keywords
Critical Care NursingCritical Illness
Enteral Nutrition
Intensive Care Units
Professional Practice
Respiration
Artificial
Critical Care
Critical Care Nursing
Metadata
Show full item recordAbstract
Mechanically ventilated critically ill patients treated in the intensive care unit (ICU) require enteral feedings to maintain adequate nutrition during critical illness. Delivery of adequate enteral nutrition is also critical to the recovery of critically ill patients. Enteral nutrition has been shown to decrease length of time on the ventilator, decrease length of stay and ICU and decrease mortality. Despite all the evidence regarding the benefits of enteral nutrition, critically ill patients continue to receive less than their prescribed calories and protein. Nurses are in a unique position to influence the delivery of enteral nutrition. Nursing practices that contribute to underfeeding must be identified and corrected to ensure adequate delivery of nutrients is achieved. The purpose of the study was to describe the professional practice of critical care nurses regarding enteral feeding in mechanically ventilated critically ill patients. Several barriers were identified by the participants in the study that contributed to underfeeding including inconsistent practice regarding gastric residual volume, holding feeds when changing patient position and lack of a standardized protocol for enteral feeding. Also identified in the study was the idea that nurses do not see enteral feeding as a life-saving intervention. It is not the “sexy part” of what ICU nurses do. Enteral feeding guidelines need to be developed to include those interventions that are important to nursing practice in order to increase enteral feeding times and improve patient outcomes.DOI
10.13028/wmd5-p208Permanent Link to this Item
http://hdl.handle.net/20.500.14038/34380Rights
© Copyright by Margaret Emmons 2014. All Rights Reserved.Distribution License
http://creativecommons.org/licenses/by/4.0/ae974a485f413a2113503eed53cd6c53
10.13028/wmd5-p208
Scopus Count
Except where otherwise noted, this item's license is described as © Copyright by Margaret Emmons 2014. All Rights Reserved.
Related items
Showing items related by title, author, creator and subject.
-
Intensive care nurse-family engagement from a global perspective: A qualitative multi-site explorationNaef, Rahel; Tehan, Tara M. (2021-10-01)BACKGROUND: Critical illness is distressing for families, and often results in negative effects on family health that influence a family's ability to support their critically ill family member. Although recent attention has been directed at improving care and outcomes for families of critically ill patients, the manner in which nurses engage with families is not fully understood. OBJECTIVES: To describe nurses' perceptions and practices of family engagement in adult intensive care units from a global perspective. DESIGN: A qualitative-descriptive multi-site design using content analysis. SETTINGS: The study was conducted in 26 intensive care units of 12 urban, metropolitan, academic medical centers in ten countries, spanning five continents. PARTICIPANTS: A total of 65 registered nurses (77% women, age of M = 39.5, SD = 11.4 years) participated. Most held intensive care certification (72%) and had worked on average 10 (SD = 9.6) years in the ICU. METHODS: Semi-structured, individual interviews (M = 38.4 min, SD = 12.0) were held with ICU nurses at the hospital (94%) or their home using an interview guide. Qualitative interview data were analysed using inductive content analysis. RESULTS: We found that nurse-family engagement was an ebb and flow of relational power that needed to be carefully negotiated and balanced, with nurses holding and often exerting more power than families. Constant fluctuations in nurses' practices of engagement occurred in day-to-day practice from shift-to-shift and from nurse-to-nurse. Family engagement was dependent on individual nurses' attitudes and perceptions of family, the patient's condition, and workload. Lastly, family engagement was shaped by the ICU context, with team culture, collaborative relationships, unit structures and organizational resources either enabling or limiting nurses' ability to engage with families. CONCLUSIONS: This global study provides an in-depth understanding of the way nurses engage with families in ICU and reflects many different cultures and health systems. We found that nurse-family engagement was marked by a shifting, yet often unequal power distribution in the nurse-family relationship, inconsistent nurse engagement practices, both of which resulted in variable family engagement in intensive care. Our research contributes a detailed description of engagement as practiced in the everyday delivery of health care. A more concentrated team effort, based on a shared culture and defined framework of family care is needed to ensure that families of critically ill persons are fully engaged in all aspects of intensive care.
-
Nursing Reflections on Resident Duty Hour RestrictionsCarpenter, Dawn (2013-11-01)In her article regarding a nurse’s perspective on the work hour limitations, Dawn Carpenter, DNP, ACNP-BC, notes that hospital work in general has transitioned to shift work because of the increase in the acuity of care of the hospitalized patient. She has noticed that residents are rested, refreshed and more engaged in didactic learning since the ICU has changed from 24-hour to 12-hour shifts.
-
Burnout: A Pandemic Needing Emergent AttentionCarpenter, Dawn (2017-09-01)Dawn Carpenter, DNP, ACNP-BC, CCR, a critical care nurse and nurse practitioner, relates that nurses who experience high rates of moral distress, where conflicts arise around treatment goals that are contrary to the nurse's values, experience a high degree of burnout. A negative work environment can have a “contagion effect,”where burnout is the result of attitudes and negative conditions of the employment environment.