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      Nurses’ knowledge and responsibility toward nutritional assessment for patients in intensive care units

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          Abstract

          Introduction:

          Nutritional assessment is a prerequisite for nutritional delivery. Patients in intensive care suffer from under-nutrition and nutritional failure due to poor assessment. Nursing ability to early detect nutritional failure is the key for minimizing imparities in practice and attaining nutritional goals. Aim of this article is to examine the ability of Jordanian ICU nurses to assess the nutritional status of critically ill patients, considering biophysical and biochemical measures.

          Methods:

          This cross sectional study recruited nurses from different health sectors in Jordan. ICU nurses from the governmental sector (two hospitals) and private sectors (two hospitals) were surveyed using a self-administered questionnaire. Nurses’ knowledge and responsibility towards nutritional assessment were examined.

          Results:

          A total of 220 nurses from both sectors have completed the questionnaire. Nurses were consistent in regard to knowledge, responsibility, and documentation of nutritional assessment. Nurses in the governmental hospitals inappropriately perceived the application of aspiration reduction measures. However, they scored higher in applying physical examination and anthropometric assessment. Although both nurses claimed higher use of biochemical measurements, biophysical measurements were less frequently used. Older nurses with longer clinical experience exhibited better adherence to biophysical measurement than younger nurses.

          Conclusion:

          Nursing nutritional assessment is still suboptimal to attain nutritional goals. Assessment of body weight, history of nutrition intake, severity of illness, and function of gastrointestinal tract should be considered over measuring albumin and pre-albumin levels. A well-defined evidence-based protocol as well as a multidisciplinary nutritional team for nutritional assessment is the best to minimize episodes of under-nutrition.

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          Most cited references 52

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          Effect of evidence-based feeding guidelines on mortality of critically ill adults: a cluster randomized controlled trial.

          Evidence demonstrates that providing nutritional support to intensive care unit (ICU) patients within 24 hours of ICU admission reduces mortality. However, early feeding is not universally practiced. Changing practice in complex multidisciplinary environments is difficult. Evidence supporting whether guidelines can improve ICU feeding practices and patient outcomes is contradictory. To determine whether evidence-based feeding guidelines, implemented using a multifaceted practice change strategy, improve feeding practices and reduce mortality in ICU patients. Cluster randomized trial in ICUs of 27 community and tertiary hospitals in Australia and New Zealand. Between November 2003 and May 2004, 1118 critically ill adult patients expected to remain in the ICU longer than 2 days were enrolled. All participants completed the study. Intensive care units were randomly assigned to guideline or control groups. Guideline ICUs developed an evidence-based guideline using Browman's Clinical Practice Guideline Development Cycle. A practice-change strategy composed of 18 specific interventions, leveraged by educational outreach visits, was implemented in guideline ICUs. Hospital discharge mortality. Secondary outcomes included ICU and hospital length of stay, organ dysfunction, and feeding process measures. Guideline and control ICUs enrolled 561 and 557 patients, respectively. Guideline ICUs fed patients earlier (0.75 vs 1.37 mean days to enteral nutrition start; difference, -0.62 [95% confidence interval {CI}, -0.82 to -0.36]; P < .001 and 1.04 vs 1.40 mean days to parenteral nutrition start; difference, -0.35 [95% CI, -0.61 to -0.01]; P = .04) and achieved caloric goals more often (6.10 vs 5.02 mean days per 10 fed patient-days; difference, 1.07 [95% CI, 0.12 to 2.22]; P = .03). Guideline and control ICUs did not differ with regard to hospital discharge mortality (28.9% vs 27.4%; difference, 1.4% [95% CI, -6.3% to 12.0%]; P = .75) or to hospital length of stay (24.2 vs 24.3 days; difference, -0.08 [95% CI, -3.8 to 4.4]; P = .97) or ICU length of stay (9.1 vs 9.9 days; difference, -0.86 [95% CI, -2.6 to 1.3]; P = .42). Using a multifaceted practice change strategy, ICUs successfully developed and introduced an evidence-based nutritional support guideline that promoted earlier feeding and greater nutritional adequacy. However, use of the guideline did not improve clinical outcomes. Trial Registration anzctr.org.au Identifier: ACTRN12608000407392.
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            The correlation of nutrition risk index, nutrition risk score, and bioimpedance analysis with postoperative complications in patients undergoing gastrointestinal surgery.

            Malnutrition in gastrointestinal (GI) surgery is associated with increased morbidity. Therefore, careful screening remains crucial to identify patients at risk for malnutrition and consequently postoperative complications. The aim of this study was to evaluate the ability of 3 established score systems to identify patients at risk of developing postoperative complications in GI surgery and to assess the correlation among the score systems. We evaluated prospectively 200 patients admitted for elective GI surgery using (1) nutrition risk index, (2) nutrition risk score, and (3) bioelectrical impedance analysis. Complications were assessed using a standardized complication classification. The findings of the score systems were correlated with the incidence and severity of complications. Parametric and nonparametric correlation analysis was performed among the different score systems. All 3 score systems correlated significantly with the incidence and severity of postoperative complications and the duration of hospital stay. Using multiple regression analysis, only nutrition risk score and malignancy remained prognostic factors for the development of complications with odds ratios of 4.2 (P = .024) and 5.6 (P < .001), respectively. The correlation between nutrition risk score and nutrition risk index was only moderate (Pearson coefficient = 0.54). Bioelectrical impedance analysis displayed only weak to trivial correlation to the nutrition risk index (0.32) and nutrition risk score (0.19), respectively. The nutrition risk score, nutrition risk index, and bioimpedance analysis correlate with the incidence and severity of perioperative complications in GI surgery. The nutrition risk score was the best score in predicting patients who will develop complications in this study population. The correlation between the individual scores was only moderate, and therefore, they do not necessarily identify the same patients.
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              Experiences of critically ill patients in the ICU.

              Experiences of critically ill patients are an important aspect of the quality of care in the intensive care (ICU). The aims of the study were firstly, to evaluate the perceptions of patients regarding nursing care in the ICU, and secondly, to explore patients' perceptions and experiences of ICU stay. A qualitative approach using a semi-structured focused interview in 11 patients was used (phase 1), followed by a quantitative approach using a self-reported questionnaire in 100 patients, 62 were returned and 50 could be evaluated (phase 2). A number of themes emerged from the interviews (phase 1), although support dominated as an important key theme. This was experienced as a continuum from the feeling being supported by the nurse to not being supported. This key theme was central to each of the three categories emerging from the data pertaining to: (1) providing the seriously ill patient with information and explanation, (2) placing the patient in a central position and (3) personal approach by the nurse. The responders to the subsequent questionnaire (phase 2) predominantly experienced sleeping disorders (48%), mostly related to the presence of noise (54%). Psychological problems after ICU stay were reported by 11% of the patients, i.e. fear, inability to concentrate, complaints of depression and hallucinations. Although the nurses' expertise and technical skills are considered important, caring behaviour, relieving the patient of fear and worries were experienced as most valuable in bedside critical care.
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                Author and article information

                Journal
                JHS
                Journal of Health Sciences
                University of Sarajevo Faculty of Health Studies (Bosnia )
                2232-7576
                1986-8049
                2014
                : 4
                : 2
                : 90-96
                Affiliations
                [1 ]Faculty of Nursing, Zarqa University, Zarqa, Jordan
                [2 ]Faculty of Nursing, Isra University, Amman, Jordan
                Author notes
                [* ]Corresponding author: Mahmoud Al Kalaldeh, PhD RN MSN CNS, Faculty of Nursing, Zarqa University, Zarqa, Jordan Phone: +962 5 3821100, E-mail: kalaldeh82@ 123456yahoo.com
                Article
                JHS-4-90
                Copyright: © Mahmoud AL Kalaldeh and Mahmoud Shahin

                This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                Product
                Self URI (journal page): http://www.jhsci.ba/OJS/index.php/jhsci
                Categories
                RESEARCH ARTICLE

                Nursing, General medicine, Medicine, Molecular medicine, Life sciences

                nurse, assessment, nutritional status

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