Research Article
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Abstract
In ICU, one of the nurse's roles is to ensure proper nutrition support to facilitate their recovery. However, few nutrition protocols for nurses are found. The European federation of Critical Care Nursing associations (EfCCNa) position statement provides ICU nurses with evidenced guidelines regarding caring for critically ill patients with enteral nutrition support.
BACKGROUND
Nutritional status impacts wound healing, ventilator weaning, organ function, mobility, and mortality (Cederholm et al., 2017). Tian, Heighes, Allingstrup, and Doig (2018) preformed a meta-analysis of randomized controlled trials and demonstrated that better outcomes occurred when patients who were unable to eat received nutrition support within 24 to 48 hours of ICU admission. Therefore, it is essential that nurses understand nutrition assessment and application, monitor and manage severely ill patient's nutrition. In ICU, one of the nurse's roles is to provide proper nutrition to ensure support of severely ill patients' organ systems. In nourishing critically ill patients, nurses have an important role in identifying those at risk of inadequate feeding, malnutrition, and preventing complications of enteral nutrition (Dhaliwal, Cahill, Lemieux, … Heyland, 2014; McClave et al., 2016).
NURSES RESPONSIBILITIES ON PROVIDING ENTERAL NUTRITION—AN EfCCNa POSITION STATEMENT
This European federation of Critical Care Nursing associations (EfCCNa) position paper provides a protocol for nurse to care critically ill patients with enteral nutrition. In this position statement, critically ill patient is defined as those with complex health situations, at high risk for insufficient nutrition, and in the need of an individual approach; enteral nutrition is defined as the application of nutritional supplements via oro/naso gastral tubes or devices placed into gastrointestinal area. Nurses must assure that patient's nutrition administration starts within 24 hr–48 hr after admission to ICU (McClave et al., 2016). Then, they should assess the nutritional status and feeding tube efficacy of patients, implement and monitor enteral nutrition, and then evaluate the outcomes of enteral nutrition. Figure 1 illustrates the protocol of caring for critically ill patients with enteral nutrition.
Figure 1.
Protocol of caring for critically ill patients with enteral nutrition.
Assessment
Nutritional Status
There are a number of tools that can be used for daily assessing the nutritional status, such as:
Nutrition risk screening (NRS) (Kondrup, Rasmussen, Hamberg, … Stanga, 2003)
The Nutrition Risk in the Critically Ill (NUTRIC) score assessing both nutritional status and disease severity (Heyland, Dhaliwal, Jiang, … Day, 2011; Kondrup, Allison, Elia, Vellas, … Plauth, 2002)
Malnutrition Risk Score (Ferguson, Capra, Bauer, … Banks, 1999)
Subjective Global Assessment (for surgical or trauma patients) and the Body Mass Index (BMI, with a BMI < 18 indicating severe malnutrition and a high risk of refeeding syndrome while nutrition support) (Cederholm et al., 2017)
Feeding Tube
Daily assessment of the placement of the feeding tube (according to the hospital standards) to ensure its correct placement
Assuring oral/nasal hygiene and care
Implementation and monitoring (enteral nutrition)
Asurring the accurate and adequate daily nutritional intake based on metabolic status
Nutrition protocols should be used (Kreymann, 2010; Makic, VonRueden, Rauen, … Chadwick, 2011)
Monitoring the tolerance of nutrition (Nguyen, 2014)
Preventing aspiration, constipation, and diarrhoea (Blaser et al., 2017)
If the patient is not absorbing leading to food residue and diminshed gastric motility, then prokinetic therapy should be considered (Knowles, McInnes, Elliot, Hardy, … Middleton, 2014; Montejo et al., 2010)
Nutritional supplement should be taken in accordance with the manufacturers instructions and under hygienic standards (National Clinical Guideline Centre, 2012)
Minimizing interruptions in nutrition intake due to surgical procedures, imaging, medical interventions, scopes and so on
Explaining and communicating to patients and significant others regarding nutritional support (Doenges, Moorhouse, … Murr, 2013)
Evaluation
If the patient is not receiving daily required dose/calories within 7–10 days after ICU admission, parenteral nutrition should be considered (McClave et al., 2016)
If the patient is suffering from intolerance of enteral nutrition, nurse can recommend considering exchanging the type of enteral supplement product (e.g., hypo-osmolare formular, nephro diet, etc.) (McClave et al., 2016; Singer et al., 2011)
Evaluating tube functionability (Ministry of Health Singapore, 2010)
CONCLUSION
The EfCCNa position stated above provides an overview concerning the key role of nurses in enteral nutrition for critically ill patient. The position statement is underpinned with evidence-based guidelines and sources from leading experts in behalf of nourishing critically ill patients such as ESPEN (European Society of Parenteral and Enteral Nutrition), ASPEN (American Society of Parenteral and Enteral Nutrition), and ESICM (European Society of Intensive Medicine).
References
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Disclosure
The authors have no relevant financial interest or affiliations with any commercial interests related to the subjects discussed within this article.
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