Critical illness is typically associated with a catabolic stress state in which patients commonly demonstrate a systemic inflammatory response that brings about changes in their body systems. Changes in the body systems make the critically ill dependent on mechanical ventilation and inotropic support for longer periods in order to survive. However, this inflammatory response can be attenuated by the timely introduction of nutritional support to provide energy and nutrients to diminish catabolism and promote anabolism. The result could be a decrease in the morbidity and mortality rates, as well as the financial burden on the patients, institutions and the state. Since registered nurses initiate and utilise feeding protocols to achieve target goals, there is a strong need for nurse-initiated feeding protocols. These protocols should be coupled with a comprehensive nurse-directed nutritional educational intervention that will focus on their safe and effective implementation. This focus on nursing nutrition education represents a major shift away from traditional education which has focused on dietitians and physicians. Evidence suggests that incorporating guideline recommendations into nurse-initiated protocols for starting and advancing enteral feedings is an effective strategy to improve the delivery of nutritional support. The study was aimed at exploring the provision of nutritional support to critically ill hospitalised patients by registered nurses to identify and describe possible gaps in the practice, through determining the potential relationship between the provision of nutritional support and characteristics of its providers. A quantitative, descriptive correlational study was undertaken. Seventy registered nurses working in neonatal/paediatric and adult critical care units in two public and three private hospitals in East London in the Eastern Cape participated in the study. The sample also included public critical care students. The results showed that registered nurses in private hospitals have more knowledge about the importance of nutritional support than their public hospital counterparts and students. The mean score was on the question was 80.3% with the highest score of 91% which was for the private hospital nurses, followed by 77.2% for public and 71.4% for students. Again, the mean score for knowledge on timing of initiating nutritional support was 48%, the highest score being 69.4% for students followed by private hospital nurses with 49.6%. Close to 63% (n = 44) of these nurses were either unsure about the availability of nutritional protocols or clearly attested to their non-availability. This is seen as an issue of concern because a protocol is meant to be a standard document with which all members of the ICU should be familiar. It is meant to guide and facilitate the manner of working in the unit. While facilitation of maintenance of nutritional support to patients is the responsibility of registered nurses, according to Regulation 2598(1984) section 45 (1) (q) of the South African Nursing Council, 68% (n = 48) of the respondents felt that this was in the practising scope of doctors and dietitians. The study concluded that the nurses are knowledgeable about the importance of nutritional support but knowledge gaps have been identified as far as the timing of initiating nutritional support is concerned. Some attested to unavailability of standard guidelines that are tailored into protocols guiding the provision of nutritional support by registered nurses in the critical care units. Nutrition should be prioritised as an important therapy for improving the outcomes of critically ill patients. Nurses need to analyse its provision, identify barriers to nutritional strategies and engage in nutritional education to empower themselves regarding the practice. Most importantly, there is a need for nurse-initiated nutritional protocols that are tailored from the broad nutritional guidelines and aligned with the local context and ways of practising. Nutritional support should be included as a key component of the curriculum in academic programmes that specialise in critical care nursing.
| Identifer | oai:union.ndltd.org:netd.ac.za/oai:union.ndltd.org:ufh/vital:11910 |
| Date | January 2014 |
| Creators | Mooi, Nomaxabiso Mildred |
| Publisher | University of Fort Hare, Faculty of Science & Agriculture |
| Source Sets | South African National ETD Portal |
| Language | English |
| Detected Language | English |
| Type | Thesis, Masters, MSc (Nursing Science) |
| Format | 121 leaves; 30 cm, pdf |
| Rights | University of Fort Hare |
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