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Barriers to Delivery of Enteral Nutrition in Pediatric Intensive Care: A World Survey
Lyvonne N Tume1, Renate D Eveleens2, Sascha C A T Verbruggen2
1Reader in Child Health (Critical Care Nursing), School of Health & Society, University of Salford, Manchester, United Kingdom.
Insights
Healthcare professionals in pediatric intensive care units (PICUs) worldwide identified key barriers to providing enteral nutrition. Top challenges include withholding feeds for procedures and insufficient dietitian and training resources.
Area of Science:
- Pediatric critical care medicine
- Clinical nutrition
- Healthcare professional barriers
Background:
- Effective enteral nutrition is crucial for critically ill children in pediatric intensive care units (PICUs).
- Understanding perceived barriers is essential for improving nutrition delivery in PICUs.
Purpose of the Study:
- To identify and analyze the barriers encountered by pediatric intensive care healthcare professionals in delivering enteral nutrition to critically ill children globally.
Main Methods:
- A cross-sectional international online survey was adapted from an adult intensive care tool, translated into 10 languages.
- Pediatric intensive care nurses, physicians, and dietitians rated 20 items on a 7-point Likert scale regarding barriers to enteral nutrition delivery.
- The survey was distributed online to professionals in PICUs worldwide from March to June 2019.
Main Results:
- 920 professionals from 57 countries responded, with nurses (52%) and physicians (44%) forming the majority.
- The top three barriers identified were: enteral feeds withheld for procedures, inadequate dietitian coverage on weekends/evenings, and insufficient time for nutrition education.
- Perception of barriers decreased with increased years of PICU experience across all professional groups.
Conclusions:
- This is the largest global survey on perceived barriers to enteral nutrition delivery in PICUs.
- Findings suggest similarities with adult intensive care barriers and highlight the need for focused nutrition education for all PICU staff.
- Addressing procedural withholding of feeds and improving dietitian and training resources are critical for optimizing enteral nutrition in critically ill children.
Objectives:
To explore the perceived barriers by pediatric intensive care healthcare professionals (nurses, dieticians, and physicians) in delivering enteral nutrition to critically ill children across the world.
Design:
Cross-sectional international online survey adapted for use in pediatric settings.
Setting:
PICUs across the world.
Subjects:
PICU nurses, physicians, and dietitians.
Interventions:
The 20-item adult intensive care "Barriers to delivery of enteral nutrition" survey was modified for pediatric settings, tested, and translated into 10 languages. The survey was distributed online to pediatric intensive care nurses, physicians, and dieticians via professional networks in March 2019 to June 2019. Professionals were asked to rate each item indicating the degree to which they perceived it hinders the provision of enteral nutrition in their PICUs with a 7-point Likert scale from 0 "not at all a barrier" to 6 "an extreme amount."
Measurement And Main Results:
Nine-hundred twenty pediatric intensive care professionals responded from 57 countries; 477 of 920 nurses (52%), 407 of 920 physicians (44%), and 36 of 920 dieticians (4%). Sixty-two percent had more than 5 years PICU experience and 49% worked in general PICUs, with 35% working in combined cardiac and general PICUs. The top three perceived barriers across all professional groups were as follows: 1) enteral feeds being withheld in advance of procedures or operating department visits, 2) none or not enough dietitian coverage on weekends or evenings, and 3) not enough time dedicated to education and training on how to optimally feed patients.
Conclusions:
This is the largest survey that has explored perceived barriers to the delivery of enteral nutrition across the world by physicians, nurses, and dietitians. There were some similarities with adult intensive care barriers. In all professional groups, the perception of barriers reduced with years PICU experience. This survey highlights implications for PICU practice around more focused nutrition education for all PICU professional groups.
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