Abstract

Objectives: Nutrition is an integral component of care in the intensive care unit. However, no international comparison has been published about the status and practices of nutrition nurses, their legal titles, gained certificates, and routine duties. To describe the working conditions, educational background, nutrition-related practices, challenges, and future development needs of nutrition nurses in Türkiye, the European countries, and the USA.

Methods: A cross-sectional design was used. A thirty-three-item online cross-sectional survey was sent to nutrition support nurses in collaboration with national nutrition societies. The data were collected between November 2020 and August 2021. One-way ANOVA and chi-squared test were used to compare the three countries.

Results: Eighty-one nurses completed the survey: 44 (54.4%) from Türkiye, 27 (33.3%) from the European countries, and 10 (12.3%) from the USA. All nurses in Türkiye reported having a clinical nutrition support team, while 88.8% in the European countries and 80% of nurses in the USA had this team (p=0.040). Significant differences were found in terms of nurses’ age, length of service, estimated number of ambulant nutritional consultations per week, and time spent on nutritional practices during work (p<0.001). The type of first-line test for nasogastric tube placement was X-ray confirmation (70%) in the US, whereas it is auscultation (77.2%) in Türkiye and pH-testing of gastric aspirate (81.4%) in the European countries (p<0.001). The most frequently reported professional challenge among nurses in Türkiye (66%) and the European countries (22.5%) was having no legal job title.

Conclusion: These findings reflect the broader picture of nutrition nurses’ status and point out the need to develop standardized strategies for education and evidence-based nutrition practices. This study has revealed important differences in the roles and responsibilities of nutrition nurses. The study guides the future development needs of nutrition nurses, highlighting the standardized guidelines and protocols for nutrition practices and calling for comprehensive training programs.

Keywords: Evidence-based practice, knowledge, nursing, nutrition, practices

Copyright and license

Copyright © 2024 The author(s). This is an open-access article under the terms of the Creative Commons Attribution License (CC BY) which permits unrestricted use, distribution, and reproduction in any medium or format, provided the original work is properly cited.

How to cite

1.
Gök Metin Z, Pars H, Boeykens K. Nutrition nurses’ status, practices, and routines: an online cross-sectional survey. Clin Sci Nutr. 2024;6(2):67-79. doi:10.62210/ClinSciNutr.2024.82

References

  1. American Nurses Association. Nursing's Social Policy Statement: The Essence of the Profession. 3rd ed. Silver Spring, MD: American Nurses Association; 2010.
  2. DiMaria-Ghalili RA, Gilbert K, Lord L, et al; ASPEN Nurses Standards Revision Task Force, American Society for Parenteral and Enteral Nutrition. Standards of Nutrition Care Practice and Professional Performance for Nutrition Support and Generalist Nurses. Nutr Clin Pract. 2016;31:527-547. https://doi.org/10.1177/0884533616653835
  3. Nightingale J. Nutrition support teams: how they work, are set up and maintained. Frontline Gastroenterol. 2010;1:171-177. https://doi.org/10.1136/fg.2009.000224
  4. DeLegge MH, Kelly AT. State of nutrition support teams. Nutr Clin Pract. 2013;28:691-697. https://doi.org/10.1177/0884533613507455
  5. Mascarenhas MR, August DA, DeLegge MH, et al. Standards of practice for nutrition support physicians. Nutr Clin Pract. 2012;27:295-299. https://doi.org/10.1177/0884533612438286
  6. Guenter P, Curtas S, Murphy L, Orr M. The impact of nursing practice on the history and effectiveness of total parenteral nutrition. JPEN J Parenter Enteral Nutr. 2004;28:54-59. https://doi.org/10.1177/014860710402800154
  7. Boeykens K, Van Hecke A. Advanced practice nursing: Nutrition Nurse Specialist role and function. Clin Nutr ESPEN. 2018;26:72-76. https://doi.org/10.1016/j.clnesp.2018.04.011
  8. Guenter P, Jensen G, Patel V, et al. Addressing disease-related malnutrition in hospitalized patients: a call for a national goal. Jt Comm J Qual Patient Saf. 2015;41:469-473. https://doi.org/10.1016/s1553-7250(15)41061-x
  9. Shang E, Hasenberg T, Schlegel B, et al. An European survey of structure and organisation of nutrition support teams in Germany, Austria and Switzerland. Clin Nutr. 2005;24:1005-1013. https://doi.org/10.1016/j.clnu.2005.07.005
  10. The European Society for Clinical Nutrition and Metabolism. Available at: https://www.espen.org (Accessed on July 12, 2022).
  11. Nutrition Care. Available at: http://www.nutritioncare.org (Accessed on July 18, 2022).
  12. National Nurses Nutrition Group. Available at: https://nnng.org.uk (Accessed on July 25, 2022).
  13. Klinik Enteral Parenteral Nutrisyon Derneği. Available at: http://kepan.org.tr (Accessed on February 8, 2024).
  14. Gok Metin Z, Pars H. Knowledge and Clinical Competence of Nurses Regarding Enteral Nutrition: A Descriptive, Cross-sectional, and Comparative Study. Top Clin Nutr. 2020;35(2):104-115. https://doi.org/10.1097/TIN.0000000000000217
  15. Al-Hawaly M, Ibrahim MH, Qalawa SAA. Assessment of nurses' knowledge and performance regarding feeding patients with nasogastric tubes in Ismailia General Hospital. Med J Cairo Univ. 2016;84:99-105.
  16. Batalla MGAP, Quero RA, Maglalang JC, et al. Enteral nutrition, and medication administration practices of nurses in a low-resource acute setting. Gastrointestinal Nursing. 2021;19(4):26-32. https://doi.org/10.12968/gasn.2021.19.4.26
  17. Morphet J, Clarke AB, Bloomer MJ. Intensive care nurses' knowledge of enteral nutrition: A descriptive questionnaire. Intensive Crit Care Nurs. 2016;37:68-74. https://doi.org/10.1016/j.iccn.2016.07.001
  18. A Competency Framework for Nutrition Support Nurse Specialists. UK: National Nurses Nutrition Group (NNNG); 2010. Available at: http://www.nnng.org.uk/members-home/nnng-publications (Accessed on July 20, 2023).
  19. American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.) Board of Directors and Nurses Standards Revision Task Force; DiMaria-Ghalili RA, Bankhead R, Fisher AA, Kovacevich D, Resler R, Guenter PA. Standards of practice for nutrition support nurses. Nutr Clin Pract. 2007;22:458-465. https://doi.org/10.1177/0115426507022004458
  20. Mehta NM, Skillman HE, Irving SY, et al. Guidelines for the Provision and Assessment of Nutrition Support Therapy in the Pediatric Critically Ill Patient: Society of Critical Care Medicine and American Society for Parenteral and Enteral Nutrition. JPEN J Parenter Enteral Nutr. 2017;41:706-742. https://doi.org/10.1177/0148607117711387
  21. Chauhan D, Varma S, Dani M, Fertleman MB, Koizia LJ. Nasogastric Tube Feeding in Older Patients: A Review of Current Practice and Challenges Faced. Curr Gerontol Geriatr Res. 2021;2021:6650675. https://doi.org/10.1155/2021/6650675
  22. Hammad SM, Al-Hussami M, Darawad MW. Jordanian Critical Care Nurses' Practices Regarding Enteral Nutrition. Gastroenterol Nurs. 2015;38:279-288. https://doi.org/10.1097/SGA.0000000000000133
  23. Darawad MW, Hammad S, Al-Hussami M, Haourani E, Aboshaiqah AE, Hamdan-Mansour AM. Investigating critical care nurses' perception regarding enteral nutrition. Nurse Educ Today. 2015;35:414-419. https://doi.org/10.1016/j.nedt.2014.11.023
  24. Motta APG, Rigobello MCG, Silveira RCCP, Gimenes FRE. Nasogastric/nasoenteric tube-related adverse events: an integrative review. Rev Lat Am Enfermagem. 2021;29:e3400. https://doi.org/10.1590/1518-8345.3355.3400
  25. Irving SY, Lyman B, Northington L, Bartlett JA, Kemper C; NOVEL Project Work Group. Nasogastric tube placement and verification in children: review of the current literature. Nutr Clin Pract. 2014;29:267-276. https://doi.org/10.1177/0884533614531456
  26. Cohen MD, Ellett ML, Perkins SM, Lane KA. Accurate localization of the position of the tip of a naso/orogastric tube in children; where is the location of the gastro-esophageal junction? Pediatr Radiol. 2011;41:1266-1271. https://doi.org/10.1007/s00247-011-2137-9
  27. Sorokin R, Gottlieb JE. Enhancing patient safety during feeding-tube insertion: a review of more than 2,000 insertions. JPEN J Parenter Enteral Nutr. 2006;30:440-445. https://doi.org/10.1177/0148607106030005440
  28. Sparks DA, Chase DM, Coughlin LM, Perry E. Pulmonary complications of 9931 narrow-bore nasoenteric tubes during blind placement: a critical review. JPEN J Parenter Enteral Nutr. 2011;35:625-629. https://doi.org/10.1177/0148607111413898
  29. Wallace SC. Data Snapshot: Complications Linked to Iatrogenic Enteral Feeding Tube Misplacements. PA Patient Saf Advis. 2017;14:1-60.
  30. Patient safety alert: Nasogastric tube misplacement: continuing risk of death and severe harm. National Health Service England; 2016. Available at: https://www.england.nhs.uk/publication/patient-safety-alert-nasogastric-tube-misplacement-continuing-risk-of-death-and-severe-harm/
  31. Brooks M. Pneumothorax Events Linked to Placement of Enteral Feeding Tube. Medscape. 2018. Available at: https://www.medscape.com/viewarticle/891200
  32. National Health Service (NHS) Improvement. Resource Set: Initial Placement Checks for Nasogastric and Orogastric Tubes. National Health Service (NHS) Improvement; 2016.
  33. National Patient Safety Agency (NPSA). Incidents related to nasogastric tubes. In: Quarterly Data Report. 2008. Available at: https://web.archive.org/web/20120907043403/http://www.npsa.nhs.uk/EasySiteWeb/getresource.axd?AssetID=29224&type=full&servicetype=Attachment
  34. National Patient Safety Agency (NPSA). Patient Safety Alert NPSA/2011/PSA002: Reducing the harm caused by misplaced nasogastric feeding tubes in adults, children, and infants. NPSA; 2011. Available at: https://www.cas.mhra.gov.uk/ViewandAcknowledgment/ViewAttachment.aspx?Attachment_id=101341
  35. Taylor SJ. Confirming nasogastric feeding tube position versus the need to feed. Intensive Crit Care Nurs. 2013;29:59-69. https://doi.org/10.1016/j.iccn.2012.07.002
  36. Irving SY, Rempel G, Lyman B, et al. Pediatric Nasogastric Tube Placement and Verification: Best Practice Recommendations From the NOVEL Project. Nutr Clin Pract. 2018;33:921-927. https://doi.org/10.1002/ncp.10189
  37. Simons SR, Abdallah LM. Bedside assessment of enteral tube placement: aligning practice with evidence. Am J Nurs. 2012;112:40-46. https://doi.org/10.1097/01.NAJ.0000411178.07179.68
  38. Lee KH, Cho HJ, Kim EY, et al. Variation between residents and attending staff interpreting radiographs to verify placement of nutrition access devices in the neonatal intensive care unit. Nutr Clin Pract. 2015;30:398-401. https://doi.org/10.1177/0884533614555552
  39. Dias FSB, Jales RM, Alvares BR, Caldas JPS, Carmona EV. Randomized Clinical Trial Comparing Two Methods of Measuring Insertion Length of Nasogastric Tubes in Newborns. JPEN J Parenter Enteral Nutr. 2020;44:912-919. https://doi.org/10.1002/jpen.1786
  40. McFarland A. A cost utility analysis of the clinical algorithm for nasogastric tube placement confirmation in adult hospital patients. J Adv Nurs. 2017;73:201-216. https://doi.org/10.1111/jan.13103
  41. Bear DE, Champion A, Lei K, et al. Use of an Electromagnetic Device Compared With Chest X-ray to Confirm Nasogastric Feeding Tube Position in Critical Care. JPEN J Parenter Enteral Nutr. 2016;40:581-586. https://doi.org/10.1177/0148607115575034
  42. Ellett MLC. What is known about methods of correctly placing gastric tubes in adults and children. Gastroenterol Nurs. 2004;27:253-259. https://doi.org/10.1097/00001610-200411000-00002
  43. Kearns PJ, Donna C. A controlled comparison of traditional feeding tube verification methods to a bedside, electromagnetic technique. JPEN J Parenter Enteral Nutr. 2001;25:210-215. https://doi.org/10.1177/0148607101025004210
  44. Chan EY, Ng IHL, Tan SLH, Jabin K, Lee LN, Ang CC. Nasogastric feeding practices: a survey using clinical scenarios. Int J Nurs Stud. 2012;49:310-319. https://doi.org/10.1016/j.ijnurstu.2011.09.014
  45. Kemper C, Haney B, Oschman A, et al. Acidity of Enteral Feeding Tube Aspirate in Neonates: Do pH Values Meet the Cutoff for Predicting Gastric Placement? Adv Neonatal Care. 2019;19:333-341. https://doi.org/10.1097/ANC.0000000000000591
  46. Metheny NA, Krieger MM, Healey F, Meert KL. A review of guidelines to distinguish between gastric and pulmonary placement of nasogastric tubes. Heart Lung. 2019;48:226-235. https://doi.org/10.1016/j.hrtlng.2019.01.003
  47. AACN Practice Alert. Initial and Ongoing Verification of Feeding Tube Placement in Adults (applies to blind insertions and placements with an electromagnetic device). Crit Care Nurse. 2016;36:e8-e13. https://doi.org/10.4037/ccn2016141
  48. Metheny NA, Pawluszka A, Lulic M, Hinyard LJ, Meert KL. Testing Placement of Gastric Feeding Tubes in Infants. Am J Crit Care. 2017;26:466-473. https://doi.org/10.4037/ajcc2017378
  49. Turgay AS, Khorshid L. Effectiveness of the auscultatory and pH methods in predicting feeding tube placement. J Clin Nurs. 2010;19:1553-1559. https://doi.org/10.1111/j.1365-2702.2010.03191.x
  50. Fernandez RS, Chau JP, Thompson DR, Griffiths R, Lo HS. Accuracy of biochemical markers for predicting nasogastric tube placement in adults--a systematic review of diagnostic studies. Int J Nurs Stud. 2010;47:1037-1046. https://doi.org/10.1016/j.ijnurstu.2010.03.015
  51. Braegger C, Decsi T, Dias JA, et al. Practical approach to paediatric enteral nutrition: a comment by the ESPGHAN committee on nutrition. J Pediatr Gastroenterol Nutr. 2010;51:110-122. https://doi.org/10.1097/MPG.0b013e3181d336d2
  52. Boeykens K, Steeman E, Duysburgh I. Reliability of pH measurement and the auscultatory method to confirm the position of a nasogastric tube. Int J Nurs Stud. 2014;51:1427-1433. https://doi.org/10.1016/j.ijnurstu.2014.03.004
  53. Metheny NA, Meert KL. A review of published case reports of inadvertent pulmonary placement of nasogastric tubes in children. J Pediatr Nurs. 2014;29:e7-e12. https://doi.org/10.1016/j.pedn.2013.08.009
  54. Fonseca VR, Domingos G, Alves P, Ribeiro R. Placement of nasogastric tube complicated by hydropneumothorax. Intensive Care Med. 2015;41:1969-1970. https://doi.org/10.1007/s00134-015-3824-z
  55. Santos SC, Woith W, Freitas MI, Zeferino EB. Methods to determine the internal length of nasogastric feeding tubes: An integrative review. Int J Nurs Stud. 2016;61:95-103. https://doi.org/10.1016/j.ijnurstu.2016.06.004
  56. Taylor SJ, Allan K, McWilliam H, Toher D. Nasogastric tube depth: the 'NEX' guideline is incorrect. Br J Nurs. 2014;23:641-644. https://doi.org/10.12968/bjon.2014.23.12.641
  57. Cirgin Ellett ML, Cohen MD, Perkins SM, Smith CE, Lane KA, Austin JK. Predicting the insertion length for gastric tube placement in neonates. J Obstet Gynecol Neonatal Nurs. 2011;40:412-421. https://doi.org/10.1111/j.1552-6909.2011.01255.x
  58. Ni MZ, Huddy JR, Priest OH, et al. Selecting pH cut-offs for the safe verification of nasogastric feeding tube placement: a decision analytical modelling approach. BMJ Open. 2017;7:e018128. https://doi.org/10.1136/bmjopen-2017-018128