Increasing the Volume of Delivered Enteral Feeds Using a Volume-Based Feeding Protocol in a Neuroscience Intensive Care Unit.

BACKGROUND: Iatrogenic malnutrition is a significant burden to patients, clinicians, and health care systems. Compared with well-nourished patients, underfed patients (those who receive less than 80% of their daily energy requirement) have more adverse outcomes related to nutritional status. Volume-based protocols allow for catch-up titrations, are consistently superior to rate-based protocols, and can be implemented in most settings. LOCAL PROBLEM: This project was conducted in an 8-bed neuroscience intensive care unit in which up to 41% of patients who required enteral feeding were underfed. METHODS: This quality improvement clinical practice change project used a before-and-after design to evaluate (1) the effect of implementing a volume-based feeding protocol on the delivery of enteral feeds and (2) the effect of a nutrition-based project on staff members' attitudes regarding nutrition in critical care. The effectiveness of a volume-based feeding titration protocol was compared with that of a rate-based feeding protocol for achieving delivery of at least 80% of prescribed nutrition per 24-hour period. Staff members' attitudes were assessed using a survey before and after the project. RESULTS: During 241 enteral feeding days (n = 40 patients), the percentage of delivered enteral feeding volume and the percentage of days patients received at least 80% of the prescribed volume increased after volume-based feeding was implemented. After project implementation, 74 staff members reported increased emphasis on nutrition delivery in their practice and a higher level of agreement that nutrition is a priority when caring for critically ill patients. CONCLUSIONS: Using a volume-based feeding protocol with supplemental staff education resulted in improved delivery of prescribed enteral feeding.

Desenvolvimento de protótipo de aplicativo móvel sobre cuidados de enfermagem para paciente cirúrgico oncológico com sonda enteral / Development of a mobile application prototype on nursing care for surgical oncology patients with enteral tubes

Objetivo: descrever a etapa de criação do protótipo de um aplicativo móvel, baseado em evidências, com informações sobre os cuidados de enfermagem para utilização de sonda enteral em pacientes cirúrgicos oncológicos. Método: estudo metodológico com uso do design instrucional fixo, que percorreu as fases de análise, desenho e desenvolvimento. Foram realizados storyboards com base nas evidências dos principais conteúdos sobre a administração de dietas e de medicamentos via sondas enterais nos seguintes guidelines: Diretrizes Brasileiras de Práticas de Enfermagem e Diretriz Americana de Práticas Seguras para Terapia de Nutrição Enteral. Resultados: na etapa de desenho, foram mapeados os conteúdos que entrariam no aplicativo e elaborados dois roteiros, denominados storyboards, sendo um para o cuidado durante a Administração de Dietas e outro para o cuidado na etapa de Administração de Medicamentos. Nos storyboards, foram descritas as sequências das telas, o conteúdo que seria apresentado em cada uma delas sob forma de texto e de imagem e como esse conteúdo deveria ser organizado no layout da tela. Os storyboards foram submetidos à validação de conteúdo por seis enfermeiros especialistas da área. Em seguida, foram realizados ajustes nos conteúdos e forma de apresentação descritos nos storyboards. Conclusão: o protótipo de aplicativo baseado em evidências científicas atuais é uma ferramenta tecnológica que poderá ser consultada pela equipe de enfermagem durante o cuidado à beira do leito, aumentando a segurança do paciente. O embasamento científico e metodológico para o desenvolvimento do storyboard viabiliza a confiabilidade do produto educativo. Ademais, a validação de conteúdo e aparência por especialistas na área torna tal dispositivo seguro para o público-alvo e uma importante ferramenta profissional, passível de ser utilizada como atividade de educação em saúde

Objective: describe the step of creating the prototype of a mobile application, based on evidence, with information about nursing care for the use of enteral tubes in surgical oncology patients. Method: methodological study using fixed instructional design, which went through the phases of analysis, design, and development. Storyboards were made based on the evidence of the main contents about the administration of diets and medications via enteral tubes in the following guidelines: Brazilian Guidelines for Nursing Practice and American Guideline for Safe Practices for Enteral Nutrition Therapy. Results: in the design stage, the contents that would enter the application were mapped and two scripts were developed, called storyboards, one for the care during Diet Administration and the other for the care in the Medication Administration stage. The storyboards described the screen sequences, the content that would be presented on each screen in text and image form, and how this content should be organized in the screen layout. The storyboards were submitted for content validation by five specialist nurses. Then, adjustments were made to the content and presentation form described in the storyboards. Conclusion: the prototype application based on current scientific evidence is a technological tool that can be consulted by the nursing team during bedside care, increasing patient safety. The scientific and methodological basis for the storyboard development enables the reliability of the educational product. Moreover, the validation of content and appearance by experts in the field makes this device safe for the target audience and an important professional tool, which can be used as a health education activity

CE: Monitoring Adult Patients for Intolerance to Gastric Tube Feedings.

ABSTRACT: Gastric tube feeding is a common and valuable intervention for patients in a variety of care settings. While tube feeding can save the lives of patients for whom oral feeding isn't possible, intolerance to tube feeding is a potential complication. This article discusses risk factors for feeding intolerance; the assessment of signs and symptoms of feeding intolerance; the various means of assessing gastric emptying, including the practice of monitoring gastric residual volume (GRV); the controversy surrounding GRV monitoring in assessing feeding tolerance; and the special considerations for monitoring feeding tolerance in acutely and critically ill adults with coronavirus disease 2019. The author, a nurse researcher with extensive experience in the area of enteral feeding, briefly summarizes recommendations and guidelines for enteral feeding published by national and international health care organizations between 2015 and 2020, and offers her perspective on best nursing practices for monitoring food tolerance in adults.

Nutritional support for children and young people: nasogastric tubes.

The need to offer nutritional support to children and young people is commonplace for health professionals. This article explores the use and indication of nasogastric tubes (NGT) in children and young people, before explaining the process of inserting NGTs and the ongoing management of this method of nutritional support.

Perfil de pacientes hospitalizados em terapia nutricional enteral / Profile of hospitalized patients on enteral nutrition therapy / Perfil de pacientes hospitalizados en terapia nutricional enteral

Objetivo: avaliar os perfis sociodemográfico e clínico de pacientes em terapia nutricional enteral em uma instituição de alta complexidade. Método: trata-se de um estudo quantitativo, descritivo, observacional e transversal. Analisaram-se dados de pacientes em terapia nutricional enteral ao longo de sete meses, considerando-se variáveis sociodemográficas e clínicas e a via de infusão da dieta. Realizaram-se análises estatísticas descritivas das frequências absoluta, relativa e média. Resultados: registrou-se que 614 pacientes usaram a terapêutica, sendo que 55,0% eram do sexo masculino e 39,9% tinham idade acima de 60 anos. Verifica-se que os diagnósticos clínicos mais prevalentes variaram de acordo com as faixas etárias, com destaque para o câncer (25,2%). Apontase que a via de infusão predominante foi a sonda nasoenteral (78,6%). Conclusão: entende-se que a terapia nutricional enteral se mostrou necessária em todas as faixas etárias e em vários diagnósticos clínicos, principalmente, para idosos e pessoas em tratamento oncológico. Avalia-se que os achados contribuem para o planejamento assistencial e o conhecimento em Enfermagem.(AU)

Objetivo: evaluar los perfiles sociodemográficos y clínicos de los pacientes sometidos a terapia nutricional enteral en una institución de alta complejidad. Método: se trata de un estudio cuantitativo, descriptivo, observacional y transversal. Se analizaron los datos de los pacientes sobre la terapia nutricional enteral durante siete meses, teniendo en cuenta las variables sociodemográficas y clínicas y la vía de infusión de la dieta. Se realizaron análisis estadísticos descriptivos de frecuencias absolutas, relativas y medias. Resultados: se registró que 614 pacientes utilizaron el tratamiento, y el 55,0% eran hombres y el 39,9% mayores de 60 años. Se verificó que los diagnósticos clínicos más frecuentes variaron según los grupos de edad, especialmente el cáncer (25,2%). Se señala que la vía de perfusión predominante fue el tubo nasoenteral (78,6%). Conclusión: se entiende que la terapia nutricional enteral era necesaria en todos los grupos de edad y en diversos diagnósticos clínicos, principalmente para los ancianos y las personas sometidas a tratamiento oncológico. Se evalúa que los hallazgos contribuyen a la planificación de la atención y al conocimiento en Enfermería.(AU)

Objective: to evaluate the sociodemographic and clinical profiles of patients undergoing enteral nutrition therapy in a high-complexity institution. Method: a quantitative, descriptive, observational, and cross-sectional study was carried out. Data from patients on enteral nutrition therapy over seven months were analyzed, considering sociodemographic and clinical variables and the diet's infusion route. Descriptive statistical analyzes of absolute, relative, and average frequencies were performed. Results: it was registered that 614 patients used the therapy, of which 55.0% were male, and 39.9% were older than 60 years. The most prevalent clinical diagnoses varied according to age groups, with an emphasis on cancer (25.2%). The predominant infusion route was the nasojejunal tube (78.6%). Conclusion: it is understood that enteral nutrition therapy was necessary for all age groups and several clinical diagnoses, mainly for the elderly and patients on cancer treatment. The findings contribute to care planning and nursing knowledge.(AU)

Simulação clínica: educação para equipe de enfermagem no cuidado aos pacientes com sonda nasoenteral / Simulación clínica: educación para el equipo de enfermería en el cuidado de pacientes con sonda nasoenteral / Clinical simulation: education for nursing team in the care of patients with nasoenteral tube

Objetivo compreender como os técnicos de Enfermagem percebem a simulação clínica como metodologia de educação no cuidado ao paciente hospitalizado em uso de sonda nasoenteral. Método trata-se de estudo exploratório, descritivo e de abordagem qualitativa, realizado com 64 técnicos de Enfermagem em um hospital de Porto Alegre, Sul do Brasil, em agosto e setembro de 2017. Realizou-se uma intervenção de educação por meio de simulações clínica, gravadas e transcritas. Utilizou-se a análise de conteúdo para tratamento dos dados. Resultados foram estabelecidas duas categorias: as potencialidades da simulação clínica como metodologia de educação e os desafios da simulação clínica para a prática da educação. Conclusão os profissionais de Enfermagem perceberam as potencialidades da atividade de simulação e mostraram-se colaborativos e receptivos a revisar as práticas de cuidados em terapia nutricional enteral. A simulação clínica é uma metodologia promissora a ser utilizada na educação permanente em serviço.

Objetivo entender cómo los técnicos de enfermería perciben la simulación clínica como una metodología educativa en la atención de pacientes hospitalizados utilizando sondas nasoenterales. Método se trata de un estudio exploratorio, descriptivo y cualitativo, realizado con 64 técnicos de enfermería en un hospital de Porto Alegre, sur de Brasil, en agosto y septiembre de 2017. Se llevó a cabo una intervención educativa a través de simulaciones clínicas, registradas y transcritas. El análisis de contenido se utilizó para el procesamiento de datos. Resultados se establecieron dos categorías: las potencialidades de la simulación clínica como metodología educativa y los desafíos de la simulación clínica para la práctica de la educación. Conclusión los profesionales de enfermería percibieron las potencialidades de la actividad de simulación y fueron colaborativos y receptivos para revisar las prácticas de atención en la terapia nutricional enteral. La simulación clínica es una metodología prometedora que se utilizará en la educación continua en el servicio.

Objective to understand Nursing technicians' perception of clinical simulation as an education methodology in the care of hospitalized patients using nasoenteral tubes. Method this is an exploratory, descriptive and qualitative study, conducted with 64 Nursing technicians from a hospital in Porto Alegre, Southern Brazil, in August and September 2017. An education intervention was carried out through clinical simulations, recorded and transcribed. Content analysis was used for data processing. Results two categories were established: the potentialities of clinical simulation as an education methodology and the challenges of clinical simulation for the practice of education. Conclusion Nursing professionals realized the potentialities of the simulation activity and were collaborative and receptive to review care practices in enteral nutritional therapy. Clinical simulation is a promising methodology to be used in continuing education in service.

Concordância interobservadores em um checklist de cuidados em terapia nutricional enteral / Concordancia interobservadores en una checklist de cuidados en terapia nutricional enteral / Interobserver agreement in a checklist of care in enteral nutrition therapy

Resumo Objetivo Avaliar a concordância interobservadores na aplicação um checklist de cuidados em Terapia Nutricional Enteral (TNE). Métodos Estudo de confiabilidade que precedeu um ensaio clínico (NCT03497221), realizado em hospital universitário do sul do Brasil (junho e julho de 2017). Checklist de 25 itens relacionado aos cuidados em TNE foi realizado por uma enfermeira (Padrão de Referência) e por nove Assistentes de Pesquisa (AP). As avaliações foram feitas concomitantemente e de modo independente. A concordância foi testada utilizando-se o Statistical Package for the Social Sciences versão 21.0. Valores de Kappa (k) foram considerados como concordância entre: pobre (0 a 0,19); relativa (0,20 a 0,39); moderada (0,40 a 0,59); substancial (0,60 e 0,79); quase perfeita (0,80 a 0,99); e perfeita (1). O estudo foi aprovado pelo Comitê de Ética da Instituição (nº 16-0534). Resultados Foram realizadas 351 observações em duplicata, sendo o menor número de observações foi com a AP 5 (n=35) e o maior com a AP 8 (n=45). Foram avaliados itens relacionados a TNE em três blocos: identificação dos frascos de infusões e bomba de infusão; materiais de apoio para administração da terapia; e cuidados ao paciente em uso de TNE. Houve concordância quase perfeita ou perfeita em todos os pares de observação, com o menor Kappa para AP 6 (k=0,890; IC95%=0.86, 0.92) e o maior para AP 3 (k=0,965; IC95%=0.93, 0.99). Conclusão A concordância interobservadores ao aplicar um checklist contendo 25 itens foi excelente, o que minimiza a ocorrência de viés de aferição nas etapas subsequentes.

Resumen Objetivo Evaluar la concordancia interobservadores en la aplicación de una checklist de cuidados en terapia nutricional enteral (TNE). Métodos Estudio de fiabilidad que precedió un ensayo clínico (NCT03497221), realizado en un hospital universitario de la región Sur de Brasil (junio y julio de 2017). Una checklist de 25 ítems relacionados con los cuidados en TNE fue realizada por una enfermera (Estándar de Referencia) y por nueve Asistentes de Investigación (AI). Las evaluaciones fueron llevadas a cabo simultánea e independientemente. La concordancia se comprobó utilizando el Statistical Package for the Social Sciences versión 21.0. Los valores de Kappa (k) se consideraron como concordancia entre: pobre (0 a 0,19); relativa (0,20 a 0,39); moderada (0,40 a 0,59); considerable (0,60 a 0,79); casi perfecta (0,80 a 0,99); y perfecta (1). El estudio fue aprobado por el Comité de Ética de la institución (n.° 16-0534). Resultados Se realizaron 351 observaciones duplicadas, de las cuales el menor número de observaciones fue de la AI 5 (n=35) y el mayor de la AI 8 (n=45). Se evaluaron ítems relacionados con la TNE en tres grupos: identificación de los frascos de infusiones y bomba de infusión, material de apoyo para la administración de la terapia y cuidados del paciente en uso de TNE. Se observó concordancia casi perfecta o perfecta en todos los pares de observación, con el menor Kappa de la AI 6 (k=0,890; IC95 %=0.86, 0.92) y el mayor de la AI 3 (k=0,965; IC95 %=0.93, 0.99). Conclusión La concordancia interobservadores al aplicar una checklist de 25 ítems fue excelente, lo que minimiza la ocurrencia de sesgo de medición en las etapas subsiguientes.

Abstract Objective To assess interobserver agreement in the application of a checklist of care in enteral nutritional therapy (ENT). Methods This is a reliability study that preceded a clinical trial (NCT03497221), carried out at a university hospital in southern Brazil (June and July 2017). A checklist of 25 items related to care in ENT was performed by a nurse (reference standard) and nine research assistants (RA). Assessments were carried out concurrently and independently. Agreement was tested using the Statistical Package for the Social Sciences, version 21.0. Kappa values (k) were considered as poor (0 to 0.19), relative (0.20 to 0.39), moderate (0.40 to 0.59), substantial (0.60 and 0.79), almost perfect (0.80 to 0.99), and perfect (1). The study was approved by an Institutional Review Board (number 16-0534). Results Three hundred fifty-one observations were made in duplicate; the lowest number of observations was with RA, 5 (n = 35) and the highest with RA, 8 (n = 45). Items related to ENT were assessed in three blocks: identification of infusion bottles and infusion pump; support materials for administering the therapy; care for patients using ENT. There was almost perfect or perfect agreement in all observation pairs, with lowest Kappa for RA 6 (k = 0.890; 95% CI = 0.86, 0.92) and the highest for RA 3 (k = 0.965; 95% CI = 0.93, 0.99). Conclusion Interobserver agreement, when applying a checklist containing 25 items, was excellent, which minimizes the occurrence of measurement bias in subsequent steps.

Improving the experience of patients who receive home enteral tube feeding.

Home enteral tube feeding is an increasingly common intervention for patients who are unable to meet their full nutritional requirements. These patients require specialist support to enable them to live as normal a life as possible at home. An integrated acute and community nutrition service developed a new role of community nutrition nurse (CNN) in 2016, with the goal of reducing the number of unplanned hospital attendances relating to enteral tube feeding issues. Following the introduction of the CNN and related troubleshooting interventions, there was a 93% reduction in unplanned hospital admissions between 2017 and 2018. The role has been found to have many benefits, such as improved patient experience, care closer to the patient's home and empowerment of patients, their relatives and carers. It has also helped to increased patient and carer confidence to self-care and has reduced costs within the acute hospital system relating to unplanned hospital attendances and admissions.

Parental care for infants with feeding tube: psychosocial repercussions.

OBJECTIVES: to understand the psychosocial repercussions experienced by caregiving parents, resulting from care for the child with dysphagic cleft lip and palate. METHODS: qualitative study, developed in a tertiary hospital in September 2016. The sample defined by theoretical saturation consisted of seven mothers. Data collection was performed by unstructured interview, being audio-recorded and fully transcribed. Symbolic Interactionism was used as theoretical framework, and Thematic Content Analysis as methodological framework. RESULTS: the following themes emerged: diagnosisimpact and coping; coping with overload and stress; interaction between caregivers as an acceptance and coping strategy; impact on family and social life of caregivers; and curiosity coping, and family and community prejudice. FINAL CONSIDERATIONS: despite the physical and emotional overload, the mother figure plays the main and determining role in care, reflecting the complexity of care.

Confirming nasogastric tube placement in adults.

Nurses are responsible for ensuring that short-term enteral feeding tubes are placed correctly before using them for gastric emptying, enteral nutrition, or medication administration. This article reviews evidence-based methods for assessing tube placement and discusses the limitations of each method with a focus on nasogastric tube placement.

Apreensões de trabalhadores hospitalares sobre orientações para o cuidado de pessoas em nutrição enteral domiciliar / The apprehensions of hospital workers regarding guidance in the care of people experiencing home enteral nutrition

Objetivo: Analisar apreensões de trabalhadores hospitalares sobre orientações para o cuidado de pessoas adultas e idosas em nutrição enteral domiciliar. Métodos: Abordagem qualitativa por intervenção hermenêutico-dialética, orientada pela Teoria da Difusão de Inovações. Realizou-se encontro único, mediado por grupo focal em uma oficina de trabalho, em agosto de 2018, junto à equipe multiprofissional de um hospital público de ensino (n=14 participantes). Registros textuais resultantes da oficina foram analisados por categorias semânticas. Resultados: Participantes reportaram tempo médio de atuação de 11 anos no hospital de ensino; 50% apresentavam pós-graduação.Aspectos condicionantes para orientações qualificadas na alta hospitalar e no cuidado doméstico permearam dificuldades relacionadas à rotina e ao trabalho em equipe, como a interação e a comunicação entre as diferentes categorias; dificuldades relacionadas ao cuidado continuado em rede de serviços de saúde devido à fragmentação dos pontos de atenção. A integração ensino-serviço foi apontada como potencialidade para a superação dessas limitações. Conclusão: A abordagem permitiu reconhecer condições contextualizadas para orientação ao cuidado domiciliar de pessoas com sonda e nutrição enteral, a partir das equipes hospitalares, que podem coincidir com cenários similares e também incrementar a produção científica nacional sobre o tema, ainda escassa. (AU)

Objective: To analyze the understanding of hospital workers with regards to the guidance for the care of adult and elderly people in home enteral nutrition. Methods: qualitative approach through hermeneutic-dialectic intervention, guided by the Theory of the Diffusion of Innovations. A single meeting, mediated by a focus group in a workshop, was held in August 2018, together with the interdisciplinary team of a public teaching hospital (n = 14 participants). Textual records resulting from the workshop were analyzed in semantic categories. Results: Participants had an average time of 11 years in the teaching hospital. 50% had a postgraduate degree. Conditioning factors for qualified hospital discharge guidelines were related to routine and teamwork difficulties, such as interaction and communication between the different categories, and to difficulties regarding the continued care in the network of health services, due to the fragmentation of the attention services. The teaching-service integration was pointed out as a potential for overcoming these limitations. Conclusion: The approach allowed the recognition of contextual conditions for hospital teams to guide the home care of people with tubes and enteral nutrition, conditions which may coincide with those in similar settings and increase the scarce national scientific production on the subject. (AU)

Providing optimal nursing care for patients undergoing enteral feeding.

Enteral feeding is defined as the intake of food directly into the gastrointestinal (GI) tract. Enteral feeding tubes can also be used to administer medicines. Patients who may require enteral feeding include those who are unconscious, or those with neurological swallowing disorders, upper GI obstruction, GI dysfunction or malabsorption. There are several routes that can be used for enteral feeding including gastrostomy, post-pyloric, nasogastric, continuous pump and bolus feeding. When undertaking enteral feeding, nurses and other healthcare professionals should be aware of the potential complications such as tube blockage and infection. This article examines the various enteral feeding routes, discusses the administration of medicines, and details the common complications associated with enteral feeding.

Bedside Postpyloric Tube Placement and Enteral Nutrition Delivery in the Pediatric Intensive Care Unit.

BACKGROUND: Enteral nutrition (EN) delivery may be more effective via a postpyloric (PP) feeding tube in critically ill children, but tube placement can be challenging. We aimed to describe PP tube placement and EN practices in a multidisciplinary pediatric intensive care unit (PICU) after the implementation of a nurse-led bedside PP tube-placement program. METHODS: In a single-center retrospective study, we identified 100 consecutive patients admitted to the PICU for >48 hours and for whom PP tube placement was attempted. Demographics, clinical characteristics, and details of PP tube placement and EN delivery were examined. RESULTS: The study cohort had a median age (25th, 75th percentiles) of 3.89 years (0.55, 14.86); 66% were male. Respiratory illness was the primary diagnosis of admission (55%); 92% were on respiratory support. Risk of aspiration was the primary indication for PP tube placement (48%). Bedside placement was the initial technique for PP tube placement in 93% of patients (successful for 84.9%) and was not associated with serious complications. Eighty-seven patients with a PP tube started EN and received a median 73.9% (12.3%, 100%) of prescribed energy goal on day 3 after EN initiation. PP EN allowed 14 of 39 patients receiving parenteral nutrition (PN) to transition off PN 7 days after EN initiation. Thirty-five percent of EN interruptions were due to feeding-tube dysfunction. CONCLUSION: Bedside PP tube placement is safe and feasible and allows for effective EN delivery and decreased PN use when applicable. Interruptions in PP EN due to tube malfunction are prevalent.

Enteral nutrition in critically ill adults: Literature review of protocols.

BACKGROUND: Managing nutrition in critically ill patients is an important intervention to promote healing. It is unknown whether the implementation of a protocol that guides enteral nutrition (EN) support is effective in improving the outcomes of critically ill patients. Furthermore, it is unknown whether a nurse-driven protocol is more or less effective than a protocol not managed by nurses. AIMS AND OBJECTIVES: The purpose of this literature review is to determine the current state of the science regarding evidence-based protocols for the administration and management of EN in critically ill patients. SEARCH STRATEGY, INCLUSION, AND EXCLUSION CRITERIA: Studies were identified by searching the Cumulative Index to Nursing and Allied Health Literature Plus database for the terms "enteral nutrition AND nursing." Studies with EN protocols for adult, critically ill patients published since 2011 were included. Studies without a protocol and those pertaining to paediatric, disease-specific, medical-surgical, or community-based populations were excluded. A total of 10 studies meeting the inclusion criteria were identified. CONCLUSIONS: Defining and implementing both early initiation of EN and adequate titration to goal are important for achieving the maximum nutritional advantage. The highest benefit is also derived from identifying and delivering an individualized caloric and/or protein goal. A protocol increases standardization of practice in relation to these themes as well as the management of gastric residual volume, complications, and potentially for managing feeding interruptions. Because of the significant effects of nursing care on nearly all aspects of the management and delivery of EN, a nurse-driven protocol may yield higher compliance and greater effectiveness than a protocol that is not nurse driven. RELEVANCE TO CLINICAL PRACTICE: Nurses are at the forefront of EN administration, although interprofessional collaboration remains paramount. Current practice must align with the best practice in the development and implementation of an EN protocol.

A Quality Improvement Project to Improve the Use of Mother's Own Milk (MOM) With Precision Oropharyngeal Therapy.

BACKGROUND: Bioprotective properties of mother's own milk (MOM) support the use of targeted MOM administration methods, including oropharyngeal therapy (OPT) with MOM, which may mimic the protective effects of swallowed amniotic fluid, thereby improving infant health outcomes. PURPOSE: To increase the use of MOM-OPT in premature infants in the first week of life. METHODS: Quality improvement methods were used to implement precision dosing of OPT. RESULTS: After changing processes and replacing the colostrum immune therapy practice with longer-term precision OPT, the percentage of ordered doses administered to infants in the first week of life increased from 24% to 64%. There was also a 15% increase in very low birth-weight infants who received MOM (from 50% to 65%) at discharge. There were no reported adverse events related to OPT administration. IMPLICATIONS FOR PRACTICE: Replacing the unit's short-term colostrum immune therapy protocol with the longer-term precision OPT increased the number of doses given in the first week of life and increased the number of very low birth-weight infants discharged receiving MOM. IMPLICATIONS FOR RESEARCH: Researchers should consider studying the reported positive effects of OPT related to infant response (positive oral stimulation, reduction in oral aversion, and improved oral feeding skills), parent participation in care, and maternal milk expression behaviors (longer milk expression duration).

Construção e validação de instrumento para avaliar o conhecimento do enfermeiro sobre terapia nutricional enteral / Construcción y validación de un instrumento para evaluar los conocimientos del enfermero sobre la terapia de nutrición enteral / Development and validation of an instrument to assess the knowledge of nurses on enteral nutrition

RESUMO Objetivo: Construir e validar instrumento para avaliar o conhecimento do enfermeiro sobre terapia nutricional enteral. Método: Estudo metodológico, com revisão de literatura, validação de conteúdo e pré-teste. Para a revisão, foram incluídos trabalhos publicados de 2008 a 2018 a respeito da terapia de nutrição enteral. O material foi apreciado por 6 juízes, seguindo os critérios da psicometria. Calculou-se percentual de concordância. O pré-teste foi realizado com 30 enfermeiros, a fim de verificar a adequação e o entendimento para uso na prática clínica. Resultados: Instrumento construído continha quatro domínios, com 10 itens cada. Os domínios Indicação da terapia enteral e Monitoramento da administração da dieta enteral apresentaram melhores percentuais de concordância - 0,94 e 0,93, respectivamente. As categorias que obtiveram valores abaixo de 0,90 foram reformuladas ou retiradas, resultando em 38 categorias distribuídas em 4 domínios. No pré-teste, a concordância foi de 0,90, sendo o instrumento considerado de fácil entendimento e adequado para a prática. Conclusão: O instrumento construído foi validado quanto ao conteúdo e à aplicação na prática pelos enfermeiros.

RESUMEN Objetivo: Construir y validar un instrumento para evaluar el conocimiento del enfermero sobre la terapia de nutrición enteral. Método: Se trata de un estudio metodológico, de revisión literaria, validación del contenido y prueba previa. Para la revisión se incluyeron trabajos publicados desde 2008 hasta 2018 relativos a la terapia de nutrición enteral. Seis jueces analizaron el material siguiendo los criterios de la psicometría. Se calculó el índice de concordancia. La prueba previa se realizó con 30 enfermeros para comprobar la idoneidad y la comprensión para su uso en la práctica clínica. Resultados: El instrumento construido contenía cuatro dominios de 10 elementos cada uno. Los dominios "Indicación de terapia enteral" y "Monitoreo del manejo de la dieta enteral" presentaron un porcentaje de concordancia - 0,94 y 0,93, respectivamente. Las categorías que obtuvieron valores por debajo de 0,90 se reformularon o se retiraron, lo que trajo como resultado 38 categorías distribuidas en 4 dominios. En la prueba previa, la concordancia fue de 0,90, por lo que se consideró al instrumento de fácil comprensión e idóneo para la práctica. Conclusión: El instrumento ha sido validado por los enfermeros según su contenido y su aplicación en la práctica.

ABSTRACT Objective: To develop and validate an instrument to assess the knowledge of nurses on enteral nutrition. Method: Methodological study, with literature review, content validation and pre-test. Studies published from 2008 to 2018 on enteral nutrition were included in the review. The material was evaluated by 6 judges, following psychometric criteria. The degree of agreement was calculated. The pre-test was carried out with 30 nurses, with the objective of verifying the suitability and understanding of the instrument for its use in clinical practice. Results: The instrument constructed had four domains with 10 items each. The domains Indication of enteral nutrition and Monitoring of enteral nutrition had better degrees of agreement −0.94 and 0.93, respectively. The categories that obtained values below 0.90 were reformulated or removed, resulting in 38 categories distributed in 4 domains. In the pre-test, the agreement was 0.90, and the instrument was considered easy to understand and adequate for practice. Conclusion: The instrument constructed was validated regarding content and application in nursing practice.

Parental care for infants with feeding tube: psychosocial repercussions / Cuidado de los padres para lactantes con sondas de alimentación: repercusiones psicosociales / O cuidado prestado por pais a lactentes com sonda alimentadora: repercussões psicossociais

ABSTRACT Objectives: to understand the psychosocial repercussions experienced by caregiving parents, resulting from care for the child with dysphagic cleft lip and palate. Methods: qualitative study, developed in a tertiary hospital in September 2016. The sample defined by theoretical saturation consisted of seven mothers. Data collection was performed by unstructured interview, being audio-recorded and fully transcribed. Symbolic Interactionism was used as theoretical framework, and Thematic Content Analysis as methodological framework. Results: the following themes emerged: diagnosisimpact and coping; coping with overload and stress; interaction between caregivers as an acceptance and coping strategy; impact on family and social life of caregivers; and curiosity coping, and family and community prejudice. Final considerations: despite the physical and emotional overload, the mother figure plays the main and determining role in care, reflecting the complexity of care.

RESUMEN Objetivos: comprender las repercusiones psicosociales experimentadas por los padres cuidadores, como resultado del cuidado del niño con labio leporino y paladar hendido disfagico. Métodos: estudio cualitativo, desarrollado en un hospital terciario en septiembre de 2016. La muestra definida por saturación teórica consistió en siete madres. La recopilación de datos se realizó mediante entrevista no estructurada, grabada en audio y totalmente transcrita. Se utilizó como referencia teórica el interaccionismo simbólico y como referencia metodológica, el análisis de contenido temático. Resultados: se aclararon cinco categorías: impacto y afrontamiento del diagnóstico; hacer frente a la sobrecarga y el estrés; interacción entre cuidadores como una estrategia de aceptación y afrontamiento; impacto en la vida familiar y social de los cuidadores; y afrontamiento de curiosidad y prejuicio familiar y comunitario. Consideraciones finales: a pesar de la sobrecarga física y emocional, la figura materna desempeña el papel principal y determinante en la atención, lo que refleja la complejidad del proceso de lo cuidado.

RESUMO Objetivos: compreender as repercussões psicossociais vivenciadas por pais cuidadores, decorrentes do cuidado do filho com fissura labiopalatina, disfágico e em uso de sonda alimentadora. Métodos: estudo qualitativo, desenvolvido em um hospital terciário em setembro de 2016. A amostra definida por saturação teórica constou sete mães. A coleta de dados foi realizada por entrevista não estruturada, audiogravada e transcrita na íntegra. Utilizou-se como referencial teórico o Interacionismo Simbólico e como referencial metodológico, a Análise de Conteúdo Temática. Resultados: foram elucidadas cinco categorias: impacto e enfrentamento do diagnóstico; enfrentamento da sobrecarga e o estresse; interação entre cuidadores como estratégia de aceitação e enfrentamento; impacto no convívio familiar e social dos cuidadores; e enfrentamento da curiosidade e o preconceito familiar e comunitário. Considerações finais: apesar da sobrecarga física e emocional, a figura materna exerce o papel principal e determinante no cuidado, refletindo a complexidade do processo de cuidar.

Cuidados a criança em terapia nutricional enteral: conhecimento teórico e prático de técnicos de enfermagem / Child care in enteral nutrition therapy: nursing technicians' theoretical and practical knowledge / Cuidados al niño en terapia nutricional enteral: conocimiento teórico y práctico de técnicos de enfermería

Objetivo: avaliar e correlacionar o conhecimento teórico e prático dos técnicos de enfermagem sobre assistência de enfermagem à criança em terapia nutricional enteral. Método: estudo analítico, comparativo, realizado com 21 técnicos de enfermagem de um hospital terciário, especializado no atendimento de pacientes com anomalias craniofaciais, realizado entre janeiro e abril de 2015. Para a coleta de dados, foram utilizadas entrevista estruturada, guiada por um instrumento elaborado pelos pesquisadores, e observação direta. Considerou-se como conhecimento satisfatório >70%. Para a análise estatística utilizou-se a Correlação de Pearson com nível de significância de 5%. O estudo foi aprovado pelo Comitê de Ética em Pesquisa. Resultados: o acerto teórico foi de 74% enquanto o prático foi de 71%. Verificou-se que quanto maior o conhecimento teórico, maior foi o prático (p<0,001). Conclusão: em geral, os técnicos de enfermagem apresentaram conhecimento satisfatório, tanto prático, quanto teórico, referente à assistência de enfermagem a crianças em terapia nutricional enteral.

Objective: to evaluate and correlate nursing technicians' theoretical and practical knowledge of nursing care for children in enteral nutritional therapy. Method: this analytical, comparative study, conducted between January and April 2015, involved 21 nursing technicians at a tertiary hospital specializing in care for patients with craniofacial anomalies. Data were collected using structured interview guided by an instrument developed by the researchers, and direct observation. A knowledge score of >70% was considered to be satisfactory. Statistical analysis was performed by Pearson correlation to a 5% level of significance. The study was approved by the research ethics committee. Results: theoretical accuracy scored 74%, and practical, 71%. The greater the theoretical knowledge, the greater the practical knowledge (p<0.001). Conclusion: the nursing technicians generally displayed satisfactory practical and theoretical knowledge of nursing care for children in enteral nutritional therapy.

Objetivo: evaluar y correlacionar los conocimientos teóricos y prácticos de los técnicos de enfermería sobre el cuidado de enfermería para niños en terapia nutricional enteral. Método: estudio analítico comparativo, realizado junto a 21 técnicos de enfermería de un hospital terciario, especializado en la atención de pacientes con anomalías craneofaciales, realizado entre enero y abril de 2015. Para la recolección de los datos se utilizó la entrevista estructurada guiada por un instrumento desarrollado por los investigadores y la observación directa. Se consideró como conocimiento satisfactorio > 70%. Para el análisis estadístico se utilizó la Correlación de Pearson con un nivel de significación del 5%. El estudio fue aprobado por el Comité de Ética en Investigación. Resultados: El porcentaje de precisión teórica fue del 74%, mientras que el práctico fue del 71%. A mayor conocimiento teórico, mayor conocimiento práctico (p<0.001). Conclusión: en general, los técnicos de enfermería presentaron conocimientos satisfactorios, tanto prácticos como teóricos, sobre el cuidado de enfermería para niños en terapia nutricional enteral.