Prioritizing Enteral Nutrition in Critical Care Nursing Practice
Critical care nurses are required to integrate the recommendations of evidence-based guidelines for nutritional therapy into the care of patients within rapidly changing clinical contexts and competing demands on the nurses' time. Successful integration of these recommendations requires prioritizing care, but how or why prioritizing occurs is not clear.
Nutrition is often promoted as an important supportive component of fundamental nursing care, that is, nutrition is important for metabolism, growth, and repair. However, the importance of nutrition as a therapeutic strategy associated with the administration of pharmacologically acting nutrients that results in improved outcomes for patients may not be as well recognized. If so, then nutrition, particularly enteral nutrition, may not be regarded the same as other therapeutic strategies, such as use of antibiotics or the administration of other medications. The consequence may be that nutrition has a lower priority than do other aspects of nursing practice, and this low priority may contribute to the development of iatrogenic malnutrition.
The lack of recognition of the importance of nutrition as a therapy could be attributed to a lack of knowledge. Some limited evidence suggests knowledge deficits specific to nutritional therapy exist for both physicians and nurses in critical care. These potential knowledge deficits highlight the importance of ensuring integration of nutrition-specific education into student nursing programs and as an integral part of ongoing continuing education, particularly because nurses have considered nutrition a low-priority topic. Further, academic programs that specialize in critical care nursing should include nutritional therapy as a key component of the curriculum.
Prioritization of nutrition is equally important in nursing research. A search of leading critical care nursing journals (keywords: enteral nutrition AND nursing AND critical care) revealed only 132 publications specific to enteral nutrition published since 2000. Of these publications, most were commentaries or literature reviews, and at best, only 1% of research articles in any single journal were related to enteral nutrition (Table 2). Of course, other avenues are available to publish the results of research on enteral nutrition, and because of the multidisciplinary nature of nutritional therapy, many of the results appear in journals specific to nutrition or critical care medicine. However, the low number of publications does highlight the dearth of new knowledge on enteral nutrition being generated by and for nurses and also raises a question about communicating research findings to nurses who may not regularly access publications other than nursing journals.