Systematic review of clinicians’ knowledge, attitudes, and beliefs about nutrition in intensive care

Abstract

Nutrition is a key component of care for critically ill patients; yet nutrition delivery is below international recommendations. In order to improve nutrition delivery to critically ill patients, an understanding of the barriers that prevent guideline adherence is required. It is known that clinicians' knowledge, attitudes, and beliefs of the role of nutrition may act as a potential barrier to nutrition delivery, but whether this remains true in critical care is unknown. The aim of this systematic scoping review was to summarize the literature exploring the knowledge, attitudes, and beliefs of clinicians around nutrition support in critically ill patients. A search of four online databases (MEDLINE via Ovid, Emcare via Ovid, PsycINFO, and CINAHL via EBSCOhost) was conducted on August 14, 2020, to identify literature that reported on clinicians' knowledge, attitudes, and beliefs of nutrition in adult intensive care patients. Data were extracted on study and participant characteristics, methodology, and key study outcomes related to nutrition. Eighteen articles met eligibility criteria and were included in the review. Key findings included the following: nutrition was seen as a priority that ranked below life-saving interventions; differences in perceived clinician responsibilities exist; common barriers to nutrition delivery included inadequate resourcing, lack of nutrition protocols, and gastrointestinal intolerance; and identified facilitators included nutrition education and the presence of a supportive multidisciplinary team. The implementation of nutrition protocols, enhanced clinical nutrition education, and further clarification of roles and responsibilities pertaining to nutrition may assist in improving nutrition delivery in critical care.

Nutrition therapy during noninvasive ventilation: oral or enteral?

“…In addition, fasting has been demonstrated, by ultrasound, to not necessarily precipitate an empty stomach [37]. The predominance of no nutrition prescription may also be a reflection of the lack of value or perceived prioritization of nutrition, which has been described previously in critically ill patients [38,39].…”

“…Although the reasons for this were not documented, this is likely driven by the potential need for intubation, with patients commonly fasted prior to intubation [35 ], and a recently published randomized controlled trial in 2138 ICU patients suggests fasting for extubation is noninferior to continued enteral feeding to the time of extubation [36 ultrasound, to not necessarily precipitate an empty stomach [37]. The predominance of no nutrition prescription may also be a reflection of the lack of value or perceived prioritization of nutrition, which has been described previously in critically ill patients [38,39].…”

Use and safety of enteral nutrition protocols in acute care: A scoping review of literature and retrospective audit of practice

“…[36][37][38] In contrast, the relative success of these protocols in the intensive care unit setting may be due a culture where nurses often adopt responsibility for nutrition provision, possibly reinforced by low dietetics resourcing in some intensive care unit settings. 39 Achieving reductions in potentially unnecessary dietitian review of EN feeding rates may require targeted strategies to support doctors and nurses to feel confident in initiating and monitoring EN for short-term feeding. In the closely controlled and monitored intensive care unit setting, standardised care protocols are viewed as a way to operationalise nutrition guidelines, enabling provision of best practice nutrition care.…”

Physical therapy and nutrition therapy: synergistic, antagonistic, or independent interventions?

“…Factors that influence the delivery of physical rehabilitation include patient physical and physiological capacity, safety, culture and teamwork, clinician beliefs about benefits/risks, and environmental aspects including staffing and equipment [29]. Similar work is emerging to understand the barriers and enablers to the successful delivery of nutrition during critical illness that includes physiological barriers [30] and clinicians' knowledge, attitudes, and beliefs [31] Further, understanding the outcomes that matter to patients and families as well as the health system will be important to define in the future. The recently published CONCISE core outcome set will be useful to improve harmonization of future study design [5].…”

“…Factors that influence the delivery of physical rehabilitation include patient physical and physiological capacity, safety, culture and teamwork, clinician beliefs about benefits/risks, and environmental aspects including staffing and equipment [29]. Similar work is emerging to understand the barriers and enablers to the successful delivery of nutrition during critical illness that includes physiological barriers [30] and clinicians’ knowledge, attitudes, and beliefs [31]…”