The Study About Nursing Intervention To Prevent Enteral Nutrition Intolerance In Critically Ill Patients

BackgroundIf the gut function and safe, use the gut! However the critically ill patients'condition are complex, and they have the intense stress to respond. In EN periods, the critically ill patients appear feed intolerance possibly, which would affect the energy acquisition, be closely related with the patients'high mortality rate. The researchs in domestic field were limit to surgical patient, in addition, the regarding nursing intervention were few.Therefore, it was need to develop related research, formulate the EN process which conformed to the clinical need. Through standardized training the nursing staff and enhancing the clinical nutrition theoretical knowledge and the skills, these intervention would cause EN implementation standard and the security.ObjectivesTo explore the risk factors of EN intolerance in critically ill patients and provide the evidence to make measures to prevent the EN intolerance; and to study the effect of nursing inverntion in preventing EN intolerance in critically ill patients.Sample and methodsFrom 2009-10 to 2010-07, 83 critically ill patients in a general hospital in Nanjing were enrolled into the prospective cohort study. The self-designed questionnaire and the grading of intolerance of EN, were used to explore the risk factors of feeding intolerance in critically ill patients with EN. Meanwhile, participant observation was conducted to get enteral nutrition status of the implementation. Combined with national and international EN guidelines and clinical practice, Delphi method was used to obtain experts'view and suggestions on EN administration safety in ICU. And then, combined with the enteral nutrition related knowledge as the training materials, the blended learning which was consisted of classroom training & blog technical was used to train the ICU nurses. At the same time, the new process was put into the clinical setting. The historical control was made between from 2009-10 to 2010-07 and from 2010-10 to 2011-02 to study the intervention's effect in preventing EN intolerance in critically ill patients.ResultsThe study showed that among the 83 patients, 36 patients (43.3%) could tolerate very well, 47 patients (56.6%) couldn't tolerate. After treatment, 27 patients'tolerance was fair, the other was poor. And that age, APACHE-II score, the time before EN, albumin, drug administration by NG tube was the risk factor of the EN intolerance, they could increase the incidence of EN intolerance.At the same time through participant observation, existing or potential problems were found in. enteral nutrition implementation.After two rounds of experts'consultation, the new process was come out, which was consisted of 10 projects and 36 statures projects. The process which was used for critically ill patients, was feasibility in clinical implementation. Through nursing intervention, nursing staff's self behavior evaluation and bedside observations in enteral nutrition implementation were improved, P<0.05.The patients'basic situation between from 2009-10 to 2010-07 and that from 2010-10 to 2011-02 had no difference. After the nursing intervention, the rate of EN intolerance in patients'age≥60 from 2010-10 to 2011-02 was lower than that from 2009-10 to 2010-07, P<0.05, with statistical significance.ConclusionSome correlation factors were fond after the study and some nursing intervention could be taken to prevent EN intolerance according to the research. Age, APACHE-II score, the time before EN, albumin, and drug administration by NG tube were the risk factor of the EN intolerance.There is a strong illness stress reaction in critically ill patients, and these objective factors definitely affect patients'tolerance, which is unable to correct within short time. At the same time, through the participant observation, existing or potential problems were found in enteral nutrition implementation. And thereby, the new process was come out, which was consisted of 10 projects and 36 statures projects. After that, enhancing nursing staff of EN knowledge and promoteing process were combined as nursing intervention.Through the nursing intervention, nursing staff's behavior in enteral nutrition implementation were improved. The intervention study showed that nursing intervention could reduce the rate of the enteral nutrition intolerance in critically ill patients.