Improving nutrition care for neurosurgery patients through a nurse‐led transition feeding protocol

Abstract

Aim Neurosurgical patients often transition from enteral nutrition (EN) to oral nutrition (ON) as they recover. Implementing a nurse‐led feeding protocol to guide this transition may improve consistency of nutrition care and dietitian workload efficiency. This pragmatic study aimed to evaluate the effect of such a protocol on these outcomes and on nurses’ nutrition care attitudes, practices and knowledge. Methods Data were collected retrospectively for 1 year pre‐ and prospectively for 1 year post‐implementation of the transition feeding protocol (TFP). Participants who transitioned from EN to ON were included in the study. Post‐implementation nurses in the neurosurgery ward were invited to complete a self‐administered questionnaire to investigate attitudes, practices and knowledge. Results One hundred and thirteen participants, 55 pre‐ and 58 post‐implementation, took part in the study. Significantly more patients received transition feeding (TF) post‐implementation (58% vs 93%, P < 0.001), there was a statistically significant improvement in the commencement of TF (0 vs 1 day after ON clearance; P = 0.029), and all patients consumed adequate oral intake 1‐week post‐EN cessation (92.3% vs 100%, P = 0.078). There was no difference in dietetic occasions of service post‐implementation (2 vs 1.5; P = 0.204). A 38% survey response rate from nursing staff (n = 15) was achieved. More nurses were found to be initiating TF (P < 0.001) and a majority reported a perceived increase in knowledge and confidence in providing nutrition support. Conclusions A TFP can optimise the transition from EN to ON by improving consistency and commencement of TF and nurses’ confidence and knowledge in overall nutrition care.

Enteral Nutrition Practice and Associated Factors Among Intensive Care Unit Nurses in South Korea

“…23 A transition feeding protocol could optimize the transition from EN to oral nutrition by improving consistency in feeding practices and nurses' confidence and knowledge in nutrition care. 24 Such nursing practice guidelines or protocols can reduce the gap between evidence and practice, resulting in a positive change in nursing EN practice, which may also improve the transition from EN to oral nutrition. The guidelines of the Korean Hospital Nursing Association 14 recommend that a medical institution's nursing practice guidelines should include EN and should be available to nurses who care for patients who require EN.…”

“…Use of an EN protocol resulted in improvement of nutrition intake through timely initiation and advancement of EN among ICU patients 23. A transition feeding protocol could optimize the transition from EN to oral nutrition by improving consistency in feeding practices and nurses' confidence and knowledge in nutrition care 24. Such nursing practice guidelines or protocols can reduce the gap between evidence and practice, resulting in a positive change in nursing EN practice, which may also improve the transition from EN to oral nutrition.…”

An evaluation of nasogastric (NG) tube removal practices and nutritional intake parameters in an acute neurosurgical population: The development of an NG Transition Feeding Protocol

“…Despite this, it is well documented that there is insufficient exposure to nutrition in healthcare education across numerous settings. 5 For example, the importance of doctors' and nurses' knowledge of nutrition is understood to improve patient outcomes and, despite little emphasis on nutrition during their clinical training, there may be limited training opportunities after the point of qualification to develop these skills further. 6,7 Clearly, there is an opportunity to enhance nutrition education and training for medical and wider healthcare professionals.…”

“…6,7 Clearly, there is an opportunity to enhance nutrition education and training for medical and wider healthcare professionals. 5 To our knowledge, there is no clear pathway outlining how NG feeding should be managed during this period of transition from NG feeding to oral diet, either locally or more widely. However, there is evidence that a Transition Feeding Protocol (TFP) on neurosurgical wards can optimise the transition from EN to ON by improving consistency and commencement of transition feeding, at the same time as improving nursing staff confidence and knowledge in overall nutrition care.…”

Evidence‐based practice in nutrition and dietetics: Translating evidence into practice

“…Consistent with the Knowledge‐to‐Action Framework, establishing the evidence‐to‐practice gap will contribute to future collaboration to develop evidence‐based practice guidelines for the nutritional management of total gastrectomy and oesophagectomy. Dux et al evaluated the implementation of a new nurse‐led transition feeding protocol on improving nutrition care for neurosurgery patients. The protocol improved the consistency and commencement of tube feeding and nurses’ confidence and knowledge.…”