Factors Influencing Utilization of Enteral Nutrition Guidelines Among Nurses Working Tertiary Hospitals in Dar Es Salaam Tanzania

Abstract

Background: Worldwide, 30% to 50 % of critically ill admitted patients are malnourished. A study done in 2017 in Latin America among 1053 patients from 116 hospitals showed that 74.1% of malnourished patients were in critical care units due to nature of their illnesses and hyper-metabolic states. The patients had compromised immune system and therefore, they were at an increased risk of infection and septicemia. Enteral nutrition plays a significant role in improving the critically ill patients’ nutrition status and hence, facilitates the healing process. Utilization of enteral nutrition (EN) guidelines may be influenced by nurses’ knowledge, education level and years of experience. Also, patients’ factors GIT complication, high GRV and coughing up a tube and organisational factors such as motivation, supervision, availability of resources, and cooperation may affect utilization of EN. However, there is limited information regarding factors influencing utilization of enteral nutrition guidelines among nurses in Tanzania. Broad objective: To assess factors influencing utilization of EN guidelines among nurses at tertiary Hospital in Dar es Salam, Tanzania. Methods: The study employed a cross-sectional study design with quantitative research approach. A self-administered questionnaire was employed to nurses taking care of critically ill patients in the selected hospitals. Data analysis was done by using SPSS version 23 software. Descriptive statistics such as frequency, percentage and tables were used to summarize the obtained data. Association between the dependent variable (utilization of enteral nutrition guidelines) and independent variables was examined by using chi-square test. A p-value less than 0.05 was considered statistically significant at 95 percent confidence level. Results: Out of 212 participants, 91.5 % completed the questionnaire. The majority (74.25 %) was aged between 26 and 35 years and they were females (58.2%) with diploma level (62.4%). Utilization of EN guidelines was significantly associated with education level and in-service EN training. Those with Masters and Bachelor’s degree were more likely to utilize EN guidelines than Diploma level (p value 0.027). Regarding patients’ factors, EN utilization was significantly influensed by coughing up tube (p-value 0.003). At organizational level, motivation and EN discussion showed significant association with the EN utilization. Nurses, patients and organizational factors influence utilization of EN guidelines in critical care units. Discussions and training should continue to motivate nurses to utilize the EN guidelines in critical care units.