The knowledge of intensive care professionals about
               diarrhea

A multicenter cross-sectional study was conducted among health care professionals working at three adult intensive care units. Participants responded individually to a self-administered questionnaire about their length of work experience in intensive care; the definition, characterization, and causes of diarrhea; types of records in the patient's medical record; and training received.

Results:

A total of 78 professionals participated in this study, of whom 59.0% were nurse technicians, 25.7% were nurses, and 15.3% were physicians; 77.0% of them had worked in intensive care for over 1 year. Only 37.2% had received training on this topic. Half of the interviewees defined diarrhea as "liquid and/or pasty stools" regardless of frequency, while the other 50.0% defined diarrhea based on the increased number of daily bowel movements. The majority of them mentioned diet as the main cause of diarrhea, followed by "use of medications" (p<0.001). Distinct nutritional practices were observed among the analyzed professionals regarding episodes of diarrhea, such as discontinuing, maintaining, or reducing the volume of enteral nutrition; physicians reported that they do not routinely communicate the problem to other professionals (for example, to a nutritionist) and do not routinely record and quantify diarrhea events in patients' medical records.

Conclusion:

Different opinions and practices were observed in intensive care professionals with regard to diarrhea.

Diarrhea; Nutritional therapy; Questionnaires; Intensive care units

	Total	Physicians	Nurse technicians	Nurses
	(N=78)	(N=12)	(N=46)	(N=20)
Male	22 (28.2)	9 (75)	11 (24)	2 (10)
Age group (years)
18-25	18 (23.1)	1 (8.3)	10 (21.7)	7 (35)
26-40	49 (62.8)	9 (75)	28 (60.9)	12 (60)
≥41	11 (14.1)	2 (16.7)	8 (17.4)	1 (5)
Hospitals
1	27 (34.6)	5 (41.7)	18 (39.1)	4 (20)
2	23 (29.5)	3 (25)	10 (21.7)	10 (50)
3	28 (35.9)	4 (33.3)	18 (39.2)	6 (30)
Length of work experience at ICU (years)
≤1	17 (21.8)	3 (25)	9 (19.6)	6 (30)
1-5	30 (38.6)	3 (25)	20 (43.5)	7 (35)
>5	30 (38.6)	6 (50)	17 (36.9)	7 (35)

	Physicians	Nurse technicians	Nurses	p value
	(N=12)	(N=46)	(N=20)	p value
Main cause of diarrhea^* * Multiple-answer questions.
Diet	9 (75.0)	41 (89.1)	17 (85.0)	<0.001
Medications	5 (41.7)	12 (26.1)	10 (50.0)	<0.001
Gastrointestinal infection	3 (25.0)	10 (21.7)	3 (15.0)	0.202
Patient-related factors	2 (16.7)	10 (21.7)	2 (10.0)	0.627
Causes of diarrhea associated with diet^* * Multiple-answer questions.
Administration rate	9 (75.0)	35 (76.1)	19 (95.0)	<0.001
Volume	10 (83.3)	29 (63.0)	14 (70.0)	<0.001
Composition	10 (83.3)	23 (50.0)	13 (65.0)	<0.001
Contamination	8 (66.7)	21 (45.6)	17 (85.0)	<0.001
Temperature	5 (41.7)	19 (41.3)	10 (50.0)	<0.001
Other	0	1 (2.2)	0	NA
Action by the professional^* * Multiple-answer questions.
Discontinue the diet	2 (16.7)	7 (15.2)	5 (25.0)	0.311
Maintain diet	4 (33.3)	15 (32.6)	3 (15.0)	0.014
Reduce diet	5 (41.7)	6 (13.0)	2 (10.0)	0.532
Communicate to other professionals	3 (25.0)	29 (63.0)	14 (70.0)	<0.001
Type of record of episodes of diarrhea
No record	2 (16.7)	0	0	NA
Verbal communication	2 (16.7)	2 (4.3)	2 (10.0)	NA
Record without quantification	5 (41.6)	1 (2.2)	0	NA
Record with quantification	3 (25.0)	43 (93.5)	18 (90.0)	<0.001

Associação de Medicina Intensiva Brasileira - AMIB Rua Arminda, 93 - Vila Olímpia, CEP 04545-100 - São Paulo - SP - Brasil, Tel.: (11) 5089-2642 - São Paulo - SP - Brazil
E-mail: rbti.artigos@amib.com.br

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[1] Corresponding author: Cláudia Regina Felicetti Lordani, Serviço de Nutrição do Hospital Universitário do Oeste do Paraná, Avenida Tancredo Neves, 3.224 - Santo Onofre, Zip code: 85806-470 - Cascavel (PR), Brazil, E-mail: clafelicetti@yahoo.com.br