Educational intervention with nursing professionals reduces interruption of enteral nutritional support

Diniz, Aline Oliveira; Meurer, Igor Rosa; Batista, Kely Cristine; Reis, Valesca Nunes dos; Moreira, Ana Paula Boroni; Silva, Silvia Lanziotti Azevedo da

doi:10.1590/1980-220X-REEUSP-2024-0132en

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ORIGINAL ARTICLE • Rev. esc. enferm. USP 58 • 2024 • https://doi.org/10.1590/1980-220X-REEUSP-2024-0132en copy

Educational intervention with nursing professionals reduces interruption of enteral nutritional support^* * Extracted from the thesis: “Análise do suporte nutricional enteral fornecido aos pacientes críticos e não críticos de um hospital universitário antes e após intervenção educativa”, Universidade Federal de Juiz de Fora, 2024.

La intervención educativa con profesionales de enfermería reduce la interrupción del soporte nutricional enteral

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Objective:

To evaluate the impact of educational intervention on the occurrence of factors that interfere with the caloric-protein supply to critical and non-critical patients undergoing enteral nutritional therapy.

Method:

This is an intervention, a field experiment without a control group, carried out in a teaching hospital in Juiz de Fora, Minas Gerais, Brazil. Three training cycles were carried out with nursing professionals over 57 weeks, covering the same content. The data collected were divided into pre-intervention and intervention periods. Interference in caloric-protein support was analyzed based on the evaluation of days with non-conforming nutritional supply and the occurrence of factors that led to non-conformities.

Results:

Following interventions, there was a significant reduction (p < 0.05) in the number of non-conforming and inadequate days (nutritional supply < 80%), the frequency of occurrence of interfering factors and non-conformities caused by failure to follow the vomiting protocol.

Conclusion:

The educational intervention was an effective strategy to increase the quality of the therapy evaluated, especially from the fifth day of enteral nutritional therapy onwards.

DESCRIPTORS
Enteral Nutrition; Energy Intake; Early Intervention; Educational; Nursing

Variable	ENT days	Ppi			Pi
Variable	ENT days	n	%^* *In relation to the 4076 days evaluated, 640 days from D1 to D4 and 3436 on D5+.	Mean ± SD	n	%^ In relation to the 3074 days evaluated, 628 days from D1 to D4 and 2446 on D5+. ENT – Enteral Nutritional Therapy, Ppi – Pre-intervention period, Pi – Intervention period.	Mean ± SD
Total non-conforming days	D1 to D4 and D5+	1220	29.93	5.35 ± 4.50	895	29.12	4.48 ± 4.14
	D1 to D4	255	39.84	1.59 ± 15.81	239	38.06	1.52 ± 1.10
	D5+	965	28.08	4.66 ± 0.95	656	26.82	3.73 ± 4.06
Non-conforming and inadequate days (≤ 80%)	D1 to D4	114	17.81	0.71 ± 1.19	81	12.90	0.52 ± 0.71
Non-conforming and inadequate days (≤ 80%)	D5+	533	15.51	2.57 ± 4.40	354	14.47	2.01 ± 2.51
Non-conforming and adequate days (> 80%)	D1 to D4	141	22.03	0.88 ± 0.90	158	25.16	1.01 ± 0.96
Non-conforming and adequate days (> 80%)	D5+	432	12.57	2.09 ± 2.57	302	12.35	1.72 ± 2.10

Variable	ENT days	Ppi		Pi
Variable	ENT days	n	Mean ± SD	n	Mean ± SD
Number of interference factors	D1 to D4	307	1.92 ± 2.56	286	1.82 ± 1.49
Number of interference factors	D5+	1108	5.33 ± 5.39	727	4.13 ± 4.77

Variable	ENT days	Random effect individual	Fixed effect
Variable	ENT days	Random effect individual	Intercept	Beta 1	SE	p value
Total non-conforming days	D1 to D4 and D5+	4.85	17.68	–2.63	1.38	0.06
	D1 to D4	0.00	0.00	0.00	0.00	1
	D5+	5.12	16.31	–4.40	1.41	0.00
Non-conforming and inadequate days (=80%)	D1 to D4	0.05	0.71	–0.19	0.09	0.03
Non-conforming and inadequate days (=80%)	D5+	0.75	2.55	–0.55	0.25	0.02
Non-conforming and adequate days (>80%)	D1 to D4	0.12	0.88	0.12	0.10	0.24
Non-conforming and adequate days (>80%)	D5+	0.80	2.04	–0.36	0.22	0.11
Number of interference factors	D1 to D4	0.00	1.91	–0.09	0.18	0.59
Number of interference factors	D5+	1.55	5.27	–1.16	0.50	0.02

Interference factors	ENT days	Attendances that suffered interference		McNamar	p value
Interference factors	ENT days	Ppi^* *Total of 160 attendances in D1 to D4 and 207 in D5+.	Pi**	McNamar	p value
At medical discretion	D1 to D4	15 (9.4%)	9 (5.7%)	0.01	1.00
At medical discretion	D5+	33 (15.9%)	25 (14.2%)	0.25	0.61
GIT complications	D1 to D4	14 (8.8%)	15 (9.5%)	0.01	1.00
GIT complications	D5+	65 (31.4%)	42 (23.9%)	1.04	0.30
Catheter obstruction	D1 to D4	5 (3.1%)	3 (1.9%)	0.8	0.37
Catheter obstruction	D5+	33 (15.9%)	14 (7.9%)	3.55	0.06
Externalization of the catheter	D1 to D4	21 (13.1%)	21 (13.4%)	0.01	1.00
Externalization of the catheter	D5+	63 (30.4%)	55 (31.2%)	0.40	0.52
Clinical complication	D1 to D4	8 (5.0%)	10 (6.4%)	0.01	1.00
Clinical complication	D5+	51 (24.6%)	31 (17.6%)	1.76	0.18
Fasting	D1 to D4	38 (23.7%)	37 (23.6%)	0.37	0.54
Fasting	D5+	121 (58.4%)	87 (49.5%)	1.29	0.25
Failure to execute the prescription	D1 to D4	79 (49.4%)	79 (50.3%)	0.01	1.00
Failure to execute the prescription	D5+	112 (54.1%)	84 (47.7%)	0.79	0.37
Failure to follow the vomiting protocol	D1 to D4	12 (7.5%)	8 (5.0%)	0.30	0.57
Failure to follow the vomiting protocol	D5+	38 (18.4%)	13 (7.4%)	5.93	0.01
Others	D1 to D4	1 (0.6%)	1 (0.7%)	0.01	1.00
Others	D5+	5 (2.4%)	2 (1.1%)	0.01	1.00
Indeterminate	D1 to D4	7 (4.4%)	7 (4.4%)	0.01	1.00
Indeterminate	D5+	14 (6.8%)	12 (6.8%)	0.01	1.00

Universidade de São Paulo, Escola de Enfermagem Av. Dr. Enéas de Carvalho Aguiar, 419 , 05403-000 São Paulo - SP/ Brasil, Tel./Fax: (55 11) 3061-7553, - São Paulo - SP - Brazil
E-mail: reeusp@usp.br

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[1] Corresponding author: Silvia Lanziotti Azevedo da Silva, Av. Eugênio do Nascimento, s/n, Dom Bosco, 36038-330 – Juiz de Fora, MG, Brazil, silviafisiojf@yahoo.com.br