Short survey for critical care RNs, NPs, & PAs

[cruisin_woodward]

Hello, I am requesting assistance from critical care RNs, NPs, and PAs who would be willing to spend a few minutes answering a 12 question survey regarding enteral nutritional therapy in the critically ill intubated patient. I am a BSN-DNP student. This is simply for a class, and to determine if this is an area that is worthy of becoming my clinical inquiry project. The survey is completely confidential, and will not be published. Please download the survey, fill it out, and then send it to my inbox here, or email it to [email protected].

Your assistance is greatly appreciated, along with any additional comments (or resources) that you may have.

PICO Question: In critically ill mechanically ventilated adults receiving temporary enteral feedings, does the implementation of a nurse driven enteral nutritional therapy assessment protocol reduce the risk of hypocaloric intake compared with current practice?

Survey questions regarding mechanically ventilated critically ill adults receiving temporary enteral nutritional therapy (applies to intensive care registered nurses, nurse practitioners, or physician assistants): Select all that apply

RN________ NP_________ PA_________ OTHER (Please specify)_____________________________

Current level of education:

ADN

BSN

MSN

DNP

PhD

BSN/MSN/DNP/PhD student (please specify)

Other______________________________________

Years in the intensive care

a. less than 5 years

b. 5-10 years

c. 10-15 years

d. more than 15 years

1.) Does your intensive care unit have a specific guideline or protocol regarding enteral nutritional therapy in critically ill mechanically ventilated adults?

a. Yes and it is clear, concise, and easy to understand

b. Yes, but I don't quite understand it

c. No

d. Not sure

2.) In your practice, do you routinely insert a nasal or oral gastric tube in the critically ill mechanically ventilated patient?

a. Always nasal

b. Always oral gastric

c. Whichever is easier

d. The purpose of the tube drives my decision (for the purposes of draining or feeding)

e. Other_________________________________________

3.) In your facility, for the purpose of temporary enteral nutritional therapy, what type of feeding tube is most often initiated?

a. Salem Sump (gastric)

b. Other Gastric______________________________________

c. Post pyloric (Nasojejunal : NJ tube)

d. Not sure

e. Other___________________________________________

4.) After enteral nutritional therapy has been ordered, what assessment criteria drives your decision that the critically ill mechanically ventilated patient is ready for enteral nutritional therapy to be initiated?

a) Bowel sounds auscultated in all four quadrants

b) Lack of abdominal distention

c) Patient has been intubated for more than 72 hours

d) The therapy has been ordered so there is no other criteria necessary

e) Other_________________________________________

5.) What rate do you currently initiate your enteral nutritional therapy in the critically ill mechanically ventilated patient?

a. 10 milliliters an hour and advance to goal as tolerated

b. 20 milliliters an hour and advance to goal as tolerated

c. Bolus feedings

d. I start my feedings at the goal rate

e. Other (please describe)___________________________

6.) What monitoring criteria do you employ when caring for a patient receiving enteral nutrition therapy?

a. Gastric residual volumes

b. Promotility agents

c. Patient positioning

d. All of the above

e. Other_______________________________________________

7.) What assessment criterion currently drives your decision that the patient will tolerate an increased rate of enteral nutrition therapy

a. Bowel sounds auscultated in all four quadrants

b. Lack of nausea and or vomiting

c. Lack of diarrhea

d. Gastric residual volumes

e. Other______________________________

8.) After initiation of enteral nutritional therapy, how often do you assess gastric residual volumes?

a. Every hour if residuals remain high

b. Every four hours

c. Every eight hours

d. Once a shift

e. Other_____________________________________

9.) What amount of gastric residual volumes would you consider acceptable to advance your feeding rate?

a. There should be no gastric residual volume

b. 10% of amount of feeding instilled

c. 20% of amount of feeding instilled

d. I do not use gastric residual volumes as an assessment criteria to determine patient tolerance to enteral nutritional therapy

e. Other____________________________________________

10.) When assessing gastric residual volumes, what amount would you consider "High volumes" which would cause you to "hold" the patient's feedings.

a. Greater than 50% of the amount of feeding instilled

b. Greater than 250 cc in a four hour period regardless of the rate

c. Greater than 500 cc in a four hour period regardless of the rate

d. Greater than 100 cc in an hour regardless of the rate

e. Other _______________________________

11.) When assessing gastric residual volumes, how much do you consider an acceptable amount to return to the patient?

a. I discard all gastric contents

b. I return all gastric contents

c. I return only 250 cc of gastric contents

d. I return only 500 cc of gastric contents

e. Other____________________________________________

12.) How often do you flush your feeding tubes?

a. 60 cc every 2 hours

b. 60 cc every 4 hours

c. 60 cc every 6 hours

d. After administering medications

e. Other________________________________________________

Please feel free to add additional comments:

[tryingtohaveitall]

I was going to answer but you only want responses from those who care for adults, correct?

[linearthinker, DNP, RN]

Do you want us to answer even if those decisions are not up to us? I would have to get a physician order to do any of those things. I have never worked anywhere that gave me the autonomy to make treatment decisions for the patients.

[cruisin_woodward]

Hello

Yes, thank you adults are what I am interested in, and yes, I'd love you to answer even if it is an order that is necessary to determine your practice, just indicate that . Thanks so much!

[ms_sheesh]

Survey questions regarding mechanically ventilated critically ill adults receiving temporary enteral nutritional therapy (applies to intensive care registered nurses, nurse practitioners, or physician assistants): Select all that apply

RN_____X___ NP_________ PA_________ OTHER (Please specify)_____________________________

Current level of education:

ADN

BSN

MSN

DNP

PhD

BSN/MSN/DNP/PhD student (please specify)

Other_________MSN Student_____________________________

Years in the intensive care

a. less than 5 years

b. 5-10 years

c. 10-15 years

d. more than 15 years

1.) Does your intensive care unit have a specific guideline or protocol regarding enteral nutritional therapy in critically ill mechanically ventilated adults?

a. Yes and it is clear, concise, and easy to understand

b. Yes, but I don't quite understand it

c. No

d. Not sure

2.) In your practice, do you routinely insert a nasal or oral gastric tube in the critically ill mechanically ventilated patient?

a. Always nasal

b. Always oral gastric

c. Whichever is easier

d. The purpose of the tube drives my decision (for the purposes of draining or feeding)

e. Other_________________________________________

3.) In your facility, for the purpose of temporary enteral nutritional therapy, what type of feeding tube is most often initiated?

a. Salem Sump (gastric)

b. Other Gastric______________________________________

c. Post pyloric (Nasojejunal : NJ tube)

d. Not sure

e. Other___________________________________________

4.) After enteral nutritional therapy has been ordered, what assessment criteria drives your decision that the critically ill mechanically ventilated patient is ready for enteral nutritional therapy to be initiated?

a) Bowel sounds auscultated in all four quadrants

b) Lack of abdominal distention

c) Patient has been intubated for more than 72 hours

d) The therapy has been ordered so there is no other criteria necessary

e) Other_All of the above________________________________________

5.) What rate do you currently initiate your enteral nutritional therapy in the critically ill mechanically ventilated patient?

a. 10 milliliters an hour and advance to goal as tolerated

b. 20 milliliters an hour and advance to goal as tolerated

c. Bolus feedings

d. I start my feedings at the goal rate

e. Other (please describe)___________________________

6.) What monitoring criteria do you employ when caring for a patient receiving enteral nutrition therapy?

a. Gastric residual volumes

b. Promotility agents

c. Patient positioning

d. All of the above

e. Other_____________________________________________ __

7.) What assessment criterion currently drives your decision that the patient will tolerate an increased rate of enteral nutrition therapy

a. Bowel sounds auscultated in all four quadrants

b. Lack of nausea and or vomiting

c. Lack of diarrhea

d. Gastric residual volumes

e. Other______________________________

8.) After initiation of enteral nutritional therapy, how often do you assess gastric residual volumes?

a. Every hour if residuals remain high

b. Every four hours

c. Every eight hours

d. Once a shift

e. Other_____________________________________

9.) What amount of gastric residual volumes would you consider acceptable to advance your feeding rate?

a. There should be no gastric residual volume

b. 10% of amount of feeding instilled

c. 20% of amount of feeding instilled

d. I do not use gastric residual volumes as an assessment criteria to determine patient tolerance to enteral nutritional therapy

e. Other____________________________________________

10.) When assessing gastric residual volumes, what amount would you consider "High volumes" which would cause you to "hold" the patient's feedings.

a. Greater than 50% of the amount of feeding instilled

b. Greater than 250 cc in a four hour period regardless of the rate

c. Greater than 500 cc in a four hour period regardless of the rate

d. Greater than 100 cc in an hour regardless of the rate

e. Other _______________________________

11.) When assessing gastric residual volumes, how much do you consider an acceptable amount to return to the patient?

a. I discard all gastric contents

b. I return all gastric contents

c. I return only 250 cc of gastric contents

d. I return only 500 cc of gastric contents

e. Other____________________________________________

12.) How often do you flush your feeding tubes?

a. 60 cc every 2 hours

b. 60 cc every 4 hours

c. 60 cc every 6 hours

d. After administering medications

e. Other_______120 cc/per shift______________________________________