Evaluating knowledge, Attitudes, and Practices Regarding Interruption of Enteral Nutrition in ICU Medical staff:A descriptive cross-sectional survey

doi:10.21203/rs.3.rs-2963178/v1

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Evaluating knowledge, Attitudes, and Practices Regarding Interruption of Enteral Nutrition in ICU Medical staff:A descriptive cross-sectional survey

https://doi.org/10.21203/rs.3.rs-2963178/v1

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Objectives: Investigate the status of knowledge, attitude, and practice(KAPs) on Interruption of enteral feeding among ICU medical staff, and explore influencing factors of KAPs score.

Design: questionnaires including general information as well as knowledge, attitude, and practice(KAPs) on Interruption of enteral feeding were distributed in November 2021 to 575 ICU medical staff. t-test and logistic and linear regressions were used to assess Status of interruption of enteral feeding and relevant influencing factors.

Setting: Hospitals in Hubei Province(n =14).

Participants: A total of 575 ICU medical staff including: nurses(n =401); doctors(n =153); all staff responded and 554 were included in the analysis.

Results: of the 554 participating ICU medical staff, the median score in knowledge, attitude and practice was 55(47, 60), 50(44, 50) ,73(67, 80),respectively. Having an advanced degree((bachelor's degree or above,p=0.007), the high grade hospital(Class III A, p =0.020), undertaking a more comprehensive training(Learned but not comprehensive,p=0.037;systematic learning, p <0.001), Main learning approaches(Books and Internet; p =0.029), the frequency in academic journals(often, p =0.005) was the contributing factor to score of total KAPs; undertaking a comprehensive the training(Systematic learning, p <0.001), High frequency in Academic journals(sometimes, p=0.008; often, p<0.001; always, p =0.032) was the contributing factor to score of knowledge dimension; Having an advanced degree(bachelor's degree or above, p =0.004) was the socre of attitude dimension; Having an Advanced degree(bachelor's degree or above, p =0.026) and undertaking a comprehensive the training(systematic learning, p =0.013) was the contributing factor to score of parctice dimension; There was a significant positive correlation between the total score and score of knowledge, attitude and practice (p <0.05).

Conclusions: Based on the findings, the hospital management department should formulate targeted training programs to further improve the level of enteral nutrition interruption among ICU medical staff.

ICU medical staff

Enternal nutrition interruption

Influencing factors

Enteral nutrition is a method of providing nutrients needed to maintain human metabolism through mouth or feeding tube. It is an important measure of nutritional support treatment for critically ill patients[1]. Enteral nutrition conforms to the physiological functions of the intestine, and can help patients regulate the intestinal microecology, protect the intestinal mucosal barrier, reduce enteric-borne infection, enhance immune function and promote intestinal peristalsis[2]. The 2016 ASPEN (American society for Parenteral and Enteral Nutrition) suggested that enteral nutrition should be the first choice for adult critically ill patients[3]. Early enteral nutrition support for severe patients can improve their nutritional status, maintain the integrity as well as function of intestinal mucosal structure, and promote disease recovery. In 2019, The European Society of Clinical Nutrition and Metabolism guidelines clearly stated that continuous infusion of enteral nutrition support is recommended for critically ill patients and should not be interrupted at will[4].

However, in the clinical practice of ICU, due to various reasons, interruption of enteral nutrition is of frequent occurrence in critically ill patients at home and abroad. According to the Relevant Data, the interruption of enteral nutrition suffered by ICU patients was about 54% − 84%, and the interruption of enteral nutrition accounts for about 38% − 100% of the hospitalization period of ICU[5].

In intensive care unit, patients' inadequate enteral feeding is caused by multiple factors, The interruption of enteral nutrition caused by routine fasting and examination will aggravate this situation[6–7]. Salciute-Simene [8]shows that 68% of patients experienced interruption of enteral nutrition during ICU hospitalization, The main causes were hemodynamic instability (20%), high gastric residual volume (17%), tracheotomy (16%) or other surgical intervention (16%). Interruption of enteral nutrition can lead to insufficient nutritional intake in critically ill patients, and the body can not meet the needs of calories, which is not conducive to the prognosis of disease[9]. In severely patients, nutrition interruption will reduce their total energy intake by at least 10%[10]. In addition, disruption of enteral nutrition further increases the risk of underfeeding in ICU patients.

Basic knowledge, positive attitude, and correct practice are necessary to improve the quality and safety of nursing care in Enteral nutrition support for critically ill patients. As an important participant in the enteral nutrition of patients, medical staff play a key role in the process of enteral nutrition. Only by mastering the relevant knowledge of enteral nutrition, understanding the impact of enteral nutrition on clinical outcomes, and reducing the feeding interruption caused by avoidable human factors, can medical staff improve the nutritional status of severe patients. A few investigations have been performed on knowledge, attitude and practice of enteral nutrition interruption among medical staff in ICU. A domestic survey[11] of the knowledge, attitude and practice of feeding interruption among ICU nurses showed that ICU nurses had a high attitude score on the interruption of enteral nutrition (the score of attitude dimension was above the middle level, accounting for 93.9%), but the relevant knowledge was relatively lacking. Most ICU nurses had no awareness of active learning and poor executive ability. Among them, self-efficacy plays an intermediary role between attitude and behavior.

In these investigations of ICU care, it found that most enteral nutrition interruption is a predictable event, and researchers can take targeted measures to improve the status of enteral nutrition according to relevant factors. However, there are few studies on the analysis of the influencing factors of the knowledge and practice investigation of enteral nutrition interruption among health care workers. Based on the previous study results, the objective of this study was to conduct a survey on the knowledge, attitude and practice of interruption of enteral nutrition status in ICU medical staff, understand the status quo of the knowledge, attitude and practice of the enteral nutrition interruption in ICU medical staff, analyze the influencing factors and provide a reference point for clinical managers to develop targeted training programs.

2.1. Samples and setting

A multicentre cross-sectional study was performed from October 2021 to November 2021 with a random sampling approach in 14 hospitals in Wuhan city, Hubei province, China. Based on previous results of 40 samples nurses in ICU, Standard deviation(σ) was 15.84, standard error(δ) was 2.51, According to bilateral inspection, α Set to 0.05, confidence level(1- α) Set to 0.95, µ Set to 1.96. considerating 20% of the ineffectiveness of the questionnaire for various reasons, the required sample size was at least 193. A total of 575 questionnaires were distributed by WeChat scanning, and 575 were recovered, with a recovery rate of 100%.

All participants met the following inclusion criteria:(1).Age > 18 years old; (2).Have the qualification of medical practitioner or nurse practitioner; (3).Medical staff working in the ICU;(4).Can correctly understand the meaning of each item of the questionnaire;(5).Informed consent and willingness to participate in this study. Medical staff who did not accept to participate or who do not sign the informed consent were excluded.

2.2. Data collection tools

2.2.1. General information questionnaire

Customised by researchers, including age, gender, job position, positional titles, years of work experience in ICU, educational background, ICU class, type of hospital and other items.

2.2.2. Knowledge, attitude and practice questionnaire for Interruption of enteral nutrition

This scale was developed by Mi et al and published in the chinese language. It contains 41 items in total including three dimensions of knowledge, attitude, practice, among which, 14 items in knowledge dimension, 10 items in attitude dimension and 17 items in practice dimension. A Likert scale was used for each item, and the score ranged from 1 to 5. The score range of the three dimensions is 14–70 points, 10–50 points and 17–85 points respectively. The higher the score, the higher the ICU medical staff’s knowledge, attitude and practice about interruption of enteral nutrition. The Cronbach’s α coefficient, reliability and validity of the questionnaire were 0.953, 0.795 and 0.975, respectively.

2.3. Data collection procedure

Entering the questionnaire including the general data questionnaire and scale content and generating a link to the questionnaire.The research team first contacted the nursing departments of 14 grade A hospitals, and after obtaining consent, asked the ICU nursing managers of the hospitals to coordinate the nurses in the department to participate in the survey. Participation in the survey was voluntary. After obtaining informed consent from the staff, the research team issued questionnaires through the Questionnaire Star platform. The questionnaire uses unified guiding language to introduce the significance, filling method and precautions of the survey to the respondents. To ensure the authenticity and validity of the survey results, the questionnaire star background will limit the number of mobile phone answers to one to avoid repeated answers. The answer cycle of the questionnaire is 2 weeks, and the answer channel will be automatically closed after 2 weeks. Two researchers independently exported the results into Microsoft Excel format, checked them and imported them into the SPSS software.

2.4. Data analysis

The data were analysed using SPSS 21.0. Descriptive statistics were used to summarize the data. The measurement data were described by means and standard deviations, and the counting data were described by frequency and percentage. The F test or t-test was used to analyse differences between groups. The measurement data subject to normal distribution were expressed as the difference in mean(± SD), and the differences between groups were compared using a t-test. Multiple linear regression analysis was used to analyse related factors. Differences were considered statistically significant when p < 0.05.

3.1. Sample Characteristics

A total of 575 ICU nurses were investigated in this study, and 554 valid questionnaires were available, with the effective rate of 96.35%. In the included questionnaires, there were 182 male ICU Medical staff, 368 female ICU Medical staff, including 153 doctors and 401 nurses. The Median age of participants was 31 (28–37) years, and age range was 21–64 years. Among questionnaire results, 50.72% of participants were Primary professional title, 32.85% were Intermediate professional title, and 16.43% were Senior professional title. In addition, 345 people have worked for more than 5 years, accounting for 62.27%; A total of 493 persons with bachelor's degree or above, accounting for 88.00%; 83.21% of the subjects were from comprehensive ICU. For medical staff general information (Table 1).

3.2. Scores of each dimension of the questionnaire

The total score of 544 questionnaires included in this study was 205,and the median of total score was 174(161–187). The scores of knowledge, attitude, and practice on Interruption of enteral nutrition feeding were 70, 50, 85, the the median of each dimension was 55(47–60), 50(44–50), 73(67–80), respectively.

3.3. Factors related to Interruption of enteral nutrition in ICU medical staff

Analysis of variance or t-test showed that the overall scores of Interruption of enteral nutrition for ICU medical staff, and the score of knowledge as well as practice dimension differed significantly among age, positional title, work experience, education level, hospital level, nutrition team member, received training, Main learning path, frequency rate in academic journals(P < 0.05)(Table 1).

Table 1

Investigation on the status of knowledge, attitude and practice of enteral nutrition interruption among medical staff in ICU(N = 554)
variable	Numbers(%)	Total score	Knowledge dimension	Belief dimension	Behavioral dimension
Gender		P = 0.848^#	P = 0.601^#	P = 0.155^#	P = 0.655^#
Female	186(33.57)	173.5(161.8,187.0)	54.5(47.0,59.0)	49.0(44.0,50.0)	73.5(68.0,80.0)
Male	368(66.43)	174.0(161.0,187.8)	55.0(47.0,60.8)	50.0(45.0,50.0)	73.0(67.0,80.0)
Age(years)		P = < 0.001^*	P = < 0.001^*	P = < 0.001^*	P= <0.001^*
≤ 25	60(10.83)	167.0(155.3,188.5)	53.5(46.0,58.0)	48.0(40.0,50.0)	71.5(65.5,80.0)
26–30	183(33.03)	169.0(155.0,183.0)	52.0(42.0,58.0)	49.0(40.0,50.0)	72.0(65.0,79.0)
31–35	140(25.27)	174.0(161.0,185.0)	53.0(47.0,58.8)	50.0(47.0,50.0)	73.0(67.0,80.0)
36–40	92(16.61)	178.0(168.3,188.0)	56.0(50.0,62.0)	50.0(48.0,50.0)	75.0(68.3,80.0)
༞40	79(14.26)	184.0(173.0,191.0)	58.0(54.0,63.0)	50.0(48.0,50.0)	76.0(72.0,82.0)
Post		P = 0.652^#	P = 0.458^#	P = 0.026^#	P = 0.374^#
Doctor	153(27.62)	172.0(162.5,186.0)	54.0(48.0,59.0)	50.0(47.0,50.0)	72.0(66.5,79.0)
Nurse	401(72.38)	175.0(161.0,187.5)	55.0(47.0,60.0)	49.0(43.5,50.0)	74.0(67.0,80.0)
Positional title		P <0.001^*	P = 0.001^*	P = 0.002^*	P = 0.004^*
Primary	281(50.72)	171.0(157.0,187.0)	54.0(43.0,59.0)	49.0(41.0,50.0)	73.0(66.0,80.0)
Intermediate	182(32.85)	173.5(160.0,185.0)	54.0(47.0,59.0)	50.0(46.0,50.0)	72.5(66.8,79.3)
Senior	91(16.43)	183.0(173.0,191.0)	58.0(52.0,63.0)	50.0(48.0,50.0)	76.0(72.0,81.0)
Years in practice		P < 0.001^*	P <0.001^*	P = 0.008^*	P = 0.024^*
≤ 5	209(37.73)	170.0(155.0,185.5)	53.0(42.0,58.0)	49.0(40.5,50.0)	73.0(66.5,80.0)
6–10	186(33.57)	172.0(160.0,185.0)	53.0(47.0,59.0)	49.5(44.8,50.0)	73.0(66.0,79.0)
༞10	159(28.70)	182.0(170.0,191.0)	57.0(52.0,63.0)	50.0(48.0,50.0)	75.0(69.0,81.0)
Educational		P < 0.001^#	P = 0.007^#	P < 0.001^#	P = 0.001^#
Below undergraduate	61(11.01)	164.0(150.0,174.5)	51.0(42.0,56.0)	46.0(40.0,50.0)	69.0(63.0,75.5)
Bachelor degree or above	493(88.99)	176.0(162.5,188.0)	55.0(48.0,61.0)	50.0(46.0,50.0)	74.0(68.0,80.0)
ICU category		P = 0.813^#	P = 0.744^#	P = 0.260^#	P = 0.601^#
Comprehensive ICU	461(83.21)	174.0(162.0,186.5)	55.0(48.0,59.0)	50.0(45.0,50.0)	73.0(67.0,80.0)
Other specialized ICUs	93(16.79)	174.0(152.5,190.00)	55.0(42.0,61.50)	50.0(40.0,50.0)	74.0(67.0,82.0)
Hospital level		P = 0.001^#	P = 0.008^#	P = 0.350^#	P = 0.001^#
Grade III Grade A	449(81.05)	175.0(162.5,188.0)	55.0(48.0,61.0)	50.0(45.0,50.0)	74.0(68.0,80.0)
Grade III Grade B	105(18.95)	169.0(155.0,183.0)	52.0(43.0,57.0)	49.0(42.5,50.0)	70.0(64.5,78.0
Nutrition team member		P < 0.001^#	P < 0.001^#	P = 0.349^#	P < 0.001^#
Yes	162(29.24)	179.0(166.8,193.0)	56.0(50.0,63.0)	50.0(47.0,50.0)	75.0(68.0,82.0)
No	392(70.76)	172.0(159.0,185.0)	54.0(45.3,58.0)	49.0(44.0,50.0)	73.0(67.0,79.0)
Received training		P < 0.001^*	P < 0.001^*	P = 0.349^*	P < 0.001^*
Systematic learning	89(16.07)	190.0(172.5,197.5)	61.0(56.0,67.0)	50.0(44.0,50.0)	80.0(71.0,83.0)
Little	381(68.77)	174.0(162.5,186.0)	54.0(48.0,59.0)	50.0(45.0,50.0)	73.0(67.0,79.0)
Never	84(15.16)	162.5(148.3,176.0)	47.5(39.3,53.8)	49.0(42.3,50.0)	70.5(62.5,76.0)
Learning approaches		P < 0.001^*	P < 0.001^*	P < 0.001^*	P = 0.019^*
School	9(1.62)	144.0(122.0,162.0)	42.0(32.5,51.0)	44.0(39.5,49.0)	52.0(41.0,72.5)
Hospital/lecture	362(65.34)	172.0(159.0,187.0)	54.0(45.0,59.0)	49.0(42.0,50.0)	73.0(67.0,80.0)
Acdemic conferences	108(19.50)	179.0(167.0,189.8)	56.0(51.3,63.0)	50.0(48.0,50.0)	74.0(68.0,80.0)
Books or online	75(13.54)	179.0(162.0,186.0)	54.0(48.0,61.0)	50.0(47.0,50.0)	75.0(68.0,79.0)
Frequency rate in academic journals		P < 0.001^*	P < 0.001^*	P = 0.024^*	P < 0.001^*
Never	32(5.78)	160.5(146.3,178.0)	49.5(42.0,52.8)	50.0(40.5,50.0)	66.0(57.3,75.8)
Little	215(38.81)	169.0(153.0,181.0)	51.0(42.0,56.0)	49.0(43.0,50.0)	71.0(65.0,77.0)
Sometimes	228(41.16)	176.0(163.3,188.8)	55.0(49.3,60.8)	50.0(45.0,50.0)	74.5(68.0,80.0)
Usually	71(12.81)	189.0(175.0,199.0)	61.0(56.0,67.0)	50.0(48.0,50.0)	80.0(73.0,83.0)
Always	8(1.44)	197.500(181.0,202.0)	67.5(63.0,68.0)	50.0(49.0,50.0)	85.0(78.5,85.0)
^#t-test; ^*analysis of variance

3.4. Analysis of multiple factors associated with Interruption of enteral nutrition in ICU medical staff

Multiple linear regression analysis performed in our research. The variables with P < 0.10 in the results of the univariate analysis were included as independent variables, and the score of the level of ICU medical staff was included as independent variables to explore the influencing factors of knowledge, attitude and practice scores of ICU medical staff

3.4.1. Logistic regression analysis of factors influencing total socre

The median of the total score of knowledge, attitude, practice in ICU medical staff on interruption of enteral nutrition was taken as the cutoff value, and the total score of knowledge, attitude, practice of the respondents was divided into two categories:low score(= 0) and high score (= 1), with which as the dependent variable. After the single factor analysis, the variables with P < 0.10 were considered the independent variables, and were substituted into the logistic regression model. Result suggested that having an advanced education (bachelor's degree or above: OR = 2.477,95%CI: 1.286 ~ 4.770, P = 0.007); Hospital level (Grade III, Grade A: OR = 1.781,95%CI: 1.095 ~ 2.895, P = 0.020); undertaking more comprehensive of relevant training (learned but not comprehensive: OR = 1.922,95%CI: 1.041–3.551, P = 0.037; Systematic learning: OR = 4.765,95%CI: 2.164–10.491, P < 0.001); The understanding frequency of academic journals (often:OR = 4.432,95%CI: 1.565–12.554, P = 0.005) was the promoting factor of the high total score of learning. In terms of the main learning channels, compared with school learning, books and the Internet were the promoting factors of the high total score of KAPs. (Table 2).

Table 2

Logistic Regression Analysis Results of the Total Knowledge, Attitude and Practice Score of Enteral Nutrition Interruption in ICU Medical Staff(N = 554)
Variable	β value	S.E	P value	OR value (95%CI)
educational background
Below undergraduate				1.0
Bachelor degree or above	0.907	0.334	0.007	2.477(1.286–4.770)
Hospital level
Grade III Grade B				1.0
Grade III Grade A	0.577	0.248	0.020	1.781(1.095–2.895)
received training
Never				1.0
A little	0.654	0.313	0.037	1.922(1.041–3.551)
Systematic learning	1.561	0.403	༜0.001	4.765(2.164–10.491)
Main learning approaches
School				1.0
Hospital/Department Lectures	1.590	1.128	0.159	4.905(0.537–44.762)
Academic conferences	1.974	1.144	0.084	7.202(0.765–67.772)
Books and Internet	2.512	1.152	0.029	12.327(1.290–117.800)
frequency rate in learning from academic journals
Never				1.0
Little	0.245	0.450	0.586	1.278(0.529–3.089)
Sometimes	0.772	0.459	0.092	2.165(0.881–5.319)
Regularly	1.489	0.531	0.005	4.432(1.565–12.554)
Always	21.131	14096.505	0.999	1502972144(0.000~)

3.4.2. Logistic regression analysis of factors influencing Knowledge dimension

The median score of the knowledge dimension score of enteral nutrition interruption among ICU medical staff was taken as the cutoff value, and the knowledge dimension scores of the respondents were divided into two categories: low score (= 0) and high score (= 1), which were taken as the dependent variable. After univariate analysis, the variable with P < 0.10 was taken as the independent variable and replaced in the Logistic regression model. Results show: The more comprehensive the training (systematic learning:OR = 4.818; 95%CI:2.216 ~ 10.479, P < 0.001); In academic journals (sometimes:OR = 4.018,95%CI:1.429 ~ 11.298, P = 0.008; Regular:OR = 22.667,95%CI:6.633 ~ 77.457,P < 0.001;Always:OR = 13.338,95%CI:1.245 ~ 142.959,P = 0.032) was the contributing factor to the high knowledge dimension score (Table 3).

Table 3

Logistic Regression Analysis Results of knowledge Dimension Scores of Enteral Nutrition Interruption in ICU Medical staff(N = 554)
Variable	β value	S.E	P value	OR value (95%CI)
received training
Never				1.0
A little	0.507	0.307	0.098	1.660(0.910–3.028)
Systematic learning	1.572	0.396	< 0.001	4.818(2.216–10.479)
frequency rate in learning from academic journals
Never				1.0
Little	0.715	0.524	0.173	2.044(0.731–5.709)
Sometimes	1.391	0.528	0.008	4.018(1.429–11.298)
Regularly	3.121	0.627	< 0.001	22.667(6.633–77.457)
Always	2.591	1.210	0.032	13.338(1.245-142.959)

3.4.3. Logistic regression analysis of factors influencing Attitude dimension

The median belief dimension score of enteral nutrition interruption was taken as the cutoff, and the belief dimension scores of respondents were divided into low score (= 0) and high score (= 1), which were used as the dependent variable. After univariate analysis, the variable with P < 0.10 was used as the independent variable and replaced into the Logistic regression model. Results show: Advanced education (undergraduate or above: OR = 2.353,95%CI: 1.322 ~ 4.188, P = 0.004) was the contributing factor of the belief dimension score (Table 4).

Table 4

Logistic regression analysis of the attitude dimension score of enteral nutrition disruption in the ICU Medical Staff(N = 554)
Variable	β value	S.E	P value	OR value(95%CI)
educational background
Below undergraduate				1.0
Bachelor degree or above	0.856	0.294	0.004	2.353(1.322–4.188)

3.4.4. Logistic regression analysis of factors influencing Practice dimension

The median score of the enteral behavioral dimension of interrupted nutrition in ICU staff was taken as the cutoff, and the behavioral dimension scores of respondents were divided into low score (= 0) and high score (= 1), which were used as the dependent variable. After univariate analysis, the variable with P < 0.10 was taken as the independent variable and replaced into the Logistic regression model. Having an advanced degree(bachelor's degree or above:OR = 1.996,95%CI: 1.085–3.672, P = 0.026); undertaking a more comprehensive training (systematic learning:OR = 2.481,95%CI: 1.207–5.097, P = 0.013) was the contributing factor to the high behavioral dimension score; Compared with the junior title, having a senior title (OR = 1.734,95%CI: 1.010–2.977, P = 0.046) was the promoting factor of the high behavioral dimension score of ICU medical staff; taking the behavior of nerver knowing academic journals as a reference, frequent understanding of academic journals(often: OR = 3.544,95%CI: 1.324–9.484, P = 0.012) were the promoting factors of the high behavioral dimension score of ICU medical staff (Table 5).

Table 5

Logstic Regression Analysis Results of Behavior Dimension Scores of Enteral Nutrition Interruption in ICU(N = 554)
Variable	β value	S.E	P value	OR value(95%CI)
positional titles
Primary				1.0
Intermediate	-0.175	0.208	0.401	0.840(0.559–1.262)
Senior	0.550	0.276	0.046	1.734(1.010–2.977)
educational background
Below undergraduate				1.0
Bachelor degree or above	0.691	0.311	0.026	1.996(1.085–3.672)
Received training
Never				1.0
A little	0.373	0.282	0.186	1.452(0.835–2.526)
Systematic learning	0.909	0.367	0.013	2.481(1.207–5.097)
frequency rate in academic journals
Never				1.0
Little	0.185	0.423	0.662	1.203(0.525–2.755)
Sometimes	0.661	0.434	0.128	1.937(0.827–4.536)
Regularly	1.265	0.502	0.012	3.544(1.324–9.484)
Always	1.952	1.169	0.095	7.041(0.712–69.634)

3.5 Correlation analysis between the scores of knowledge, attitude, practice level of ICU medical staff and the score of each dimension

Spearman correlation analysis showed that the correlation coefficient value between the total score and the knowledge dimension score was 0.852, with the belief dimension score was 0.625, with the correlation coefficient value between the behavioral dimension scores was 0.859, The correlation coefficient value between the knowledge dimension score and the attitude dimension score was 0.405. The value of the correlation coefficient between it and the behavioral dimension score was 0.517. The correlation coefficient value between attitude, practice dimension score was 0.463. It indicated a significant positive correlation between score of total, knowledge, attitude, and practice dimension (Table 6)

Table 6

The score of knowledge, attitude, practice level of ICU medical staff and the score of each dimension(N = 554)
Variable	Knowledge dimension	Attitude dimension	practice dimension	Total score
Knowledge	1.0
Attitude	0.405 **	1.0
Behavioral	0.517 **	0.463 **	1.0
Total score	0.852 **	0.625 **	0.849 **	1.0
Notes. N = 191 including Sample 1 and Sample 2; Pearson-Correlations; ** p < 0.001,

4.1. The status of KAPs of Interruption of enteral nutrition in ICU medical staff

Our findings showed that the general level of knowledge, attitude, practice of ICU medical staff at a relatively high level, the median total score for enteral nutrition interruption in ICU staff was 174 (quartiles: 161 to 187),but there is still room for further improvement. Enteral nutrition is one of the most important means of life support in ICU patients, the ways in reasonable, scientific and continuous support for enteral nutrition support in severe patients is an important problems faced by ICU medical staff. As the main nutrition support for critically ill patients, enteral nutrition can better protect the gastrointestinal mucosal barrier, regulate immune function and promote gastrointestinal peristalsis. Additionally, the higher frequency of enteral nutrition interruption will further lead to the deterioration of nutritional status of critically ill patients.Therefore, it is one of the key development directions of future nursing to popularize the knowledge level of enteral nutrition interruption in acute and critical departments and reduce the frequency of enteral nutrition interruption.

In terms of knowledge dimension, the median score for the enteral nutrition interruption was 55 (quartile: 47 to 60), which at the upper middle level of the total score. Among them, the cognition of the definition of enteral nutrition interruption was generally at a low level, while the cognitive level of the measures of preventing enteral nutrition interruption was higher. This result showed that the medical staff cannot correctly and clearly recognize and find the phenomenon of enteral nutrition interruption in clinical work. Results of one research showed[12] that The higher the frequency of enteral nutrition interruption, the worse the disease prognosis, and the higher the risk of malnutrition. Enteral nutrition, as the main means of nutritional support for critically ill patients,the continuous and stable enteral nutritional feeding pattern can directly affect the patient's disease prognosis, length of stay and the probability of feeding complications. Therefore, health care workers should further enhance their awareness of enteral nutrition interruption, avoid and early detection of enteral nutrition interruption, take measures and reduce the feeding deficiency caused by enteral nutrition interruption.

The median attitude dimension score of enteral nutrition interruption was 50 (quartile: 44–50), which at a high level, indicating that the attitude of ICU health care workers towards enteral nutrition interruption was positive. The attitude in Interruption of enteral nutrition are related to avoidance, early detection, early intervention in Interruption of enteral nutrition. The results also showed that the attitude to feeding interruption was positively correlated with the behavior of enteral nutrition interruption, which can positively affect the relevant behaviors of health care workers. Therefore, the positive attitude of the medical staff on the enteral nutrition interruption is extremely important. the lowest score of the item “the prevention of enteral nutrition interruption was more important than the treatment”, which indicated that the attitude of medical staff towards the prevention of enteral nutrition interruption needs to be improved, and the heads of relevant departments should strengthen the education of the attitude of medical staff.

The median score for enteral nutrition disruption was 73 (quartile: 67–80), which above the average. In behavioral dimension, the worst execution was the item “I will take the initiative to learn enteral nutrition interruption knowledge”, which with the median score of 4 (quartiles: 3–4), showed that severe health care workers lack of consciousness, can not be better use of spare time to retrieve and learn to master relevant professional knowledge. along the intervention treatment, the main factors affecting the results include professional title and understanding the frequency of consulting academic journals. The level of enteral nutrition interruption behavior of people with higher professional titles at a relatively high level, However, the change level of professional titles and score at a relatively moderate, which may be related to the accumulated clinical experience of the working years and the business learning of daily departments. It is like the conclusion of Yu et al Research[13]. The survey subjects of this study were all ICU medical staff from tertiary hospitals. In addition to undertaking clinical diagnosis and treatment tasks, tertiary hospitals often undertake a large many scientific studies, talent training, university teaching and other tasks, Facing the pressure of clinical practice, scientific research and teaching. To prevent the occurrence of enteral nutrition interruption events effectively, Clinical medical staff need to constantly learn the knowledge related with nutrition and technology of knowledge and diagnosis[14].

4.2. Analysis of the factors affecting enteral nutrition interruption in ICU medical staff

The results of this study showed that having received nutrition-related training and the frequency of knowledge in academic journals were the main factors affecting the knowledge dimension scores of enteral nutrition interruption in ICU healthcare staff. The more comprehensive and frequent the ICU staff were trained on enteral nutrition, the higher the level of knowledge of enteral nutrition interruption in the ICU. The reason may be that the severe patients themselves are in critical condition, This means they having a long course of disease, their body suffering a state of high stress as well as high energy consumption, their metabolic decomposition process is different from that of healthy people, which needs to be fully evaluated by professional nutrition medical workers to develop personalized nutrition support treatment plan. Therefore, it is particularly important for ICU medical satff to receive the relevant nutrition knowledge training. Through regular organization of enteral nutrition training, ICU medical staff can early detect the symptoms, take correct treatment in the process of nutrition support, and reduce the interruption of enteral nutrition[15]. In addition, The mian function of medical academic journals is to spread new medical technologies,new achievements and new theories, promoting the transformation of scientific and technological achievements into productive forces. Medical staff can improve their professional skills through the medical innovations published in journals[16]. In this study, most medical staff have paid attention to the full application of academic resources. It suggested that medical staff should further use modern information tools to deeply obtain, explore and apply specialized cutting-edge technologies as well as theories[17].

According to the results of the present study, the bachelor degree or above was the main factor influencing the score of attitude dimension. ICU providers with a bachelor degree or above had higher scores on the attitude dimension than ICU staff with a bachelor degree or below, which were similar to other studies[18]. The theory of knowledge,attitude, and practice points out that when cognition accumulates to a certain extent, it will promote the change of attitude and eventually lead to the change of behavior[19–20]. In the process of ICU enteral nutrition therapy, including numerous Expertise and technology of Nutrition, such the nutritional metabolism characteristics of severe patients, the selection and establishment of enteral feeding routes and the observation and monitoring of enteral nutrition complications etc, which requires ICU medical staff to have a higher degree. ICU medical staff with higher education background tend to have a more systematic, comprehensive and solid grasp of theoretical knowledge. They are also more motivated and self-disciplined in learning skills and knowledge related to the interruption of enteral nutrition in ICU, As well as deeper understanding of the importance of the interruption of enteral nutrition in ICU.

The results of this study demonstrated that bachelor degree or above, senior professional title, systematic nutrition-related training and frequent browsing of academic journals were the contributing factors for high scores of enteral nutrition interruption behavior dimension in ICU medical staff. High educated medical staff have rich experience in clinical diagnosis and treatment, nursing, scientific research, teaching and other aspects, and have high welfare benefits and autonomy[21]. Clinical medical staff need to have high independent learning ability and clinical decision-making ability, to carry out better clinical work. The results of univariate analysis in this study showed that in ICU, the more comprehensive the medical staff received enteral nutrition-related training, the higher their behavioral dimension scores, which consistented with Huang et al [22]. Therefore, the comprehensive and systematic training of ICU medical staff is an effective way to improve the level of knowledge and trust. Meanwhile, Compared with never browsing academic journals, ICU healthcare staff who frequently browse academic journals had higher scores on behavioral dimensions. As the source of knowledge dissemination, the professional knowledge and expert opinions published by academic journals can reflect the current research hotspots in a certain field, provide opportunities for ICU medical staff to communicate, learn experience, and broaden the horizon of medical staff. It suggested that hospital managers can refer to the practice of “medical association” or “group hospitals” of large hospitals, to encourage actively medical staff to conduct standardized training in higher-level hospitals, improve their own treatment level, realize the balanced allocation of medical resources. Hospital management can also take measures from the medical staff layered training, throughing creating and building supportive academic environment, such as electronic libraries, and professional academic databases for ICU medical staff to browse academic journals, thus enhancing ICU medical staff of enteral nutrition interruption event attention as well as cognitive ability, adopting scientific methods to prevent and management of ICU enteral nutrition interruption events.

The results of the study still showed that the total score and the scores of each dimension of enteral nutrition interruption were moderately positive correlated(r:0.405–0.859). Moreover, the score of the correlation in knowledge, attitude dimension was the lowest(r:0.405), which indicated that there were some obstacles for ICU medical staff to transform the knowledge of enteral nutrition interruption into practice. Research in Hamdan et al[23] also showed that caregivers have correlated knowledge on the knowledge and attitude of enteral nutrition. In clinical, the acquisition of relevant knowledge of enteral nutrition interruption is a process of continuous learning and accumulation, only by actively and seriously deliberating, thinking and perception of professional knowledge, having a high sense of responsibility and mission for their work, can they gradually form a correct belief. In the research results, the correlation coefficient between the scores of knowledge dimension and behavior dimension was the highest, the reason for this result may be the rapid development of the department of critical medicine. Critical care medicine and nursing is an area of high,precison,sharp technology, doctors and nurses must take the initiative to learn theoretical knowledge to grasp. Through the high degree of work collaboration between doctors and nurses, formed a medical community between medical treatment and nursing profession. Meanwhile, the transformation of knowledge into behavior requires professional education and training as a bridge. It suggested that hospital managers should broaden their horizons, actively promote feasible strategies and use fragmented time to provide targeted training[24], then gradually improve the breadth and depth of knowledge about enteral nutrition for ICU healthcare staff. The correlation coefficient between the attitude dimension and the behavioral dimension scores was(r:0.463), which demonstrated that attitude of enteral nutrition interruption among ICU medical staff can positively affect their related behaviors. Attitude can reflect the tendency of ICU medical staff to behavior in enteral nutrition interruption. To change their behavior, the first thing is to change their attitude, Cause belief cannot be generated without the knowledge of ICU medical staff. Only when knowledge rises to belief is it possible to adopt a positive attitude to take the correct enteral nutrition interruption intervention behavior[25]. In summary, only when ICU medical staff have enough knowledge of enteral nutrition interruption and fully understand the consequences of enteral nutrition interruption, can they correct their attitude towards enteral nutrition interruption and better promote behavior to deal with enteral nutrition interruption.

Due to complications such as diarrhea, aspiration, high level of gastric residual volume and abdominal distension during the implementation of ICU enteral nutrition, and the influence in medical examination and operation, feeding interruption often occurs in ICU patients[5]. In ICU clinical practice, the busy working pressure, deficiencies of cognition and misunderstanding in Guidelines for enteral nutrition Leading to great differences in clinical practice[26]. Therefore, Continuous education and training is significant element in the implementation and management of enteral nutrition and it also critical to the success of nutritional treatment[27]. Based on the results, enteral nutrition managers should consider the ways to Management and training, grasp the knowledge situation of ICU medical staff in the hospital, understand their cognitive level, pay attention to the training effect, and focused on the training of new ICU medical staff. In the way and content of education and training, manager can Implement interprofessional educationa[28–29] and Scenario simulation training combined with multi-station assessment[30]; use mind mapping[31] to arrange the training structure and content system thus forming a variety of training methods, dynamic assessment, evaluation and feedback. It also advised the administrator to take means to help ICU medical professionals fully grasp the knowledge and skills related to enteral nutrition interruption, thus reducing the adverse effects of enteral nutrition interruption on the clinical outcomes of ICU patients.

Scientific implementation of enteral nutrition can improve the energy intake of critically ill patients and reduce the incidence of enteral nutrition-related adverse events[32]. Relevant research shows that[33–34] Volume-based enteral nutrition feeding regimen significantly increases energy and protein intake, with high safety, and can be tolerated by patients. From the management level, it should establish a management process for the prevention of enteral nutrition interruption, which Guided by level and purpose, and the content of the program formulated around the process links, such the assessment of cause in enteral nutrition interruption, Assessment and selection of enteral nutrient infusion route suitability, Monitoring of gastrointestinal tolerance for enteral nutrition, management of body position etc. By controlling and managing the operation process of enteral nutrition, standardizing the safe infusion of enteral nutrition thus improving the outcome of enteral nutrition interruption. Evidence-based practice can optimize the enteral nutrition process, improve the efficacy of enteral nutrition, and improve the nutritional status of patients[35]. Therefore, Medical staff should analyze the causes based on the current findings and build the prevention plan for ICU enteral nutrition interruption stemed from evidence, which can regulate the operation behavior of enteral nutrition, reduce the occurrence of enteral nutrition interruption and ensure the continuity and effectiveness of enteral nutrition implementation in the ICU.

The results of this study indicated that the level of KAPs of ICU medical staff in Wuhan tertiary hospital at the upper middle level, with room for further improvement. Educational background, hospital level, nutrition-related training, main learning routes and the frequency of academic journals were important factors affecting the level of enteral nutrition interruption in ICU medical staff. Based on the findings, the hospital management department should formulate targeted training programs to further improve the level of enteral nutrition interruption among ICU medical staff.

Limitations of the current study include the memory bias when asking participants if they had received nutrition-related training information. In addition, as this research was aimed at the ICU medical staff in Hubei tertiary hospitals, the results can only reflect the level of knowledge, attitude, practice of ICU medical staff in tertiary hospitals. Future research should add the ICU medical staff in secondary hospitals or other specialized hospitals to further elucidate KAPs of Interruption of enteral nutrition in ICU medical staff.

Author contributions

Mi Yuanyuan were responsible for data collection;Tian fei were responsible for statistical analysis; Zeng Chao were responsible for statistical analysis support; Liu Jing and Huang Haiyan were responsible for providing guidance,Mi Yuanyuan drafted the manuscript. All authors have read and agreed to published version of the manuscipt.

Funding

This work was supported by Huazhong University of Science and Technology Tongji Medical College Affiliated Union Hospital Pharmaceutical Care Project fund (protocol code 02.03.2021-35).

Availability of data and materials

The data that support the findings of this study are available from the corresponding author upon reasonable request.

Ethical approval and consent to participate

This study was conducted according to the guidelines laid down in the Declaration of Helsinki and all procedures involving research study participants were approved by the Tongji medical college, Huazhong University of Science and Technology.

Consent for publication

Not applicable.

Competing interests

The authors declare no conflict of interest.

Author details

¹Department of Critical Care Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China. ²Department of Critical Care Medicine, The First Clinical Medicine College of China Three Gorges University, Yichang, 433000, China. ³Department of gynecology, The first affiliated hospital of Chongqing medical university, Chongqing 400042, China. ⁴Department of orthopedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China.

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No competing interests reported.

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Evaluating knowledge, Attitudes, and Practices Regarding Interruption of Enteral Nutrition in ICU Medical staff:A descriptive cross-sectional survey

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Abstract

1. Introduction

2. Materials and methods

2.1. Samples and setting

2.2. Data collection tools

2.2.1. General information questionnaire

2.2.2. Knowledge, attitude and practice questionnaire for Interruption of enteral nutrition

2.3. Data collection procedure

2.4. Data analysis

3. Results

3.1. Sample Characteristics

3.2. Scores of each dimension of the questionnaire

3.3. Factors related to Interruption of enteral nutrition in ICU medical staff

3.4. Analysis of multiple factors associated with Interruption of enteral nutrition in ICU medical staff

3.4.1. Logistic regression analysis of factors influencing total socre

3.4.2. Logistic regression analysis of factors influencing Knowledge dimension

3.4.3. Logistic regression analysis of factors influencing Attitude dimension

3.4.4. Logistic regression analysis of factors influencing Practice dimension

4. Discussion

4.1. The status of KAPs of Interruption of enteral nutrition in ICU medical staff

4.2. Analysis of the factors affecting enteral nutrition interruption in ICU medical staff

5. Implications for practice

6. Conclusions

7. Limitations and Future Directions

Declarations

References

Additional Declarations

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