Development of Nursing Practice Guidelines for Enteral Nutrition In Critically Ill Pediatric Patients
Keywords:
enteral nutrition administration, nursing practice guidelines, critically-ill pediatric patientsAbstract
Critically ill pediatric patients often face multiple limitations, such as the severity of illness and, in some cases, gastrointestinal dysfunction. These challenges increase the risk of inadequate nutritional intake, which can adversely affect growth and clinical outcomes. This study employed a research and development approach to develop a set of nursing practice guidelines for enteral nutrition in critically ill pediatric patients. The development was guided based on Soukup's three-phase model: (1) Problem Identification and Needs Assessment, (2) Evidence Review and Guideline Development, and (3) Pilot Implementation and Evaluation of the developed guideline among a sample of 10 pediatric patients in a semi-critical care pediatric medical ward. Research instruments included: (1) a feasibility assessment tool for guideline implementation, (2) a nurse satisfaction questionnaire, and (3) a quality appraisal checklist based on the AGREE II instrument.
Results: In Phase 1, the study explored the factors contributing to malnutrition in critically ill children and examined various nursing activities. In Phase 2, a total of 12 research articles were reviewed to inform the development of the guidelines, which consisted of three key components: (1) patient assessment, (2) nursing care for enteral nutrition administration, and (3) outcome evaluation. In Phase 3, the pilot implementation of the guidelines demonstrated high quality and validity. Following being quality-validated by experts, the nursing practice guidelines for enteral nutrition in critically ill pediatric patients had an Item-Objective Congruence score of 1 and a Content Validity Index of 0.94. The overall feasibility of implementing the guideline was rated at 90.27%, while nurse satisfaction reached 86.68%. The AGREE II-based quality evaluation yielded an overall score of 83.33%. In conclusion, the developed nursing practice guidelines meet established quality standards and are suitable for adaptation in other clinical contexts to ensure critically ill pediatric patients receive appropriate and adequate enteral nutrition.
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