title: Barriers to feeding critically ill patients: a multicenter survey of critical care nurses.
abstract: OBJECTIVE
  The aims of this study were to describe the barriers to enterally feeding critically ill patients from a nursing perspective and to examine whether these barriers differ across centers.
  
  
  METHODS
  A cross-sectional survey was conducted in 5 hospitals in North America. A 45-item questionnaire was administered to critical care nurses to evaluate the barriers to enterally feeding patients.
  
  
  RESULTS
  A total of 138 of 340 critical care nurses completed the questionnaire (response rate of 41%). The 5 most important barriers to nurses were as follows: (1) other aspects of patient care taking priority over nutrition, (2) not enough feeding pumps available, (3) enteral formula not available on the unit, (4) difficulties in obtaining small bowel access in patients not tolerating enteral nutrition, and (5) no or not enough dietitian coverage during weekends and holidays. For 18 (81%) of 22 potential barriers, the rated magnitude of importance was similar across the 5 intensive care units.
  
  
  CONCLUSIONS
  Nurses in our multicenter survey identified important barriers to providing adequate enteral nutrition to their critically ill patients. The importance of these barriers does not appear to differ significantly across different clinical settings. Future research is required to evaluate if tailoring interventions to overcome these identified barriers is an effective strategy of improving nutrition practice.
authors.affiliation: Department of Community Health and Epidemiology, Queen's University, Kingston, Ontario, Canada. cahilln@kgh.kari.net
authors.forename: Naomi E
authors.initials: NE
authors.lastname: Cahill
authors.forename: Lauren
authors.initials: L
authors.lastname: Murch
authors.forename: Deborah
authors.initials: D
authors.lastname: Cook
authors.forename: Daren K
authors.initials: DK
authors.lastname: Heyland
mesh_terms: D016638:Critical Illness / Q000451:nursing*; D003430:Cross-Sectional Studies; D004750:Enteral Nutrition / Q000451:nursing*; D019983:Guideline Adherence; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007362:Intensive Care Units; D009741:Nursing Staff, Hospital; D017410:Practice Guidelines as Topic