Nurses privilege information through social interaction when making enteral feeding related decisions

Abstract

Enteral feeding is the preferred nutritional therapy in critically ill patients however variability in nursing management of enteral feeding may contribute to under delivery of prescribed feeds. This study sought to determine if information to support enteral feeding decisions might explain this variability in enteral feeding practice and potentially contribute to hypocaloric feeding. Case study method was used to examine the information sources used by intensive care nurses to support enteral feeding related decisions. Two intensive care units served as the case sites, allowing for theoretical replication. Data collection methods included concurrent verbal protocols and retrospective probing (n = 12), Q sort (n = 25), and focus group interviews (n = 9). Data were analysed separately, by case and culminated with cross-case analysis. Nurses privileged information obtained through social interaction when uncertain about enteral feeding decisions. Information sources considered useful were predominantly people (n = 9); only one was an institutional document. Perspectives of information accessibility were similar. Peer-reviewed and published information were not considered useful or accessible. In a climate where evidence-based decision making is an expectation of all health care providers it appears that institutional documents and published literature may be perceived as having minimal value in supporting critical care nurses' decisions. The preference for information obtained from people suggests a useful strategy for facilitating the transfer of information into clinical practice. The development of nurses skilled in knowledge utilisation and transfer who can serve as information conduits in the clinical setting may increase the use of evidence in practice and reduce variability in clinical decisions.