Thematic domain and sub-domain
Example of potential Item
Current scientific evidence supporting some nutrition interventions is inadequate to inform practice.
● Vague or complex statements
● Lack of evidence
● Lack of availability of all ICU Team to attend meetings, educational sessions etc.
Not enough time dedicated to education and training on how to optimally feed patients.
● No dedicated individual willing to ‘champion’ the guidelines
● Time commitment to develop and implement educational strategies
● Restricted access to computers
● Displacement of posters and pamphlets over time
Hospital and ICU Structure
● Community hospital
N/A (i.e., non actionable barriers)
● Open structure
● Rural location
● Small hospital and/or ICU
● Lack of geographical consolidation
● Long, slow administrative process
Our ICU Managers/Directors are [not] supportive of implementing nutrition guidelines.
● Disconnect between priorities of management and clinical personnel
● Organizational constraints on practice
Resources for Implementation
● Shortage of staff
Not enough nursing staff to deliver adequate nutrition.
● Limited budget
● Lack of appropriate equipment/materials
● Lack of access to specialist services
Prevailing Culture of ICU
● No cohesive, multi-disciplinary team structure
Our ICU team [does not] engage in joint decision-making in planning, coordinating and implementing nutrition therapy for our patients.
● No multi-disciplinary daily rounds
● Unresolved conflict or disagreements between ICU team members
● Reliance on written communication (e.g., Cardex, paper notes)
● Leadership not physically present on unit
● Poor communication
Provider Intent to Adhere
● Circle of influence of nursing staff and allied healthcare professionals (e.g., dietitian) dependent on support of physician and leadership team
I [do not] feel responsible for ensuring that my patients receive adequate nutrition while in the ICU.
Critical Care Expertise
● Junior, novice staff
● Locum or casual staff
● Clinical training >10 years
● Reliance on expert opinion
● Type B personality (i.e. relaxed and easygoing)
● CPGs infrequently used due to rare clinical condition or narrow case-mix
I am not familiar with our current guidelines for nutrition in the ICU.
● Conflicting and numerous CPGs on same topic
There is not enough time dedicated to education and training on how to optimally feed patients.
● Information overload
● Time required to remain updated
● Poor dissemination
● Experience of adverse event from following guideline
Fear of adverse events due to aggressively feeding patients.
General belief among ICU team that provision of adequate nutrition does not impact on patient outcome.
Self-efficacy (i.e., belief that one does not have the capability to perform the actions required to implement the recommendation )
My lack of skills on how to achieve goal calories.
● Complex procedure
● Limited circle of influence
● Inertia of previous practice, especially among experienced, older staff
I am [not] willing to change my routines and habits in order to implement the recommendations of nutrition guidelines.
● Resistance to change, especially locums, surgeons and non-ICU physicians.
● High cost/work burden associated with following the guideline
● Paucity of evidence supporting recommendation
Current scientific evidence
● Lack of generalizability to critical care and/or specific patient groups
supporting some nutrition interventions is inadequate to inform practice.
● Poor prognosis
In resuscitated, hemodynamically stable patients, other aspects of patient care still take priority over nutrition.
● Other priorities of care
● Unstable clinical condition or contraindication
● Surgical patients
● Reconciliation with family preferences