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Table 4 Descriptive statistics of barrier questionnaire items

From: Development and psychometric properties of a questionnaire to assess barriers to feeding critically ill patients

Framework domain Item Median Interquartile range Mode Range Don’t know (%) Missing (%) Endorsement (%)
Part A: General barriers
Institutional Characteristics 1. Overall, our unit functions very well together as a team. 6.0 6 – 7 6.0 3 – 7 1 (0.5) 1 (0.5) 96.2
Institutional Characteristics 2. Our ICU team engages in joint decision-making in planning, coordinating and implementing nutrition therapy for our patients. 6.0 6 – 7 6.0 1 – 7 1 (0.5) 0 93.6
Institutional Characteristics 3. Overall, it is easy for me to openly talk with other members of the ICU team about matters related to the nutritional needs of my patient. 7.0 6 – 7 7.0 1 – 7 1 (0.5) 0 95.7
Institutional Characteristics 4. In our ICU, implementing best practices, as defined by clinical practice guidelines, is intrinsic to our culture. 6.0 6 – 7 6.0 2 – 7 2 (1.1) 1 (0.5) 93.0
Institutional Characteristics 5. Our ICU Managers/Directors are supportive of implementing nutrition guidelines. 6.0 6 – 7 7.0 2 – 7 7 (3.8) 1 (0.5) 82.7
Provider Intent 6. Nutrition is very important for my critically ill patients. 7.0 7 – 7 7.0 6 – 7 2 (1.1) 1 (0.5) 98.9
Provider Intent 7. I feel responsible for ensuring that my patients receive adequate nutrition while in the ICU. 7.0 6 – 7 7.0 5 – 7 1 (0.5) 3 (1.6) 99.5
Provider Intent 8. I am familiar with our current national guidelines for nutrition in the ICU. 6.5 4 – 6 6.0 2 – 7 10 (5.4) 0 (0.0) 67.2
Provider Intent 9. If the recommendations of the current national guidelines for nutrition are followed in our ICU, patient outcomes will improve. 6.0 5 – 7 6.0 1 – 7 19 (10.2) 0 (0.0) 77.4
Part B. Guideline recommendations for enteral nutrition
Provider Intent 1. Enteral nutrition should be used in preference to parenteral nutrition. 7.0 6 – 7 7.0 4 – 7 3 (1.6) 0 (0.0) 95.7
Provider Intent 2. Enteral nutrition should be initiated early (24 – 48 hours following admission to ICU). 6.0 6 – 7 7.0 3 – 7 1 (0.5) 0 (0.0) 97.9
Provider Intent 3. An evidence-based feeding protocol should be used. 7.0 6 – 7 7.0 2 – 7 1 (0.5) 1 (0.5) 96.8
Provider Intent 4. If a feeding protocol is used, it should tolerate a higher gastric residual volume (i.e., >250 mls) before holding feeds. 6.0 3 – 7 7.0 1 – 7 9 (4.8) 1 (0.5) 60.5
Provider Intent 5. In patients who have feed intolerance (i.e., high gastric residual volumes, emesis) a promotility agent should be used. 6.0 6 – 7 6.0 1 – 7 3 (1.6) 0 (0.0) 96.2
Provider Intent 6. Small bowel feeding should be considered for those select patients who repeatedly demonstrate high gastric residual volumes and are not tolerating adequate amounts of enteral nutrition delivered into the stomach. 6.0 6 – 7 6.0 1 – 7 10 (5.4) 0 (0.0) 91.4
Provider Intent 7. Patients receiving enteral nutrition should have the head of the bed elevated to 45 degrees. 6.0 5 – 7 7.0 1 – 7 2 (1.1) 2 (1.1) 78.3
Provider Intent 8. In all critically ill patients, hyperglycemia (blood glucose >10 mmol/l or 180mg/dl) should be avoided by minimizing intravenous dextrose and using insulin administration when necessary. 6.0 6-7 6.0 2-7 2 (1.1) 0 (0.0) 94.6
Part C: Barriers to the provision of enteral nutrition in the Intensive Care Unit
Institutional characteristics 1. Not enough nursing staff to deliver adequate nutrition. 3.0 2 – 5 1.0 1 – 7   2 (2.2) 30.2
Institutional characteristics 2. Not enough dietitian time dedicated to the ICU during regular weekday hours. 3.0 2 – 6 2.0 1 – 7   5 (2.7) 38.1
Institutional characteristics 3. No or not enough dietitian coverage during weekends and holidays. 5.0 3 – 6 6.0 1 – 7   5 (2.7) 60.8
Institutional characteristics 4. Enteral formula not available on the unit. 4.0 2 – 6 6.0 1 – 7   4 (2.2) 50.0
Institutional characteristics 5. No or not enough feeding pumps on the unit. 5.0 2 – 6 6.0 1 – 7   5 (2.7) 58.0
Guideline characteristics 6. Current scientific evidence supporting some nutrition interventions is inadequate to inform practice. 4.0 2 – 5 5.0 1 – 7   13 (7.0) 46.8
Guideline characteristics 7. The current national guidelines for nutrition are not readily accessible when I want to refer to them. 5.0 2 – 6 5.0 1 – 7   7 (3.8) 55.3
Guideline characteristics 8. The language of the recommendations of the current national guidelines for nutrition are not easy to understand. 4.0 2 – 5 4.0 1 – 7   11 (5.9) 38.3
Implementation Process 9. Not enough time dedicated to education and training on how to optimally feed patients. 5.0 3 – 6 5.0 1 – 7   6 (3.2) 57.8
Implementation Process 10. No feeding protocol in place to guide the initiation and progression of enteral nutrition. 4.0 2 – 5 1.0 1 – 7   7 (3.8) 45.3
Implementation Process 11. Current feeding protocol is outdated. 4.0 2 – 5 4.0 1 – 7   13 (7.0) 34.1
Provider intent 12. Delay in physicians ordering the initiation of EN. 5.0 3 – 6 5.0 1 – 7   5 (2.7) 65.2
Provider intent 13. Waiting for the dietitian to assess the patient. 4.0 2 – 6 6.0 1 – 7   6 (3.2) 48.3
Provider intent 14. Non-ICU physicians (i.e., surgeons, gastroenterologists) requesting patients not be fed enterally. 5.0 3 – 6 6.0 1 – 7   6 (3.2) 57.8
Provider intent 15. Nurses failing to progress feeds as per the feeding protocol. 4.0 2 – 6 6.0 1 – 7   4 (2.2) 45.6
Provider Intent 16. Fear of adverse events due to aggressively feeding patients. 4.0 2 – 5 5.0 1 – 7   5 (2.7) 48.6
Provider Intent 17. Feeding being held too far in advance of procedures or operating room visits. 5.0 2 – 6 5.0 1 – 7   6 (3.2) 58.9
Provider Factor 18. No feeding tube in place to start feeding. 5.0 2 – 6 6.0 1 – 7   4 (2.2) 54.4
Patients Factor 19. Delays in initiating motility agents in patients not tolerating enteral nutrition (i.e., high gastric residual volumes). 5.0 3 – 6 5.0 1 – 7   4 (2.2) 55.5
Patient Factor 20. Delays and difficulties in obtaining small bowel access in patients not tolerating enteral nutrition (i.e., high gastric residual volumes). 5.0 4 – 6 6.0 1 – 7   5 (2.7) 67.4
Patient Factor 21. In resuscitated, hemodynamically stable patients, other aspects of patient care still take priority over nutrition. 5.0 4 – 6 6.0 1 – 7   5 (2.7) 68.0
Institutional characteristic/Patient Factor 22. Lack of agreement among ICU team on the best nutrition plan of care for the patient. 3.0 2 – 5 2.0 1 – 7   4 (2.2) 32.4
  1. Framework domain column indicates which of the five thematic domains of our previously developed framework [28] that the specific questionnaire item maps on to.
  2. Responses options for Part A: 1 = fully disagree 2 = disagree 3 = somewhat disagree 4 = no opinion 5 = somewhat agree 6 = agree 7 = fully agree Endorsement = % respondents who responded ‘fully agree,’ ‘agree’ or ‘somewhat agree’ in Part A.
  3. Responses options for Part B: 1 = fully disagree 2 = disagree 3 = somewhat disagree 4 = no opinion 5 = somewhat agree 6 = agree 7 = fully agree.
  4. Endorsement = % respondents who responded ‘fully agree,’ ‘agree’ or ‘somewhat agree’ in Part B.
  5. Response options for Part C: 1 = not at all important 2 = unimportant 3 = somewhat unimportant 4 = neither important or unimportant 5 = somewhat important 6 = important 7 = very important. Endorsement = % respondents responded ’very important,’ ‘important’ or ‘somewhat important’ in Part C. Items ordered in table as per questionnaire distributed during field test.
  6. Italics = items eliminated due to high endorsement frequency bolded italics= items retained but reworded.