From Best Evidence to Best Practice: Enteral Nutrition from Continuous Nasal Feeding in Stroke Patients

Figures & data

Table 1 Demographic Characteristics of Stroke Patients

Items	Characteristics	Observation Group (n=30)	Control Group(n=38)	χ2 (t)	P
Age	Years	61.71±10.17	62.71±7.70	−0.207	0.839
Gender	Male	21	26	0.020	0.889
	Female	9	12
Nation	Han nationality	28	34	0.310	0.577
	Minority	2	4
Marital status	Married	28	35	0.037	0.847
	Unmarried	2	3
Education	Elementary or Junior	18	27	2.365	0.306
	Senior	11	8
	College or above	1	3
Medical payment mode	Health insurance/Commercial insurance.	28	37	0.044	0.834
	Self-paying	2	1
GCS score		11.57±4.39	10.50±4.59	0.429	0.676

Table 2 Summary of the Best Evidence of Continuous Nasal Feeding

Type of Evidence	Content of Evidence	Recommendation Degree
Nursing group of nasal feeding	A multi-disciplinary nutrition support group should be formed to make clinical decisions on nutritional support methods, feeding patterns, and management plans. All staff involved in nasal feeding care should be educated and trained	A
The patient’s condition must be evaluated before choosing a certain method of nasal feeding.	Nutrition pump was used to patients with long-term nasal feeding (2 to 3 weeks or more).	A
	Patients who cannot tolerate intermittent nasal feeding adopted continuously nasal feeding by a nutrition pump.	A
	To use a nutrition pump when nasal feeding is recommended for the elderly lying in bed patients.	A
	Patients with a critical illness or major surgery should use a nutrition pump at the beginning of nasal feeding.	A
	When the viscosity of the nutrient solution is higher, or infusion speed needs to be strictly controlled or infusing higher dose and higher osmotic pressure nutrient solution, it is recommended to use a nutrition pump.	A
	For patients with normal gastrointestinal function, the nutrient solution of whole protein standard formula is recommended; dietary fiber can reduce diarrhea caused by nasal feeding in elderly patients and promote normal intestinal peristalsis.	A
Nasal feeding position	Keep the bed head raised at 30 °to 45 °during nasal feeding, except for contraindications. It is recommended that patients remain in a semi-recumbent position for 30–60 minutes after nasal feeding.	A
Nasal feeding checking	The nutrition pump should adopt the centralized management mode of specialist responsibility, and the nutrition pump should be calibrated and maintained regularly to ensure its accuracy.	B
Special nursing	For patients with long-term nasal feeding, oral care is recommended twice a day, and oral care with chlorhexidine is given to mechanically ventilated nasal feeding patients twice a day to reduce the incidence of pneumonia.	A
Complications monitoring	During nasal feeding, nurses should regularly monitor the occurrence of gastrointestinal complications (gastric retention, diarrhea, constipation, reflux), aspiration and aspiration pneumonia.	A

Table 3 Compliance of Nurses Before and After the Application of the Best Evidence

Standard Number	Compliance Before Evidence Applied					Compliance After Evidence Applied
	Case	Y	N	NA	Compliance rate/100%	Case	Y	N	NA	Compliance rate/100%
Standard 1	125	25	100	0	20%	60	60		0	100%
Standard 2	125	0	125	0	0%	60	60		0	100%
Standard 3	125	0	125	0	0%	60	60		0	100%
Standard 4	125	89	36	0	71.2%	60	60		0	100%
Standard 5	125	55	70	0	44%	60	60		0	100%
Standard 6	125	27	98	0	21.6%	60	60		0	100%

Notes: Y-The nurse performed correctly in completing the examination standard; N- The nurse performed an error in completing the examination standard, NA- No audit criteria were observed.

Abbreviations: Standard 1, nurses were aware of the importance of continuous nasal feeding and followed its standard procedures; Standard 2, nurses evaluated patients clinical situation before nasal feeding; Standard 3, nurses performed nasal feeding for patients rather than other medical staff; Standard 4, nurses could evaluate and deal with the patient’s adverse reactions or complications correlated with nasal feeding timely; Standard 5, nurses provided oral care for nasal feeding patients; Standard 6, nurses inspected and maintenance the nutrition pump regularly.

Table 4 The Incidence of Gastrointestinal Complications Before and After Application of the Best Evidence

Time	Cases	Vomit	Palirrhea	Diarrhea	Constipation	Gastric Retention
Before evidence applied	38	6	5	11	8	12
After evidence applied	30	0	0	4	1	3
χ2		5.195	4.216	4.514	5.535	4.541
P		0.023	0.039	0.042	0.035	0.042

Table 5 The Incidence of Aspiration and Aspiration Pneumonia Before and After Application of the Best Evidence

Time	Cases	Aspiration	Aspiration Pneumonia
Before evidence applied	38	3	2
After evidence applied	30	0	0
F		2.478	1.627
p		0.249	0.500

Table 6 The Workload of the Nurse and the Length of Hospitalization of Patients Before and After the Application of the Best Evidence

Time	Case	Nurse’s Daily Work (min)	Length of Hospitalization (d)
Before evidence applied	38	23.71±3.22	35.63±4.45
After evidence applied	30	7.73 ±1.14	35.00±3.70
t		25.881	0.625
p		0.000	0.534