Donnette Wright is a middle aged adult whose primary responsibility is to lecture undergraduate students regarding nutrition and diet therapy. She has responsibilities for the academic guidance of 35 students and the administrative management of 150 third year students. She has been recently tasked with the supervision of graduate research and is currently undertaking a PhD in nursing. She has an avid interest in primary health care particularly the prevention of chronic non-communicable diseases through nutrition education and dietary planning. She has conducted research in crime prevention and has a strong interest in youth development. Inter-disciplinary research in wellness maintenance in school age children is an interest that she is currently engaging. Other areas of research include psychometrics, preceptorship, clinical nursing supervision, knowledge practice gaps, and nutrition in cancer and childhood disease.
Critical illness is includes a physical assault on the health and metabolic processes in human functioning; it also impairs nutrition and impacts both morbidity and mortality. The health care team works in tandem to ensure that nutritional status is maintained through advocacy, assessment, treatment and management. The quality and quantity of nurse-patient interactions creates a unique opportunity and responsibility for nurses to positively influence nutritional outcomes and thereby the effects of critical illness. Moreover, very little has happened in the Caribbean and few studies in the developed world tests nutritional management in critical illness.
This study is situated within a multiphase intervention student within an overall purpose of developing a protocol for nutritional screening, assessment and management of critical care patients. The purpose of phase two was examine the critical care nurses’ knowledge, skill and perceptions of the nutritional needs of critically ill clients.
The second phase of the study involved a census sampling process of data collection at three type A hospitals in rural and urban Jamaica. Nurses were asked to respond to three self administered likert type tools standardized to measure knowledge skill and perception of nutritional needs and support of critically ill clients. The tools measuring knowledge, skill and perception were Knowledge of Nutritional Care of Critically Ill Patients Survey (KNCCIPS) (40 items), Nutrition Skills Assessment Tool (NSAT) and Nutritional Survey among Medical Staff (SAMS), respectively. Tools demonstrated good test-retest reliability and internal consistency Cronbach alpha > 0.7 and IIR of 0.4 or above for more than 70% of the items. Packages of tests were left at each site and following consent procedures each nurse was required to complete the analysis.
Statistical Package for Social Sciences (SPSS) version 19 was used. Descriptive statistics was used to summarize demographic data, nutritional skill level and knowledge level and perception category. In order to determine perception, knowledge and skill level, responses for each item on the individual tools were scored and categorized. The means of these scores computed and were ranked to determine which domain the revealed better skill, knowledge or perception level. A correlation analysis was done to determine the relationship between the demographic characteristics and skill, knowledge or perception level. Chi-square was ran to ascertain age-correlated variables.
The overall response rate was 71% (50/70). Mean age- 32 years (min 24, max 48), SD- 4.85, Gender= 92% female (46- F, 4-M). 64% of participants (32) reported no formal nutritional training. 50% (25) of the sample reported being trained Critical Care Nurses and 72% (36) of the sample had been employed to the institution for less than 5 years. 90% of nurses examined had poor skill (score of 23 to 71) and 80% had proficient knowledge of nutritional needs and management and nearly all nurses examined reported (92%) positive perceptions of the management of the nutritional needs of critically ill patients. Length of time working the ICU and age significantly correlated with skill and knowledge levels (r= o.67, p< 0.05).
Nurses had poor skill and reported not being trained as ICU nurses but knowledge of nutritional management was good particularly under the management and follow up domains, while assessment and diagnosis domains yielded poorer results. This is divergent from international evidence which finds that nurses are more skilled and knowledge than those assessed in this study. The data regarding perception is consistent with international evidence where the tools used were the same. The evidence shows that while perception and knowledge maybe good, skill may not be equally effective. A triangulation study is needed assessing qualitative reasons for affecting skill acquisition, competence and self-efficacy.