Table 2 Description of enteral feeding barriers as perceived by the nurses working in adults and paediatric ICUs

Domain 1

 Current scientific evidence supporting some nutrition interventions is inadequate to inform practice

3.25 ± 1.19

3.1 ± 1.066

3.49 ± 1.265

0.053

 Lack of feeding protocol in place to guide the initiation and progression of enteral nutrition in your institution

3.19 ± 1.25

3.05 ± 1.188

3.42 ± 1.322

0.095

Mean ± SD Likert rating for Domain 1

3.24 ± 1.23

Domain 2

 Delay in physician ordering initiation of enteral nutrition

3.09 ± 1.19

2.98 ± 1.158

3.26 ± 1.195

0.164

 Waiting for physician/radiology to read x-ray and confirm tube placement

3.10 ± 1.27

3.11 ± 1.21

3.09 ± 1.39

0.95

 Frequent displacement of feeding tube, requiring reinsertion

3.29 ± 1.28

3.28 ± 1.233

3.32 ± 1.37

0.847

 Delays in initiating motility agents in patients not tolerating enteral nutrition (ie, high gastric residual volumes)

3.27 ± 1.24

3.24 ± 1.226

3.32 ± 1.283

0.717

 Delays and difficulties in obtaining small bowel access in patients not tolerating enteral nutrition (i.e., high gastric residual volumes)

3.22 ± 1.23

3.22 ± 1.25

3.23 ± 1.235

0.965

 In resuscitated, hemodynamically stable patients, other aspects of patient care still take priority over nutrition

3.13 ± 1.51

3.04 ± 1.12

3.26 ± 1.211

0.264

 Nutrition therapy not routinely discussed on patient care rounds

3.10 ± 1.18

2.93 ± 1.135

3.36 ± 1.226

0.038*

Mean ± SD Likert rating for Domain 2

3.22 ± 1.25

Domain 3

 Not enough nursing staff to deliver adequate nutrition

3.33 ± 1.27

3.25 ± 1.208

3.45 ± 1.367

0.373

 Enteral formula not available on the unit

3.27 ± 1.26

3.17 ± 1.257

3.43 ± 1.264

0.233

 No or not enough feeding pumps on the unit

3.30 ± 1.3

3.25 ± 1.351

3.38 ± 1.244

0.59

Mean ± SD Likert rating for Domain 3

3.18 ± 1.32

Domain 4

 Non-ICU physicians (i.e., surgeons, gastroenterologists) requesting patients not be fed enterally

2.94 ± 1.21

3.02 ± 1.22

2.81 ± 1.194

0.561

 Nurses failing to progress feeds as per the feeding protocol

3.00 ± 1.25

3.2 ± 1.266

3.08 ± 1.253

0.141

 Feeds being held due to diarrhea

3.03 ± 1.19

3.08 ± 1.128

2.94 ± 1.307

0.506

 Fear of adverse events due to aggressively feeding patients

3.18 ± 1.25

3.23 ± 1.253

3.09 ± 1.26

0.543

 Feeding being held too far in advance of procedures or operating room visits

3.24 ± 1.20

3.29 ± 1.195

3.17 ± 1.221

0.574

 General belief among ICU team that provision of adequate nutrition does not impact on patient outcome

3.13 ± 1.29

3.11 ± 1.288

3.15 ± 1.321

0.853

 Lack of familiarity with current guidelines for nutrition in the ICU

3.26 ± 1.26

3.23 ± 1.337

3.3 ± 1.153

0.744

Mean ± SD Likert rating for Domain 4

3.09 ± 1.28

Domain 5

 Waiting for the dietitian to assess the patient

3.22 ± 1.17

3.19 ± 1.184

3.26 ± 1.163

0.73

 Dietitian not routinely present on weekday patient rounds

3.21 ± 1.22

3.3 ± 1.207

3.08 ± 1.253

0.297

 Not enough dietitian time dedicated to the ICU during regular weekday hours

3.15 ± 1.14

3.25 ± 1.157

3.00 ± 1.109

0.208

 No or not enough dietitian coverage during evenings, weekends, and holidays

3.21 ± 1.27

3.22 ± 1.288

3.21 ± 1.261

0.967

 There is not enough time dedicated to education and training on how to optimally feed patients

3.17 ± 1.15

3.16 ± 1.184

3.19 ± 1.128

0.876

Mean ± SD Likert rating for Domain 5

3.16 ± 1.25

Comparison between the 5 domains (P value)

0.284