ICU NURSES' KNOWLEDGE, ATTITUDE AND PERCEIVED BARRIERS TO EFFECTIVE ENTERAL NUTRITION PRACTICES: A MULTICENTER SURVEY STUDY

Abstract

Abstract

Background: Nutritional support was considered to be an important aspect when dealing with critical patients admitted to the intensive care units. The enteral nutrition approach should serve as a primary form of nutrition support for those patients that have functioning gastrointestinal tracts. However, even considering the significance of enteral nutrition in ICU practice, there are some barriers related to its use. Purpose: This study aimed to assess the levels of knowledge, attitude, and perceived barriers to effective enteral nutrition practices among ICUs' nurses. Material and method: This study was conducted by using cross-sectional design. Sample size was calculated by using G*Power program. The calculated sample size was 150 nurses from adult intensive care units departments. The study was conducted from October 2025 to March 2026. Data were collected by using self-administered questionnaire, and analyzed by using SPSS version 25. Result: Nurses demonstrated a moderate level of knowledge about enteral nutrition (mean = 15.95). They performed well in most clinical aspects but showed knowledge gaps in technical areas, particularly flushing procedures and drug–nutrient interactions. Nurses showed a positive attitude toward enteral nutrition (mean = 2.52). Most believed enteral nutrition is safe, beneficial, and part of their professional responsibility. The overall perceived barriers were moderate (mean = 4.38). Major barriers included gastrointestinal intolerance, delays due to procedures or radiology confirmation, staffing shortages, limited dietitian coverage, and workflow interruptions. Nurses demonstrated a high level of practice in enteral nutrition care (mean = 3.94), including proper tube flushing, monitoring, and pump use. However, unsafe practice was noted in crushing non-crush medications. Years of intensive care units experience significantly improved knowledge levels. Access to written guidelines and participation in education programs significantly improved knowledge, attitude, and practice. Knowledge was positively correlated with attitude, practice, age, and years of experience. Practice was also positively associated with knowledge, age, and experience. Perceived barriers decreased with increasing years of experience. Demographic factors such as gender had no significant effect on knowledge, attitude, barriers, or practice. Conclusion: Overall, despite moderate knowledge and high practice levels, systemic and workflow-related barriers remain significant challenges in implementing enteral nutrition effectively in intensive care units. Key words: Enteral nutrition, knowledge, attitude, practice, barriers and nurses