FACTORS INFLUENCING PRACTICE OF ENTERAL NUTRITION BY NURSES IN HEALTH FACILITIES OF KISUMU COUNTY, KENYA

Abstract

Enteral nutrition is a method of providing feeds through the gastrointestinal tract using a tube. It is used in patients; whose oral intake is not possible. Annually, over 3 million people receive enteral nutrition globally. Nurses play a key role in enteral nutrition but despite the progress, studies have demonstrated approaches that are not in line with the approved standards. In Kenya there are few studies on enteral nutrition. Kisumu County is among the regions where minimal studies on enteral nutrition have been done. It is found in western Kenya region. The main objective was to evaluate factors influencing practice of enteral nutrition among nurses in health facilities of Kisumu County. The specific objectives were to assess nurses’ factors influencing management of enteral nutrition, to examine patient factors influencing nurses’ management of enteral nutrition and to determine health facility factors influencing nurses’ management of enteral nutrition. A cross-sectional, analytical study, employing both quantitative and qualitative approaches. It involved four referral hospitals that provide Enteral nutrition, namely; Jaramogi Oginga Odinga Teaching and Referral Hospital, Kisumu County Referral Hospital, Aga Khan Hospital Kisumu and Avenue Hospital Kisumu. They were selected through random sampling. A total of 88 participants were randomly selected from a study population that included all the nurses providing enteral nutrition in Kisumu County. 12 key informants were also interviewed. Data collection tools included a structured questionnaire, observation check list and an interview guide. Ethical approval was sought and given from relevant authorities. A pilot study was conducted in Nyamira County Referral Hospital. Collected data was analysed using statistical package for social sciences version 27. Both descriptive and inferential statistics were used in data analysis including frequencies, percentages, p-value, Bivariate Logistic Regression and Odds ratio. Use of guidelines that are well displayed influences EN (P value 0.03). Nurses’ level of knowledge influences enteral nutrition though with minimal significance. Considering the age of the patient and presence of co- morbidity while planning for enteral nutrition had a positive influence in enteral nutrition practice. Use of technology in the management of enteral nutrition was minimal (37.9%) and had minimal influence on EN practice. It was therefore concluded that enteral nutrition is an essential intervention in the healing process and can be influenced by use of guidelines and nurses’ knowledge. Co-morbidity and age of the patient can influence planning of care. Use of technology and evaluating enteral nutrition also has a relationship with EN practices. It was recommended that enteral nutrition providers should adhere to the guidelines and should acquire more knowledge. Age of patient and co morbidity should be factored when planning for enteral nutrition. Health facilities should make use of technology in the management of enteral nutrition and there should be consistent audit of the practice.