الفهرس 
IntroductionOnly 14 pages are availabe for public view
 |  | from | 273 |  |  |
| | | from | 273 | | |
Abstract
Trophic feeding usually defined as 10- 20 ml/ hour or 10-20 Kcal/Kg/day or the practice of feeding small volumes of enteral feeds (typically 12-24 ml/kg/day) intragastrically starting within the first few days after birth without advancing the feed volumes during the first week postnatal in order to stimulate the development of the immature gastrointestinal tract of the preterm infant. Trophic feeding (also referred to as minimal enteral nutrition (MEN), gut priming and hypo caloric feeding) improves gastrointestinal enzyme activity, hormone releases, blood flow, motility and microbial flora ( Skinner et al.,2021).
Aim of the study:
This study aimed to assess nurses’ performance regarding trophic feeding for preterm infant at neonatal intensive care unit (NICU) through:
Assess nurses’ knowledge level regarding trophic feeding for preterm infant at NICU.
Assess nurses’ practices regarding trophic feeding for preterm infant at NICU.
Assess nurses’ attitude regarding trophic feeding for preterm infant at NICU.
Research questions:
What is nurses’ knowledge level regarding trophic feeding for preterm infants at neonatal intensive care unit?
What is the nurses’ performance regarding trophic feeding for preterm infant at neonatal intensive care unit?
What is the nurses’ attitudes level regarding trophic feeding for preterm infant at neonatal intensive care unit?
Technical design:
Research design:
A descriptive research design was used to conduct this study.
Research Setting:
This study was conducted at Neonatal Intensive Care Unitof El-Fayoum General Hospital.
The general hospital NICU placed at the third floor of the hospital building and its design consists of 4 rooms; first and second room for routine care and equipped with 20 incubators, third room for isolation and equipped with 12 incubators and fourth room for intensive care and equipped with 12 incubators.
Research subject:
A convenient sample included all available nurses working at the NICU of the previously mentioned settings regardless their age, gender, qualifications or experience.
A purposive sample of neonates with inclusions criteria:
Preterm and low birth weight.
Don’t receive enteral feeding during first week of life
Exclusions criteria:
Neonates with gestational age more than 37 weeks of gestation.
Neonates with other congenital dysfunctions.
Neonates with severe hemodynamic instability, suspected or confirmed necrotizing enter colitis (NEC), evidence of intestinal obstruction perforation or paralytic.
Tools of data collection:
Three tools were used in this study.
1-Pre-Designed Questionnaire Sheet (Appendix III) :
It was adapted from Elhusein & Rshad (2015) and Sinha & Venkatnarayan (2017) and developed by the researcher.
Adjusted to the Egyptian culture and translated into an Arabic language by the researcher to assess nurses’ knowledge about trophic feeding. It was divided into:
Part 1:
This part concerned with characteristics of study subjects including:
Characteristics of studied nurses such as age, gender, qualifications, marital status, years of experience at NICU, as well as the attendance of previous training courses about trophic feeding for preterm infants.
Characteristics of studied preterm infants such as age, gestational age, birth weight, gender, mode of delivery medical diagnosis and duration of hospitalization.
Part 2:
It was concerned with nurses’ knowledge regarding trophic feeding. It was composed of (37) questions related to definition of trophic feeding, aim, indication, contraindication, benefits and success of trophic feeding. Also,types of feeding tubes, feeding methods,the required amount of breast milk,best types of dairy, problems occurring during installation of feeding tube, result of false insertion, indications for changing tubes, ideal duration for tube changing, complications of trophic feeding, common nursing pitfalls.In addition, encourage breastfeeding andor breast milk expression, types of expressed breast milk, benefits of expressed breast milk.best methods of expression,tools for storing breast milk, methods of storing breast milk, available temperature, maximum length of time for expressing milk,tips for safe breast milk storage, required amount, safe thawing for storage milk and nursing role toward trophic feeding.Different types of questions used in this format including closed and open- ended questions, multiple-choice questions and true or false. The questionnaire was filled by the nurses; the time consumed to fill the sheet was from 10 to 15 minutes.
Scoring system:
A scoring system was followed to assess nurses’ knowledge about trophic feeding. The right answer was scored one score and the wrong answer was scored zero score. These scores summed up and converted into a percentage score. Then the percentage scores classified into 3 categories:
-Good knowledge if score ≥75%.
-Average knowledge if score from 60 < 75%.
-Poor knowledge if score <60%.
II Observational Checklists (Appendix IV):
It was adopted from Aliakbari Sharabiani et al., (2017) & Foote et al., (2020). It used to assess the actual nurses’ practices of trophic feeding at NICUs. The checklists consisted of (73) questions figuring out nurses’ practices of trophic feeding such as application of weight (12 steps) length (14 steps), head circumference (11 steps), chest circumference (5 steps) and nasogastric tube insertion (31 steps).
Nurses were observed and their practices were evaluated throughout their working shifts. The researcher filled the checklists; the time consumed to fill the checklists were from one to two shifts per week up to 6 months.
Scoring system:
A scoring system was followed to assess nurses’ practices; where each correct practice scored as a one score and incorrect practice scored as a zero score. These scores summed up and converted into a percentage score. Then the percentage scores classified into 2 categories:
Competent if score ≥ 85%.
Incompetent if score <85%.
III. Attitude Type- rating Scale (Appendix V).
This scale designed by the researcher in the light of related literature and used to assess the attitudes of the nurses toward trophic feeding for preterm infants at NICUs. It included 15 items asking about nurses’ attitude regarding trophic feeding at NICUs.
Scoring system:
Neonatal nurses responses classified as “agree”, “uncertain”, “disagree” and respectively scored 3, 2 and 1. The scoring of the items summed up and converted into a percentage scores. Then all data classified into: 2 categories (positive attitude if score ≥ 70% and negative attitude if score < 70%).
Validity and reliability:
The content validity of the study tools was assessed by a panel of 5 experts in the field of nursing for its clarity, content and sequences of items. According to their suggestions, some modifications were done . The internal consistency of the developed tools was tested for their reliability by cronbach’s Alpha. The reliability was 0.792 for nurses’ knowledge questionnaire sheet, 0.804 for nurses’ practices and 0.835 for nurses’ attitude.
Operational design:
Preparatory phase:
It included reviewing of related literatures and theoretical knowledge of various aspects of the study using books, articles, internet searching and periodicals.
Ethical Considerations:
Research ethical committee approvals obtained . Consent obtained from each participated nurse and confidentiality of data and results considered. Every nurse has the right to withdraw from the study at any time and without giving any reason.
Pilot study:
A pilot study carried out on 10% of the total sample size to test the content, the effectiveness and time consumed to fill in the study tools. Based on the results of the pilot study the necessary modifications done.
Fieldwork:
The actual fieldwork was carried out for data collection over 6 months started from the beginning of (February, 2022) till the end of (July, 2022). The researcher attended 2 days/week to collect data. Each nurse interviewed individually according to their physical and mental readiness. In addition to the mitigating circumstances of the work. The researcher statred by introducing herself to each nurse, giving a clear and brief idea about the aim of the study and its expectations. The researcher observed the nurse while giving trophic feeding for preterm infants.
Results:
The most important findings can be summarized as the following:
The X ̅± SD of the nurses’ age was 31.26±5.81 years.
All (100%) of the studied nurses were females.
More than half of them (58.6%) were married.
More than three quarters (76.9%) of them did not attend previous training courses about trophic feeding.
The majority (90.8%) of the studied nurses had Technical Institute of Nursing.
More than half of the studied nurses (52.3%) had less than 5 years experience at NICUs.
The X ̅± SD of preterm infant age was 7.28±4.11 days.
The X ̅± SD of preterm infant birth weight 2490.8±0.56 grams.
The X ̅± SD of length of hospital stay to preterm infant was 10.20±11.67 weeks.
More than half (55.4%) of preterm infants were males.
More than half of the studied preterm infants (58.5%) were given artificial feeding.
Diagnosis of more than two thirds (69.2%) of preterm infants was respiratory distress syndrome.
More than two fifth (43.1%) ofthe nurses had poor knowledge about trophic feeding.
More than two thirds (72.3%) of the nurses had incompetent level of practices about trophic feeding for preterm infants.
More than half (55.4%) of the studied nurses had positive attitude regarding the trophic feeding at NICUs.
There was highly statistically significant difference between nurses’ knowledge, age, years of experience and previous attendance of training courses about trophic feeding.
There was no statistical significant difference between nurses knowledge, their marital status and educational qualification.
There were highly statistically significant differences between nurses’ total practices, age, and years of experience and training courses.
There was a statistically significant difference between total practices with educational qualification.
There was no statistical significant difference between nurses’ practices and marital status.
There were highly statistically significant differences between total attitude and years of experience.
There was no statistical significant difference between nurse attitude, marital status and educational qualification.
There was highly statistically significant differences with positive correlations between knowledge, total practices and total attitude with p-value = <0.001respectively.