Department of Public Health Sciences, Queen's University, Carruthers Hall, Kingston, Ontario, Canada.
Implement Sci. 2013 Dec 4;8:140. doi: 10.1186/1748-5908-8-140.
To successfully implement the recommendations of critical care nutrition guidelines, one potential approach is to identify barriers to providing optimal enteral nutrition (EN) in the intensive care unit (ICU), and then address these barriers systematically. Therefore, the purpose of this study was to develop a questionnaire to assess barriers to enterally feeding critically ill patients and to conduct preliminary validity testing of the new instrument.
The content of the questionnaire was guided by a published conceptual framework, literature review, and consultation with experts. The questionnaire was pre-tested on a convenience sample of 32 critical care practitioners, and then field tested with 186 critical care providers working at 5 hospitals in North America. The revised questionnaire was pilot tested at another ICU (n = 43). Finally, the questionnaire was distributed to a random sample of ICU nurses twice, two weeks apart, to determine test retest reliability (n = 17). Descriptive statistics, exploratory factor analysis, Cronbach alpha, intraclass correlations (ICC), and kappa coefficients were conducted to assess validity and reliability.
We developed a questionnaire with 26 potential barriers to delivery of EN asking respondents to rate their importance as barriers in their ICU. Face and content validity of the questionnaire was established through literature review and expert input. The factor analysis indicated a five-factor solution and accounted for 72% of the variance in barriers: guideline recommendations and implementation strategies, delivery of EN to the patient, critical care provider attitudes and behavior, dietitian support, and ICU resources. Overall, the indices of internal reliability for the derived factor subscales and the overall instrument were acceptable (subscale Cronbach alphas range 0.84 - 0.89). However, the test retest reliability was variable and below acceptable thresholds for the majority of items (ICC's range -0.13 to 0.70). The within group agreement, an indices reflecting the reliability of aggregating individual responses to the ICU level was also variable (ICC's range 0.0 to 0.82).
We developed a questionnaire to identify barriers to enteral feeding in critically ill patients. Additional studies are planned to further revise and evaluate the reliability and validity of the instrument.
为了成功实施重症监护营养指南的建议，一种潜在的方法是确定在重症监护病房（ICU）提供最佳肠内营养（EN）的障碍，并系统地解决这些障碍。因此，本研究的目的是开发一种评估危重症患者肠内喂养障碍的问卷，并对新工具进行初步有效性测试。
问卷的内容由已发表的概念框架、文献综述和专家咨询指导。问卷在 32 名重症护理从业人员的便利样本中进行了预测试，然后在北美 5 家医院的 186 名重症监护提供者中进行了现场测试。修订后的问卷在另一家 ICU（n=43）进行了试点测试。最后，将问卷分两次随机发放给 ICU 护士进行两次测试，间隔两周（n=17），以确定测试-再测试的可靠性。采用描述性统计、探索性因子分析、克朗巴赫α、组内相关系数（ICC）和kappa 系数评估有效性和可靠性。
我们开发了一个包含 26 种可能的肠内营养障碍的问卷，要求受访者在其 ICU 中对这些障碍的重要性进行评分。通过文献综述和专家意见，确定了问卷的表面效度和内容效度。因子分析表明存在五因素解决方案，占障碍方差的 72%：指南建议和实施策略、向患者输送 EN、重症监护提供者的态度和行为、营养师支持和 ICU 资源。总体而言，得出的因子子量表和整个仪器的内部可靠性指标是可以接受的（子量表克朗巴赫α范围为 0.84-0.89）。然而，大多数项目的测试-再测试可靠性是可变的，低于大多数项目的可接受阈值（ICC 范围为-0.13 至 0.70）。群体内一致性，一个反映将个体反应汇总到 ICU 水平的可靠性的指标也是可变的（ICC 范围为 0.0 至 0.82）。
我们开发了一种识别危重症患者肠内喂养障碍的问卷。计划进行更多研究，以进一步修改和评估该工具的可靠性和有效性。
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