Factors affecting performance of critical care nurses regarding enteral tube flushing

: Flushing of an enteral tube is essential for maintaining hydration, nutrition and enteral tubes patency in enterally tube-fed patients. Improper or lack of enteral tube flushing (ETF) increases the risk for malnutrition and dehydration that may increase the risk for both morbidity and mortality in critically ill patients. In addition, tube occlusion that it's unclogging wastes time, effort, and resources. There is a lack of study on factors affecting performance of critical care nurses regarding ETF in intensive care units (ICUs). Therefore, this study was conducted. Aim identify of critical nurses (CCNs) Design: A descriptive research study Settings: The study was conducted at the ICUs of Alexandria Main University Hospital, Health Insurance Hospital (Gamal Abd-Elnaser), and the Royal Hospital. Subjects: A convenience sample of 60 CCNs who are providing direct care for adult critically ill patients with nasogastric tube in the previous "Enteral tube flushing questionnaire" and tube flushing performance observational Results: It was observed that the majority of CCNs (90%) had poor knowledge and 88.3% of CCNS had unsatisfactory performance regarding ETF. Critical care nurses' age, educational level, years of experience, place of work and knowledge had statistically significant effects on CCNs' performance regarding ETF. While, organizational and patients' related factors had no statistically significant effects on CCNs' performance regarding ETF. Conclusion: CCNs had poor knowledge and unsatisfactory performance regarding ETF in ICUs of AMUH. Recommendations: Enteral tube flushing should be done before and after each use. Critical care nurses are responsible for administer safely and effectively ordered nutrition, medication and fluid (Yoon2018 and, Khalatbari et al. 2018) (3, 4) . Maintaining the enteral tubes, preventing and detecting its complications are nurses' roles (5) . However, variances in nursing practice share in developing serious deficiencies and complications resulting from poor nutritional care (6) . Patient safety is a national and international priority in all health care and promoting it in enterally fed patients is dependent on ongoing surveillance and identification risks of patients harm. Identifying areas for potential human error, administrative and organizational conditions that are contributory to error need to be recognized by the healthcare practitioners (7) . The results of current study revealed that majority of nurses agree that lack of administrative support affect their performance. Administrative support improves performance of CCNs via acknowledging their roles, their motivation, and effective communications with nurses. This is supported by khalden et al who reported that the nurses‘ perspectives, institutional support is also essential for developing nursing care through acknowledging nurses‘ contributions and suggestions in that field (6) . The results of present study revealed that majority of nurses agree that lack of teamwork affect their performance regarding enteral tube flushing. These results reflect importance of team work. This is supported by Persenius et al. (2009) (28) who state that nurses reported the importance of teamwork and nurses indicated that despite having limited knowledge and experiences; an open mind to inquiry helped them to look for new solutions through dialogue with others.