Enteral feeding barriers in the intensive care unit of a tertiary hospital in Ghana
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Abstract
Background. Enteral nutrition (EN) is an important aspect of patient management in the intensive care unit (ICU). However, various barriers have been reported that limit the provision of EN, with implications for patient care and outcomes.
Objective. To evaluate the perceived barriers to the provision of EN among ICU healthcare professionals in our resource-limited setting, as a preliminary step toward developing tailored quality improvement interventions in our unit.
Methods. A cross-sectional survey of 21 ICU healthcare professionals (17 nurses and 4 doctors) was conducted. The Revised Barriers to Feeding Critically Ill Patients questionnaire was used to evaluate barriers to the provision of EN in our ICU. A Likert scale was used to assess perceived barriers, with each factor rated from 0 to 6; 0 indicating ‘not at all’ and 6 indicating ‘an extreme amount’. Descriptive statistics were used to describe the data as medians, interquartile ranges, counts and proportions. The Wilcoxon-Mann-Whitney test was used to evaluate differences in medians between doctors and nurses, given the skewed distribution of data. Likert-based responses were used to generate a stacked bar chart. Statistical significance was set at p<0.05.
Results. The main barriers to the provision of EN were related to dietitian support, ICU resources and EN delivery. Dietitian-related barriers included insufficient coverage on weekends, evenings and holidays (median 5), delayed nutritional assessments (median 3) and limited time dedicated to education and training on optimal feeding (median 3). ICU resource constraints included the absence or shortage of feeding pumps and the unavailability of enteral formulas (median 3 for both). Barriers to EN delivery included delayed initiation of motility agents in patients with feeding intolerance (median 3).
Conclusion. These findings underscored the importance of developing context-specific quality improvement initiatives to address local barriers to the provision of EN.
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1. Li JQ, Sun T, Zuo JT, et al. What influences the implementation of clinical guidelines related to enteral nutrition in the intensive care unit: A mixed‐methods systematic review. J Adv Nurs 2025;81(3):1172-1183. https://doi.org/10.1111/jan.16384
2. Pouwels S, van Nieuwkoop MM, Ramnarain D. Enteral nutrition interruptions in the intensive care unit: A systematic review of frequency, causes, and nutritional implications. Cureus 2025;17(4):81834. https://doi.org/10.7759/cureus.81834
3. Yébenes JC, Bordeje-Laguna ML, Lopez-Delgado JC, et al. Smartfeeding: A dynamic strategy to increase nutritional efficiency in critically ill patients – Positioning document of the Metabolism and Nutrition Working Group and the Early Mobilisation Working Group of the Catalan Society of Intensive and Critical Care Medicine (SOCMiC). Nutrients 2024;16(8):1157. https://doi. org/10.3390/nu16081157
4. Cahill NE, Murch L, Cook D, Heyland DK. Barriers to feeding critically ill patients: A multicenter survey of critical care nurses. J Crit Care 2012;27(6):727-734. https://doi.org/10.1016/j. jcrc.2012.07.006
5. Elmezoughi E, de Vasconcellos K. An evaluation of feeding practices and determination of barriers to providing nutritional support in a multidisciplinary South African intensive care unit. South Afr J Crit Care 2020;36(1):57. https://doi.org/10.7196/SAJCC.2020.v36i1.412
6. Elmokadem EM, Hanna MG, Darweesh EA, Bassiouny AM, Sabri NA, El Borolossy RM. Assessment of barriers to optimum enteral nutrition practices as perceived by critical care providers. Future J Pharm Sci 2023;9:56. https://doi.org/10.1186/s43094-023-00507-y
7. Cahill NE, Jiang X, Heyland DK. Revised questionnaire to assess barriers to adequate nutrition in the critically ill. J Parenter Enter Nutr 2016;40(4):511-518. https://doi.org/10.1177/0148607115571015
8. Alsohime F, Assiry G, AlSalman M, et al. Barriers to the delivery of enteral nutrition in pediatric intensive care units: A national survey. Int J Pediatr Adolesc Med 2021;8(3):186-190. https://doi.
org/10.1016/j.ijpam.2020.12.003
9. Darawad MW, Alfasfos N, Zaki I, Alnajar M, Hammad S, Samarkandi OA. ICU nurses’ perceived barriers to effective enteral nutrition practices: A multicenter survey study. Open Nurs J 2018;12:67-75. https://doi.org/10.2174/1874434601812010067
10. Zaher S. Barriers to delivery of enteral nutrition in intensive care settings in Saudi Arabia: A comparative study of the perceptions of health care providers working in adult and paediatric ICUs. Risk Manag Healthc Policy 2022;15:2357-2370. https://doi.org/10.2147/RMHP.S394035
11. Gore J, Staubmann W, Findling T, Pail E. Barriers to enteral nutrition on ICUs in Austria. Ernahrungs Umsch 2021;68(11):218-223. https://doi.org/10.4455/eu.2021.045
12. Kozeniecki M, Pitts H, Patel JJ. Barriers and solutions to delivery of intensive care unit nutrition therapy. Nutr Clin Pract 2018;33(1):8-15. https://doi.org/10.1002/ncp.10051
13. Mirhosiny M, Arab M, Shahrbabaki PM. How do physicians and nurses differ in their perceived barriers to effective enteral nutrition in the intensive care unit? Acute Crit Care 2021;36(4):342- 350. https://doi.org/10.4266/acc.2021.00185
14. Chapple LA, Chapman M, Shalit N, Udy A, Deane A, Williams L. Barriers to nutrition intervention for patients with a traumatic brain injury: Views and attitudes of medical and nursing practitioners in the acute care setting. J Parenter Enter Nutr 2018;42(2):318-326. https:// doi.org/10.1177/0148607116687498
15. Anku EK, Samad LO, Akafity G, Amoo SA, Hill LT. Nutrition support practices in the intensive care unit of a tertiary hospital in Ghana. South Afr J Crit Care 2024;40(1):5-15. https://doi. org/10.7196/SAJCC.2024.v40i1.1396
16. Ayande REA, Agordoh PD, Salino VJ, et al. Knowledge, attitudes, and practices of registered dietitians and nutritionists regarding enteral and parenteral nutrition support in Ghana: A needs assessment study. Front Nutr 2023;10:1197610. https://doi.org/10.3389/fnut.2023.1197610
17. Abdoola F, Adu-Amoah HG, Addo BK, et al. The critical care nutrition landscape in sub-Saharan Africa: Field insights and clinical commentary from resource-limited clinical settings. Nutrition 2025;134:112740. https://doi.org/10.1016/j.nut.2025.112740
18. Cahill NE, Murch L, Cook D, Heyland DK. Improving the provision of enteral nutrition in the intensive care unit: A description of a multifaceted intervention tailored to overcome local barriers. Nutr Clin Pract 2014;29(1):110-117. https://doi.org/10.1177/0884533613516512
19. Cunningham CA, Gervais LB, Mazurak VC, et al. Adherence to a nurse‐driven feeding protocol in a pediatric intensive care unit. J Parenter Enter Nutr 2018;42(2):327-334. https://doi. org/10.1177/0148607117692751
20. McCall ME, Adamo A, Latko K, Rieder AK, Durand N, Nathanson T. Maximizing nutrition support practice and measuring adherence to nutrition support guidelines in a Canadian tertiary care ICU. J Intensive Care Med 2017;33(3):209-217. https://doi.org/10.1177/0885066617749175
21. Friesecke S, Schwabe A, Stecher SS, Abel P. Improvement of enteral nutrition in intensive care unit patients by a nurse‐driven feeding protocol. Nurs Crit Care 2014;19(4):204-210. https://doi. org/10.1111/nicc.12067
22. Orinovsky I, Raizman E. Improvement of nutritional intake in intensive care unit patients via a nurse-led enteral nutrition feeding protocol. Crit Care Nurse 2018;38(3):38-44. https://doi. org/10.4037/ccn2018433
23. Al Kalaldeh M, Watson R, Hayter M. Jordanian nurses’ knowledge and responsibility for enteral nutrition in the critically ill. Nurs Crit Care 2015;20(5):229-241. https://doi.org/10.1111/ nicc.12065
24. Musazadeh N, Hakimi H, Sharif-Nia H, Dorri S. Disadvantages of various methods of gastrointestinal feeding in patients admitted to the intensive care unit: A systematic review. Caspian J Intern Med 2024;16(1):28-36. https://doi.org/10.22088/cjim.16.1.28
25. Adom R. Nutrient profiles of enteral feeds in selected hospitals in Accra, Ghana. MSc Dietetics dissertation. Accra, Ghana: University of Ghana, 2020:1-116. https://ugspace.ug.edu.gh/items/ c651ce48-29ad-4416-be27-e034c337f1ee
26. Epp L, Blackmer A, Church A, et al. Blenderized tube feedings: Practice recommendations from the American Society for Parenteral and Enteral Nutrition. Nutr Clin Pract 2023;38(6):1190-1219. https://doi.org/10.1002/ncp.11055
27. Johnson W, Carter H, Johnson T, Maday K. Real food for tube feeding makes a comeback. Am J Biomed Sci Res 2020;10(6):551-554. https://doi.org/10.34297/AJBSR.2020.10.001572
28. Ojo O, Adegboye ARA, Ojo OO, Wang X, Brooke J. The microbial quality and safety of blenderised enteral nutrition formula: A systematic review. Int J Environ Res Public Health 2020;17(24):9563. https://doi.org/10.3390/ijerph17249563
29. Eustace K, Cole L, Hollaway L. Attitudes and perceptions of blenderized tube feed use among physicians and advanced practice providers. J Parenter Enter Nutr 2021;45(8):1755-1761. https:// doi.org/10.1002/jpen.2069
30. Ojo O, Adegboye ARA, Ojo OO, Wang X, Brooke J. An evaluation of the nutritional value and physical properties of blenderised enteral nutrition formula: A systematic review and meta- analysis. Nutrients 2020;12(6):1840. https://doi.org/10.3390/nu12061840