Dr Nomaxabiso Mooi’s PhD study examined enteral nutritional therapy practices, availability and implementation of related guidelines in adults within district hospitals and primary healthcare centres, with the goal of developing an implementation model relevant to the South African context.
‘The number of patients who should not be admitted to the intensive care unit, but rather be offered palliative care in district/primary healthcare institutions or their homes is increasing,’ said Mooi.
‘Enteral nutritional therapy has become an important component in the management of these patients and illness-related malnutrition globally, as it is associated with a decreased complication rate, shortened hospitalisation and reduced readmission rate,’ she added.
There is a dearth of literature on the implementation of enteral nutritional therapy practice guidelines in adults presenting at district hospitals and primary healthcare clinics before admission or after discharge from acute care.
Data were collected from 96 healthcare professionals, three patients, four family caregivers and by means of observation. This was followed by data collection from 13 nutrition experts at international, national and local levels using the Delphi technique.
Mooi said that the healthcare professionals showed poor knowledge but a positive attitude regarding the implementation of the South African enteral nutritional therapy practice guidelines in their institutions. They indicated that they were willing to implement the guidelines provided they were introduced to them and were given relevant education and in-service training.
‘Patients and family caregivers reported unmet needs related to the management of home-based enteral nutrition (HEN) that included socioeconomic and psychosocial needs.’
Mooi commented that the study’s findings point to the need for focused professional training and continuing professional education about enteral nutritional therapy implementation at district and primary healthcare centres.
‘The model that was developed has the potential to enhance guideline implementation, empower healthcare professionals, identify and address patients’ and family caregivers’ needs regarding HEN management, improve nutritional therapy practices, curb critical illness-related malnutrition and save healthcare costs,’ she concluded.
Four research articles have been produced from the thesis, with one in print and three submitted to accredited journals. Mooi is currently working on a research proposal for a collaborative research project that will involve international, national and local stakeholders to enhance community engagement and maximise societal impact.
The study was supervised by Deputy Vice-Chancellor of the College of Health Sciences, Professor Busisiwe Ncama. ‘I was so honoured to be supervised by Professor Ncama. We are both critical care nurses who are interested in managing patients before and after admission in the Intensive Care Unit and in the best possible and affordable ways, including provision of nutritional therapy,’ said Mooi.
Words: Nombuso Dlamini