A description of feeding practices with critically ill patients in the adult intensive care unit in the South African public healthcare sector
Date
2023
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Abstract
Introduction: Feeding critically ill patients in the Intensive Care Unit (ICU) is a complex process which requires a high level of clinical decision-making. Dysphagia in critically ill patients has become a recent topic of interest as research has found that dysphagia assessment and management within the speech therapy profession varies greatly.
Aims: This study aimed to research the feeding practices in the public healthcare ICU in Johannesburg, Gauteng with a special interest in the clinical decision-making process that takes place by the multidisciplinary team (MDT).
Method: A qualitative design with a nonprobability purposive sampling strategy was used. There were 15 participants across two sites. Data was derived from observations, focus groups and individual interviews in June 2022 and analysed using a deductive latent approach to thematic analysis.
Results: Six themes emerged namely, decision-making in the ICU, non-patient related factors, feeding the ill patient, tolerance, the MDT in the ICU and, the role of the speech therapist (ST) in the ICU. The findings revealed that decisions regarding feeding are made by the doctor, however the ST was involved when they were referred to see the patient. Nonpatient related factors impact on the decisions and collaboration positively influenced the clinical decision-making process.
Conclusion: Results confirmed the lack of a protocol to inform the choice of mode of feeding. Clinical factors of the patient were however the main deciding factor, while environmental factors are also taken into consideration. Occasionally, the MDT would discuss their findings and come to a decision while the medical doctors, were more likely to make unilateral decisions.
Description
A dissertation submitted in partial fulfilment of the requirements for the degree of Master of Arts in Speech Pathology to the Faculty of Humanities, University of the Witwatersrand, 2023
Keywords
Clinical decision-making, Intensive care unit, Multidisciplinary team