الفهرس 
utritional Therapy for High-Risk NeonatesOnly 14 pages are availabe for public view
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Abstract
Nutritional therapy is important to support the high-risk neonate’s ongoing metabolic and energy needs, prevent catabolism of protein stores for energy, replenish or establish glycogen and fat stores, and promote growth and neurodevelopmental outcome. As well, to meet neonates’ nutritional needs through enteral nutritional therapy or parenteral nutrition to promote growth at rates comparable to good newborns of comparable age neonates (Miller et al., 2013)
The study aims to assess the nurses’ role toward nutritional therapy for high-risk neonates through assessing nurses’ knowledge, attitude and practice regarding nutritional therapy for high-risk neonates.
The subjects and methods of the current study discussed under the following four (4) designs:
I. Technical design
II. Operational design
III. Administrative design
III. Statistical design
I. Technical design
The technical design included the research design, study setting, subjects and tools of data collection.
Research design
A descriptive research design was used to conduct this study.
Study setting
The study was conducted at Neonatal Intensive Care Unit Children Hospital and Gynaecological Hospital affiliated to Ain Shams University where their capacity is 34 incubators.
Subjects
• The subjects of this study included a purposive sample composed of 50 nurses regardless of their age, gender and years of experience who were working at the Neonatal Intensive Care Unit at Children Hospital and Gynaecological Hospital and allowed to care for and administer nutritional therapy for high-risk neonates.
• All available high-risk neonates regardless of their gestational age, diagnosis, gender, birth weight, gestational age appropriateness and current weight who were subjected to nutritional therapy throughout data collection.
Tools of data collection
Tools were developed by the researcher based on the review of the literature including textbooks, articles, and network search.
I: Assessment Sheet of High-Risk Neonates (Appendix II): It was used to assess characteristics of the studied high-risk neonates receiving nutritional therapy including gestational age, diagnosis, gender, birth weight, the proportion between weight and gestational age, current weight and type of nutritional therapy.
II: Predesigned Questionnaire Sheet (Appendix III): This tool was designed by the researcher based on the review of literature and guidance of supervisors in simple Arabic language and it was composed of two parts:
Part I: characteristics of the studied nurses included: gender, age, level of education, and years of experience in NICU and attendance of training courses.
Part II: This part was developed and adapted from Al-Rafay and Al-Sharkawy, (2012), Mohamed and Taha, (2014), Al-Hawaly et al., (2016), Adel and Abdel-fattah et al., (2018) to assess nurses’ knowledge related nutritional therapy of high-risk neonates (28 Questions) as the following:
Nutritional therapy of high-risk neonates (7 items):
o Definition of nutritional therapy.
o Nutritional needs of high-risk neonates.
o Methods of nutrition for high-risk neonates.
o Indications of nutritional therapy.
o Signs and symptoms of insufficient nutritional therapy.
o Laboratory test for assessment of the nutritional status of high-risk neonates.
o Indicator of successful nutritional therapy for high-risk neonates.
Parenteral nutritional therapy for high-risk neonates (10 items):
o Indications of parenteral nutrition.
o Component of parenteral nutrition.
o Common veins are used for parenteral nutrition.
o Precautions of parenteral nutrition.
o Amount of parenteral nutrition during 24 hours and equation of flow rate.
o Nursing role (before, during and after) for high-risk neonates with parenteral nutrition.
o Complications of parenteral nutrition.
o Daily recording items for high-risk neonates with parenteral nutrition.
o Criteria for transition feeding on parenteral nutritional therapy to gastric tube feeding
Enteral nutrition therapy for high-risk neonates (6 items):
o Indications of enteral nutrition
o Precautions of enteral nutrition
o Nursing role:
(Before, during and after) giving enteral nutrition for high-risk neonates.
Toward properties and acceptable amount of residual.
o Daily recording of nursing care during giving enteral nutrition.
o Complications of enteral nutrition
o Criteria for transition feeding on gastric tube feeding to oral feeding.
Oral feeding (5 items):
o Indications of oral feeding
o Precautions of oral feeding
o Nursing role:
(Before, during and after) giving oral feeding for high-risk neonates.
o Daily recording of nursing care during giving oral feeding.
o Complications of oral feeding.
The questions were in the form of open, closed-ended and multiple-choice questions.
Scoring system:
The correct answers scored one grade, and the incorrect answer scored zero. These scores summed up and converted into a percent score. The total score of the questionnaire was 100 % and three score levels accordingly as the following, more than 75% was considered a good level of knowledge, from 60% to 75% considered the average level of knowledge and less than 60% considered the poor level of knowledge
III: Observational Checklists (Appendix IV): It was adopted from Bowden&Greenberg, (2012) and Macdonald&Ramasethu, (2013) to assess nurses’ competency level of practices regarding nutritional therapy for high-risk neonates, included the following procedure:
Care of neonates with Intermittent Naso/Orogastric tube (47 steps).
Administration of neonate bolus feeding (20 steps).
Connecting &administrate neonatal TPN solutions (31 steps).
Disconnecting TPN (10 steps).
Bottle-feeding (9 steps).
Measuring weight (15 steps)
Measuring abdominal circumference (11 steps)
Assessment of skin integrity (15 steps)
Scoring system
Each step was scored one grade if done correctly and scored zero if done incorrectly or not done. These scores summed up and converted into a percent score. The total score of checklists was 100 %: However, the total score was categorized into, the competent level (more than 85%) and the incompetent level (less 85 %).
IV: An attitude Likert type scale (Appendix V): This tool was developed and adapted from Hassan, (2014), Nalukenge, (2016) and Weshahy et al., (2019) and used to assess nurses’ attitudes regarding nutritional therapy for high-risk neonates; it consisted of (12items). Each response for each item was ranged from agreeing, sometimes agree and disagree about the nutritional therapy for high-risk neonates.
Scoring system
The scoring system was determined according to the studied nurses’ responses as the follow disagree, sometimes and agree. It is 3 points Likert scale; the scoring system was as follows: 1 grade for Disagree, 2 grades for Sometimes agree and 3 grades for Agree; reverse scoring considered for statements reflecting negative attitude. These scores summed up and converted into a percent score. The total score of scale was (36 grade) 100 % and two score levels accordingly as the follow, score from 60% ≥100% were referred to a total positive level of attitude, and score < 60% was referred to the total negative level of attitude
Results:
• 26% of the studied nurses their ages ranged between 30:≤ 35years old with a mean age of 28.2± 1.9 and 30% of them were graduated from a technical institute.
• 46%of the studied nurses had years of experience between 5:< 10 and 56% of them attended training courses.
• 58% of the studied neonates were males and 44% of them their gestational age ranged between 32:< 34 weeks old with a mean of 33.2± 1.1.
• 72% of the studied neonates were preterm, 46% of them their birth weight ranged between 2000:< 2500 gram and 60 % of the studied neonates were small for gestational age.
• 50% of the studied neonates received enteral nutrition.
• 46% of the studied nurses had an average level of knowledge regarding nutritional therapy for high-risk neonates, while 34% of them had a poor level of knowledge and 20% of them had a good level of knowledge.
• 66% of the studied nurses were incompetent regarding the care enteral feeding using OGT/NGT for the high-risk neonates.
• 60% of the studied nurses were incompetent regarding the administration of bolus enteral feeding using OGT/NGT for the high-risk neonates.
• 64% of the studied nurses were incompetent regarding connecting & administrating TPN solution high-risk neonates.
• 60% of the studied nurses were incompetent regarding disconnecting TPN for high-risk neonates.
• 64% of the studied nurses were incompetent regarding bottle feeding for high-risk neonates.
• 58% of the studied nurses were incompetent regarding measuring weight for high-risk neonates.
• 64% of the studied nurses were incompetent regarding measuring abdominal circumference for high-risk neonates.
• 62% of the studied nurses were incompetent regarding the assessment of skin integrity for high-risk neonates.
• 62% of the studied nurses were incompetent regarding total practices regarding nutritional therapy for high-risk neonates.
• 44.8%of the studied nurses had a negative attitude and 55.2% of them had a positive attitude.
• There are statistically significant differences between gender, qualifications and attending training courses of the studied nurses with their practices about nutritional therapy for high-risk neonates (p ≤0.05).
• There are no statistically significant differences between age and years of experience of the studied nurses with their practices about nutritional therapy for high-risk neonates (p >0.05).
• There are statistically significant differences between gender, qualifications and attending of training courses of the studied nurses with their knowledge about nutritional therapy for high-risk neonates (p ≤0.05
• There are no statistically significant differences between age and years of experience of the studied nurses with their knowledge about nutritional therapy for high-risk neonates (p >0.05).
• There are statistically significant differences between gender, qualifications and attending of training courses of the studied nurses with their attitude about nutritional therapy for high-risk neonates (p ≤0.05
• There are no statistically significant differences between age and years of experience of the studied nurses with their attitude about nutritional therapy for high-risk neonates (p >0.05).
• There is a positive correlation between nurse’s knowledge concerning their practices about nutritional therapy for high-risk neonates.
• There is a positive correlation between nurses’ practice and attitude concerning nutritional therapy for high-risk neonates.
• There is a positive correlation between nurses’ knowledge and attitude concerning nutritional therapy for high-risk neonates.
Conclusion
The current study It was concluded that, less than half of the studied nurses had an average level of total knowledge regarding nutritional therapy for high-risk neonates. Also, less than two-thirds of them had an incompetent level of practice in relation to nutritional therapy for high-risk neonates and more than half of them had a negative attitude toward nutritional therapy for high-risk neonates.