Enhancing Nutritional Care in Palliative Care Units: Assessing Nurse Knowledge and Quality Perception in Enteral Nutrition Practices

Enhancing Nutritional Care in Palliative Care Units: Assessing Nurse Knowledge and Quality Perception in Enteral Nutrition Practices | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Enhancing Nutritional Care in Palliative Care Units: Assessing Nurse Knowledge and Quality Perception in Enteral Nutrition Practices Zehra BATU, Gül BÜLBÜL MARAŞ, Kadriye TURAN This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4155845/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 23 Dec, 2024 Read the published version in BMC Nursing → Version 1 posted 12 You are reading this latest preprint version Abstract Background: Sufficient and well-balanced nutrition is pivotal in sustaining essential functions among patients in palliative care units. Aim: To determine the knowledge levels of nurses working in palliative care units regarding enteral nutrition practices and their perceptions of nutritional care quality in their units. Methods: This descriptive, cross-sectional study was conducted in 25 palliative care units located in Izmir, Türkiye, between June and September 2022. The study sample consisted of 205 nurses working in palliative care units. Data were collected using a general information form, an Enteral Nutrition Practices Knowledge Form, and the Nurses' Perceived Nutrition Care Quality Assessment Scale. STROBE checklist was used. Results: The study found that the majority of participating nurses (94.6%) were female, with 78.5% holding bachelor's degrees. The median knowledge score for enteral nutrition: 15 (range: 2-27), perceived care quality score: 36 (range: 9-45). Those with enteral nutrition training had significantly higher knowledge scores ( p <.001); palliative care certificate showed no difference ( p = .846). Nurses lacking nutrition counseling knowledge had lower perceived care quality scores ( p = 0.001). Monthly tube feeding applications correlated positively with knowledge scores (r = .173, p = .013), unlike professional experience duration ( p = .126) and time spent in palliative care ( p = .839). Conclusion: Nurses working in the palliative care unit find the quality of nutrition care provided to patients in their clinics to be sufficient, and the level of knowledge regarding enteral nutrition is at a moderate level. However, in questions related to nursing care such as fluid requirements during enteral nutrition with enteral solutions that affect both nutritional care and medical treatment, maintaining the opening of the jejunostomy tube, and enteral drug administration, correct response rates were low. Low correct response rates on specific issues highlight a need for targeted educational interventions. enteral nutrition knowledge nurses nutritional care quality palliative care units palliative care nurses Figures Figure 1 Figure 2 Introduction The rapid advancements in medicine and technology, along with the increasing human lifespan, have ushered in an era where individuals are living longer with chronic and life-threatening illnesses [ 1 – 3 ]. As a result, healthcare professionals are encountering palliative care patients with chronic and life-threatening illnesses more frequently [ 2 , 3 ]. Palliative care, encompassing holistic support for individuals of all ages enduring severe health-related suffering, especially those nearing the end of life, is crucial [ 4 ] According to the World Health Organization (WHO), "Palliative care is an approach that aims to improve the quality of life for patients and their families facing problems associated with life-threatening illnesses. It involves the early identification and impeccable assessment and treatment of pain and other physical, psychosocial, and spiritual issues to prevent and alleviate suffering [ 2 ]. Its goal is to ensure terminal patients can live their remaining days in comfort [ 4 , 5 ]. Adequate and balanced nutrition is crucial for maintaining essential functions in palliative care patients. However, symptoms like discomfort, nausea, oral ulcers, diarrhea, and vomiting can severely impact their nutritional intake, leading to deficiencies [ 3 ]. Malnutrition in these patients can result in loss of body mass, weakened immunity, and organ dysfunction, ultimately affecting disease progression, reducing quality of life, and increasing hospitalization duration and mortality risk [ 6 , 7 ]. Therefore, palliative care patients should be assessed for the risk of malnutrition, and early nutritional support should be initiated as needed [ 5 ]. Therefore, assessing palliative care patients for malnutrition risk and providing early nutritional support is imperative [ 5 ]. Nurses are integral members of the multidisciplinary palliative care team, playing key roles in enhancing patients' quality of life and ensuring adequate nutrition [ 8 – 10 ]. Their responsibilities, though varying based on hospital policies, typically involve tasks such as inserting and maintaining nasogastric feeding tubes, assessing calorie needs, initiating and adjusting nutrition plans, and promptly identifying and addressing any changes in patients' conditions [ 8 , 11 , 12 ]. Nurses' lack of knowledge about enteral nutrition [ 13 – 15 ], noncompliance with feeding guidelines [ 13 ], and practice inconsistencies all contribute to malnutrition in critically ill patients, including those in palliative care units [ 7 , 8 , 10 ]. Enteral nutrition, delivering essential nutrients via tube feeding to patients unable to eat orally, is widely utilized in palliative care units [ 3 , 17 ]. Consequently, nurses in these units are expected to possess adequate knowledge of enteral nutrition. Despite numerous studies examining nurses' enteral nutrition knowledge levels [ 11 , 18 – 21 ], research on the nutritional care perceptions of palliative care nurses is limited [ 10 , 22 , 23 ]. Particularly in Turkey, where studies on nutrition and nursing in palliative care are scarce, there's a need to assess nurses' knowledge and perceptions in this context. The aim of this study to determine the knowledge levels of nurses working in palliative care units regarding enteral nutrition practices and their perceptions of nutritional care quality in their units. Methods Design This study is a cross-sectional, descriptive, quantitative research. Setting and sample This descriptive cross-sectional study was conducted in the 25 palliative care units within public hospitals in İzmir, Turkey, between June and September 2022. The study population consisted of 237 nurses working in palliative care units. There was no sample selection process because the entire universe was to be used as the study sample. The inclusion criteria for the sample comprised individuals who had served as nurses in palliative care units for a minimum duration of six months and demonstrated willingness to engage in the study. Nurses who refused to participate in the study and filled out the questionnaire incompletely were excluded from the study. The study sample comprised 205 nurses. The rate of participation in the study was 86.5%. Data collection After a verbal explanation of the study goals, informed consent form was obtained from the nurses who agreed to participate in the study. Palliative nurses filled out the data collection forms under the supervision of the researchers. Data collection was carried out in their units. The completion of the forms took approximately 8–10 minutes. Data collection tools The knowledge level of nurses regarding enteral nutrition practices was determined using the Information Form on Enteral Nutrition Practices developed by Koçhan and Akın (2018) [ 20 ]. This form consists of two sections: the first contains questions about enteral nutrition practices, and the second contains questions about indications for enteral nutrition, enteral nutrition solutions and complications, the duration of enteral solution administration, and questions to assess enteral nutrition knowledge. This form yields a minimum of 0 points and a maximum of 27 points [ 20 ]. The perceived quality of nutritional care was assessed using the third section of the "Scale for Evaluating the Importance of Nutritional Assessment, Knowledge Level of Nutritional Care, and Perceived Quality of Nutritional Care in Nurses," developed by Theilla et al. [ 21 ] and validated by Kısacık et al. (2019). Each section of the scale can be evaluated separately. The score range that can be obtained from this section of the scale is 9–45. A higher score from this section, consisting of nine items, reflects that nurses evaluate the quality of nutritional care provided to patients in their units more positively [ 24 ]. The data collection flowchart of the study is presented in Fig. 1 . Data analysis The collected data were analyzed using the Statistical Package for Social Sciences (SPSS) 22.0 software. Descriptive statistics were performed, including means, standard deviations, medians, minimum-maximum values, and frequency measurements. Conformity to a normal distribution of measurable variables was calculated with the Shapiro-Wilk test. Non-normally distributed data were analyzed using the Mann-Whitney U test for comparisons between two groups and the Kruskal-Wallis test for more than two categories. Fisher's Exact test was used when the Chi-Square test could not be applied for comparing categories. In correlation analyses for non-normally distributed data, the Spearman correlation test was used. The level of significance was set at p < .05. Results The majority of nurses are female (94.6%) and bachelor's degree graduates (78.5%). About 37.56% of nurses stated that they have never received any training on enteral nutrition, while 66.34% do not have a palliative care certificate. In 19.51% of the units where they work, no nutrition counseling is provided, while in 29.76% of units, counseling is provided for all patients receiving nutritional support, and in 39.51% of units, counseling is provided for some patients receiving nutritional support. Additionally, 11.22% of participants stated that they do not have knowledge about the nutrition counseling practices implemented in their units (Table 1 ). Table 1 Palliative care nurses sociodemographic and institutional characteristics n % Gender Men 11 5.3 Women 194 94.6 Education Health Vocational High School 8 3.9 Associate degree 15 7.3 Bachelor's degree 161 78.5 Master degree 21 10.2 Palliative Care Certification Yes 69 33.6 No 136 66.3 Enteral Nutrition Training Yes 128 62.4 No 77 37.5 Nutritional Counseling Yes All patients receiving nutritional support. 61 29.7 Some patients receiving nutritional support. 81 39.5 No 40 19.5 I have no knowledge 23 11.2 The most commonly used method of nutritional support ONS 37 18.0 Tube feeding PEG 71 34.6 NG 61 29.7 Parenteral 36 17.5 ONS: Oral nutritional support, NG: Nasogastric tube, PEG: Percutaneous endoscopic gastrostomy The median age of the participants is 36 ± years (Min: 21, Max: 51), the median professional experience is 14 years (Min: 1, Max: 34), the median palliative care unit experience is 3 ± years (Min: 1, Max: 16). The median values of Nutritional Care Quality Perception Score and Knowledge Level Total Score were determined as 36± (Min: 9, Max: 45), 15± (Min: 2, Max: 27), respectively (Table 2 ). Table 2 Monthly nutritional support numbers, knowledge levels, and perceived nutritional care quality scores Median Minimum Maximum Work Experience Duration 14 1 34 Palliative Care Experience Duration 3 1 16 Montly ONS Frequency 10 0 200 Montly Tube (NG + PEG) Feeding Frequency 10 0 70 Montly Parenteral Frequency 6 0 120 Nutritional Care Quality Perception Score 36 9 45 Knowledge Level Total Score 15 2 27 ONS: Oral nutritional support, NG: Nasogastric tube, PEG: Percutaneous endoscopic gastrostomy The responses to questions related to knowledge levels regarding enteral nutrition practices are presented in Table 3 . It is observed that questions related to fluid requirements, maintaining the patency of the jejunostomy tube, enteral administration of medications, and types of tubes used during enteral nutrition with liquid solutions were answered correctly at rates lower than 25%. However, questions related to the use and maintenance of feeding sets/bags, nursing interventions to prevent gastrointestinal complaints during enteral nutrition with solutions, storage conditions for enteral products, care for NG tubes and PEG, infusion rates for NJ feeding, and nursing interventions to prevent NG tube obstruction were answered correctly at rates higher than 75%. The median score of the Enteral Nutrition Practices Knowledge Form was determined as 15 (Min: 2-Max: 27) (Table 3 ). Table 3 Knowledge levels regarding enteral nutrition practices (n = 205) Right (%) 1. Which type of solutions should be preferred for enteral nutrition? 127(61.9) 2. Which of the following statements is correct regarding continuous enteral feeding? 17(8.2) 3. How many hours can enteral nutrition solutions remain in the feeding set? 121(59.0) 4. Which of the following indicates delayed gastric emptying in enteral feeding? 69(33.6) 5. How often should gastric residual volume be checked in intermittent enteral feeding to assess the tolerance of the given nutrition? 91(44.3) 6. How often should the enteral nutrition bag and set be changed in tube-fed patients? 181(88.2) 7. Where and for how long should enteral nutrition products be stored after opening? 159(77.5) 8. What is the maximum amount of enteral nutrition product that can be given in one feeding in bolus intermittent feeding? 54(26.3) 9. What is the maximum duration for each meal in intermittent enteral feeding? 77(37.5) 10. To prevent possible pulmonary aspiration in patients receiving enteral nutrition, how many degrees should the patient's head be elevated during and after enteral feeding? 131(63.9) 11. Nursing interventions to prevent abdominal distension and nausea/vomiting during enteral feeding are listed below. Which one is incorrect? 166(80.9) 12. Which of the following interventions regarding medication administration in patients receiving enteral nutrition is incorrect? 24(11.7) 13. Which nursing interventions are important to plan to prevent blockages in a nasogastric tube in an enterally fed patients? 150(73.1) 14. What can develop if the enteral feeding solution is given cold to a patient receiving enteral nutrition? 175(85.3) 15. Which of the following interventions to prevent nausea and vomiting in enterally fed patients is incorrect? 179(87.3) 16. Which of the following interventions is incorrect for preventing bacterial growth in feeding bags and tubes during enteral nutrition? 174(84.8) 17. Which of the following methods is not used to confirm the placement of a nasogastric tube in a patient with a nasogastric tube? 168(81.9) 18. In patients requiring nutritional support who cannot take food orally, parenteral nutrition should be preferred initially. 94(45.8) 19. Enteral feeding solutions completely meet fluid requirements. 6(2.9) 20. If a patient is being fed through a jejunostomy tube, drinking water should be given through the jejunostomy tube to maintain tube patency. 20(9.7) 21. Enteral feeding can be applied in cases such as intestinal obstruction, paralytic ileus, severe enteritis and peritonitis, severe diarrhea, and malabsorption. 135(65.8) 22. In the nasojejunal feeding method, since the nutrition solution is given directly to the intestine, complaints due to rapid gastric emptying (Dumping syndrome) may develop. 154(75.1) 23. Polyurethane and silicone tubes should be preferred in patients undergoing enteral nutrition. 165(80.4) 24. Hypertonic enteral nutrition solutions may cause diarrhea. 92(44.8) 25. Rapid and excessive administration of hypertonic nutrition solutions can cause dehydration. 102(49.7) 26. Polyvinyl tubes should be preferred in patients where the risk of complications is low and enteral nutrition is applied. 21(10.2) 27. In patients with a PEG catheter, the catheter insertion site (stoma) is cleaned using 0.9% NaCl or antiseptic solution. 161(78.5) Enteral Nutrition Practices Knowledge Form – Section 1 = Median: 11(Min: 1-Max:17) Enteral Nutrition Practices Knowledge Form - Section 2 = Median: 5(Min: 0-Max:10) Total Score of the Knowledge Form on Enteral Nutrition Practices = Median: 15(Min: 2-Max:27) When the correct answer rates given to the Information Form on Enteral Nutrition Practices are evaluated; 0.98% (n = 2) of the participants answered 75% correctly (Fig. 2 ). There was no statistically significant difference between the correct answer rates on the Enteral Nutrition Practices Knowledge Form and the presence of a palliative care certificate. However, the rate of correct answers was higher for those who received enteral nutrition training compared to those who did not ( p = .008) (Table 4 ). Nurses who received enteral nutrition training had a higher total score on the Enteral Nutrition Practices Knowledge Form compared to those who did not ( p < .01). However, there was no statistically significant difference in the Nutritional Care Quality Perception Scores between the two groups ( p = .190). Regarding the presence of a palliative care certificate, there was no statistically significant difference in the total knowledge score on the Enteral Nutrition Practices Knowledge Form ( p = .846) or the Nutritional Care Quality Perception Score ( p = .496). Table 4 Distribution of correct answer rates based on palliative care certificate and enteral nutrition training status The Correct Answer Rates Palliative Care Certification Yes No p n % n % %75.0 6 8.7 9 6.6 Total 69 100.0 136 100.0 Enteral Nutrition Training %75.0 13 10.1 2 2.6 Total 128 100.0 77 100.0 Fisher’s Exact testi, * p < .05 The presence of a nutrition consultant in the unit did not have a statistically significant impact on the total score of the Enteral Nutrition Practices Knowledge Form ( p = .543). However, there was a statistically significant difference in the Nutritional Care Quality Perception Score among groups ( p < .05). According to the results of the Posthoc test (Tamhane-2 test), the group with a nutrition consultant in their unit had a higher Nutritional Care Quality Perception Score compared to those who did not have nutrition consulting ( p = .01). The results of the Posthoc test (Tamhane-2 test) indicate that the group with a nutrition consultant in their unit had a higher Nutritional Care Quality Perception Score compared to those who did not have nutrition consulting ( p = .01). This suggests that the presence of a nutrition consultant in the unit is associated with a higher perceived quality of nutritional care among nurses, and this difference is statistically significant (Table 5 ). Table 5 The impact of palliative care certificate, enteral nutrition training, and nutrition counseling on the total knowledge score related to enteral nutrition practices and the perception score of nutritional care quality Enteral Nutrition Practices Knowledge Form Score Nutritional Care Quality Perception Score Median(Min-Max) p Median(Min-Max) p Palliative Care Certification Yes 15 (2–22) .846 36 (9–45) .496 No 15 (7–27) 36 (10–45) Enteral Nutrition Training Yes 16 (2–27) < .001 a * 36 (9–45) .190 No 14 (7–21) 36 (13–45) Nutritional Counseling Yes 15(8–27) .543 37(9–45) .001 b * No 15(2–22) 35(19–43) I don’t know 15(7–20) 32(13–44) a Mann-Whitney U Test , b Kruskal Wallis Test , c Spearman Korelasyon Testi, * p < .05 The correlations between the Total Knowledge Score Related to Enteral Nutrition Practices and the Perception Score of Nutritional Care Quality, as well as monthly tube feeding frequency, monthly ONS (Oral Nutrition Support) frequency, monthly parenteral nutrition frequency, professional experience duration, and duration of working in palliative care, were examined. It was found that there is a positive correlation between the monthly tube feeding frequency and the Total Knowledge Score Related to Enteral Nutrition Practices (r = .173, p = .013), while there was no statistically significant correlation with the other variables (Table 4 ). Table 6 The correlation between the perception score of nutritional care quality and the total knowledge score related to enteral nutrition practices Nutrisyonel Nutritional Care Quality Perception Score Total Score of the Information Form on Enteral Nutrition Practices Montly Tube Feeding Frequency r c .048 .173 p .497 .013* Monthly ONS Frequency r − .036 .011 p .613 ,876 Monthly Parenteral Nutrition Frequency r − .105 .038 p .137 .588 Palliative Care Experience Duration r .14 − .10 p .839 .888 Professional Experience Duration r .107 − .56 p .126 .429 Nutritional Care Quality Perception Score r 1 .089 p - .202 Total Score of the Knowledge Form on Enteral Nutrition Practices r .089 1 p .202 - n 205 205 ONS: Oral nutritional support Discussion The aim of this study was to examine the knowledge levels of nurses working in palliative care units regarding enteral nutrition practices, as well as their perceptions of the quality of nutritional care in their units. Receiving enteral nutrition training and the monthly frequency of tube feeding in the unit where nurses work had a significant effect on the overall score of the Enteral Nutrition Practices Knowledge Form. However, having a palliative care certificate did not have a significant effect on this score. The findings also highlighted that the perceived quality of nutritional care was above average and was influenced by whether the unit received nutrition counseling units. In Turkey, there used to be a requirement that individuals must be female to become a nurse according to the nursing law in effect between 1954 and 2007 [ 25 ]. However, the current law allows men to work as nurses, but for many years, nursing was predominantly considered a profession for women, which limited the number of male nurses [ 26 , 27 ]. This historical gender bias is reflected in your study, where the majority (94.63%) of the volunteers who participated in the study were female nurses. Furthermore, the expansion of palliative care centers in Turkey began with the Pallia Turk project, which was part of the National Cancer Control Program from 2009 to 2015. The number of these centers started to increase in 2012–2013 [ 28 ]. As a result, nurses in Turkey have had limited opportunities to work in palliative care units or centers, and their duration of employment in these settings has generally been relatively short. Your study found that the median duration of employment in a palliative care center for nurses was 3 years (minimum: 1 year, maximum: 16 years). This suggests that palliative care nursing is a field that is still developing in Turkey, and nurses with more experience may be more likely to work for longer periods in palliative care settings. These historical and contextual factors highlight the gender dynamics and the emerging field of palliative care nursing in Turkey. Palliative care focuses on managing symptoms and disease-related stress in terminally ill patients. The goal of palliative care is to improve the quality of life for these patients while relieving them from pain, symptoms, and stress [ 29 ]. Malnutrition is common in palliative care patients and can be influenced by various factors. As the disease progresses in these patients, nutritional disorders become more common, leading to the need for nutritional support [ 30 ]. Proper nutritional interventions can support overall well-being and improve the overall quality of life [ 31 ]. Therefore, enteral nutrition is considered an essential component of providing quality care to patients in palliative care settings [ 29 , 30 , 31 ]. Studies conducted in Turkey report a malnutrition risk of over 90% in palliative care units and enteral nutrition support rates of approximately 20–60% [ 17 , 32 , 33 ]. Given the frequency of enteral nutrition use and its significant potential benefits for patients, it is important for nurses to have comprehensive and adequate knowledge in this area. [ 34 ]. It is expected that nurses being trained in enteral nutrition would enable them to assess patients' nutritional needs, administer enteral nutrition, monitor complications, and provide education on enteral nutrition to patients and their families. In the present study, 62.4% of the participating nurses reported receiving training in enteral nutrition. Previous studies conducted in Turkey have reported varying results regarding nurses' status of receiving enteral nutrition training, ranging from 7.8–62% [ 20 , 24 , 35 , 36 ]. This variation could be attributed to factors such as the policies of the institution/department where the study was conducted, the patient population served by the institution/department, and the year in which the research was carried out. Studies have shown that educational programs designed for nurses can significantly improve their practices, performance, and knowledge level related to enteral nutrition [ 19 , 37 , 38 , 39 ]. In this study, nurses who received enteral nutrition training had a higher total score on the Enteral Nutrition Practices Related Knowledge Form compared to those who did not receive training (p 75% of the questions correctly, and 17.18% answered < 50% of the questions correctly. Insufficient knowledge and incorrect practices by nurses in providing enteral nutrition to patients can negatively affect both the quality of care and patient safety, while well-implemented nutritional nursing care can improve patients' nutritional status and clinical outcomes [ 19 , 37 ]. Therefore, it is recommended to plan regular and continuous education to enhance nurses' enteral nutrition practices and improve the quality of care. In this study, it can be said that nurses' knowledge level regarding enteral nutrition practices is at a moderate level. This result is similar to previous studies conducted in Turkey [ 20 , 24 ]. In a study by Koçhan & Akın (2018), it was shown that nurses had insufficient knowledge in areas such as storage conditions of enteral products, tolerance of the feed given to enterally fed patients, gastric residual volume indicating delayed gastric emptying in enteral nutrition, and medication administration in enterally fed patients [ 20 ]. In another study, it was found that nurses answered questions related to skin problems around stomas (83.53%), feeding position (80.59%), and interventions to prevent nausea and vomiting (73.53%) more correctly. However, they mostly couldn't answer questions about residual volume (88.82%), pulmonary aspiration (61.76%), and tube care (56.47%) [24;35]. In this study, the questions related to fluid requirements during tube feeding (2.9%), maintaining the patency of jejunostomy tubes (9.8%), and medication administration (11.71%) during tube feeding were the least correctly answered questions. For patients receiving tube feeding, if fluid restriction is not applied, fluid requirements are calculated as 1 mL/kcal. Since most of the isocaloric formulas commonly used in these patients consist of approximately 75% water, additional fluid support is needed, typically at least 25% of the used feeding product. The remaining amount in the calculated fluid requirement can be completed with drinking water to meet the patient's fluid needs. The amount of water used in tube irrigations is also included in this calculation [ 20 , 40 , 41 ]. It's worth noting that one of the questions with the highest number of incorrect answers in this study was "Enteral nutrition solutions completely meet fluid requirements." Only 2.92% of the nurses in the study answered this question correctly. This indicates that nurses may not have sufficient knowledge about the content of enteral nutrition products and determining daily fluid requirements. In tube feeding, the patency of the feeding tube cannot be maintained due to various factors, and blockages may occur. Proper flushing is required to prevent blockages and maintain patency. In continuous feeding, the tube should be flushed with water every 4–6 hours, and in intermittent feeding, before and after each feeding, and if the tube is not in use, it should be flushed every eight hours. In addition, to prevent potential blockages due to drug and formula interactions, it is recommended to flush the tube before and after drug administration [ 42 ]. In this study, the question about preventing blockages in nasogastric tubes was answered correctly by 73.17%, while the question about maintaining patency in jejunostomy tubes was only answered correctly by 9.76%. This may be due to the fact that PEG and NG tubes are commonly used in the units where the nurses work, while jejunostomy tubes are not frequently used. Nutrition tubes can also be used for administering orally administered medications. Incorrect preparation and/or administration of medication in these processes can affect patients [ 43 ]. In the literature, there are studies that report that nurses are not sufficient in preventing drug interactions in enteral drug administration and that the flushing procedures vary [ 44 – 46 ]. It has been shown that the knowledge level, behavior, and attitudes of nurses on this subject can be significantly improved with an educational intervention. In a case-control study conducted in Iran, in-service training provided to nurses working in intensive care units improved their knowledge level, attitudes, and behaviors related to tube-mediated drug administration and increased the rate of consultation with pharmacists regarding medication administration [ 18 ]. In another case-control study conducted in Jordan, similar to previous studies, it was found that education provided to intensive care nurses improved their knowledge in areas such as tube cleaning, medication preparation, and recognition of dosage forms [ 47 ]. In a study conducted in Turkey, training provided to ninety nurses working in a neurology clinic, palliative care unit, and intensive care unit improved the nurses' knowledge and attitudes regarding medication administration through enteral routes [ 48 ]. In the current study, the correct response rate for questions related to medication administration is quite low (11.7%). Therefore, it is recommended to provide training to nurses working in palliative care units regarding medication administration in patients with tube feeding. In 2015, the Turkish Ministry of Health introduced a Palliative Care Nursing Certification Training Program, comprising 35 hours of theory and 80 hours of practical training over a five-year validity period. The program aims to equip nurses caring for palliative care patients with essential knowledge, skills, and attitudes [ 49 ]. While the theoretical part of the training program includes the topic of "Total Parenteral/Enteral Nutrition Application," this topic is not covered in the practical training section. In the current study, 33.66% of nurses reported that they received a certificate by completing the certification training program. However, only 7.32% of the nurses correctly answered questions on the Enteral Nutrition Practices Knowledge Form by more than 75%. It was also determined that having the palliative care certificate did not have a significant effect on the scores of the Enteral Nutrition Practices Knowledge Form and Nutritional Care Quality Perception score ( p > .05). Therefore, it is considered beneficial to enhance the content related to enteral nutrition in the palliative care certificate training programs and add this topic to practical lessons. In hospitals where nutrition support teams (NST) are established, nutrition support can be applied in a more individualized manner [ 50 ]. It has been shown that the implementation of nutrition support by NST significantly reduces nutrition-related complications, enables early detection of malnutrition, reduces calorie deficits in patients, and reduces costs [ 51 , 52 , 53 ]. Nutrition counseling teams are becoming increasingly common in hospitals worldwide [ 53 ]. In a study conducted by Kurt and Paslı Gündoğan (2023) in intensive care units in Turkey, 48.3% of the participating nurses reported that their institutions did not have NST [ 54 ]. This indicates the need for the more widespread use of nutrition support teams in hospital settings. In study, 29.7% of the nurses reported receiving consultation services from the nutrition team for all patients requiring nutritional support, while 39.5% reported receiving such services for some patients. It has been observed that the presence of nutrition counseling in the unit where the participant works significantly differentiated the Nutritional Care Quality Perception Score among groups. Although the percentage (11.22%) of nurses who were not aware of the presence of nutrition counseling in the palliative care unit where they work may seem proportionally low, it is an important finding. The lack of knowledge about the nutrition support protocol in the unit where the nurse works is a point that needs attention. Continuous training on the importance of nutrition support should be conducted in units where such support is frequently applied, and providing information about the unit's nutrition support practices during orientation training for those new to the unit is recommended. Strengths and limitations A strength of the current study is that it used validated evaluation tools to collect comprehensive data on nurses' knowledge and perceptions of enteral nutrition. It carried out thorough data analysis, investigating correlations between variables with a variety of statistical techniques. These results provide relevant information for improving the delivery of enteral nutrition care in palliative settings and designing focused educational interventions. The study also identified contextual elements that enriched the interpretation within wider societal and healthcare contexts, such as gender bias and Turkey's changing palliative care landscape. Accessing a significant percentage of the study population in Turkey's Izmir provience provided valuable insights into the local context. However, relying solely on data collected from a single province limits the generalizability of the findings. The study, which included 205 palliative care nurses, may not adequately represent the diversity and heterogeneity of the nursing profession in palliative care units. Furthermore, the dependence on self-reported data increases the possibility of bias, as nurses' behaviors regarding enteral feeding may differ from their self-reports. These limitations highlight the need for caution when applying the study's findings to other regions or groups, as well as the need of future research efforts that use broader sampling methodologies and objective assessments of nursing practices. Conclusion Nurses play a crucial role in implementing nutritional interventions, contributing significantly to the quality of nutrition care. This study revealed that nurses demonstrated moderate levels of knowledge regarding enteral nutrition practices, with lower correct answer rates for certain aspects such as fluid requirements and tube maintenance. The study found a positive correlation between nurses having received enteral nutrition training and higher knowledge scores. The presence of a nutrition consultant in units was associated with a higher perceived quality of nutritional care among nurses. The study found also a positive correlation between monthly tube feeding frequency and knowledge scores related to enteral nutrition practices. This study sheds light on nurses' enteral nutrition practices in palliative care units, offering valuable insights for clinical development. Ongoing training programs, formation of nutrition support teams, and dissemination of best practices in enteral nutrition are crucial for enhancing care quality in palliative units. Focused educational interventions are crucial for improving nurses' proficiency in enteral nutrition administration, particularly in fluid requirements, tube maintenance, and medication administration. Moreover, the presence of nutrition counseling teams positively influences perceived nutritional care quality, emphasizing the significance of interdisciplinary collaboration for better patient outcomes. Abbreviations WHO World Health Organization NST Nutrition Support Team ONS Oral Nutritional Support NG Nasogastric Tube NJ Nasojejunal PEG Percutaneous Endoscopic Gastrostomy Declarations Acknowledgements Our sincere thanks go to all participants of the study. Author contributions The listed authors meet the criteria for authorship and agree with the content of the manuscript. Study conception and design: ZB, GBM, Data collection: KT, Data analysis and interpretation: ZB, Drafting of the article: ZB, GBM. Critical revision of the article: GBM. All authors supervised critically reviewed the manuscript and checked spelling and grammar. All the authors read and approved the final manuscript. Funding source No funding was received for conduction this study. Data availability statement The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request. Ethics approval and consent to participate Non-Interventional Clinical Studies Ethics Committee of Health Sciences University Tepecik Training and Research Hospital (Approval no. 2022/01-26, Approved date: 17.01.2022) approved the proposal. The study was conducted following the Declaration of Helsinki. The participants were informed of the study's goal and given the assurance that their nonparticipation or withdrawal would not affect them negatively. The written consent forms were obtained from all participants. Consent for publication Not applicable. Competing interests The authors declare no competing interests. References World Health Organization. (2021). Body mass index – BMI. Available from: https://www.euro.who.int/en/health-topics/disease-prevention/nutrition/a-healthy-lifestyle/body-mass-index-bmi. (Date of access: 23.01.2023). Cimete G. Yaşam Sonu Bakım: Ölümcül Hastalarda Bütüncü Yaklaşım. İstanbul: İstanbul: Nobel Tıp Kitapevi, 2002. (in Turkish). 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Quality of life and its relation with nutritional status in patients with incurable cancer in palliative care. Support Care Cancer. 2020;28:4971-4978. https://doi.org/10.1007/s00520-020-05339-7 Bozzetti F. Is there a place for nutrition in palliative care?. Support. Care Cancer. 2020;28:4069-4075. https://doi.org/10.1007/s00520-020-05505-x Cadirci D, Ayazöz Y, & Koçakoğlu Ş. Evaluation of patients followed in a palliative care unit in Turkey. Turk Geriatri Derg. 2021; 24(2): 227. https://doi.org/10.31086/tjgeri.2021.219 Zengin H, & Taşçi I. Factors influencing the length of stay in the palliative care unit in patients dischargedhome: results from a tertiary hospital in Turkey. Turk. J. Med. Sci. 2021; 21;51(5): 2420-2426. https://doi.org/10.3906/sag-2101-307. Acreman S. Nutrition in palliative care. Br. J. Community Nurs. 2009;14(10):427-431. https://doi.org/10.12968/bjcn.2009.14.10.44494 Özbaş, N., & Baykara, Z. G. 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A review of the nursing care of enteral feeding tubes in critically ill adults: Part I. Intensive Crit. Care Nurs. 2004;20(6):330–343. https://doi.org/ 10.1016/j.iccn.2004.08.003. Gimenes FRE, Pareira RA, Horak ACP, Oliveira CC, Reis AMM, da Silva PICDS,…&Atilla E. Medication incidents related to feeding tube: A cross-sectional study. Afr J Pharm Pharmacol. 2017;11(27):305-313. https://doi.org/10.5897/AJPP2017.4799 Tillott H, Barrett D, Ruan J, Li V, Merrick S, Steed H, Morrissey H, Anthony Ball P. Survey of nurses’ knowledge and practice regarding medication administration using enteral tubes. J. Clin. Nurs. 2020;29(23-24):4614- 4622. https://doi.org/10.1111/jocn.15498. Çelik S, Demiray Y, Acar T, Köymen H, Coşkun Y, Doğru Ö, Keskin S, Kaya S. Evaluation of drug administrations via enteral tube of intensive care nurses. J Contemp Med. 2014;4(1):18-25. (in Turkish) Available from: https://dergipark.org.tr/en/pub/gopctd/issue/7310/95647 Hdaib NA, Albsoul-Younes A, & Wazaify M. Oral medications administration through enteral feeding tube: Clinical pharmacist-led educational intervention to improve knowledge of intensive care units’ nurses at Jordan University Hospital. Saudi Pharm J. 2021;29(2):134-142. https://doi.org/10.1016/j.jsps.2020.12.015 Çevik Ş. The effect of the training about the drug administration through enteral route by crushing and changing the shape of the drug on the knowledge and the attitudes of pediatric nurses, Nursing Program, Master Thesis, Gaziantep, 2021, Hasan Kalyoncu University (in Turkish). Available from: https://openaccess.hku.edu.tr/xmlui/bitstream/handle/20.500.11782/2394/Ezilerek%20ve%20%C5%9Fekli%20de%C4 %9Fi%C5%9Ftirilerek%20enteral%20yol%20ile%20verilen%20ila%C3%A7%20uygulamalar%C4%B1%20konusundaki%20e%C4%9Fitimin %20pediatri%20hem%C5%9Firelerinin%20bilgi%20ve%20tutumlar%C4%B1na%20etkisi.pdf?sequence=1&isAllowed=y Turkish Health Ministry (2015) Palyatif bakım hemşireliği sertifikalı eğitim programı standartları. 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Supplementary Files Questionnaire.docx Cite Share Download PDF Status: Published Journal Publication published 23 Dec, 2024 Read the published version in BMC Nursing → Version 1 posted Editorial decision: Revision requested 03 Nov, 2024 Reviews received at journal 10 Jun, 2024 Reviewers agreed at journal 08 Jun, 2024 Reviewers agreed at journal 15 May, 2024 Reviewers agreed at journal 30 Apr, 2024 Reviews received at journal 28 Apr, 2024 Reviewers agreed at journal 28 Apr, 2024 Reviewers invited by journal 26 Apr, 2024 Editor invited by journal 01 Apr, 2024 Editor assigned by journal 01 Apr, 2024 Submission checks completed at journal 01 Apr, 2024 First submitted to journal 23 Mar, 2024 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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As a result, healthcare professionals are encountering palliative care patients with chronic and life-threatening illnesses more frequently [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. Palliative care, encompassing holistic support for individuals of all ages enduring severe health-related suffering, especially those nearing the end of life, is crucial [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e] According to the World Health Organization (WHO), \"Palliative care is an approach that aims to improve the quality of life for patients and their families facing problems associated with life-threatening illnesses. It involves the early identification and impeccable assessment and treatment of pain and other physical, psychosocial, and spiritual issues to prevent and alleviate suffering [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. Its goal is to ensure terminal patients can live their remaining days in comfort [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eAdequate and balanced nutrition is crucial for maintaining essential functions in palliative care patients. However, symptoms like discomfort, nausea, oral ulcers, diarrhea, and vomiting can severely impact their nutritional intake, leading to deficiencies [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. Malnutrition in these patients can result in loss of body mass, weakened immunity, and organ dysfunction, ultimately affecting disease progression, reducing quality of life, and increasing hospitalization duration and mortality risk [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. Therefore, palliative care patients should be assessed for the risk of malnutrition, and early nutritional support should be initiated as needed [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. Therefore, assessing palliative care patients for malnutrition risk and providing early nutritional support is imperative [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eNurses are integral members of the multidisciplinary palliative care team, playing key roles in enhancing patients' quality of life and ensuring adequate nutrition [\u003cspan additionalcitationids=\"CR9\" citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. Their responsibilities, though varying based on hospital policies, typically involve tasks such as inserting and maintaining nasogastric feeding tubes, assessing calorie needs, initiating and adjusting nutrition plans, and promptly identifying and addressing any changes in patients' conditions [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. Nurses' lack of knowledge about enteral nutrition [\u003cspan additionalcitationids=\"CR14\" citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e], noncompliance with feeding guidelines [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e], and practice inconsistencies all contribute to malnutrition in critically ill patients, including those in palliative care units [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eEnteral nutrition, delivering essential nutrients via tube feeding to patients unable to eat orally, is widely utilized in palliative care units [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. Consequently, nurses in these units are expected to possess adequate knowledge of enteral nutrition. Despite numerous studies examining nurses' enteral nutrition knowledge levels [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan additionalcitationids=\"CR19 CR20\" citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e], research on the nutritional care perceptions of palliative care nurses is limited [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]. Particularly in Turkey, where studies on nutrition and nursing in palliative care are scarce, there's a need to assess nurses' knowledge and perceptions in this context.\u003c/p\u003e \u003cp\u003eThe aim of this study to determine the knowledge levels of nurses working in palliative care units regarding enteral nutrition practices and their perceptions of nutritional care quality in their units.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eDesign\u003c/h2\u003e \u003cp\u003eThis study is a cross-sectional, descriptive, quantitative research.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003eSetting and sample\u003c/h2\u003e \u003cp\u003e This descriptive cross-sectional study was conducted in the 25 palliative care units within public hospitals in İzmir, Turkey, between June and September 2022. The study population consisted of 237 nurses working in palliative care units. There was no sample selection process because the entire universe was to be used as the study sample. The inclusion criteria for the sample comprised individuals who had served as nurses in palliative care units for a minimum duration of six months and demonstrated willingness to engage in the study. Nurses who refused to participate in the study and filled out the questionnaire incompletely were excluded from the study. The study sample comprised 205 nurses. The rate of participation in the study was 86.5%.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003eData collection\u003c/h2\u003e \u003cp\u003e After a verbal explanation of the study goals, informed consent form was obtained from the nurses who agreed to participate in the study. Palliative nurses filled out the data collection forms under the supervision of the researchers. Data collection was carried out in their units. The completion of the forms took approximately 8\u0026ndash;10 minutes.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003eData collection tools\u003c/h2\u003e \u003cp\u003eThe knowledge level of nurses regarding enteral nutrition practices was determined using the Information Form on Enteral Nutrition Practices developed by Ko\u0026ccedil;han and Akın (2018) [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. This form consists of two sections: the first contains questions about enteral nutrition practices, and the second contains questions about indications for enteral nutrition, enteral nutrition solutions and complications, the duration of enteral solution administration, and questions to assess enteral nutrition knowledge. This form yields a minimum of 0 points and a maximum of 27 points [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. The perceived quality of nutritional care was assessed using the third section of the \"Scale for Evaluating the Importance of Nutritional Assessment, Knowledge Level of Nutritional Care, and Perceived Quality of Nutritional Care in Nurses,\" developed by Theilla et al. [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e] and validated by Kısacık et al. (2019). Each section of the scale can be evaluated separately. The score range that can be obtained from this section of the scale is 9\u0026ndash;45. A higher score from this section, consisting of nine items, reflects that nurses evaluate the quality of nutritional care provided to patients in their units more positively [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]. The data collection flowchart of the study is presented in Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003eData analysis\u003c/h2\u003e \u003cp\u003eThe collected data were analyzed using the Statistical Package for Social Sciences (SPSS) 22.0\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003esoftware. Descriptive statistics were performed, including means, standard deviations, medians,\u003c/p\u003e \u003cp\u003eminimum-maximum values, and frequency measurements. Conformity to a normal distribution of measurable variables was calculated with the Shapiro-Wilk test. Non-normally distributed data were analyzed using the Mann-Whitney U test for comparisons between two groups and the Kruskal-Wallis test for more than two categories. Fisher's Exact test was used when the Chi-Square test could not be applied for comparing categories. In correlation analyses for non-normally distributed data, the Spearman correlation test was used. The level of significance was set at \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;.05.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003eThe majority of nurses are female (94.6%) and bachelor's degree graduates (78.5%). About 37.56% of nurses stated that they have never received any training on enteral nutrition, while 66.34% do not have a palliative care certificate. In 19.51% of the units where they work, no nutrition counseling is provided, while in 29.76% of units, counseling is provided for all patients receiving nutritional support, and in 39.51% of units, counseling is provided for some patients receiving nutritional support. Additionally, 11.22% of participants stated that they do not have knowledge about the nutrition counseling practices implemented in their units (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003ePalliative care nurses sociodemographic and institutional characteristics\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"8\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003en\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003e%\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eGender\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003eMen\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e5.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003eWomen\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e194\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e94.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003eEducation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003eHealth Vocational High School\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e3.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003eAssociate degree\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e7.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003eBachelor's degree\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e161\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e78.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003eMaster degree\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e10.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003ePalliative Care Certification\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e69\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e33.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e136\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e66.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eEnteral Nutrition Training\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e128\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e62.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e77\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e37.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003eNutritional Counseling\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003eAll patients receiving nutritional support.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e61\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e29.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003eSome patients receiving nutritional support.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e81\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e39.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e19.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003eI have no knowledge\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e23\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e11.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003eThe most commonly used method of nutritional support\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003eONS\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e37\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e18.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" morerows=\"1\" nameend=\"c3\" namest=\"c2\" rowspan=\"2\"\u003e \u003cp\u003eTube feeding\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePEG\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e71\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e34.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eNG\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e61\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e29.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003eParenteral\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e36\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e17.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"8\" nameend=\"c8\" namest=\"c1\"\u003e \u003cp\u003e\u003cem\u003eONS: Oral nutritional support, NG: Nasogastric tube, PEG: Percutaneous endoscopic gastrostomy\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eThe median age of the participants is 36\u0026thinsp;\u0026plusmn;\u0026thinsp;years (Min: 21, Max: 51), the median professional experience is 14 years (Min: 1, Max: 34), the median palliative care unit experience is 3\u0026thinsp;\u0026plusmn;\u0026thinsp;years (Min: 1, Max: 16). The median values of Nutritional Care Quality Perception Score and Knowledge Level Total Score were determined as 36\u0026plusmn; (Min: 9, Max: 45), 15\u0026plusmn; (Min: 2, Max: 27), respectively (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eMonthly nutritional support numbers, knowledge levels, and perceived nutritional care quality scores\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMedian\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMinimum\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eMaximum\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWork Experience Duration\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e34\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePalliative Care Experience Duration\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e16\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMontly ONS Frequency\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e200\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMontly Tube (NG\u0026thinsp;+\u0026thinsp;PEG) Feeding Frequency\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e70\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMontly Parenteral Frequency\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e120\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNutritional Care Quality Perception Score\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e36\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e45\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eKnowledge Level Total Score\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e27\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"4\" nameend=\"c4\" namest=\"c1\"\u003e \u003cp\u003e\u003cem\u003eONS: Oral nutritional support, NG: Nasogastric tube, PEG: Percutaneous endoscopic gastrostomy\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eThe responses to questions related to knowledge levels regarding enteral nutrition practices are presented in Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e. It is observed that questions related to fluid requirements, maintaining the patency of the jejunostomy tube, enteral administration of medications, and types of tubes used during enteral nutrition with liquid solutions were answered correctly at rates lower than 25%. However, questions related to the use and maintenance of feeding sets/bags, nursing interventions to prevent gastrointestinal complaints during enteral nutrition with solutions, storage conditions for enteral products, care for NG tubes and PEG, infusion rates for NJ feeding, and nursing interventions to prevent NG tube obstruction were answered correctly at rates higher than 75%. The median score of the Enteral Nutrition Practices Knowledge Form was determined as 15 (Min: 2-Max: 27) (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eKnowledge levels regarding enteral nutrition practices (n\u0026thinsp;=\u0026thinsp;205)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"2\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRight (%)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1. Which type of solutions should be preferred for enteral nutrition?\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e127(61.9)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2. Which of the following statements is correct regarding continuous enteral feeding?\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e17(8.2)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e3. How many hours can enteral nutrition solutions remain in the feeding set?\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e121(59.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e4. Which of the following indicates delayed gastric emptying in enteral feeding?\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e69(33.6)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e5. How often should gastric residual volume be checked in intermittent enteral feeding to assess the tolerance of the given nutrition?\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e91(44.3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e6. How often should the enteral nutrition bag and set be changed in tube-fed patients?\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e181(88.2)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e7. Where and for how long should enteral nutrition products be stored after opening?\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e159(77.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e8. What is the maximum amount of enteral nutrition product that can be given in one feeding in bolus intermittent feeding?\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e54(26.3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e9. What is the maximum duration for each meal in intermittent enteral feeding?\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e77(37.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e10. To prevent possible pulmonary aspiration in patients receiving enteral nutrition, how many degrees should the patient's head be elevated during and after enteral feeding?\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e131(63.9)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e11. Nursing interventions to prevent abdominal distension and nausea/vomiting during enteral feeding are listed below. Which one is incorrect?\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e166(80.9)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e12. Which of the following interventions regarding medication administration in patients receiving enteral nutrition is incorrect?\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e24(11.7)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e13. Which nursing interventions are important to plan to prevent blockages in a nasogastric tube in an enterally fed patients?\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e150(73.1)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e14. What can develop if the enteral feeding solution is given cold to a patient receiving enteral nutrition?\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e175(85.3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e15. Which of the following interventions to prevent nausea and vomiting in enterally fed patients is incorrect?\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e179(87.3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e16. Which of the following interventions is incorrect for preventing bacterial growth in feeding bags and tubes during enteral nutrition?\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e174(84.8)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e17. Which of the following methods is not used to confirm the placement of a nasogastric tube in a patient with a nasogastric tube?\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e168(81.9)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e18. In patients requiring nutritional support who cannot take food orally, parenteral nutrition should be preferred initially.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e94(45.8)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e19. Enteral feeding solutions completely meet fluid requirements.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6(2.9)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e20. If a patient is being fed through a jejunostomy tube, drinking water should be given through the jejunostomy tube to maintain tube patency.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e20(9.7)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e21. Enteral feeding can be applied in cases such as intestinal obstruction, paralytic ileus, severe enteritis and peritonitis, severe diarrhea, and malabsorption.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e135(65.8)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e22. In the nasojejunal feeding method, since the nutrition solution is given directly to the intestine, complaints due to rapid gastric emptying (Dumping syndrome) may develop.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e154(75.1)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e23. Polyurethane and silicone tubes should be preferred in patients undergoing enteral nutrition.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e165(80.4)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e24. Hypertonic enteral nutrition solutions may cause diarrhea.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e92(44.8)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e25. Rapid and excessive administration of hypertonic nutrition solutions can cause dehydration.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e102(49.7)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e26. Polyvinyl tubes should be preferred in patients where the risk of complications is low and enteral nutrition is applied.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e21(10.2)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e27. In patients with a PEG catheter, the catheter insertion site (stoma) is cleaned using 0.9% NaCl or antiseptic solution.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e161(78.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eEnteral Nutrition Practices Knowledge Form \u0026ndash; Section 1\u0026thinsp;=\u0026thinsp;Median: 11(Min: 1-Max:17)\u003c/p\u003e \u003cp\u003eEnteral Nutrition Practices Knowledge Form - Section 2\u0026thinsp;=\u0026thinsp;Median: 5(Min: 0-Max:10)\u003c/p\u003e \u003cp\u003eTotal Score of the Knowledge Form on Enteral Nutrition Practices\u0026thinsp;=\u0026thinsp;Median: 15(Min: 2-Max:27)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eWhen the correct answer rates given to the Information Form on Enteral Nutrition Practices are evaluated; 0.98% (n\u0026thinsp;=\u0026thinsp;2) of the participants answered\u0026thinsp;\u0026lt;\u0026thinsp;25% of the questions, 23.41% (n\u0026thinsp;=\u0026thinsp;48) answered 25\u0026ndash;50%, 68.29% (n\u0026thinsp;=\u0026thinsp;140) answered 50\u0026ndash;75% and 7.32% (n\u0026thinsp;=\u0026thinsp;15) answered\u0026thinsp;\u0026gt;\u0026thinsp;75% correctly (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eThere was no statistically significant difference between the correct answer rates on the Enteral Nutrition Practices Knowledge Form and the presence of a palliative care certificate. However, the rate of correct answers was higher for those who received enteral nutrition training compared to those who did not (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.008) (Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e). Nurses who received enteral nutrition training had a higher total score on the Enteral Nutrition Practices Knowledge Form compared to those who did not (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;.01). However, there was no statistically significant difference in the Nutritional Care Quality Perception Scores between the two groups (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.190). Regarding the presence of a palliative care certificate, there was no statistically significant difference in the total knowledge score on the Enteral Nutrition Practices Knowledge Form (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.846) or the Nutritional Care Quality Perception Score (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.496).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eDistribution of correct answer rates based on palliative care certificate and enteral nutrition training status\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eThe Correct Answer Rates\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"4\" nameend=\"c5\" namest=\"c2\"\u003e \u003cp\u003ePalliative Care Certification\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003ep\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003en\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e%\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003en\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e%\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026lt;%25.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"4\" rowspan=\"5\"\u003e \u003cp\u003e.129\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e%25.0\u0026ndash;50.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e27.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e29\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e21.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e%50.0\u0026ndash;75.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e42\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e60.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e98\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e72.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026gt;%75.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e8.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e6.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTotal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e69\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e100.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e136\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e100.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"4\" nameend=\"c5\" namest=\"c2\"\u003e \u003cp\u003e\u003cb\u003eEnteral Nutrition Training\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026lt;%25.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003e.008*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e%25.0\u0026ndash;50.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e15.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e28\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e36.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e%50.0\u0026ndash;75.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e93\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e72.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e47\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e61.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026gt;%75.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTotal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e128\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e100.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e77\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e100.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"6\" nameend=\"c6\" namest=\"c1\"\u003e \u003cp\u003e\u003cem\u003eFisher\u0026rsquo;s Exact testi, * p\u0026thinsp;\u0026lt;\u0026thinsp;.05\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eThe presence of a nutrition consultant in the unit did not have a statistically significant impact on the total score of the Enteral Nutrition Practices Knowledge Form (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.543). However, there was a statistically significant difference in the Nutritional Care Quality Perception Score among groups (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;.05). According to the results of the Posthoc test (Tamhane-2 test), the group with a nutrition consultant in their unit had a higher Nutritional Care Quality Perception Score compared to those who did not have nutrition consulting (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.01). The results of the Posthoc test (Tamhane-2 test) indicate that the group with a nutrition consultant in their unit had a higher Nutritional Care Quality Perception Score compared to those who did not have nutrition consulting (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.01). This suggests that the presence of a nutrition consultant in the unit is associated with a higher perceived quality of nutritional care among nurses, and this difference is statistically significant (Table\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab5\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eThe impact of palliative care certificate, enteral nutrition training, and nutrition counseling on the total knowledge score related to enteral nutrition practices and the perception score of nutritional care quality\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003eEnteral Nutrition Practices Knowledge Form Score\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003eNutritional Care Quality Perception Score\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMedian(Min-Max)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003ep\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eMedian(Min-Max)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cem\u003ep\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003ePalliative Care Certification\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e15 (2\u0026ndash;22)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e.846\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e36 (9\u0026ndash;45)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e.496\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e15 (7\u0026ndash;27)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e36 (10\u0026ndash;45)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eEnteral Nutrition Training\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e16 (2\u0026ndash;27)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;.001\u003csup\u003ea\u003c/sup\u003e*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e36 (9\u0026ndash;45)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e.190\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e14 (7\u0026ndash;21)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e36 (13\u0026ndash;45)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eNutritional Counseling\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e15(8\u0026ndash;27)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e.543\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e37(9\u0026ndash;45)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e.001\u003csup\u003eb\u003c/sup\u003e*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e15(2\u0026ndash;22)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e35(19\u0026ndash;43)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eI don\u0026rsquo;t know\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e15(7\u0026ndash;20)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e32(13\u0026ndash;44)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"6\" nameend=\"c6\" namest=\"c1\"\u003e \u003cp\u003e\u003csup\u003e\u003cem\u003ea\u003c/em\u003e\u003c/sup\u003e\u003cem\u003eMann-Whitney U Test\u003c/em\u003e, \u003csup\u003e\u003cem\u003eb\u003c/em\u003e\u003c/sup\u003e\u003cem\u003eKruskal Wallis Test\u003c/em\u003e, \u003csup\u003e\u003cem\u003ec\u003c/em\u003e\u003c/sup\u003e\u003cem\u003eSpearman Korelasyon Testi, * p\u0026thinsp;\u0026lt;\u0026thinsp;.05\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eThe correlations between the Total Knowledge Score Related to Enteral Nutrition Practices and the Perception Score of Nutritional Care Quality, as well as monthly tube feeding frequency, monthly ONS (Oral Nutrition Support) frequency, monthly parenteral nutrition frequency, professional experience duration, and duration of working in palliative care, were examined. It was found that there is a positive correlation between the monthly tube feeding frequency and the Total Knowledge Score Related to Enteral Nutrition Practices (r\u0026thinsp;=\u0026thinsp;.173, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.013), while there was no statistically significant correlation with the other variables (Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab6\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 6\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eThe correlation between the perception score of nutritional care quality and the total knowledge score related to enteral nutrition practices\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNutrisyonel Nutritional Care Quality Perception Score\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eTotal Score of the Information Form on Enteral Nutrition Practices\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eMontly Tube Feeding Frequency\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003er\u003csup\u003ec\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e.048\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.173\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cem\u003ep\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e.497\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.013*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eMonthly ONS Frequency\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003er\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026minus;\u0026thinsp;.036\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.011\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cem\u003ep\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e.613\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e,876\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eMonthly Parenteral Nutrition Frequency\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003er\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026minus;\u0026thinsp;.105\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.038\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cem\u003ep\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e.137\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.588\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003ePalliative Care Experience Duration\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003er\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e.14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026minus;\u0026thinsp;.10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cem\u003ep\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e.839\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.888\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eProfessional Experience Duration\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003er\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e.107\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026minus;\u0026thinsp;.56\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cem\u003ep\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e.126\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.429\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eNutritional Care Quality Perception Score\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003er\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.089\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cem\u003ep\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.202\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eTotal Score of the Knowledge Form on Enteral Nutrition Practices\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003er\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e.089\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cem\u003ep\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e.202\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003en\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e205\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e205\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"5\"\u003eONS: Oral nutritional support\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe aim of this study was to examine the knowledge levels of nurses working in palliative care units regarding enteral nutrition practices, as well as their perceptions of the quality of nutritional care in their units. Receiving enteral nutrition training and the monthly frequency of tube feeding in the unit where nurses work had a significant effect on the overall score of the Enteral Nutrition Practices Knowledge Form. However, having a palliative care certificate did not have a significant effect on this score. The findings also highlighted that the perceived quality of nutritional care was above average and was influenced by whether the unit received nutrition counseling units. In Turkey, there used to be a requirement that individuals must be female to become a nurse according to the nursing law in effect between 1954 and 2007 [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]. However, the current law allows men to work as nurses, but for many years, nursing was predominantly considered a profession for women, which limited the number of male nurses [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e, \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]. This historical gender bias is reflected in your study, where the majority (94.63%) of the volunteers who participated in the study were female nurses. Furthermore, the expansion of palliative care centers in Turkey began with the Pallia Turk project, which was part of the National Cancer Control Program from 2009 to 2015. The number of these centers started to increase in 2012\u0026ndash;2013 [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e]. As a result, nurses in Turkey have had limited opportunities to work in palliative care units or centers, and their duration of employment in these settings has generally been relatively short. Your study found that the median duration of employment in a palliative care center for nurses was 3 years (minimum: 1 year, maximum: 16 years). This suggests that palliative care nursing is a field that is still developing in Turkey, and nurses with more experience may be more likely to work for longer periods in palliative care settings. These historical and contextual factors highlight the gender dynamics and the emerging field of palliative care nursing in Turkey.\u003c/p\u003e \u003cp\u003ePalliative care focuses on managing symptoms and disease-related stress in terminally ill patients. The goal of palliative care is to improve the quality of life for these patients while relieving them from pain, symptoms, and stress [\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e]. Malnutrition is common in palliative care patients and can be influenced by various factors. As the disease progresses in these patients, nutritional disorders become more common, leading to the need for nutritional support [\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e]. Proper nutritional interventions can support overall well-being and improve the overall quality of life [\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e]. Therefore, enteral nutrition is considered an essential component of providing quality care to patients in palliative care settings [\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e, \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e, \u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e]. Studies conducted in Turkey report a malnutrition risk of over 90% in palliative care units and enteral nutrition support rates of approximately 20\u0026ndash;60% [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e, \u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e]. Given the frequency of enteral nutrition use and its significant potential benefits for patients, it is important for nurses to have comprehensive and adequate knowledge in this area. [\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIt is expected that nurses being trained in enteral nutrition would enable them to assess patients' nutritional needs, administer enteral nutrition, monitor complications, and provide education on enteral nutrition to patients and their families. In the present study, 62.4% of the participating nurses reported receiving training in enteral nutrition. Previous studies conducted in Turkey have reported varying results regarding nurses' status of receiving enteral nutrition training, ranging from 7.8\u0026ndash;62% [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e, \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e, \u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e, \u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e]. This variation could be attributed to factors such as the policies of the institution/department where the study was conducted, the patient population served by the institution/department, and the year in which the research was carried out. Studies have shown that educational programs designed for nurses can significantly improve their practices, performance, and knowledge level related to enteral nutrition [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e, \u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e, \u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e, \u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e]. In this study, nurses who received enteral nutrition training had a higher total score on the Enteral Nutrition Practices Related Knowledge Form compared to those who did not receive training (p\u0026thinsp;\u0026lt;\u0026thinsp;0.01). However, even among those who received training, only 10.16% answered\u0026thinsp;\u0026gt;\u0026thinsp;75% of the questions correctly, and 17.18% answered\u0026thinsp;\u0026lt;\u0026thinsp;50% of the questions correctly. Insufficient knowledge and incorrect practices by nurses in providing enteral nutrition to patients can negatively affect both the quality of care and patient safety, while well-implemented nutritional nursing care can improve patients' nutritional status and clinical outcomes [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e, \u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e]. Therefore, it is recommended to plan regular and continuous education to enhance nurses' enteral nutrition practices and improve the quality of care.\u003c/p\u003e \u003cp\u003eIn this study, it can be said that nurses' knowledge level regarding enteral nutrition practices is at a moderate level. This result is similar to previous studies conducted in Turkey [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e, \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]. In a study by Ko\u0026ccedil;han \u0026amp; Akın (2018), it was shown that nurses had insufficient knowledge in areas such as storage conditions of enteral products, tolerance of the feed given to enterally fed patients, gastric residual volume indicating delayed gastric emptying in enteral nutrition, and medication administration in enterally fed patients [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. In another study, it was found that nurses answered questions related to skin problems around stomas (83.53%), feeding position (80.59%), and interventions to prevent nausea and vomiting (73.53%) more correctly. However, they mostly couldn't answer questions about residual volume (88.82%), pulmonary aspiration (61.76%), and tube care (56.47%) [24;35]. In this study, the questions related to fluid requirements during tube feeding (2.9%), maintaining the patency of jejunostomy tubes (9.8%), and medication administration (11.71%) during tube feeding were the least correctly answered questions.\u003c/p\u003e \u003cp\u003eFor patients receiving tube feeding, if fluid restriction is not applied, fluid requirements are calculated as 1 mL/kcal. Since most of the isocaloric formulas commonly used in these patients consist of approximately 75% water, additional fluid support is needed, typically at least 25% of the used feeding product. The remaining amount in the calculated fluid requirement can be completed with drinking water to meet the patient's fluid needs. The amount of water used in tube irrigations is also included in this calculation [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e, \u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e, \u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e]. It's worth noting that one of the questions with the highest number of incorrect answers in this study was \"Enteral nutrition solutions completely meet fluid requirements.\" Only 2.92% of the nurses in the study answered this question correctly. This indicates that nurses may not have sufficient knowledge about the content of enteral nutrition products and determining daily fluid requirements.\u003c/p\u003e \u003cp\u003eIn tube feeding, the patency of the feeding tube cannot be maintained due to various factors, and blockages may occur. Proper flushing is required to prevent blockages and maintain patency. In continuous feeding, the tube should be flushed with water every 4\u0026ndash;6 hours, and in intermittent feeding, before and after each feeding, and if the tube is not in use, it should be flushed every eight hours. In addition, to prevent potential blockages due to drug and formula interactions, it is recommended to flush the tube before and after drug administration [\u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e]. In this study, the question about preventing blockages in nasogastric tubes was answered correctly by 73.17%, while the question about maintaining patency in jejunostomy tubes was only answered correctly by 9.76%. This may be due to the fact that PEG and NG tubes are commonly used in the units where the nurses work, while jejunostomy tubes are not frequently used.\u003c/p\u003e \u003cp\u003eNutrition tubes can also be used for administering orally administered medications. Incorrect preparation and/or administration of medication in these processes can affect patients [\u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e]. In the literature, there are studies that report that nurses are not sufficient in preventing drug interactions in enteral drug administration and that the flushing procedures vary [\u003cspan additionalcitationids=\"CR45\" citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e46\u003c/span\u003e]. It has been shown that the knowledge level, behavior, and attitudes of nurses on this subject can be significantly improved with an educational intervention. In a case-control study conducted in Iran, in-service training provided to nurses working in intensive care units improved their knowledge level, attitudes, and behaviors related to tube-mediated drug administration and increased the rate of consultation with pharmacists regarding medication administration [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. In another case-control study conducted in Jordan, similar to previous studies, it was found that education provided to intensive care nurses improved their knowledge in areas such as tube cleaning, medication preparation, and recognition of dosage forms [\u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e47\u003c/span\u003e]. In a study conducted in Turkey, training provided to ninety nurses working in a neurology clinic, palliative care unit, and intensive care unit improved the nurses' knowledge and attitudes regarding medication administration through enteral routes [\u003cspan citationid=\"CR48\" class=\"CitationRef\"\u003e48\u003c/span\u003e]. In the current study, the correct response rate for questions related to medication administration is quite low (11.7%). Therefore, it is recommended to provide training to nurses working in palliative care units regarding medication administration in patients with tube feeding.\u003c/p\u003e \u003cp\u003eIn 2015, the Turkish Ministry of Health introduced a Palliative Care Nursing Certification Training Program, comprising 35 hours of theory and 80 hours of practical training over a five-year validity period. The program aims to equip nurses caring for palliative care patients with essential knowledge, skills, and attitudes [\u003cspan citationid=\"CR49\" class=\"CitationRef\"\u003e49\u003c/span\u003e]. While the theoretical part of the training program includes the topic of \"Total Parenteral/Enteral Nutrition Application,\" this topic is not covered in the practical training section. In the current study, 33.66% of nurses reported that they received a certificate by completing the certification training program. However, only 7.32% of the nurses correctly answered questions on the Enteral Nutrition Practices Knowledge Form by more than 75%. It was also determined that having the palliative care certificate did not have a significant effect on the scores of the Enteral Nutrition Practices Knowledge Form and Nutritional Care Quality Perception score (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026gt;\u0026thinsp;.05). Therefore, it is considered beneficial to enhance the content related to enteral nutrition in the palliative care certificate training programs and add this topic to practical lessons.\u003c/p\u003e \u003cp\u003eIn hospitals where nutrition support teams (NST) are established, nutrition support can be applied in a more individualized manner [\u003cspan citationid=\"CR50\" class=\"CitationRef\"\u003e50\u003c/span\u003e]. It has been shown that the implementation of nutrition support by NST significantly reduces nutrition-related complications, enables early detection of malnutrition, reduces calorie deficits in patients, and reduces costs [\u003cspan citationid=\"CR51\" class=\"CitationRef\"\u003e51\u003c/span\u003e, \u003cspan citationid=\"CR52\" class=\"CitationRef\"\u003e52\u003c/span\u003e, \u003cspan citationid=\"CR53\" class=\"CitationRef\"\u003e53\u003c/span\u003e]. Nutrition counseling teams are becoming increasingly common in hospitals worldwide [\u003cspan citationid=\"CR53\" class=\"CitationRef\"\u003e53\u003c/span\u003e]. In a study conducted by Kurt and Paslı G\u0026uuml;ndoğan (2023) in intensive care units in Turkey, 48.3% of the participating nurses reported that their institutions did not have NST [\u003cspan citationid=\"CR54\" class=\"CitationRef\"\u003e54\u003c/span\u003e]. This indicates the need for the more widespread use of nutrition support teams in hospital settings.\u003c/p\u003e \u003cp\u003eIn study, 29.7% of the nurses reported receiving consultation services from the nutrition team for all patients requiring nutritional support, while 39.5% reported receiving such services for some patients. It has been observed that the presence of nutrition counseling in the unit where the participant works significantly differentiated the Nutritional Care Quality Perception Score among groups. Although the percentage (11.22%) of nurses who were not aware of the presence of nutrition counseling in the palliative care unit where they work may seem proportionally low, it is an important finding. The lack of knowledge about the nutrition support protocol in the unit where the nurse works is a point that needs attention. Continuous training on the importance of nutrition support should be conducted in units where such support is frequently applied, and providing information about the unit's nutrition support practices during orientation training for those new to the unit is recommended.\u003c/p\u003e \u003cdiv id=\"Sec10\" class=\"Section2\"\u003e \u003ch2\u003eStrengths and limitations\u003c/h2\u003e \u003cp\u003eA strength of the current study is that it used validated evaluation tools to collect comprehensive data on nurses' knowledge and perceptions of enteral nutrition. It carried out thorough data analysis, investigating correlations between variables with a variety of statistical techniques. These results provide relevant information for improving the delivery of enteral nutrition care in palliative settings and designing focused educational interventions. The study also identified contextual elements that enriched the interpretation within wider societal and healthcare contexts, such as gender bias and Turkey's changing palliative care landscape.\u003c/p\u003e \u003cp\u003eAccessing a significant percentage of the study population in Turkey's Izmir provience provided valuable insights into the local context. However, relying solely on data collected from a single province limits the generalizability of the findings. The study, which included 205 palliative care nurses, may not adequately represent the diversity and heterogeneity of the nursing profession in palliative care units. Furthermore, the dependence on self-reported data increases the possibility of bias, as nurses' behaviors regarding enteral feeding may differ from their self-reports. These limitations highlight the need for caution when applying the study's findings to other regions or groups, as well as the need of future research efforts that use broader sampling methodologies and objective assessments of nursing practices.\u003c/p\u003e \u003c/div\u003e"},{"header":"Conclusion","content":"\u003cp\u003eNurses play a crucial role in implementing nutritional interventions, contributing significantly to the quality of nutrition care. This study revealed that nurses demonstrated moderate levels of knowledge regarding enteral nutrition practices, with lower correct answer rates for certain aspects such as fluid requirements and tube maintenance. The study found a positive correlation between nurses having received enteral nutrition training and higher knowledge scores. The presence of a nutrition consultant in units was associated with a higher perceived quality of nutritional care among nurses. The study found also a positive correlation between monthly tube feeding frequency and knowledge scores related to enteral nutrition practices. This study sheds light on nurses' enteral nutrition practices in palliative care units, offering valuable insights for clinical development. Ongoing training programs, formation of nutrition support teams, and dissemination of best practices in enteral nutrition are crucial for enhancing care quality in palliative units. Focused educational interventions are crucial for improving nurses' proficiency in enteral nutrition administration, particularly in fluid requirements, tube maintenance, and medication administration. Moreover, the presence of nutrition counseling teams positively influences perceived nutritional care quality, emphasizing the significance of interdisciplinary collaboration for better patient outcomes.\u003c/p\u003e"},{"header":"Abbreviations ","content":"\u003cp\u003eWHO \u0026nbsp; \u0026nbsp; \u0026nbsp;World Health Organization\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eNST \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Nutrition Support Team\u003c/p\u003e\n\u003cp\u003eONS \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Oral Nutritional Support\u003c/p\u003e\n\u003cp\u003eNG \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Nasogastric Tube\u003c/p\u003e\n\u003cp\u003eNJ \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; Nasojejunal\u0026nbsp;\u003c/p\u003e\n\u003cp\u003ePEG \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Percutaneous Endoscopic Gastrostomy\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgements\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eOur sincere thanks go to all participants of the study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe listed authors meet the criteria for authorship and agree with the content of the manuscript. Study\u0026nbsp;conception\u0026nbsp;and design: ZB, GBM, Data collection: KT, Data analysis\u0026nbsp;and interpretation: ZB,\u0026nbsp;Drafting of the article: ZB, GBM.\u0026nbsp;Critical revision of the article: GBM. All authors supervised critically reviewed the manuscript and checked spelling and grammar.\u0026nbsp;All the authors read and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding source\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNo funding was received for conduction this study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData availability statement\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets used and/or analysed during the current study are available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNon-Interventional Clinical Studies Ethics Committee of Health Sciences University Tepecik Training and Research Hospital\u0026nbsp;(Approval no. 2022/01-26, Approved date: 17.01.2022)\u0026nbsp;approved the proposal.\u0026nbsp;The study was conducted following the Declaration of Helsinki.\u0026nbsp;The participants were informed of the study\u0026apos;s goal and given the assurance that their nonparticipation or withdrawal would not affect them negatively.\u0026nbsp;The written consent forms were obtained from all participants.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare no competing interests.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n \u003cli\u003eWorld Health Organization. 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Evaluation of patients followed in a palliative care unit in Turkey. Turk Geriatri Derg. 2021; 24(2): 227. https://doi.org/10.31086/tjgeri.2021.219\u003c/li\u003e\n \u003cli\u003eZengin H, \u0026amp; Taş\u0026ccedil;i I. Factors influencing the length of stay in the palliative care unit in patients dischargedhome: results from a tertiary hospital in Turkey. Turk. J. Med. Sci. 2021; 21;51(5): 2420-2426. https://doi.org/10.3906/sag-2101-307.\u003c/li\u003e\n \u003cli\u003eAcreman S. Nutrition in palliative care. Br. J. Community Nurs. 2009;14(10):427-431. https://doi.org/10.12968/bjcn.2009.14.10.44494\u003c/li\u003e\n \u003cli\u003e\u0026Ouml;zbaş, N., \u0026amp; Baykara, Z. G. The determination of the level of knowledge of nurses on enteral tube feeding. J. Hum. Sci. 2018; 15(1), 359-367. https://doi.org/10.14687/jhs.v15i1.3907\u003c/li\u003e\n \u003cli\u003eKalender N, \u0026amp; Nuran Tosun RN. Nursing studies about central venous catheter care: A literature review and recommendations for clinical practice. Int. J. Caring Sci. 2015;8(2): 461. Available from: https://www.internationaljournalofcaringsciences.org/docs/26_kalender-1.pdf\u003c/li\u003e\n \u003cli\u003eAhmed AT, \u0026amp; Hassan HB. Interventional nursing program for nurses practices about enteral feeding guidelines in critical units. Indian J. Forensic Med. Toxicol. 2021;15(2):4574-4580. https://doi.org/10.37506/ijfmt.v15i2.15107.\u003c/li\u003e\n \u003cli\u003eKim H, \u0026amp; Chang SJ. Implementing an educational program to improve critical care nurses\u0026apos; enteral nutritional support. Aust Crit Care. 2019;32(3):218-222. https://doi.org/10.1016/j.aucc.2018.04.001\u003c/li\u003e\n \u003cli\u003eBedier NA, EL-Ata ABA, \u0026amp; Shehab MS. Effect of educational program on nurses\u0026apos; practice related to care of patients undergoing nasogastric tube feeding. Int. J. Caring Sci. 2016;9(2):432. 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Nutr Clin Pract. 2023;38(2): 216-239. https://doi.org/10.1002/ncp.10959\u003c/li\u003e\n \u003cli\u003eWilliams TA, Leslie GD. A review of the nursing care of enteral feeding tubes in critically ill adults: Part I. Intensive Crit. Care Nurs. 2004;20(6):330\u0026ndash;343. https://doi.org/ 10.1016/j.iccn.2004.08.003.\u003c/li\u003e\n \u003cli\u003eGimenes FRE, Pareira RA, Horak ACP, Oliveira CC, Reis AMM, da Silva PICDS,\u0026hellip;\u0026amp;Atilla E. Medication incidents related to feeding tube: A cross-sectional study. Afr J Pharm Pharmacol. 2017;11(27):305-313. https://doi.org/10.5897/AJPP2017.4799\u003c/li\u003e\n \u003cli\u003eTillott H, Barrett D, Ruan J, Li V, Merrick S, Steed H, Morrissey H, Anthony Ball P. Survey of nurses\u0026rsquo; knowledge and practice regarding medication administration using enteral tubes. J. Clin. 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PLoS One. 2019;14(3): e0213076. https://doi.org/ 10.1371/journal.pone.0213076 from: https://pdfs.semanticscholar.org/9cc1/46ede9f708aec73d9fa42d88680b90594c74.pdf.\u003c/li\u003e\n \u003cli\u003eReber E, Strahm R, Bally L, Schuetz P, \u0026amp; Stanga Z. Efficacy and efficiency of nutritional support teams. J. Clin. Med. 2019; 8(9):1281. https://doi.org/10.3390/jcm8091281\u003c/li\u003e\n \u003cli\u003eKurt D. \u0026amp; Paslı G\u0026uuml;rdoğan E. Nutritional awareness in intensive care nurses. Istanbul Gelisim University Journal of Health Sciences.\u003cem\u003e\u0026nbsp;\u003c/em\u003e2023;(19):240-254. https://doi.org/10.38079/igusabder.1199757\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-nursing","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"nurs","sideBox":"Learn more about [BMC Nursing](http://bmcnurs.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/nurs/default.aspx","title":"BMC Nursing","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"enteral nutrition, knowledge, nurses, nutritional care quality, palliative care units, palliative care nurses","lastPublishedDoi":"10.21203/rs.3.rs-4155845/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4155845/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground: \u003c/strong\u003eSufficient and well-balanced nutrition is pivotal in sustaining essential functions among patients in palliative care units.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAim: \u003c/strong\u003eTo determine the knowledge levels of nurses working in palliative care units regarding enteral nutrition practices and their perceptions of nutritional care quality in their units.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods: \u003c/strong\u003eThis descriptive, cross-sectional study was conducted in 25 palliative care units located in Izmir, Türkiye, between June and September 2022. The study sample consisted of 205 nurses working in palliative care units. Data were collected using a general information form, an Enteral Nutrition Practices Knowledge Form, and the Nurses' Perceived Nutrition Care Quality Assessment Scale. STROBE checklist was used.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults: \u003c/strong\u003eThe study found that the majority of participating nurses (94.6%) were female, with 78.5% holding bachelor's degrees. The median knowledge score for enteral nutrition: 15 (range: 2-27), perceived care quality score: 36 (range: 9-45). Those with enteral nutrition training had significantly higher knowledge scores (\u003cem\u003ep\u003c/em\u003e \u0026lt;.001); palliative care certificate showed no difference (\u003cem\u003ep\u003c/em\u003e = .846). Nurses lacking nutrition counseling knowledge had lower perceived care quality scores (\u003cem\u003ep\u003c/em\u003e = 0.001). Monthly tube feeding applications correlated positively with knowledge scores (r = .173, \u003cem\u003ep\u003c/em\u003e = .013), unlike professional experience duration (\u003cem\u003ep\u003c/em\u003e= .126) and time spent in palliative care (\u003cem\u003ep\u003c/em\u003e = .839).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion: \u003c/strong\u003eNurses working in the palliative care unit find the quality of nutrition care provided to patients in their clinics to be sufficient, and the level of knowledge regarding enteral nutrition is at a moderate level. However, in questions related to nursing care such as fluid requirements during enteral nutrition with enteral solutions that affect both nutritional care and medical treatment, maintaining the opening of the jejunostomy tube, and enteral drug administration, correct response rates were low. Low correct response rates on specific issues highlight a need for targeted educational interventions.\u003c/p\u003e","manuscriptTitle":"Enhancing Nutritional Care in Palliative Care Units: Assessing Nurse Knowledge and Quality Perception in Enteral Nutrition Practices","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-10-21 08:13:57","doi":"10.21203/rs.3.rs-4155845/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2024-11-04T04:59:00+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-06-10T09:29:58+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"38457188327580552918045373656578975857","date":"2024-06-08T08:19:44+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"337456399753287266374146112356994907595","date":"2024-05-15T10:23:58+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"273221021115492327855487622069506335605","date":"2024-04-30T22:32:41+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-04-28T19:50:05+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"281665854085868582097531946616482221402","date":"2024-04-28T18:30:14+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2024-04-26T17:16:03+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2024-04-01T10:06:20+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2024-04-01T10:04:58+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2024-04-01T10:04:57+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Nursing","date":"2024-03-23T21:37:55+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-nursing","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"nurs","sideBox":"Learn more about [BMC Nursing](http://bmcnurs.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/nurs/default.aspx","title":"BMC Nursing","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"9806ad19-d243-4354-b406-8e5cb1cd1557","owner":[],"postedDate":"October 21st, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2024-12-30T16:04:55+00:00","versionOfRecord":{"articleIdentity":"rs-4155845","link":"https://doi.org/10.1186/s12912-024-02580-x","journal":{"identity":"bmc-nursing","isVorOnly":false,"title":"BMC Nursing"},"publishedOn":"2024-12-23 15:57:29","publishedOnDateReadable":"December 23rd, 2024"},"versionCreatedAt":"2024-10-21 08:13:57","video":"","vorDoi":"10.1186/s12912-024-02580-x","vorDoiUrl":"https://doi.org/10.1186/s12912-024-02580-x","workflowStages":[]},"version":"v1","identity":"rs-4155845","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4155845","identity":"rs-4155845","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}