- kalaldeh82@yahoo.com
P.O Box: 694-11592
Amman - Jordan - (00962) 777 997754
Mahmoud Kalaldeh
Zarqa University, Faculty of Nursing, Faculty Member
- Critical Care Nursingedit
Background Self-efficacy in resuscitation is influenced by various educational models, including high-fidelity simulation (HFS). Method Sixty-two nurses who were enrolled in an Advanced Cardiac Life Support (ACLS) course using HFS were... more
Background Self-efficacy in resuscitation is influenced by various educational models, including high-fidelity simulation (HFS). Method Sixty-two nurses who were enrolled in an Advanced Cardiac Life Support (ACLS) course using HFS were recruited for this pretest–posttest, quasi-experimental study. Self-efficacy was assessed three times—twice via the participants' self-report and once via the instructor's assessment—using the Resuscitation Self-Efficacy Scale (RSES). Results The four dimensions of self-efficacy—recognition, debriefing and recording, responding and rescuing, and reporting—improved after the HFS education ( t = 4.89, SE = 1.84, p < .001, confidence interval [−12.7, −5.33]). The instructor's scoring was higher than the participants' scoring in two of the four dimensions. The score on the ACLS written examination was positively correlated with the posttest RSES score ( r = 0.303, p = .017). Despite minimal variations between demographic subgroups, nurs...
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Aim: To examine the congruency between patient self-reporting and nurse assessment of pain in the emergency department (ED) through the use of the numerical rating scale (NRS) and visual analogue scale (VAS). Materials & methods: Patient... more
Aim: To examine the congruency between patient self-reporting and nurse assessment of pain in the emergency department (ED) through the use of the numerical rating scale (NRS) and visual analogue scale (VAS). Materials & methods: Patient self-reporting of pain and nurse assessments were concurrently conducted using the NRS and VAS. Results & conclusion: Self-reported pain assessment was collected from 200 ED patients in parallel with their corresponding nurse-reported pain scores, conducted by 67 ED nurses. Although nurse–patient pain scoring was associated with a high congruency using both NRS and VAS (88.2 and 91.5%, respectively), nurses still underestimated patients' pain intensity using both tools (t = 2.37 and 2.60; p = 0.007 and 0.010 and CI: 0.17–1.1 and 0.06–0.46, respectively). Some nurse–patient characteristics showed relationships with a discrepancy in pain scoring.
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Knowledge and attitude towards pain management. A comparison between oncology and non-oncology nurses in Jordan
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Background: Despite considerable research on violence and unintentional injuries among Jordanian students that focused primarily on those aged 13 - 15 years, very little attention has been paid to such injuries regarding 15 - 19 year-old... more
Background: Despite considerable research on violence and unintentional injuries among Jordanian students that focused primarily on those aged 13 - 15 years, very little attention has been paid to such injuries regarding 15 - 19 year-old students. Objectives: The purpose of this study was to estimate the prevalence of violence and unintentional injuries, among the Jordanian school students aged 15 - 19 years, and to compare the patterns of these behaviors between male and female students. Materials and Methods: This descriptive-analytic cross-sectional study comprised 750 secondary school students and carried out on randomly selected eight comprehensive secondary schools (four schools for females and four schools for males) from the public educational directorate located in Amman. A modified Arabic version of the general school health survey questionnaire was used to measure violence-related behaviors and unintentional injuries. Results: The findings showed that 26.8% of students had been physically attacked. Overall, 43.3% of students were involved in a physical fight and 20.1% were bullied. Overall, 45.3% of students sustained serious injuries, of whom 31.2% were engaged in playing or training for sports, 35.6% were injured in a fall, and 60.3% hurt themselves by accident, with broken bone or dislocated joint presenting the most serious injuries. There was a difference between male and female students regarding physical attack, physical fight, and injuries. Conclusions: It is necessary to implement an effective school health program including social and physical environments that promote safety and prevent injuries and violence.
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Background: Severe brain attack patients demonstrate hypermetabolic state and gastrointestinal dysfunction, leading to faster onset of nutritional failure. Aim: To estimate the time point where the development of nutritional failure is... more
Background: Severe brain attack patients demonstrate hypermetabolic state and gastrointestinal dysfunction, leading to faster onset of nutritional failure. Aim: To estimate the time point where the development of nutritional failure is more probable among patients with acute brain attacks in the intensive care unit (ICU). Methods: Direct bedside observation for selected nutritional parameters was performed. When enteral nutrition was initiated, observation was performed at five points over 9 days. Findings: 84 patients with 55% mortality risk and on mechanical ventilation were included. Over the observation period, gastric residual volume increased (144 ml vs 196 ml), body weight decreased (79.4 kg vs 74.3 kg), and serum albumin reduced (3.6 g/dl to 3.1 g/dl). Caloric attainment and malnutrition score deteriorated, and feeding-related complications increased. Nutritional failure was evidently prevalent between the third and fifth day of observation. Conclusion: An earlier period of ...
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Background: Hazardous alcohol addiction is one of the worldwide problematic issues that entail physical, social, and psychological negative conseq uences. Heath education was found as a key to increase patients' level of awareness of... more
Background: Hazardous alcohol addiction is one of the worldwide problematic issues that entail physical, social, and psychological negative conseq uences. Heath education was found as a key to increase patients' level of awareness of those fact ors triggering addiction and prohibiting alcohol quitting. Aim: To examine the effect of implementing a brief alco hol intervention, using the heath-belief model, on the perception of susceptibility, severity, bene fits, and barriers. Method: This pre-test post-test interventional study recru ited 70 alcohol use disorders patients residing in the addiction centre in Amman-Jordan. The programme consisted of three 30-minuts sessions and included an introduction about alcohol abuse, orien tation of the consequences of alcohol addiction, an d practices towards promoting self-motivation. Data were collected before and two weeks after the intervention using a questionnaire of 58 items cove ring all the health-belief model components which were ...
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Background and PurposeAccreditation is viewed to enhance the total quality of healthcare. The present study aims at assessing patients' perspectives toward the quality of emergency healthcare services at different hospitals with... more
Background and PurposeAccreditation is viewed to enhance the total quality of healthcare. The present study aims at assessing patients' perspectives toward the quality of emergency healthcare services at different hospitals with different characteristics in Jordan. The elements of patients' perception were aligned with the conceptual framework of Patient Centeredness Model.MethodsThis descriptive cross-sectional study was carried out in four emergency departments from different healthcare sectors and accreditation statuses in Jordan. Less urgent/nonurgent, alert, and cooperative patients were identified directly after the completion of emergency treatment. The perspectives of patients about the quality of emergency services were evaluated by 10 domains articulated in a validated accident and emergency questionnaire.ResultsA total of 276 patients were enrolled in the study. Private sector scored higher in all assessment domains in both accredited and nonaccredited hospitals i...
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Background: Fatigue, depression and sleep disturbance are regarded as a symptom cluster associated with pregnancy. The mediation effect of sleep disturbance on the relationship between depression on fatigue is still unclear. Objective: To... more
Background: Fatigue, depression and sleep disturbance are regarded as a symptom cluster associated with pregnancy. The mediation effect of sleep disturbance on the relationship between depression on fatigue is still unclear. Objective: To assess the mediation effect of sleep disturbance on the established relationship between depression and fatigue among pregnant women. Methods: This study used a cross-sectional design. Pregnant women (n = 130) at a private gynecology and obstetrics outpatient clinic in Amman, Jordan. Participants were recruited to complete the Brief Fatigue Inventory, the Insomnia Severity Index, and the Zung depression scale, in addition to the demographic questionnaire. The mediation effect was examined through a Hierarchal Multiple Regression model. Results: A total of 130 pregnant women participated (mean of ages= 27.3). Of those, 41.5% were in the first trimester, while the rest were in their second and the third trimesters (27.7%, and 30.8%, respectively). Re...
BACKGROUND It has been identified that ineffective nurse-patient communication in the emergency department (ED) can lead to frustration, mistrust and inadequate pain management. Therefore, it is important to recognise the potential... more
BACKGROUND It has been identified that ineffective nurse-patient communication in the emergency department (ED) can lead to frustration, mistrust and inadequate pain management. Therefore, it is important to recognise the potential barriers to effective communication, including nurse and patient-related factors. AIM To identify what emergency nurses perceive as barriers to nurse-patient communication, and if there is any difference in the perception of communication barriers between nurses' demographic subgroups. METHOD A total of 199 emergency nurses were recruited using convenience sampling, from nine hospitals in the West Bank, Palestine. These nurses completed a 27-item questionnaire that encompassed six domains of barriers that may affect nurse-patient communication: demographic, knowledge-related, environmental, social, economic and psychological factors. RESULTS Of the six domains covered by the questionnaire, environmental factors scored the highest, meaning that emergency nurses perceived these to be the most significant barriers to effective nurse-patient communication. This was followed by knowledge-related and psychological factors. Knowledge-related factors were perceived to be a greater communication barrier by male nurses more than female nurses, and by younger nurses more than older nurses. CONCLUSION To enhance nurse-patient communication, it is important to establish a comfortable working environment and to provide ongoing training for nurses to develop their communication skills.
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PURPOSE This case report investigated the transactional model of stress and coping as guidance for nursing care of an adolescent patient with thalassemia. SOURCES USED A case study of a 15-year-old female patient with β-thalassemia major.... more
PURPOSE This case report investigated the transactional model of stress and coping as guidance for nursing care of an adolescent patient with thalassemia. SOURCES USED A case study of a 15-year-old female patient with β-thalassemia major. Data were collected using patient medical records, an interview with the patient and physical examination. RESULTS Four issues related to coping were isolated: Worsening physical symptoms; psychosocial consequences, coping process, and building supportive networks. These issues and the patient's adaption are explored via the transactional model. CONCLUSIONS Having thalassemia was cognitively appraised by the patient as a stressful and taxing situation with detrimental consequences, such as changes in physical appearance, stigmatization, and depression. Nurses should evaluate each patient's physical and psychosocial needs, utilizing appropriate theoretical models for designing a suitable care plan. As the case study demonstrates, the transactional model was an effective guide for nurses in planning care of an adolescent patient with thalassemia.
Research Interests: Psychology and Nursing
BACKGROUND There is still no concrete guidance for assessing malnutrition risk in the critically ill. Nutrition Risk in the Critically Ill (NUTRIC) score is undertaken cautiously compared with other validated tools such as bioelectrical... more
BACKGROUND There is still no concrete guidance for assessing malnutrition risk in the critically ill. Nutrition Risk in the Critically Ill (NUTRIC) score is undertaken cautiously compared with other validated tools such as bioelectrical impedance analysis (BIA). This study aimed to assess the malnutrition risk in the critically ill using NUTRIC score and assess its congruency with the BIA. METHODS In this cross-section observational study, intensive care unit (ICU) patients from various etiologies were assessed using the earlier tools in addition to other prognostic markers (Acute Physiologic Assessment and Chronic Health Evaluation II [APACHE II] and Sequential Organ Failure Assessment [SOFA] scores), caloric attainment, and feeding complications. RESULTS Of a total 411 assessed patients, 313 (76.2%) were enterally fed, and 318 (77.4%) were mechanically ventilated. Mean age was 60.7 years, and the median of the assessment since admission was the 12th day. Of those enterally fed patients, 57.9% attained the caloric requirements. Both APACHE II and SOFA scores were compatible in ascertaining ICU mortality at a moderate level (17.88 and 7.17, respectively). The NUTRIC score and phase angle (PA) measured by BIA revealed no differences in the malnutrition risk between patients with and without enteral nutrition. However, regression indicated that the NUTRIC score has explained only 1.1% of the variance of PA after controlling other covariates (β = -0.222, P = .009, confidence interval = -0.31 to -0.05). CONCLUSIONS NUTRIC score has a limited prediction to the urgency of aggressive nutrition therapy within the early period of ICU admission.
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Work functioning is a relatively new conceptual model developed to embrace various aspects surrounding work performance, work participation, and individual capacity. The assessment of work performance (AWP) in nursing has gained... more
Work functioning is a relatively new conceptual model developed to embrace various aspects surrounding work performance, work participation, and individual capacity. The assessment of work performance (AWP) in nursing has gained inconsistent evidence due to examining it from multidimensional aspects. This study aimed to perform the AWP in nurses working in the emergency departments (EDs) at different healthcare sectors in Jordan. A descriptive, cross-sectional design was used in which ED nurses completed a questionnaire. ED nurses were recruited conveniently from four referral hospitals located in Amman (two government and two private hospitals). The Nursing Work Functioning Questionnaire (NWFQ), in addition to the demographic questionnaire were completed. A total of 179 ED nurses participated in the study (100 government and 79 private nurses). A few differences were found between government and private sector nurses in respect to work functioning domains. Overall, nurses from both...
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No consensus exists on using a specific screening tool to assess malnutrition in critically ill patients. Thus, we assessed malnutrition in intensive care unit (ICU) patients by comparing similarity of results between the Malnutrition... more
No consensus exists on using a specific screening tool to assess malnutrition in critically ill patients. Thus, we assessed malnutrition in intensive care unit (ICU) patients by comparing similarity of results between the Malnutrition Universal Screening Tool (MUST) and Phase Angle (PhA) measured by Bioelectrical Impedance Analysis. A cross-sectional observational study of 321 patients examined their nutritional status at least 1 week after the ICU admission using MUST, PhA, and anthropometric measurements. Diagnoses and Acute Physiologic Assessment and Chronic Health Evaluation II scores were retrieved retrospectively. The mean of Acute Physiologic Assessment and Chronic Health Evaluation II score was 17.73, indicating moderate morbidity. The majority of patients (71.0%) were fed enterally while the remaining (29.0%) did not have any nutritional intervention. Although the average body mass index was normal, only 55.3% of patients received the prescribed calories up to the day of assessment (median day of assessment was 11 [interquartile range: 9-18]). The MUST and PhA results showed that patients fell consistently into 3 malnutrition levels. Hierarchical Multiple Regression revealed that MUST (risk of malnutrition) explained an additional 44.9% of the variance in PhA (&bgr;: −.449, P < .001, confidence interval: −1.25 to −0.740). Although MUST measures malnutrition subjectively, it demonstrated higher congruency with Bioelectrical Impedance Analysis in the screening of malnutrition in this sample of critically ill patients.
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Background Despite management of acute pain, concerns regarding pain are still prevalent in the emergency department (ED). Purpose This study aimed to explore the factors influencing patients’ pain management in a Jordanian ED. Method... more
Background Despite management of acute pain, concerns regarding pain are still prevalent in the emergency department (ED). Purpose This study aimed to explore the factors influencing patients’ pain management in a Jordanian ED. Method Fifteen semistructured interviews (N = 15) with purposively selected patients in the ED. Results The thematic analysis uncovered two related themes. The first theme described the stage of “being on ED bed” which encapsulates two subthemes: “bad pain means, bad diagnosis” and “smiley faces versus grumpy faces.” The second theme referred to as “being discharged” including two subthemes, namely, “praying for not paying” and “being grateful to God.” The lack of money to pay for pain management was equally as stressful as pain itself. Patients’ narratives suggest that nursing pain management is a critical time, extending beyond medical management to encompass communication and spirituality. Conclusions The factors influencing the patients’ experience of pain management extend beyond addressing the source of the pain. Consequently, effective communication coupled with respecting patients’ spirituality and socioeconomic concerns is essential to pain management. To enhance patients’ experience of pain management, the ED system should shift toward a patient-centric model.
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BACKGROUND Early warning Score is a bedside track and trigger system used to facilitate early detection and management of deteriorating patients. Although emergency department nurses are the key to implement this task, their interaction... more
BACKGROUND Early warning Score is a bedside track and trigger system used to facilitate early detection and management of deteriorating patients. Although emergency department nurses are the key to implement this task, their interaction and contribution to provide an estimate of patients' severities is still suboptimal and neglected. AIM This study aimed to introduce an educational programme using the Modified Early Warning Score (MEWS) to nurses working in the emergency departments and to assess the programme impact on nurses' self-efficacy and perceived role. METHODS This non-equivalent, multi-centre, quasi-experimental study, assigned two groups of emergency nurses into intervention and control. The intervention group received three interactive educational sessions totalling 12 h relevant to the application of MEWS in emergency situations using a validated programme called 'COMPASs'. The other group received no intervention. Both groups were assessed for self-efficacy and perceived role in the pre-test, immediate post-test, and three months later follow-up phase. RESULTS A total of 232 participants were divided into intervention and control groups (118 and 114, respectively), having no variations in age, gender, or experience as registered nurses. The intervention group showed a significant improvement in the self-efficacy scores for the nurses (F: 152.21, df: 2, p < 0.001). Similarly, the intervention nurses exhibited a significant improvement in the perceived role scores after the intervention (F: 121.20, df: 2, p < 0.001). The control group showed no changes in either variable across the three phases. While older nurses with longer experience showed higher self-efficacy after the programme, the perceived role explained an additional 57.0% of the variance in self-efficacy after controlling these two demographics (Beta: 0.743, p < 0.001, CI: 1.18-1.66). CONCLUSION The existence of an early warning system in the emergency department is able to enhance nurses' self-efficacy and perceived role coinciding with nursing interactions with the multidisciplinary team.
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Uncertainty impacts negatively on adaptation and disease outcomes. During recovery, coronary artery bypass graft (CABG) patients experience uncertainty, symptom distress, and learning needs. This study aimed to examine predictors... more
Uncertainty impacts negatively on adaptation and disease outcomes. During recovery, coronary artery bypass graft (CABG) patients experience uncertainty, symptom distress, and learning needs. This study aimed to examine predictors associated with uncertainty among CABG patients. This cross-sectional correlational study recruited CABG patients conveniently from out-patient clinics 1 month after discharge. Participants completed a self-administered questionnaire which included: demographic questionnaire, Mishel's Uncertainty of Illness Scale, Cardiac Symptoms Survey, and Cardiac Patients Learning Needs. A total of 161 participants completed the study questionnaires. Participants showed a moderate level of uncertainty, less cardiac symptom distress, and high learning needs. Uncertainty was significantly correlated with learning needs while less correlated with symptom distress. Hierarchal multiple regression revealed that gender, employment status, education level, and learning need...
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Thalassaemia major is a chronic inherited illness that requires everlasting treatment with blood transfusions and chelating drug therapies. Primary caregivers, especially mothers, encounter many challenges when dealing with their affected... more
Thalassaemia major is a chronic inherited illness that requires everlasting treatment with blood transfusions and chelating drug therapies. Primary caregivers, especially mothers, encounter many challenges when dealing with their affected child. This study aimed to explore challenges facing Jordanian mothers when having a child with thalassaemia major. A descriptive phenomenological approach was used. Mothers were selected purposefully from two major thalassaemia treatment clinics in Jordan. Semi-structured, face-to-face interviews were conducted and supported by a pre-prepared interview agenda. Colaizzi’s process of descriptive phenomenology was used for analysing interviewees’ transcripts. A total of 23 Jordanian mothers joined the study. A number of formulated meanings, categories and clusters of themes were instrumental in the emergence of three main themes: ‘unprecedented psychosocial distress’, ‘additional financial burden’ and ‘deficiency of knowledge and its sources’. The st...
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Background: Adherence to infection control precautions (ICP) is important to reduce the transmission of healthcare-associated infections (HAIs). Aims: To determine nurses and physician’s knowledge, attitude and compliance to ICPs and... more
Background: Adherence to infection control precautions (ICP) is important to reduce the transmission of healthcare-associated infections (HAIs). Aims: To determine nurses and physician’s knowledge, attitude and compliance to ICPs and factors associated with reported compliance. Methods: A cross-sectional survey of nurses and physicians recruited from three hospitals at three different healthcare sectors in Jordan. Three instruments were used to assess knowledge, attitudes and compliance to ICPs. Findings: A total of 211 professionals completed the survey: 155 nurses and 56 physicians. Both groups had low knowledge scores for ICP but a high positive attitude. Although both groups had high reported compliance scores, nurses scores were higher ( P = 0.04). Participants from the private hospital had higher knowledge and compliance scores. Length of experience, knowledge and attitude were significant predictors of reported compliance to ICPs. Discussion: Despite poor knowledge, Jordanian...
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Background Health education on proper inhaler usage is the most feasible and accessible strategy to increase inhaler effectiveness. Purpose To assess the impact of nurse-driven inhaler education on the compliance and proficiency of using... more
Background Health education on proper inhaler usage is the most feasible and accessible strategy to increase inhaler effectiveness. Purpose To assess the impact of nurse-driven inhaler education on the compliance and proficiency of using inhalers among inhaler users. Methods This single-center, quasi-experimental study included the implementation of an individualized 60-min educational session on inhalers use. Health education and pretest and posttest outcomes were assessed by the Inhaler Proficiency Schedule and Patient Reported Behaviour tools. Results One hundred and twenty-one participants joined the study. At pretest, participants showed inadequate knowledge of general inhaler use. No previous training had been received by participants and difficulty with use and complications from using the inhalers were reported. At posttest, participants reported improvement in inhaler proficiency scores from 5.72 to 8.60 ( t = 17.99, df = 220, p
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Research Interests: Nurse and Assertiveness
To assess the perceptions and attitudes of undergraduate nursing students toward NANDA-I nursing diagnosis. A descriptive cross-sectional design was used. A convenient sample was recruited from nursing students at Zarqa University/Jordan.... more
To assess the perceptions and attitudes of undergraduate nursing students toward NANDA-I nursing diagnosis. A descriptive cross-sectional design was used. A convenient sample was recruited from nursing students at Zarqa University/Jordan. Perceptions toward NANDA-I Nursing Diagnosis scale and Positions on Nursing Diagnosis scale were used. A total of 101 nursing students were included. A correct perception toward NANDA-I nursing diagnosis was evident. Attitudes toward NANDA appeared positive. However, insufficient distinction between nursing diagnosis and medical diagnosis and feeling less comfort while using NANDA-I were reported. Nursing students showed correct perceptions and positive attitudes toward the application of NANDA-I. Proper implementation of NANDA-I is a prerequisite to the better understanding of nursing language.
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ABSTRACT Enteral nutrition is a pivotal strategy for nutrition in ICUs (Fulbrook et al. 2007). Nurses are keys to assess patients&#39; nutritional status, detect feeding-intolerance, and curtail the prospect of complications... more
ABSTRACT Enteral nutrition is a pivotal strategy for nutrition in ICUs (Fulbrook et al. 2007). Nurses are keys to assess patients&#39; nutritional status, detect feeding-intolerance, and curtail the prospect of complications (Persenius et al., 2006; Bourgault et al., 2007). This study aimed to assess ICU nurses&#39; perception of their ability to assess critically ill patients&#39; nutritional status using the evidence-based guidelines.
Research Interests: Clinical Sciences and Gut
This study aimed to explore Jordanian nurses&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; perspectives on the implementation of... more
This study aimed to explore Jordanian nurses&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; perspectives on the implementation of evidence-based practice and team-working related to nutritional care in the critically ill. Poor adherence to evidence-based practice and poor collaboration may contribute to nutritional failure. Fourteen critical care nurses from three healthcare sectors in Jordan were selected purposively and interviewed using semi-structured interviews. The information obtained was subjected to a thematic analysis. Four themes emerged from the study: &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;undertaking nutritional responsibilities&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;, &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;approaching evidence-based practice&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;, &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;multidisciplinary team working&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; and &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;consequences of enteral nutrition care deficits&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;. Although evidence-based practice was emphasised by nurses, lack of evidence-based resources, and ineffective aspiration reduction measures were found to impede adherence to evidence-based practice. Multidisciplinary team working was introduced as means to improve practice. However, ineffective nursing involvement and poor interaction were obstacles to effective sharing.