Optimizing nutrition in intensive care units: empowering critical care nurses to be effective agents of change.

Observational studies have consistently revealed wide variation in nutritional practices across intensive care units and indicated that the provision of adequate nutrition to critically ill patients is suboptimal. To date, the potential role of critical care nurses in implementing nutritional guideline recommendations and improving nutritional therapy has received little consideration. Factors that influence nurses' nutritional practices include the lack of guidelines or conflicting evidence-based recommendations pertaining to nurses' practice, strategies for implementing guidelines that are not tailored to barriers nurses face when feeding patients, strategies to communicate best evidence that do not capitalize on nurses' preference for seeking information through social interaction, prioritization of nutrition in initial and continuing nursing education, and a lack of interdisciplinary team collaboration in the intensive care unit when decisions on how to feed patients are made. Future research and quality improvement strategies are required to correct these deficits and successfully empower nurses to become nutritional champions at the bedside. Using nurses as agents of change will help standardize nutritional practices and ensure that critically ill patients are optimally fed.