Prevention and management of enteral nutrition-related diarrhea in stroke patients: barriers and enablers from best evidence to best practice.

Purpose: This study aimed to identify the gap between the clinical practice and best evidence for preventing and managing enteral nutrition-related diarrhea in stroke patients, to recognize barriers and enablers in translating this evidence into best practice, and to develop specific and effective action strategies to advance evidence-based practice. Methods: A convergent mixed-methods study was conducted, integrating cross-sectional surveys with descriptive qualitative research. Twenty-nine audit criteria were developed based on the current best evidence for the prevention and management of enteral nutrition-related diarrhea in stroke patients. A self-designed audit sheet, which was based on the developed audit criteria, was administered to conduct a baseline audit to identify gaps between best evidence and current clinical practice. A self-designed questionnaire based on the current best evidence was used to collect data on healthcare professionals' knowledge regarding the prevention and management of enteral nutrition-related diarrhea in stroke patients. In-depth interviews were used to produce in-depth views of stakeholders about implementing the best evidence for preventing and managing enteral nutrition-related diarrhea in stroke patients. The qualitative data was analyzed using directed content analysis, guided by the Ottawa Model of Research Use (OMRU). Results: A total of 86 stroke patients, 34 nurses, and 4 doctors were recorded for their adherence to best evidence. The audit results showed that compliance rates for 19 out of 29 audit criteria were below 60.00%, and the incidence of enteral nutrition-related diarrhea among stroke patients was 43.02%. Thirty-eight healthcare professionals from the neurology department completed the questionnaire. The average knowledge score of the prevention and management of enteral nutrition-related diarrhea among these professionals was 53.68 (SD 15.74) points, with a pass rate of 42.11%. A total of 8 healthcare providers and 8 stroke patients were interviewed. We generated 11 themes and 23 sub-themes based on the data, which were categorized under three aspects of OMRU. At the evidence-based innovation level, the evidence meeting clinical needs served as a facilitator, while the lack of specific implementation standards for some evidence acted as a barrier. At the level of potential adopters, healthcare professionals' positive attitudes toward evidence implementation and their exceptional work capabilities served as enablers for the best practice in preventing and managing diarrhea related to enteral nutrition in stroke patients. However, a lack of initiative among medical staff and the increased workload from evidence implementation were barriers. At the practice environment level, comprehensive supporting facilities, positive interpersonal relationships, patients' positive rehabilitation mindset, and their absolute trust in medical professionals were important enablers. Important barriers included non-establishment of a multidisciplinary team, insufficient organizational support (e.g., lack of diarrhea prevention and management systems, lack of a quality assessment system for enteral nutrition), patients' lack of relevant knowledge, low self-efficacy, and patients' diminished abdominal sensitivity. Eleven strategies were developed to amplify enablers and overcome barriers to the implementation of evidence-based practice in preventing and managing enteral nutrition-related diarrhea in stroke patients. Conclusion: This study systematically investigated the barriers and enablers contributing to the gaps between the best evidence and clinical practice regarding the prevention and management of enteral nutrition-related diarrhea in stroke patients. Action strategies to promote the implementation of best evidence should focus on addressing barriers related to evidence-based innovation, potential adopters, and the practice environment.