preceptor and interns

By Austin Hua & Page Smith

Overview of Home Enteral Nutrition (HEN)  

Tube feeding is essential for individuals who cannot meet their nutritional needs orally for a variety of health conditions.1 Over 400,000 Americans relied on home enteral nutrition (HEN) in 2013, with its prevalence increasing today.2 Bolus feeding is favored among HEN patients because it is practical for a more active lifestyle and aligns with mealtimes. Bolus feeding also supports patient mobility and offers greater freedom and quality of life.3 

Challenges of HEN 

Although HEN is widely used, gaps in education and training persist. Patients and caregivers often receive insufficient education to manage HEN, increasing the risk of complications such as vomiting, bloating, diarrhea, and constipation,tube malfunctions, and poor nutrition status.4 The lack of training can be a burden in addition to the numerous responsibilities associated with HEN.1 

Role of RDN in Bolus Feeding Education 

Registered Dietitian Nutritionists (RDNs) play a critical role in nutrition support care by developing personalized feeding plans, providing reassurance to patients, managing complications, reducing unnecessary hospital admissions, and enhancing patient satisfaction.5 

Despite handling these crucial responsibilities RDNs have  indicated feeling unqualified to teach HEN delivery and management.5 A critical component of RDN education is supervised practice, where dietetic interns gain the skills required for practice competency under the guidance of dietetic preceptors.6 Exploring bolus feeding exposure during supervised practice, a transformative stage of their academic career, provided valuable insight into their learning.

Key Findings: Preceptor Perspectives 

In this qualitative study eight dietetic preceptors representing the Northwestern United States reflected on their teaching methods and considered how their internship experiences shaped their mentorship approaches. Data were collected through a survey and two focus groups.  

Participants revealed how their own gaps or successes in nutrition support education shaped the learning opportunities they offered to interns. Teaching methods were influenced by hospital dynamics, situational learning opportunities, and intern comfort with nutrition support skills.  

Preceptors who had positive bolus feeding education experiences emulated teaching strategies that they found effective, combining hands-on demonstrations and modeling patient education. Preceptors noted that developing confidence in nutrition support during supervised practice profoundly influenced their learning and influenced the trajectory of their careers. 

Limited bolus feeding education during internships prompted preceptors to adopt supplemental teaching methods such as calculation practice, case studies, or equipment exposure to co-learn nutrition support skills alongside interns. Participants agreed that basic exposure to bolus feeding techniques should be taught to dietetic interns to ensure entry-level competency and reduce challenges in professional practice, especially for interns who may begin their careers in rural healthcare.  

Supportive and reciprocal learning throughout the internship journey also influenced preceptors’ teaching methods. Preceptors preferred guided learning over stress-inducing teaching methods, fostering an environment where mistakes were viewed as part of growth. Reciprocal learning further enriched both interns’ and preceptors’ professional development, encouraging interns to bring fresh perspectives or different approaches to problem-solving, prompting preceptors to reflect on their own practices and even update their clinical approaches.  

Strengthening Nutrition Support Education 

This study highlighted the critical role of preceptors in shaping the next generation of RDNs through mentorship and instructional approaches. Providing bolus feeding exposure to interns not only enhanced their skillset, but it also encouraged interns to pass on valuable knowledge to future generations. Equipping future RDNs with proficiency in nutrition support through comprehensive teaching methods is essential for optimizing patient care.  

Making a Difference  

These findings may prompt dietetic preceptors to evaluate the incorporation of bolus feeding techniques into dietetic internship supervised practice. Preceptors may consider teaching with hands-on practice and visual demonstrations. Additionally, this study may inspire dietetic interns to advocate for greater involvement in nutrition support practices during clinical rotations.  

 

Check out the following resources for more information on best practices in HEN and the significant role RDNs play in nutrition support care:  

 

References: 

  1. Sandhu R, Saran D, Ho G, Vandop K, Hussain W. High costs and limited dietitian services for home enteral nutrition users: A Canadian study. Nutr Clin Pract. 2022;37(1):167-175. doi:10.1002/ncp.10649
  2. Mundi MS, Pattinson A, McMahon MT, Davidson J, Hurt RT. Prevalence of home parenteral and enteral nutrition in the United States. Nutr Clin Pract. 2017;32(6):799-805. doi:10.1177/0884533617718472
  3. Ichimaru S. Methods of enteral nutrition administration in critically ill patients: Continuous, cyclic, intermittent, and bolus feeding. Nutr Clin Pract. 2018;33(6):790-795. doi:10.1002/ncp.10105
  4. Madrid-Paredes A, Leyva-Martínez S, Ávila-Rubio V, et al. Impact of nutritional and educational support on home enteral nutrition. J Health Popul Nutr. 2023;42(1):45. doi:10.1186/s41043-023-00384-4
  5. Byrnes C, Mockler D, Lyons L, Loane D, Russell E, Bennett AE. A scoping review of best practices in home enteral tube feeding. Prim Health Care Res Dev. 2022;23:e43. doi:10.1017/S1463423622000366
  6. Sarcona AR, Burrowes JD, Fornari AJ. Characteristics of an effective preceptor: Dietetics education as a paradigm. Journal of Allied Health. 2015;44(4), 229–235.