| Course | NURS 8705 Doctoral Seminar |
|---|---|
| Week | Week 9 |
| Paper type | Preliminary literature search record |
| Length | About 1,000 words, 6 pages |
| Format | APA 7 student paper |
| School | Walden University |
| Program | Doctor of Nursing Practice (DNP) |
| Updated | October 2026 |
Free sample paper for NURS 8705 Week 9
Has It Already Been Answered? A Preliminary Search on Starting Enteral Feeding Within Forty-Eight Hours in a Surgical Intensive Care Unit
Student Name
College of Nursing, Walden University
NURS 8705: Doctoral Seminar
Instructor Name
Month Day, Year
Has It Already Been Answered? A Preliminary Search on Starting Enteral Feeding Within Forty-Eight Hours in a Surgical Intensive Care Unit
The Question Searched
My problem concerns adults admitted to a 16-bed surgical intensive care unit after abdominal or trauma surgery who cannot eat and for whom enteral feeding begins later than 48 hours after admission. In a review of 50 recent admissions, 22 started enteral feeding after 48 hours, usually because of uncertainty about bowel function after surgery or because feeding was held repeatedly for procedures. The question for this search was whether the evidence already settles when enteral feeding should start in surgical critical care patients, and whether that evidence applies to a unit like mine. If it is settled, my doctoral problem is one of practice, not of evidence.
The record below is written so that it can be repeated. All searches were run on October 4, 2026.
Databases and Strings
PubMed. Four concept blocks were combined. Block 1, enteral feeding: "Enteral Nutrition"[Mesh] OR "early enteral"[tiab] OR "enteral feeding"[tiab], 27,572 results. Block 2, critical care: "Critical Care"[Mesh] OR "Intensive Care Units"[Mesh] OR "intensive care"[tiab] OR "critically ill"[tiab], 359,744 results. Blocks 1 and 2 combined: 5,231. Adding block 3, surgery: "Surgical Procedures, Operative"[Mesh] OR surgical[tiab] OR postoperative[tiab], 1,162. Adding block 4, timing: early[tiab] OR "within 24"[tiab] OR "within 48"[tiab] OR timing[tiab], 385.
Filters in PubMed. Publication date limited to 2016 through 2026, a ten-year window, and language restricted to English: 157. Restricting the publication type to trial, review and meta-analysis designs: 13.
Europe PMC. The same concepts were searched in abstracts using the database's field syntax: (ABSTRACT:"early enteral" OR ABSTRACT:"enteral feeding" OR ABSTRACT:"enteral nutrition"), 16,939; AND (ABSTRACT:"intensive care" OR ABSTRACT:"critically ill"), 3,955; AND (ABSTRACT:surgical OR ABSTRACT:postoperative), 593. Publication years 2016 to 2026: 283. English language plus the same three design types: 28.
A third planned database, CINAHL, was not searched for this preliminary record because access through the university library was unavailable on the search date; it will be searched before the literature review proper.
Screening
The 13 PubMed records and 28 Europe PMC records were combined, and 9 duplicates were removed, leaving 32 titles. Titles and abstracts were screened against two questions: does the study compare earlier with later enteral feeding, or address timing directly, and does it include surgical or trauma intensive care patients? Twenty-three were excluded, mostly because they compared enteral with parenteral nutrition without addressing timing or studied medical patients only. Nine full texts were retrieved. Reference lists of the two clinical guidelines found were also checked, which identified two older meta-analyses that fall outside the ten-year limit but were too relevant to ignore.
Screening was done by one reviewer, the author, which is acceptable for a quick preliminary search of this kind but not for the full review that follows, where a second reviewer will screen a sample to check agreement. The nine full texts that were retrieved, beyond the four described below, were set aside for the literature review: three addressed feeding interruptions in mixed medical and surgical units, two compared feeding routes after trauma, two examined feeding intolerance and two were protocols for trials not yet reported. None changed the answer to the question this search asked, and none was large enough to be described here on its own, but the three on interruptions bear directly on the narrower question the search leaves standing.
The Four Closest Studies
Doig et al. (2009). A meta-analysis of randomized trials comparing enteral nutrition started within 24 hours of injury or intensive care admission with later feeding. It reported that early feeding was associated with lower mortality and fewer cases of pneumonia in critically ill patients. It answers the timing question for critically ill patients in general. It leaves open how many surgical patients were included and whether the result holds after abdominal surgery, where bowel function is the main concern in my unit.
Lewis et al. (2009). A meta-analysis of trials of feeding within 24 hours after intestinal surgery compared with later feeding. It addresses the concern that early feeding harms a fresh anastomosis and did not find evidence of that harm. It answers the surgical part of my question but not the critical care part, since most of its patients were on surgical wards rather than in intensive care.
McClave et al. (2016). The 2016 SCCM and ASPEN joint guideline recommends starting enteral nutrition within 24 to 48 hours in critically ill patients who cannot maintain oral intake. It is the closest to a settled answer, and it is the document clinicians in my unit already cite when they argue for earlier feeding, but it is a general recommendation, and it allows clinical judgment about patients with uncertain bowel function, which is exactly where my unit's delays occur.
Compher et al. (2022). The 2022 ASPEN update revisits energy and protein delivery and the choice of feeding route in the first week of critical illness, drawing on trials published since 2016. It does not reverse the earlier advice on early enteral feeding, but it does not add surgical-specific guidance on timing either.
Does the Question Survive?
The general timing question is largely answered: guidelines recommend early enteral feeding for critically ill adults, and meta-analyses support it. The question as I originally framed it, whether to feed early, does not survive. A narrower question does. In my unit, delays occur in the patients for whom guidelines leave room for judgment, those with uncertain bowel function after abdominal surgery and those whose feeding is repeatedly held for procedures. The surviving problem is why early feeding does not happen for these patients in this unit when the evidence and guidelines support it. That is a problem of practice and implementation, and it is one a DNP project can address.
The search also showed what the literature review must still do: search CINAHL, look specifically for studies of feeding interruptions for procedures and look for evidence on feeding after emergency abdominal surgery, which none of the four studies addressed directly.
References
Compher, C., Bingham, A. L., McCall, M., Patel, J., Rice, T. W., Braunschweig, C., & McKeever, L. (2022). Guidelines for the provision of nutrition support therapy in the adult critically ill patient: The American Society for Parenteral and Enteral Nutrition. Journal of Parenteral and Enteral Nutrition, 46(1), 12-41. https://doi.org/10.1002/jpen.2267
Doig, G. S., Heighes, P. T., Simpson, F., Sweetman, E. A., & Davies, A. R. (2009). Early enteral nutrition, provided within 24 h of injury or intensive care unit admission, significantly reduces mortality in critically ill patients: A meta-analysis of randomised controlled trials. Intensive Care Medicine, 35(12), 2018-2027. https://doi.org/10.1007/s00134-009-1664-4
Lewis, S. J., Andersen, H. K., & Thomas, S. (2009). Early enteral nutrition within 24 h of intestinal surgery versus later commencement of feeding: A systematic review and meta-analysis. Journal of Gastrointestinal Surgery, 13(3), 569-575. https://doi.org/10.1007/s11605-008-0592-x
McClave, S. A., Taylor, B. E., Martindale, R. G., Warren, M. M., Johnson, D. R., Braunschweig, C., McCarthy, M. S., Davanos, E., Rice, T. W., Cresci, G. A., Gervasio, J. M., Sacks, G. S., Roberts, P. R., & Compher, C. (2016). Guidelines for the provision and assessment of nutrition support therapy in the adult critically ill patient: Society of Critical Care Medicine (SCCM) and American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.). Journal of Parenteral and Enteral Nutrition, 40(2), 159-211. https://doi.org/10.1177/0148607115621863
The Walden NURS 8705 Week 9 instructions
The search assignment in this seminar generally asks you to find out whether your question has already been answered, in a record someone else could repeat. Name each database and give the exact strings, including controlled vocabulary and field tags. Show the result count beside every string, not only the final total. State each filter and its setting, such as date range and language. Report screening in a few lines: titles reviewed, exclusions and full texts retrieved. Then describe the closest studies, each by its finding, the patients it studied and the gap it leaves for your unit. Finish by saying plainly whether your question survives, and in what form, and what the full review must still do.
How the NURS 8705 Week 9 example is put together
The opening section states the problem with its 22 of 50 count and the search date. A section lists four PubMed blocks with counts, the date and language filters and the design limit, then the Europe PMC strings and counts, and notes that CINAHL was not searched. A screening section reports 41 records, 9 duplicates, 32 titles and 9 full texts, with a paragraph on single-reviewer screening and the set-aside studies. Four italic study paragraphs cover Doig and colleagues, Lewis and colleagues, the 2016 SCCM and ASPEN guideline and Compher and colleagues. The final section concludes that the timing question is answered and an implementation question remains.
Where the marks sit in the NURS 8705 Week 9 rubric
Search records are generally graded on reproducibility, appropriateness of strategy, transparency and the quality of the conclusion. Faculty reward records that show strings and counts at every step, since those let a reader repeat the search. Credit rises when filters are named with their settings and when databases not searched are acknowledged. Describing the closest studies by what they answered and what they leave open is often what separates strong submissions. A frank conclusion, including that the original question is answered, is valued. Accurate study descriptions matter, because misreporting a finding is a serious error in this genre. Naming the database you could not search, and why, is credited as honesty rather than marked as a gap.
NURS 8705 Week 9 help from the desk
Search records often report only a final number of articles, so nobody can repeat or judge the search. Others list keywords without showing how they were combined. Some describe studies by their topic rather than by what they found, which hides whether the question is answered. Build your search in blocks and record the count after each one. Check the reference lists of any guideline you find, since key studies may fall outside your date filter. Be prepared for the answer to be already known, and say what question remains. Our writers can prepare a preliminary search record for your question, with strings, counts and a clear verdict. Record the date you ran each search, since counts change.
Get a NURS 8705 Week 9 example written to your instructions
Send the search prompt with the databases your section requires and any template it distributes for recording strings, and an example built to that template comes back. The first custom one is free and arrives within 24 to 48 hours. Saved results inside your own library account, and any protected record they open, are never reconstructed on a page like this.
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NURS 8705 Week 9 questions, answered
What if the search finds the question already answered?
That is a real result and the document should say so plainly, which is why the example is written to permit that ending. A candidate who finds the question settled has learned something in week nine rather than in the second year. Most faculty treat an honest negative finding as a stronger submission than a search that reports a convenient gap.
Should gray literature be included?
It depends on the question and on what the prompt asks for. The example searches published work only and states that restriction in the filters section rather than leaving it implicit. Where practice guidance or regulatory documents would change the answer, a search that excludes them without saying so is the version faculty tend to send back.
Where can I find a free NURS 8705 Week 9 sample paper?
The complete search record, every string and count included, is shown above and costs nothing to read.
Does the question in the NURS 8705 Week 9 search survive?
The general question of whether to feed early is largely answered, but a narrower one survives: why early feeding does not happen in this unit for patients whose guidelines leave room for judgment.
Why were two older meta-analyses included despite the date filter?
They were found in the reference lists of the guidelines and were too relevant to ignore, so the record reports them while noting they fall outside the ten-year limit.