A qualitative study of dietetic preceptors teaching Bolus feeding skills

Abstract

The number of patients transitioning from hospital to home with enteral nutrition (EN), a method of delivering nutrients through a feeding tube, continues to rise. Most of these patients receive care under what is known as home enteral nutrition (HEN). Bolus feeding, the most common form of HEN, is a method of nutrition delivery provided in set volumes several times per day. As this form of nutrition support becomes more common, registered dietitian nutritionists (RDNs) are expected to provide patient education and clinical management. However, current dietetics education provides limited guidance on how dietetic interns should be trained in these skills, especially during supervised practice. This lack of clarity raises questions about the consistency and adequacy of intern preparation. This study explored how RDN preceptors in the Northwestern United States (Montana, Idaho and Colorado) teach bolus feeding techniques to dietetic interns. Two virtual focus group interviews were conducted with eight preceptors who had experience supervising interns in clinical settings. Participants responded to five open-ended focus group questions about their strategies, perceived nutrition support competency and their own background. Data was analyzed using a thematic analysis approach. The findings revealed a complex and nuanced set of practices and beliefs, which were organized into six major themes: (1) practicing nutrition support skills; (2) contextual logistics that shape intern exposure; (3) ambiguity of intern competency; (4) generational influence on precepting; (5) preceptor competence; and (6) Preceptor are human. The findings suggest that dietetic interns receive inconsistent training in bolus feeding, often shaped by the individual preceptor's experience and setting, rather than by clear educational standards. Preceptors, especially in rural or resource limited settings, often use creative strategies to offer learning opportunities despite limited time or patient access. This study highlights the experiences of rural preceptors in teaching bolus feeding and their desire for more support and training. Strengthening these areas across the health care system may help prepare future RDNs and support preceptors to confidently manage this increasingly common form of nutrition care.