Nutrition support for malnourished, acutely ill adults

As the acuity of the hospitalized patient increases, so does the need for nurses to become knowledgeable about nutritional support for the acutely ill. The nurse clinician provides safe and comprehensive enteral and parenteral nutritional support to the malnourished patient.

Nutritional assessment in home care patients

Nutrition, a critical requirement of all living organisms, involves several processes that must be maintained to sustain life. Nutrition consists of ingestion of food and fluid, digestion, absorption, distribution (transportation), utilization (metabolism), and excretion of the end products. Problems arise when the amount of various nutrients ingested is either deficient or excessive or when any of these processes are significantly altered.

The five-year evolution of a malnutrition treatment program in a community hospital

BACKGROUND

Studies suggest that 30%-55% of hospitalized patients are at risk for malnutrition, an avoidable comorbidity contributing to increases in hospitalization and readmission, length of stay, complications, and mortality. Yet a variety of issues have impeded many hospitals' implementation of effective nutrition intervention programs. BENCHMARKING STUDY: St Francis Hospital (SFH), a 395-bed community acute care facility in Wilmington, Delaware, participated in a nationwide benchmark study in fall 1993. In comparison with the 12-hospital means, data for SFH showed both delays in initiating a nutrition care plan for acutely ill patients and a significantly higher risk for malnutrition. NUTRITION SCREENING PILOT: A pilot study was implemented in 1994 to identify nutrition needs within 48 hours of admission as a first step in the improvement process. Although interventions occurred earlier for a greater number of high-risk patients, nutrition intervention was not being provided in a uniform and timely manner. THE MALNUTRITION CLINICAL PATHWAY: A free-standing hospital committee, the Nutrition Care Committee (NCC), with guidance from the care management department, began developing a malnutrition pathway that would serve as an integrated plan for providing nutrition care to high-risk patients. The original pathway was organized into four stages that outlined the progression and timing of care--identification of the patient at high risk for malnutrition, nutrition care decisions, treatment in progress (the remainder of the patient's hospitalization), and discharge planning. OUTCOME STUDIES: Outcome studies were conducted in 1996 and again in 1998 to assess the malnutrition treatment pathway's impact on patient health outcomes and the cost of care. The 1996 outcome study indicated significant improvements in the identification of high-risk patients (from 25.9% to 86%) and the timeliness of nutrition intervention (from 6.9 days to 2.4 days). A second outcome study was conducted in 1998, following revision of the pathway. Comparison of the 1996 after-pathway patient population with a matched study group in 1998 indicated reductions in average length of stay from 10.8 to 8.1 days; the incidence of major complications from 75.3% to 17.5%; and 30-day readmission rates from 16.5% to 7.1%.

DISCUSSION

The performance improvement project described in this article began with SHF's voluntary participation in an interdisciplinary benchmarking study and continued when it was apparent that SFH had an opportunity for performance improvement. Forming an NCC at SFH was the first step in a process that gained the administrative support necessary to fully develop the program.

SUMMARY AND CONCLUSIONS

SFH has developed and implemented a malnutrition treatment program that is integrated into the care plan of all acute care patients and is included in the discharge planning process. Outcome studies have demonstrated the effect of the malnutrition treatment program on patient recovery and cost of care.

Nutritional care of the patient: nurses' knowledge and attitudes in an acute care setting

Concern is growing about the occurrence of malnutrition in hospitals throughout the developed world. Reduced involvement of nurses in patients' nutritional care may be one of the contributing factors. This study explored nurses' attitudes and knowledge about nutrition and food service in hospital. Semi-structured interviews were conducted with seven nurses from the internal medical service of a large Australian acute care hospital. Analysis of the interview transcripts revealed that many nurses lacked the in-depth knowledge needed to give proper nutritional care to their patients. Although nurses considered nutritional care to be important many had difficulty in raising its priority above other nursing activities, as a result of time constraints and multitasking issues. Several problems relating to food service arrangements were also highlighted. The findings suggest a need to raise nurses' awareness of the importance of nutrition in patient outcome. This study provides information which will guide in-service nurse education programs about nutrition, and suggests strategies for practice and organizational change.

Evaluating nurses' knowledge and patients energy intake after intervention

The aims of this study were to describe and assess nutritionally at-risk patients' energy intake and nurses' knowledge and opinions of patients' need of energy during their hospital stay, before and after training and education. The effects of the intervention were evaluated by using a questionnaire, answered by the nurses before and after the intervention, and indirectly by measuring the patients' nutritional outcome, using a nutritional assessment form. A total of 230 matched patients and 171 nurses (86 before the intervention and 85 after) participated in the study. After the education, results indicated that a greater number of patients received increased levels of energy intake, an increased average intake of energy, and more dietary supplements. Nurses' knowledge about the content of energy in a standard portion of food had increased, and they found it easier to assess patients' need of energy. After the education, more nurses had the opinion that well-educated nurses in nutrition make it easier to motivate patients to reach a sufficient intake of energy.

Minimizing HIV/AIDS malnutrition

HIV/AIDS malnutrition influences immune function, disease progression, and quality of life. Changes in dietary intake, altered metabolism, and malabsorption are among the mechanisms that contribute to the nutritional alterations seen in HIV/AIDS. Medical-surgical nurses can help their patients minimize HIV/AIDS malnutrition through early and ongoing assessment, which guides nutritional and pharmacologic interventions.

Nutritional screening: an audit

Despite much guidance, patients in hospital are still not eating properly. This article discusses the development of a Nutritional Screening Tool (NST) and an audit of the use of the tool with nutritional supplements.

Nutrition and pressure area management

The eighth session in an educational initiative for staff in nursing homes

Nutritional assessment, intervention, and evaluation of weight loss in patients with non-small cell lung cancer

PURPOSE/OBJECTIVES

To describe weight change in patients from the time of cancer diagnosis to the last healthcare encounter before death, to describe reported nutritional assessment, intervention, and evaluation; and to determine the relationship of weight change and cancer-related symptoms to nutritional assessment, intervention, and evaluation.

DESIGN

Descriptive, correlational.

SETTING

A National Cancer Institute-designated cancer center and its associated university medical center in the northeastern United States.

SAMPLE

Medical records of 93 individuals with non-small cell lung cancer.

METHODS

Retrospective chart review.

MAIN RESEARCH VARIABLES

Weight change; nutritional assessment, intervention, and evaluation; and cancer-related symptoms.

FINDINGS

Mean weight change from cancer diagnosis to last healthcare encounter was -4.75 kg (SD = 6.05 kg). The mean regression slope of weight change was -3.69 kg/healthcare encounter (SD = 6.49 kg). The results of content analysis indicated that 90 subjects had nutritional assessments, 54 subjects had interventions, and 24 subjects had evaluations of intervention effectiveness. No association existed between weight change or cancer-related symptoms and nutritional assessment. Nutritional intervention was positively associated with dysphagia and depression, and evaluation of intervention effectiveness was positively associated with weight loss and dysphagia.

CONCLUSIONS

Assessments of weight change and appetite usually were reported and appeared to be a routine part of patient care. However, assessments of weight loss and anorexia led to interventions only 60% of the time. When interventions were recommended, only 44% were evaluated for effectiveness.

IMPLICATIONS FOR NURSING PRACTICE

Assessment of nutritional status needs to be broadened, interventions need to be initiated more often, and creative solutions to nutritional problems need to be sought. Regular evaluation of interventions is essential.

Total parenteral nutrition in surgical patients

Malnutrition is common in the hospitalized surgical patient. There is a strong association between improved nutritional status and a favorable postoperative recovery, while malnutrition has an adverse effect on surgical outcome (Driscoll & Blackburn, 1990; Souba, 1997). Advances in providing parenteral nutrition have had a positive impact on nutrition care of these patients and will be reviewed in this article.

Nutritional screening and assessment

Health professionals need to take part in nutritional screening and assessment. Nutritional screening tools must meet criteria for reliability and validity. A number of assessment techniques can be used to establish nutritional status. Effective interdisciplinary working can improve outcome.

Follow-up study of children with growth deficiency

This follow-up study revealed that all the children with growth deficiency in the original study had slower growth velocity after termination of the study. Two years later, 56% of the sample was located and the measures were repeated. The experimental group had diets significantly higher in fat and zinc than did the control group. The amount of fat, calories, zinc, and protein intake in all the children's diets was significantly related to their percentile level for weight. The stress of all the mothers, both experimental and control, had increased, and there was a significant increase in stress in the experimental mothers. There was no difference in the children's home environments, but the parent-child interactions were significantly more positive between the experimental children and their mothers. This follow-up study demonstrates that children with growth deficiency benefited over time from the original intervention but need continued intervention for positive significant changes to persist.

Feeding the elderly population

The elderly are adults that have unique nutritional needs. The focus for nutrition in the elderly is on "successful aging" or living well, not just living longer. Optimal physical and cognitive function is greatly enhanced by good nutritional status combined with physical activity. Nutrition plays a pivotal role in maintaining quality of life through enhanced health benefits.

Fishing for understanding: nurses knowledge and attitudes in relation to nutritional care

Many studies have demonstrated that malnutrition is a significant problem amongst hospital patients, but little is known about what nurses actually do, and what factors influence this. This study aimed to explore the nutritional attitudes, knowledge base and nursing care of qualified nurses in an acute hospital. A survey of nurses' records for documented nutrition related activities was carried out for all (141) patients from five wards for two weeks, followed by a questionnaire, focused on nutrition-related attitudes, activities and knowledge, to all qualified nurses of these and a further four wards (110 nurses). Results revealed evidence of some knowledgeable and pro-active attitudes and nursing care; however, there was little association between knowledge, stated attitudes and behaviour and discrepancies were observed between questionnaire responses and documented activities. Ajzen and Fishbein's (1980) theory relating beliefs, attitudes, intentions and behaviour was not supported although this might be attributed, in part at least, to nurses not regarding weighing patients as nutritional assessment. Behaviour appeared to have been influenced by a variety of factors and relationships between attitudes, knowledge and activities seemed far from straightforward.

Nutritional assessment. A practical approach

The early identification of patients with existing malnutrition or those at risk of developing malnutrition, has important implications for both short and long term outcomes. A comprehensive nutritional assessment provides accurate baseline data from which calorie and protein goals are defined and a patient tailored nutrient prescription is generated. This article presents a rational, systematic approach to nutritional assessment, including 2 assessment tools, that can be applied to patients in any health care setting.

The nutritional and nursing benefits of social mealtimes

Hospital-induced malnutrition is a major care issue for nurses. Society values meals as social occasions and as an expression of community, but hospitals tend to break with this tradition. This paper proposes that making patient mealtimes a social occasion offers nurses a chance to improve nutritional care, enhance opportunities for communication and give patients a welcome break from the ward routine.