Nurses knowledge and attitudes regarding nutrition in the elderly

Malnutrition knowledge among nursing staff in four European countries: A cross-sectional study

BACKGROUND

Nursing staff must have sufficient knowledge in order to adequately prevent and treat malnutrition. However, only a marginal amount of information on this topic is available in the literature.

OBJECTIVES

This paper provides a comparison of the malnutrition knowledge among nursing staff in Austria, the Czech Republic, the Netherlands, and Turkey and presents factors associated with the malnutrition knowledge of nursing staff.

DESIGN

A cross-sectional study was performed.

SETTING AND PARTICIPANTS

Nursing staff from different care settings in Austria, the Czech Republic, the Netherlands, and Turkey participated in the study.

METHODS

The KoM-G 2.0 (Knowledge of Malnutrition - Geriatric) questionnaire was used for data collection.

RESULTS

In total, 2056 participants from different care settings took part in the study. Between 11.7 % (Turkey) and 32.5 % (Austria) of the participants had high levels of malnutrition knowledge. The country itself was the factor most strongly associated with malnutrition knowledge. The nurses' educational level and specialised training of nursing staff were also significantly (p < 0.001) associated with malnutrition knowledge. Questions about "factors that should be considered during older persons' food intake" were most frequently answered correctly, while questions about "different aspects of nutritional screening" were less often answered correctly in all four countries.

CONCLUSIONS

This study was one of the first to describe the rather low level of malnutrition knowledge among nursing staff in different countries. The country itself was identified as the factor most strongly associated with the nurses' knowledge of malnutrition, while the nursing staff's basic education as well as further training were also detected as significant factors. These results indicate that it is necessary to extend and improve (academic) nursing education and to offer specialised training programmes which may improve nutritional care across country borders over the long run.

Interdisciplinary communication and collaboration as key to improved nutritional care of malnourished older adults across health-care settings - A qualitative study

Background

Malnutrition is a risk factor for impaired functionality and independence. For optimal treatment of malnourished older adults (OA), close collaboration and communication between all stakeholders involved (OA, their caregivers and health‐care and welfare professionals) is important. This qualitative study assesses current collaboration and communication in nutritional care over the continuum of health‐care settings and provides recommendations for improvement.

Methods

Eleven structured focus group interviews and five individual interviews took place in three regions across the Netherlands from November 2017 until February 2018, including OA, caregivers and health‐care and welfare professionals. Various aspects of collaboration and communication between all stakeholders were discussed. Interviews were transcribed and analysed using a thematic approach.

Results

Six main themes emerged: causes of malnutrition, knowledge and awareness, recognition and diagnosis of malnutrition, communication, accountability and food preparation and supply. Physical and social aspects were recognized as important risk factors for malnutrition. Knowledge and awareness regarding malnutrition were acknowledged as being insufficient among all involved. This may impair timely recognition and diagnosis. Responsibility for nutritional care and its communication to other disciplines are low. Food preparation and supply in hospitals, rehabilitation centres and home care are below expected standards.

Conclusion

Many stakeholders are involved in nutritional care of OA, and lack of communication and collaboration hinders continuity of nutritional care over health‐care settings. Lack of knowledge is an important risk factor. Establishing one coordinator of nutritional care is suggested to improve collaboration and communication across health‐care settings.

Supporting nutrition in frail older people: a qualitative study exploring views of primary care and community health professionals

BACKGROUND

Malnutrition is associated with increased morbidity and mortality, and is very common in frail older people. However, little is known about how weight loss in frail older people can be managed in primary care.

AIMS

To explore the views and practices of primary care and community professionals on the management of malnutrition in frail older people; identify components of potential primary care-based interventions for this group; and identify training and support required to deliver such interventions.

DESIGN AND SETTING

Qualitative study in primary care and community settings.

METHOD

Seven focus groups and an additional interview were conducted with general practice teams, frailty multidisciplinary teams (MDTs), and community dietitians in London and Hertfordshire, UK (n = 60 participants). Data were analysed using thematic analysis.

RESULTS

Primary care and community health professionals perceived malnutrition as a multifaceted problem. There was an agreement that there is a gap in care provided for malnutrition in the community. However, there were conflicting views regarding professional accountability. Challenges commonly reported by primary care professionals included overwhelming workload and lack of training in nutrition. Community MDT professionals and dietitians thought that an intervention to tackle malnutrition would be best placed in primary care and suggested opportunistic screening interventions. Education was an essential part of any intervention, complemented by social, emotional, and/or practical support for frailer or socially isolated older people.

CONCLUSIONS

Future interventions should include a multifaceted approach. Education tailored to the needs of older people, carers, and healthcare professionals is a necessary component of any intervention.

Nurses' knowledge and attitudes regarding malnutrition in children and its management in Ghana

Background

Malnutrition contributes significantly to child morbidity and mortality. Nurses require appropriate knowledge, skills and attitudes to prevent and treat malnutrition in children using appropriate guidelines or protocols.

Objectives

The aim of this article was to assess nurses’ knowledge, attitudes towards malnutrition and its management using the World Health Organization (WHO) or United Nations International Children’s Fund guidelines for the treatment of severely malnourished children and to evaluate factors associated with their knowledge and attitudes.

Methods

Participants included 104 nurses working in the outpatient and paediatric units or departments of four hospitals in Tamale metropolis. An 88-item questionnaire was used to measure nurses’ socio-demographic characteristics as well as their knowledge and attitudes towards malnutrition in children and its management using the WHO guidelines for the inpatient treatment of severely malnourished children.

Results

Nurses’ knowledge in malnutrition and its management was slightly above average (54.0%), but their attitudes were highly positive. Factors that were associated with nurses’ knowledge were number of nutrition courses undertaken in nursing school, number of years working as a nurse, receipt of a refresher course on nutrition after school and receipt of training on the guidelines. Nurses’ attitudes were associated with report of having awareness on the guidelines, number of years a nurse has been involved in the treatment of a severely malnourished child.

Conclusion

Nurses’ knowledge levels in the inpatient treatment of severely malnourished children were not desirable. However, their attitudes were generally positive. Receipt of previous training, awareness of the WHO guidelines, practice experience and number of years as a nurse significantly affected knowledge and attitude scores in the positive direction.

Research in Nursing and Nutrition: Is Randomized Clinical Trial the Actual Gold Standard?

The aim of this study was to assess the quality of reporting of nurse-driven randomized controlled trials involving a direct nutritional intervention. A bibliometric search for randomized controlled trials involving a direct nutritional intervention from 1991 to 2011 in nursing research was conducted. Both quality of the study and design aspects were evaluated. The prevalent randomized controlled trial design used is 2-arm parallel, individual, and randomized with a continuous primary endpoint. Global numbers of randomized controlled trials and the proportion of good-quality randomized controlled trials began a steady and marked rise, more than doubling, from the 1990s to about 2001 and increased slowly thereafter. Studies are overall sufficiently well designed, although there is still room for quality improvement. Additionally, implementation of new randomized controlled trial designs exists and should be advocated.

A multifaceted intervention model can give a lasting improvement of older peoples' nutritional status

OBJECTIVE

The purpose of this study was with a multifaceted intervention model improve the nutritional status of elderly people living in residential homes to increase their energy intake and to maintain improvements over time.

SETTING

Three different municipal residential homes in the south-east of Sweden.

PARTICIPANTS

The study population consisted of 67 elderly people. A within-subjects design was used which means that the participants were their own controls.

INTERVENTION

A multifaceted intervention model was chosen, which included education on both theoretical and practical issues, training and support for staff, and individualized snacks to the residents.

MEASUREMENTS

Nutritional status was measured by Mini Nutritional Assessment (MNA), the consumption of food was recorded by the staff using a food record method for 3 consecutive days. The length of night-time fasting has been calculated from the food records.

RESULTS

Nutritional status improved after 3 months of intervention and was maintained after 9 months. Weight increased during the whole study period. Night-time fasting decreased but not to the recommended level.

CONCLUSION

This study shows that it is possible by a multifaceted intervention model to increase energy intake including expanding snacks and thereby improve and maintain nutritional status over a longer period in the elderly living in residential homes. This result was possible to achieve because staff received education and training in nutritional issues and by provision of support during a period when new routines were introduced.

Malnutrition and cognitive impairment among people 60 years of age and above living in regular housing and in special housing in Sweden: a population-based cohort study

BACKGROUND

Malnutrition is a common problem among older people and associated with reduced functional and cognitive ability. Furthermore, malnutrition among people living in special housing, i.e. in nursing homes or sheltered accommodation, appears to be more common than among those living in regular housing, i.e. in their own homes. However, it is still unclear if the relationship between malnutrition and impaired cognitive ability is connected to living arrangement, i.e. if the relationship is stronger among those who live alone compared to those who cohabit in regular housing.

OBJECTIVES

The purpose with the present study was to describe the relationship between nutritional status and cognitive ability among people 60 years of age and above in Sweden, with a focus on housing and living arrangement.

DESIGN

Population-based cohort study.

SETTING AND PARTICIPANTS

The study focused on people living in regular or in special housing and comprised 1,402 randomly selected individuals (60-96 years of age) who lived in one municipality in south-eastern Sweden and participated in SNAC-B (the Swedish study on Aging and Care - Blekinge), 2001-2003.

METHODS

Data regarding demography, nutrition and functional and cognitive ability were collected through questionnaires, medical examinations and structured interviews.

RESULTS

The relationship was the strongest between cognitive ability and nutritional status among those living in special housing. Regardless of housing and living arrangement, older people with a moderate or severe cognitive impairment risked (OR 2.59-16.00) being malnourished, irrespective of functional ability.

CONCLUSION

This study highlights that those with a moderate and severe cognitive impairment suffer a risk of developing malnutrition, irrespective of living and housing arrangement. The findings suggest that nurses in the social service and health care system need to consider changes in weight and nutritional intake as well as the individual needs of older people with cognitive impairment to avoid malnutrition.