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Nielsen LP, Thomsen KH, Alleslev C, Mikkelsen S, Holst M. Implementation of nutritional care in hospitals: A qualitative study of barriers and facilitators using implementation theory. Scand J Caring Sci 2024. [PMID: 38520146 DOI: 10.1111/scs.13255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Revised: 01/19/2024] [Accepted: 02/25/2024] [Indexed: 03/25/2024]
Abstract
BACKGROUND Disease-related malnutrition is prevalent among hospitalised patients, but not all patients achieve the needed nutritional care. At a Danish University Hospital, focus has been on implementing nutritional practices based on clinical guidelines, but there is continuously variation between the wards regarding the quality of nutritional care. AIM The aim of this study was to identify the potential barriers and facilitators for implementation of the clinical guidelines for nutritional practices and to recommend suggestions for development of nutritional practices, using a theoretical implementation strategy. METHOD The design was a qualitative interview study of employees at a Danish University Hospital, using a semi-structured interview guide. The participants were nurses, nurse's assistant, nurse nutrition expert, head nurse and dieticians. We recruited 11 employees, representing eight different wards. FINDINGS The analysis identified six themes: (1) clear allocation of responsibilities and committed management enhances nutrition practices, (2) leadership support is essential, (3) physical settings and tools affect possibilities for action, (4) selection of equivalent staff is core, (5) teaching promotes the knowledge and skills and (6) a dietitian in the ward facilitates implementation of nutritional care. Barriers and facilitators among the themes were identified and has led to suggestions to strengthen nutritional care, based on implementation theory. CONCLUSION Various factors were identified as having impact on the implementation of nutrition practices and different suggestions have emerged to accommodate those factors, as well as to apply an implementation strategy to facilitate change in practice.
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Affiliation(s)
| | | | - Camilla Alleslev
- Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
| | - Sabina Mikkelsen
- Department of Gastroenterology, Aalborg University Hospital, Aalborg, Denmark
| | - Mette Holst
- Department of Gastroenterology, Aalborg University Hospital, Aalborg, Denmark
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
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Mikkelsen S, Tobberup R, Skadhauge LB, Rasmussen HH, Holst M. "More2Eat" in patients at nutritional risk during hospital stay lowers the risk of three-month mortality. Clin Nutr ESPEN 2023; 57:29-38. [PMID: 37739671 DOI: 10.1016/j.clnesp.2023.06.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2023] [Revised: 06/06/2023] [Accepted: 06/14/2023] [Indexed: 09/24/2023]
Abstract
BACKGROUND & AIMS Malnutrition is a common problem among hospitalized patients due to increased nutrient requirements and reduced food intake or uptake of nutrients. The aim of this prospective cohort study was to investigate the association of nutritional risk status (at or not at risk by NRS-2002) as well as energy and protein intake, use of oral nutritional supplements (ONS) and snack meals in at risk patients during hospitalization and adverse outcomes (length of stay (LOS), readmissions and mortality) at three-months follow-up. METHODS Data were collected at baseline and at three-months follow-up in patients hospitalized at 31 units at a Danish University Hospital. Diet records were performed at baseline by using the nurses' quartile nutrition recording methods. Data about disease and clinical outcomes were collected from electronic medical records at baseline and three-months follow-up. RESULTS A total of 318 patients were included. Patients at nutritional risk (n = 149, 47%) had higher risk of longer LOS (≥20 days (OR = 4.24 [1.81;9.95] and ≥30 days OR = 2.50 [1.22;5.14])), having one readmission (OR = 1.86 [1.15;3.01]) and death (OR = 2.56 [1.27;5.20]) compared to patients not at nutritional risk (n = 169, 53%). A longer LOS was associated with patients who achieved ≥75% of energy and protein requirements, consumed snack meals incl. and excl. oral nutritional supplements. Readmissions in patients at nutritional risk during the three-months were not associated with food intake during the index hospitalization. Mortality was observed in 43 of the 318 (13.5%) hospitalized patients. A lower mortality was associated with increased energy and protein intake in patients at nutritional risk. CONCLUSIONS The results of this study indicate a longer LOS, higher readmission rate and increased mortality in patients at nutritional risk compared to patients not at risk. Patients at nutritional risk had lower risk of three-month mortality and longer LOS during index hospitalization with increased energy and protein intake. Readmissions in patients at nutritional risk were not affected by food intake. The association of nutritional risk with poorer outcomes indicates that good nutritional care including constant attention to food-intake during hospitalization can be beneficial regarding mortality.
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Affiliation(s)
- Sabina Mikkelsen
- Danish Nutrition Science Centre and Department of Gastroenterology, Aalborg University Hospital, Søndre skovvej 5, 9000 Aalborg, Denmark.
| | - Randi Tobberup
- Danish Nutrition Science Centre and Department of Gastroenterology, Aalborg University Hospital, Søndre skovvej 5, 9000 Aalborg, Denmark.
| | - Lotte Boa Skadhauge
- Danish Nutrition Science Centre and Department of Gastroenterology, Aalborg University Hospital, Søndre skovvej 5, 9000 Aalborg, Denmark.
| | - Henrik Højgaard Rasmussen
- Danish Nutrition Science Centre and Department of Gastroenterology, Aalborg University Hospital, Søndre skovvej 5, 9000 Aalborg, Denmark; Department of Clinical Medicine, Aalborg University, Søndre skovvej 5, 9000 Aalborg, Denmark.
| | - Mette Holst
- Danish Nutrition Science Centre and Department of Gastroenterology, Aalborg University Hospital, Søndre skovvej 5, 9000 Aalborg, Denmark; Department of Clinical Medicine, Aalborg University, Søndre skovvej 5, 9000 Aalborg, Denmark.
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Jespersen JB, Beck AM, Munk T, Jensen HO, Knudsen AW. Low-intake dehydration and nutrition impact symptoms in older medical patients - A retrospective study. Clin Nutr ESPEN 2023; 57:190-196. [PMID: 37739655 DOI: 10.1016/j.clnesp.2023.06.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 06/23/2023] [Accepted: 06/24/2023] [Indexed: 09/24/2023]
Abstract
BACKGROUND AND AIMS Malnutrition and low-intake dehydration both increase complications and mortality in hospitalized older medical patients. Nutrition Impact Symptoms (NIS) are barriers for obtaining an adequate nutritional intake and possibly adequate fluid. Therefore, we aimed to assess the prevalence of low-intake dehydration and specific NIS, and the relation between low-intake dehydration and specific NIS. METHODS A retrospective cohort study among older patients (≥65 years) from the Medical Department at Herlev-Gentofte Hospital and referred to a clinical dietitian. Data about sex, age, BMI, prevalence of nutritional risk (NRS-2002), low-intake dehydration (calculated osmolarity >295 mmol/L), and NIS (the EATEN-questionnaire, comprising 16 NIS-questions and whether these were respectively present and limiting nutritional intake) were collected from the hospital records. RESULTS We included 99 patients (61% women), mean age 81 years (±7.9), median BMI 21.8 kg/m2 (IQR:19.5-25.4). Nutritional risk was found in 74%, and low-intake dehydration in 40% of the included patients. The three most frequent NIS-present were: Early satiety (84%), no appetite (82%), and tiredness (72%). The three most frequent NIS-limiting intake were: No appetite (73%), early satiety (69%), and dry mouth (42%). We found low-intake dehydration to be related to a lower prevalence of the following NIS-present; dry mouth (58% vs.80%, p = 0.0210), and breathlessness (24% vs.49%, p = 0.0179). Among the NIS-limiting intake a lower prevalence of other pains was related to low-intake dehydration (7% vs.29%, p = 0.0233). CONCLUSION NIS and low-intake dehydration are highly prevalent in older patients. There is limited association between low-intake dehydration and specific NIS.
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Affiliation(s)
- Jacob Bækgaard Jespersen
- The Dietitians and Nutritional Research Unit, EATEN, Copenhagen University Hospital, Herlev and Gentofte, Copenhagen, Denmark.
| | - Anne Marie Beck
- The Dietitians and Nutritional Research Unit, EATEN, Copenhagen University Hospital, Herlev and Gentofte, Copenhagen, Denmark.
| | - Tina Munk
- The Dietitians and Nutritional Research Unit, EATEN, Copenhagen University Hospital, Herlev and Gentofte, Copenhagen, Denmark.
| | - Helena Osbæck Jensen
- The Dietitians and Nutritional Research Unit, EATEN, Copenhagen University Hospital, Herlev and Gentofte, Copenhagen, Denmark.
| | - Anne Wilkens Knudsen
- The Dietitians and Nutritional Research Unit, EATEN, Copenhagen University Hospital, Herlev and Gentofte, Copenhagen, Denmark.
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Orell H, Pohju A, Tuokkola J, Junttila K, Heikkilä A, Österlund P, Schwab U, Mäkitie A. Time to act! - A cross-sectional study on how nutritional risk increases during hospitalization and associates with worse outcome. Clin Nutr ESPEN 2023; 57:364-374. [PMID: 37739680 DOI: 10.1016/j.clnesp.2023.07.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 06/22/2023] [Accepted: 07/11/2023] [Indexed: 09/24/2023]
Abstract
BACKGROUND & AIMS Nutritional risk is prevalent, and it develops negatively during hospital stay. The aim of this cohort study was to assess the association of nutritional risk with total costs of hospital care, length of stay, and in-hospital mortality. METHODS Cross-sectional study with hospitalized patients (n = 3053). Nutritional risk screening 2002 and outcome were investigated. Chi-square, Fisher, and Mann-Whitney tests, univariable and multivariable generalized linear and binary logistic regression models were used. RESULTS Nutritional risk was detected in 18% (184/1024) of those patients assessed at admission while the number of patients at risk increased 3-fold (47%,152/265) in those screened 14 days after admission (odds ratio 6.25; 95% CI 4.58-8.53, p < 0.001). Nutritionally at-risk patients had 5.6 days longer length of stay (p < 0.001) and 9% higher adjusted total costs compared with non-risk patients (p < 0.001). Adjusted overall risk for in-hospital mortality was 4.4 (95% CI 2.44-7.92, p < 0.001) for patients at nutritional risk. The screening rate was between 52% and 68%, and only 4% of the nutritionally at-risk patients had dietitian consultation during their hospital stay. CONCLUSIONS The number of patients with nutritional risk increased clearly during hospitalization associating with a four times higher in-hospital mortality and substantially increased hospital costs. The results demonstrate that the nutritional risk and its detrimental influence on the outcome increases during hospitalization emphasizing the importance to screen patients at admission and repeated weekly.
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Affiliation(s)
- Helena Orell
- Clinical Nutrition Unit, Internal Medicine and Rehabilitation, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
| | - Anne Pohju
- Clinical Nutrition Unit, Internal Medicine and Rehabilitation, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Jetta Tuokkola
- Clinical Nutrition Unit, Internal Medicine and Rehabilitation, University of Helsinki and Helsinki University Hospital, Helsinki, Finland; School for Medicine, Institute of Public Health and Clinical Nutrition, University of Eastern Finland and Department of Medicine, Endocrinology and Clinical Nutrition, Kuopio University Hospital, Kuopio, Finland
| | - Kristiina Junttila
- Nursing Research Center, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Anniina Heikkilä
- HUS Nursing Administrative Group University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Pia Österlund
- Department of Oncology, Tampere University Hospital and University of Tampere, Tampere, Finland; Department of Oncology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland; Department of Oncology/Pathology, Karolinska Institute and Tema Cancer/ GI-cancer, Karolinska University Hospital, Stockholm, Sweden
| | - Ursula Schwab
- School for Medicine, Institute of Public Health and Clinical Nutrition, University of Eastern Finland and Department of Medicine, Endocrinology and Clinical Nutrition, Kuopio University Hospital, Kuopio, Finland
| | - Antti Mäkitie
- Department of Otorhinolaryngology - Head and Neck Surgery, Helsinki University Hospital and University of Helsinki, Helsinki, Finland; Research Program in Systems Oncology, Faculty of Medicine, University of Helsinki, Helsinki, Finland
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Wunderle C, Gomes F, Schuetz P, Stumpf F, Austin P, Ballesteros-Pomar MD, Cederholm T, Fletcher J, Laviano A, Norman K, Poulia KA, Schneider SM, Stanga Z, Bischoff SC. ESPEN guideline on nutritional support for polymorbid medical inpatients. Clin Nutr 2023; 42:1545-1568. [PMID: 37478809 DOI: 10.1016/j.clnu.2023.06.023] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Accepted: 06/20/2023] [Indexed: 07/23/2023]
Abstract
BACKGROUND Disease-related malnutrition in polymorbid medical inpatients is a highly prevalent syndrome associated with significantly increased morbidity, disability, short- and long-term mortality, impaired recovery from illness, and cost of care. AIM As there are uncertainties in applying disease-specific guidelines to patients with multiple conditions, our aim was to provide evidence-based recommendations on nutritional support for the polymorbid patient population hospitalized in medical wards. METHODS This update adheres to the standard operating procedures for ESPEN guidelines. We did a systematic literature search for 15 clinical questions in three different databases (Medline, Embase and the Cochrane Library), as well as in secondary sources (e.g. published guidelines), until July 12th. Retrieved abstracts were screened to identify relevant studies that were used to develop recommendations (incl. SIGN grading), which was followed by submission to Delphi voting. RESULTS From a total of 3527 retrieved abstracts, 60 new relevant studies were analyzed and used to generate a guideline draft that proposed 32 recommendations (7x A, 11x B, 10x O and 4x GPP), which encompass different aspects of nutritional support including indication, route of feeding, energy and protein requirements, micronutrient requirements, disease-specific nutrients, timing, monitoring and procedure of intervention. The results of the first online voting showed a strong consensus (agreement of >90%) on 100% of the recommendations. Therefore, no final consensus conference was needed. CONCLUSIONS Recent high-quality trials have provided increasing evidence that nutritional support can reduce morbidity and other complications associated with malnutrition in polymorbid patients. The timely screening of patients for risk of malnutrition at hospital admission followed by individualized nutritional support interventions for at-risk patients should be part of routine clinical care and multimodal treatment in hospitals worldwide. Use of this updated guideline offers an evidence-based nutritional approach to the polymorbid medical inpatients and may improve their outcomes.
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Affiliation(s)
- Carla Wunderle
- Cantonal Hospital Aarau and University of Basel, Switzerland
| | - Filomena Gomes
- Cantonal Hospital Aarau and University of Basel, Switzerland; NOVA Medical School, Universidade NOVA de Lisboa, Lisboa, Portugal
| | - Philipp Schuetz
- Cantonal Hospital Aarau and University of Basel, Switzerland.
| | - Franziska Stumpf
- Cantonal Hospital Aarau and University of Basel, Switzerland; Institute of Clinical Nutrition, University of Hohenheim, 70599 Stuttgart, Germany
| | - Peter Austin
- Pharmacy Department, Oxford University Hospitals NHS Foundation Trust, Oxford, UK, University College London School of Pharmacy, London, United Kingdom
| | | | - Tommy Cederholm
- Uppsala University, Uppsala and Karolinska University Hospital, Stockholm Sweden
| | - Jane Fletcher
- Queen Elizabeth Hospital, Birmingham, United Kingdom
| | | | - Kristina Norman
- Charité University Medicine Berlin and German Institute for Human Nutrition, Germany
| | | | | | - Zeno Stanga
- University Hospital and University of Bern, Switzerland
| | - Stephan C Bischoff
- Institute of Nutritional Medicine, University of Hohenheim, Stuttgart, Germany
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Mikkelsen S, Frost KH, Engelbreth EM, Nilsson L, Peilicke KM, Tobberup R, Skadhauge LB, Rasmussen HH, Holst M. Are nutritional sufficiency of ≥75% energy and protein requirements relevant targets in patients at nutritional risk? - A one month follow-up study. Clin Nutr ESPEN 2023; 54:398-405. [PMID: 36963885 DOI: 10.1016/j.clnesp.2023.02.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Revised: 11/17/2022] [Accepted: 02/07/2023] [Indexed: 02/13/2023]
Abstract
BACKGROUND & AIM Nutrient intake in patients at nutritional risk was recorded with the aim of reaching at least 75% of estimated requirements for energy and protein. However, the cutoff at 75% has only been sparsely investigated. The aim of this study was to re-evaluate the 75% cutoff of estimated energy and protein requirements among patients at or not at nutritional risk in relation to 30-day mortality and readmissions. METHODS A 30-day follow-up study was performed among hospitalized patients in 31 units at a Danish University Hospital. Data was collected using the nurses' quartile nutrition registration method and electronic patient journals. All patients were screened using the NRS-2002 and classified as either at nutritional risk (NRS-2002, score ≥3) or not at nutritional risk (NRS-2002, score <3). Energy and protein requirements were estimated using weighted Harris-Benedict equation and 1.3 g/kg/day, respectively. RESULTS In total, 318 patients were included in this study. Patients at nutritional risk were older, lower BMI, male, more comorbidities and a longer primary length of stay compared to patients not at nutritional risk (p < 0.05). After 30-day follow-up, mortality was higher among patients at risk (9.5% vs. 2.0%, p < 0.05). Patients at nutritional risk showed increased risk of mortality if they did not achieve 75% of estimated requirements (energy: OR = 8.08 [1.78; 36.79]; protein: OR = 3.40 [0.74; 15:53]). Furthermore, predicted probability of mortality decreased with increased energy and protein intakes. No significant associations were found for readmissions achieving 75% of estimated energy or protein requirements. A cutoff of 76-81% for energy and 58-62% for protein was equivalent with accepting a 6-8% mortality rate. CONCLUSION The results of this study indicate that an energy intake ≥75% of estimated requirement among patients at nutritional risk has a preventative effect regarding mortality within one month, but not for readmissions.
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Affiliation(s)
- Sabina Mikkelsen
- Department of Gastroenterology, Aalborg University Hospital, Søndre skovvej 5, 9000 Aalborg, Denmark.
| | - Karen Hougaard Frost
- Department of Gastroenterology, Aalborg University Hospital, Søndre skovvej 5, 9000 Aalborg, Denmark.
| | - Emma Mølgaard Engelbreth
- Department of Gastroenterology, Aalborg University Hospital, Søndre skovvej 5, 9000 Aalborg, Denmark.
| | - Lærke Nilsson
- Department of Gastroenterology, Aalborg University Hospital, Søndre skovvej 5, 9000 Aalborg, Denmark.
| | - Karen Marie Peilicke
- Department of Gastroenterology, Aalborg University Hospital, Søndre skovvej 5, 9000 Aalborg, Denmark.
| | - Randi Tobberup
- Department of Gastroenterology, Aalborg University Hospital, Søndre skovvej 5, 9000 Aalborg, Denmark.
| | - Lotte Boa Skadhauge
- Department of Gastroenterology, Aalborg University Hospital, Søndre skovvej 5, 9000 Aalborg, Denmark.
| | - Henrik Højgaard Rasmussen
- Department of Gastroenterology, Aalborg University Hospital, Søndre skovvej 5, 9000 Aalborg, Denmark; Department of Clinical Medicine, Aalborg University, Denmark.
| | - Mette Holst
- Department of Gastroenterology, Aalborg University Hospital, Søndre skovvej 5, 9000 Aalborg, Denmark; Department of Clinical Medicine, Aalborg University, Denmark.
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McCray S, Barsha L, Maunder K. Implementation of an electronic solution to improve malnutrition identification and support clinical best practice. J Hum Nutr Diet 2022; 35:1071-1078. [PMID: 35510388 DOI: 10.1111/jhn.13026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Accepted: 04/25/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND Routine malnutrition risk screening of patients is critical for optimal care and comprises part of the National Australian Hospital Standards. Identification of malnutrition also ensures reimbursement for hospitals to adequately treat these high-risk patients. However, timely, accurate screening, assessment and coding of malnutrition remains suboptimal. The present study aimed to investigate manual and digital interventions to overcome barriers to malnutrition identification for improvements in the hospital setting. METHODS Retrospective reporting on malnutrition identification processes was conducted through two stages: (1) manual auditing intervention and (2) development of a digital solution - the electronic malnutrition management solution (eMS). Repeated process audits were completed at approximately 6-monthly intervals through both stages between 2016 and 2019 and the results were analysed. In Stage 2, time investment and staff adoption of the digital solution were measured. RESULTS Overall, the combined effect of both regular auditing and use of the eMS resulted in statistically significant improvements across all six key measures: patients identified (97%-100%; p < 0.001), screened (68%-95%; p < 0.001), screened within 24 h (51%-89%; p < 0.001), assessed (72%-95%; p < 0.001), assessed within 24 h (66%-93%; p < 0.001) and coded (81%-100%; p = 0.017). The eMS demonstrated a reduction in screening time by over 60% with user adoption 100%. Data analytics enabled automated, real-time auditing with a 95% reduction in time taken to audit. CONCLUSIONS A single digital solution for management of malnutrition and automation of auditing demonstrated significant improvements where manual or combinations of manual and electronic systems continue to fall short.
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Affiliation(s)
- Sally McCray
- Dept of Dietetics and Foodservices, Mater Group, Raymond Terrace, South Brisbane, QLD, Australia.,Mater Research Institute, University of Queensland Brisbane, QLD, Australia
| | - Laura Barsha
- Dept of Dietetics and Foodservices, Mater Group, Raymond Terrace, South Brisbane, QLD, Australia.,Mater Research Institute, University of Queensland Brisbane, QLD, Australia
| | - Kirsty Maunder
- The CBORD Group, Sydney, NSW, Australia.,University of Wollongong, Faculty of Science, Medicine and Health, Wollongong, NSW, Australia
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Terp R, Lindhardt T, Kayser L. Theory-driven development of an educative nutritional intervention (ENI) supporting older hospital patients to eat sufficiently, assisted by an eHealth solution: an intervention mapping approach. BMC Health Serv Res 2022; 22:1435. [DOI: 10.1186/s12913-022-08679-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Accepted: 10/14/2022] [Indexed: 11/29/2022] Open
Abstract
Abstract
Background:
Insufficient protein and energy intake is a prevalent and serious problem in older hospital patients. Here, we describe the development of a program consisting of 1) an educative nutritional intervention (ENI) to support older hospital patients to participate in their own nutritional care using the eHealth solution Food’n’Go, and 2) a plan for education and support of healthcare professionals, enabling them to conduct the ENI. Further, we describe the evaluation of the acceptability of the program as perceived by nursing staff and dieticians.
Methods:
The Intervention Mapping (IM) framework was used to design and develop the ENI through six steps: 1) a logic model of the problem was developed; 2) performance objectives and related change objectives were defined for patients, relatives, and healthcare professionals; 3) the intervention was designed using relevant theory-based change methods; 4) program materials were produced; and finally, 5) implementation and maintenance were planned and 6) evaluation of the program was planned. End users (patients, relatives, and healthcare professionals) were involved in the design and development of the ENI.
Results:
Based on the logic model, the personal determinants (knowledge, skills, self-efficacy, outcome expectation, social support, attitude, and awareness) related to the patients and their relatives were addressed in the ENI, and those related to the healthcare professionals were addressed in the plan for their education and support. Theories of behavioral change, technology acceptance, and nutritional management for older persons were applied. A plan for evaluation of the effectiveness (intake of energy and protein) and feasibility of the ENI was conducted. The feasibility measurements were the behaviors and determinants related to the intervention outcome that were identified in the logic model of change. The ENI was perceived as acceptable by the nursing staff and dieticians.
Conclusion:
We developed a theory- and evidence-based intervention guided by the IM framework and a sociotechnical approach, which was perceived as acceptable and ready for use to support older hospital patients to eat sufficiently assisted by eHealth.
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Frederiksen AK, Beck AM, Luiking YC, Hofstede JM, Knudsen AW, Munk T. Protein intake in hospitalized older patients after hip fracture: Pilot feasibility study evaluating ESPEN guidelines for geriatrics. CLINICAL NUTRITION OPEN SCIENCE 2022. [DOI: 10.1016/j.nutos.2022.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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