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Wong A, Huang Y, Banks MD, Sowa PM, Bauer JD. A Cost-Consequence Analysis of Nutritional Interventions Used in Hospital Settings for Older Adults with or at Risk of Malnutrition. Healthcare (Basel) 2024; 12:1041. [PMID: 38786451 PMCID: PMC11120964 DOI: 10.3390/healthcare12101041] [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: 03/30/2024] [Revised: 05/15/2024] [Accepted: 05/16/2024] [Indexed: 05/25/2024] Open
Abstract
BACKGROUND Malnutrition is a significant and prevalent issue in hospital settings, associated with increased morbidity and mortality, longer hospital stays, higher readmission rates, and greater healthcare costs. Despite the potential impact of nutritional interventions on patient outcomes, there is a paucity of research focusing on their economic evaluation in the hospital setting. This study aims to fill this gap by conducting a cost-consequence analysis (CCA) of nutritional interventions targeting malnutrition in the hospital setting. METHODS We performed a CCA using data from recent systematic reviews and meta-analyses, focusing on older adult patients with or at risk of malnutrition in the hospital setting. The analysis included outcomes such as 30-day, 6-month, and 12-month mortality; 30-day and 6-month readmissions; hospital complications; length of stay; and disability-adjusted life years (DALYs). Sensitivity analyses were conducted to evaluate the impact of varying success rates in treating malnutrition and the proportions of malnourished patients seen by dietitians in SingHealth institutions. RESULTS The CCA indicated that 28.15 DALYs were averted across three SingHealth institutions due to the successful treatment or prevention of malnutrition by dietitians from 1 April 2021 to 31 March 2022, for an estimated 45,000 patients. The sensitivity analyses showed that the total DALYs averted ranged from 21.98 (53% success rate) to 40.03 (100% of malnourished patients seen by dietitians). The cost of implementing a complex nutritional intervention was USD 218.72 (USD 104.59, USD 478.40) per patient during hospitalization, with additional costs of USD 814.27 (USD 397.69, USD 1212.74) when the intervention was extended for three months post-discharge and USD 638.77 (USD 602.05, USD 1185.90) for concurrent therapy or exercise interventions. CONCLUSION Nutritional interventions targeting malnutrition in hospital settings can have significant clinical and economic benefits. The CCA provides valuable insights into the costs and outcomes associated with these interventions, helping healthcare providers and policymakers to make informed decisions on resource allocation and intervention prioritization.
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Affiliation(s)
- Alvin Wong
- Department of Dietetics, Changi General Hospital, Singapore 529889, Singapore
- School of Human Movement and Nutrition Sciences, University of Queensland, St. Lucia, QLD 4072, Australia
| | - Yingxiao Huang
- Department of Dietetics, Changi General Hospital, Singapore 529889, Singapore
| | - Merrilyn D. Banks
- Department of Nutrition and Dietetics, Royal Brisbane and Women’s Hospital, Herston, QLD 4029, Australia
| | - P. Marcin Sowa
- Centre for the Business and Economics of Health, University of Queensland, St Lucia, QLD 4067, Australia
| | - Judy D. Bauer
- Department of Nutrition, Dietetics and Food, Monash University, Notting Hill, VIC 3168, Australia;
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Jonathan A, Reid K, Radcliffe T. Managing food waste in the inpatient population. BMJ Open Qual 2023; 12:e002436. [PMID: 38123474 DOI: 10.1136/bmjoq-2023-002436] [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: 06/13/2023] [Accepted: 12/02/2023] [Indexed: 12/23/2023] Open
Abstract
INTRODUCTION For medical students, food is rarely discussed from the clinical perspective. Yet, in hospitals reduced food intake poses the risk of malnutrition, along with increased morbidity and mortality. The issue of food waste, a cause of inadequate dietary intake and a common issue within the National Health Service, is rarely addressed. The implementation of protected mealtimes has done little to solve this. This quality improvement project aimed to reduce the average amount of inpatient food waste by 20% by May 2022. METHODS A standardised meal size intervention was tested. Meals were weighed before and after meal services to collect baseline and postintervention data. The percentage consumed and the percentage wasted were then calculated. Finally, the overall average of the percentage wasted across both meal services was determined. RESULTS Quantitative data showed a change in the average amount of food waste from 70.16% to 65.75%, a decrease of 4.41%. Survey results also found an increase of 3% in patient satisfaction with meal sizes. CONCLUSION Standardising meal sizes is shown to improve inpatient food waste and may serve as a starting point for healthcare providers to devise further strategies to reduce wastage in hospitals.
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Affiliation(s)
- Adrienne Jonathan
- University Hospitals of Morecambe Bay NHS Foundation Trust, Lancaster, UK
| | - Kim Reid
- East Lancashire Hospitals NHS Trust, Blackburn, UK
| | - Tim Radcliffe
- Estates & Facilities Division, East Lancashire Hospitals NHS Trust, Blackburn, UK
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3
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Wong A, Huang Y, Sowa PM, Banks MD, Bauer JD. An Umbrella Review and Meta-analysis of Interventions, Excluding Enteral and Parenteral Nutrition, Initiated in the Hospital for Adults with or at Risk of Malnutrition. Am J Clin Nutr 2023; 118:672-696. [PMID: 37437779 DOI: 10.1016/j.ajcnut.2023.07.003] [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: 11/03/2022] [Revised: 06/12/2023] [Accepted: 07/03/2023] [Indexed: 07/14/2023] Open
Abstract
BACKGROUND Multiple systematic reviews and meta-analyses (SRMAs) on various nutritional interventions in hospitalized patients with or at risk of malnutrition are available, but disagreements among findings raise questions about their validity in guiding practice. OBJECTIVES We conducted an umbrella review (a systematic review of systematic reviews in which all appropriate studies included in SRMAs are combined) to assess the quality of reviews, identify the types of interventions available (excluding enteral and parenteral nutrition), and re-analyze the effectiveness of interventions. METHODS The databases MEDLINE/PubMed, CINAHL, Embase, The Cochrane Library, and Google Scholar were searched. AMSTAR-2 was used for quality assessment and GRADE for certainty of evidence. Updated meta-analyses with risk of bias (ROB) by Cochrane ROB 2.0 were performed. Pooled effects were reported as relative risk (RR), with zero-events and publication bias adjustments, and trial sequential analysis (TSA) performed for mortality, readmissions, complications, length of stay, and quality of life. RESULTS A total of 66 randomized controlled trials were cited by the 19 SRMAs included in this umbrella review, and their data extracted and analyzed. Most clinical outcomes were discordant with variable effect sizes in both directions. In trials with low ROB, interventions targeting nutritional intake reduce mortality at 30 d (15 studies, n: 4156, RR: 0.72, 95% CI: 0.55, 0.94, P: 0.02, I2: 6%, Certainty: High), 6 mo (27 studies, n: 6387, RR: 0.81, 95% CI: 0.71, 0.92, P = 0.001, I2: 4%, Certainty: Moderate), and 12 mo (27 studies, n: 6387, RR: 0.80, 95% CI: 0.67, 0.95, P: 0.01, I2: 33%, Certainty: Moderate), with TSA verifying an adequate sample size and robustness of the meta-analysis. CONCLUSION Existing evidence is sufficient to show that nutritional intervention is effective for mortality outcomes at 30 d, 6 mo, and 12 mo. Future clinical trials should focus on the effect of nutritional interventions on other clinical outcomes. TRIAL REGISTRATION NUMBER The protocol is registered on PROSPERO (CRD42022341031).
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Affiliation(s)
- Alvin Wong
- Department of Dietetics, Changi General Hospital, Singapore, Singapore; School of Human Movement and Nutrition Sciences, University of Queensland, St. Lucia, QLD, Australia.
| | - Yingxiao Huang
- Department of Dietetics, Changi General Hospital, Singapore, Singapore
| | - Przemyslaw M Sowa
- Centre for the Business and Economics of Health, The University of Queensland, St Lucia, QLD, Australia
| | - Merrilyn D Banks
- Department of Nutrition and Dietetics, Royal Brisbane and Women's Hospital, Herston, QLD, Australia
| | - Judith D Bauer
- School of Human Movement and Nutrition Sciences, University of Queensland, St. Lucia, QLD, Australia; Department of Nutrition, Dietetics and Food, Monash University, Notting Hill, VIC, Australia
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4
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Kevdzija M, Laviano A, Worf I, Schuh C, Tarantino S, Hiesmayr M. Indirect Nutrition and Mobility Risks during Hospitalization: An Architectural Perspective on the nutritionDay Study Findings. Nutrients 2023; 15:nu15061527. [PMID: 36986257 PMCID: PMC10059895 DOI: 10.3390/nu15061527] [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: 02/17/2023] [Revised: 03/17/2023] [Accepted: 03/20/2023] [Indexed: 03/30/2023] Open
Abstract
Nutrition and mobility risks include complex and interrelated physiological, medical, and social factors. A growing body of evidence demonstrates that the built environment can affect patients' well-being and recovery. Nevertheless, the relationship between the built environment, nutrition, and mobility in general hospitals is largely unexplored. This study examines the implications of the nutritionDay study's results for the architectural design of hospital wards and nutrition environments. This one-day annual cross-sectional study uses online questionnaires in 31 different languages to collect ward-specific and patient-specific variables. The main findings relevant to the design of hospital wards were: (1) 61.5% of patients (n = 48,700) could walk before hospitalization and (2) this number dropped to 56.8% on nutritionDay (p < 0.0001), while the number of bedridden patients increased from 6.5% to 11.5% (p < 0.0001), (3) patients who needed more assistance had a much longer mean LOS than mobile patients, (4) mobility was associated with changes in eating, and (5) 72% of units (n = 2793) offered additional meals or snacks, but only 30% promoted a positive eating environment. The built environment may indirectly affect hospitalized patients' mobility, independence, and nutritional intake. Possible future study directions are suggested to further investigate this relationship.
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Affiliation(s)
- Maja Kevdzija
- TU Wien, Faculty of Architecture and Planning, Institute of Architecture and Design, 1040 Vienna, Austria
| | - Alessandro Laviano
- Department of Translational and Precision Medicine, University of Rome La Sapienza, 00185 Roma, Italy
| | - Isabella Worf
- Center for Medical Data Science (CeDAS), Medical University of Vienna, 1090 Vienna, Austria
| | - Christian Schuh
- IT-Systems & Communications (ITSC), Medical University of Vienna, 1090 Vienna, Austria
| | - Silvia Tarantino
- Center for Medical Data Science (CeDAS), Medical University of Vienna, 1090 Vienna, Austria
| | - Michael Hiesmayr
- Center for Medical Data Science (CeDAS), Medical University of Vienna, 1090 Vienna, Austria
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5
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[Quality and safety in clinical nutrition]. NUTR HOSP 2022; 38:31-36. [PMID: 35137591 DOI: 10.20960/nh.04067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
Clinical nutrition and food provision in a hospital environment must be regulated by quality management programs that ensure maximum clinical benefit and maximum patient safety. This article gives an overview of quality management in clinical nutrition and hospital feeding. Likewise, keys and critical points to be taken into account in all the processes and threads that are carried out during specialized nutritional support and alimentation of patients are analyzed.
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6
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Eble J, Harms L, Verbeek J, Morgan RL, Schünemann HJ, Meerpohl JJ, Schwingshackl L. The use of the GRADE dose-response gradient domain in nutrition evidence syntheses varies considerably. J Clin Epidemiol 2022; 146:12-21. [DOI: 10.1016/j.jclinepi.2022.02.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Revised: 01/17/2022] [Accepted: 02/20/2022] [Indexed: 10/19/2022]
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Hospitality through negotiations: The performing of everyday meal activities among nursing staff and meal hosts. A qualitative study. Int J Gastron Food Sci 2022. [DOI: 10.1016/j.ijgfs.2022.100478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Thibault R, Abbasoglu O, Ioannou E, Meija L, Ottens-Oussoren K, Pichard C, Rothenberg E, Rubin D, Siljamäki-Ojansuu U, Vaillant MF, Bischoff SC. ESPEN guideline on hospital nutrition. Clin Nutr 2021; 40:5684-5709. [PMID: 34742138 DOI: 10.1016/j.clnu.2021.09.039] [Citation(s) in RCA: 54] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Accepted: 09/17/2021] [Indexed: 12/16/2022]
Abstract
In hospitals through Europe and worldwide, the practices regarding hospital diets are very heterogeneous. Hospital diets are rarely prescribed by physicians, and sometimes the choices of diets are based on arbitrary reasons. Often prescriptions are made independently from the evaluation of nutritional status, and without taking into account the nutritional status. Therapeutic diets (low salt, gluten-free, texture and consistency modified, …) are associated with decreased energy delivery (i.e. underfeeding) and increased risk of malnutrition. The European Society for Clinical Nutrition and Metabolism (ESPEN) proposes here evidence-based recommendations regarding the organization of food catering, the prescriptions and indications of diets, as well as monitoring of food intake at hospital, rehabilitation center, and nursing home, all of these by taking into account the patient perspectives. We propose a systematic approach to adapt the hospital food to the nutritional status and potential food allergy or intolerances. Particular conditions such as patients with dysphagia, older patients, gastrointestinal diseases, abdominal surgery, diabetes, and obesity, are discussed to guide the practitioner toward the best evidence based therapy. The terminology of the different useful diets is defined. The general objectives are to increase the awareness of physicians, dietitians, nurses, kitchen managers, and stakeholders towards the pivotal role of hospital food in hospital care, to contribute to patient safety within nutritional care, to improve coverage of nutritional needs by hospital food, and reduce the risk of malnutrition and its related complications.
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Affiliation(s)
- Ronan Thibault
- Unité de Nutrition, CHU Rennes, INRAE, INSERM, Univ Rennes, Nutrition Metabolisms and Cancer Institute, NuMeCan, Rennes, France.
| | - Osman Abbasoglu
- Department of Surgery, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Elina Ioannou
- Department of Nutrition, Limassol General Hospital, Cyprus
| | - Laila Meija
- Riga Stradins University, Pauls Stradins Clinical University Hospital, Latvia
| | - Karen Ottens-Oussoren
- Department of Nutrition and Dietetics, Amsterdam University Medical Centers, Location VUmc, Amsterdam, the Netherlands
| | - Claude Pichard
- Unité de Nutrition, Hôpitaux Universitaires de Genève, Geneva, Switzerland
| | - Elisabet Rothenberg
- Faculty of Health Sciences Kristianstad University Kristianstad Sweden, Sweden
| | - Diana Rubin
- Vivantes Netzwerk für Gesundheit GmbH, Humboldt Klinikum und Klinikum Spandau, Berlin, Germany
| | | | | | - Stephan C Bischoff
- University of Hohenheim, Institute of Nutritional Medicine, Stuttgart, Germany
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Sorensen J, Fletcher H, Macdonald B, Whittington-Carter L, Nasser R, Gramlich L. Canadian Hospital Food Service Practices to Prevent Malnutrition. CAN J DIET PRACT RES 2021; 82:167-175. [PMID: 34286621 DOI: 10.3148/cjdpr-2021-013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Purpose: The study aimed to determine current practice, barriers, and enablers of foodservices in Canadian hospitals relative to guiding principles for best practice to prevent malnutrition.Methods: Foodservice managers completed a 55-item cross-sectional, online survey (closed- and open-ended questions).Results: Survey responses (n = 286) were from diverse hospitals in all Canadian regions; 56% acute care; 13% had foodservices contracted out; and 60% had a reporting structure combined with clinical nutrition. Predominantly, foodservice systems were 43% in-house versus 41% pre-prepared, 46% cook-serve food production, 64% meals assembled centrally (on-site), and 40% non-selective menus with limited opportunities for patient choice in advance or at meals. The "regular menu" (44%) was most commonly served as 3 meals, no snacks at specific times. Energy and protein-dense menus were available, but not widespread (9%). Daily energy targets ranged from 1200 to 2400 kcal and 32% of respondents viewed protein targets as important. The number of therapeutic diets varied from 2 to 150.Conclusions: Although hospital foodservice practices vary across Canada, the survey results demonstrate gaps in national evidence-based practices and an opportunity to formalize guiding principles. This work highlights the need for standards to improve practice through patient-centered, foodservice practices focused on addressing malnutrition.
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Affiliation(s)
- Janice Sorensen
- Long-Term Care and Assisted Living, Fraser Health Authority, Surrey, BC
| | - Heather Fletcher
- Patient Food, Patient Transport and Environmental Services, Unity Health, Toronto, ON
| | - Brenda Macdonald
- Nutrition and Food Services, Nova Scotia Health Authority, Halifax, NS
| | | | - Roseann Nasser
- Department of Nutrition and Food Services, Pasqua Hospital, Saskatchewan Health Authority, Regina, SK
| | - Leah Gramlich
- Division of Gastroenterology, Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB
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10
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Bonetti L, Terzoni S, Lusignani M, Negri M, Froldi M, Destrebecq A. Nutritional care of older people: Investigating nurses' attitudes in medical and surgical units. Contemp Nurse 2021; 57:159-171. [PMID: 34024250 DOI: 10.1080/10376178.2021.1934501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Background: Malnutrition in older people in hospitals leads to negative patient outcomes. Nurses often underestimate the problem, showing negative attitudes.Aims: To compare nurses' attitudes towards nutritional care of older people in surgical and medical wards. Design: Multicentre cross-sectional survey, conducted in January 2015.Methods: All nurses in surgical and medical wards in 10 hospitals in northern Italy were surveyed using the Staff Attitudes to Nutritional Nursing Care Geriatric Scale (SANN-G scale).Results: 799 out of 1,293 questionnaires were returned (61.8%). 23.2% (185) had a negative attitude, 56.6%(452) had a neutral attitude, and 20.2%(162), positive. Multivariate analysis showed no significant differences between medical and surgical wards (OR = 1.298; CI95% = .883-1.886, p = .18).Conclusions: It is necessary to raise nurses' awareness of poor nutritional care in both settings. More research is needed within the barriers to nutritional care.Impact statement: Strategies such as education and more clearly defined nutritional responsibilities are needed to improve nurses' attitudes.
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Affiliation(s)
- Loris Bonetti
- Nursing Research and Development Unit, Oncology Institute of Southern Switzerland, EOC Ente Ospedaliero Cantonale, Via Gallino, 12, Bellinzona 6500, CH, Switzerland.,Department of Business Economics, Health and Social Care, University of Applied Sciences and Arts of Southern Switzerland, Via Violino, 11, Manno 6928, CH, Switzerland
| | - Stefano Terzoni
- San Paolo bachelor school of Nursing, San Paolo teaching hospital - ASST Santi Paolo e Carlo, Milan, Italy
| | - Maura Lusignani
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
| | - Marina Negri
- Bachelor School of Nursing (now retired), ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Marco Froldi
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Anne Destrebecq
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
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11
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Naughton C, Simon R, White TJ, de Foubert M, Cummins H, Dahly D. Mealtime and patient factors associated with meal completion in hospitalised older patients: An exploratory observation study. J Clin Nurs 2021; 30:2935-2947. [PMID: 33945183 DOI: 10.1111/jocn.15800] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Revised: 03/17/2021] [Accepted: 03/18/2021] [Indexed: 12/11/2022]
Abstract
AIMS AND OBJECTIVES To examine mealtime and patient factors associated with meal completion among hospitalised older patients. We also considered contextual factors such as staffing levels and ward communication. BACKGROUND Sub-optimum nutrition is a modifiable risk factor for hospital associated decline (HAD) in older patients. Yet, the quality of mealtime experiences can be overlooked within ward routinised practice. DESIGN Cross sectional, descriptive observation study. METHODS We undertook structured observation of mealtimes examining patient positioning, mealtime set-up and feeding assistance. The outcome was meal completion categorised as 0, 25%, 50%, 75% or 100%. Data were collected on patient characteristics and ward context. We used mixed-effects ordinal regression models to examine patient and mealtime factors associated with higher meal completion producing odds ratios (OR) and 95% confidence intervals (CI). The study was reported as per STROBE guidelines. RESULTS We included 60 patients with a median age of 82 years (IQR 76-87) and clinical frailty score of 5 IQR (4-6). Of the 279 meals, 51% were eaten completely, 6% three quarters, 15% half, 18% a quarter and 10% were not eaten at all. Mealtime predictors with a weak association with less-meal completion were requiring assistance, special diets, lying in bed, and red tray (indicator of nutrition risk), but were not statistically significant. Significant patient-level factors were higher values for frailty (OR 0.34 [0.11-1.04]) and Malnutrition Universal Screening Tool (OR 0.22 [0.08-0.62]). The average nurse-to-patient ratio was 1:5.5. CONCLUSION Patient factors were the strongest predictors for meal completion, but mealtime factors had a subtle influence. The nursing teams' capacity to prioritise mealtimes above competing demands is important as part of a comprehensive nutrition strategy. RELEVANCE TO CLINICAL PRACTISE Nurses are central to optimising nutrition for frail older patients. It requires ward leadership to instil a culture of prioritising assisted mealtimes, improved communication, greater autonomy to tailor nutrition strategies and safe staffing levels.
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Affiliation(s)
- Corina Naughton
- Catherine McAuley School of Nursing and Midwifery, College of Medicine and Health, Brookfield, University College Cork, Cork, Ireland
| | - Rachel Simon
- South Tipperary General Hospital, Clonmel, Ireland
| | - T J White
- South Tipperary General Hospital, Clonmel, Ireland
| | - Marguerite de Foubert
- Catherine McAuley School of Nursing and Midwifery, University College Cork, Cork, Ireland
| | - Helen Cummins
- Catherine McAuley School of Nursing and Midwifery, University College Cork, Cork, Ireland
| | - Darren Dahly
- HRB Clinical Research Facility Cork, School of Public Health, University College Cork, Cork, Ireland
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12
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Eating Alone or Together among Community-Living Older People-A Scoping Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18073495. [PMID: 33801775 PMCID: PMC8036467 DOI: 10.3390/ijerph18073495] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 03/04/2021] [Accepted: 03/25/2021] [Indexed: 12/30/2022]
Abstract
Research on healthy aging commonly concerns problems related to loneliness and food intake. These are not independent aspects of health since eating, beyond its biological necessity, is a central part of social life. This scoping review aimed to map scientific articles on eating alone or together among community-living older people, and to identify relevant research gaps. Four databases were searched, 989 articles were identified and 98 fulfilled the inclusion criteria. In the first theme, eating alone or together are treated as central topics of interest, isolated from adjoining, broader concepts such as social participation. In the second, eating alone or together are one aspect of the findings, e.g., one of several risk factors for malnutrition. Findings confirm the significance of commensality in older peoples' life. We recommend future research designs allowing identification of causal relationships, using refined ways of measuring meals alone or together, and qualitative methods adding complexity.
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13
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Nienow MK, Susterich CE, Peterson SJ. Prioritizing nutrition during recovery from critical illness. Curr Opin Clin Nutr Metab Care 2021; 24:199-205. [PMID: 33394715 DOI: 10.1097/mco.0000000000000728] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
PURPOSE OF REVIEW Patients admitted to the intensive care unit (ICU) often experience a significant decline in nutritional status due to a combination of the physiologic response to critical illness and insufficient calorie intake. The majority of research related to nutrition interventions for this population focuses on nutrition support during the acute phase. Minimal attention is given to the nutritional status of ICU patients during the recovery phase. This review will describe calorie intake when ICU care ends, provide an overview of barriers that limit intake, and possible interventions to improve nutritional status. RECENT FINDINGS Current evidence suggests patients are consuming < 60% of calorie requirements after extubation and ICU discharge. This inadequate calorie intake may exacerbate weight loss and muscle and fat wasting. Physiologic, physical, and cognitive manifestations of critical illness can lead to multiple issues that cause poor intake. Possible interventions to improve calorie intake include a patient-centered approach that utilizes oral nutrition supplements and enteral nutrition. SUMMARY Consuming adequate caloric intake in the recovery phase of critical illness is essential for rehabilitation. A systematic, patient centered approach that includes close monitoring of calorie and protein and timely interventions may be the best method to improve overall intake.
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Affiliation(s)
- Morgan K Nienow
- Department of Food and Nutrition, Rush University Medical Center
| | | | - Sarah J Peterson
- Department of Clinical Nutrition, College of Health Sciences, 600 S Paulina St, Office 737B, Chicago, Illinois, USA
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14
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van den Berg GH, Huisman-de Waal GGJ, Vermeulen H, de van der Schueren MAE. Effects of nursing nutrition interventions on outcomes in malnourished hospital inpatients and nursing home residents: A systematic review. Int J Nurs Stud 2021; 117:103888. [PMID: 33647842 DOI: 10.1016/j.ijnurstu.2021.103888] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 01/15/2021] [Accepted: 01/19/2021] [Indexed: 01/07/2023]
Abstract
CONTEXT Malnutrition in institutionalized patients is associated with adverse outcomes and increased costs. Nurses have a crucial role in the recognition and treatment of malnutrition and empowering patients in nutritional care. OBJECTIVE This systematic review provides an overview of the effectiveness of nursing nutritional interventions to counteract malnutrition. DATA SOURCES Data were obtained through a systematic search in MEDLINE/PubMed, Cochrane, CINAHL, EMBASE and ISI Web of Science databases from inception to February 15th 2018. DATA EXTRACTION Studies were eligible for inclusion when published in English, Spanish or German. Primary outcome parameters were nutritional status and dietary intake. DATA ANALYSIS The Evidence analysis checklist from the American Dietetic Association and GRADE were used to evaluate the methodological quality of the studies. RESULTS Out of 8162 studies, fifteen studies were included in the study, representing nine hospitals and six long-term care facilities. Two main categories of nursing nutrition interventions were identified; the implementation of 1) a nursing nutrition plan focusing on nursing actions in nutritional care or 2) nursing assistance in feeding support, mostly during mealtimes. Studies were heterogeneous and of most of them of low quality. This hampered drawing conclusions on effectiveness of nursing nutrition interventions on malnutrition related outcomes in clinical care. Nevertheless, six out of 15 studies reported a slightly improved nutritional status and/or clinical outcomes as a result of the interventions. CONCLUSION This review identified two categories of nursing nutrition interventions to counteract malnutrition. Their effectiveness needs to be further evaluated in future studies. Tweetable abstract: Systematic review of effective Nursing Nutrition Interventions in the management of malnutrition in hospital and nursing home care.
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Affiliation(s)
- Gerda H van den Berg
- HAN University of Applied Sciences, School of Allied Health, Department of Nutrition and Health, Nijmegen, the Netherlands; Radboud Institute of Health Sciences, IQ Healthcare, Department of Nursing Sciences, Nijmegen, the Netherlands.
| | - Getty G J Huisman-de Waal
- Radboud Institute of Health Sciences, IQ Healthcare, Department of Nursing Sciences, Nijmegen, the Netherlands.
| | - Hester Vermeulen
- HAN University of Applied Sciences, School of Allied Health, Department of Nutrition and Health, Nijmegen, the Netherlands; Radboud Institute of Health Sciences, IQ Healthcare, Department of Nursing Sciences, Nijmegen, the Netherlands.
| | - Marian A E de van der Schueren
- HAN University of Applied Sciences, School of Allied Health, Department of Nutrition and Health, Nijmegen, the Netherlands.
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15
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Beck AM, Husted MM, Weekes CE, Baldwin C. Interventions to Support Older People's Involvement in Activities Related to Meals. A Systematic Review. J Nutr Gerontol Geriatr 2020; 39:155-191. [PMID: 33079642 DOI: 10.1080/21551197.2020.1834484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
The objective of this systematic review is to assess whether old people should be actively involved in activities related to meals to support quality of life, nutritional status and functional abilities related to meals. Two electronic databases Cochrane Database of Systematic Reviews and the Database of Abstracts of Reviews of Effectiveness were searched, supported by PubMed citation, snowball searches. Eleven primary studies were included. The quality was low. No studies assessed the effect on health-related quality of life. Three types of interventions to support activities related to meals were identified: Meal-related activities to facilitate improved autonomy seemed to overall improve nutritional intake, physical and social function related to meals, plus mealtime coping. Interventions of encouragement and reinforcement by staff to facilitate independence in eating seemed to have beneficial effect on nutritional intake and physical function related to meals. Interventions using food preparation and cooking to support participation seemed to have beneficial effects on social function related to meals and mealtime coping. There is an urgent need for good quality, adequately powered studies in this area and among old people in all health care settings.
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Affiliation(s)
- Anne Marie Beck
- Faculty of Health, University College Copenhagen, Copenhagen, Denmark.,Research Unit for Nutrition, Herlev and Gentofte Hospital, Copenhagen, Denmark
| | | | - C Elizabeth Weekes
- Department of Nutrition and Dietetics, Guy's and St Thomas NHS Foundation Trust, London, UK
| | - Christine Baldwin
- Department of Nutritional Sciences, King's College London, London, UK
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Sørensen D, Wieghorst AR, Elbek JA, Mousing CA. Mealtime challenges in patients with chronic obstructive pulmonary disease: Who is responsible? J Clin Nurs 2020; 29:4583-4593. [DOI: 10.1111/jocn.15491] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2020] [Revised: 08/20/2020] [Accepted: 08/28/2020] [Indexed: 11/28/2022]
Affiliation(s)
- Dorthe Sørensen
- Research Centre for Health and Welfare Technology Programme for rehabilitation, VIA University College Aarhus Denmark
| | - Anna Rottensten Wieghorst
- Research Centre for Health and Welfare Technology Programme for rehabilitation, VIA University College Aarhus Denmark
| | - Johanne Andersen Elbek
- Research Centre for Health and Welfare Technology Programme for rehabilitation, VIA University College Aarhus Denmark
| | - Camilla Askov Mousing
- Research Centre for Health and Welfare Technology Programme for rehabilitation, VIA University College Aarhus Denmark
- Center for Research in Clinical Nursing Viborg Denmark
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17
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Kontogianni MD, Poulia KA, Bersimis F, Sulz I, Schindler K, Hiesmayr M, Chourdakis M. Exploring factors influencing dietary intake during hospitalization: Results from analyzing nutritionDay's database (2006–2013). Clin Nutr ESPEN 2020; 38:263-270. [DOI: 10.1016/j.clnesp.2020.04.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Accepted: 04/07/2020] [Indexed: 10/24/2022]
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18
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Malnutrition in an Academic Health Sciences Centre: Applying results from nutritionDay 2011 to the proposed Global Leadership Initiative on Malnutrition approach to diagnosing malnutrition. CLINICAL NUTRITION EXPERIMENTAL 2020. [DOI: 10.1016/j.yclnex.2020.06.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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Porter J, Hanna L. Evidence-Based Analysis of Protected Mealtime Policies on Patient Nutrition and Care. Risk Manag Healthc Policy 2020; 13:713-721. [PMID: 32753984 PMCID: PMC7352007 DOI: 10.2147/rmhp.s224901] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Accepted: 06/16/2020] [Indexed: 01/07/2023] Open
Abstract
Malnutrition in hospitalized patients remains a significant problem. Protected Mealtimes is a complex, inter-professional ward-based intervention that was first introduced in the United Kingdom to address this issue. Now implemented internationally, the approach still remains in key policy documents including the National Health Service Essence of Care. This review aims to synthesize the nutrition, satisfaction and quality of life patient/resident outcomes that arise from the implementation of Protected Mealtimes in hospitals and residential aged care facilities and to consider fidelity issues that have been reported in previous research. A defined search strategy was implemented in seven databases to identify full text papers of original research that evaluated Protected Mealtimes implementation. After screening, data were extracted from eight studies (7 quantitative and 1 qualitative study) that were conducted in hospitals. There was no research identified from the aged care sector. There were few positive outcomes that resulted from Protected Mealtimes implementation, many fidelity issues with the intervention were reported. It is apparent that Protected Mealtimes provide few, if any, benefits for hospitalized patients. It is a complex, multi-pronged initiative that has limited fidelity and limited outcomes. As such, we recommend that disinvestment by policy makers for hospitals should be considered, with the implementation of other evidence based mealtime initiatives. We provide no recommendation for disinvestment in the aged care sector, since the approach has not been evaluated against any of the eligible outcomes of this review.
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Affiliation(s)
- Judi Porter
- Deakin University, Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Geelong, Victoria, Australia.,Department of Nutrition, Dietetics & Food, Monash University, Notting Hill, Victoria 3168, Australia
| | - Lauren Hanna
- Department of Nutrition, Dietetics & Food, Monash University, Notting Hill, Victoria 3168, Australia.,Department of Nutrition and Dietetics, Monash Health, Clayton, Victoria, Australia
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20
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Jonsson AS, Nyberg M, Jonsson IM, Öström Å. Older patients' perspectives on mealtimes in hospitals: a scoping review of qualitative studies. Scand J Caring Sci 2020; 35:390-404. [PMID: 32372410 DOI: 10.1111/scs.12866] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Accepted: 04/13/2020] [Indexed: 01/12/2023]
Abstract
The increasing age of populations throughout the world means that healthcare services are faced with new challenges, not least regarding the provision of food during hospital stay. There is a lack of knowledge of how hospital mealtimes are experienced by older patients, and so the aim of this article was to review current knowledge regarding mealtimes in hospitals from the perspectives of older patients. A literature search was performed using seven databases: PubMed, Web of Science, Scopus, Sociological Abstracts, SweMed+, ASSIA and CINAHL with no limits regarding publication date. The inclusion criteria were peer-reviewed articles in English or Swedish that used qualitative methods to examine older patients' (>65 years) mealtime experiences. The Five Aspect Meal Model (FAMM) served as a framework for understanding the complexity behind a mealtime experience. Qualitative content analysis was used as a guide when analysing the material. The search produced 415 studies, 14 of which were included in the review. The findings generated three main themes for understanding how older patients experience mealtimes while in hospital: (1) the food and the food service, (2) mealtime assistance and commensality during mealtimes and (3) the importance of retaining one's independence. The review also clearly indicated a shortage of studies that solely focus on older patients' experiences of their mealtime. More research is therefore needed to be fully able to understand the complex task of providing meals in hospitals.
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Affiliation(s)
- Ann-Sofie Jonsson
- School of Hospitality, Culinary Arts and Meal Science, Örebro University, Grythyttan, Sweden
| | - Maria Nyberg
- Department of Food and Meal Science, Kristianstad University, Kristianstad, Sweden
| | - Inger M Jonsson
- School of Hospitality, Culinary Arts and Meal Science, Örebro University, Grythyttan, Sweden
| | - Åsa Öström
- School of Hospitality, Culinary Arts and Meal Science, Örebro University, Grythyttan, Sweden
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Roberts S, Grealish L, Williams LT, Hopper Z, Jenkins J, Spencer A, Marshall AP. Development and Process Evaluation of a Complex Intervention for Improving Nutrition among Hospitalised Patients: A Mixed Methods Study. Healthcare (Basel) 2019; 7:E79. [PMID: 31238528 PMCID: PMC6628331 DOI: 10.3390/healthcare7020079] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Revised: 06/11/2019] [Accepted: 06/20/2019] [Indexed: 11/23/2022] Open
Abstract
Hospital-acquired malnutrition is a significant issue with complex aetiology, hence nutrition interventions must be multifaceted and context-specific. This paper describes the development, implementation and process evaluation of a complex intervention for improving nutrition among medical patients in an Australian hospital. An integrated knowledge translation (iKT) approach was used for intervention development, informed by previous research. Intervention strategies targeted patients (via a nutrition intake monitoring system); staff (discipline-specific training targeting identified barriers); and the organisation (foodservice system changes). A process evaluation was conducted parallel to implementation assessing reach, dose, fidelity and staff responses to the intervention using a mixed-methods design (quantitative and qualitative approaches). Staff-level interventions had high fidelity and broad reach (61% nurses, 93% foodservice staff and all medical staff received training). Patient and organisation interventions were implemented effectively, but due to staffing issues, only reached around 60% of patients. Staff found all intervention strategies acceptable with benefits to practice. This study found an iKT approach useful for designing a nutrition intervention that was context-specific, feasible and acceptable to staff. This was likely due to engagement of multiple disciplines, identifying and targeting specific areas in need of improvement, and giving staff frequent opportunities to contribute to intervention development/implementation.
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Affiliation(s)
- Shelley Roberts
- School of Allied Health Sciences, Gold Coast Campus, Griffith University, Southport, QLD 4222, Australia.
- Gold Coast Hospital and Health Service, 1 Hospital Blvd, Southport, QLD 4215, Australia.
- Menzies Health Institute Queensland, Gold Coast Campus, Griffith University, Southport, QLD 4222, Australia.
| | - Laurie Grealish
- Gold Coast Hospital and Health Service, 1 Hospital Blvd, Southport, QLD 4215, Australia.
- Menzies Health Institute Queensland, Gold Coast Campus, Griffith University, Southport, QLD 4222, Australia.
- School of Nursing and Midwifery, Gold Coast Campus, Griffith University, Southport, QLD 4222, Australia.
| | - Lauren T Williams
- School of Allied Health Sciences, Gold Coast Campus, Griffith University, Southport, QLD 4222, Australia.
- Menzies Health Institute Queensland, Gold Coast Campus, Griffith University, Southport, QLD 4222, Australia.
| | - Zane Hopper
- Gold Coast Hospital and Health Service, 1 Hospital Blvd, Southport, QLD 4215, Australia.
| | - Julie Jenkins
- Gold Coast Hospital and Health Service, 1 Hospital Blvd, Southport, QLD 4215, Australia.
| | - Alan Spencer
- Gold Coast Hospital and Health Service, 1 Hospital Blvd, Southport, QLD 4215, Australia.
| | - Andrea P Marshall
- Gold Coast Hospital and Health Service, 1 Hospital Blvd, Southport, QLD 4215, Australia.
- Menzies Health Institute Queensland, Gold Coast Campus, Griffith University, Southport, QLD 4222, Australia.
- School of Nursing and Midwifery, Gold Coast Campus, Griffith University, Southport, QLD 4222, Australia.
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Robertson ST, Grimley RS, Anstey C, Rosbergen IC. Acute stroke patients not meeting their nutrition requirements: Investigating nutrition within the enriched environment. Clin Nutr 2019; 39:1470-1477. [PMID: 31235416 DOI: 10.1016/j.clnu.2019.06.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Revised: 05/22/2019] [Accepted: 06/06/2019] [Indexed: 11/29/2022]
Abstract
BACKGROUND & AIMS Malnutrition is common after stroke. We investigated the impact of environmental enrichment strategies on dietary intake and rates of malnutrition in an acute stroke unit. METHODS We performed a before-after study. In standard care, meals were delivered to participants' rooms whilst in the enriched environment, communal meals with assistance were offered and nutritional intake reminders were placed at the patient bedside. Nutrition supplementation was provided to both groups if indicated. Breakfast and lunch meals were directly observed while remaining intake was calculated using food charts. Nutrition requirements were calculated for energy (ratio method), protein (1 g/kg) and proportion of requirements met. Malnutrition was assessed using the Subjective Global Assessment and body weight. ANCOVA adjusting for stroke severity was used to determine between group differences. Stepwise multivariable logistic regression was performed to assess predictors of nutritional outcomes, adjusting for intervention group, demographic, clinical and baseline nutritional factors. RESULTS Neither standard care (n = 30, age 76.0yrs ± SD12.8) nor enriched environment (n = 30, age 76.7yrs ± SD12.1, p = 0.84) met daily requirements for energy (70.7% ± SD16.8 vs. 70.7% ± SD17.3, p = 0.94) or protein intake (73.2% ± SD18.6 vs. 69.8% ± SD17.3, p = 0.70). Mean body weight dropped: standard care 0.92 kg ± SD2.47 vs. enriched 0.64 kg ± SD3.12 (p = 0.53) and malnutrition increased: standard care 3.3%-26.6% vs. enriched 6.6%-13.3% (p = 0.07). Predictors of malnutrition on discharge in logistic regression models were: length of stay (p < 0.01) and protein (p < 0.01) or energy intake (p = 0.02). CONCLUSIONS Acute stroke patients were not meeting nutritional requirements and losing body weight. The enriched environment showed no effect on nutritional intake. Malnutrition was associated with lower energy and protein intakes and increased length of stay.
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Affiliation(s)
- Samantha T Robertson
- Allied Health Medical Services, Sunshine Coast Hospital and Health Service, Birtinya, Australia.
| | - Rohan S Grimley
- Sunshine Coast Clinical School, The University of Queensland, Birtinya, Australia; Department of Medicine, Sunshine Coast Hospital and Health Service, Birtinya, Australia
| | - Chris Anstey
- Department of Medicine, Sunshine Coast Hospital and Health Service, Birtinya, Australia; Faculty of Medicine, University of Queensland, Australia; School of Medicine, Griffith University, Australia; Intensive Care Unit, Sunshine Coast University Hospital, Birtinya, Australia
| | - Ingrid Cm Rosbergen
- Allied Health Medical Services, Sunshine Coast Hospital and Health Service, Birtinya, Australia; Division of Physiotherapy, School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
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Dijxhoorn DN, Mortier MJMJ, van den Berg MGA, Wanten GJA. The Currently Available Literature on Inpatient Foodservices: Systematic Review and Critical Appraisal. J Acad Nutr Diet 2019; 119:1118-1141.e36. [PMID: 31031106 DOI: 10.1016/j.jand.2019.01.018] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Revised: 01/22/2019] [Accepted: 01/25/2019] [Indexed: 01/20/2023]
Abstract
BACKGROUND An adequate hospital foodservice is important to optimize protein and energy intake and to maintain or improve a patient's nutritional status. Key elements that define an optimal foodservice have yet to be identified. OBJECTIVES To systematically describe the effects of published foodservice interventions on nutrition and clinical outcomes and determine which elements should be considered essential. Secondly, to describe the outcome measures used in these studies and evaluate their relevance and validity to guide future research. METHODS PubMed, Embase, the Cochrane Library, and the Web of Science databases were searched. Studies that included assessment of nutrition and/or clinical outcomes of hospital foodservice up to December 2017 were eligible. The details of the subject population, the type of intervention, and the effects on reported outcomes were extracted from each study. RESULTS In total, 33 studies that met inclusion criteria were identified, but only nine (27%) were rated as having sufficient methodologic quality. These nine studies concluded that various elements of a foodservice can be considered essential, including using volunteers to provide mealtime assistance, encouraging patients to choose protein-rich foods, adding protein-enriched items to the menu, replacing existing items with protein-enriched items, giving patients the ability to order food by telephone from a printed menu (room service concept), or a combination of these interventions. The interstudy heterogeneity was high for both outcome measures and methods. CONCLUSIONS Various foodservice interventions have the potential to improve outcome measures. Recommendations are made to facilitate future research.
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Marshall AP, Takefala T, Williams LT, Spencer A, Grealish L, Roberts S. Health practitioner practices and their influence on nutritional intake of hospitalised patients. Int J Nurs Sci 2019; 6:162-168. [PMID: 31406886 PMCID: PMC6608649 DOI: 10.1016/j.ijnss.2019.03.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Revised: 02/20/2019] [Accepted: 03/06/2019] [Indexed: 11/05/2022] Open
Abstract
Objectives In the hospital setting, poor dietary intake interacts with disease and represents a major and modifiable cause of malnutrition. Understanding barriers to adequate dietary intake is an important strategy to guide the development of interventions to improve nutrition intake. The aim of this study reported in this paper was to explore patient, family and health care professionals' perceptions of barriers to and enablers of adequate nutrition care and dietary intake of medical inpatients. Methods An exploratory qualitative study design incorporating group and individual interviews of patients (n = 14), their family members (n = 4), and health care professionals (n = 18) was undertaken. Participants were recruited pragmatically, using a mix of convenience and purposive sampling. A theoretically informed, semi-structured interview schedule was based on observations of practice and the Theoretical Domains Framework. Interviews were audio-recorded, transcribed verbatim and analysed inductively using a general inductive approach. Results Three key themes emerged from analysing participant interviews. Siloed approaches to nutrition care reflected the diverse range of health care professionals responsible for nutrition care but who often worked in isolation from their colleagues. Competing work priorities for nurses reflected the challenge in prioritise nutrition care which was often constrained because of other care needs or work-related pressures. Helping patients to eat highlighted that nurses were often the only health care professional who would provide assistance to patients at mealtimes and lack of available staff could negatively influence patients' nutrition intakes. Conclusions We have identified many complex and interrelated barriers which preclude adequate dietary intake in acute medical patients. These predominantly reflect issues inherent in the hospital culture and environment. Multi-faceted and sustainable interventions that support a facilitating nutrition culture and multidisciplinary collaboration, inclusive of patients and families, are needed to address these underlying barriers.
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Affiliation(s)
- Andrea P Marshall
- Menzies Health Institute Queensland, Griffith University, Parklands Drive, Southport, QLD, Australia.,School of Nursing and Midwifery, Griffith University, Parklands Drive, Southport, QLD, Australia.,Nursing and Midwifery Education and Research Unit, Gold Coast University Hospital, 1 Hospital Blvd, QLD, Australia
| | - Tahnie Takefala
- School of Allied Health Sciences, Griffith University, Gold Coast Campus, Parklands Drive, Southport, QLD, Australia
| | - Lauren T Williams
- Menzies Health Institute Queensland, Griffith University, Parklands Drive, Southport, QLD, Australia.,School of Allied Health Sciences, Griffith University, Gold Coast Campus, Parklands Drive, Southport, QLD, Australia
| | - Alan Spencer
- Department of Nutrition and Dietetics, Gold Coast Health, 1 Hospital Blvd, QLD, Australia
| | - Laurie Grealish
- Menzies Health Institute Queensland, Griffith University, Parklands Drive, Southport, QLD, Australia.,School of Nursing and Midwifery, Griffith University, Parklands Drive, Southport, QLD, Australia.,Nursing and Midwifery Education and Research Unit, Gold Coast University Hospital, 1 Hospital Blvd, QLD, Australia
| | - Shelley Roberts
- Menzies Health Institute Queensland, Griffith University, Parklands Drive, Southport, QLD, Australia.,School of Allied Health Sciences, Griffith University, Gold Coast Campus, Parklands Drive, Southport, QLD, Australia.,Department of Nutrition and Dietetics, Gold Coast Health, 1 Hospital Blvd, QLD, Australia
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Curtis LJ, Valaitis R, Laur C, McNicholl T, Nasser R, Keller H. Low food intake in hospital: patient, institutional, and clinical factors. Appl Physiol Nutr Metab 2018; 43:1239-1246. [DOI: 10.1139/apnm-2018-0064] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
In-hospital malnutrition and inadequate food intake have been associated with negative outcomes (e.g., prolonged length of stay, readmission, mortality, and increased hospital costs). Studies examining the factors associated with low food intake in hospital, commonly defined as the consumption of ≤50% of meals, have produced mixed results. We examined the correlates of food intake including patient socioeconomic, demographic, and health characteristics, institutional factors, and common clinical strategies in 1129 medical patients from 5 Canadian hospitals. Low food intake was found in 35% of patients (41% of females and 29% of males) (p < 0.001). In multivariate analyses, sex, socioeconomic status, demographics, and diagnoses were not significantly related to food intake. Patients assessed as malnourished (subjective global assessment (SGA) B/C) (odds ratio (OR), 2.41; p = 0.003) or as not at risk of malnutrition (OR, 1.67; p = 0.040) were more likely to have low intake when compared with those assessed as well nourished (SGA A). Patient reports of mealtime challenges (OR, 2.70; p < 0.001) and barriers to food intake (OR, 1.11; p = 0.008) were positively related to low intake throughout the study sample. Higher 12-Item Short Form Health Survey Mental Component Summary scores were related to better food intake (OR, 0.98; p < 0.001). Clinical strategies such as between-meal snacks lowered the likelihood of low food intake (OR, 0.55; p = 0.037), whereas a group of “other strategies” increased the odds (OR, 2.77; p = 0.001). These results offer a better understanding of the correlates of in-hospital low food intake. The conclusion discusses some avenues for improving food intake in the clinical setting, such as better mealtime monitoring and a reduction in barriers to food intake.
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Affiliation(s)
- Lori J. Curtis
- Department of Economics, University of Waterloo, 200 University Avenue, Waterloo, ON N2L 3G1, Canada
| | - Renata Valaitis
- Faculty of Applied Health Sciences, University of Waterloo, Waterloo, ON N2L 3G1, Canada
| | - Celia Laur
- Faculty of Applied Health Sciences, University of Waterloo, Waterloo, ON N2L 3G1, Canada
| | - Tara McNicholl
- Faculty of Applied Health Sciences, University of Waterloo, Waterloo, ON N2L 3G1, Canada
| | - Roseann Nasser
- Nutrition and Food Services, Pasqua Hospital, Saskatchewan Health Authority, Regina, SK S4T 1A5, Canada
| | - Heather Keller
- Schlegel–UW Research Institute for Aging and Department of Kinesiology, University of Waterloo, Waterloo, ON N2L 3G1, Canada
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Ottrey E, Porter J, Huggins CE, Palermo C. Ward culture and staff relationships at hospital mealtimes in Australia: An ethnographic account. Nurs Health Sci 2018; 21:78-84. [DOI: 10.1111/nhs.12559] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Revised: 05/28/2018] [Accepted: 06/25/2018] [Indexed: 12/20/2022]
Affiliation(s)
- Ella Ottrey
- Department of Nutrition, Dietetics and Food; Monash University; Melbourne Victoria Australia
- Department of Dietetics; Eastern Health; Melbourne Victoria Australia
| | - Judi Porter
- Department of Nutrition, Dietetics and Food; Monash University; Melbourne Victoria Australia
- Allied Health Clinical Research Office; Eastern Health; Melbourne Victoria Australia
| | - Catherine E. Huggins
- Department of Nutrition, Dietetics and Food; Monash University; Melbourne Victoria Australia
| | - Claire Palermo
- Department of Nutrition, Dietetics and Food; Monash University; Melbourne Victoria Australia
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Sanson G, Bertocchi L, Dal Bo E, Di Pasquale CL, Zanetti M. Identifying reliable predictors of protein-energy malnutrition in hospitalized frail older adults: A prospective longitudinal study. Int J Nurs Stud 2018; 82:40-48. [DOI: 10.1016/j.ijnurstu.2018.03.007] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2017] [Revised: 03/04/2018] [Accepted: 03/06/2018] [Indexed: 01/10/2023]
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Porter J, Ottrey E. Process evaluation of implementing Protected Mealtimes under clinical trial conditions. J Adv Nurs 2018; 74:1955-1963. [PMID: 29700844 DOI: 10.1111/jan.13693] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/09/2018] [Indexed: 11/26/2022]
Abstract
AIM To evaluate the implementation of Protected Mealtimes and contrast the findings with implementation fidelity. BACKGROUND Protected Mealtimes is a systems approach developed to address the issue of malnutrition in hospitalized patients. Previous studies have used a pre--post study design, with no high-quality trials previously undertaken to measure the effect of the intervention. DESIGN A prospective, stepped-wedge cluster randomized controlled trial was undertaken October-November 2015. This process evaluation was conducted using qualitative and quantitative methods to explain discrepancies between expected and observed clinical trial outcomes. METHODS Qualitative data were collected using focus groups with the healthcare team and contrasted with fidelity data. Quantitative data were collected using attendance lists, audits and observations and analysed descriptively. Concept-driven coding was undertaken using a framework derived from studies citing the Theoretical Domains Framework. FINDINGS Staff training in the trial protocol was viewed positively, however, not all staff attended. Staff were generally enthusiastic about Protected Mealtimes with many programme aspects successfully implemented. Limited staffing resources, particularly of nursing staff, hindered implementation. The presence of trial observers affected staff morale by increasing feelings of stress and anxiety. CONCLUSION Process data allowed challenges for the implementation of Protected Mealtimes under clinical trial conditions to be described. Given our inability to implement the trial protocol fully due to the complexity of the mealtime environment and the lack of efficacy on nutritional intake, alternative approaches should be considered to resolve the problem of hospital malnutrition.
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Affiliation(s)
- Judi Porter
- Department of Nutrition, Dietetics & Food, Monash University, Notting Hill, Vic., Australia
- Allied Health Clinical Research Office, Eastern Health, Box Hill, Vic., Australia
| | - Ella Ottrey
- Department of Nutrition, Dietetics & Food, Monash University, Notting Hill, Vic., Australia
- Dietetics Department, Eastern Health, Box Hill, Vic., Australia
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Jarden RJ, Sutton-Smith L, Boulton C. Oral intake evaluation in patients following critical illness: an ICU cohort study. Nurs Crit Care 2018; 23:179-185. [PMID: 29659093 DOI: 10.1111/nicc.12343] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2017] [Revised: 01/13/2018] [Accepted: 01/19/2018] [Indexed: 12/18/2022]
Abstract
Timely and adequate nutrition improves health outcomes for the critically ill patient. Despite clinical guidelines recommending early oral nutrition, survivors of critical illness experience significant nutritional deficits. This cohort study evaluates the oral nutrition intake in intensive care unit (ICU) patients who have experienced recent critical illness. The oral nutrition intake of a convenience sample of ICU patients post-critical illness was observed during a 1-month period. Data pertaining to both the amount of oral nutrition intake and factors impacting optimal oral nutrition intake were collected and analysed. Inadequate oral intake was identified in 62% of the 79 patients assessed (n = 49). This was noted early in the ICU stay, around day 1-2, for most of the patients. A significant proportion (25%) of patients remained in the hospital with poor oral intake that persisted beyond ICU day 5. Unsurprisingly, these were the patients who had longer ICU stays. Critical illness weakness was a factor in the assessment of poor oral intake. To conclude, patients who have experienced critical illness also experience suboptimal oral nutrition. The three key factors that were identified as impacting optimal oral nutrition were early removal of nasogastric tubes, critical illness weakness and poor appetite post-critical illness. Seven key recommendations are made based on this cohort study. These recommendations are related to patient assessment, monitoring, documentation and future guidelines. Future research opportunities are highlighted, including the investigation of strategies to improve the transition of patients' post-critical illness to oral nutrition.
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Affiliation(s)
- Rebecca J Jarden
- Department of Nursing, School of Clinical Sciences, Auckland University of Technology (AUT), Auckland, New Zealand
| | - Lynsey Sutton-Smith
- Intensive Care Unit, Intensive Care Services, Wellington Regional Hospital, Capital and Coast District Health Board, Wellington, New Zealand.,Graduate School of Nursing Midwifery & Health (GSNMH), Victoria University of Wellington, Wellington, New Zealand
| | - Catherine Boulton
- Wellington Regional Hospital, Capital and Coast District Health Board, Wellington, New Zealand
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Beck M, Martinsen B, Birkelund R, Poulsen I. Raising a beautiful swan: a phenomenological-hermeneutic interpretation of health professionals' experiences of participating in a mealtime intervention inspired by Protected Mealtimes. Int J Qual Stud Health Well-being 2017; 12:1360699. [PMID: 28835178 PMCID: PMC5590627 DOI: 10.1080/17482631.2017.1360699] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/21/2017] [Indexed: 10/29/2022] Open
Abstract
The British concept named Protected Mealtimes is known for stopping all non-acute activities and giving health professionals an opportunity to focus on providing patients their meals without being interrupted or disturbed. PM involves a cultural and behavioural change in the clinical setting, since health professionals are asked to adjust their daily routines. This study investigate how health professionals experience participating in a mealtime intervention inspired by the concept of Protected Mealtimes and intend to change mealtime practices. Three focus group interviews was conducted and included a total of 15 interdisciplinary staff members. After transcribing the interviews, the text material was analysed and interpreted in a three-methodological-step process inspired by the French philosopher Paul Ricoeur. In the analysis and interpretation three themes was identified. The themes were: (1) a chance towards a new and better scene; (2) a step towards a more neurologically friendly environment; and (3) a renewed view of the neurological patients. This study concludes that to the health professionals, the intervention was meaningful in several ways because it created structure during mealtimes and emphasized the importance of creating a calm environment for both patients and health professionals. The intervention was described as an eye-opening and well-regarded event in the field of neurological care that facilitated community, and reflections on nursing care and professional identity were expressed.
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Affiliation(s)
- Malene Beck
- Institute of Public Health, Department of Nursing Science, Aarhus University, Copenhagen, Denmark
- Department of Neurology, Zealand University Hospital, Roskilde, Denmark
| | - Bente Martinsen
- Institute of Health, Department of Nursing Science, Aarhus University, Copenhagen, Denmark
| | - Regner Birkelund
- Section of Health Services Research Lillebaelt Hospital, University of Southern Denmark, Odense, Denmark
| | - Ingrid Poulsen
- Institute of Public Health, Aarhus University Research Manager at the Research Unit on Brain Injury Rehabilitation Copenhagen (RUBRIC), Clinic of Neurorehabilitation, TBI Unit, Rigshospitalet, Hvidovre, Denmark
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Ottrey E, Porter J, Huggins CE, Palermo C. “Meal realities” - An ethnographic exploration of hospital mealtime environment and practice. J Adv Nurs 2017; 74:603-613. [DOI: 10.1111/jan.13477] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/28/2017] [Indexed: 12/24/2022]
Affiliation(s)
- Ella Ottrey
- Department of Nutrition, Dietetics and Food; Monash University; Notting Hill Vic. Australia
- Dietetics Department; Eastern Health; Box Hill Vic. Australia
| | - Judi Porter
- Department of Nutrition, Dietetics and Food; Monash University; Notting Hill Vic. Australia
- Allied Health Clinical Research Office; Eastern Health; Box Hill Vic. Australia
| | - Catherine E. Huggins
- Department of Nutrition, Dietetics and Food; Monash University; Notting Hill Vic. Australia
| | - Claire Palermo
- Department of Nutrition, Dietetics and Food; Monash University; Notting Hill Vic. Australia
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Porter J. The perspectives of patients and their families remain largely unheard in mealtime assistance research. Evid Based Nurs 2017; 20:95-96. [PMID: 28601809 DOI: 10.1136/eb-2017-102682] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/29/2017] [Indexed: 11/03/2022]
Affiliation(s)
- Judi Porter
- Department of Nutrition, Dietetics and Food, Monash University, Notting Hill, Victoria, Australia.,Allied Health Clinical Research Office, Eastern Health, Box Hill, Victoria, Australia
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