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Interrelationships between Dietary Outcomes, Readmission Rates and Length of Stay in Hospitalised Oncology Patients: A Scoping Review. Nutrients 2023; 15:nu15020400. [PMID: 36678271 PMCID: PMC9865609 DOI: 10.3390/nu15020400] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 01/06/2023] [Accepted: 01/10/2023] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND Poor food intake is an independent risk factor for malnutrition in oncology patients, and achieving adequate nutrition is essential for optimal clinical and health outcomes. This review investigated the interrelationships between dietary intakes, hospital readmissions and length of stay in hospitalised adult oncology patients. METHODOLOGY Three databases, MEDLINE, Web of Science and PubMed were searched for relevant publications from January 2000 to the end of August 2022. RESULTS Eleven studies investigating the effects of dietary intakes on length of stay (LOS) and hospital readmissions in cohorts of hospitalised patients that included oncology patients were identified. Heterogenous study design, nutritional interventions and study populations limited comparisons; however, a meta-analysis of two randomised controlled trials comparing dietary interventions in mixed patient cohorts including oncology patients showed no effect on LOS: mean difference -0.08 (95% confidence interval -0.64-0.49) days (p = 0.79). CONCLUSIONS Despite research showing the benefits of nutritional intake during hospitalisation, evidence is emerging that the relationship between intakes, LOS and hospital readmissions may be confounded by nutritional status and cancer diagnosis.
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2
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Søe Jensen P, Nørholm V, Poulsen I, Vendel Petersen H. Dialogue is a prerequisite for the nurse-patient relationship in nutritional care: A secondary analysis using the fundamentals of care framework. Scand J Caring Sci 2022; 36:1206-1216. [PMID: 35778822 PMCID: PMC9795910 DOI: 10.1111/scs.13094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Revised: 04/01/2022] [Accepted: 05/13/2022] [Indexed: 12/30/2022]
Abstract
BACKGROUND Providing good nutritional care is complex as it goes beyond assessing and ensuring the patients' dietary needs. So far, nutritional research has mainly focused on establishing evidence for the nutritional treatment, while less attention has been on the complexity of providing nutritional care. The Fundamentals of Care (FoC) describes five elements (focus, knowledge, anticipate, evaluate and trust) essential for establishing a nurse-patient relationship as a foundation for quality care. By studying how these elements shape nutritional care and dialogue, we can explore and describe the complexity of nutritional care. AIM By using the FoC framework as an analytic framework, this study explores how the nurse-patient relationship shapes the nutritional care of orthopaedic patients. METHOD This study is a secondary analysis using deductive content analysis of interviews with patients undergoing major orthopaedic surgery, nursing staff and observations of interactions between nursing staff and patients. The core dimension of the FoC framework, 'Establishment of relationship,' was used as an analytic framework. RESULT The nurses perceived serving meals and providing nutritional supplements as an essential part of the nutritional care. Still, the nutritional care was organised as a routine task to be less time-consuming. Appropriate care was initiated when the nursing staff explored patients´ food preferences. When the nursing staff failed to familiarise themselves with the patient's preferences, the patients interpreted nutritional care as unrelated to their needs, resulting in a lack of trust. CONCLUSION The need for efficiency within nutritional care must not compromise the patients' need for dialogue with the nurse. Establishing a trusting relationship between nurses and patients prevents nutritional care from becoming a routine task unrelated to the patients' needs.
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Affiliation(s)
- Pia Søe Jensen
- Department of Clinical ResearchCopenhagen University HospitalHvidovreDenmark,Department of Orthopaedic SurgeryCopenhagen University HospitalHvidovreDenmark,Research Unit of Nursing and Health CareHealth, Aarhus UniversityAarhusDenmark
| | - Vibeke Nørholm
- Department of Clinical ResearchCopenhagen University HospitalHvidovreDenmark
| | - Ingrid Poulsen
- Department of Clinical ResearchCopenhagen University HospitalHvidovreDenmark,Research Unit of Nursing and Health CareHealth, Aarhus UniversityAarhusDenmark,Department of Brain InjuryCopenhagen University HospitalRigshospitaletCopenhagenDenmark
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Exploring Meal Provision and Mealtime Challenges for Aged Care Residents Consuming Texture-Modified Diets: A Mixed Methods Study. Geriatrics (Basel) 2022; 7:geriatrics7030067. [PMID: 35735772 PMCID: PMC9222299 DOI: 10.3390/geriatrics7030067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Revised: 06/07/2022] [Accepted: 06/14/2022] [Indexed: 11/17/2022] Open
Abstract
Dysphagia has become more prevalent with age. Thus, the demand for texture-modified diets (TMDs) has increased. While the nutritional perspectives have been studied, the provision of TMDs and mealtime practice has received less attention. This study aimed to explore the TMD provision and mealtime challenges of residents requiring TMDs in aged care facilities. The study was conducted across five aged care facilities using a mixed methods design involving 14 TMD menu audits by a foodservice dietitian, 15 mealtime observations, and semi-structured interviews with residents and staff (n = 18). TMD menus failed to meet all nutrition requirements and foodservice and clinical standards based on the dietitian NZ foodservice and nutrition audit tool. A content analysis offered three main themes: (1) Foodservice production. Inconsistent quality and meal portions were observed. The variety, choice, and portion size of TMDs required improvement based on the residents’ preferences; (2) Serving procedures. There was a lack of standardisation of meal distribution and feeding assistance; and (3) Dining environment. The dining room set-up varied across facilities, and residents expressed different preferences towards the dining environment. There is a need to improve staff awareness of mealtime consistency and optimise feeding assistance. The dining environment should be individualised to accommodate residents’ psychosocial needs. Standardised policies and continuous training can facilitate quality mealtime implementation.
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A Qualitative Exploration of Nutrition Screening, Assessment and Oral Support Used in Patients Undergoing Cancer Surgery in Low- and Middle-Income Countries. Nutrients 2022; 14:nu14040863. [PMID: 35215513 PMCID: PMC8876193 DOI: 10.3390/nu14040863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 02/11/2022] [Accepted: 02/14/2022] [Indexed: 11/17/2022] Open
Abstract
Preoperative undernutrition is a prognostic indicator for postoperative mortality and morbidity. Evidence suggests that treating undernutrition can improve surgical outcomes. This study explored the provision of nutritional screening, assessment and support on surgical cancer wards in low- and middle-income countries (LMICs). This was a qualitative study and participants took part in one focus group or one individual interview. Data were analysed thematically. There were 34 participants from Ghana, India, the Philippines and Zambia: 24 healthcare professionals (HCPs) and 10 patients. Results showed that knowledge levels and enthusiasm were high in HCPs. Barriers to adequate nutritional support were a lack of provision of ward and kitchen equipment, food and sustainable nutritional supplements. There was variation across countries towards nutritional screening and assessment which seemed to be driven by resources. Many hospitals where resources were scarce focused on the care of individual patients in favour of an integrated systems approach to identify and manage undernutrition. In conclusion, there is scope to improve the efficiency of nutritional management of surgical cancer patients in LMICs through the integration of nutrition assessment and support into routine hospital policies and procedures, moving from case management undertaken by interested personnel to a system-based approach including the whole multidisciplinary team.
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Trinca V, Duizer L, Paré S, Keller H. Investigating the patient food experience: Understanding hospital staffs' perspectives on what leads to quality food provision in Ontario hospitals. J Hum Nutr Diet 2021; 35:980-994. [PMID: 34786772 DOI: 10.1111/jhn.12964] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Accepted: 10/25/2021] [Indexed: 01/01/2023]
Abstract
BACKGROUND Food quality influences patient food satisfaction, which may subsequently affect food intake and recovery, influencing hospital costs. The present qualitative study aimed to gain an understanding of hospital staff/volunteers experiences of serving food in Ontario hospitals, perceptions of food quality and challenges to quality food provision. METHODS Sixteen Ontario hospitals participated. Semi-structured interviews (n = 64 participants) and focus groups (n = 24; 150 participants) were conducted. Transcripts were analysed using inductive thematic analysis. RESULTS Four themes emerged: (1) Providing Good Quality Food (e.g., attributes that comprise the construct of meal quality, patients' expectations and desires from meals); (2) Individualising the Food and Mealtime Experience (e.g., processes to identify and cater to patients' needs and preferences); (3) Acknowledging Organisational Constraints (e.g., staffing, budget, etc.); and (4) Innovating Beyond Constraints (e.g., identifying innovation within potential modifiable and unmodifiable organisational constraints). CONCLUSIONS Serving meals in hospital is complex because of organisational and patient factors; however, current efforts to serve quality food despite these complexities were uncovered in our investigation. Discussions highlighted current practices that promote food quality and strategies for improvement. Improving food quality and the hospital meal experience can support food intake and patient outcomes, as well as reduce waste and hospital associated costs. The findings can be used to support quality improvement measures aiming to serve high quality food that meets patients' expectations and nutritional needs.
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Affiliation(s)
- Vanessa Trinca
- Kinesiology Department, University of Waterloo, Waterloo, ON, Canada
| | - Lisa Duizer
- Department of Food Science, University of Guelph, Guelph, ON, Canada
| | - Shannon Paré
- Department of Food Science, University of Guelph, Guelph, ON, Canada
| | - Heather Keller
- Schlegel-UW Research Institute for Aging, Department of Kinesiology and Health Sciences, University of Waterloo, Waterloo, ON, Canada
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6
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Trinca V, Iraniparast M, Morrison-Koechl J, Duizer L, Keller H. Hospital Food Experience Questionnaire (HFEQ): Reliable, valid and predicts food intake in adult patients. Clin Nutr 2021; 40:4011-4021. [PMID: 34144411 DOI: 10.1016/j.clnu.2021.04.041] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Revised: 03/31/2021] [Accepted: 04/25/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS Low food intake is a primary contributor to iatrogenic hospital malnutrition and can be influenced by perceptions of poor food quality. Valid and reliable tools to assess the food experience of hospital patients are lacking. This study aimed to determine the internal reliability, convergent construct and predictive validity of the new Hospital Food Experience Questionnaire (HFEQ) and to methodically derive and test a shortened version of the questionnaire (HFEQ-sv). METHODS Data from a multi-site study on 1087 patients from 16 Ontario hospitals were used. The HFEQ was developed to assess the importance of food (n = 6) and food-related (n = 10) traits using a 5-point Likert scale anchored by "not important" (1) and "very important" (5), and ratings of a single meal served (n = 7) using a 5-point Likert scale anchored by "very poor" (1) and "very good" (5). Food intake at the same meal was assessed using visual estimation (0%, 25%, 50%, 75%, 100%). Internal reliability was determined using Cronbach's alpha, and principal components analysis (PCA). Convergent validity was assessed using ordinal logistic regression with a single question on patients' overall meal quality rating. Cross validation was conducted in an attempt to shorten the questionnaire and binary logistic regression determined predictive validity with food intake. RESULTS The HFEQ demonstrated good internal reliability (α = .86), and all but one of the questionnaire items clustered together in PCA, revealing 5 factors. Subscales and the total HFEQ demonstrated convergent validity, with the importance of food taste, choice, easy-to-open packaging, easy-to-eat food and local food provision, in addition to meal ratings of taste, appearance, texture, temperature and combination of food served being associated with the overall meal quality rating (p < .050). These items became the basis for the HFEQ-sv, which was found to independently predict food intake (LRT(42) = 142.17, p < .001). CONCLUSIONS The HFEQ is internally reliable, demonstrates convergent validity with the construct of meal quality and predicts food intake. The 11-item HFEQ-sv promotes feasibility. The HFEQ has potential to be used globally to benchmark and quantify the patient food experience in hospital, contributing to quality improvement strategies that will support food intake among patients.
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Affiliation(s)
- Vanessa Trinca
- Department of Kinesiology, University of Waterloo, 200 University Ave W, Waterloo, ON, N2L 3G1, Canada
| | - Maryam Iraniparast
- Schlegel-UW Research Institute for Aging, 250 Laurelwood Dr, Waterloo, ON, N2J 0E2, Canada
| | - Jill Morrison-Koechl
- Department of Kinesiology, University of Waterloo, 200 University Ave W, Waterloo, ON, N2L 3G1, Canada
| | - Lisa Duizer
- Food Science Department, University of Guelph, 50 Stone Rd E, Guelph, ON, N1G 2W1, Canada
| | - Heather Keller
- Department of Kinesiology, University of Waterloo, 200 University Ave W, Waterloo, ON, N2L 3G1, Canada; Schlegel-UW Research Institute for Aging, 250 Laurelwood Dr, Waterloo, ON, N2J 0E2, Canada.
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7
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Rapo S, Mattson Sydner Y, Kautto E, Hörnell A. Exploring patient satisfaction with hospital foodservice: A Swedish study using the Acute Care Hospital Foodservice Patient Satisfaction Questionnaire. Nutr Diet 2021; 78:487-495. [PMID: 33691342 DOI: 10.1111/1747-0080.12665] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 02/01/2021] [Accepted: 02/06/2021] [Indexed: 11/27/2022]
Abstract
AIM The aim of this study was to explore patient satisfaction with hospital foodservice in the Swedish setting, using a validated instrument, adding this context to the existing body of research. METHODS The study was carried out at three hospitals employing cyclic menus and conventional cook-serve foodservice systems with centralised tray assemblies and hot-trolley distributions to the wards for service. Patient satisfaction was explored using a translated version of the validated Acute Care Hospital Foodservice Patient Satisfaction Questionnaire. Groups were compared with Mann-Whitney U-test and Kruskal Wallis test with a set significance level of P < .05. RESULTS Questionnaires from 439 patients were included in the analysis. The majority (80%) reported an overall satisfaction of "good" or "very good." Questions related to Staff and Service received mostly the highest possible ratings, while questions related to Food Quality and Meal Size had slightly lower ratings and higher variation. Comparisons between groups showed that differences were small even when statistically significant. Low appetite and a long hospital stay had an adverse effect on overall satisfaction and food quality-related questions. Men and younger patients reported more often being hungry after and between meals. CONCLUSIONS Hospital foodservice faces the challenge of catering to multiple patient needs. Monitoring patient satisfaction is crucial to ensure that foodservice operations remain evidence based. The Acute Care Hospital Foodservice Patient Satisfaction Questionnaire provided a general overview that indicated foodservice areas with potential for improvement, although patient satisfaction overall was high. However, patient satisfaction is a complex measure and reflexivity is required when interpreting empirical results.
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Affiliation(s)
- Sofia Rapo
- Department of Food, Nutrition and Culinary Science, Umeå University, Umeå, Sweden.,Umeå Centre for Gender Studies, Umeå University, Umeå, Sweden
| | - Ylva Mattson Sydner
- Department of Food, Nutrition and Dietetics, Uppsala University, Uppsala, Sweden
| | - Ethel Kautto
- Department of Food, Nutrition and Culinary Science, Umeå University, Umeå, Sweden
| | - Agneta Hörnell
- Department of Food, Nutrition and Culinary Science, Umeå University, Umeå, Sweden
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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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Sossen L, Bonham M, Porter J. Does a High-Energy High-Protein Diet Reduce Unintentional Weight Loss in Residential Aged Care Residents? J Nutr Gerontol Geriatr 2020; 39:56-68. [PMID: 31769350 DOI: 10.1080/21551197.2019.1691108] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Malnutrition and unintentional weight loss are known to occur in residential aged care facilities (RACFs). The use of oral nutritional supplements (ONS) and high-energy high-protein (HEHP) diets are two foodservice strategies that may be implemented in efforts to reduce unintentional weight loss in RACFs. This observational study aimed to determine whether incorporation of a structured high-energy high-protein diet (sHEHP) into the standard menu could reduce unintentional weight loss in RACF residents. RACFs in this study were facilities that provide long-term care to older adult residents. Weight change, body mass index and subjective global assessment scores of participants were measured at baseline and at six months across five RACFs receiving usual care with ONS or a sHEHP diet. Groups were different at baseline, with a high prevalence of severe malnutrition observed in the ONS group. Over the six-month period, there was a small but statistically significant difference in weight change within the groups: -1.64 ± 3.62 kg, ONS group; 0.56 ± 2.76 kg, sHEHP group, P = 0.0004. Both approaches investigated are feasible, however, future research using high-quality methods is needed to determine the most effective approach to deliver best practice nutrition care for residents into the future.
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Affiliation(s)
- Lisa Sossen
- Department of Nutrition, Dietetics and Food, Faculty of Medicine, Nursing and Health Sciences, Monash University, Notting Hill, VIC, Australia
| | - Maxine Bonham
- Department of Nutrition, Dietetics and Food, Faculty of Medicine, Nursing and Health Sciences, Monash University, Notting Hill, VIC, Australia
| | - Judi Porter
- Department of Nutrition, Dietetics and Food, Faculty of Medicine, Nursing and Health Sciences, Monash University, Notting Hill, VIC, Australia
- Allied Health Clinical Research Office, Eastern Health, Box Hill, VIC, Australia
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Facilitators and barriers to optimizing eating performance among cognitively impaired older adults: A qualitative study of nursing assistants’ perspectives. DEMENTIA 2018; 19:2090-2113. [DOI: 10.1177/1471301218815053] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Background and Objectives Cognitively impaired individuals are at increased risk for functional and behavioral difficulties at mealtimes, leading to compromised eating performance, low food and fluid intake, and negative functional and nutritional outcomes. Nursing assistants are the most critical front-line care staff and best positioned to manage the personal and environmental factors that influence resident eating performance. Identifying nursing assistants’ perceptions of barriers and facilitators to engaging residents in eating will provide important experientially based foundation for developing and testing evidence-driven interventions to promote mealtime care. Methods A qualitative descriptive study was conducted in three sites: two nursing homes and one hospital gero-psychiatric inpatient unit. Six focus groups were conducted with a purposive sample of 23 nursing assistants who regularly provided mealtime care to residents with cognitive impairment. Interview questions addressed barriers and facilitators at resident, caregiver, environmental (facility), and policy levels in optimizing mealtime care. Audio recordings of focus groups were transcribed and analyzed using qualitative descriptive content analysis. Both barriers and facilitators were organized into a hierarchical taxonomy based on similarities and differences framed by the Social Ecological Model. Results The majority of barriers and facilitators were at the caregiver level. Caregiver-level barriers included lack of preparation and training, competing work demands, time pressure, and frustration. Caregiver-level facilitators included caregiver preparation and motivational, technical, informational, and instrumental assistance. Environmental-level barriers and facilitators related to the physical, social, and cultural environment and facility practices. Only barriers to optimizing mealtime care were identified at resident and policy levels. Conclusions Nursing assistants identified multilevel barriers as well as a wide range of caregiver and environmental facilitators to optimizing dementia mealtime care. Findings can inform the development and implementation of multifaceted innovative mealtime assistance and staff training programs to promote resident eating performance while fostering person-centered individualized mealtime care practice.
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11
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Jensen PS, Green SM, Petersen J, Andersen O, Poulsen I. Perceptions and experiences of nutritional care following the overwhelming experience of lower extremity amputation: A qualitative study. J Clin Nurs 2017; 27:e808-e819. [PMID: 29193468 DOI: 10.1111/jocn.14192] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/19/2017] [Indexed: 12/20/2022]
Abstract
INTRODUCTION Good nutritional care of people following major lower extremity amputation is essential as poor nutritional status can lead to delayed wound healing. Working with patients to identify their perspectives on food, views on nutritional care and the need for dietary counselling enables the development of optimised nutritional care. AIMS AND OBJECTIVES To explore hospital patients' perspectives on food, dietary counselling and their experiences of nutritional care following lower extremity amputation. DESIGN A qualitative, explorative study design was employed. METHOD An inductive content analysis of semi-structured interviews with a purposive sample of 17 people over 50 years of age, who had recently undergone major lower extremity amputation, was undertaken. The study was reported according to the consolidated criteria for reporting qualitative research guideline. FINDINGS Three themes emerged: responsible for own dietary intake, diet based on preferences and experiences with dietary counselling and feeling overwhelmed. The participants expressed motivation to ensure their nutritional needs were met but described feeling emotionally overwhelmed by the experience of amputation. They appeared not to expect nursing staff to focus on nutritional issues as they expressed belief that they themselves were solely responsible for their dietary intake. They described being motivated to receive nutritional counselling but indicated advice should be compatible with their lifestyle and eating habits. CONCLUSION Lower extremity amputation can be an overwhelming experience which affects nutritional intake. People appear to consider themselves responsible for their nutritional care and describe not experiencing or expecting nursing staff to engage in this aspect of care. Dietary counselling by nurses who respect and incorporate patient preferences and experiences following amputation has the potential to enhance nutritional care. RELEVANCE TO CLINICAL PRACTICE This study illustrates that nurses caring for people who undergo lower extremity amputation need to recognise that nutritional care is an essential component of nursing and should focus on working in partnership with the patient.
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Affiliation(s)
- Pia Søe Jensen
- Optimed, Clinical Research Centre, Copenhagen University Hospital, Hvidovre, Denmark.,Department of Orthopaedic Surgery, Copenhagen University Hospital, Hvidovre, Denmark
| | - Sue M Green
- Faculty of Health Sciences, University of Southampton, Southampton, UK
| | - Janne Petersen
- Optimed, Clinical Research Centre, Copenhagen University Hospital, Hvidovre, Denmark.,Section of Biostatistics, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Ove Andersen
- Optimed, Clinical Research Centre, Copenhagen University Hospital, Hvidovre, Denmark
| | - Ingrid Poulsen
- RUBRIC (Research Unit on Brain Injury Rehabilitation Copenhagen), Department of Neurorehabilitation, Traumatic Brain Injury Unit, Rigshospitalet, Copenhagen, Denmark.,Section of Nursing Science, Department of Health, Aarhus University, Aarhus, Denmark
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12
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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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13
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Budiningsari D, Shahar S, Abdul Manaf Z, Susetyowati S. Needs assessment for patients food intake monitoring among Indonesian healthcare professionals. Int Nurs Rev 2017; 65:317-326. [DOI: 10.1111/inr.12394] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Affiliation(s)
- D. Budiningsari
- Department of Health Nutrition; Faculty of Medicine; Gadjah Mada University; Yogyakarta Indonesia
| | - S. Shahar
- Dietetic Programme; School of Healthcare Sciences; Faculty of Health Sciences; The National University of Malaysia; Kuala Lumpur Malaysia
| | - Z. Abdul Manaf
- Dietetic Programme; School of Healthcare Sciences; Faculty of Health Sciences; The National University of Malaysia; Kuala Lumpur Malaysia
| | - S. Susetyowati
- Department of Health Nutrition; Faculty of Medicine; Gadjah Mada University; Yogyakarta Indonesia
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Collins J, Porter J, Truby H, Huggins CE. A foodservice approach to enhance energy intake of elderly subacute patients: a pilot study to assess impact on patient outcomes and cost. Age Ageing 2017; 46:486-493. [PMID: 27974307 DOI: 10.1093/ageing/afw238] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2016] [Indexed: 12/13/2022] Open
Abstract
Background effective strategies are required to support the nutritional status of patients. Objectives to evaluate a foodservice nutrition intervention on a range of participant outcomes and estimate its cost. Design parallel controlled pilot study. Setting subacute hospital ward. Subjects all consecutively admitted adult patients were eligible for recruitment under waiver of consent. Methods the intervention was a modified hospital menu developed by substituting standard items with higher energy options. The control was the standard menu. All participants received usual multidisciplinary care. Outcomes were change in weight and hand grip strength (HGS) between admission and day 14 and; energy and protein intake and patient satisfaction with the foodservice at day 14. The additional cost of the intervention was also estimated. Results the median (interquartile range) age of participants (n = 122) was 83 (75-87) years and length of stay was 19 (11-32) days. One-third (38.5%) were malnourished at admission. There was no difference in mean (SD) HGS change (1.7 (5.1) versus 1.4 (5.8) kg, P = 0.798) or weight change (-0.55 (3.43) versus 0.26 (3.33) %, P = 0.338) between the intervention and control groups, respectively. The intervention group had significantly higher mean (SD) intake of energy (132 (38) versus 105 (34) kJ/kg/day, P = 0.003) and protein (1.4 (0.6) versus 1.1 (0.4) g protein/kg/day, P = 0.035). Both groups were satisfied with the foodservice. The additional cost was £4.15/participant/day. Conclusions in this pilot, the intervention improved intake and may be a useful strategy to address malnutrition. Further consideration of clinical and cost implications is required in a fully powered study.
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Affiliation(s)
- Jorja Collins
- Department of Nutrition and Dietetics, Monash University, Level 1, 264 Ferntree Gully Road , Notting Hill, Victoria 3168, Australia
| | - Judi Porter
- Department of Nutrition and Dietetics, Monash University, Level 1, 264 Ferntree Gully Road, Notting Hill, Victoria 3168, Australia
- Department of Dietetics, Eastern Health, 5 Arnold Street, Box Hill, Victoria, Australia
| | - Helen Truby
- Department of Nutrition and Dietetics, Monash University, Level 1, 264 Ferntree Gully Road , Notting Hill, Victoria 3168, Australia
| | - Catherine E Huggins
- Department of Nutrition and Dietetics, Monash University, Level 1, 264 Ferntree Gully Road , Notting Hill, Victoria 3168, Australia
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15
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Collins J, Huggins CE, Porter J, Palermo C. Factors influencing hospital foodservice staff's capacity to deliver a nutrition intervention. Nutr Diet 2017; 74:129-137. [DOI: 10.1111/1747-0080.12344] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2016] [Revised: 01/04/2017] [Accepted: 01/15/2017] [Indexed: 11/28/2022]
Affiliation(s)
- Jorja Collins
- Department of Nutrition, Dietetics and Food; Monash University; Notting Hill, Victoria Australia
| | - Catherine E. Huggins
- Department of Nutrition, Dietetics and Food; Monash University; Notting Hill, Victoria Australia
| | - Judi Porter
- Department of Nutrition, Dietetics and Food; Monash University; Notting Hill, Victoria Australia
- Dietetics Department; Eastern Health; Melbourne, Victoria Australia
| | - Claire Palermo
- Department of Nutrition, Dietetics and Food; Monash University; Notting Hill, Victoria Australia
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Porter J, Ottrey E, Huggins CE. Protected Mealtimes in hospitals and nutritional intake: Systematic review and meta-analyses. Int J Nurs Stud 2016; 65:62-69. [PMID: 27866011 DOI: 10.1016/j.ijnurstu.2016.11.002] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2016] [Revised: 11/02/2016] [Accepted: 11/05/2016] [Indexed: 10/20/2022]
Abstract
OBJECTIVES Protected Mealtimes is an intervention developed to address the problem of malnutrition, particularly in the hospital setting. The intervention aims to provide interruption-free time to eat during a hospital admission, thus supporting increased nutritional intake. This review aimed to determine the impact of Protected Mealtimes on the nutritional intake of hospitalised patients. DESIGN The review was registered with the PROSPERO International Prospective Register of Systematic Reviews (CRD42015023423) and followed the PRISMA guidelines. Meta-analyses were conducted of energy and protein intake. DATA SOURCES Seven databases were searched to identify relevant publications: Ovid MEDLINE, Embase, CINAHL Plus, PsycInfo, Scopus, Cochrane Library (including NHS economic evaluations), and NICE clinical guidelines. A supplementary internet search of Google and Google Scholar was undertaken. The search terms protect* AND (mealtime* OR "meal time*") were used for all searches. REVIEW METHODS Eligible studies were original research where Protected Mealtimes was implemented in hospitals and nutritional intake measured. Studies were selected for inclusion following a systematic process of identification, screening and eligibility assessment. Two authors completed the screening and eligibility assessment, and quality assessment of included studies. The Quality Criteria Checklist for Primary Research was used to evaluate the quality of each study, whilst the overall body of evidence was assessed using the GRADE approach. One author extracted data and ran the meta-analyses, these were verified by a second author. RESULTS Database and hand searching yielded 150 papers for consideration; the final review library was seven studies where nutritional intake of patients had been evaluated before and after the introduction of Protected Mealtimes. No clinical trials of the intervention were identified. The meta-analyses of energy and protein intake in four observational studies found no effect in favour of Protected Mealtimes implementation. The GRADE of evidence was rated as very low. CONCLUSIONS Given the small number of observational studies and the quality of evidence on the effect of the intervention on nutritional intake, we conclude that there is insufficient evidence for widespread implementation of Protected Mealtimes in hospitals. More research including clinical trials, with subgroup reporting of patients' nutritional status and estimated energy requirements are needed to further understand the merits of this complex healthcare intervention.
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Affiliation(s)
- Judi Porter
- Department of Nutrition & Dietetics, Monash University, Australia; Dietetics Department, Eastern Health, Australia.
| | - Ella Ottrey
- Department of Nutrition & Dietetics, Monash University, Australia; Dietetics Department, Eastern Health, Australia.
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At Your Request® room service dining improves patient satisfaction, maintains nutritional status, and offers opportunities to improve intake. Clin Nutr 2016; 35:1174-80. [DOI: 10.1016/j.clnu.2015.10.009] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2015] [Revised: 10/12/2015] [Accepted: 10/13/2015] [Indexed: 12/15/2022]
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Edwards D, Carrier J, Hopkinson J. Mealtime assistance for older adults in hospital settings and rehabilitation units from the perspective of patients, families and healthcare professionals: a mixed methods systematic review. JBI DATABASE OF SYSTEMATIC REVIEWS AND IMPLEMENTATION REPORTS 2016; 14:261-357. [PMID: 27755326 DOI: 10.11124/jbisrir-2016-003100] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/02/2023]
Abstract
BACKGROUND The prevalence of malnutrition for older adults (>65 years) in hospital and rehabilitation units has been reported as being as high as 60%; some older patients with good appetites do not receive sufficient nourishment because of inadequate feeding assistance. Mealtime assistance can therefore enhance nutritional intake, clinical outcomes and patient experience. OBJECTIVES This mixed methods review sought to develop an aggregated synthesis of quantitative and qualitative data on assistance at mealtimes for older adults in hospital settings and rehabilitation units to determine current practices, what practices work, and the perceptions of patients, families, and healthcare professionals of mealtime assistance. INCLUSION CRITERIA TYPES OF PARTICIPANTS: Participants included older adults (65 years and over) in hospital settings, including rehabilitation units. TYPES OF INTERVENTION(S)/PHENOMENA OF INTEREST The review focused on interventions for mealtime assistance, observed mealtime assistance, or discussed experiences of mealtime assistance with patients, families and healthcare professionals. TYPES OF STUDIES The review included qualitative, quantitative and mixed methods studies. OUTCOMES The outcomes of interest were the effectiveness of mealtime assistance initiatives and experiences of assistance at mealtimes. SEARCH STRATEGY The search strategy identified studies from seven databases published between 1998 and 2015. METHODOLOGICAL QUALITY Methodological quality of studies was independently assessed by two reviewers using standardized Joanna Briggs Institute critical appraisal instruments. DATA EXTRACTION Standardized Joanna Briggs Institute data extraction tools were used. DATA SYNTHESIS Synthesis of the findings was reached through discussion. The results of quantitative studies could not be statistically pooled because of heterogeneity and are presented in narrative form. The results are presented as three aggregated mixed methods syntheses. RESULTS A total of 21 publications (19 studies) were included: 11 quantitative, five qualitative and three mixed method studies. Two studies were conducted in rehabilitation units, and 17 in hospital wards. Eight qualitative studies (nine papers) considered extrinsic and intrinsic factors that influence mealtime support. Evidence for the effectiveness of interventions was limited to eight studies (nine papers); the remaining quantitative studies included two cross-sectional studies, three descriptive evaluations (four papers) and one observational/case study. The following are the aggregated mixed methods syntheses: CONCLUSION: No firm conclusions can be drawn with respect to the most effective initiatives. Initiatives with merit include those that encourage social interaction, either through the use of a dining room, or employed staff or volunteers, relatives or visitors supporting the older patient during mealtimes. Volunteers value training and support and clarification of their roles and responsibilities.
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Affiliation(s)
- Deborah Edwards
- 1The Wales Centre for Evidence-based Care, a Joanna Briggs Institute Centre of Excellence 2School of Healthcare Sciences, College of Biomedical and Life Sciences, Cardiff University, Cardiff, UK
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Holst M, Beermann T, Mortensen MN, Skadhauge LB, Køhler M, Lindorff-Larsen K, Rasmussen HH. Optimizing protein and energy intake in hospitals by improving individualized meal serving, hosting and the eating environment. Nutrition 2016; 34:14-20. [PMID: 28063508 DOI: 10.1016/j.nut.2016.05.011] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2016] [Revised: 04/14/2016] [Accepted: 05/17/2016] [Indexed: 01/10/2023]
Abstract
OBJECTIVE Optimizing protein and energy intake by food in nutritional risk patients is difficult. The aim of this study was to improve the ≥75% of energy and protein requirements. We would like to see nurses take on the role of hosting the nutritional-risk patients, including focusing on bringing nutrition to the forefront in the collaboration between nurses and patients. METHODS This was an interventional study that included patients admitted to the Departments of Infectious Diseases, Hematology, and Heart-Lung Surgery in a baseline and follow-up investigation. It included 24-h food intake registrations (FRs) for 3 d consecutively, a questionnaire, and a semistructured patient interview. The interventions included in this study helped to improve the eating environment and serving, integrated nutrition into the nurse-patient welcome interview, and targeted individual preferences and challenges for eating. RESULTS The study comprised 76 24-h FRs at baseline and 108 FRs at follow-up. The total group had improved food intake; 75% of individual energy requirements were met by (67.6% vs. 40%; P = 0.036) and the Heart-Lung Surgery group (85.7 vs. 38.5; P = 0.036). This was not reflected for protein (NS). Energy intake improved for the entire group, albeit not significantly (P = 0.862). Patients reported being happy with the interventions regarding individualized food serving, nurse communication, and improved meal environments. CONCLUSION Only insignificant improvements to overall energy intake were seen in two of the three departments and in the overall group, and no statistical or clinically significant improvements to protein intake were observed. The relative risk of meeting 75% of energy requirements was improved in the overall group and in patients in the Department of Heart-Lung Surgery. This did not include the meeting of protein requirements. Improvements were welcomed by patients and staff. Focus on individualized nutrition from the nursing staff also improved.
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Affiliation(s)
- Mette Holst
- Centre for Nutrition and Bowel Disease, Aalborg University Hospital and Aalborg University, School of Medicine and Health, Aalborg, Denmark.
| | - Tina Beermann
- Centre for Nutrition and Bowel Disease, Department of Gastroenterology, Aalborg University Hospital, Aalborg, Denmark
| | | | - Lotte Boa Skadhauge
- Centre for Nutrition and Bowel Disease, Department of Gastroenterology, Aalborg University Hospital, Aalborg, Denmark
| | - Marianne Køhler
- Centre for Nutrition and Bowel Disease, Aalborg University Hospital, Aalborg, Denmark
| | | | - Henrik Højgaard Rasmussen
- Centre for Nutrition and Bowel Disease, Department of Gastroenterology, Aalborg University Hospital, Aalborg, Denmark
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Edwards D, Carrier J, Hopkinson J. Assistance at mealtimes in hospital settings and rehabilitation units for older adults from the perspective of patients, families and healthcare professionals: a mixed methods systematic review protocol. ACTA ACUST UNITED AC 2015; 13:17-32. [DOI: 10.11124/jbisrir-2015-2425] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Laur C, Keller HH. Implementing best practice in hospital multidisciplinary nutritional care: an example of using the knowledge-to-action process for a research program. J Multidiscip Healthc 2015; 8:463-72. [PMID: 26491344 PMCID: PMC4599637 DOI: 10.2147/jmdh.s93103] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Background Prospective use of knowledge translation and implementation science frameworks can increase the likelihood of meaningful improvements in health care practices. An example of this creation and application of knowledge is the series of studies conducted by and with the Canadian Malnutrition Task Force (CMTF). Following a cohort study and synthesis of evidence regarding best practice for identification, treatment, and prevention of malnutrition in hospitals, CMTF created an evidence-informed, consensus-based pathway for nutritional care in hospitals. The purpose of this paper is to detail the steps taken in this research program, through four studies, as an example of the knowledge-to-action (KTA) process. The KTA process The KTA process includes knowledge creation and action cycles. The steps of the action cycle within this program of research are iterative, and up to this point have been informed by three studies, with a fourth underway. The first study identified the magnitude of the malnutrition problem upon admission to hospital and how it is undetected and undertreated (study 1). Knowledge creation resulted in an evidence-based pathway established to address care gaps (study 2) and the development of monitoring tools (study 3). The study was then adapted to local context: focus groups validated face validate the evidence-based pathway; during the final phase, study site implementation teams will continue to adapt the pathway (studies 2 and 4). Barriers to implementation were also assessed; focus groups and interviews were conducted to inform the pathway implementation (studies 1, 2, and 4). In the next step, specific interventions were selected, tailored, and implemented. In the final study in this research program, plan–do–study–act cycles will be used to make changes and to implement the pathway (study 4). To monitor knowledge use and to evaluate outcomes, audits, staff surveys, patient outcomes, etc will be used to record process evaluations (studies 3 and 4). Finally, a sustainability plan will be incorporated into the final study of the program (study 4) to sustain knowledge use. Discussion Use of frameworks can increase the likelihood of meaningful and sustainable improvements in health care practice. The example of this program of research demonstrates how existing evidence has been used to identify, create, and adapt knowledge, and how multidisciplinary teams have been used to effect changes in the hospital setting. Conclusion Effective implementation is essential in nutritional health care, and this multidisciplinary program of research provides an example of how the KTA process can facilitate implementation and promote sustainability.
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Affiliation(s)
- Celia Laur
- University of Waterloo, Research Institute for Aging, Waterloo, Ontario, Canada
| | - Heather H Keller
- University of Waterloo, Research Institute for Aging, Waterloo, Ontario, Canada ; Schlegel-University of Waterloo, Research Institute for Aging, Waterloo, Ontario, Canada
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Kimber K, Gibbs M, Weekes CE, Baldwin C. Supportive interventions for enhancing dietary intake in malnourished or nutritionally at-risk adults: a systematic review of nonrandomised studies. J Hum Nutr Diet 2015; 28:517-45. [DOI: 10.1111/jhn.12329] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- K. Kimber
- Barts Health NHS Trust; Newham University Hospital; Plaistow London UK
| | - M. Gibbs
- Diabetes and Nutritional Sciences Division; King's College London; London UK
| | - C. E. Weekes
- Department of Nutrition & Dietetics; Guy's & St Thomas NHS Foundation Trust; London UK
| | - C. Baldwin
- Diabetes and Nutritional Sciences Division; King's College London; London UK
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Keller HH, McCullough J, Davidson B, Vesnaver E, Laporte M, Gramlich L, Allard J, Bernier P, Duerksen D, Jeejeebhoy K. The Integrated Nutrition Pathway for Acute Care (INPAC): Building consensus with a modified Delphi. Nutr J 2015; 14:63. [PMID: 26089037 PMCID: PMC4473836 DOI: 10.1186/s12937-015-0051-y] [Citation(s) in RCA: 58] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2015] [Accepted: 06/10/2015] [Indexed: 02/07/2023] Open
Abstract
Background Malnutrition is commonly underdiagnosed and undertreated in acute care patients. Implementation of current pathways of care is limited, potentially as a result of the perception that they are not feasible with current resources. There is a need for a pathway based on expert consensus, best practice and evidence that addresses this crisis in acute care, while still being feasible for implementation. Methods A modified Delphi was used to develop consensus on a new pathway. Extant literature and other resources were reviewed to develop an evidence-informed background document and draft pathway, which were considered at a stakeholder meeting of 24 experts. Two rounds of an on-line Delphi survey were completed (n = 28 and 26 participants respectively). Diverse clinicians from four hospitals participated in focus groups to face validate the draft pathway and a final stakeholder meeting confirmed format changes to make the pathway conceptually clear and easy to follow for end-users. Experts involved in this process were researchers and clinicians from dietetics, medicine and nursing, including management and frontline personnel. Results 80 % of stakeholders who were invited, participated in the first Delphi survey. The two rounds of the Delphi resulted in consensus for all but two minor components of the Integrated Nutrition Pathway for Acute Care (INPAC). The format of the INPAC was revised based on the input of focus group participants, stakeholders and investigators. Conclusions This evidence-informed, consensus based pathway for nutrition care has greater depth and breadth than prior guidelines that were commonly based on systematic reviews. As extant evidence for many best practices is absent, the modified Delphi process has allowed for consensus to be developed based on better practices. Attention to feasibility during development has created a pathway that has greater implementation potential. External validation specifically with practitioner groups promoted a conceptually easy to use format. Test site implementation and evaluation is needed to identify resource requirements and demonstrate process and patient reported outcomes resulting from embedding INPAC into clinical practice.
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Affiliation(s)
- Heather H Keller
- Schlegel- University of Waterloo Research Institute for Aging, University of Waterloo, Waterloo, Canada.
| | - James McCullough
- Department of Kinesiology, University of Waterloo, Waterloo, Canada.
| | - Bridget Davidson
- Canadian Malnutrition Task Force, Canadian Nutrition Society, Ottawa, Canada.
| | - Elisabeth Vesnaver
- Department of Family Relations and Applied Nutrition, University of Guelph, Guelph, Canada.
| | - Manon Laporte
- Réseau de Santé Vitalité Health Network, Campbellton, NB, Canada.
| | - Leah Gramlich
- Department of Medicine, University of Alberta, Alberta Health Services, Edmonton, Canada.
| | - Johane Allard
- Department of Medicine, University Hospital Network,University of Toronto, Toronto, Canada.
| | | | - Donald Duerksen
- Department of Medicine St-Boniface Hospital, University of Manitoba, Winnipeg, Canada.
| | - Khursheed Jeejeebhoy
- Department of Medicine St-Michael's Hospital, University of Toronto, Toronto, Canada.
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Palmer M, Huxtable S. Aspects of protected mealtimes are associated with improved mealtime energy and protein intakes in hospitalized adult patients on medical and surgical wards over 2 years. Eur J Clin Nutr 2015; 69:961-5. [PMID: 26039317 DOI: 10.1038/ejcn.2015.87] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2014] [Revised: 03/11/2015] [Accepted: 04/11/2015] [Indexed: 11/09/2022]
Abstract
BACKGROUND/OBJECTIVES Protected mealtimes programs aim to improve inpatient intakes. Yet its efficacy has not yet been established. We aimed to determine which patient-related factors and aspects of protected mealtimes, for example, mealtime assistance and meal within reach, were associated with energy and protein intakes of adult inpatients on medical and surgical wards. SUBJECTS/METHODS Patient characteristics and dietary intake data were collected at main meals over 2 years. Proportions of individual foods and drinks consumed were visually estimated and converted to nutrients using averaged ready reckoner data. Mealtime factors associated with energy and protein intakes were determined using multivariate linear hierarchical regression analyses. RESULTS Over 2 years, mealtime nutrient intakes of 798 inpatients were calculated ((63 ± 19) years, 52% male). Average intakes at main meals were 1419 ± 614 kJ and 15 ± 7 g protein. Inpatient intakes were significantly associated with gender, age, season, stopping or refusing a meal, time until discharge and eating at dinner (B = -829-222 kJ, B = -8.8 to 2.2 g protein, P = 0.000-0.032). Protected mealtimes program implementation was not associated with inpatient intake (P=0.094-0.157). However, aspects of protected mealtimes were associated with intake. This included requiring and documenting the need for mealtime assistance, introduction of mealtime volunteers, time to eat and appropriate positioning during mealtimes (B = 177-296 kJ, B = 0.07-3.9 g protein, P=0.000-0.014, R(2) = 0.148-0.154). In those specifically requiring mealtime assistance, inpatient protein intake was associated with mealtime volunteers and appropriate positioning (B = 4.1-4.4 g protein, P = 0.013-0.026, R(2) = 0.197). CONCLUSIONS Aspects of protected mealtimes were associated with improved intake. Identifying these achievable aspects during planning and ensuring successful implementation of protected mealtimes may be critical for optimizing acute inpatient intake.
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Affiliation(s)
- M Palmer
- 1] Department of Nutrition and Dietetics, Logan Hospital, Queensland Health, Meadowbrook, Queensland, Australia [2] Department of Nutrition and Dietetics, Logan Hospital, Queensland Health, Meadowbrook, Queensland, Australia
| | - S Huxtable
- Department of Nutrition and Dietetics, Logan Hospital, Queensland Health, Meadowbrook, Queensland, Australia
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Laur C, McCullough J, Davidson B, Keller H. Becoming Food Aware in Hospital: A Narrative Review to Advance the Culture of Nutrition Care in Hospitals. Healthcare (Basel) 2015; 3:393-407. [PMID: 27417769 PMCID: PMC4939541 DOI: 10.3390/healthcare3020393] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2015] [Revised: 05/16/2015] [Accepted: 05/22/2015] [Indexed: 01/04/2023] Open
Abstract
The Nutrition Care in Canadian Hospitals (2010-2013) study identified the prevalence of malnutrition on admission to medical and surgical wards as 45%. Nutrition practices in the eighteen hospitals, including diagnosis, treatment and monitoring of malnourished patients, were ad hoc. This lack of a systematic approach has demonstrated the need for the development of improved processes and knowledge translation of practices aimed to advance the culture of nutrition care in hospitals. A narrative review was conducted to identify literature that focused on improved care processes and strategies to promote the nutrition care culture. The key finding was that a multi-level approach is needed to address this complex issue. The organization, staff, patients and their families need to be part of the solution to hospital malnutrition. A variety of strategies to promote the change in nutrition culture have been proposed in the literature, and these are summarized as examples for others to consider. Examples of strategies at the organizational level include developing policies to support change, use of a screening tool, protecting mealtimes, investing in food and additional personnel (healthcare aides, practical nurses and/or diet technicians) to assist patients at mealtimes. Training for hospital staff raises awareness of the issue, but also helps them to identify their role and how it can be modified to improve nutrition care. Patients and families need to be aware of the importance of food to their recovery and how they can advocate for their needs while in hospital, as well as post-hospitalization. It is anticipated that a multi-level approach that promotes being "food aware" for all involved will help hospitals to achieve patient-centred care with respect to nutrition.
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Affiliation(s)
- Celia Laur
- Applied Health Sciences, University of Waterloo, Waterloo, ON N2L 3G1, Canada.
| | - James McCullough
- Applied Health Sciences, University of Waterloo, Waterloo, ON N2L 3G1, Canada.
| | | | - Heather Keller
- Applied Health Sciences, University of Waterloo, Waterloo, ON N2L 3G1, Canada.
- Canadian Nutrition Society, Ottawa, ON K1C 6A8, Canada.
- Schlegel-University of Waterloo Research Institute for Aging, Waterloo, ON N2J 0E2, Canada.
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Lee JY, Park HA, Min YH. Transtheoretical Model-based Nursing Intervention on Lifestyle Change: A Review Focused on Intervention Delivery Methods. Asian Nurs Res (Korean Soc Nurs Sci) 2015; 9:158-67. [PMID: 26160246 DOI: 10.1016/j.anr.2015.05.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2014] [Revised: 08/17/2014] [Accepted: 03/13/2015] [Indexed: 11/26/2022] Open
Abstract
PURPOSE The transtheoretical model (TTM) was used to provide tailored nursing for lifestyle management such as diet, physical activity, and smoking cessation. The present study aims to assess the provision of intervention delivery methods, intervention elements, and stage-matched interventions, in order to identify ways in which information technology is used in the TTM-based research. METHODS The relevant literature was selected by two researchers using inclusion criteria after searching for "TTM (transtheoretical or stage of change)" and "nursing" from the databases PubMed and CINAHL. The selected studies were categorized in terms of study characteristics, intervention delivery method, intervention element, and use and level of stage-matched intervention. RESULTS A total of 35 studies were selected including eight studies that used information communication technology (ICT). Nine different intervention delivery methods were used, of which "face-to-face" was the most common at 24 times. Of the 35 studies, 26 provided stage-matched interventions. Seven different intervention elements were used, of which "counseling" was the most common at 27 times. Of all the intervention elements, tailored feedback used ICT the most at seven instances out of nine, and there was a significant difference in the rate of ICT usage among intervention elements. CONCLUSIONS ICT is not yet actively used in the TTM-based nursing interventions. Stage-matched interventions and TTM concepts were shown to be in partial use also in the TTM-based interventions. Therefore, it is necessary to develop a variety of ways to use ICT in tailored nursing interventions and to use TTM frameworks and concepts.
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Affiliation(s)
- Joo Yun Lee
- College of Nursing, Seoul National University, Seoul, South Korea
| | - Hyeoun-Ae Park
- College of Nursing, Seoul National University, Seoul, South Korea; Systems Biomedical Informatics Research Center, Seoul National University, Seoul, South Korea.
| | - Yul Ha Min
- College of Nursing, Gachon University, Incheon, South Korea
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Keller H, Allard J, Vesnaver E, Laporte M, Gramlich L, Bernier P, Davidson B, Duerksen D, Jeejeebhoy K, Payette H. Barriers to food intake in acute care hospitals: a report of the Canadian Malnutrition Task Force. J Hum Nutr Diet 2015; 28:546-57. [DOI: 10.1111/jhn.12314] [Citation(s) in RCA: 68] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
- H. Keller
- Schlegel-UW Research Institute for Aging; University of Waterloo; Waterloo ON Canada
| | - J. Allard
- Department of Medicine; University Hospital Network; University of Toronto; Toronto ON Canada
| | | | - M. Laporte
- Réseau de Santé Vitalité Health Network; Cambellton NB Canada
| | - L. Gramlich
- Department of Medicine; University of Alberta; Alberta Health Services; Edmonton AB Canada
| | - P. Bernier
- Jewish General Hospital; Montréal QC Canada
| | - B. Davidson
- Canadian Malnutrition Task Force; Canadian Nutrition Society; Toronto ON Canada
| | - D. Duerksen
- Department of Medicine St-Boniface Hospital; University of Manitoba; Winnipeg MB Canada
| | - K. Jeejeebhoy
- Department of Medicine St-Michael Hospital; University of Toronto; Toronto ON Canada
| | - H. Payette
- Centre de recherche sur le vieillissement; CSSS-IUGS; Faculté de Médecine et des Sciences de la Santé; Université de Sherbrooke; Sherbrooke QC Canada
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Zisberg A, Shadmi E, Gur-Yaish N, Tonkikh O, Sinoff G. Hospital-Associated Functional Decline: The Role of Hospitalization Processes Beyond Individual Risk Factors. J Am Geriatr Soc 2015; 63:55-62. [DOI: 10.1111/jgs.13193] [Citation(s) in RCA: 244] [Impact Index Per Article: 27.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Anna Zisberg
- Cheryl Spencer Department of Nursing; Faculty of Social Welfare and Health Sciences; University of Haifa; Mount Carmel Israel
| | - Efrat Shadmi
- Cheryl Spencer Department of Nursing; Faculty of Social Welfare and Health Sciences; University of Haifa; Mount Carmel Israel
| | - Nurit Gur-Yaish
- Cheryl Spencer Department of Nursing; Faculty of Social Welfare and Health Sciences; University of Haifa; Mount Carmel Israel
| | - Orly Tonkikh
- Cheryl Spencer Department of Nursing; Faculty of Social Welfare and Health Sciences; University of Haifa; Mount Carmel Israel
| | - Gary Sinoff
- Department of Gerontology; Faculty of Social Welfare and Health Sciences; University of Haifa; Mount Carmel Israel
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Keller H, Allard JP, Laporte M, Davidson B, Payette H, Bernier P, Jeejeebhoy K, Duerksen DR, Gramlich L. Predictors of dietitian consult on medical and surgical wards. Clin Nutr 2014; 34:1141-5. [PMID: 25510874 DOI: 10.1016/j.clnu.2014.11.011] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2014] [Revised: 11/04/2014] [Accepted: 11/14/2014] [Indexed: 01/04/2023]
Abstract
BACKGROUND & AIM Guidelines promote dietitian consult (DC) for nutrition support. In Canada, dietitians are involved in the assessment of malnutrition and provide specialized dietary counseling. It is unknown however, what leads to a DC for patients fed orally. This study identifies independent predictors for a DC and determines what is the proportion of malnourished patients seeing a dietitian. METHODS The Canadian Malnutrition Task Force conducted a prospective cohort study in medical and surgical wards of 18 Canadian hospitals. 947 patients who did not receive enteral or parenteral nutrition were analyzed. At admission, subjective global assessment (SGA), body mass index, patient demography were collected. During hospitalization clinical data, including dietary intake and presence of a DC were obtained. Multivariate logistic regression was completed with dietitian consult ≤ 3 days and 4 + days as the outcome variables. RESULTS The prevalence of malnutrition (SGA B + C) was 45%. Dietitians were consulted for 23% of patients, and of these consults 44% were well nourished (SGA-A), 37% were mildly/moderately malnourished (SGA-B), and 19% were severely malnourished (SGA-C). DC missed 75% of the SGA-B and 60% of SGA-C patients. Predictors of consultation within 3 days of hospitalization were: renal diet (OR 5.75) modified texture diet (OR 5.38), metabolic diagnosis (3.91), ONS use pre-admission (OR 2.33), severe malnutrition (SGA-C, OR 1.88) and age (OR 0.98). Predictors for 4 + days were: dysphagia (OR 11.4), a new medical diagnosis (OR 2.3), severe malnutrition (OR 2.17), constipation (OR 2.16), more than one diagnosis (OR 1.8), antibiotic use (OR 1.6), and male gender (OR 1.6). Consuming < 50% of food in the first week was not a predictor as only 19% of those with low intake had a DC at 4 + days. CONCLUSIONS Overall predictors of DC were appropriate but SGA B and C patients and those eating <50% were missed. Screening at admission with algorithms of care that include referral to the dietitian are needed to improve the process of nutrition care.
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Affiliation(s)
- Heather Keller
- Schlegel-UW Research Institute for Aging, University of Waterloo, 200 University Avenue, West Waterloo, ON, N2L 3G1, Canada.
| | - Johane P Allard
- Department of Medicine, Division of Gastroenterology, Toronto General Hospital, 585 University Avenue, 9N-973, Toronto, ON, M5G 2C4 Canada
| | - Manon Laporte
- Reseau de sante Vitalite Health Network, Campbellton Regional Hospitals, 189 Lily Lake Road, PO Box 880, Campbellton, NB, E3N 3H3, Canada
| | | | - Helénè Payette
- Université de Sherbrooke, Research Center on Aging, CSSS-IUGS, 1036, Belvedere Street, Sherbrooke, QC, J1H 4C4, Canada
| | - Paule Bernier
- Jewish General Hospital, 3755 ch Cote Ste-Catherine, Montreal, QC, H3T 1E2, Canada
| | - Khursheed Jeejeebhoy
- Department of Medicine, St. Michael's Hospital, 30 Bond Street, Toronto, ON M5B 1W8, Canada
| | - Donald R Duerksen
- Department of Medicine, Division of Gastroenterology, C5120 409 Tache Avenue, St. Boniface Hospital, Winnipeg, MB R2H 2A6, Canada
| | - Leah Gramlich
- University of Alberta, Division of Gastroenterology, Room 214, Community Services Centre, Royal Alexandra Hospital, Edmonton, AB T5H 3V9, Canada
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Keller HH, Vesnaver E, Davidson B, Allard J, Laporte M, Bernier P, Payette H, Jeejeebhoy K, Duerksen D, Gramlich L. Providing quality nutrition care in acute care hospitals: perspectives of nutrition care personnel. J Hum Nutr Diet 2013; 27:192-202. [DOI: 10.1111/jhn.12170] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
| | | | - B. Davidson
- Canadian Nutrition Society; Toronto ON Canada
| | - J. Allard
- University Health Network; Toronto ON Canada
| | - M. Laporte
- Vitalité Health Network; Campbellton NB Canada
| | - P. Bernier
- Jewish General Hospital; Montreal QC Canada
| | - H. Payette
- University of Sherbrooke; Sherbrooke QC Canada
| | | | - D. Duerksen
- St Boniface General Hospital; Winnipeg MB Canada
| | - L. Gramlich
- Royal Alexandra Hospital; Edmonton AB Canada
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