Nursing's role in nutrition

Nutrition integration across the nursing curriculum: A novel teaching model within a pre-licensure program

Across the healthcare spectrum, the provision of evidence-based nutrition education is critical in supporting optimal patient care and health outcomes. Nurses are uniquely positioned to deliver nutrition-focused patient education related to health promotion and disease management; yet widespread evidence of sufficient nutrition instruction in nursing curricula is not available. Although lifestyle and nutrition recommendations have historically been the domain of registered dietitians, interprofessional collaboration requires that nurses are prepared to reinforce and support the dissemination of accurate nutrition education. Interdisciplinary teaching approaches are therefore imperative for consistent communication and execution of nutrition guidance. At a private nursing college, an innovative model for nutrition integration across a nursing curriculum has been developed and implemented. This model features an ongoing instructional partnership between registered dietitian faculty and nurse educators. This integrative model enhances nutrition-related nursing competencies demonstrated by undergraduate nursing students and aims to produce graduates who are confident in the delivery of nutrition-related nursing care.

Adolescent SBIRT Practices Among Pediatricians in Massachusetts

OBJECTIVES

Adolescent Screening, Brief Intervention, and Referral to Treatment (SBIRT) in primary care is a key strategy to prevent, identify, and respond to substance use problems and disorders, including opioid and other drug addictions. Despite substantial investment in recent years to increase its implementation, few studies have reported on recent levels of SBIRT implementation among pediatricians. We aimed to assess self-reported use of the SBIRT framework with adolescent patients among Massachusetts pediatricians, and describe trends since an earlier survey.

METHODS

We analyzed responses to a cross-sectional survey mailed in 2017 to a representative sample of pediatricians in Massachusetts. We computed response frequencies for all SBIRT practice questions. We used the chi-square test to compare current data to data collected in 2014, as we found no demographic differences between the 2 samples.

RESULTS

Nearly all pediatricians in the 2017 sample (n = 160) reported annual screening of their adolescent patients (99%). The majority reported giving positive reinforcement (87%), brief advice (92%), counseling (90%), and referral to treatment (66%) in response to screen results. Compared with 2014, a significantly higher proportion of pediatricians in 2017 referred patients who screened positively for problematic alcohol use, but perceived barriers to screening and follow-up remain, such as insufficient time to screen and patient refusal to return.

CONCLUSIONS

Among respondents to a Massachusetts pediatrician survey, we found high rates of delivering SBIRT in accordance with published guidelines, though barriers remain. Whether the content of the counseling adheres to guidelines is unknown.

Improving oncology nurses' knowledge, self-confidence, and self-efficacy in nutritional assessment and counseling for patients with cancer: A quasi-experimental design

OBJECTIVE

Our objective was to assess the effectiveness of a structured educational program on improving oncology nurses' knowledge, self-confidence, and self-efficacy in nutritional assessment and counseling for patients with cancer.

METHODS

A pretest-posttest quasi-experimental design was used. A sample of 60 nurses from oncology units participated as an experimental group (n = 30) and a control group (n = 30). The participants completed a knowledge test before completing the educational program. Self-confidence and self-efficacy also were assessed pre- and postintervention.

RESULTS

There was a significant difference between the experimental (mean [M] = 26.00, SD = 8.00) and control (M = 10.00, SD = 3.75) groups regarding knowledge after the interventional sessions (t = -16.00, P = 0.001). Furthermore, the results indicated a significant difference (t = -24.00, P = 0.001) between the experimental group (M = 60.50, SD = 13.10) and the control group (M = 36.50, SD = 7.60) regarding self- confidence in managing cancer patients. Finally, there was a significant difference between the experimental group (M = 33.50, SD = 3.10) and control group (M = 23.25, SD = 2.75) regarding self-efficacy (t = -10.25, P = 0.001).

CONCLUSIONS

The educational program improved the oncology nurses' knowledge, self-confidence, and self-efficacy in relation to nutritional assessment and counseling. Improving nurses' competencies will improve the quality of care provided to the patients and patient health outcomes.

The Use of Technology in Identifying Hospital Malnutrition: Scoping Review

Background

Malnutrition is a condition most commonly arising from the inadequate consumption of nutrients necessary to maintain physiological health and is associated with the development of cardiovascular disease, osteoporosis, and sarcopenia. Malnutrition occurring in the hospital setting is caused by insufficient monitoring, identification, and assessment efforts. Furthermore, the ability of health care workers to identify and recognize malnourished patients is suboptimal. Therefore, interventions focusing on the identification and treatment of malnutrition are valuable, as they reduce the risks and rates of malnutrition within hospitals. Technology may be a particularly useful ally in identifying malnutrition due to scalability, timeliness, and effectiveness. In an effort to explore the issue, this scoping review synthesized the availability of technological tools to detect and identify hospital malnutrition.

Objective

Our objective was to conduct a scoping review of the different forms of technology used in addressing malnutrition among adults admitted to hospital to (1) identify the extent of the published literature on this topic, (2) describe key findings, and (3) identify outcomes.

Methods

We designed and implemented a search strategy in 3 databases (PubMed, Scopus, and CINAHL). We completed a descriptive numerical summary and analyzed study characteristics. One reviewer independently extracted data from the databases.

Results

We retrieved and reviewed a total of 21 articles. We categorized articles by the computerized tool or app type: malnutrition assessment (n=15), food intake monitoring (n=5), or both (n=1). Within those categories, we subcategorized the different technologies as either hardware (n=4), software (n=13), or both (n=4). An additional subcategory under software was cloud-based apps (n=1). Malnutrition in the acute hospital setting was largely an unrecognized problem, owing to insufficient monitoring, identification, and initial assessments of identifying both patients who are already malnourished and those who are at risk of malnourishment. Studies went on to examine the effectiveness of health care workers (nurses and doctors) with a knowledge base focused on clinical care and their ability to accurately and consistently identify malnourished geriatric patients within that setting.

Conclusions

Most articles reported effectiveness in accurately increasing malnutrition detection and awareness. Computerized tools and apps may also help reduce health care workers’ workload and time spent assessing patients for malnutrition. Hospitals may also benefit from implementing malnutrition technology through observing decreased length of stay, along with decreased foregone costs related to missing malnutrition diagnoses. It is beneficial to study the impact of these technologies to examine possible areas of improvement. A future systematic review would further contribute to the evidence and effectiveness of the use of technologies in assessing and monitoring hospital malnutrition.

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

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

The 2015-2020 Dietary Guidelines: Overview and Implications for Nursing Practice

This article reviews the 2015-2020 Dietary Guidelines for Americans released in 2016. Key recommendations are summarized and significant changes in the guidelines are highlighted. Implications for nursing practice to promote nutrition health are identified and resources to support implementation are included.

The nursing contribution to nutritional care in cancer cachexia

Cancer cachexia is a complex syndrome. Its defining feature is involuntary weight loss, which arises, in part, because of muscle atrophy and is accompanied by functional decline. International expert consensus recommends that nutritional support and counselling is a component of multimodal therapy for cancer cachexia, as poor nutritional intake can contribute to progression of the syndrome. The present paper focuses on what is presently known about the nursing contribution to nutritional care in cancer cachexia. There is potential for nurses to play an important role. However, obstacles to this include lack of a robust evidence base to support their nutritional care practices and unmet need for education about nutrition in cancer. The nursing role's boundaries and the outcomes of nurse-delivered nutritional care in cancer cachexia are both uncertain and should be investigated.

Nutritional support of the elderly cancer patient: the role of the nurse

Cancer in the geriatric population is a growing problem. Malnutrition is common in cancer. A number of factors increase the risk for malnutrition in older people with cancer, including chronic comorbid conditions and normal physiological changes of aging. Nurses have an important role in the nutritional support of older cancer patients. To contribute to the improvement of nutritional support of these patients, nurses need appropriate training to be able to identify risk for malnutrition and offer a range of interventions tailored to individual need. Factors to consider in tailoring interventions include disease status, cancer site, cancer treatment, comorbidity, physiological age, method of facilitating dietary change, and family support. This article identifies ways in which nurses can contribute to the nutritional support of older cancer patients and thus help mitigate the effects of malnutrition.