Nutritional care of Danish medical inpatients - patients' perspectives

Individualised nutritional treatment increases the positive effects of a novel á la carte hospital food service concept: Results of a quasi-experimental study

BACKGROUND & AIMS

One-third of hospitalised patients are at nutritional risk, and limited choice regarding meals and meal times, and inadequate nutritional support may contribute to inadequate nutritional intake during hospitalisation. The aim was to test the effect of a novel á la carte hospital food service concept as a stand-alone intervention and combined with individualised nutritional treatment.

METHODS

Medical inpatients at nutritional risk were recruited for this three-arm quasi-experimental study. The control group received meals from the traditional bulk trolley food service system. Intervention group 1 (IG1) received meals from a novel á la carte food service concept with an electronic ordering system, whereas intervention group 2 (IG2) in addition to this received individualised nutritional treatment by a clinical dietitian. Nutritional intake and length of stay was measured, and patient satisfaction was assessed with purpose-designed questionnaires.

RESULTS

206 patients were included: 67 in the control group, 68 in IG1, and 71 in IG2. The proportion of participants reaching ≥75 % of both their energy and protein requirement was higher in IG1 compared to the control group (34 % vs. 12 %, p = 0.002) and higher in IG2 compared to IG1 (53 % vs. 34 %, p = 0.035). Length of stay was shorter in IG2 compared to the control group (6.0 vs. 8.7 days, p = 0.005). It was important to participants to be able to choose when and what to eat, and this preference was met to a larger extent in the intervention groups.

CONCLUSION

The novel á la carte concept increases energy and protein intake in hospitalised patients, and the positive effects are increased, when the concept is used in combination with individualised nutritional treatment.

Opportunities for Patient Participation in Perioperative Malnutrition Care: A Qualitative Study

Introduction

In the perioperative period of hospitalization, barriers to food intake are common due to special nutritional needs, compromised nutritional status, and metabolic stress. Good nutritional care call for an interdisciplinary approach. And patients themselves may also play an essential role in managing nutritional care.

Objective

This study aimed to explore how patients with malnutrition experience nutritional care, their perspectives on patient participation, and their own role in malnutrition care in the perioperative period of hospitalization.

Methods

A qualitative study was conducted using an interpretive phenomenological approach. To follow patients' experiences, in-depth longitudinal interviews were undertaken before, during, and after hospitalization. Interview transcripts were analyzed thematically using open, axial, and selective coding and interpreted in an iterative process.

Results

Fifty-six interviews were undertaken with 26 patients with malnutrition scheduled for surgery and during the perioperative period of hospitalization. Four themes were identified: (1) unawareness and stigmata about being malnourished, (2) feasibility of optimal nutritional care, (3) needs and expectations for self-management, and (4) barriers and facilitators of taking own responsibilities in nutritional care.

Conclusion

Awareness and responsiveness to patients' perspectives, motivation, and compliance are prerequisites for patient participation in malnutrition care. This requires good communication between healthcare professionals and patients in all phases of hospitalization.

Satisfaction with regular hospital foodservices and associated factors among adult patients in Wolaita zone, Ethiopia: A facility-based cross-sectional study

Background

Food service in hospital is one of the essential parts of the treatment process that determines recovery length and a hospital stay of patients. Even though many researches have been conducted on patients’ satisfaction with healthcare services, there is a lack of studies that specifically address the satisfaction with food service at healthcare facilities in Ethiopia. This study aimed to assess patient satisfaction with regular hospital food service and associated factors among adults admitted to in-patient departments of hospitals.

Methods

A hospital-based cross-sectional study design was conducted to interview 423 patients admitted to three randomly selected hospitals namely Wolaita Sodo University Referral and Teaching Hospital, Dubo St. Catholic Hospital and Sodo Christian Hospital. Participants were recruited based on probability proportional to the number of clients in each hospital. After data entry using EpiInfo v7.2.2.6, the data were exported to SPSS v23 software for further analysis. Bivariate and multivariate logistic regressions were undertaken to see the association between variables. Statistically significant variables were declared using an adjusted odds ratio with a 95% confidence interval.

Result

Among the total participants 33.6% (95%CI: [29.1, 38.3]) of patients were satisfied with regular hospital food services. Multivariate analysis revealed that residence (AOR = 2.16; 95%CI: [1.28, 3.63]), monthly income (AOR = 5.64; 95%CI: [2.30, 8.28]), flavour of meal, (AOR = 2.63; 95%CI: [1.34, 5.56]), and provision of easily chewable food (AOR = 7.50; 95%CI: [2.00, 12.82]) were influencing factors for satisfaction on hospital foodservices.

Conclusion

This research ascertained a low patient satisfaction with regular hospital meal service. The identified factors need to be addressed giving attention for each foodservice dimension to scale up the patient satisfaction with hospital food services.

Patients' experiences eating in a hospital - A qualitative study

BACKGROUND AND AIMS

Even though there is a lot of focus on nutrition in hospitals, patients often continue to lose weight during their stay. A meal is a complex activity. Several factors have an influence on the intake of nutrition. The purpose of the study is to identify the experiences of patients about eating situations, wishes and needs in connection with meals during their stay in the hospital.

METHODS

Twenty individual semi structured interviews were conducted at the North Denmark Regional Hospital and Aalborg University Hospital, Thisted. The inclusion criteria were age ≥18, cognitively and linguistically capable of participating and able to consume food ≥24 h. The participants were selected based on sex, age, and surgical and medical departments to ensure a broad representation.

RESULTS

The patients experienced that the health professionals were friendly and caring and the food was really good. Despite general satisfaction, the patients reported many different experiences that are presented in the following themes: "The care relationship," "Meeting the system," "Influence from the surroundings," and "Social interaction with fellow patients and physical discomfort". The care relationship is considered to be essential. Some patients felt that they were met by helpful and accommodating health professionals while others felt rejected and corrected. The patients reacted to the health professionals being busy by adapting their expectations to the system and accepting the conditions. Hospital surroundings with catheter bags and IV drips influenced the patients and diminished their desire for food. The physical surroundings could make it difficult to sit comfortably when eating. Some patients wanted the company of other patients during their meal but would like to be able to choose with whom they shared their meals. Some patients tended to feel exposed and found it undignified and preferred to eat alone.

CONCLUSIONS

The study indicates that it is important to ensure individual settings for the patients during meals and the focus should be on the relationship between patients and health professionals.

The accessibility and probability of encountering catastrophic health expenditure by Lao patients in Thai hospitals

It is common for people in Laos to use health services in Thailand and other foreign countries. This study analyzes and compares the probability of using health care services and the financial catastrophe occurring due to health service utilization in both local and Thai hospitals. This study includes 390 respondents from Savannakhet Province, Laos. Households' income levels play an essential role in selected locations of hospital admission. The regression model proves that lower income quintiles were more likely to use local health services, whereas the higher income households preferred Thailand's hospital services. There is a negative relationship between income level and the probability of experiencing catastrophic health expenditure. The National Health Insurance (NHI) is recommended to seek greater cooperation with foreign hospitals, to allow Lao patients to use NHI's coverage as a co-payment system for specific health services not available in Lao hospitals. NHI should have to include proper-nutrition meal services in hospitals for patients to reduce the need for accompanied household members during patients' time at hospitals. It is proven that NHI successfully enhances accessibility to local health services; in the long run, the government should expand national hospitals' capacity, medical equipment availability and quantity of health care personnel.

Older Adults' and Their Informal Caregivers' Experiences and Needs regarding Nutritional Care Provided in the Periods before, during and after Hospitalization: A Qualitative Study

To enhance prevention and treatment of malnutrition in older adults before, during and after hospitalization, deeper understanding of older adults' and informal caregivers' perspective on nutritional care is important. One-time in-depth interviews were conducted with 15 older adults who had been discharged from hospital, and seven informal caregivers. We explored their experiences and needs regarding nutritional care provided in the periods before, during and after hospitalization. Five themes emerged from the data: (1) dietary intake, (2) food service during hospitalization, (3) nutrition-related activities, (4) whose job it is to give nutritional care, and (5) competing care priorities. Further, several opinions about nutritional issues were identified. Older adults and informal caregivers did not always experience optimal nutritional care. When discussing nutritional care, they mainly focused on the in-hospital period. When providing nutritional care and developing guidelines, older adults' and informal caregivers' perspective on nutritional care should be incorporated. Here, the periods before, during and after hospitalization should be taken into account equally.

Health economic benefits from optimized meal services to older adults-a literature-based synthesis

Malnutrition among older adults causes health problems and economic costs. Prevention of malnutrition through meal service can reduce such costs. This study estimates potential health economic benefits to be generated through meal service to home-dwelling older adults. The study contains three components: (1) systems analysis describing the relationship between meal service, nutritional status, health risk, and health-related costs, focusing on older adults, (2) a series of literature reviews to quantify the identified elements in each stage-subject combination: (i) meal service impact on nutrition status of older adults, (ii) associations between nutrition status and health risks, (iii) health care resource needs associated with these health risks, and (3) a model synthesis of literature findings to estimate the expected economic benefit of improved health status derived from meal service enrollment, using Denmark as an example. Expected economic benefits in terms of saved direct and indirect health care costs and improved quality-of-life was estimated at an amount of €307 per year per individual enrolled, of which direct health care cost savings constituted €75, while value of improved quality-of-life and reduced mortality constituted the rest. The average health economic benefit from enrolling older adults into meal service is likely to decrease with the number of subscribers. Findings like these are important to take into consideration, when making policy decisions regarding size of the meal service capacity, although it should be noted that the presented estimates are based on a number of assumptions of which some are subject to uncertainty.

Older patients' perspectives on mealtimes in hospitals: a scoping review of qualitative studies

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.

Nutrition care quality indicators in hospitals and nursing homes: A systematic literature review and critical appraisal of current evidence

OBJECTIVE

Quality indicators (QIs) can be used to assess and improve the quality of care in health care institutions. Although QIs about nutrition care in hospitals and nursing homes have been used in studies, no systematic catalogue exists to date. This systematic literature review identifies nutrition care QIs in hospitals and nursing homes and maps them according to QI type, stakeholder level and nutrition care theme. We also assess the level of consensus between studies and critically appraise the QIs presented therein based on two conceptual frameworks.

METHODS

Ovid, Scopus and grey literature were searched from 1995 to 2016 including studies in English and German. Papers were considered if they presented, developed, assessed, rated or applied nutrition care QIs in hospitals or nursing homes. We used Donabedian's framework to define structure, process and outcome indicators, the WHO (World Health Organization) definition to describe stakeholder levels, and a structured table to map indicators within themes. Further, we used the Institute of Medicine (IOM) and the Organisation for Economic Cooperation and Development (OECD) frameworks' key dimensions to measure the conceptual quality of the QIs. Results are summarised and presented tabulated and narratively.

RESULTS

From 536 identified studies, 46 were included. Eight hundred and twenty-two QIs were extracted and mapped into 19 themes and 151 sub-themes. Half were process indicators (49%) and about a quarter were outcome (28%) and structure (23%) indicators, respectively. The vast majority (71%) targeted micro level, while 28% meso level and only 1% macro level information. The nutrition themes meals/mealtimes (12%), treatment (adherence) (12%), nutrition screening (7%), assessment (7%) and monitoring (7%) were most frequently covered. 69% of indicators were cited by more than one study. Most frequent framework dimensions were patient-centeredness (33%), timeliness (30%), validity (30%) and actionability/feasibility (30%).

CONCLUSION

The large number of nutrition care QIs in hospitals and nursing homes indicates the high interest in and importance of better nutrition care provision in institutions. However, the great variability indicates little consensus of the nutrition community on how to best assess and measure the quality of nutrition care. The limited methodological and conceptual validity of presented QIs and the low representation of QIs at macro and meso levels make international consensus finding complicated. Increased efforts including all stakeholder levels and using conceptual frameworks to define a limited number of key QIs with high methodological validity, actionability and stakeholder relevance are needed. Registration in clinicaltrials.gov: Identifier: NCT02820246.

Hospital meals are existential asylums to hospitalized people with a neurological disease: A phenomenological-hermeneutical explorative study of the meaningfulness of mealtimes

AIM

Hospital meals are challenging for neurological patients. Patients struggle with both physical eating disabilities and social issues during mealtimes. The aim of this study was to examine the meaningfulness of the phenomenon of hospital meals for hospitalized patients with a neurological disease.

DESIGN

Interviews (N = 23) with neurological patients were analysed and interpreted to gain in-depth comprehensive knowledge of the phenomenon of hospital mealtimes.

METHOD

Data were analysed and interpreted in a three-phased process using a phenomenological-hermeneutic approach inspired by Paul Ricouer.

RESULTS

Four themes were identified: (a) A lonely ride together with others; (b) Letting the chaotic setting fade into the background; (c) Mechanical activity with great personal significance; and (d) Humanizing the setting when eating in the hospital. Mealtimes were supporting existential moments to patients. Offering a calm mealtime setting was experienced by the patients as an asylum where uplifting and comforting feelings were raised.

Perceptions and experiences of nutritional care following the overwhelming experience of lower extremity amputation: A qualitative study

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.

Epilepsy monitoring - The patients' views: A qualitative study based on Kolcaba's Comfort Theory

PURPOSE

The aim of this qualitative study was to determine which perception of personal comfort patients name in the context of their hospitalization in an Austrian Epilepsy Monitoring Unit (EMU).

METHODS

Problem-centred interviews with twelve inpatients were conducted. Data analyses were done according to Mayring's qualitative content analyses following the technique of structuring-deductive category assignment.

RESULTS

Patients experienced different kinds of comfort along with their hospitalization in the EMU. Comfort-decreasing factors were bed rest, boredom, and waiting for possible seizures. As comfort-increasing factors, hope for enhanced seizure control, support by family and staff, and intelligible information about the necessity of restrictive conditions were identified.

CONCLUSIONS

The study results should assist health care professionals, enabling them to design comfort enhancing interventions for patients undergoing video-electroencephalography (EEG) investigations in an EMU. Some of these seem to be simple and obtainable without high financial or technical effort. Others are more complex and have to be further assessed for their feasibility.

Hospital menu interventions: a systematic review of research

PURPOSE

Most patients in developed countries solely depend on the hospital menu to order their food. The provision of menu choices to patients differs between facilities. The purpose of this paper is to determine which strategies that provide menu choices to patients are effective in improving clinical and non-clinical outcomes in hospital.

DESIGN/METHODOLOGY/APPROACH

Five databases were searched to identify relevant publications. Prospective research published in English with the menu as the primary intervention was included. Study eligibility was determined and risk of bias assessed. Outcome data were combined narratively due to absence of homogeneous study design and outcomes.

FINDINGS

Of the 2,201 records screened, six studies met inclusion criteria. Standardised menu formatting and the spoken menu system were found to improve meal tray accuracy. The spoken menu and computerised interactive menu selector system enhanced aspects of patient satisfaction without cost increases. Descriptive menus may increase food consumption. Branding food items was not well supported by patients. One study rated positively for study quality with the remaining five studies receiving neutral quality ratings.

RESEARCH LIMITATIONS/IMPLICATIONS

The small number of studies conducted on each intervention and the quality of the evidence made it difficult to establish a solid evidence base around providing menu choices to patients. Further research is needed on menu ordering systems, including spoken and visual menus, to determine their impact on outcomes in hospital.

ORIGINALITY/VALUE

This review is first to examine the effectiveness of menu interventions in hospital. Hospital foodservice departments should consider these findings when reviewing local systems.

Lived experiences and challenges of older surgical patients during hospitalization for cancer: an ethnographic fieldwork

This paper explores the lived experiences of older surgical patients’ (aged 74 years and older) experienced challenges during a brief admission to hospital. Age, gender, polypharmacy, and the severity of illness are also factors known to affect the hospitalization process. For an ethnographic study using participant observation and interviews, surgical cancer patients (n = 9, aged 74 years and older) were recruited during admission to a Danish teaching hospital. Using ethnographic strategies of participant observation and interviews, each patient was followed through the course of 1 day during their stay at the hospital. Interviews were carried out with all patients during this time. Three areas of concern were identified as prominent in the patients’ experiences and challenges during their short hospital stay: teeth and oral cavity, eating in a hospital setting, and medication during hospitalization. Short-term hospitalization requires focused collaboration between staff and patient concerning individual challenges from their teeth and oral cavity as support of nutritional needs during surgical treatment for cancer.

Patients' evaluation of hospital foodservice quality in Italy: what do patients really value?

OBJECTIVE

Patients often do not eat/drink enough during hospitalization. To enable patients to meet their energy and nutritional requirements, food and catering service quality and staff support are therefore important. We assessed patients' satisfaction with hospital food and investigated aspects influencing it.

DESIGN

We conducted a cross-sectional study collecting patients' preferences using a slightly modified version of the Acute Care Hospital Foodservice Patient Satisfaction Questionnaire (ACHFPSQ). Factor analysis was carried out to reduce the number of food-quality and staff-issue variables. Univariate and multivariate ordinal categorical regression models were used to assess the association between food quality, staff issues, patients' characteristics, hospital recovery aspects and overall foodservice satisfaction (OS).

SETTING

A university hospital in Florence, Italy, in the period November-December 2009.

SUBJECTS

Hospital patients aged 18+ years (n 927).

RESULTS

Of the 1288 questionnaires distributed, 927 were returned completely or partially filled in by patients and 603 were considered eligible for analysis. Four factors (explained variance 64·3 %, Cronbach's alpha α(C) = 0.856), i.e. food quality (FQ; α(C) = 0·74), meal service quality (MSQ; α(C) = 0·73), hunger and quantity (HQ; α(C) = 0·74) and staff/service issues (SI; α(C) = 0·65), were extracted from seventeen items. Items investigating staff/service issues were the most positively rated while certain items investigating food quality were the least positively rated. After ordinal multiple regression analysis, OS was only significantly associated with the four factors: FQ, MSQ, HQ and SI (OR = 17·2, 6·16, 3·09 and 1·75, respectively, P < 0·001), and gender (OR = 1·53, P = 0·024).

CONCLUSIONS

The most positively scored aspects of foodservice concerned staff/service, whereas food quality was considered less positive. The aspects that most influenced patients' satisfaction were those related to food quality.

Patients' lived experiences of a reduced intake of food and drinks during illness: a literature review

AIM

This study aims to identify patients' lived experiences of having a reduced intake of food and drink during illness, through a literature review.

METHODS

Scientific studies were selected through a systematic search of CINAHL, PubMed, SweMed, British Nursing Index, Psycinfo and EMBASE. A deductive thematic analysis was performed on the studies included. The analysis provided three main themes: (i) serving of food and drink - patient experiences. (ii) Modifications related to illness - patient experiences. (iii) Nutritional care provided by healthcare professionals nutritional care - patient experiences.

FINDINGS

Generally speaking, the findings showed high satisfaction with the food served at hospitals. However, patients' individual tastes and preferences as to when and where to eat were found to affect their intake of food and drink. Physical changes because of illness were stated as the main reason for the patients' lived experiences of a reduced intake of food and drink. These experiences seemed to be related to negative feelings, such as anxiety and shame during meals. Furthermore, the literature review revealed a lack of professional assistance during meals and insufficient guidance on how to handle specific nutritional problems.

CONCLUSIONS

Patients expect committed nursing care in regard to nutritional advice during illness and assistance in meal-related situations. Nurses need to refocus on fundamental caring.

Aceitação de dietas em ambiente hospitalar

OBJETIVO: O objetivo do estudo foi avaliar a aceitação de dietas de pacientes internados em um hospital público do município de Florianópolis, Santa Catarina. MÉTODOS: Realizou-se análise dos restos alimentares de pacientes internados em unidades de internação médica durante 15 dias, por meio do índice resto-ingestão. O índice foi determinado por tipos de dieta, classificadas em normal, especial com sal e especial sem sal. Enquetes de satisfação com pacientes avaliaram os fatores que influenciam a aceitação das refeições. RESULTADOS: O peso total distribuído correspondente a 1.877 refeições foi de 868kg e o peso dos restos totalizou 313kg. Foi encontrado um índice resto-ingestão de 36,09% e um retorno de 53,68%, 33,99% e 33,84% de dietas especiais com sal, normais e especiais sem sal respectivamente. A variedade, a quantidade e a apresentação das refeições foram avaliadas de forma positiva. A temperatura e o uso de temperos foram os aspectos de menor satisfação, representando 43,00% e 34,30%, respectivamente, para os critérios de regular a ruim. O índice resto-ingestão encontrado (36,09%) estava acima do aceitável para uma população enferma (20,00%), demonstrando uma perda considerável de alimentos. CONCLUSÃO: A partir dos resultados, observou-se a necessidade de avaliar os processos envolvidos na produção dessas refeições e de elaborar estratégias que estimulem a ingestão alimentar do paciente.

[Improvements in the general services of a hospital as the result of patients surveys]

OBJECTIVE

The progressive decrease in the level of satisfaction expressed by our patients with respect to the Hospital's Cooking and Cleaning Services highlighted the need to implement a series of measures in order to identify areas for improvement and increase the satisfaction of our patients with those services.

METHODOLOGY

We reviewed the scores of patients satisfaction surveys in recent years and analysed the trends. Later, we identified the worse rated aspects, investigated the possible causes of the decrease in scores and proposed some solutions. After a feasibility analysis, we established a plan of action and implemented the accepted improvements. Finally, with the surveys of 2008 and 2009, we evaluated whether we had achieved the expected results in our patients' opinion.

RESULTS

Improvement in patient satisfaction in most of the items related to the Cooking Service: increased by 6% and 4.2%, respectively in the quantity and variety variables, and 0.5% in quality. On the other hand, the increase in Cleaning Services satisfaction was minimal, 0.9% at best.

CONCLUSIONS

Obtaining direct opinions of patients can be useful when our purpose is to implement changes. Paying greater attention to particular aspects has enabled us to improve our patients' satisfaction, not only with general services but also with the overall care they received during the hospital stay.

Undernutrition in hospitalized older adults: patterns and correlates, outcomes, and opportunities for intervention with a focus on processes of care

Undernutrition in hospitalized older adults is increasingly being recognized as a serious problem with implications for both patient care and outcomes and health service utilization and costs. This article presents an overview of research that has been conducted examining undernutrition in hospitalized older adults. First, findings from observational studies examining patterns and predictors of undernutrition in hospitalized older adults will be described, with a focus on methodological challenges. Second, clinical outcomes and costs associated with undernutrition in hospitalized older adults will be presented, both while in the hospital and subsequent to discharge. Third, a description of interventions that have already been implemented in hospitalized older adults will be described. Finally, future areas of inquiry and opportunities for evidence-based nutritional interventions targeted at older adults during and following hospitalization will be suggested. The emphasis of the discussion on interventions will focus on processes of care and the hospital environment.

Comida de hospital: percepções de pacientes em um hospital público com proposta de atendimento humanizado

O objetivo do estudo foi conhecer a percepção de pacientes sobre a alimentação em um hospital de referência para a Política Nacional de Humanização. Trata-se de uma pesquisa qualitativa para a qual foram realizadas 26 entrevistas em profundidade, semiestruturadas, aplicadas a pacientes adultos e idosos internados há quatro ou mais dias em clínicas médicas. O estudo revelou que os pacientes aprovam o bom atendimento e consideram o cuidado humanizado da equipe de saúde; percebem a alimentação como parte das regras da instituição e a relacionam com a doença e com a recuperação da saúde; consideram que a presença de acompanhante, o ambiente hospitalar, medicamentos e aspectos sensoriais influenciam a aceitação da alimentação. O horário das refeições foi considerado modelo a ser seguido. Os pacientes demonstraram dificuldade em opinar sobre mudanças na alimentação ou sobre suas rotinas. A refeição é um momento de interação entre os próprios pacientes, acompanhantes e equipe de saúde. O estudo concluiu que comer bem no hospital depende do que os pacientes podem ou não comer devido a sua doença, revelando que, possivelmente, não haja identificação da alimentação hospitalar com a sua história alimentar, preferências ou hábitos adquiridos ao longo de sua vida.

Effect of changed organisation of nutritional care of Danish medical inpatients

Background

Many patients are undernourished during hospitalisation. The clinical consequences of this include lassitude, an increased risk of complications and prolonged convalescence. The aim of the study is 1) to implement a new organisation with a focus on improving the quality of the nutritional care of medical inpatients at risk of undernutrition, and 2) to investigate the effect of the intervention.

Methods

Social and healthcare assistants are educated to the higher level of nutritional and healthcare assistants to provide nutritional care in daily practice to undernourished medical inpatients. The effect of the intervention is investigated before and five months after the employment of the nutritional and healthcare assistants. Data are obtained from structured interviews with patients and staff, and the amount of ordered and wasted food is recorded.

Results

Patients regard the work of the nutritional and healthcare assistant as very important for their recovery and weight gain: the assistant takes care of the individual patient's nutritional requirements and wishes, and she imparts knowledge to the patient about optimum nutrition. Staff members benefit from the knowledge and dedication of the nutritional and healthcare assistant and from her work; the staff is often too busy with other nursing tasks to make it a priority to ensure that patients who are nibblers get sufficient nutrition. The choices of food from the production kitchen are utilised to a higher degree, and more of the food is eaten by the patients. Before the intervention, a 20% increase in ordered food in relation to the food budget is found. During the intervention a 20% decrease in ordered food in relation to the food budget is found, and food wastage decreases from 55% to 18% owing to the intervention.

Conclusion

The job function of the nutritional and healthcare assistants on the medical wards is of great value to patients, nursing staff members and the production kitchen. The quality of the nutritional care of undernourished patients increases significantly, and a considerable optimisation of resources in the production and ordering of food takes place. Hospitals can benefit from implementation of the present organisational model if they focus on improving the quality of the nutritional care of weak and elderly inpatients and on optimisating the use of resources.

Plate versus bulk trolley food service in a hospital: comparison of patients’ satisfaction

OBJECTIVE

The aim of this research was to compare plate with bulk trolley food service in hospitals in terms of patient satisfaction. Key factors distinguishing satisfaction with each system would also be identified.

METHODS

A consumer opinion card (n = 180), concentrating on the quality indicators of core foods, was used to measure patient satisfaction and compare two systems of delivery, plate and trolley. Binary logistic regression analysis was used to build a model that would predict food service style on the basis of the food attributes measured. Further investigation used multinomial logistic regression to predict opinion for the assessment of each food attribute within food service style.

RESULTS

Results showed that the bulk trolley method of food distribution enables all foods to have a more acceptable texture, and for some foods (potato, P = 0.007; poached fish, P = 0.001; and minced beef, P < or = 0.0005) temperature, and for other foods (broccoli, P < or = 0.0005; carrots, P < or = 0.0005; and poached fish, P = 0.001) flavor, than the plate system of delivery, where flavor is associated with bad opinion or dissatisfaction. A model was built indicating patient satisfaction with the two service systems.

CONCLUSION

This research confirms that patient satisfaction is enhanced by choice at the point of consumption (trolley system); however, portion size was not the controlling dimension. Temperature and texture were the most important attributes that measure patient satisfaction with food, thus defining the focus for hospital food service managers. To date, a model predicting patient satisfaction with the quality of food as served has not been proposed, and as such this work adds to the body of knowledge in this field. This report brings new information about the service style of dishes for improving the quality of food and thus enhancing patient satisfaction.

A dieta hospitalar na perspectiva dos sujeitos envolvidos em sua produção e em seu planejamento

OBJETIVO: Conhecer as razões objetivas e subjetivas, materiais e simbólicas que fundamentam a atitude das instituições hospitalares frente à alimentação, considerando-as como uma construção social, produto de concepções e práticas de profissionais que, direta ou indiretamente, a determinam e a reproduzem. MÉTODOS: Trata-se de uma pesquisa qualitativa para a qual foram realizadas 32 entrevistas em profundidade, semi-estruturadas, aplicadas aos sujeitos que participam do processo de produção das dietas: cozinheiros, copeiros, nutricionistas, médicos, enfermeiros, auxiliares de enfermagem e diretores clínico e administrativo e observação de campo em dois hospitais, um público e um privado. RESULTADOS: A análise de conteúdo das entrevistas e dos dados de observação de campo foi organizada em duas categorias: aspectos nutricionais desagregados da comida, na qual se constatou a valorização do aspecto nutricional, principalmente em ações de suporte nutricional, em detrimento dos aspectos sensoriais e simbólicos da alimentação hospitalar; e dieta hospitalar, sobre a qual observou-se escassez de informações técnicas e a influência da própria hospitalização nas representações sociais sobre esta, no que diz respeito à condição de controle e disciplina, a pouca autonomia e poder de voz do doente. A importância dada à dieta hospitalar é limitada e a atenção nutricional hospitalar é ainda embrionária. CONCLUSÃO: São necessários esforços para mudanças na cultura alimentar hospitalar, a fim de constituir uma visão da assistência nutricional hospitalar na qual a dieta hospitalar e a atenção nutricional possam ser parte importante no tratamento do paciente hospitalizado e colaborem com a qualidade da experiência de internação.

Nutritional care of medical inpatients: a health technology assessment

BACKGROUND

The inspiration for the present assessment of the nutritional care of medical patients is puzzlement about the divide that exists between the theoretical knowledge about the importance of the diet for ill persons, and the common failure to incorporate nutritional aspects in the treatment and care of the patients. The purpose is to clarify existing problems in the nutritional care of Danish medical inpatients, to elucidate how the nutritional care for these inpatients can be improved, and to analyse the costs of this improvement.

METHODS

Qualitative and quantitative methods are deployed to outline how nutritional care of medical inpatients is performed at three Danish hospitals. The practices observed are compared with official recommendations for nutritional care of inpatients. Factors extraneous and counterproductive to optimal nutritional care are identified from the perspectives of patients and professional staff. A review of the literature illustrates the potential for optimal nutritional care. A health economic analysis is performed to elucidate the savings potential of improved nutritional care.

RESULTS

The prospects for improvements in nutritional care are ameliorated if hospital management clearly identifies nutritional care as a priority area, and enjoys access to management tools for quality assurance. The prospects are also improved if a committed professional at the ward has the necessary time resources to perform nutritional care in practice, and if the care staff can requisition patient meals rich in nutrients 24 hours a day. At the kitchen production level prospects benefit from a facilitator contact between care and kitchen staff, and if the kitchen staff controls the whole food path from the kitchen to the patient. At the patient level, prospects are improved if patients receive information about the choice of food and drink, and have a better nutrition dialogue with the care staff. Better nutritional care of medical patients in Denmark is estimated to hold a cost savings potential reaching approximately USD 22 million.

CONCLUSION

Every hospital and every bed ward has its strengths and weaknesses, but none of the participating bed wards fully satisfy nutritional care success criteria. All organisational levels have a significant potential for improvements of nutritional care of medical inpatients.