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Lindström R, Orrevall Y, Belqaid K, McGreevy J, Ottenblad A, Rothenberg E, Slinde F, Ottery FD, Jager-Wittenaar H, Einarsson S. Swedish translation and cultural adaptation of the scored Patient-Generated Subjective Global Assessment (PG-SGA©)-A validated tool for screening and assessing malnutrition in clinical practice and research. Scand J Caring Sci 2024; 38:589-601. [PMID: 38713754 DOI: 10.1111/scs.13267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2023] [Revised: 04/09/2024] [Accepted: 04/20/2024] [Indexed: 05/09/2024]
Abstract
INTRODUCTION The scored Patient-Generated Subjective Global Assessment (PG-SGA©) is a validated tool for the screening, assessment and monitoring of malnutrition, and triaging of interventions. It contains a patient-generated component and a healthcare professional (HCP)-generated component. AIM To translate the PG-SGA into Swedish, assess the linguistic and content validity of the Swedish version, and ensure conceptional, semantic and operational equivalence to the original English PG-SGA. METHODS In line with the methodology used in previously translated and culturally adapted versions, the standardised 10-step process suggested by the International Society for Health Economics and Outcomes Research (ISPOR) was followed. In step 7, a cross-sectional study targeting patients n = 51 and HCPs n = 52 was performed at a university hospital in Sweden. Using separate questionnaires, patients assessed the patient component and HCPs, the professional component regarding perceived comprehensibility and difficulty (linguistic validity). The HCPs also assessed perceived relevance (content validity) of all items on the PG-SGA. Item indices for comprehensibility (I-CI), difficulty (I-DI) and content validity (I-CVI) were calculated and averaged into scale indices (S-CI, S-DI and S-CVI). Cut-off standards for item and scale indices were used as reference. RESULTS The Swedish version of the PG-SGA rated excellent for comprehensibility (S-CI 0.96) and difficulty (S-DI 0.93) for the patient component. The professional component rated acceptable for comprehensibility (S-CI 0.89) and below acceptable for difficulty (S-DI 0.70), with the physical examination rated most difficult (I-DI 0.39 to 0.69). Content validity for the full Swedish PG-SGA was rated excellent (S-CVI 0.94). CONCLUSION The patient component was considered clear and easy to complete. The full Swedish PG-SGA was considered relevant by HCPs for screening and assessment of malnutrition. Due to perceived difficulty with the physical examination, training of Swedish HCPs in using the PG-SGA is essential before implementing the professional component into clinical practice or research.
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Affiliation(s)
- Rebecca Lindström
- Medical Unit Clinical Nutrition, Women's Health and Allied Health Professionals Theme, Karolinska University Hospital, Solna, Sweden
| | - Ylva Orrevall
- Medical Unit Clinical Nutrition, Women's Health and Allied Health Professionals Theme, Karolinska University Hospital, Solna, Sweden
- Department of Biosciences and Nutrition, Karolinska Institutet, Stockholm, Sweden
| | - Kerstin Belqaid
- Medical Unit Clinical Nutrition, Women's Health and Allied Health Professionals Theme, Karolinska University Hospital, Solna, Sweden
- Department of Biosciences and Nutrition, Karolinska Institutet, Stockholm, Sweden
| | - Jenny McGreevy
- Department of Food Studies, Nutrition and Dietetics, Uppsala University, Uppsala, Sweden
- Centre for Clinical Research Sörmland/Uppsala University, Eskilstuna, Sweden
- Department of Dietetics, Nykoping Hospital, Nykoping, Sweden
| | - Anna Ottenblad
- Medical Department, Nutricia Part of Danone AB, Solna, Sweden
| | - Elisabet Rothenberg
- Department of Nursing and Integrated Health Sciences, Kristianstad University, Kristianstad, Sweden
| | - Frode Slinde
- Department of Food and Nutrition and Sport Science, University of Gothenburg, Göteborg, Sweden
| | | | - Harriët Jager-Wittenaar
- Research Group Healthy Ageing, Allied Health Care and Nursing, Hanze University of Applied Sciences Groningen, Groningen, The Netherlands
- Department of Gastroenterology and Hepatology, Dietetics, Radboud University Medical Center, Nijmegen, The Netherlands
- Research Unit Experimental Anatomy, Department Physiotherapy and Human Anatomy, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium
| | - Sandra Einarsson
- Department of Food, Nutrition and Culinary Science, Umeå University, Umeå, Sweden
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Carrera-Gil F, Prieto Rusca MI. Efficiency of a technology-assisted nutritional screening system: A retrospective analysis of 11,722 admissions in a tertiary hospital. Clin Nutr ESPEN 2024; 64:51-56. [PMID: 39214246 DOI: 10.1016/j.clnesp.2024.08.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2024] [Revised: 08/02/2024] [Accepted: 08/23/2024] [Indexed: 09/04/2024]
Abstract
BACKGROUND AND AIM Nutritional screening is essential for addressing malnutrition and its consequences. However, routine implementation in large hospitals faces several challenges. To overcome these obstacles, the Clinical Nutrition Service of a tertiary hospital developed a technology-assisted nutritional screening system. This study evaluates the system's efficiency in detecting and assessing patients at nutritional risk upon hospital admission. It also examines the association between nutritional risk, clinical outcomes, and sociodemographic characteristics. METHODS This retrospective, analytical, observational study examined 11,722 hospital admissions of adult patients in 2019, each with a minimum hospital stay of 48 hours (h) in a tertiary hospital. Rates and timing for the detection, referral, and assessment of patients at nutritional risk were calculated. Participants were divided into low (Malnutrition Screening Tool [MST] < 2 points) and moderate/high (MST ≥2) nutritional risk groups to evaluate the relationship between nutritional risk and clinical and demographic variables. RESULTS We found that 91% of patients underwent nutritional screening within the first hours of admission, with a median time of 9 h from admission to screening (interquartile range [IQR] 3-19). The prevalence of nutritional risk (MST ≥2) was 21%. All patients identified as being at nutritional risk were immediately referred for a nutritional assessment once identified, with a median referral time of 0 h (IQR 0-0). This assessment was carried out by a nutritionist for 98% of these patients, with a median time of 19 h from referral to assessment (IQR 6-24). Compared to the low-risk group, patients with nutritional risk were older, had higher rates of mortality and admission to the intensive care unit (ICU), longer hospital stays, and a higher proportion of men and cancer diagnoses (p< 0.001 for all comparisons). After adjusting for age and sex, nutritional risk was significantly associated with a higher probability of ICU admission (Odds Ratio [OR] 1.13; 95% CI 1.02-1.24) and in-hospital mortality (OR 2.32; 95% CI 1.97-2.73). CONCLUSION The integration of technology into nutritional screening was highly efficient for early detection and assessment of at-risk patients upon hospital admission. Features of this system could guide other hospitals. The association found between nutritional risk and clinical outcomes emphasizes the importance of prompt and appropriate nutritional interventions.
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Affiliation(s)
- Frank Carrera-Gil
- Servicio de Nutrición Clinica, Fundación Valle del Lili, Cali 760026, Colombia; Departamento de Alimentación y Nutrición, Facultad de Ciencias de la Salud, Pontificia Universidad Javeriana Seccional Cali, Cali 760021, Colombia.
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Gomes K, Bell J, Desbrow B, Roberts S. Lost in Transition: Insights from a Retrospective Chart Audit on Nutrition Care Practices for Older Australians with Malnutrition Transitioning from Hospital to Home. Nutrients 2024; 16:2796. [PMID: 39203932 PMCID: PMC11357024 DOI: 10.3390/nu16162796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2024] [Revised: 08/10/2024] [Accepted: 08/20/2024] [Indexed: 09/03/2024] Open
Abstract
Care transitions from hospital to home for older adults with malnutrition present a period of elevated risk; however, minimal data exist describing the existing practice. This study aimed to describe the transition of nutrition care processes provided to older adults in a public tertiary hospital in Australia. A retrospective chart audit conducted between July and October 2022 included older (≥65 years), malnourished adults discharged to independent living. Dietetic care practices (from inpatient to six-months post-discharge) were reported descriptively. Of 3466 consecutive admissions, 345 (10%) had a diagnosis of malnutrition documented by the dietitian and were included in the analysis. The median number of dietetic visits per admission was 2.0 (IQR 1.0-4.0). Nutrition-focused discharge plans were inconsistently developed and documented. Only 10% of patients had nutrition care recommendations documented in the electronic discharge summary. Post-discharge oral nutrition supplementation was offered to 46% and accepted by 34% of the patients, while only 23% attended a follow-up appointment with dietetics within six months of hospital discharge. Most patients who are seen by dietitians and diagnosed with malnutrition appear lost in transition from hospital to home. Ongoing work is required to explore determinants of post-discharge nutrition care in this vulnerable population.
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Affiliation(s)
- Kristin Gomes
- School of Health Sciences and Social Work, Griffith University, Gold Coast Campus, Southport, QLD 4222, Australia; (J.B.); (B.D.); (S.R.)
| | - Jack Bell
- School of Health Sciences and Social Work, Griffith University, Gold Coast Campus, Southport, QLD 4222, Australia; (J.B.); (B.D.); (S.R.)
- Allied Health Research Collaborative, The Prince Charles Hospital, 627 Rode Road, Chermside, QLD 4032, Australia
| | - Ben Desbrow
- School of Health Sciences and Social Work, Griffith University, Gold Coast Campus, Southport, QLD 4222, Australia; (J.B.); (B.D.); (S.R.)
| | - Shelley Roberts
- School of Health Sciences and Social Work, Griffith University, Gold Coast Campus, Southport, QLD 4222, Australia; (J.B.); (B.D.); (S.R.)
- Allied Health Research, Gold Coast Hospital and Health Service, 1 Hospital Blvd, Southport, QLD 4219, Australia
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Papoutsakis C, Sundar C, Woodcock L, Abram JK, Lamers-Johnson E. Translating malnutrition care from the hospital to the community setting. Nutr Clin Pract 2024. [PMID: 39105676 DOI: 10.1002/ncp.11197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2024] [Revised: 06/20/2024] [Accepted: 07/16/2024] [Indexed: 08/07/2024] Open
Affiliation(s)
- Constantina Papoutsakis
- Data Science Center, Research, International, and Scientific Affairs (RISA), Academy of Nutrition and Dietetics, Chicago, Illinois, USA
| | - Charanya Sundar
- Milken Institute School of Public Health, The George Washington University, Washington, District of Columbia, USA
| | - Lindsay Woodcock
- Data Science Center, Research, International, and Scientific Affairs (RISA), Academy of Nutrition and Dietetics, Chicago, Illinois, USA
| | - Jenica K Abram
- Nutrition Research Network, Research, International, and Scientific Affairs (RISA), Academy of Nutrition and Dietetics, Chicago, Illinois, USA
| | - Erin Lamers-Johnson
- Nutrition Research Network, Research, International, and Scientific Affairs (RISA), Academy of Nutrition and Dietetics, Chicago, Illinois, USA
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Brandl A, Lundon D, Lorenzon L, Schrage Y, Caballero C, Holmberg CJ, Santrac N, Smith H, Vasileva-Slaveva M, Montagna G, Bonci EA, Sgarbura O, Sayyed R, Ben-Yaacov A, Herrera Kok JH, Suppan I, Kaul P, Sochorova D, Vassos N, Carrico M, Mohan H, Ceelen W, Arends J, Sandrucci S. Current practice in assessment and management of malnutrition in surgical oncology practice - An ESSO-EYSAC snapshot analysis. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2024; 50:106953. [PMID: 37429796 DOI: 10.1016/j.ejso.2023.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 06/01/2023] [Accepted: 06/06/2023] [Indexed: 07/12/2023]
Abstract
INTRODUCTION Malnutrition is common in patients suffering from malignant diseases and has a major impact on patient outcomes. Prevention and early detection are crucial for effective treatment. This study aimed to investigate current international practice in the assessment and management of malnutrition in surgical oncology departments. MATERIAL AND METHODS The survey was designed by European Society of Surgical Oncology (ESSO) and ESSO Young Surgeons and Alumni Club (EYSAC) Research Academy as an online questionnaire with 41 questions addressing three main areas: participant demographics, malnutrition assessment, and perioperative nutritional standards. The survey was distributed from October to November 2021 via emails, social media and the ESSO website to surgical networks focussing on surgical oncologists. Results were collected and analysed by an independent team. RESULTS A total of 156 participants from 39 different countries answered the survey, reflecting a response rate of 1.4%. Surgeons reported treating a mean of 22.4 patients per month. 38% of all patients treated in surgical oncology departments were routinely screened for malnutrition. 52% of patients were perceived as being at risk for malnutrition. The most used screening tool was the "Malnutrition Universal Screening Tool" (MUST). 68% of participants agreed that the surgeon is responsible for assessing preoperative nutritional status. 49% of patients were routinely seen by dieticians. In cases of severe malnutrition, 56% considered postponing the operation. CONCLUSIONS The reported rate of malnutrition screening by surgical oncologists is lower than expected (38%). This indicates a need for improved awareness of malnutrition in surgical oncology, and nutritional screening.
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Affiliation(s)
- Andreas Brandl
- Department of General, Visceral and Transplantation Surgery, University Hospital Heidelberg, Germany.
| | - Dara Lundon
- Mount Sinai Department of Urology, New York, United States
| | - Laura Lorenzon
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Yvonne Schrage
- Department of Surgical Oncology, Netherlands Cancer Institute, Amsterdam, the Netherlands
| | | | - Carl Jacob Holmberg
- Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, Gothenburg University, Sweden
| | - Nada Santrac
- Surgical Oncology Clinic, Institute for Oncology and Radiology of Serbia, Belgrade, Serbia
| | - Henry Smith
- Digestive Disease Center, Bispebjerg and Frederiksberg Hospitals, University of Copenhagen, Denmark
| | | | - Giacomo Montagna
- Breast Surgery Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Eduard-Alexandru Bonci
- Surgical Oncology and Gynecologic Oncology Department, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania; Breast Unit, Champalimaud Clinical Centre, Champalimaud Foundation, Lisbon, Portugal
| | - Olivia Sgarbura
- Department of Surgical Oncology, Institut du Cancer Montpellier, University of Montpellier, France
| | - Raza Sayyed
- Department of Surgical Oncology, Patel Hospital, Karachi, Pakistan
| | - Almog Ben-Yaacov
- Department of General and Oncological Surgery - Surgery C, Sheba Medical Center, Tel-Hashomer, Israel
| | | | - Ina Suppan
- Breast Center, Department of Gynaecology, Rottal-Inn-Kliniken Eggenfelden, Germany
| | - Pallvi Kaul
- Department of Surgical Oncology, Shri Guru Ram Rai Institute of Medical and Health Sciences, Dehradun, India
| | - Dana Sochorova
- Department of Surgery, University Hospital Brno, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Nikolaos Vassos
- Division of Surgical Oncology and Thoracic Surgery, Department of Surgery, University Medical Center Mannheim, University of Heidelberg, Mannheim, Germany
| | - Marta Carrico
- Nutrition Department - Champalimaud Foundation, Champalimaud Centre for the Unknown, Lisbon, Portugal
| | - Helen Mohan
- Peter MacCallum Cancer Centre in Melbourne, Australia
| | - Wim Ceelen
- Department of GI Surgery and Cancer Research Institute Ghent (CRIG), Ghent University Hospital, Belgium
| | - Jann Arends
- Department of Medicine I, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Germany
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Castaldo A, Bassola B, Zanetti ES, Nobili A, Zani M, Magri M, Verardi AA, Ianes A, Lusignani M, Bonetti L. Nursing Home Organization Mealtimes and Staff Attitude Toward Nutritional Care: A Multicenter Observational Study. J Am Med Dir Assoc 2024; 25:898-903. [PMID: 37989497 DOI: 10.1016/j.jamda.2023.10.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 10/04/2023] [Accepted: 10/09/2023] [Indexed: 11/23/2023]
Abstract
OBJECTIVES The aims of this study were to investigate the practices of registered nurses and nurse aides at mealtimes in nursing homes (NHs) and to evaluate the attitudes of health care staff toward the nutritional care of older people. DESIGN This is a multicenter cross-sectional study. SETTING AND PARTICIPANTS The study involved a convenience sample of NH health care staff: physicians, registered nurses, and nurse aides. METHODS Data were collected on characteristics of the dining environment, organizational and nutritional care practices, staff-resident ratio, and staff activities during meals, using 2 questionnaires and staff attitudes were assessed with Staff Attitudes to Nutritional Nursing Care Geriatric Scale (SANN-G). Total score ranges from 18 to 90 points, with the following cutoffs: ≥72, positive attitude; ≤54, negative; and 55-71 points, neutral attitude. RESULTS A total of 1267 workers from 29 NHs in northern Italy participated in the study. The most common nutritional assessment tool used by nurses was the Malnutrition Universal Screening Tool. A median of 4.0 and 4.2 people (family caregivers, volunteers and staff) were present for feeding support, respectively, at lunch and dinner. A median of 2.5 and 2.0 staff members at lunch and at dinner, respectively, fed residents. Overall, 1024 health care workers responded to SANN-G of which 21.9% showed a negative attitude, 57.2% neutral, and 20.9% a positive attitude. Nurse aides (190/714) showed worse attitudes compared with registered nurses (20/204) and physicians (2/36); differences were statistically significant. Overall, the best attitudes were toward "habits," "interventions," and "individualization" of nutritional care. Staff who had received nutritional training (29.2%) had best attitudes. CONCLUSIONS AND IMPLICATIONS The results suggest that NHs should ensure adequate staff-resident ratio during meals, involving trained volunteers and relatives. Moreover, health professionals' knowledge and attitude toward nutritional care should be improved through continuous training.
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Affiliation(s)
- Anna Castaldo
- IRCCS S. Maria Nascente Don Gnocchi Foundation, Milan, Italy; Bachelor in Nursing, University of Milan, Milan, Italy.
| | | | | | | | - Michele Zani
- Fondazione Le Rondini Città di Lumezzane Onlus, Lumezzane (BS), Italy
| | | | | | | | - Maura Lusignani
- Department of Biomedical Sciences for Health, University of Milan, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Loris Bonetti
- Department of Nursing, Nursing Research Competence Center, Ente Ospedaliero Cantonale, Bellinzona, Canton Ticino, Switzerland; Department of Business Economics, Health and Social Care, University of Applied Sciences and Arts of Southern Switzerland (SUPSI), Manno, Switzerland
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Bauer S, Pospichal J, Huppertz V, Blanar V, Saka B, Eglseer D. The Knowledge of Malnutrition-Geriatric (KoM-G) 2.0 Questionnaire for Health Care Institutions: Cross-Cultural Adaptation into German, Czech, Dutch and Turkish. Nutrients 2024; 16:1374. [PMID: 38732621 PMCID: PMC11085606 DOI: 10.3390/nu16091374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2024] [Revised: 04/11/2024] [Accepted: 04/29/2024] [Indexed: 05/13/2024] Open
Abstract
It is necessary for nursing staff to have adequate knowledge of malnutrition in older people in order to provide high quality care. This study was conducted to update the Knowledge of Malnutrition-Geriatric (KoM-G) questionnaire to fit different settings and to cross-culturally adapt it to the German, Czech, Dutch and Turkish languages. In Part 1 of the study, the KoM-G questionnaire was updated and adapted for use in different settings. Content validation of the KoM-G 2.0 was carried out in a Delphi study with 16 experts. The final KoM-G 2.0 questionnaire consists of 16 items with a Scale Content Validity Index/Average of 94.5%. In Part 2, the English KoM-G 2.0 was cross-culturally adapted into the German, Czech, Dutch and Turkish languages. In the pilot test, between 96.9% (The Netherlands) and 97.8% (Austria) of the nursing staff rated the items as understandable. The KoM-G 2.0 is an up-to-date questionnaire with a highly satisfactory Content Validity Index. It was cross-culturally adapted into the German, Czech, Dutch, and Turkish languages, and the understandability was high. At the moment, the necessary comprehensive psychometric testing of the KoM-G 2.0 is in process. Afterwards it can be used to compare nurses' knowledge between various countries and settings.
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Affiliation(s)
- Silvia Bauer
- Department of Nursing Science, Medical University of Graz, Neue Stiftingtalstraße 6, 8010 Graz, Austria
| | - Jan Pospichal
- Faculty of Health Studies, University of Pardubice, Studentska 95, 532 10 Pardubice, Czech Republic
| | - Viviënne Huppertz
- Department of Respiratory Medicine, School of Nutrition and Translational Research in Metabolism (NUTRIM), Maastricht University, Universiteitssingel 50, 6202 AZ Maastricht, The Netherlands
| | - Vit Blanar
- Faculty of Health Studies, University of Pardubice, Studentska 95, 532 10 Pardubice, Czech Republic
| | - Bulent Saka
- Department Internal Medicine, Istanbul Faculty of Medicine, Istanbul University, Millet Str., Çapa, Fatih, 34093 Istanbul, Turkey
| | - Doris Eglseer
- Department of Nursing Science, Medical University of Graz, Neue Stiftingtalstraße 6, 8010 Graz, Austria
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Roberts S, Marshall AP, Bromiley L, Hopper Z, Byrnes J, Ball L, Collins PF, Kelly J. Patient-Led, Technology-Assisted Malnutrition Risk Screening in Hospital: A Feasibility Study. Nutrients 2024; 16:1139. [PMID: 38674830 PMCID: PMC11055004 DOI: 10.3390/nu16081139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Revised: 03/29/2024] [Accepted: 04/09/2024] [Indexed: 04/28/2024] Open
Abstract
Malnutrition risk screening is crucial to identify at-risk patients in hospitals; however, screening rates can be suboptimal. This study evaluated the feasibility, acceptability, and potential cost-effectiveness of patient-led, technology-assisted malnutrition risk screening. A prospective multi-methods study was conducted in a 750-bed public hospital in Australia. Patients were recruited from seven wards and asked to complete an electronic version of the Malnutrition Screening Tool (e-MST) on bedside computer screens. Data were collected on feasibility, acceptability, and cost. Feasibility data were compared to pre-determined criteria on recruitment (≥50% recruitment rate) and e-MST completion (≥75% completion rate). Quantitative acceptability (survey) data were analyzed descriptively. Patient interview data were analyzed thematically. The economic evaluation was from the perspective of the health service using a decision tree analytic model. Both feasibility criteria were met; the recruitment rate was 78% and all 121 participants (52% male, median age 59 [IQR 48-69] years) completed the e-MST. Patient acceptability was high. Patient-led e-MST was modeled to save $3.23 AUD per patient and yield 6.5 more true malnutrition cases (per 121 patients) with an incremental cost saving per additional malnutrition case of 0.50 AUD. Patient-led, technology-assisted malnutrition risk screening was found to be feasible, acceptable to patients, and cost-effective (higher malnutrition yield and less costly) compared to current practice at this hospital.
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Affiliation(s)
- Shelley Roberts
- School of Health Sciences and Social Work, Griffith University, Southport, QLD 4222, Australia;
- Allied Health Research, Gold Coast Hospital and Health Service, Southport, QLD 4215, Australia
| | - Andrea P. Marshall
- School of Nursing and Midwifery, Griffith University, Southport, QLD 4222, Australia;
- Nursing and Midwifery Education and Research Unit, Gold Coast Hospital and Health Service, Southport, QLD 4215, Australia
| | - Leisa Bromiley
- Nutrition and Food Services, Gold Coast Hospital and Health Service, Southport, QLD 4215, Australia;
| | - Zane Hopper
- School of Health Sciences and Social Work, Griffith University, Southport, QLD 4222, Australia;
- Nutrition and Food Services, Gold Coast Hospital and Health Service, Southport, QLD 4215, Australia;
| | - Joshua Byrnes
- Centre for Applied Health Economics, Menzies Health Institute Queensland, Griffith University, Southport, QLD 4222, Australia;
- School of Medicine and Dentistry, Griffith University, Southport, QLD 4222, Australia
| | - Lauren Ball
- Centre for Community Health and Wellbeing, The University of Queensland, St Lucia, QLD 4072, Australia;
| | - Peter F. Collins
- Faculty of Medicine and Health, Sydney Nursing School/Susan Wakil School of Nursing and Midwifery, The University of Sydney, Sydney, NSW 2006, Australia;
- Charles Perkins Centre, The University of Sydney, Sydney, NSW 2006, Australia
| | - Jaimon Kelly
- Centre for Online Health, The University of Queensland, Woolloongabba, QLD 4102, Australia;
- Centre for Health Services Research, The University of Queensland, Woolloongabba, QLD 4102, Australia
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Verstraeten LMG, van Wijngaarden JP, Meskers CGM, Maier AB. High Sarcopenia Awareness Contrasts a Lack of Clinical Implementation Among Geriatric Rehabilitation Health Care Professionals in the Netherlands: EMPOWER-GR. J Geriatr Phys Ther 2024; 47:67-76. [PMID: 36827678 DOI: 10.1519/jpt.0000000000000379] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/26/2023]
Abstract
BACKGROUND AND PURPOSE Despite being associated with serious adverse outcomes, such as mortality, sarcopenia remains largely undiagnosed in older individuals. This study aimed to assess the awareness, practices, and barriers and enablers to clinical implementation of sarcopenia diagnosis and treatment among geriatric rehabilitation health care professionals in the Netherlands. METHODS As part of EMPOWER-GR, a cross-sectional survey among geriatric rehabilitation health care professionals working in the Netherlands was undertaken between September 23, 2020, and January 28, 2021. Professionals were recruited via a geriatric rehabilitation care provider, health care professional associations, professional networks of the research team, and social media. Descriptive statistics were used to assess the study outcomes. RESULTS AND DISCUSSION Of the 501 geriatric rehabilitation health care professionals, 12.2% were physicians, 23.0% physical therapist/occupational therapists, 30.3% dietitians, 19.6% nurses, and 11.0% health care assistants. The concept of sarcopenia was known by 83.8% of the participants, 92.5% correctly identified sarcopenia as low muscle mass and strength (and low physical performance), and 73.8% identified sarcopenia as very important in the management of older adults admitted for rehabilitation. Although 26.2% and 18.9% of the participants reported screening and diagnosing sarcopenia, respectively, in their current practice, only 3.0% adequately used the (revised) definition of the European Working Group on Sarcopenia in Older People. When sarcopenia has been diagnosed, 65.0% reported initiating treatment consisting of resistance exercise training (78.7%), food fortification/high-energy or protein diet (85.4%), and oral nutritional supplements (70.4%). Most important barriers to screening and diagnosis were lack of knowledge, access to tools, and equipment and time, while enablers were protocol implementation, access to training, and clear responsibilities. CONCLUSIONS Sarcopenia awareness is high among geriatric rehabilitation health care professionals in the Netherlands, but adequate screening and diagnosis is almost nonexistent in current clinical practice, which hampers interventions. Better knowledge, clear responsibilities, and access to tools and protocols, as well as prioritization, are needed for sarcopenia to be diagnosed and treated in geriatric rehabilitation in the Netherlands.
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Affiliation(s)
- Laure M G Verstraeten
- Department of Human Movement Sciences, @AgeAmsterdam, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, the Netherlands
| | | | - Carel G M Meskers
- Department of Rehabilitation Medicine, Amsterdam University Medical Center, Amsterdam Movement Sciences, Amsterdam, the Netherlands
| | - Andrea B Maier
- Department of Human Movement Sciences, @AgeAmsterdam, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, the Netherlands
- Department of Medicine and Aged Care, @AgeMelbourne, The Royal Melbourne Hospital, The University of Melbourne, Parkville, Victoria, Australia
- Healthy Longevity Translational Research Program, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Center for Healthy Longevity, @AgeSingapore, National University Health System, Singapore
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Jost N, Erickson N, Bratu E, Nasseh D, Morasch V, Kraus-Pfeiffer G, Heinemann V, Fey T. Closing the cancer care gap with a patient-reported nutrition screening: A retrospective analysis of a quality improvement project on an oncology ward (CCC study). Clin Nutr ESPEN 2023; 57:246-252. [PMID: 37739664 DOI: 10.1016/j.clnesp.2023.06.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 03/22/2023] [Accepted: 06/25/2023] [Indexed: 09/24/2023]
Abstract
BACKGROUND & AIMS Early identification of patients at risk for malnutrition followed by individualized nutrition interventions is a central step to the provision of appropriate nutrition care. However, a health care professional (HCP)-based nutrition screening is not always consistently integrated into routine care. Patient-reported (PR) nutrition screening could thus potentially alleviate the burden on the HCPs and contribute to a greater number of patients who are identified and treated for malnutrition. METHODS In 2021 a Quality Improvement Project (QIP) at our out-patient oncology clinic was undertaken to implement the change from a HCP-based nutrition screening to a PR-screening. This was followed by a retrospective analysis in which the primary outcome measure was the rate of nutrition consultations initiated for patients undergoing cancer therapy. RESULTS In total n = 1657 patient data sets derived from comparable time periods before and after the QIP were analyzed and compared. Both groups had a comparable mean age and gender distribution. The most common diagnosis in both groups was gastrointestinal tumors. The change in routine care from a HCP-based nutrition screening to a PR-screening led to a significant increase in nutrition consultation rates (RD = 19%; p < 0.001; 95% CI 14.4%-23.5%) and screening rates (RD = 30.5%; p < 0.001; 95% CI 26.2%-34.7%). CONCLUSIONS The change to PR-screening potentially facilitates an increase in nutrition screening rates. This in turn leads to an increased rate of patients identified at risk for malnutrition and thus referrals for nutrition consultations. Our findings indicate that a PR nutrition screening tool could play a role in closing the care gap and contribute to reducing rates of malnutrition among this population where screening is not consistently integrated into routine care.
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Affiliation(s)
- Nicole Jost
- Comprehensive Cancer Center (CCC Munich LMU), Ludwig Maximilians University (LMU) University Hospital, Munich, Germany.
| | - Nicole Erickson
- Comprehensive Cancer Center (CCC Munich LMU), Ludwig Maximilians University (LMU) University Hospital, Munich, Germany
| | - Elena Bratu
- Comprehensive Cancer Center (CCC Munich LMU), Ludwig Maximilians University (LMU) University Hospital, Munich, Germany
| | - Daniel Nasseh
- Comprehensive Cancer Center (CCC Munich LMU), Ludwig Maximilians University (LMU) University Hospital, Munich, Germany
| | - Vinzenz Morasch
- Comprehensive Cancer Center (CCC Munich LMU), Ludwig Maximilians University (LMU) University Hospital, Munich, Germany
| | - Gabriele Kraus-Pfeiffer
- Comprehensive Cancer Center (CCC Munich LMU), Ludwig Maximilians University (LMU) University Hospital, Munich, Germany
| | - Volker Heinemann
- Comprehensive Cancer Center (CCC Munich LMU), Ludwig Maximilians University (LMU) University Hospital, Munich, Germany; Department of Oncology and Hematology, Ludwig Maximilians University (LMU) Hospital, Munich, Germany
| | - Theres Fey
- Comprehensive Cancer Center (CCC Munich LMU), Ludwig Maximilians University (LMU) University Hospital, Munich, Germany
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11
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Jackson H. Enhancing nutrition screening in patients with kidney disease. Nurs Stand 2023; 38:77-81. [PMID: 37547939 DOI: 10.7748/ns.2023.e11934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/19/2023] [Indexed: 08/08/2023]
Abstract
Malnutrition is common in patients with kidney disease, and can exacerbate the individual and economic burden of the condition. The identification of malnutrition is essential to inform management interventions and improve patient outcomes, and nutrition screening can be considered the first stage in this process. The development of simple nutrition screening tools has assisted nurses in undertaking widespread, rapid assessments of patients' malnutrition risk. However, generic tools may not be appropriate or accurate in patients with kidney disease. This article explains some of the challenges of identifying malnutrition in this patient group and outlines some disease-specific tools that nurses can use to enhance nutrition screening.
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Affiliation(s)
- Helena Jackson
- St George's University Hospitals NHS Foundation Trust, London, England
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12
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Caruso R, Dellafiore F, Arrigoni C, Bonetti L. Individual-Level Variables Associated with Self-Efficacy in Nutritional Care for Older People among Italian Nurses: A Multicenter Cross-Sectional Study. J Nutr Gerontol Geriatr 2023; 42:46-58. [PMID: 36946327 DOI: 10.1080/21551197.2023.2188340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/23/2023]
Abstract
Malnutrition in older people is still an unsolved issue. Clinical nurses have a key role in malnutrition prevention. This study aims to describe the individual-level variables associated with self-efficacy in nutrition care for older adults among nurses. A cross-sectional descriptive observational study was performed involving nurses from four northern Italy hospitals. The self-efficacy scale for nursing nutrition care (SE-NNC) and Multiple linear regression (MLR) models were used, enrolling 305 nurses. The mean SE-NNC total score was 53.3 ± 19.7. Considering the three dimensions of the SE-NNC, mean scores were 45.9 ± 21.7 for boosting knowledge, 55.4 ± SD = 20.3 for assessment and evidence utilization, and 57.7 ± 21.1 for care delivery. To be a younger nurse, working in a chronic care setting, and being male were associated with a higher level of self-efficacy, both considering the SE-NNC total score and its dimensions. Working in acute care settings and being an older nurse was associated with lower nursing self-efficacy in nutrition care for older adults.
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Affiliation(s)
- Rosario Caruso
- Health Professions Research and Development Unit, IRCCS Policlinico San Donato, San Donato Milanese, Italy
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
| | - Federica Dellafiore
- Department of Public Health, Experimental and Forensic Medicine, Section of Hygiene, University of Pavia, Pavia, Italy
| | - Cristina Arrigoni
- Department of Public Health, Experimental and Forensic Medicine, Section of Hygiene, University of Pavia, Pavia, Italy
| | - Loris Bonetti
- Nursing Direction Department, Nursing Research Competence Centre, Ente Ospedaliero Cantonale (EOC), Bellinzona, Switzerland
- Department of Business Economics, Health and Social Care, University of Applied Sciences and Arts of Southern Switzerland, Manno, Switzerland
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Shakhshir M, Alkaiyat A. Healthcare providers' knowledge, attitude, and practice on quality of nutrition care in hospitals from a developing country: a multicenter experience. JOURNAL OF HEALTH, POPULATION, AND NUTRITION 2023; 42:15. [PMID: 36879345 PMCID: PMC9990276 DOI: 10.1186/s41043-023-00355-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Accepted: 02/28/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND Despite the fact that malnutrition can affect both recovery and outcome in acute care patients, little is known about malnutrition in Palestine, and even less is known about the assessment of malnutrition knowledge, attitudes, and practices (M-KAP) toward healthcare providers and nutrition care quality measures in hospitalized patients. Therefore, this study aimed to evaluate the M-KAP of physicians and nurses in routine clinical care and determine the influencing factors. METHODS From April 1 to June 31, 2019, cross-sectional research was performed at governmental (n = 5) and non-governmental (n = 4) hospitals in the North West Bank of Palestine. Data were collected using a structured self-administered questionnaire from physicians and nurses to collect information on knowledge, attitude, and practices related to malnutrition and nutrition care, alongside sociodemographic characteristics. RESULTS A total of 405 physicians and nurses were participated in the study. Only 56% of participants strongly agreed that nutrition was important, only 27% strongly agreed that there should be nutrition screening, only 25% felt food helped with recovery, and around 12% felt nutrition as part of their job. Approximately 70% of participants said they should refer to a dietitian, but only 23% knew how and only 13% knew when. The median knowledge/attitude score was 71, with an IQR ranging from 65.00 to 75.00, and the median practice score was 15.00 with an IQR of 13.00-18.00. The mean knowledge attitude practice score was 85.62 out of 128 with SD (9.50). Respondents who worked in non-governmental hospitals showed higher practice scores (p < 0.05), while staff nurses and ICU workers showed the highest practice score (p < 0.001). Respondents with younger age categories, working in non-governmental hospitals in the ICU as practical and staff nurses, showed the highest KAP score (p < 0.05). Significance positive correlations were found between respondents' knowledge/attitude and practice scores regarding the quality of nutrition care in hospitals (r = 0.384, p value < 0.05). In addition, the result also revealed that almost half of respondents believed that the most important barriers to inadequate intake of food at the bedside are related to food appearance, taste, and aroma of meals served (58.0%). CONCLUSIONS The research revealed that inadequate knowledge was perceived as a barrier to effective nutrition care to the patient. Many beliefs and attitudes do not always translate into practice. Although the M-KAP of physicians and nurses is lower than in some other countries/studies, it highlights a strong need for more nutrition professionals in the hospital and increasing nutrition education to improve nutrition care in hospitals in Palestine. Furthermore, establishing a nutrition task force in hospitals elaborated by dietitians as the unique nutrition care provider will assure to implementation of a standardized nutrition care process.
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Affiliation(s)
- Muna Shakhshir
- Department of Nutrition, An-Najah National University Hospital, Nablus, 44839 Palestine
- Health Division, College of Medicine and Health Sciences, An-Najah National University, Nablus, 44839 Palestine
| | - Abdulsalam Alkaiyat
- Health Division, College of Medicine and Health Sciences, An-Najah National University, Nablus, 44839 Palestine
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Geraghty AA, Dominguez Castro P, Reynolds CM, Browne S, Bourke F, Bradley C, Finnigan K, Clarke S, Clyne B, Bury G, Perrotta C, Kennelly S, Corish CA. Impact of malnutrition management e-learning module on GPs' knowledge: a pilot study. BJGP Open 2023; 7:BJGPO.2022.0111. [PMID: 36410769 DOI: 10.3399/bjgpo.2022.0111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Revised: 10/04/2022] [Accepted: 10/10/2022] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Malnutrition is underdiagnosed in primary care. GPs are key healthcare contacts for older adults at risk of protein-energy malnutrition; however, lack of knowledge and confidence in its diagnosis and treatment is often reported. AIM To evaluate the impact of a bespoke online education module on GP malnutrition knowledge and management. DESIGN & SETTING A prospective pre-post pilot study with 23 GPs and eight GP trainees in the Republic of Ireland. METHOD The module included units on the following: 'malnutrition definition, prevalence, and latest evidence'; 'identifying malnutrition in clinical practice'; 'food-first advice'; 'reviewing malnutrition'; and 'oral nutritional supplements'. Participant knowledge was measured using a multiple choice questionnaire (MCQ) before and after the module (n = 31), and 6 weeks following completion (n = 11). Case studies assessing identification and management of malnutrition were evaluated by a clinical specialist dietitian with expertise in managing malnutrition. Changes in assessment performance were calculated using paired t-tests. Acceptability was evaluated using a questionnaire. RESULTS Post-training, 97% of GPs increased MCQ scores from baseline (+25%, P<0.001), with the greatest improvement in 'identifying malnutrition in clinical practice' (mean increase 47%, P<0.001). Eleven GPs completed the 6-week MCQ with scores remaining significantly higher than baseline (mean increase 15%, P = 0.005); 'identifying malnutrition in clinical practice' remained the most highly scored (mean increase 40%, P<0.001). Seventeen GPs completed the case studies; 76% at baseline and 88% post-module correctly calculated malnutrition risk scores. Appropriate malnutrition management improved for 47% of GPs after module completion. CONCLUSION This e-learning module improved malnutrition knowledge, with good short-term retention in a small cohort. Development of online evidence-based nutrition education may improve GP nutrition care.
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Affiliation(s)
- Aisling A Geraghty
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Republic of Ireland
- UCD Institute of Food and Health, University College Dublin, Dublin, Republic of Ireland
| | - Patricia Dominguez Castro
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Republic of Ireland
- UCD Institute of Food and Health, University College Dublin, Dublin, Republic of Ireland
| | - Ciara Me Reynolds
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Republic of Ireland
- UCD Institute of Food and Health, University College Dublin, Dublin, Republic of Ireland
| | - Sarah Browne
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Republic of Ireland
- UCD Institute of Food and Health, University College Dublin, Dublin, Republic of Ireland
| | - Frank Bourke
- Irish Institute of Pharmacy, Royal College of Surgeons in Ireland, Dublin, Republic of Ireland
| | - Catriona Bradley
- Irish Institute of Pharmacy, Royal College of Surgeons in Ireland, Dublin, Republic of Ireland
| | - Karen Finnigan
- Health Service Executive Medicines Management Programme, Trinity Centre for Health Sciences, St James's Hospital, Dublin, Republic of Ireland
| | - Sarah Clarke
- Health Service Executive Medicines Management Programme, Trinity Centre for Health Sciences, St James's Hospital, Dublin, Republic of Ireland
| | - Barbara Clyne
- Department of General Practice, RCSI University of Medicine and Health Sciences, Dublin, Republic of Ireland
| | - Gerard Bury
- School of Medicine, University College Dublin, Dublin, Republic of Ireland
| | - Carla Perrotta
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Republic of Ireland
- UCD Institute of Food and Health, University College Dublin, Dublin, Republic of Ireland
| | - Sharon Kennelly
- National Primary Care Division, Community Funded Schemes Service Improvement, County Laois, Republic of Ireland
| | - Clare A Corish
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Republic of Ireland
- UCD Institute of Food and Health, University College Dublin, Dublin, Republic of Ireland
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15
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Comparison of nutritional risk screening with NRS2002 and the GLIM diagnostic criteria for malnutrition in hospitalized patients. Sci Rep 2022; 12:19743. [PMID: 36396666 PMCID: PMC9672100 DOI: 10.1038/s41598-022-23878-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Accepted: 11/07/2022] [Indexed: 11/19/2022] Open
Abstract
Nutritional risk screening, to identify patients at risk of malnutrition, is the first step in the prevention and treatment of malnutrition in hospitalized patients, and should be followed by a thorough nutritional assessment resulting in a diagnosis of malnutrition and subsequent treatment. In 2019, a consensus on criteria has been suggested for the diagnosis of malnutrition by the Global Leadership Initiative for Malnutrition (GLIM). This study investigates the diagnosis of malnutrition in hospitalized patients using nutritional risk screening and the diagnostic assessment suggested by GLIM. Hospitalized patients (excluding cancer, intensive care, and transmissible infections) who underwent nutritional risk screening (by NRS2002) were included. Nutritional risk screening was followed by anthropometric measurements including measurement of muscle mass, assessment of dietary intake and measurement of serum C-reactive protein (CRP) for inflammation in all patients. Malnutrition was diagnosed according to the GLIM-criteria. In total, 328 patients (median age 71 years, 47% women, median length of stay 7 days) were included. Nutritional risk screening identified 143 patients as at risk of malnutrition, while GLIM criteria led to a diagnosis of malnutrition in 114 patients. Of these 114 patients, 77 were also identified as at risk of malnutrition by NRS2002, while 37 patients were not identified by NRS2002. Malnutrition was evident in fewer patients than at risk of malnutrition, as expected. However, a number of patients were malnourished who were not identified by the screening procedure. More studies should investigate the importance of inflammation and reduced muscle mass, which is the main difference between nutritional risk screening and GLIM diagnostic assessment.
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16
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The patient generated subjective global assessment short form is a useful screening tool to detect risk for malnutrition in patients with cirrhosis. Clin Nutr ESPEN 2022; 50:330-333. [DOI: 10.1016/j.clnesp.2022.05.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Revised: 05/08/2022] [Accepted: 05/17/2022] [Indexed: 11/19/2022]
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17
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Laing E, Kiss N, Krishnasamy M, Gough K, Michael M. Exploring health professional knowledge and management of nutritional complications in neuroendocrine cancer patients: Results of an international multidisciplinary survey. Clin Nutr ESPEN 2022; 49:466-473. [DOI: 10.1016/j.clnesp.2022.02.124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 02/20/2022] [Accepted: 02/28/2022] [Indexed: 11/25/2022]
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Taipa-Mendes AM, Amaral TF, Gregório M. Undernutrition risk and nutritional screening implementation in hospitals: Barriers and time trends (2019-2020). Clin Nutr ESPEN 2021; 45:192-199. [PMID: 34620317 DOI: 10.1016/j.clnesp.2021.08.029] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 08/12/2021] [Accepted: 08/23/2021] [Indexed: 01/04/2023]
Abstract
BACKGROUND & AIMS Undernutrition screening is the starting point for high-quality nutrition care. In Portugal, the systematic nutritional risk assessment became mandatory for every inpatient in hospitals of the National Health System in 2019. The aims of this study were to describe the country's nutritional risk prevalence of hospitalized patients, and the experience of implementing a systematic undernutrition screening method, including time trends, barriers, and facilitators. METHODS This research was carried out in Portuguese Public Hospitals (n = 49) and included both the analysis of data from health information systems between January 2019 and December 2020 and from an online survey. The performance indicators are described for 38 hospitals that use the SClinico electronic health records software provided by the Ministry of Health. The Nutritional Risk Screening 2002 (NRS 2002) was applied to adult patients and the STRONGkids to paediatric patients. In order to assess barriers and facilitators the online survey was applied to all public hospitals (n = 49), including Hospital Centres and Local Health Units. RESULTS In 2020, 25.5% of the screened patients were nutritionally at risk. There was a significant increase in the proportion of patients screened from the pre- (10.6 ± 1.9%) to the post-adaptation period of the electronic health record (23.3 ± 4.8%, July-December 2019, and 25.4 ± 2.2%, January-June 2020) (p < 0.001). Data from 41 Hospital Centres and Local Health Units (84%) were obtained from the online survey. The major barriers identified were the lack of human resources (89.7%) and equipment (41.0%), as well as insufficient knowledge about the role of undernutrition screening (35.9%). The most-reported facilitators were the integration of undernutrition screening to electronic health records (22.2%) and good multidisciplinary articulation (36.1%). CONCLUSION The high prevalence of nutritional risk justifies the mandatory nutritional screening, which leads to the improvement of the quality of hospital care. However, local and national efforts are warranted to adapt nutritional screening policies to local conditions and to increase and improve its implementation.
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Affiliation(s)
- A M Taipa-Mendes
- Faculty of Nutrition and Food Sciences, University of Porto, Rua do Campo Alegre, 823, 4150-180, Porto, Portugal.
| | - T F Amaral
- Faculty of Nutrition and Food Sciences, University of Porto, Rua do Campo Alegre, 823, 4150-180, Porto, Portugal
| | - M Gregório
- Faculty of Nutrition and Food Sciences, University of Porto, Rua do Campo Alegre, 823, 4150-180, Porto, Portugal; Directorate-General of Health, Alameda Afonso Henriques, 45 1049-005, Lisboa, Portugal
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19
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Lyons GCE, Summers MJ, Marshall AP, Chapple LAS. Systematic review of clinicians' knowledge, attitudes, and beliefs about nutrition in intensive care. Nutr Clin Pract 2021; 37:825-842. [PMID: 34617630 DOI: 10.1002/ncp.10785] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Nutrition is a key component of care for critically ill patients; yet nutrition delivery is below international recommendations. In order to improve nutrition delivery to critically ill patients, an understanding of the barriers that prevent guideline adherence is required. It is known that clinicians' knowledge, attitudes, and beliefs of the role of nutrition may act as a potential barrier to nutrition delivery, but whether this remains true in critical care is unknown. The aim of this systematic scoping review was to summarize the literature exploring the knowledge, attitudes, and beliefs of clinicians around nutrition support in critically ill patients. A search of four online databases (MEDLINE via Ovid, Emcare via Ovid, PsycINFO, and CINAHL via EBSCOhost) was conducted on August 14, 2020, to identify literature that reported on clinicians' knowledge, attitudes, and beliefs of nutrition in adult intensive care patients. Data were extracted on study and participant characteristics, methodology, and key study outcomes related to nutrition. Eighteen articles met eligibility criteria and were included in the review. Key findings included the following: nutrition was seen as a priority that ranked below life-saving interventions; differences in perceived clinician responsibilities exist; common barriers to nutrition delivery included inadequate resourcing, lack of nutrition protocols, and gastrointestinal intolerance; and identified facilitators included nutrition education and the presence of a supportive multidisciplinary team. The implementation of nutrition protocols, enhanced clinical nutrition education, and further clarification of roles and responsibilities pertaining to nutrition may assist in improving nutrition delivery in critical care.
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Affiliation(s)
- Gemma C E Lyons
- College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia, Australia
| | - Matthew J Summers
- Adelaide Medical School, The University of Adelaide, Adelaide, South Australia, Australia
- Intensive Care Unit, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Andrea P Marshall
- Gold Coast University Hospital, Southport, Queensland, Australia
- Griffith University, Gold Coast Campus, Southport, Queensland, Australia
| | - Lee-Anne S Chapple
- Adelaide Medical School, The University of Adelaide, Adelaide, South Australia, Australia
- Intensive Care Unit, Royal Adelaide Hospital, Adelaide, South Australia, Australia
- Centre of Research Excellence in Translating Nutritional Science to Good Health, The University of Adelaide, Adelaide, Australia
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Bonetti L, Terzoni S, Lusignani M, Negri M, Froldi M, Destrebecq A. Nutritional care of older people: Investigating nurses' attitudes in medical and surgical units. Contemp Nurse 2021; 57:159-171. [PMID: 34024250 DOI: 10.1080/10376178.2021.1934501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Background: Malnutrition in older people in hospitals leads to negative patient outcomes. Nurses often underestimate the problem, showing negative attitudes.Aims: To compare nurses' attitudes towards nutritional care of older people in surgical and medical wards. Design: Multicentre cross-sectional survey, conducted in January 2015.Methods: All nurses in surgical and medical wards in 10 hospitals in northern Italy were surveyed using the Staff Attitudes to Nutritional Nursing Care Geriatric Scale (SANN-G scale).Results: 799 out of 1,293 questionnaires were returned (61.8%). 23.2% (185) had a negative attitude, 56.6%(452) had a neutral attitude, and 20.2%(162), positive. Multivariate analysis showed no significant differences between medical and surgical wards (OR = 1.298; CI95% = .883-1.886, p = .18).Conclusions: It is necessary to raise nurses' awareness of poor nutritional care in both settings. More research is needed within the barriers to nutritional care.Impact statement: Strategies such as education and more clearly defined nutritional responsibilities are needed to improve nurses' attitudes.
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Affiliation(s)
- Loris Bonetti
- Nursing Research and Development Unit, Oncology Institute of Southern Switzerland, EOC Ente Ospedaliero Cantonale, Via Gallino, 12, Bellinzona 6500, CH, Switzerland.,Department of Business Economics, Health and Social Care, University of Applied Sciences and Arts of Southern Switzerland, Via Violino, 11, Manno 6928, CH, Switzerland
| | - Stefano Terzoni
- San Paolo bachelor school of Nursing, San Paolo teaching hospital - ASST Santi Paolo e Carlo, Milan, Italy
| | - Maura Lusignani
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
| | - Marina Negri
- Bachelor School of Nursing (now retired), ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Marco Froldi
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Anne Destrebecq
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
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21
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Dabbous M, Hastings R, Weekes CE, Baldwin C. The role of non-dietetic healthcare professionals in managing interventions among adults at risk of malnutrition: A systematic review. Clin Nutr 2021; 40:4509-4525. [PMID: 34224986 DOI: 10.1016/j.clnu.2021.05.032] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Revised: 05/28/2021] [Accepted: 05/28/2021] [Indexed: 01/07/2023]
Abstract
BACKGROUND Malnutrition is estimated to affect over three million people in the UK resulting in serious consequences on both the individuals' health and healthcare system. While dietitians are uniquely qualified to provide nutritional interventions, they have one of the lowest workforce numbers in the NHS making it difficult to tackle the malnutrition burden alone. Thus, innovative ways of working are needed. Non-dietetic health care professionals are often involved in the identification, assessment and treatment of malnutrition and research has shown benefits of their involvement in identification and management of nutritional issues, however their role in delivering nutritional interventions has not yet been evaluated. The aim of this systematic review is to collate evidence on the potential roles and effectiveness of non-dietetic healthcare professionals in providing nutritional interventions and their impact on patient-centred outcomes in malnourished or at-risk individuals. METHODS Three electronic databases were searched on 10th October 2019. Titles and abstracts were initially screened, followed by full texts, against inclusion criteria and included/excluded studies by two authors independently. Data were extracted and tabulated where possible and grouped according to type of intervention and outcomes. Risk of bias and quality of evidence was assessed using the GRADE approach. Data were combined in the form of a narrative synthesis. RESULTS Eighteen eligible studies were included; five involved feeding assistance, 10 involved implementing individualised nutrition monitoring or care plans and three were multi-factorial interventions. Interventions took place in a range of settings including hospital and long term care facilities. Very low and low quality evidence suggests that non-dietetic HCP interventions may improve weight, percent of patients reaching estimated energy requirements, quality of life, falls and frailty rate and patient satisfaction. Very low quality evidence suggests that non-dietetic HCP interventions may not improve mid-arm circumference, energy or protein intake, activities of daily living, handgrip strength or length of hospital stay. Low quality evidence suggests that non-dietetic HCP interventions have no effect on mortality. CONCLUSIONS A lack of good quality evidence on the effectiveness of non-dietetic HCP delivered interventions on the management of malnutrition in adults makes it difficult to draw conclusions. However, this review has highlighted the types of interventions and potential roles of non-dietetic HCPs, providing a groundwork for further high-quality research such as feasibility studies in this area, for the effective management of malnutrition within clinical and community practice.
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Affiliation(s)
- Massar Dabbous
- Department of Nutritional Sciences, King's College London, London, SE1 9NH, United Kingdom.
| | - Rebecca Hastings
- Department of Nutritional Sciences, King's College London, London, SE1 9NH, United Kingdom
| | - C Elizabeth Weekes
- Department of Nutrition and Dietetics, Guy's and St. Thomas' NHS Foundation Trust, London, SE1 7HE, UK
| | - Christine Baldwin
- Department of Nutritional Sciences, King's College London, London, SE1 9NH, United Kingdom
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22
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Dellafiore F, Caruso R, Arrigoni C, Magon A, Baroni I, Alotto G, Quaccini C, Bianchi M, Bonetti L. The development of a self-efficacy scale for nurses to assess the nutritional care of older adults: A multi-phase study. Clin Nutr 2021; 40:1260-1267. [DOI: 10.1016/j.clnu.2020.08.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 07/23/2020] [Accepted: 08/07/2020] [Indexed: 12/31/2022]
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van den Berg GH, Huisman-de Waal GGJ, Vermeulen H, de van der Schueren MAE. Effects of nursing nutrition interventions on outcomes in malnourished hospital inpatients and nursing home residents: A systematic review. Int J Nurs Stud 2021; 117:103888. [PMID: 33647842 DOI: 10.1016/j.ijnurstu.2021.103888] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 01/15/2021] [Accepted: 01/19/2021] [Indexed: 01/07/2023]
Abstract
CONTEXT Malnutrition in institutionalized patients is associated with adverse outcomes and increased costs. Nurses have a crucial role in the recognition and treatment of malnutrition and empowering patients in nutritional care. OBJECTIVE This systematic review provides an overview of the effectiveness of nursing nutritional interventions to counteract malnutrition. DATA SOURCES Data were obtained through a systematic search in MEDLINE/PubMed, Cochrane, CINAHL, EMBASE and ISI Web of Science databases from inception to February 15th 2018. DATA EXTRACTION Studies were eligible for inclusion when published in English, Spanish or German. Primary outcome parameters were nutritional status and dietary intake. DATA ANALYSIS The Evidence analysis checklist from the American Dietetic Association and GRADE were used to evaluate the methodological quality of the studies. RESULTS Out of 8162 studies, fifteen studies were included in the study, representing nine hospitals and six long-term care facilities. Two main categories of nursing nutrition interventions were identified; the implementation of 1) a nursing nutrition plan focusing on nursing actions in nutritional care or 2) nursing assistance in feeding support, mostly during mealtimes. Studies were heterogeneous and of most of them of low quality. This hampered drawing conclusions on effectiveness of nursing nutrition interventions on malnutrition related outcomes in clinical care. Nevertheless, six out of 15 studies reported a slightly improved nutritional status and/or clinical outcomes as a result of the interventions. CONCLUSION This review identified two categories of nursing nutrition interventions to counteract malnutrition. Their effectiveness needs to be further evaluated in future studies. Tweetable abstract: Systematic review of effective Nursing Nutrition Interventions in the management of malnutrition in hospital and nursing home care.
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Affiliation(s)
- Gerda H van den Berg
- HAN University of Applied Sciences, School of Allied Health, Department of Nutrition and Health, Nijmegen, the Netherlands; Radboud Institute of Health Sciences, IQ Healthcare, Department of Nursing Sciences, Nijmegen, the Netherlands.
| | - Getty G J Huisman-de Waal
- Radboud Institute of Health Sciences, IQ Healthcare, Department of Nursing Sciences, Nijmegen, the Netherlands.
| | - Hester Vermeulen
- HAN University of Applied Sciences, School of Allied Health, Department of Nutrition and Health, Nijmegen, the Netherlands; Radboud Institute of Health Sciences, IQ Healthcare, Department of Nursing Sciences, Nijmegen, the Netherlands.
| | - Marian A E de van der Schueren
- HAN University of Applied Sciences, School of Allied Health, Department of Nutrition and Health, Nijmegen, the Netherlands.
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Keller H, Donnelly R, Laur C, Goharian L, Nasser R. Consensus-Based Nutrition Care Pathways for Hospital-to-Community Transitions and Older Adults in Primary and Community Care. JPEN J Parenter Enteral Nutr 2021; 46:141-152. [PMID: 33417240 DOI: 10.1002/jpen.2068] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Revised: 12/10/2020] [Accepted: 01/05/2021] [Indexed: 12/27/2022]
Abstract
BACKGROUND Practical guidance for providers on preventing, detecting, and treating malnutrition in primary care (PC) and the community is limited. The purpose of this study was to develop nutrition care pathways for adult patients (aged ≥18 years) transitioning from hospital to community and community-dwelling older adults (aged ≥65 years) who are at risk for malnutrition. METHODS A review of best-practice nutrition evidence and guidelines published between 2009 and 2019 was performed using PubMed and CINAHL. Findings were summarized into two draft care pathways by the Primary Care Working Group of the Canadian Malnutrition Task Force. Diverse stakeholders (n = 21) reviewed and suggested revisions at a 1-day meeting. Revisions were made and an online survey was conducted to determine the relevance and importance of discrete care practices, and to establish consensus for which practices should be retained in the pathways. Providers (e.g., dietitians, physicians, nurses; n = 291) across healthcare settings completed the survey. Consensus on relevance and importance of practices was set at ≥80%. RESULTS One hundred twenty-eight resources were identified and used to develop the draft pathways. Survey participants assigned ratings of ≥80% for relevance and importance for all nutrition care practices, except community service providers monitoring patient weight and appetite. CONCLUSION These evidence- and consensus-based nutrition pathways offer guidance to healthcare and service providers on how to deliver nutrition care during hospital-to-community transitions for malnourished adult patients and community-dwelling older adults at risk for malnutrition. These pathways are flexible for diverse PC and community models.
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Affiliation(s)
- Heather Keller
- Department of Kinesiology, University of Waterloo, 200 University Ave W, Waterloo, Ontario, N2L 3G1, Canada.,Schlegel-University of Waterloo Research Institute for Aging, 250 Laurelwood Dr, Waterloo, Ontario, N2J 0E2, Canada
| | - Rachael Donnelly
- Department of Kinesiology, University of Waterloo, 200 University Ave W, Waterloo, Ontario, N2L 3G1, Canada
| | - Celia Laur
- Women's College Hospital Institute for Health System Solutions and Virtual Care and Women's College Research Institute, Women's College Hospital, 76 Grenville St, Toronto, Ontario, M5S 1B2, Canada.,NNEdPro Global Centre for Nutrition and Health, St John's Innovation Centre, Cowley Road, Cambridge, CB4 0WS, United Kingdom
| | - Leila Goharian
- Evergreen Community Health Centre, Vancouver Coastal Health, 3425 Crowley Dr, Vancouver, British Columbia, V5R 6G3, Canada
| | - Roseann Nasser
- Nutrition and Food Services, Pasqua Hospital, 4101 Dewdney Ave, Regina, Saskatchewan, S4T 1A5, Canada
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Views of public hospital professional nurses on adult malnutrition and their role in nutrition-related activities. INTERNATIONAL JOURNAL OF AFRICA NURSING SCIENCES 2021. [DOI: 10.1016/j.ijans.2021.100300] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
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Griffin A, O'Neill A, O'Connor M, Ryan D, Tierney A, Galvin R. The prevalence of malnutrition and impact on patient outcomes among older adults presenting at an Irish emergency department: a secondary analysis of the OPTI-MEND trial. BMC Geriatr 2020; 20:455. [PMID: 33160319 PMCID: PMC7648316 DOI: 10.1186/s12877-020-01852-w] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Accepted: 10/26/2020] [Indexed: 11/10/2022] Open
Abstract
Background Malnutrition is common among older adults and is associated with adverse outcomes but remains undiagnosed on healthcare admissions. Older adults use emergency departments (EDs) more than any other age group. This study aimed to determine the prevalence and factors associated with malnutrition on admission and with adverse outcomes post-admission among older adults attending an Irish ED. Methods Secondary analysis of data collected from a randomised controlled trial exploring the impact of a dedicated team of health and social care professionals on the care of older adults in the ED. Nutritional status was determined using the Mini Nutritional Assessment- short form. Patient parameters and outcomes included health related quality of life, functional ability, risk of adverse health outcomes, frailty, hospital admissions, falls history and clinical outcomes at index visit, 30-day and 6-month follow up. Aggregate anonymised participant data linked from index visit to 30-days and 6-month follow-up were used for statistical analysis. Results Among 353 older adults (mean age 79.6 years (SD = 7.0); 59.2% (n = 209) female) the prevalence of malnutrition was 7.6% (n = 27) and ‘risk of malnutrition’ was 28% (n = 99). At baseline, those who were malnourished had poorer quality of life scores, functional ability, were more frail, more likely to have been hospitalised or had a fall recently, had longer waiting times and were more likely to be discharged home from the ED than those who had normal nutrition status. At 30-days, those who were malnourished were more likely to have reported another hospital admission, a nursing home admission, reduced quality of life and functional decline than older adults who had normal nutrition status at the baseline ED visit. Differences between the MNA SF and 6-month outcomes were similar but not statistically significant. Conclusion Over one-third of older adults admitted to an Irish ED are either malnourished or at risk of malnourishment. Malnutrition was associated with a longer stay in the ED, functional decline, poorer quality of life, increased risk of hospital admissions and a greater likelihood of admission to a nursing home at 30 days. Trial registration Protocol registered in ClinicalTrials.gov, ID: NCT03739515, first posted November 13, 2018.
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Affiliation(s)
- Anne Griffin
- School of Allied Health, Faculty of Education and Health Sciences, Health Implementation Science and Technology, Health Research Institute, University of Limerick, Limerick, V94 T9PX, Ireland.
| | - Aoife O'Neill
- School of Allied Health, Faculty of Education and Health Sciences, Ageing Research Centre, Health Research Institute, University of Limerick, Limerick, Ireland
| | - Margaret O'Connor
- Department of Ageing and Therapeutics, University Hospital Limerick, Dooradoyle, Limerick, Ireland.,Graduate Entry Medical School, Faculty of Education and Health Sciences, University of Limerick, Limerick, Ireland
| | - Damien Ryan
- Graduate Entry Medical School, Faculty of Education and Health Sciences, University of Limerick, Limerick, Ireland.,Retrieval, Emergency and Disaster Medicine Research and Development Unit (REDSPoT), Emergency Department, University Hospital Limerick, Dooradoyle, Limerick, Ireland
| | - Audrey Tierney
- School of Allied Health, Faculty of Education and Health Sciences, Health Implementation Science and Technology, Health Research Institute, University of Limerick, Limerick, V94 T9PX, Ireland
| | - Rose Galvin
- School of Allied Health, Faculty of Education and Health Sciences, Ageing Research Centre, Health Research Institute, University of Limerick, Limerick, Ireland
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Nurses’ knowledge about malnutrition in older people: A multicenter cross-sectional study. Nutrition 2020; 78:110947. [DOI: 10.1016/j.nut.2020.110947] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 07/04/2020] [Accepted: 07/04/2020] [Indexed: 01/06/2023]
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Quality of Care: Ecological Study for the Evaluation of Completeness and Accuracy in Nursing Assessment. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17093259. [PMID: 32392838 PMCID: PMC7246491 DOI: 10.3390/ijerph17093259] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Revised: 04/25/2020] [Accepted: 05/02/2020] [Indexed: 01/04/2023]
Abstract
Nursing documentation is an important proxy of the quality of care, and quality indicators in nursing assessment can be used to assess and improve the quality of care in health care institutions. The study aims to evaluate the completeness and the accuracy of nursing assessment, analyzing the compilation of pain assessment and nutritional status (body mass index (BMI)) in computerized nursing records, and how it is influenced by four variables: nurse to patient ratio, diagnosis related group weight (DRG), seniority of charge nurse, and type of ward (medical, surgical or other). The observational ecological pilot study was conducted between September and October 2018 in an Italian Tertiary-Level Teaching Hospital. The nursing documentation analyzed for the ‘Assessment’ phase included 12,513 records, 50.4% concerning pain assessment, and 45% BMI. The nurse–patient ratio showed a significant direct association with the assessment of nutritional status (p = 0.032). The average weight DRG has a negative influence on pain and BMI assessment; the surgical units positively correlate with the compilation of nursing assessment (BMI and pain). The nursing process is an essential component for the continuous improvement in the quality of care. Nurses need to be accountable to improve their knowledge and skills in nursing documentation.
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van Noort HHJ, Heinen M, van Asseldonk M, Ettema RGA, Vermeulen H, Huisman-de Waal G. Using intervention mapping to develop an outpatient nursing nutritional intervention to improve nutritional status in undernourished patients planned for surgery. BMC Health Serv Res 2020; 20:152. [PMID: 32106862 PMCID: PMC7047387 DOI: 10.1186/s12913-020-4964-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Accepted: 02/05/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Undernutrition in surgical patients leads to a higher risk of postoperative complications like infections and delayed recovery of gastrointestinal functions, often resulting in a longer hospital stay and lower quality of life. Nurses at outpatient clinics can deliver nutritional care during outpatient preoperative evaluation of health status to ensure that patients are properly fed in preparation for hospital admission for surgery. However, nutritional nursing care was not determined in research yet. This paper describes the structural development of an Outpatient Nursing Nutritional Intervention (ONNI). METHODS A project group followed the steps of the Intervention Mapping. The needs assessment included assessment of delivery of nutritional care and nutritional care needs at two anaesthesia outpatient clinics of an academic and a teaching hospital. Also, outpatient clinic nurses and patients at risk for undernutrition were interviewed. Determinants resulted from these methods were matched with theories on behaviour change and nutritional support. RESULTS Both patients and nurses were unaware of the consequences of undernutrition, and nurses were also unaware of their roles with regard to nutritional support. The intervention goals were: 1) enabling surgical patients to improve or maintain their nutritional status before hospital admission for surgery, and 2) enabling nurses to deliver nutritional support. The ONNI was developed for outpatients at risk for or with undernutrition. A training was developed for nurses. The ONNI included the five following components: 1) identification of the causes of undernutrition; 2) provision of a nutritional care plan including general and individually tailored advice; 3) self-monitoring of nutrient intake; 4) counselling and encouragement; and 5) support during a telephone follow-up meeting. The intervention and training were tested. A multifaceted implementation strategy was used to deliver the intervention in daily practice. CONCLUSIONS Despite the unique position of the nurses at outpatient clinics, nurses were unaware of their role with regard to nutritional care. The ONNI was developed and implemented along with a training program for nurses. The test confirmed that the training can improve nurses' knowledge, skills, and sense of responsibility for nutritional support. The intervention may empower patients to actively improve their nutritional status.
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Affiliation(s)
- Harm H J van Noort
- Department of Nutrition, Physical Activity and Sports, Department of Surgery, Gelderse Vallei Hospital, P.O. Box 9025, 6710, HN, Ede, The Netherlands. .,Radboud University Medical Centre, Radboud Institute for Health Sciences, IQ Healthcare, P.O. Box 9101, 6500, HB, Nijmegen, The Netherlands.
| | - Maud Heinen
- Radboud University Medical Centre, Radboud Institute for Health Sciences, IQ Healthcare, P.O. Box 9101, 6500, HB, Nijmegen, The Netherlands
| | - Monique van Asseldonk
- Department of Gastroenterology and Hepatology - Dietetics and Intestinal Failure, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Roelof G A Ettema
- Julius Center for Health Sciences and Primary Care, University Utrecht Str. 6.131, P.O. Box 85500, 3508, GA, Utrecht, The Netherlands.,Research Center Health and Sustainable Living, Utrecht University of Applied Sciences, P.O. Box 12011, 3501, AA, Utrecht, The Netherlands
| | - Hester Vermeulen
- Radboud University Medical Centre, Radboud Institute for Health Sciences, IQ Healthcare, P.O. Box 9101, 6500, HB, Nijmegen, The Netherlands.,Faculty of Health and Social Studies, HAN University of Applied Sciences, Nijmegen, The Netherlands
| | - Getty Huisman-de Waal
- Radboud University Medical Centre, Radboud Institute for Health Sciences, IQ Healthcare, P.O. Box 9101, 6500, HB, Nijmegen, The Netherlands
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Kiss N, Bauer J, Boltong A, Brown T, Isenring L, Loeliger J, Steer B, Findlay M. Awareness, perceptions and practices regarding cancer-related malnutrition and sarcopenia: a survey of cancer clinicians. Support Care Cancer 2020; 28:5263-5270. [PMID: 32103357 DOI: 10.1007/s00520-020-05371-7] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Accepted: 02/19/2020] [Indexed: 11/28/2022]
Abstract
PURPOSE Cancer-related malnutrition and sarcopenia have severe negative consequences including reduced survival and reduced ability to complete treatment. This study aimed to determine the awareness, perceptions and practices of Australian oncology clinicians regarding malnutrition and sarcopenia in people with cancer. METHODS A national cross-sectional survey of Australian cancer clinicians was undertaken between November 2018 and January 2019. The 30-item online purpose-designed survey was circulated through professional organizations and health services. RESULTS The 111 participants represented dietetic (38%), nursing (34%), medical (14%) and other allied health (14%) clinicians. Overall, 86% and 88% clinicians were aware of accepted definitions of malnutrition and sarcopenia, respectively. Perception of responsibility for identification of these conditions varied across participants, although 93% agreed this was a component of their role. However, 21% and 43% of clinicians had limited or no confidence in their ability to identify malnutrition and sarcopenia, respectively. Common barriers to the identification and management of malnutrition were access to the tools or skills required and a lack of services to manage malnourished patients. Common barriers to identification of sarcopenia were lack of confidence and lack of services to manage sarcopenic patients. Enablers for identification and management of malnutrition and sarcopenia were variable; however, training and protocols for management ranked highly. CONCLUSION While awareness of the importance of cancer-related malnutrition and sarcopenia are high, participants identified substantial barriers to delivering optimal nutrition care. Guidance at a national level is recommended to strengthen the approach to management of cancer-related malnutrition and sarcopenia.
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Affiliation(s)
- Nicole Kiss
- Institute for Physical Activity and Nutrition, Deakin University, Geelong, Australia. .,Department of Cancer Experiences Research, Peter MacCallum Cancer Centre, Melbourne, Australia.
| | - Judy Bauer
- School of Human Movement and Nutrition Sciences, University of Queensland, St Lucia, Australia
| | - Anna Boltong
- Victorian Comprehensive Cancer Centre, Melbourne, Australia.,Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
| | - Teresa Brown
- School of Human Movement and Nutrition Sciences, University of Queensland, St Lucia, Australia.,Nutrition and Dietetics Department, Royal Brisbane and Women's Hospital, Brisbane, Australia
| | - Liz Isenring
- Faculty of Health Sciences and Medicine, Bond University, Robina, Australia.,Department of Nutrition and Dietetics, Princess Alexandra Hospital, Brisbane, Australia
| | - Jenelle Loeliger
- Nutrition and Speech Pathology Department, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Belinda Steer
- Nutrition and Speech Pathology Department, Peter MacCallum Cancer Centre, Melbourne, Australia
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Assessing the Concurrent Validity and Interrater Reliability of Patient-Led Screening Using the Malnutrition Screening Tool in the Ambulatory Cancer Care Outpatient Setting. J Acad Nutr Diet 2019; 120:1210-1215. [PMID: 31892501 DOI: 10.1016/j.jand.2019.10.015] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Accepted: 10/21/2019] [Indexed: 01/16/2023]
Abstract
BACKGROUND The prevalence of malnutrition in cancer patients is reported as high as 65%; however, malnutrition screening is often substandard. The Malnutrition Screening Tool (MST) has been validated for use by health care professionals to detect at-risk patients; however, there is a gap in the literature regarding validation of patient-led MST screening. OBJECTIVE The aim of the study was to assess the concurrent validity of patient-led MST against the Subjective Global Assessment (SGA) and the interrater reliability of patient-led MST against dietitian-led MST in patients attending ambulatory cancer care services for chemotherapy or supportive treatments. DESIGN/PARTICIPANTS A single-site diagnostic accuracy study of 201 patients between May and June 2017 attending the ambulatory cancer care setting at an Australian metropolitan tertiary hospital in Queensland. MAIN OUTCOME MEASUREMENTS The primary outcome measures were concurrent validity and interrater reliability of MST scores as determined by patients (patient-MST), dietitians (dietitian-MST), and SGA as completed by the dietitian. STATISTICAL ANALYSIS Concurrent validity of patient-led MST scores against the SGA was determined using specificity, sensitivity, positive predictive values, and negative predictive values. Interrater reliability of patient-MST and dietitian-MST was assessed using κ coefficient. RESULTS The ability of the patient-led MST scores (0 to 1 vs 2 to 5) to indicate nutrition status was found to have a sensitivity of 94% (95% CI 81% to 99%), a specificity of 86% (95% CI 79% to 91%), and an area under the receiver operating characteristic curve of 0.93 (95% CI 0.89 to 0.96). The positive predictive value was 59% (95% CI 45% to 71%), and the negative predictive value was 99% (95% CI 95% to 100%). A weighted κ of 0.83 (95% CI 0.82 to 0.87) between patient-MST and dietitian-MST was found. CONCLUSION Patient-led MST screening is a reliable and valid measure that can accurately identify ambulatory cancer care patients as at risk or not at risk of malnutrition.
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Kenworthy S, Agarwal E, Farlow L, Angus R, Marshall AP. Feasibility of using the "modified NUTrition Risk In the Critically ill" nutritional risk screening tool to identify nutritionally at-risk patients in an Australian intensive care unit. Aust Crit Care 2019; 33:259-263. [PMID: 31679984 DOI: 10.1016/j.aucc.2019.08.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Revised: 08/07/2019] [Accepted: 08/19/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The modified NUTrition Risk In the Critically ill (mNUTRIC) score has been demonstrated to accurately quantify the risk of negative patient outcomes and discriminate which patients will benefit the most from nutrition intervention in an intensive care unit (ICU) setting. Calculation of an mNUTRIC score, however, may be time-intensive and unable to be performed within available resources. This may prevent high-risk patients from being identified and reviewed by a dietitian. OBJECTIVES The purpose of this study was to assess the feasibility of using the mNUTRIC tool to screen for patients at increased nutrition risk and to determine the proportion of those high-risk patients who were reviewed by a dietitian. SUBJECTS/METHODS A retrospective observational study of 260 critically ill patients was conducted between 01/01/2017 and 30/05/2017 in a 20-bed Australian tertiary ICU. Participants included all adults admitted to the ICU for more than 72 h. Feasible implementation was defined as calculating an mNUTRIC score in <5 min per patient where all data were available for >90% of patients. RESULTS A median time of 4 min and 54 s (interquartile range: 4.3-5.6 min) was required to calculate each mNUTRIC score, with 96% of scores calculated in <10 min. Data were available to calculate mNUTRIC scores for 93% (241/260) of patients. The mNUTRIC tool identified 81 patients at high nutrition risk, 44% (36/81) of whom were not reviewed by a dietitian. There were 21 high-risk patients who were purposefully excluded from dietetic review for various clinical reasons, leaving 15 high-risk patients (19%) who were not reviewed by a dietitian. CONCLUSIONS Implementation of the mNUTRIC tool was not feasible in our ICU, given the set dietetic resources (0.6 full-time equivalent). Shared responsibility of nutrition screening or automating the calculation may be possible solutions to increase feasibility of mNUTRIC screening.
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Affiliation(s)
- Sean Kenworthy
- Bond University, 14 University Dr, Robina QLD 4226, Australia.
| | - Ekta Agarwal
- Bond University, 14 University Dr, Robina QLD 4226, Australia.
| | - Lisa Farlow
- Gold Coast University Hospital, 1 Hospital Blvd, Southport QLD 4215, Australia; Griffith University, Gold Coast Campus; Parklands Dr, Southport QLD 4215, Australia.
| | - Rebecca Angus
- Gold Coast University Hospital, 1 Hospital Blvd, Southport QLD 4215, Australia; Griffith University, Gold Coast Campus; Parklands Dr, Southport QLD 4215, Australia.
| | - Andrea P Marshall
- Gold Coast University Hospital, 1 Hospital Blvd, Southport QLD 4215, Australia; Griffith University, Gold Coast Campus; Parklands Dr, Southport QLD 4215, Australia.
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Håkonsen SJ, Pedersen PU, Bygholm A, Thisted CN, Bjerrum M. Lack of focus on nutrition and documentation in nursing homes, home care- and home nursing: the self-perceived views of the primary care workforce. BMC Health Serv Res 2019; 19:642. [PMID: 31492130 PMCID: PMC6729022 DOI: 10.1186/s12913-019-4450-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2018] [Accepted: 08/22/2019] [Indexed: 11/10/2022] Open
Abstract
Background Malnutrition is a comprehensive challenge for the nursing home, home care- and home nursing sector. Nutritional care and the subsequent documentation are a common and multifaceted healthcare practice that requires that the healthcare professionals possess complex combinations of competencies in order to deliver high-quality care and treatment. The purpose of this study was to investigate how a varied group of healthcare professionals’ perceive their own competencies within nutrition and documentation and how organizational structures influence their daily work and the quality of care provided. Methods Two focus groups consisting of 14 healthcare professionals were conducted. The transcribed focus group interviews was analyzed using the qualitative content analysis approach. Results Six categories were identified: 1) Lack of uniform and systematic communication affect nutritional care practices 2) Experience-based knowledge among the primary workforce influences daily clinical decisions, 3) Different attitudes towards nutritional care lead to differences in the quality of care 4) Differences in organizational culture affect quality of care, 5) Lack of clear nutritional care responsibilities affect how daily care is performed and 6) Lack of clinical leadership and priorities makes nutritional care invisible. Conclusions The six categories revealed two explanatory themes: 1) Absent inter- and intra-professional collaboration and communication obstructs optimal clinical decision-making and 2) quality deterioration due to poorly-established nutritional care structure. Overall, the two themes explain that from the healthcare professionals’ point of view, a visible organization that allocates resources as well as prioritizing and articulating the need for daily nutritional care and documentation is a prerequisite for high-quality care and treatment. Furthermore, optimal clinical decision making among the healthcare professionals are compromised by imprecise and unclear language and terminology in the patients’ healthcare records and also a lack of clinical guidelines and standards for collaboration between different healthcare professionals working in nursing homes, home care or home nursing. The findings of this study are beneficial to support organizations within these settings with strategies focusing on increasing nutritional care and documentation competencies among the healthcare professionals. Furthermore, the results advocate for the daily involvement and support of leaders and managers in articulating and structuring the importance of nutritional care and treatment and the subsequent documentation. Electronic supplementary material The online version of this article (10.1186/s12913-019-4450-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- S J Håkonsen
- Centre of Clinical Guidelines - Danish National Clearing house, Department of Health Science and Technology, University of Aalborg, Aalborg, Denmark. .,Danish Centre of Systematic Reviews: A Joanna Briggs Institute Centre of Excellence, Aalborg, Denmark.
| | - P U Pedersen
- Centre of Clinical Guidelines - Danish National Clearing house, Department of Health Science and Technology, University of Aalborg, Aalborg, Denmark.,Danish Centre of Systematic Reviews: A Joanna Briggs Institute Centre of Excellence, Aalborg, Denmark
| | - A Bygholm
- Department of Communication and Psychology, University of Aalborg, Aalborg, Denmark
| | - C N Thisted
- Department of Public Health, Section of Nursing Science, Aarhus University, Aarhus, Denmark
| | - M Bjerrum
- Centre of Clinical Guidelines - Danish National Clearing house, Department of Health Science and Technology, University of Aalborg, Aalborg, Denmark.,Danish Centre of Systematic Reviews: A Joanna Briggs Institute Centre of Excellence, Aalborg, Denmark.,Department of Public Health, Section of Nursing Science, Aarhus University, Aarhus, Denmark
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Use of an electronic malnutrition screening tool in a hospital setting: effects on knowledge, attitudes and perceived practices of healthcare staff. Br J Nutr 2019; 120:150-157. [PMID: 29947326 DOI: 10.1017/s0007114518001447] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Malnutrition risk screening is essential for the adequate identification and treatment of malnourished hospitalised patients. The aim of this study was to determine the effect of the use of an electronic malnutrition screening tool on the knowledge, attitudes and perceived practices (KAP) of a pool of nurses, nurses' aides and physicians. A controlled study using a pre-test-post-test design was carried out in two Austrian hospitals. The hospital that was assigned to the intervention group used the Graz malnutrition screening tool. The hospital that was assigned to the control group received no intervention. To collect data, a questionnaire was filled out by the study participants at baseline (T0) and 1 month after the implementation (T1) to assess KAP. All data were analysed using descriptive statistics, χ 2 tests, Wilcoxon signed-rank tests and Student's t tests. A total of 269 nurses, nurses' aides and physicians participated in the study and completed the questionnaires at T0, and 190 people at T1. The sum score for the KAP questionnaire changed significantly after the implementation of the malnutrition screening tool in the intervention group (P<0·001), but not in the control group. The use of a valid and reliable malnutrition screening tool effectively improved the KAP of healthcare staff. The KAP described here are essential for providing successful nutritional care in malnourished patients, and improving these factors may result in improved patient outcomes. To attain these outcomes, stakeholders, as well as members of all professions involved in multidisciplinary nutritional care, must invest significant efforts.
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Choueiry G, Fattouh N, Hallit R, Kazour F, Hallit S, Salameh P. Nutritional Status of Lebanese Hospitalized Patients With Chronic Disease: A Cross-Sectional Study. Hosp Pharm 2019; 56:102-108. [PMID: 33790485 DOI: 10.1177/0018578719867664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background: In a hospitalized setting, malnutrition is known to increase patient's mortality and lower the quality of life; therefore, it is essential to detect such cases and intervene at the earliest possible. The goal of this study is to estimate the rate of malnutrition in hospitalized Lebanese patients, explore its association with different factors, and create a simple tool to detect patients at high risk of malnutrition. Methods: One hundred and fifty Lebanese hospitalized patients, suffering at least from one chronic disease, were randomly chosen from Centre Hospitalier Universitaire Notre Dame de Secours (CHU-NDS) hospital. The Mini Nutritional Assessment (MNA) score was used to assess nutritional status. Results: A total of 34.7% of patients in our sample were at risk of malnutrition and 9.3% were malnourished. A higher risk of malnutrition was found in patients with a low body mass index, who were physically inactive or admitted to the hospital more than once in the past 6 months. The nutritional status was not associated with certain chronic diseases more than others. We designed a simple decision tree model based only on 3 questions to detect patients at high risk of malnutrition/malnourished. This tool has a sensitivity of 62% and a specificity of 77%. Conclusion: The prevalence found in our study was comparable with previous data. However, factors associated with poor nutritional status were somewhat different. Further studies are needed to validate our screening tool and to examine the effect of specific diseases on malnutrition on a larger scale.
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Affiliation(s)
- Georges Choueiry
- Faculty of Pharmacy Lebanese University, Hadath, Lebanon.,Department of Epidemiology & Biostatistics, Faculty of Public Health Lebanese University, Fanar, Lebanon
| | - Nour Fattouh
- Faculty of Medicine and Medical Sciences Holy Spirit University of Kaslik (USEK), Jounieh, Lebanon
| | - Rabih Hallit
- Faculty of Medicine and Medical Sciences Holy Spirit University of Kaslik (USEK), Jounieh, Lebanon
| | - Francois Kazour
- Faculty of Philosophy and Human Sciences, Holy Spirit University, (USEK), Jounieh, Lebanon.,Faculty of Sciences, Lebanese University, Fanar, Lebanon.,Psychiatric Hospital of the Cross, Jal Eddib, Lebanon.,INSERM U930, équipe 4 "Troubles affectifs", Université François-Rabelais de Tours, Tours, France.,Faculty of Medicine, Saint Joseph University, Beirut, Lebanon
| | - Souheil Hallit
- Faculty of Medicine and Medical Sciences Holy Spirit University of Kaslik (USEK), Jounieh, Lebanon.,INSPECT-LB: Institut National de Sante Publique, Epidemiologie Clinique et Toxicologie, Beirut, Lebanon
| | - Pascale Salameh
- Faculty of Pharmacy Lebanese University, Hadath, Lebanon.,INSPECT-LB: Institut National de Sante Publique, Epidemiologie Clinique et Toxicologie, Beirut, Lebanon.,Faculty of Medicine, Lebanese University, Hadat, Lebanon
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Harris PS, Payne L, Morrison L, Green SM, Ghio D, Hallett C, Parsons EL, Aveyard P, Roberts HC, Sutcliffe M, Robinson S, Slodkowska-Barabasz J, Little PS, Stroud MA, Yardley L. Barriers and facilitators to screening and treating malnutrition in older adults living in the community: a mixed-methods synthesis. BMC FAMILY PRACTICE 2019; 20:100. [PMID: 31307402 PMCID: PMC6631945 DOI: 10.1186/s12875-019-0983-y] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Accepted: 06/18/2019] [Indexed: 12/16/2022]
Abstract
BACKGROUND Malnutrition (specifically undernutrition) in older, community-dwelling adults reduces well-being and predisposes to disease. Implementation of screen-and-treat policies could help to systematically detect and treat at-risk and malnourished patients. We aimed to identify barriers and facilitators to implementing malnutrition screen and treat policies in primary/community care, which barriers have been addressed and which facilitators have been successfully incorporated in existing interventions. METHOD A data-base search was conducted using MEDLINE, Embase, PsycINFO, DARE, CINAHL, Cochrane Central and Cochrane Database of Systematic Reviews from 2012 to June 2016 to identify relevant qualitative and quantitative literature from primary/community care. Studies were included if participants were older, community-dwelling adults (65+) or healthcare professionals who would screen and treat such patients. Barriers and facilitators were extracted and mapped onto intervention features to determine whether these had addressed barriers. RESULTS Of a total of 2182 studies identified, 21 were included (6 qualitative, 12 quantitative and 3 mixed; 14 studies targeting patients and 7 targeting healthcare professionals). Facilitators addressing a wide range of barriers were identified, yet few interventions addressed psychosocial barriers to screen-and-treat policies for patients, such as loneliness and reluctance to be screened, or healthcare professionals' reservations about prescribing oral nutritional supplements. CONCLUSION The studies reviewed identified several barriers and facilitators and addressed some of these in intervention design, although a prominent gap appeared to be psychosocial barriers. No single included study addressed all barriers or made use of all facilitators, although this appears to be possible. Interventions aiming to implement screen-and-treat approaches to malnutrition in primary care should consider barriers that both patients and healthcare professionals may face. REVIEW REGISTRATIONS PROSPERO: CRD42017071398 . The review protocol was registered retrospectively.
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Affiliation(s)
- Philine S Harris
- Centre for Clinical and Community Applications of Health Psychology (CCCAHP), University of Southampton, Building 44, Highfield Campus, Southampton, SO17 1BJ, UK
| | - Liz Payne
- Centre for Clinical and Community Applications of Health Psychology (CCCAHP), University of Southampton, Building 44, Highfield Campus, Southampton, SO17 1BJ, UK.
| | - Leanne Morrison
- Centre for Clinical and Community Applications of Health Psychology (CCCAHP), University of Southampton, Building 44, Highfield Campus, Southampton, SO17 1BJ, UK.,Primary Care and Population Sciences, Aldermoor Health Centre, Aldermoor Close, Southampton, SO16 5ST, UK
| | - Sue M Green
- Bournemouth University, Bournemouth House B236, 19 Christchurch Road, Bournemouth, BH1 3LH, UK
| | - Daniela Ghio
- Primary Care and Population Sciences, Aldermoor Health Centre, Aldermoor Close, Southampton, SO16 5ST, UK
| | - Claire Hallett
- Friarsgate Surgery, Stockbridge Road, Winchester, SO22 6EL, UK
| | - Emma L Parsons
- Wessex Academic Health Science Network and NIHR Southampton Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton, SO16 6YD, UK
| | - Paul Aveyard
- Nuffield Department of Primary Care Health Sciences, Radcliffe Observatory Quarter, University of Oxford, Woodstock Road, Oxford, OX2 6GG, UK
| | - Helen C Roberts
- Academic Geriatric Medicine, Level E Centre Block, Mailpoint 807, University Hospital Southampton, Southampton, SO16 6YD, UK
| | - Michelle Sutcliffe
- Community Dietetic Department, Southampton NHS Treatment Centre, Royal South Hampshire Hospital, Brintons Terrace, Southampton, SO14 0YG, UK
| | - Siân Robinson
- AGE Research Group, Biomedical Research Building, Campus for Ageing and Vitality, Newcastle University, Newcastle upon Tyne, NE4 5PL, UK
| | - Joanna Slodkowska-Barabasz
- Centre for Clinical and Community Applications of Health Psychology (CCCAHP), University of Southampton, Building 44, Highfield Campus, Southampton, SO17 1BJ, UK
| | - Paul S Little
- Primary Care and Population Sciences, Aldermoor Health Centre, Aldermoor Close, Southampton, SO16 5ST, UK
| | - Michael A Stroud
- Gastroenterology and Clinical Nutrition, University Hospital Southampton NHS Foundation Trust, Tremona Road, Southampton, SO16 6YD, UK
| | - Lucy Yardley
- Centre for Clinical and Community Applications of Health Psychology (CCCAHP), University of Southampton, Building 44, Highfield Campus, Southampton, SO17 1BJ, UK.,Centre for Academic Primary Care and School of Psychological Science, University of Bristol, 39 Whatley Road, Bristol, BS8 2PS, UK
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Bollo M, Terzoni S, Ferrara P, Destrebecq A, Bonetti L. Nursing students' attitudes towards nutritional care of older people: A multicentre cross-sectional survey incorporating a pre post design. NURSE EDUCATION TODAY 2019; 78:19-24. [PMID: 31029954 DOI: 10.1016/j.nedt.2019.03.016] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/02/2018] [Revised: 02/16/2019] [Accepted: 03/12/2019] [Indexed: 06/09/2023]
Abstract
BACKGROUND Malnutrition is a debilitating and highly prevalent condition in acute hospital settings especially in older person; however international literature revealed negative attitudes in providing nutritional care among nurses and health professionals. Few studies have investigated attitudes towards nutritional care among nursing students, there are no data regarding the Italian context. OBJECTIVES The aim of this study was to explore nursing students' attitudes towards nutritional care in older people. DESIGN A multicentre cross-sectional survey incorporating a pre post design. SETTING AND PARTICIPANTS A convenience sample of nursing students of the bachelor's degree in Nursing in the three hospitals were recruited. METHODS Nursing students completed "The Staff Attitudes to Nutritional Nursing Care Geriatric Scale (Italian version) (SANN_GITA scale)"; first year students completed the scale before (T0) and after (T1) lectures about nutrition and nutritional care. RESULTS 245 students were enrolled (response rate 88.4%). The overall score of sample attitudes was Median(Me) = 66 (IQR = [60; 72]); at the variation of the year the neutral attitudes are prevalent with a significant tendency to increase the positive attitudes (p < .003) and there is a statistically significant difference (p < .05) in all dimensions except the "habits" dimension "(P = .1126). After two months from the end of the lessons regarding nutritional care there is an increase in subjects with neutral attitudes and a decrease in those with negative attitudes (P = .05). CONCLUSIONS This study revealed a progressive improvement of the attitudes during the three-year course, underling the importance of nutritional contents provided; understanding the most critical aspects about nutritional care can be helpful in understanding in which areas university education should be improved, in order to train nurses able to assess and face with each patients' assistance need.
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Affiliation(s)
| | - Stefano Terzoni
- San Paolo Bachelor School of Nursing, San Paolo Teaching hospital - ASST Santi Paolo e Carlo, Milan, Italy.
| | - Paolo Ferrara
- San Paolo Bachelor School of Nursing, San Paolo Teaching hospital - ASST Santi Paolo e Carlo, Milan, Italy.
| | - Anne Destrebecq
- University of Milan, Department of Biomedical Sciences for Health, Milan, Italy.
| | - Loris Bonetti
- Istituto Oncologico della Svizzera Italiana, EOC Ente Ospedaliero Cantonale, Bellinzona, Nursing Research and Development Unit, Switzerland.
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Roberts HC, Lim SER, Cox NJ, Ibrahim K. The Challenge of Managing Undernutrition in Older People with Frailty. Nutrients 2019; 11:E808. [PMID: 30974825 PMCID: PMC6521101 DOI: 10.3390/nu11040808] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Revised: 04/05/2019] [Accepted: 04/08/2019] [Indexed: 12/11/2022] Open
Abstract
Many older people with frailty are at risk of malnutrition and poor health, yet there is evidence that improving nutrition and weight loss can reduce frailty. This will become more important as the number of older people with frailty increases worldwide in future. Identifying those at risk is challenging due to the difficulty of reaching and screening those older people most at risk, the large number of nutritional assessment tools used, and the lack of consensus on the criteria to make a diagnosis of malnutrition. The management of older people with or at risk of malnutrition should be multi-modal and multi-disciplinary, and all care staff have an important role in delivering appropriate nutritional advice and support. This paper will highlight a number of practical approaches that clinicians can take to manage malnutrition in older people with frailty in community and acute settings, including environmental changes to enhance mealtime experience, food fortification and supplementation.
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Affiliation(s)
- Helen C Roberts
- Academic Geriatric Medicine, Faculty of Medicine, University of Southampton, Southampton SO16 6YD, UK.
- NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton SO16 6YD, UK.
- NIHR Collaboration for Leadership in Applied Health Research and Care (NIHR CLAHRC) Wessex, University of Southampton, Southampton SO16 7NP, UK.
| | - Stephen E R Lim
- Academic Geriatric Medicine, Faculty of Medicine, University of Southampton, Southampton SO16 6YD, UK.
- NIHR Collaboration for Leadership in Applied Health Research and Care (NIHR CLAHRC) Wessex, University of Southampton, Southampton SO16 7NP, UK.
| | - Natalie J Cox
- Academic Geriatric Medicine, Faculty of Medicine, University of Southampton, Southampton SO16 6YD, UK.
- NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton SO16 6YD, UK.
| | - Kinda Ibrahim
- Academic Geriatric Medicine, Faculty of Medicine, University of Southampton, Southampton SO16 6YD, UK.
- NIHR Collaboration for Leadership in Applied Health Research and Care (NIHR CLAHRC) Wessex, University of Southampton, Southampton SO16 7NP, UK.
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SCI-SCREEN: A More Targeted Nutrition Screening Model to Detect Spinal Cord-Injured Patients at Risk of Malnutrition. Rehabil Nurs 2019; 44:11-19. [PMID: 30601797 DOI: 10.1097/rnj.0000000000000108] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
PURPOSE To explore if SCI-SCREEN was applicable as nutritional screening model in a neurorehabilitation unit, able to detect spinal cord injury (SCI) persons at nutritional risk. DESIGN AND METHODS SCI-SCREEN underwent reliability test by 3 specialist nurses, using 10 consecutive SCI in-patients. Audit of 41 SCI-patients was conducted comparing SCI SCREEN with the Danish-Nutritional-Screening-Model-for-hospitalized-persons (DNSM). FINDINGS Inter- and intra-tester reliability (Cohen's Kappa: 0.89-0.93) was high. SCI-SCREEN estimated average energy needs 23% lower (mean difference± SD: 2516.2±1349.1kJ) and protein needs 10% lower (9.5±19.7g/day). Risk assessment differed in 61% (CI95: 42.1; 73.7%) of cases and risk-agreement was obtained in 22% (CI95: 10.6; 37.6%). SCI-SCREEN detected 66% (CI95: 44.5; 75.8%) and DNSM 39% at risk of malnutrition. CONCLUSIONS The SCI-SCREEN model estimates SCI-energy and protein needs more accurately than DNSM by adjusting to SCI-consequences. However, more studies are needed. CLINICAL RELEVANCE SCI-SCREEN is a reasonable starting-point in the screening procedure and may be a valuable instrument to identify SCI-patients at risk of malnutrition.
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Abstract
The term malnutrition refers to both undernutrition and overnutrition. In healthcare, it most often refers to undernutrition, in particular disease-related malnutrition, which can be a result or a cause of an illness. The reasons for malnutrition are multifactorial, and its consequences may include an increased risk of pressure ulcers, reduced mobility and psychological effects such as depression. It is essential that nurses prioritise the nutritional care of all patients and identify those at risk of malnutrition using accurate and reliable nutrition screening tools. If there is a risk of malnutrition, further assessment and nutrition action planning can reduce the risk to the patient and improve their nutritional status. This article discusses the effects of disease-related malnutrition and outlines the role of screening tools and assessment in identifying patients who are malnourished or at risk of becoming malnourished. It also describes the nursing care that should be provided to patients with disease-related malnutrition, and emphasises the importance of using a multidisciplinary team approach involving speech and language therapists, dieticians, occupational therapists and physiotherapists.
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Affiliation(s)
- Hardip Malhi
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, England
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42
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Eglseer D, Schoberer D, Halfens R, Lohrmann C. The impact of using a malnutrition screening tool in a hospital setting: a mixed methods study. Eur J Clin Nutr 2018; 73:284-292. [PMID: 30323176 DOI: 10.1038/s41430-018-0339-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Revised: 08/29/2018] [Accepted: 09/26/2018] [Indexed: 01/04/2023]
Abstract
BACKGROUND/OBJECTIVES Malnutrition risk screening represents a crucial starting point for the successful management of malnourished patients. This study was conducted to (1) examine the effect of the use of a malnutrition screening tool on process indicators of nutritional care and (2) explore healthcare professionals' perceptions and opinions regarding this tool. METHODS A mixed methods design was used. A controlled pretest-posttest study was conducted to carry out quantitative analyses, and semi-structured, qualitative interviews were held. Quantitative data were analysed with descriptive statistics, Chi-squared tests, Student's t-tests and Kruskal-Wallis H tests, using SPSS 23. Qualitative data were analysed by performing a qualitative content analysis using MAXQDA 12. Two comparable hospitals participated in the study, representing one intervention group (IG) and one control group (CG). The Graz Malnutrition Screening Tool (GMS) was implemented and used in the IG for at least 1 month, while the CG received no intervention. RESULTS The use of the screening tool positively correlated with significant improvements in the process indicators of nutritional care after 1 month, in terms of the number of nutritional interventions and the frequency of documentation of the diagnosis and the patient's weight and height. The content of the interviews revealed that nearly all professionals involved perceived the overall screening process positively. Few barriers were identified. CONCLUSIONS The results of this study show that the use of a screening tool has a positive, short-term impact on the hospital's process quality of nutritional care. Ongoing efforts are required to sustainably maintain these positive changes. During this process, positive attitudes, nomination of motivated 'opinion-leaders' and concerted management support are helpful facilitators.
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Affiliation(s)
- Doris Eglseer
- Institute of Nursing Science, Medical University of Graz, Graz, Austria.
| | - Daniela Schoberer
- Institute of Nursing Science, Medical University of Graz, Graz, Austria
| | - Ruud Halfens
- Department of Health Services Research, CAPHRI, Maastricht University, Maastricht, The Netherlands
| | - Christa Lohrmann
- Institute of Nursing Science, Medical University of Graz, Graz, Austria
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Jackson HS, MacLaughlin HL, Vidal-Diez A, Banerjee D. A new renal inpatient nutrition screening tool (Renal iNUT): a multicenter validation study. Clin Nutr 2018; 38:2297-2303. [PMID: 30390999 DOI: 10.1016/j.clnu.2018.10.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2018] [Revised: 09/20/2018] [Accepted: 10/02/2018] [Indexed: 01/04/2023]
Abstract
BACKGROUND Screening of patients with renal disease for malnutrition risk on hospital admission provides an opportunity to improve prognosis. This study aimed to assess the validity and reliability of the Renal iNUT, a novel renal-specific inpatient nutrition screening tool. METHODS Adult inpatient admissions to three renal units were screened using the Renal Inpatient Nutrition Screening Tool (iNUT) and the generic Malnutrition Universal Screening Tool (MUST) and compared against nutritional status using Subjective Global Assessment (SGA) as the standard. Construct validity was assessed by Handgrip Strength (HGS), reliability by repeated iNUT administration and nurse opinion by questionnaire. RESULTS Of 141 admissions, 45% were malnourished (SGA score B or C). Using iNUT, 49% patients had increased malnutrition risk (score ≥1), 35.5% requiring dietetic referral (score ≥2). MUST indicated 20% at increased malnutrition risk and dietetic referral in 7%. iNUT was more sensitive than MUST in identifying increased malnutrition risk (92.1% vs 44.4%) and dietetic referral (69.8% vs 15.9%). Specificity of iNUT for increased risk was 82.1% and 92.3% for dietetic referral. 47% patients had sarcopenic-range HGS, with significant difference between iNUT score ≥2 and 0 (p < 0.001). iNUT reliability assessed by kappa was 0.74 (95% CI, 0.58 to 0.9), indicating substantial agreement. Nurse evaluation (n = 71) was highly favorable. CONCLUSIONS The Renal iNUT is a valid and reliable nutrition screening tool when used by nurses admitting patients to specialist renal wards. In comparison with MUST, use of iNUT is likely to improve the identification of malnourished patients for nutritional intervention and dietetic referral.
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Affiliation(s)
- Helena S Jackson
- Renal and Transplantation Unit (Nutrition & Dietetics), St George's University Hospitals NHS Foundation Trust, Blackshaw Road, London SW17 0QT, UK.
| | - Helen L MacLaughlin
- Department of Nutrition and Dietetics, King's College Hospital, London SE5 9RS, UK.
| | - Alberto Vidal-Diez
- Population Health Research Institute (PHRI), St George's, University of London, Cranmer Terrace, London SW17 0RE, UK.
| | - Debasish Banerjee
- Renal and Transplantation Unit, St George's University Hospitals NHS Foundation Trust, Cardiology Clinical Academic Group, Molecular and Clinical Sciences Research Institute, St George's University of London, Cranmer Terrace, London SW17 0RE, UK.
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Huisman-de Waal G, Feo R, Vermeulen H, Heinen M. Students' perspectives on basic nursing care education. J Clin Nurs 2018; 27:2450-2459. [PMID: 29399907 DOI: 10.1111/jocn.14278] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/19/2018] [Indexed: 01/23/2023]
Abstract
AIMS AND OBJECTIVES To explore the perspectives of nursing students on their education concerning basic nursing care, learned either during theoretical education or clinical placement, with a specific focus on nutrition and communication. BACKGROUND Basic care activities lie at the core of nursing, but are ill-informed by evidence and often poorly delivered. Nursing students' education on basic care might be lacking, and the question remains how they learn to deliver basic care in clinical practice. DESIGN Descriptive study, using an online questionnaire. METHODS Nursing students at the vocational and bachelor level of six nursing schools in the Netherlands were invited to complete an online questionnaire regarding their perception of basic nursing care education in general (both theoretical education and clinical placement) and specifically in relation to nutrition and communication. RESULTS Nursing students (n = 226 bachelor students, n = 30 vocational students) completed the questionnaire. Most students reported that they learned more about basic nursing care during clinical placement than during theoretical education. Vocational students also reported learning more about basic nursing care in both theoretical education and clinical practice than bachelor students. In terms of nutrition, low numbers of students from both education levels reported learning about nutrition protocols and guidelines during theoretical education. In terms of communication, vocational students indicated that they learned more about different aspects of communication during clinical practice than theoretical education and were also more likely to learn about communication (in both theoretical education and clinical practice) than were bachelor students. CONCLUSION Basic nursing care seems to be largely invisible in nursing education, especially at the bachelor level and during theoretical education. RELEVANCE TO CLINICAL PRACTICE Improved basic nursing care will enhance nurse-sensitive outcomes and patient satisfaction and will contribute to lower healthcare costs. This study shows that there is scope within current nurse education in the Netherlands to focus more systematically and explicitly on basic nursing care.
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Affiliation(s)
- Getty Huisman-de Waal
- Radboud Institute for Health Sciences, IQ Healthcare, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Rebecca Feo
- Adelaide Nursing School, The University of Adelaide, Adelaide, Australia
| | - Hester Vermeulen
- Radboud Institute for Health Sciences, IQ Healthcare, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Maud Heinen
- Radboud Institute for Health Sciences, IQ Healthcare, Radboud University Medical Center, Nijmegen, The Netherlands
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45
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Eglseer D, Halfens RJG, Schüssler S, Visser M, Volkert D, Lohrmann C. Is the topic of malnutrition in older adults addressed in the European nursing curricula? A MaNuEL study. NURSE EDUCATION TODAY 2018; 68:13-18. [PMID: 29870869 DOI: 10.1016/j.nedt.2018.05.015] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Revised: 04/13/2018] [Accepted: 05/18/2018] [Indexed: 06/08/2023]
Abstract
BACKGROUND The lack of sufficient knowledge of health care professionals is one main barrier to implementing adequate nutritional interventions. Until now, it is not known to which extent European nurses are exposed to the topic of malnutrition in older adults during their education. OBJECTIVE To determine whether formal nursing degree programs in Europe address the topic of nutrition and, specifically, malnutrition in older adults. DESIGN A cross-sectional study was conducted using an online-survey. PARTICIPANTS The online-survey link was e-mailed to 926 nursing education institutions in 31 European countries. METHODS This study was conducted as part of the Healthy Diet for Healthy Life Joint Programming Initiative, Malnutrition in the Elderly Knowledge Hub (MaNuEL) project. Descriptive analyses were performed using SPSS. Associations were calculated using the chi-square tests and Fisher's exact test. RESULTS The response rate of our survey was 14.2% (131 institutions). Of these, 113 (86.3%) addressed the topic of nutrition in their educational programs, and 73.7% addressed the topic of malnutrition in older adults. Malnutrition screening (70.8%), causes (67.2%) and consequences (68.7%) of malnutrition were frequently-addressed topics of content. Topics that were rarely addressed included nutritional support in intensive care units (ICU) (23.7%), cooperation in multidisciplinary nutrition teams (28.2%), dietary counselling (32.1%) and the responsibilities of various professions in nutritional support (35.1%). The topic of malnutrition in older adults is taught by nurses in 52.7%, by dietitians in 23.7%, by nutritional scientists in 18.3%, and physicians in 19.8% of the institutions. CONCLUSIONS The topics of malnutrition and malnutrition screening are currently not included in the content of nutrition courses taught at nearly 30% of the European educational institutions for nurses. Nursing educators urgently need to improve curriculum content with respect to the topic of malnutrition in older adults to enable nurses to provide high-quality nutritional care of older persons.
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Affiliation(s)
- Doris Eglseer
- Medical University of Graz, Institute of Nursing Science, Universitätsplatz 4, 8010 Graz, Austria.
| | - Ruud J G Halfens
- Maastricht University, Department of Health Services Research, Care and Public Health Research Institute, Duboisdomein 30, 6229 GT Maastricht, The Netherlands.
| | - Sandra Schüssler
- Medical University of Graz, Institute of Nursing Science, Universitätsplatz 4, 8010 Graz, Austria.
| | - Marjolein Visser
- VU Medical Center, Department of Internal Medicine & Vrije Universiteit Amsterdam, Department of Health Sciences, Amsterdam, The Netherlands.
| | - Dorothee Volkert
- Friedrich-Alexander-Universität Erlangen-Nürnberg, Institute for Biomedicine of Aging, Kobergerstraße 60, 90408 Nürnberg, Germany.
| | - Christa Lohrmann
- Medical University of Graz, Institute of Nursing Science, Universitätsplatz 4, 8010 Graz, Austria.
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Sinclair PM, Day J, Levett-Jones T, Kable A. Barriers and facilitators to opportunistic chronic kidney disease screening by general practice nurses. Nephrology (Carlton) 2018; 22:776-782. [PMID: 27436704 DOI: 10.1111/nep.12856] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2016] [Revised: 07/11/2016] [Accepted: 07/12/2016] [Indexed: 11/30/2022]
Abstract
AIM Opportunistic screening in general practice (GP) is a cost-effective and viable approach to the early identification of chronic kidney disease (CKD). This study sought to identify the barriers and facilitators to CKD screening practices of GP nurses working in a regional area of New South Wales, Australia. METHODS An eight-item elicitation questionnaire informed by the Theory of Planned Behaviour was administered to a convenience sample of 26 GP nurses. RESULTS Participants identified that the advantages of CKD screening were its early detection and treatment, the reduction of disease burden, and the opportunity to increase awareness and provide disease prevention education. These positive attitudinal beliefs were offset by negative beliefs about the impost of opportunistic screening on nursing time, particularly when there were other competing clinical priorities. Participants reported that practice doctors were wary of the financial costs associated with additional non-claimable services and believed that unfunded services, regardless of patient benefit, were difficult to justify in a private business environment. Screening was enabled in GP settings with existing screening protocols or initiatives, and when patients presented with known risk factors. Barriers to screening were more frequently described and illustrated a strong focus on financial aspects of GP. Without reimbursement through the Medicare Benefits Scheme, screening was not considered an economical use of nursing time. Other competing and billable clinical services took precedence. CONCLUSION The findings of this study can be used to inform the development and evaluation of interventions that target opportunistic CKD screening in the GP setting.
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Affiliation(s)
- Peter M Sinclair
- School of Nursing and Midwifery, Faculty of Health and Medicine, University of Newcastle, Newcastle, New South Wales, Australia
| | - Jenny Day
- School of Nursing and Midwifery, Faculty of Health and Medicine, University of Newcastle, Newcastle, New South Wales, Australia
| | - Tracy Levett-Jones
- School of Nursing and Midwifery, Faculty of Health and Medicine, University of Newcastle, Newcastle, New South Wales, Australia
| | - Ashley Kable
- School of Nursing and Midwifery, Faculty of Health and Medicine, University of Newcastle, Newcastle, New South Wales, Australia
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Di Bella A, Blake C, Young A, Pelecanos A, Brown T. Reliability of Patient-Led Screening with the Malnutrition Screening Tool: Agreement between Patient and Health Care Professional Scores in the Cancer Care Ambulatory Setting. J Acad Nutr Diet 2018; 118:1065-1071. [PMID: 29398570 DOI: 10.1016/j.jand.2017.11.023] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Accepted: 11/29/2017] [Indexed: 01/04/2023]
Abstract
BACKGROUND The prevalence of malnutrition in patients with cancer is reported as high as 60% to 80%, and malnutrition is associated with lower survival, reduced response to treatment, and poorer functional status. The Malnutrition Screening Tool (MST) is a validated tool when administered by health care professionals; however, it has not been evaluated for patient-led screening. OBJECTIVES This study aims to assess the reliability of patient-led MST screening through assessment of inter-rater reliability between patient-led and dietitian-researcher-led screening and intra-rater reliability between an initial and a repeat patient screening. DESIGN/PARTICIPANTS This cross-sectional study included 208 adults attending ambulatory cancer care services in a metropolitan teaching hospital in Queensland, Australia, in October 2016 (n=160 inter-rater reliability; n=48 intra-rater reliability measured in a separate sample). MAIN OUTCOME MEASUREMENTS Primary outcome measures were MST risk categories (MST 0-1: not at risk, MST ≥2: at risk) as determined by screening completed by patients and a dietitian-researcher, patient test-retest screening, and patient acceptability. STATISTICAL ANALYSIS Percent and chance-corrected agreement (Cohen's kappa coefficient, κ) were used to determine agreement between patient-MST and dietitian-MST (inter-rater reliability) and MST completed by patient on admission to unit (patient-MSTA) and MST completed by patient 1 to 3 hours after completion of initial MST (patient-MSTB) (intra-rater reliability). RESULTS High inter-rater reliability and intra-rater reliability were observed. Agreement between patient-MST and dietitian-MST was 96%, with "almost perfect" chance-adjusted agreement (κ=0.92, 95% CI 0.84 to 0.97). Agreement between repeated patient-MSTA and patient-MSTB was 94%, with "almost perfect" chance-adjusted agreement (κ=0.88, 95% CI 0.71 to 1.00). Based on dietitian-MST, 33% (n=53) of patients were identified as being at risk for malnutrition, and 40% of these reported not seeing a dietitian. Of 156 patients who provided feedback, almost all reported that the MST was clear (92%), questions were easy to understand (95%), and completion time was ≤5 minutes (99%). CONCLUSION Patient-led screening with the MST is reliable and well accepted by patients. Patient-led screening in the cancer care ambulatory setting has the potential to improve patient autonomy and screening completion rates.
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Computer-Based Training in Eating and Nutrition Facilitates Person-Centered Hospital Care: A Group Concept Mapping Study. Comput Inform Nurs 2018; 36:199-207. [PMID: 29334516 DOI: 10.1097/cin.0000000000000416] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Studies have shown that computer-based training in eating and nutrition for hospital nursing staff increased the likelihood that patients at risk of undernutrition would receive nutritional interventions. This article seeks to provide understanding from the perspective of nursing staff of conceptually important areas for computer-based nutritional training, and their relative importance to nutritional care, following completion of the training. Group concept mapping, an integrated qualitative and quantitative methodology, was used to conceptualize important factors relating to the training experiences through four focus groups (n = 43), statement sorting (n = 38), and importance rating (n = 32), followed by multidimensional scaling and cluster analysis. Sorting of 38 statements yielded four clusters. These clusters (number of statements) were as follows: personal competence and development (10), practice close care development (10), patient safety (9), and awareness about the nutrition care process (9). First and second clusters represented "the learning organization," and third and fourth represented "quality improvement." These findings provide a conceptual basis for understanding the importance of training in eating and nutrition, which contributes to a learning organization and quality improvement, and can be linked to and facilitates person-centered nutritional care and patient safety.
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Silver HJ, Pratt KJ, Bruno M, Lynch J, Mitchell K, McCauley SM. Effectiveness of the Malnutrition Quality Improvement Initiative on Practitioner Malnutrition Knowledge and Screening, Diagnosis, and Timeliness of Malnutrition-Related Care Provided to Older Adults Admitted to a Tertiary Care Facility: A Pilot Study. J Acad Nutr Diet 2018; 118:101-109. [DOI: 10.1016/j.jand.2017.08.111] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2017] [Accepted: 08/17/2017] [Indexed: 01/04/2023]
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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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