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Montero-Marco J, Charlo-Bernardos M, Subirón-Valera AB, Erickson H, Herrero-Cortina B, Altarribas-Bolsa E. The role of nursing care continuity report in predicting length of hospital stay in older people: A retrospective cohort study. J Clin Nurs 2024; 33:1830-1838. [PMID: 38178555 DOI: 10.1111/jocn.16953] [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: 05/04/2023] [Revised: 08/29/2023] [Accepted: 11/22/2023] [Indexed: 01/06/2024]
Abstract
BACKGROUND The Nursing Care Continuity Report (NCCR) is a tool for evaluating the quality of nursing care during hospital admission. AIM To explore the role of the NCCR in predicting longer length of stay (LOS) in older adults (≥65 years) admitted to a tertiary hospital and determine possible clinical differences at discharge between patients who had a short LOS (≤7 days) and a prolonged LOS (>7 days). RESEARCH DESIGN AND SETTING A retrospective cohort study was conducted including all patients with a completed NCCR admitted to the hospital between 2015 and 2019. Sociodemographic data, risk of pressure injuries, level of dependence, presence and intensity of pain, and presence and type of pressure injury were the variables registered in the NCCR. RESULTS A total of 41,354 patients were included in this study, with a mean age of 78 years, of whom 47% were female. At admission, 21% of patients were at potential risk of developing pressure ulcers. Age, admission to the internal or respiratory medicine unit, and having at least medium risk of developing pressure ulcers were the predictors of prolonged LOS using a random sample of 950 patients. At discharge, patients with prolonged LOS presented higher risk of pressure ulcers and a higher level of dependency and were more likely to present hospital-acquired pressure ulcers. CONCLUSIONS Older adults from the internal or respiratory medicine unit who exhibited higher risk of pressure ulcers were related to a prolonged LOS, a higher level of dependency, and hospital-acquired ulcers at hospital discharge. RELEVANCE TO CLINICAL PRACTICE Identifying clinical data that have a greater relationship with LOS could be a useful tool for nursing management and for the implementation of strategies to prevent adverse events during hospitalisation. NO PATIENT OR PUBLIC CONTRIBUTION No direct patient contact was made during the data collection.
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Affiliation(s)
- Jesica Montero-Marco
- Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain
- Instituto de Investigación Sanitaria (IIS) Aragón, Zaragoza, Spain
| | - Marta Charlo-Bernardos
- Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain
- Instituto de Investigación Sanitaria (IIS) Aragón, Zaragoza, Spain
| | - Ana Belén Subirón-Valera
- Instituto de Investigación Sanitaria (IIS) Aragón, Zaragoza, Spain
- Department of Physiatry and Nursing, Faculty of Health Sciences, University of Zaragoza, Zaragoza, Spain
| | | | - Beatriz Herrero-Cortina
- Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain
- Instituto de Investigación Sanitaria (IIS) Aragón, Zaragoza, Spain
- Universidad San Jorge, Zaragoza, Spain
| | - Elena Altarribas-Bolsa
- Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain
- Instituto de Investigación Sanitaria (IIS) Aragón, Zaragoza, Spain
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Butcher RDCGES, Guandalini LS, de Barros ALBL, Damiani BB, Jones DA. Psychometric evaluation of the Functional Health Pattern Assessment Screening Tool - Modified Brazilian Version. Rev Lat Am Enfermagem 2024; 32:e4119. [PMID: 38511736 PMCID: PMC10949848 DOI: 10.1590/1518-8345.6755.4119] [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: 04/16/2023] [Accepted: 11/17/2023] [Indexed: 03/22/2024] Open
Abstract
OBJECTIVE to test the factorial structure, reliability and convergent validity of the Functional Health Pattern Assessment Screening Tool - Modified Brazilian Version. METHOD this was a psychometric evaluation of the Functional Health Pattern Assessment Screening Tool - Modified Brazilian Version. Seven hundred and seventeen participants answered the data collection instrument consisting of two parts. Part I included a structured questionnaire to collect sociodemographic data and the participants' perceptions and satisfaction with their current health status. Part II consisted of the tool being tested. The internal structure was assessed using Confirmatory Factor Analysis. Convergent validity was evaluated by the correlation of the tool scores with the rates corresponding to self-perception and satisfaction with current health status. Reliability was assessed using Cronbach's alpha. RESULTS the Confirmatory Factor Analysis confirmed a three-factor solution. The factor loadings were significant and varied from 0.16 to 0.75; the fit indices suggested moderate fit of the model. Internal consistency for all three components varied between 0.779 and 0.919. CONCLUSION the findings suggest that the tool is valid and reliable to be used in the Brazilian population, although caution is recommended when interpreting the results due to the moderate fit of the model. BACKGROUND (1) The FHPAST-BR is a structured, valid and reliable Nursing-driven assessment tool. BACKGROUND (2) The tool provides a way of organizing clinical data and easing decision-making. BACKGROUND (3) The FHPAST-BR can be used in clinical practice and research.
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Affiliation(s)
| | | | | | | | - Dorothy Anne Jones
- Boston College, William F Connell School of Nursing, Chesnut Hill, MA, United States of America
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González-Chordá VM, Aleixos DL, Reverter IL, Cervera-Gash À, Machancoses FH, Moreno-Casbas MT, Arasil PF, Chillerón MJV. Diagnostic accuracy study of the VALENF instrument in hospitalization units for adults: a study protocol. BMC Nurs 2023; 22:401. [PMID: 37891575 PMCID: PMC10604410 DOI: 10.1186/s12912-023-01567-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Accepted: 10/19/2023] [Indexed: 10/29/2023] Open
Abstract
Recently, the VALENF instrument, Nursing Assessment by its acronym in Spanish, was developed as a meta-tool composed of only seven items with a more parsimonious approach for nursing assessment in adult hospitalization units. This meta-tool integrates the assessment of functional capacity, the risk of pressure injuries and the risk of falls. The general objective of this project is to validate the VALENF instrument by studying its diagnostic accuracy against the instruments commonly used in nursing to assess functional capacity, the risk of pressure injuries and the risk of falls. An observational, longitudinal, prospective study is presented, with recruitment and random selection based on admissions to six adult hospitalization units of the Hospital Universitario de La Plana. The study population will be made up of patients hospitalized in these units. The inclusion criteria will be patients over 18 years of age with a nursing assessment within the first 24 h of admission and an expected length of stay greater than 48 h and who sign the informed consent form. The exclusion criteria will be transfers from other units or centers. A sample of 521 participants is estimated as necessary. The evaluation test will be the VALENF instrument, and the reference tests will be the Barthel, Braden and Downton indices. Sociodemographic variables related to the care process and results such as functional loss, falls or pressure injuries will be collected. The evolution of functional capacity, the risk of falls and the risk of pressure injuries will be analyzed. The sensitivity, specificity and positive predictive values of the VALENF instrument will be calculated and compared to those of the usual instruments. A survival analysis will be performed for pressure injuries, falls and patients with functional loss. The VALENF instrument is expected to have at least the same diagnostic validity as the original instruments.Trial registration The study will be retrospectively registered (ISRCTN 17699562, 25/07/2023).
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Affiliation(s)
- Víctor M González-Chordá
- Nursing Research Group (GIENF-241), Ministerio de Ciencia E Innovación, Universitat Jaume I, Investén-ISCIII, Instituto de Salud Carlos III, Castellón de La Plana, Spain
| | - David Luna Aleixos
- Nursing Research Group (GIENF-241), Unidad de Hospitalización De Traumatología y Corta Estancia, Hospital Universitario de La Plana, Universitat Jaume I, EnfermeroCastellón de La Plana, Spain
| | - Irene Llagostera Reverter
- Nursing Research Group (GIENF-241, Universitat Jaume I, Avda Sos Baynat Sn. 12071, Castellón de La Plana, Spain.
| | - Àgueda Cervera-Gash
- Nursing Research Group (GIENF-241, Universitat Jaume I, Avda Sos Baynat Sn. 12071, Castellón de La Plana, Spain
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Llagostera-Reverter I, Luna-Aleixos D, Valero-Chillerón MJ, Martínez-Gonzálbez R, Mecho-Montoliu G, González-Chordá VM. Improving Nursing Assessment in Adult Hospitalization Units: A Secondary Analysis. NURSING REPORTS 2023; 13:1148-1159. [PMID: 37755342 PMCID: PMC10536114 DOI: 10.3390/nursrep13030099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Revised: 08/12/2023] [Accepted: 08/19/2023] [Indexed: 09/28/2023] Open
Abstract
The main objective of this study was to analyze the impact of a multifaceted strategy to improve the assessment of functional capacity, risk of pressure injuries, and risk of falls at the time of admission of patients in adult hospitalization units. This was a secondary analysis of the VALENF project databases during two periods (October-December 2020, before the strategy, and October-December 2021, after the strategy). The quantity and quality of nursing assessments performed on patients admitted to adult hospitalization units were evaluated using the Barthel index, Braden index, and Downton scale. The number of assessments completed before the implementation of the new strategy was n = 686 (28.01%), versus n = 1445 (58.73%) in 2021 (p < 0.001). The strategy improved the completion of the evaluations of the three instruments from 63.4% (n = 435) to 71.8% (n = 1038) (p < 0.001). There were significant differences depending on the hospitalization unit and the assessment instrument (p < 0.05). The strategy employed was, therefore, successful. The nursing assessments show a substantial improvement in both quantity and quality, representing a noticeable improvement in nursing practice. This study was not registered.
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Affiliation(s)
- Irene Llagostera-Reverter
- Nursing Research Group (GIENF Code 241), Nursing Department, Universitat Jaume I, 12071 Castellón, Spain; (I.L.-R.); (M.J.V.-C.)
| | - David Luna-Aleixos
- Nursing Research Group (GIENF Code 241), Nursing Department, Universitat Jaume I, 12071 Castellón, Spain; (I.L.-R.); (M.J.V.-C.)
- Hospital Universitario de La Plana, Vila-Real, 12520 Castellón, Spain; (R.M.-G.); (G.M.-M.)
| | - María Jesús Valero-Chillerón
- Nursing Research Group (GIENF Code 241), Nursing Department, Universitat Jaume I, 12071 Castellón, Spain; (I.L.-R.); (M.J.V.-C.)
| | | | - Gema Mecho-Montoliu
- Hospital Universitario de La Plana, Vila-Real, 12520 Castellón, Spain; (R.M.-G.); (G.M.-M.)
| | - Víctor M. González-Chordá
- Nursing Research Group (GIENF Code 241), Nursing Department, Universitat Jaume I, 12071 Castellón, Spain; (I.L.-R.); (M.J.V.-C.)
- Nursing and Healthcare Research Unit (INVESTÉN-ISCIII), Institute of Health Carlos III, 28029 Madrid, Spain
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Shimoni Z, Dusseldorp N, Cohen Y, Barnisan I, Froom P. The Norton scale is an important predictor of in-hospital mortality in internal medicine patients. Ir J Med Sci 2023; 192:1947-1952. [PMID: 36520351 DOI: 10.1007/s11845-022-03250-0] [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: 09/19/2022] [Accepted: 12/07/2022] [Indexed: 12/23/2022]
Abstract
BACKGROUND The Norton scale, a marker of patient frailty used to predict the risk of pressure ulcers, but the predictive value of the Norton scale for in-hospital mortality after adjustment for a wide range of demographic, and abnormal admission laboratory test results shown in themselves to have a high predictive value for in-hospital mortality is unclear. AIM The study aims to determine the value of the Norton scale and the presence of a urinary catheter in predicting in hospital mortality. METHODS The study population included all acutely admitted adult patients in 2020 through October 2021 to one of three internal medicine departments at the Laniado Hospital, a regional hospital with 400 beds in Israel. The main objective was to (a) identify the variables associated with the Norton Scale and (b) determine whether it predicts in-hospital mortality after adjustment for these variables. RESULTS The Norton scale was associated with an older age, female gender, presence of a urinary catheter, and abnormal laboratory tests. The odds of in-hospital mortality in those with intermediate, high, and very high Norton scale risk groups were 3.10 (2.23-3.56), 6.48 (4.02-10.46), and 12.27 (7.37-20.44), respectively, after adjustment for the remaining predictors. Adding the Norton scale and the presence of a urinary catheter to the prediction logistic regression model that included age, gender, and abnormal laboratory test results increased the c-statistic from 0.870 (0.864-0.876) to 0.908 (0.902-0.913). CONCLUSIONS The Norton scale and presence of a urinary catheter are important predictors of in-hospital mortality in acutely hospitalized adults in internal medicine departments.
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Affiliation(s)
- Zvi Shimoni
- The Adelson School Of Medicine, Ariel University, Ariel, Israel
- Sanz Medical Center, Laniado Hospital, Netanya, 4244916, Israel
| | | | - Yael Cohen
- Nursing Department, Laniado Hospital, Netanya, Israel
| | | | - Paul Froom
- Clinical Utility Department, Sanz Medical Center, Laniado Hospital, Netanya, 4244916, Israel.
- School of Public Health, University of Tel Aviv, Tel Aviv, Israel.
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Frontline Nurses' clinical judgment in recognizing, understanding, and responding to patient deterioration: A qualitative study. Int J Nurs Stud 2023; 139:104436. [PMID: 36731308 DOI: 10.1016/j.ijnurstu.2023.104436] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2022] [Revised: 01/06/2023] [Accepted: 01/07/2023] [Indexed: 01/15/2023]
Abstract
BACKGROUND Early warning systems and rapid response teams have been widely implemented in hospitals worldwide to facilitate early recognition and response to patient deterioration. Unfortunately, evidence suggests that these interventions have made little impact on unexpected cardiac or respiratory arrest, hospital mortality, unplanned admission to intensive care units, or hospital length of stay. These programs depend on nurses recognizing at risk patients and initiating a timely response. Although physiologic abnormalities commonly precede serious adverse events, nurses often fail to recognize or respond effectively. Clinical judgment is a critical component in the effective response to deterioration, yet little is known about factors that influence nurses' clinical judgment in these situations. Noticing, interpreting, and responding are aspects of clinical judgment and are essential to preventing further patient deterioration and serious adverse events. OBJECTIVE To describe medical-surgical nurses' perceptions of factors that influenced their clinical judgment in situations of patient deterioration. DESIGN A qualitative descriptive design using individual, semi-structured interviews. Tanner's Clinical Judgment Model served as the framework for interview questions and data analysis. PARTICIPANTS A purposive sample of 20 medical-surgical registered nurses were recruited from 10 adult medical-surgical units at an academic medical center hospital in the United States. METHODS Telephone interviews occurred between March and July 2018. A directed approach to content analysis was used to code the transcribed data and identify themes. RESULTS Eight themes related to each aspect of clinical judgment emerged from the analysis: Knowing the patient, Experience matters, Lots of small points where the system can fail, Making sense of the data, Something doesn't go together, Caught in the middle, Culture of teamwork, and Increased nursing workload. An overarching theme was Nurses' keen sense of responsibility. Findings revealed that factors within the nurse, the patient, and the work environment influence each component of noticing, interpreting, and initiating an effective response to deteriorating patients. CONCLUSIONS Findings have implications for health care systems regarding interventions to support timely recognition and response to deterioration. Nurses' clinical judgment and factors that influence each aspect (noticing, interpreting, and responding) should be a key consideration in organizational efforts to improve the overall response to patient deterioration. Research is needed to enhance understanding of the contextual factors that impact nurses' clinical judgment to inform interventions to support timely recognition and response.
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Effectiveness of community hospital post-acute care on mortality, re-admission, institutionalization, and activation of a home care programme in Emilia-Romagna region, Italy. Aging Clin Exp Res 2023; 35:367-374. [PMID: 36396895 DOI: 10.1007/s40520-022-02298-3] [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: 08/17/2022] [Accepted: 11/02/2022] [Indexed: 11/18/2022]
Abstract
BACKGROUND In Italy, there is scant evidence on the impact of Community Hospitals (CHs) on clinical outcomes. AIMS To assess the effectiveness of CHs versus long-term care hospital or inpatient rehabilitation facilities on mortality, re-admission, institutionalization, and activation of a home care programme in the Emilia-Romagna Region (ERR-Italy) after acute hospitalisation. METHODS We implemented a cohort study drawing upon the ERR Administrative Healthcare Database System and including hospital episodes of ERR residents subject ≥ 65 years, discharged from a public or private hospital with a medical diagnosis to a CH or to usual care between 2017 and 2019. To control for confounding, we applied a propensity score matching. RESULTS Patients transferred to CHs had a significantly lower risk of dying but an increased risk of being readmitted to community or acute hospital within 30/90 days from discharge. The hazard of institutionalisation within 30/90 days was significantly lower in the whole population of the CH exposed group but not among patients with cardiac or respiratory chronic diseases or diabetes. The activation of a home care program within 90 days was slightly higher for those who were transferred to a CH. DISCUSSION The findings of our study show mixed effects on outcomes of patients transferred to CHs compared to those who followed the post-acute usual care and should be taken with cautious as could be affected by the so-called 'confounding by indication'. CONCLUSIONS The study contributes to the intermediate care available evidence from a region with a well-established care provision through CHs.
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Luna-Aleixos D, Llagostera-Reverter I, Castelló-Benavent X, Aquilué-Ballarín M, Mecho-Montoliu G, Cervera-Gasch Á, Valero-Chillerón MJ, Mena-Tudela D, Andreu-Pejó L, Martínez-Gonzálbez R, González-Chordá VM. Development and Validation of a Meta-Instrument for Nursing Assessment in Adult Hospitalization Units (VALENF Instrument) (Part I). INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:14622. [PMID: 36429341 PMCID: PMC9690557 DOI: 10.3390/ijerph192214622] [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: 10/06/2022] [Revised: 11/02/2022] [Accepted: 11/04/2022] [Indexed: 06/16/2023]
Abstract
Nursing assessment is the basis for performing interventions that match patient needs, but nurses perceive it as an administrative load. This research aims to develop and validate a meta-instrument that integrates the assessment of functional capacity, risk of pressure ulcers and risk of falling with a more parsimonious approach to nursing assessment in adult hospitalization units. Specifically, this manuscript presents the results of the development of this meta-instrument (VALENF instrument). A cross-sectional study based on recorded data was carried out in a sample of 1352 nursing assessments. Socio-demographic variables and assessments of Barthel, Braden and Downton indices at the time of admission were included. The meta-instrument's development process includes: (i) nominal group; (ii) correlation analysis; (iii) multiple linear regressions models; (iv) reliability analysis. A seven-item solution showed a high predictive capacity with Barthel (R2adj = 0.938), Braden (R2adj = 0.926) and Downton (R2adj = 0.921) indices. Likewise, reliability was significant (p < 0.001) for Barthel (ICC = 0.969; τ-b = 0.850), Braden (ICC = 0.943; τ-b = 0.842) and Downton (ICC = 0.905; κ = 7.17) indices. VALENF instrument has an adequate predictive capacity and reliability to assess the level of functional capacity, risk of pressure injuries and risk of falls.
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Affiliation(s)
- David Luna-Aleixos
- Hospital Universitario de La Plana, Nursing Department, Universitat Jaume I, 12006 Castelló de la Plana, Spain
- Nursing Research Group (GIENF Code 241), Nursing Department, Universitat Jaume I, 12006 Castelló de la Plana, Spain
| | - Irene Llagostera-Reverter
- Nursing Research Group (GIENF Code 241), Nursing Department, Universitat Jaume I, 12006 Castelló de la Plana, Spain
| | | | - Marta Aquilué-Ballarín
- Hospital Comarcal Universitario de Vinarós, Nursing Research Group (GIENF Code 241), Nursing Department, Universitat Jaume I, 12006 Castelló de la Plana, Spain
| | | | - Águeda Cervera-Gasch
- Nursing Research Group (GIENF Code 241), Nursing Department, Universitat Jaume I, 12006 Castelló de la Plana, Spain
| | - María Jesús Valero-Chillerón
- Nursing Research Group (GIENF Code 241), Nursing Department, Universitat Jaume I, 12006 Castelló de la Plana, Spain
| | - Desirée Mena-Tudela
- Nursing Research Group (GIENF Code 241), Nursing Department, Universitat Jaume I, 12006 Castelló de la Plana, Spain
| | - Laura Andreu-Pejó
- Nursing Research Group (GIENF Code 241), Nursing Department, Universitat Jaume I, 12006 Castelló de la Plana, Spain
| | | | - Víctor M. González-Chordá
- Nursing Research Group (GIENF Code 241), Nursing Department, Universitat Jaume I, 12006 Castelló de la Plana, Spain
- Nursing and Healthcare Research Unit (INVESTÉN-ISCIII), Institute of Health Carlos III, 28029 Madrid, Spain
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Recognising undernutrition in a community hospital: the nursing judgement is insufficient. Eur J Clin Nutr 2022; 76:1611-1614. [PMID: 35444266 PMCID: PMC9019789 DOI: 10.1038/s41430-022-01145-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2022] [Revised: 04/03/2022] [Accepted: 04/06/2022] [Indexed: 12/01/2022]
Abstract
Introduction Standardised nutritional screening methods improve the rate of recognising older patients with undernutrition, which is strongly encouraged in hospitals and residential settings. Therefore, our study compared the rates of identifying undernutrition before and after introducing the Mini Nutritional Assessment (MNA®) in a community hospital. Methods This was a single-centre, retrospective, observational before–after study. Participants were subjects aged 65 years or older, admitted to a community hospital from May 2018 to December 2020. The nursing assessment at admission included the MNA® from January 2020. The prevalence of undernutrition gathered by nursing diagnoses from 2018 to 2019 was compared with data obtained using the MNA® in 2020. Then, a confirmatory analysis was conducted to compare the prevalence of undernutrition in 2020 when both nursing diagnoses and the MNA® were used. Results We analysed data of approximately 316 patients (238 before and 78 after introducing the MNA®). Overall, results showed that 47.1% (n = 149) of the patients were undernourished. As observed, the prevalence of undernutrition was 38.6% (n = 92) in 2018–2019 and 73.1% (n = 57) in 2020 (p < 0.001). In 2020, however, 38.5% of patients (n = 30) were identified as undernourished using the MNA® but not using nursing diagnoses. Therefore, the correlation between these two methods was poor (Pearson’s correlation 0.169, p = 0.14). Conclusion Identifying elderly patients with undernutrition significantly increased after introducing the MNA®. Undernutrition is a common condition that should be systematically screened using a validated tool to activate personalised nutritional interventions promptly.
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OUP accepted manuscript. Eur J Cardiovasc Nurs 2022; 21:702-709. [DOI: 10.1093/eurjcn/zvac011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 12/16/2021] [Accepted: 02/07/2022] [Indexed: 11/12/2022]
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