The effect of nutrition training for health care staff on learner and patient outcomes in adults: a systematic review and meta-analysis

Nutritional Care for Institutionalized Persons with Dementia: An Integrative Review

BACKGROUND

Older people are at risk of malnutrition, especially when they suffer from cognitive impairment. Guidelines that orient nursing care in this regard need to be updated. The aim of this review is to address the best available evidence on interventions that can benefit nutritional nursing care for institutionalized older adults with dementia.

METHODS

Integrative review using the Dimensions and Eureka search engines, and the PubMed, Embase, Scielo, CINAHL, and ScienceDirect databases. We searched from the year 2015 through to 2021. We employed the MMAT guidelines for mixed, qualitative, and quantitative studies, and the PRISMA, CASP, and JBI guidelines to value the reviews.

RESULTS

A total of 55 studies met the inclusion criteria. The best available evidence to support nutritional nursing care for institutionalized older adults with dementia highlights several aspects related to the assessment and caring interventions that are focused on people with dementia, their caregivers, and their context.

CONCLUSIONS

Both the assessment and nutritional care interventions for older people with dementia should consider the patient-caregiver dyad as the subject of care and understand the context as a fundamental part of it. The analysis of the context should look further than the immediate environment.

Exploring the effect of two different teaching strategies on first-year nursing students' understanding of nutritional concepts: A mixed-method approach

AIM

The aim of the study was twofold. First, to explore understanding difficulties in nutritional concepts among nursing students and second, to analyse the effect of two teaching strategies on the level of understanding.

BACKGROUND

Previous studies have pointed out the need to improve the nutritional care education offered to undergraduates in health sciences. As nurses play a crucial role in lifestyle counselling and nutrition assessment, it is essential to identify the learning difficulties that can impair their learning capacity and the more effective teaching strategy in the nutrition area during the nursing degree.

DESIGN

A pretest-posttest study was conducted with a mixed-method conversion design.

METHODS

146 first-year-nursing students were included. Two teaching methods, debate-based learning and lecture-based learning were used for instruction on the effect of macronutrient intake on an individual's state of health. Each group completed two open-ended questions before and after the intervention. Firstly, phenomenographic analysis was performed to identify the learning categories representing variations in students' understanding. Secondly, qualitative data were quantised and statistically analysed to address differences in learning improvement.

RESULTS

More than 40% of students struggled with the idea that proteins are associated with weight gain independently of the teaching strategy applied. In the first evaluation question, the debate-based learning teaching method improved students' learning, achieving higher levels of understanding (p < 0.05). In the second evaluation question, no significant differences were found between the two groups.

CONCLUSIONS

Areas of problematic knowledge in nutrition education have been identified for the first time that will allow nurse educators to design research-based teaching strategies. Further studies are necessary not only on how to address these misconceptions in nursing students, but also to investigate how nurse educators can contribute to deeper levels of student learning.

The role of non-dietetic healthcare professionals in managing interventions among adults at risk of malnutrition: A systematic review

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.

Trends and Novel Research in Hospital Nutrition Care: A Narrative Review of Leading Clinical Nutrition Journals

Hospital malnutrition is a longstanding problem that continues to be underrecognized and undertreated. The aim of this narrative review is to summarize novel, solution-focused, recent research or commentary to update providers on the prevention of iatrogenic malnutrition as well as the detection and treatment of hospital malnutrition. A narrative review was completed using the top 11 clinically relevant nutrition journals. Of the 13,850 articles and editorials published in these journals between 2013 and 2019, 511 were related to hospital malnutrition. A duplicate review was used to select (n = 108) and extract key findings from articles and editorials. Key criteria for selection were population of interest (adult hospital patients, no specific diagnostic group), solution-focused, and novel perspectives. Articles were categorized (6 classified in >1 category) as Screening and Assessment (n = 17), Standard (n = 25), Advanced (n = 12) and Specialized Nutrition Care (n = 8), Transitions (n = 15), Multicomponent (n = 21), Education and Empowerment (n = 9), Economic Impact (n = 3), and Guidelines (n = 4) for summarizing. Research advances in screening implementation, standard nutrition care, transitions, and multicomponent interventions provide new strategies to consider for malnutrition prevention (iatrogenic), detection, and care. However, several areas requiring further research were identified. Specifically, larger and more rigorous studies that examine health outcomes and economic analyses are urgently needed.

Measuring professional self and collective efficacy for dietary advice in Primary Health Care

BACKGROUND

There is a lack of instruments to measure the ability of health professionals to promote dietary advice according to dietary guidelines.

AIM

To develop and validate a web-based and self-applied scale for measuring primary health care (PHC) professionals' self-efficacy and collective efficacy to apply the Brazilian Dietary Guidelines for dietary advice.

METHODS

Methodological procedures comprised six steps: development of the items; content validation with panel of experts; face validation through focus group conducted with PHC professionals; online reevaluation by the participants of content and face validation panels; online application with PHC professionals working all over Brazil's macro-regions; confirmatory factorial analysis to test construct validity.

RESULTS

The scale was initially developed with 22 items. After content and face validation panels, changes in content and semantics were performed. The second version consisted of 24 items equally divided into part A (self-efficacy) and B (collective efficacy). All items, when reevaluated, were considered clear and representative of the Brazilian Dietary Guidelines' chapters. The multidimensional model was shown to have excellent fit indices in the confirmatory factorial analysis. The scale's peak of information was centered around the mean, indicating that both domains are more precise for perception of self-efficacy and collective efficacy on average values.

CONCLUSION

The scale demonstrated validity for measuring PHC professionals' perceived self-efficacy and collective efficacy to apply the Brazilian Dietary Guidelines. To our knowledge, this is the first valid scale for measuring the capability of PHC professionals to apply national dietary guidelines for healthy diet promotion.

Interventions to Support Older People's Involvement in Activities Related to Meals. A Systematic Review

The objective of this systematic review is to assess whether old people should be actively involved in activities related to meals to support quality of life, nutritional status and functional abilities related to meals. Two electronic databases Cochrane Database of Systematic Reviews and the Database of Abstracts of Reviews of Effectiveness were searched, supported by PubMed citation, snowball searches. Eleven primary studies were included. The quality was low. No studies assessed the effect on health-related quality of life. Three types of interventions to support activities related to meals were identified: Meal-related activities to facilitate improved autonomy seemed to overall improve nutritional intake, physical and social function related to meals, plus mealtime coping. Interventions of encouragement and reinforcement by staff to facilitate independence in eating seemed to have beneficial effect on nutritional intake and physical function related to meals. Interventions using food preparation and cooking to support participation seemed to have beneficial effects on social function related to meals and mealtime coping. There is an urgent need for good quality, adequately powered studies in this area and among old people in all health care settings.

Developing professional education for primary healthcare providers about nutrition

Nutrition care is an important component of primary health care as a way to promote positive lifestyle behaviours and reduce risks of chronic disease. Despite this, it appears that primary healthcare settings, including antenatal care, miss opportunities to deliver nutrition care. Time constraints, lack of nutrition knowledge and lack of confidence have been identified as barriers for primary healthcare providers in delivering nutrition care. Nutrition training to upskill primary healthcare providers to deliver nutrition care in a timely manner therefore appears warranted. This forum article discusses models and methods of continuing professional development (CPD) and the effectiveness of nutrition CPD for primary healthcare professionals. It includes a case study as an example of developing nutrition CPD for midwives using adult learning theory and concludes with implications for developing nutrition education resources for primary healthcare providers.

Lack of focus on nutrition and documentation in nursing homes, home care- and home nursing: the self-perceived views of the primary care workforce

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.

A prospective investigation of direct and indirect home care activities in three rural Norwegian municipalities

BACKGROUND

Home care providers struggle to manage their day-to-day work, which is increasing in volume and complexity. In general, they are expected to achieve more with the same planning methods, resources, and capacity. To meet emerging needs and use the available resources more effectively and efficiently, evidence and strategies are needed to inform planning methods for home care services. However, limited data are available to inform this change. This paper investigated the amount of time used to carry out direct activities and six indirect activities across three rural Norwegian municipalities (M1, M2 and M3).

METHODS

Home care staff recorded data over 8 weeks in 2016; the majority of the staff used a smartphone application and some staff used a manual form to report the durations of the activities.

RESULTS

The median time spent on direct activities was 11-13 min, and this work constituted less than 50% of the total work in the three municipalities. The median driving time was 5-7 min, which accounted for 43-54% of the total indirect work. Administration, particularly reporting and documentation, displayed greater differences across the municipalities, together accounting for 38-50% of the total indirect time. M2 and M3 used substantially more time for documentation, including 20 min in M2 and M3, in contrast to only 1 min in M1. Similarly, the median reporting times were 30 min (M2) and 28 min (M3), compared with only 17 min in M1.

CONCLUSIONS

Home care staff spent less time on direct activities than on indirect activities, of which several activities have the potential for change. These results may help managers utilize resources effectively and plan appropriately, and they may also serve as a basis for future research to identify areas with improvement opportunities and, in turn, make more time available for direct patient care.