Eating matters--improving dietary care in hospitals

Malnutrition and pressure ulcers: nutritional assessment tools

Good nutrition is essential throughout life and often patients have a poor understanding of what a balanced diet comprises. Nurses need to have a good comprehension of malnutrition. Where malnutrition is evident it can be resolved by working with the patient to encourage a healthy diet. One way to improve patient nutrition is by a nutrition audit of patient food. Numerous nutritional assessment tools exist which help to identify a patient's nutritional status. No nationally standardized nutritional assessment tool exists and there is a danger of assessment methods becoming as proliferate as pressure ulcer risk assessment tools. A solution to this problem may be to use a pressure ulcer risk assessment tool with a nutritional risk assessment tool such as the Burton Score. Pressure ulcers and malnutrition have been demonstrated to be strongly correlated with each other. Malnutrition is not just present in hospitals but also in nursing homes. A solution to this problem is to use nutritional tools to highlight nutritional deficiency in a patient's diet not only in hospitals but also in the community and in nursing homes.

Understanding physiology of wound healing and how dressings help

One of the most fascinating features of the human body is its ability to repair damaged tissue. When the skin is injured a complex process occurs. The natural healing process can be divided into four distinct stages: inflammatory, granulation, epithelization and maturation. This process can take up to 2 years. Brunner and Suddarth (1992) classified wound healing into three stages: primary; secondary; and tertiary. Many factors affect how long a wound will take to heal, e.g. concurrent illnesses, nutritional status and the dressing used. A holistic approach to wound care is the key, and if all the factors are not addressed then wound healing will not prevail.

Physiology of the skin and prevention of pressure sores

Historically, pressure sores have been seen as a nursing problem, and still are to a certain extent today. Nurses therefore need to have a comprehensive understanding of the physiology of the skin to assist them in preventing and treating pressure sores. Despite a great deal of research on the aetiology of pressure sores, their origins are still not fully understood. This article discusses the physiology of the skin and the aetiology of pressure sores. Influences on pressure sore development are multifactorial and tend to be divided into three main categories: extrinsic (e.g. environmental pressure, shear and friction), intrinsic (e.g. general health, age, mobility, body weight, incontinence and nutrition), and external factors (e.g. long trolley waits in accident and emergency departments or before admission following a long period collapsed on the floor, hard chairs, and immobilization with traction).