Nutrition-related care needs of older patients in hospital: A qualitative multimethod study.

PURPOSE: To investigate the nutrition-related care needs of older patients in hospitals. METHODS: A qualitative multimethod study was performed. By purposive sampling, older patients were included for observations of the nutrition process and interviews from a perioperative unit, an internal Medicine unit, and one acute geriatric care ward of an acute care hospital. Preliminary findings were discussed, validated, and further explored in two focus group discussions with interprofessional nutritional healthcare experts. FINDINGS: Seventeen women and five men with a mean age of 86 years participated in patient observations and interviews. Eight experts with at least 10 years of professional experience who were employed in this setting for 3 years or more participated in interviews. Three themes of nutrition-related care needs were elaborated: The need to assess and address older patients' attitudes toward life, the need for nutrition-related education, and the need for food intake support. These care needs added to the development and validation of a new nursing diagnosis "risk for inadequate protein energy nutrition" and in consequence to develop a complex nursing intervention to optimize the nutrition of older patients. CONCLUSIONS: It is crucial to assess and understand the patients' attitudes toward life, which affect purposes of treatment, diet, and menu choices. IMPLICATIONS FOR NURSING PRACTICE: Implementation of assessing nutrition-related care needs of older inpatients is needed. Addressing these care needs within the Advanced Nursing Process can lead to appropriate nursing diagnoses, nursing outcomes, and interventions, which enhance person-centered care, patients' self-care abilities, and consequently patients' nutritional status.

ZIEL: Untersuchung der ernährungsbezogenen Pflegebedürfnisse älterer Patient*innen im Krankenhaus. METHODE: Es wurde eine qualitative Multimethodenstudie durchgeführt. Mittels zielgerichteter Rekrutierung wurden ältere Patient*innen aus den Abteilungen allgemeine Chirurgie, innere Medizin und universitäre Klinik für Akutgeriatrie eines Krankenhauses für Beobachtungen des Ernährungsprozesses und Interviews einbezogen. Die vorläufigen Ergebnisse wurden in zwei Fokusgruppengesprächen mit Expert*innen aus verschiedenen Berufsgruppen diskutiert, validiert und weiter analysiert. ERGEBNISSE: Siebzehn Frauen und fünf Männer mit einem Durchschnittsalter von 86 Jahren nahmen an Patient*innenbeobachtungen und -interviews teil. Es wurden drei Themen ernährungsbezogener Pflegebedürfnisse herausgearbeitet: Das Bedürfnis, die Lebenseinstellung älterer Patient*innen zu erfassen; das Bedürfnis, ernährungsbezogene Informationen zu erhalten und das Bedürfnis nach Unterstützung bei der Nahrungsaufnahme. Diese Pflegebedürfnisse unterstützten die Entwicklung und Validierung einer neuen Pflegediagnose "Risiko für inadequate Protein-Energie-Ernährung" und infolgedessen einer komplexen pflegerischen Intervention zur Optimierung der Ernährung älterer Patient*innen. SCHLUSSFOLGERUNG: Es ist von entscheidender Bedeutung, die Lebenseinstellung der Patient*innen einzuschätzen und zu verstehen, da sich diese auf die Behandlungsziele, die Ernährung und die Menüwahl auswirkt. AUSWIRKUNGEN AUF DIE PFLEGEPRAXIS: Die Erfassung der ernährungsbezogenen Pflegebedürfnisse älterer stationärer Patient*innen muss implementiert werden. Die Berücksichtigung dieser Pflegebedürfnisse im Rahmen des Advanced Nursing Process kann zu angemessenen Pflegediagnosen, Pflegeergebnissen und Interventionen führen, welche die personenzentrierte Versorgung, Selbstpflegefähigkeiten der Patient*innen und damit deren Ernährungszustand verbessern.

Safety in nutrition nursing-a need to protect patients and professionals.

Suzy Cole, National Nurses Nutrition Group Committee Member (suzy.cole@nhs.net) and Natalie Welsh, Vice Chair National Nurses Nutrition Group, outline recent work from several nutrition professional groups.

Intervenciones educativas sobre nutrición y actividad física en niños de Educación Primaria: una revisión sistemática / Educational interventions on nutrition and physical activity in Primary Education children: a systematic review

INTRODUCCIÓN: Las intervenciones educativas en el entorno escolar, parecen la forma más efectiva de actuar contra la obesidad infantil. Los objetivos de esta revisión sistemática fueron, describir las intervenciones educativas sobre alimentación y/o actividad física llevadas a cabo en alumnos de Educación Primaria con el fin de disminuir o prevenir la obesidad infantil y analizar la eficacia de dichas intervenciones. METODOLOGÍA: Se realizó una búsqueda bibliográfica en las bases de datos WOS y SCOPUS. Los criterios de elegibilidad fueron esTablecidos en base al acrónimo PICOS: (P) niños de educación primaria (6-12 años), (I) estudios que llevaran a cabo intervenciones de nutrición y/o actividad física en el ámbito escolar, (C) no recibir ninguna intervención, (O) evaluar el efecto de los programas educacionales sobre la obesidad infantil, (S) estudios experimentales, publicados entre 2013 y 2017. RESULTADOS Y DISCUSIÓN: Se identificaron 571 artículos, y finalmente se incluyeron 22 estudios. Se encontró que las intervenciones más prometedoras fueron las combinadas. La duración, la participación de los padres, el sexo y nivel socioeconómico pueden influir en la efectividad de las intervenciones. Se observó una escasez de intervenciones teóricamente fundamentadas. CONCLUSIONES: Las intervenciones con mejores resultados son las combinadas, con actividades incluidas en el currículo y la participación de los padres. Las intervenciones a largo plazo parecen tener mejores resultados. Estos programas ayudan a la adquisición de hábitos saludables y existe cierta evidencia de que son útiles en la disminución del Índice de Masa Corporal (IMC) o en la prevención de la obesidad infantil

INTRODUCTION: Educational interventions in the school environment seem the most effective way to act against childhood obesity. The objectives of this systematic review were to describe the educational interventions on nutrition and / or physical activity carried out in primary school students in order to reduce or prevent childhood obesity and analyze the effectiveness of these interventions. METHODOLOGY: A bibliographic search was carried out in the WOS and SCOPUS databases. Eligibility criteria were established based on the acronym PICOS: (P) primary school children (6-12 years), (I) studies that will carry out nutrition and / or physical activity interventions in the school setting, (C) not receive any intervention, (O) evaluate the effect of educational programs on childhood obesity, (S) experimental studies, published between 2013 and 2017. RESULTS AND DISCUSSION: 571 articles were identified, and finally 22 studies were included. It was found that the most promising interventions were the combined ones. Duration, parental involvement, gender and socioeconomic status can influence the effectiveness of interventions. A shortage of theoretically based interventions was observed. CONCLUSIONS: The interventions with the best results are the combined ones, with activities included in the curriculum and the participation of the parents. Long-term interventions seem to have better results. These programs help the acquisition of healthy habits and there is some evidence that they are useful in decreasing the Body Mass Index (BMI) or in the prevention of childhood obesity

An outpatient nursing nutritional intervention to prehabilitate undernourished patients planned for surgery: A multicentre, cluster-randomised pilot study.

BACKGROUND & AIMS: To improve the nutritional status of surgical patients before hospital admission, an Outpatient Nursing Nutritional Intervention (ONNI) was developed. The ONNI comprehends five components: determining causes of undernutrition, performing a nutritional care plan including tailored and general advice, self-monitoring of nutritional intake and eating patterns, counselling and encouragement, and conducting a follow-up telephone call to discuss improvements in nutritional behaviour. Here, we evaluate the feasibility and effectiveness of the ONNI. METHODS: In a multi-centred, cluster-randomised pilot study, nurses from outpatient clinics were randomly allocated to usual care (UC) or the ONNI. Patients planned for elective surgery were included if they were at increased risk for undernutrition based on the Malnutrition Universal Screening Tool (MUST) and hospital admission was not planned within seven days. Feasibility outcomes included participation rate, extent of intervention delivery, and patient satisfaction. Nutritional intake was monitored for two days before admission. Body weight, BMI and MUST scores at hospital admission were compared to measurements from the outpatient clinic visit. Data were analysed on an intention-to-treat basis by researchers who were blinded for patients and caregivers. RESULTS: Forty-eight patients enrolled the feasibility phase. Participation rate was 72%. Nurses delivered all intervention components adequately in the end of the implementation period. Finally, 152 patients (IG: n = 66, 43%) participated in the study. A significant difference in mean energy intake (870 kcal/d, 95%CI:630-1109 p < 0.000) and mean protein intake (34.1 g/d, 95%CI: 25.0-43.2; p < 0.000) was observed in favour of the IG. Nutritional energy requirements were achieved in 74% (n = 46) of the IG and in 17% (n = 13) of the UC group (p < 0.000), and protein requirements were achieved in 52% (n = 32) of the IG, compared to 8% (n = 6) of the UC group (p < 0.000). Body weight, BMI and MUST scores did not change in either group. CONCLUSIONS: The ONNI is a feasible and effective intervention tool for nurses at outpatient clinics. Patients in the IG had more nutritional intake and fulfilled nutritional requirements significantly more often than patients receiving UC. Further research is required to determine the optimal pre-operative timing of nutritional support and to measure its effect on other patients groups. CLINICAL TRIAL REGISTRATION: The study protocol was registered at the ClinicalTrial.gov website with the following identifier: NCT02440165.

Fundamental nursing care: A systematic review of the evidence on the effect of nursing care interventions for nutrition, elimination, mobility and hygiene.

AIMS AND OBJECTIVES: To determine the effects of nursing interventions for people's nutrition, elimination, mobility and hygiene needs. BACKGROUND: Patient experience of health care is sensitive to nursing quality. A refocus on fundamental nursing care is undermined by lack of evidence of effectiveness for interventions in core areas such as elimination, nutrition, mobility and hygiene. DESIGN: Systematic review. METHODS: We searched for and included experimental studies on interventions by professionally qualified and unregistered nurses that addressed participants' nutrition, elimination, mobility and hygiene needs. We extracted data on scope, quality and results of studies followed by descriptive narrative synthesis of included study outcomes using a novel form of harvest plots. RESULTS: We included 149 studies, 35 nutrition, 56 elimination, 16 mobility, 39 hygiene and three addressing two or more areas simultaneously (67 randomised controlled trials, 32 non-randomised controlled trials and 50 uncontrolled trials). Studies into interventions on participant self-management of nutrition (n = 25), oral health (n = 26), catheter care (n = 23) and self-management of elimination (n = 21) were the most prevalent. Most studies focussed their outcomes on observational or physiological measures, with very few collecting patient-reported outcomes, such as quality of life, experience or self-reported symptoms. All but 13 studies were of low quality and at significant risk of bias. The majority of studies did not define primary outcomes, included multiple measures of identical concepts, used inappropriate analyses and did not conform to standard reporting quality criteria. CONCLUSIONS: The current evidence for fundamental nursing care interventions is sparse, of poor quality and unfit to provide evidence-based guidance to practising nurses. RELEVANCE TO CLINICAL PRACTICE: Researchers in nursing internationally should now undertake a programme of work to produce evidence for clinical practice in the fundamentals of care that is reliable, replicable and robust.

Propuesta de nueva etiqueta diagnóstica: riesgo de estado nutricional deficiente / Proposal of new nursing diagnosis label: risk of deficient nutritional status

Son diversas las patologías y las etapas de la vida en las que las necesidades nutricionales del organismo se ven modificadas, siendo necesario prestar especial atención a los requerimientos de nutrientes y a su ingesta para evitar potenciales estados de desnutrición. Ante un estado nutricional que se pueda ver comprometido, la enfermera ha de tener las herramientas metodológicas adecuadas para nominar y clasificar dicho estado de manera que pueda tratarse con premura y de manera correcta. Por ello es conveniente un diagnóstico de enfermería que permita abordar aquellas situaciones en las que aún no se haya alcanzado el grado de desnutrición, pero sí exista un riesgo para el estado nutricional. Puesto que actualmente no existe un diagnóstico en la NANDA-I con el que enfrentarse a estas situaciones, se ha realizado una búsqueda bibliográfica que ha permitido elaborar una etiqueta diag nóstica que identifique estados nutricionales en riesgo de ser deficitarios con el tiempo suficiente para actuar en consecuencia. De esta manera, el objetivo del presente trabajo es describir las fases en las que se ha desarrollado la etiqueta diagnóstica Riesgo de estado nutricional deficiente para su propuesta de inclusión en la taxonomía NANDA-I (AU)

There are several pathologies and stages of life where the nutritional needs of the organism are modified, being necessary to focus on nutrient requirements and its intake to prevent potential states of malnutrition. When a nutritional status is compromised, the nurse must have the appropriate methodological tools to nominate and classify that state so that it could be treated with urgency and correctly. Therefore, it is advisable a nursing diagnosis that can address those situations that have not reached yet the degree of malnutrition, but there is a risk to nutritional status. Because there is not currently a diagnosis in NANDA-I to deal with these situations, we have performed a literature search to develop a diagnostic label to identify nutritional status at risk for being deficient in time to act accordingly. Thus, the objective of this paper is to describe the phases in which we have developed the diagnostic label Risk of deficient nutritional status for its proposed inclusion in the NANDA-I taxonomy (AU)

Identifying malnutrition: From acute care to discharge and beyond.

Nutrition assessment and intervention significantly contribute to the well-being of patients. NPs should advocate that patients be appropriately evaluated and implement recommendations as part of a comprehensive care plan to avoid malnutrition in patients while they are in the hospital and when they return home.

Evaluation of the effect of an intervention on the nutritional status of hospitalized patients. / Evaluación del efecto de una intervención en el estado nutricional de pacientes hospitalizados.

BACKGROUND AND OBJECTIVES: To compare the nutritional status of a population of hospitalized patients, divided into 2 different groups, both at admission and hospital discharge, and to assess the influence of nutritional alteration during the hospital stay. MATERIAL AND METHODS: Quasi-experimental study comprising 2 groups of patients (N=581); an intervention group (n=303), in which nurses received specific training on managing care methodology, and a control group (n=278), in which nurses continued their usual dynamics. Each group was made up of 2 care units with patients from both surgical and medical specialties. INCLUSION CRITERIA: patients admitted to the selected units with a minimum stay of 5 days. The sample selection was performed prospectively and consecutively after implementing the training. RESULTS: Of the 581 patients studied, 49.4% were women and 50.6% were men. Mean patient age was 68.29 (SD 16.23) years. In the intervention group, the odds ratio (OR) associated with good nutritional status was multiplied by 1.7 (OR=1.67) compared to the control group in the first evaluation and by 1.4 times (OR=1.43) at hospital discharge. The average stay in days was higher in the control group (13.71, SD 10.19) than in the intervention group (10.89, SD 7.49) (P<.001). CONCLUSION: The systematic methodology-based intervention in the chosen units was positive. Patients admitted to the intervention units had a lower nutritional alteration and a shorter hospital stay than those admitted to the control units.

[Organising nutritional support for patients with anorexia]. / Organiser l'accompagnement alimentaire de l'anorexie.

Nutritional care in the Eating Disorder unit of Sainte-Anne general hospital in Paris, is organised around a care model based on cognitive behavioural therapy. Hospitalisation is generally prepared beforehand and aims to draw on patients' resources enabling them to clarify a request for help. A care contract can be drawn up to provide step-by-step support for the patient in terms of the goals to achieve.

Valoración del estado nutricional y consumo alimentario de los pacientes en terapia renal sustitutiva mediante hemodiálisis / Assessment of nutritional status and food intake of patients in renal replacement therapy with hemodialysis

Introducción: La malnutrición proteico-energética es un hecho frecuente entre los pacientes en tratamiento sustitutivo renal con hemodiálisis y a ello contribuye, además de la propia técnica dialítica, la dieta inadecuada. Objetivos: Valorar la evolución del estado nutricional y la ingesta alimentaria de los pacientes de 3 unidades de hemodiálisis extrahospitalaria, tras una intervención enfermera educativa. Pacientes y métodos: Hemos realizado un estudio transversal en 66 pacientes de 3 unidades extrahospitalarias (44 hombres y 23 mujeres) con dosis de diálisis medida por KT/V > 1,3 .Se hizo una determinación del estado nutricional por métodos convencionales y del consumo alimentario mediante encuesta dietética, determinándose mediante soporte informático el índice de alimentación saludable, identificando los déficits y/o excesos de nutrientes en cada paciente. Se llevaron a cabo intervenciones educativas personalizadas dirigidas a corregir los excesos o déficits de nutrientes detectados en los pacientes, y se volvieron a hacer las mismas valoraciones a los seis meses. Resultados: La prevalencia de desnutrición es leve en el 41% de hombres y 43% de las mujeres y moderada en el 34% de los hombres y 21% de las mujeres. El índice de alimentación saludable era inadecuado en el 37,31% de los pacientes en el análisis basal y postintervención educativa paso al 18,8%. La ingesta media energética es elevada (1398.86 Kcal/paciente/día) con alto consumo de colesterol y déficit de aminoácidos. Se detectó un alto consumo de hidratos de carbono simples (> 20%) y un elevado uso de proteínas de origen animal. El contenido mineral y vitamínico de la dieta es muy deficiente, destacando el bajo consumo de Vitamina D (1.45±2.55 ng) y elevado de fósforo (1052.28±356.23 m/día). Conclusion: Tras una intervención educativa sobre nuestros pacientes, corrigiendo hábitos dietéticos no saludables, hemos conseguido mejorar su estado nutricional, reduciendo la prevalencia de desnutrición en nuestras unidades (AU)

Introduction: Protein-energy malnutrition is a common occurrence among patients on renal replacement therapy with hemodialysis and this in addition to the dialysis technique itself, improper diet contributes. Objective: Assess the evolution of nutritional status and food intake of patients from 3 outpatient hemodialysis units, after an educational nurse intervention. Methods: We conducted a cross-sectional study in 66 outpatient units from 3 patients (44 men and 23 women) with dialysis dose measured by Kt / V> 1.3. It was made a determination of nutritional status by conventional methods and food consumption by a diet questionnaire, determining by computer support the healthy eating index, identifying deficits and / or excess nutrients in each patient.Customized educational interventions designed to correct the excesses or deficiencies of nutrients detected in patients were carried out. The same assessments were made at six months. Results: The prevalence of malnutrition was mild in 41% of men and 43% of women and moderate in 34% of men and 21% of women. The healthy eating index was inadequate in 37.31% of patients at baseline but after the educational intervention was 18.8%. The average energy intake was high (1398.86 Kcal / patient / day) with high intake of cholesterol and amino acid deficiency. A high intake of simple carbohydrates (> 20%) and a high use of animal protein were detected. The mineral and vitamin content of the diet was very poor, highlighting the low consumption of vitamin D (1.45 ± 2.55 ng) and high phosphorus (1052.28 ± 356.23 m / day). Conclusion: After an educational intervention on our patients, correcting unhealthy dietary habits, we managed to improve their nutritional status, reducing the prevalence of malnutrition in our units (AU)

Nutritional support of the elderly cancer patient: the role of the nurse.

Cancer in the geriatric population is a growing problem. Malnutrition is common in cancer. A number of factors increase the risk for malnutrition in older people with cancer, including chronic comorbid conditions and normal physiological changes of aging. Nurses have an important role in the nutritional support of older cancer patients. To contribute to the improvement of nutritional support of these patients, nurses need appropriate training to be able to identify risk for malnutrition and offer a range of interventions tailored to individual need. Factors to consider in tailoring interventions include disease status, cancer site, cancer treatment, comorbidity, physiological age, method of facilitating dietary change, and family support. This article identifies ways in which nurses can contribute to the nutritional support of older cancer patients and thus help mitigate the effects of malnutrition.

The self-perceived knowledge, skills and attitudes of Australian practice nurses in providing nutrition care to patients with chronic disease.

BACKGROUND: Nutrition is important for the management of chronic diseases. While practice nurses have numerous roles in primary care, the expectations on practice nurses to provide nutrition care for chronic disease management are increasing. The self-perceived knowledge, skills and attitudes of practice nurses in providing nutrition care has not been widely investigated. OBJECTIVES: The aim of the present study was to investigate the perceptions of Australian practice nurses on the provision of nutrition care for chronic disease management, including specific nutrition-related activities. METHODS: A cross-sectional online survey was completed by 181 Australian practice nurses in 2013. Descriptive analyses were conducted on each survey item. The survey sample was tested for representation of the Australian practice nurse workforce, and associations between respondents' demographic characteristics and responses to survey items were explored. RESULTS: Almost all practice nurses (89%) felt it was important to address diet whenever they cared for a patient. Over half of practice nurses (61%) were unsure if their practices were effective in increasing patients' compliance with nutritional recommendations. Nearly all practice nurses (98%) perceived further education on nutrition would assist them in their role. CONCLUSION: Practice nurses perceive they have an important role and favourable attitudes towards providing nutrition care; however, further training and education to enhance their self-perceived effectiveness is warranted. Future research should clarify whether an increase in nutrition-focused training results in improved effectiveness of nutrition care provided by practice nurses in terms of patient health outcomes.