1
|
Mattila E, Heikkilä P, Harju E, Kortteisto T, Kaunonen M, Sorsa M, Haavisto E. The Effectiveness of Nursing Interventions in Hospital: An Umbrella Review. J Clin Nurs 2025; 34:2047-2066. [PMID: 40183304 DOI: 10.1111/jocn.17766] [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: 10/14/2024] [Revised: 02/22/2025] [Accepted: 03/25/2025] [Indexed: 04/05/2025]
Abstract
AIM The aim of this umbrella review was to summarise the existing evidence on the effectiveness of nursing interventions targeted at adult patients in hospitals. DESIGN Existing systematic reviews were synthesised. DATA SOURCES The literature search was conducted in PubMed, CINAHL Complete, and the Cochrane Library by two of the authors until June 6th 2024 without a time limit. METHODS A total of 2652 records were identified. After screening the titles and abstracts, 2421 records were excluded. Then two records were excluded as they were not retrieved, and 125 records were excluded during full-text review as they did not meet the inclusion criteria. Finally, 11 reviews (141 original studies) were included in the quality assessment and were analysed narratively. RESULTS The most commonly used interventions were educational, followed by preventive, observative, or combinations of various interventions. All interventions were targeted at the care of somatic patients. The interventions lacked detailed descriptions of their content and duration. Nursing interventions were found to reduce anxiety, depression, disorder symptoms, pain intensity, length of hospital stay, serious adverse effects, mortality, infections and pressure ulcer prevalence. CONCLUSIONS There is limited high-quality evidence on the effectiveness of nursing interventions used by nurses at hospital settings. While nursing interventions can improve hospital patient outcomes, more high-quality systematic reviews and meta-analyses are needed. Only preventive interventions (such as pressure ulcer prevention and use of early warning scores) consistently showed positive effects and are relatively easy to implement in hospital nursing practice. Other interventions are not yet widely integrated into standard care in hospitals. It is necessary to study the cost-effectiveness of nursing interventions. NO PATIENT OR PUBLIC CONTRIBUTIONS This umbrella review did not include any patient or public involvement. REPORTING METHOD This umbrella review of systematic reviews adheres to the PRISMA statement.
Collapse
Affiliation(s)
- Elina Mattila
- Tampere University Hospital, General Administration, The Wellbeing Services County of Pirkanmaa, Tampere, Finland
| | - Paula Heikkilä
- Division of Oncology, Surgery and Gastroenterology, Tampere University Hospital, The Wellbeing Services County of Pirkanmaa, Tampere, Finland
- Tampere Center for Child, Adolescent and Maternal Health Research, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Eeva Harju
- Division of Oncology, Surgery and Gastroenterology, Tampere University Hospital, The Wellbeing Services County of Pirkanmaa, Tampere, Finland
- Health Sciences (Nursing), Faculty of Social Sciences, Tampere University, Tampere, Finland
| | - Tiina Kortteisto
- Tampere University Hospital, General Administration, The Wellbeing Services County of Pirkanmaa, Tampere, Finland
| | - Marja Kaunonen
- Tampere University Hospital, General Administration, The Wellbeing Services County of Pirkanmaa, Tampere, Finland
- Health Sciences (Nursing), Faculty of Social Sciences, Tampere University, Tampere, Finland
| | - Minna Sorsa
- Health Sciences (Social Psychiatry), Faculty of Social Sciences, Tampere University, Tampere, Finland
- Child Psychiatry, The Wellbeing Services County of Pirkanmaa, Tampere, Finland
| | - Elina Haavisto
- Tampere University Hospital, General Administration, The Wellbeing Services County of Pirkanmaa, Tampere, Finland
- Health Sciences (Social Psychiatry), Faculty of Social Sciences, Tampere University, Tampere, Finland
| |
Collapse
|
2
|
Lu P, Yang S, Shi Y, Wang N, Ding B, Liu W, Zhang P, Rong L, Bian D. Influencing factors on nutritional knowledge, attitudes, and practices among nursing assistants in nursing homes. BMC Nurs 2024; 23:886. [PMID: 39633395 PMCID: PMC11616342 DOI: 10.1186/s12912-024-02553-0] [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: 09/02/2024] [Accepted: 11/25/2024] [Indexed: 12/07/2024] Open
Abstract
BACKGROUND The nutritional status of older adults requires focused attention. In Chinese nursing homes, nursing assistants are often the primary caregivers responsible for the daily care of older adults, and their knowledge and attitudes toward nutrition play a fundamental role in providing adequate nutritional care. However, research on the knowledge and attitudes of nursing assistants is limited, despite the fact that these factors play a fundamental role in providing adequate nutritional practices. OBJECTIVE The aim of this study is to investigate the knowledge, attitudes, and practices (KAP) of nursing assistants in nursing homes and to analyze the influencing factors. METHOD This cross-sectional study was conducted from January to September 2023, involving 692 nursing assistants from 76 nursing homes in Shanghai. We used validated Nutrition Knowledge, Attitude, and Practice Questionnaire for nursing assistants. RESULTS The findings indicated that the mean scores for nutritional knowledge, attitudes, and practices were 45.07 ± 16.18, 76.22 ± 10.03, and 69.94 ± 21.46, respectively. Notably, the mean score for nutritional knowledge was the lowest, with 66.04% of nursing assistants scored below 50% accuracy. A significant negative correlation was observed between nutritional knowledge and practices (r=-0.194, p < 0.001), while a positive correlation was found between attitudes and practices (r = 0.422, p < 0.001). Key predictors of higher nutritional knowledge included education level (B = 3.907, p < 0.001), whereas skill deficiency (B=-3.714, p = 0.006), years of caring (B=-2.789, p < 0.001) and regular supervision (B=-3.422, p = 0.018) were negatively associated. Positive nutritional attitudes were associated with higher education (B = 2.453, p < 0.001), years of caring (B = 1.177, p < 0.001), and participation in nutrition training (B = 4.138, p < 0.001). Nutritional practices were positively influenced by age (B = 3.068, p = 0.002), participation in nutrition training (B = 11.474, p < 0.001) and regular supervision (B = 14.597, p < 0.001), but negatively affected by insufficient income (B=-3.189, p = 0.030). CONCLUSION This study reveals a significant deficiency in nutritional knowledge among nursing assistants in Shanghai's nursing homes, which adversely impacts their nutritional practices. The findings underscore the urgent need for enhanced training programs and to improve the nutritional competencies of nursing assistants. By addressing these gaps through targeted education and consistent supervision, the quality of nutritional care provided to older adults in nursing homes can be substantially improved.
Collapse
Affiliation(s)
- Ping Lu
- Shanghai Pudong New Area Jinyang Community Health Service Center, Shanghai, China
| | - Shihan Yang
- Department of Clinical Nutrition, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yushuang Shi
- Shanghai Pudong New Area Jinyang Community Health Service Center, Shanghai, China
| | - Na Wang
- Shanghai Pudong New Area Jinyang Community Health Service Center, Shanghai, China
| | - Beijing Ding
- Shanghai Pudong New Area Jinyang Community Health Service Center, Shanghai, China
| | - Weijie Liu
- Shanghai Pudong New Area Jinyang Community Health Service Center, Shanghai, China
| | - Pei Zhang
- Shanghai Pudong New Area Jinyang Community Health Service Center, Shanghai, China.
| | - Lan Rong
- Department of Geriatrics, Medical Center on Aging of Shanghai Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
| | - Dongsheng Bian
- Department of Clinical Nutrition, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
| |
Collapse
|
3
|
Olsson Haave R, Nakrem S, Melby L. Healthcare professionals' experience with nutritional care beyond formal quality systems - A qualitative study. Int J Nurs Stud 2024; 160:104860. [PMID: 39353803 DOI: 10.1016/j.ijnurstu.2024.104860] [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: 12/12/2023] [Revised: 05/01/2024] [Accepted: 07/04/2024] [Indexed: 10/04/2024]
Abstract
BACKGROUND Numerous formal strategies, screening tools, and interventions have been used to prevent malnutrition in long-term care patients. Despite these efforts, the proportion of screened patients is low, and a large proportion are malnourished. Previous research has revealed that healthcare professionals use a broad approach in their nutritional care but has also emphasised the need for further investigation into these approaches. OBJECTIVE To explore how healthcare professionals working in long-term care experience and apply nutritional care. DESIGN A descriptive, exploratory, qualitative design containing 240 h of participant observation, 12 focus groups and 2 individual interviews. SETTING(S) Twelve nursing homes and home care units in three Norwegian municipalities. PARTICIPANTS Participant observation of interactions between healthcare professionals and patients. Forty-three registered nurses participated in focus group or individual interviews. METHODS The data were analysed using inductive thematic analysis. RESULTS The analysis identified three themes: The first theme, limited significance of nutritional screening, showed that healthcare professionals experienced the limited value of nutritional screening, as it often did not capture patients' nutritional challenges. They also perceived nutritional screening as unsuitable for patients at the end of their lives, those with overweight-related complications, or undergoing rehabilitation. In addition, nutritional screening was perceived as something healthcare professionals did for their managers or administrators, not because it was crucial to providing good nutritional care. The second theme, provision of individualised food, captures the healthcare professionals' efforts in adapting and preparing food according to the patient's preferences. Facilitation to enable patients to make individual food choices and the use of food cards or lists were two approaches to individualising nutrition care. The third theme, making meals more than about food, elucidated how healthcare professionals used meals to help patients cope with their situations and experience social belonging. Conversations about or around meals were used to provide patients with a sense of belonging to their past or present situation. The meals were also used as a diversion strategy for patients with unrest, as arenas for daily activity training, and for meaningful social interactions between patients around the tables. CONCLUSIONS Nutritional screening and prevention of malnutrition are only one part of healthcare professionals' nutritional care. Individualised food and meals that create coping, a sense of belonging, and social experiences are equally important parts of their care. Emphasising healthcare professional's person-centred approach to nutritional care would be beneficial, as it could strengthen and further develop long-term nutritional care services.
Collapse
Affiliation(s)
- Randi Olsson Haave
- Centre for Care Research, Department of Health Science in Gjøvik, Faculty of Medicine and Health Science, NTNU - Norwegian University of Science and Technology, Gjøvik, Norway.
| | - Sigrid Nakrem
- Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, NTNU - Norwegian University of Science and Technology, Trondheim, Norway
| | - Line Melby
- Centre for Care Research, Department of Health Science in Gjøvik, Faculty of Medicine and Health Science, NTNU - Norwegian University of Science and Technology, Gjøvik, Norway; SINTEF Digital, Dept. of Health Research, Trondheim, Norway
| |
Collapse
|
4
|
Welch C, Chen Y, Hartley P, Naughton C, Martinez-Velilla N, Stein D, Romero-Ortuno R. New horizons in hospital-associated deconditioning: a global condition of body and mind. Age Ageing 2024; 53:afae241. [PMID: 39497271 PMCID: PMC11534583 DOI: 10.1093/ageing/afae241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2024] [Indexed: 11/08/2024] Open
Abstract
Hospital-associated deconditioning is a broad term, which refers non-specifically to declines in any function of the body secondary to hospitalisation. Older people, particularly those living with frailty, are known to be at greatest risk. It has historically been most commonly used as a term to describe declines in muscle mass and function (i.e. acute sarcopenia). However, declines in physical function do not occur in isolation, and it is recognised that cognitive deconditioning (defined by delayed mental processing as part of a spectrum with fulminant delirium at one end) is commonly encountered by patients in hospital. Whilst the term 'deconditioning' is descriptive, it perhaps leads to under-emphasis on the inherent organ dysfunction that is associated, and also implies some ease of reversibility. Whilst deconditioning may be reversible with early intervention strategies, the long-term effects can be devastating. In this article, we summarise the most recent research on this topic including new promising interventions and describe our recommendations for implementation of tools such as the Frailty Care Bundle.
Collapse
Affiliation(s)
- Carly Welch
- Department of Twin Research & Genetic Epidemiology, King’s College London, St Thomas’ Campus, 3rd & 4th Floor South Wing Block D, Westminster Bridge Road, London SE1 7EH, UK
- Department of Ageing and Health, Guy’s and St Thomas’ NHS Foundation Trust, St Thomas’ Hospital, 9th Floor North Wing, Westminster Bridge Road, London SE1 7EH, UK
| | - Yaohua Chen
- Univ Lille, CHU Lille, U1172, Degenerative and Vascular Cognitive Disorders, Department of Geriatrics, Lille, France
- Global Brain Health Institute, Trinity College Dublin, Dublin 2, Ireland
| | - Peter Hartley
- Department of Physiotherapy, Cambridge University Hospital NHS Foundation Trust, Cambridge CB2 0QQ, UK
- Department of Public Health and Primary Care, University of Cambridge, Cambridge CB2 0SZ, UK
| | - Corina Naughton
- University College Dublin, School of Nursing Midwifery and Health Systems, Health Sciences Centre Belfield, Dublin 4, Ireland
| | - Nicolas Martinez-Velilla
- Navarre Health Service (SNS-O), Navarre University Hospital (HUN), Department of Geriatrics, Navarrabiomed, Navarre Public University (UPNA), Navarra Institute for Health Research (IdiSNA), Pamplona, Spain
| | - Dan Stein
- Department of Twin Research & Genetic Epidemiology, King’s College London, St Thomas’ Campus, 3rd & 4th Floor South Wing Block D, Westminster Bridge Road, London SE1 7EH, UK
- Department of Ageing and Health, Guy’s and St Thomas’ NHS Foundation Trust, St Thomas’ Hospital, 9th Floor North Wing, Westminster Bridge Road, London SE1 7EH, UK
| | - Roman Romero-Ortuno
- Global Brain Health Institute, Trinity College Dublin, Dublin 2, Ireland
- Discipline of Medical Gerontology, School of Medicine, Trinity College Dublin, Dublin 2, Ireland
| |
Collapse
|
5
|
Isaia G, Presta R, Brunetti E, Cacciatore CM, Carbonara F, Berardo E, Villosio C, Cicerchia F, Mulatero P, Bo S, Bo M. Nutritional screening on hospital admission and one-year clinical outcomes in a prospective cohort of older patients. Clin Nutr ESPEN 2024; 64:221-228. [PMID: 39396703 DOI: 10.1016/j.clnesp.2024.10.006] [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: 09/02/2024] [Revised: 10/07/2024] [Accepted: 10/08/2024] [Indexed: 10/15/2024]
Abstract
BACKGROUND & AIMS Malnutrition negatively affects the prognosis and quality of life of hospitalized patients. However, there are several gaps between evidence-based knowledge and current clinical practice. Our primary aim was to describe the prevalence of malnutrition risk in a cohort of in a cohort of older inpatients; secondly, we explored its predictors and its independent impact on 12-month survival. METHODS Prospective study focused on patients aged 65 years and older consecutively admitted for any reason to the acute geriatric and general medical units of an Italian university hospital. Comprehensive geriatric assessment data, including the short form of the Mini Nutritional Assessment (MNA-SF), were collected within 48 hours of admission. The prevalence of malnutrition and risk of malnutrition according to the MNA-SF represented the main outcome. Correlations among clinical variables, nutritional status, and one-year survival were analyzed using multivariable and Cox models. RESULTS Among 594 patients (median age: 84 years, 49.5 % female), mostly living at home with moderate functional autonomy, 82.3 % were identified as probably malnourished or at risk of malnutrition according to MNA-SF (39.9 % and 42.4 %, respectively). Malnutrition and the risk of malnutrition were positively associated with living alone at home (OR 2.803, 95%CI 1.567-5.177, p < 0.001), and negatively associated with autonomy in IADL (OR 0.765, 95%CI 0.688-0.846, p < 0.001) and the best performance at HST (OR 0.901, 95%CI 0.865-0.936; p < 0.001). After 12 months, 31.8 % of patients was dead and mortality was positively correlated with malnutrition according to MNA-SF (OR 2.493, 95%CI 1.345-4.751, p = 0.004), institutionalization (OR 2.815, 95%CI 1.423-5.693, p = 0.003) and severe cognitive impairment (OR 1.701, 95%CI 1.031-2.803, p = 0.036). CONCLUSION Malnutrition is common among older inpatients upon admission, primarily influenced by their functional and cognitive status, and it is linked to a worse prognosis. Early incorporation of thorough nutritional and functional assessments into clinical practice is crucial to improve prognosis prediction and enable timely, focused interventions targeting modifiable causal factors in a patient-centered approach.
Collapse
Affiliation(s)
- Gianluca Isaia
- Section of Geriatrics, Department of General and Specialistic Medicine, Città della Salute e della Scienza University Hospital, Turin, Italy.
| | - Roberto Presta
- Section of Geriatrics, Department of General and Specialistic Medicine, Città della Salute e della Scienza University Hospital, Turin, Italy; Department of Medical Sciences, University of Turin, Turin, Italy.
| | - Enrico Brunetti
- Section of Geriatrics, Department of General and Specialistic Medicine, Città della Salute e della Scienza University Hospital, Turin, Italy; Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy.
| | - Clelia Maria Cacciatore
- Section of Geriatrics, Department of General and Specialistic Medicine, Città della Salute e della Scienza University Hospital, Turin, Italy; Department of Medical Sciences, University of Turin, Turin, Italy.
| | - Francesca Carbonara
- Section of Geriatrics, Department of General and Specialistic Medicine, Città della Salute e della Scienza University Hospital, Turin, Italy; Department of Medical Sciences, University of Turin, Turin, Italy.
| | - Eleonora Berardo
- Section of Geriatrics, Department of General and Specialistic Medicine, Città della Salute e della Scienza University Hospital, Turin, Italy; Department of Medical Sciences, University of Turin, Turin, Italy.
| | - Cristina Villosio
- Section of Geriatrics, Department of General and Specialistic Medicine, Città della Salute e della Scienza University Hospital, Turin, Italy; Department of Medical Sciences, University of Turin, Turin, Italy.
| | - Francesca Cicerchia
- Department of Medical Sciences, University of Turin, Turin, Italy; Section of Internal Medicine 3, Department of General and Specialistic Medicine, Città della Salute e della Scienza University Hospital, Turin, Italy.
| | - Paolo Mulatero
- Department of Medical Sciences, University of Turin, Turin, Italy; Section of Internal Medicine 3, Department of General and Specialistic Medicine, Città della Salute e della Scienza University Hospital, Turin, Italy.
| | - Simona Bo
- Department of Medical Sciences, University of Turin, Turin, Italy; Section of Dietetic and Clinical Nutrition, Department of General and Specialistic Medicine, Città della Salute e della Scienza University Hospital, Turin, Italy.
| | - Mario Bo
- Section of Geriatrics, Department of General and Specialistic Medicine, Città della Salute e della Scienza University Hospital, Turin, Italy; Department of Medical Sciences, University of Turin, Turin, Italy.
| |
Collapse
|
6
|
Hu B, Chen S. Nutritional support for long-term hospitalized patients: Expanding research and multidisciplinary intervention. Clin Nutr 2024; 43:1852-1853. [PMID: 38959662 DOI: 10.1016/j.clnu.2024.06.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2024] [Accepted: 06/26/2024] [Indexed: 07/05/2024]
Affiliation(s)
- Bin Hu
- Department of Geriatrics, Beilun District People's Hospital, Ningbo 315800, China
| | - Shiyuan Chen
- Department of Geriatrics, Beilun District People's Hospital, Ningbo 315800, China.
| |
Collapse
|
7
|
Peng Y, Tan L, Zhang K, Zhu N, Dong H, Gao H. The mediating role of nutritional care literacy on the relationship between self-directed learning ability and nursing competence. BMC Nurs 2024; 23:513. [PMID: 39075450 PMCID: PMC11287925 DOI: 10.1186/s12912-024-02185-4] [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: 02/06/2024] [Accepted: 07/16/2024] [Indexed: 07/31/2024] Open
Abstract
BACKGROUND Nurses' nursing competence and nutritional care literacy directly affect patients' health and safety. Self-directed learning ability was pervasive throughout the entire work process of nursing work and was the basis for improving both. However, there are few studies has explored the mechanism from the perspective of nutritional care literacy. The purpose of this study was to analyze the relationship between self-directed learning ability and nursing competence, and to explore the mediating role of nutritional care literacy between self-directed learning and nursing competence among clinical nurses in China. METHODS A cross-sectional survey was conducted among 805 clinical nurses recruited from seven general hospitals in Hunan Province, China, between January 25 and March 6, 2022. The self-directed learning ability, nutritional care literacy and nursing competence of nurses were evaluated through investigation. A total of 799 questionnaires were received, resulting in an response rate of 99.25%.We performed an intermediary modeling to examine the mediating roles of nutritional care literacy on the relationship between self-directed learning ability and nursing competence in clinical nurses. RESULTS Self-directed learning ability was positively correlated with nutritional care literacy (r=0.792, P<0.001) and nursing competence (r=0.696, P<0.001). Nutritional care literacy was positively correlated with nursing competence (r=0.658, P<0.001). Nutritional care literacy mediated the relationship between self-directed learning ability and nursing competence. The mediating effect accounted for 32.48% of the total effect and 48.10% of the direct effect . CONCLUSIONS This study confirmed the positive correlation between self-directed learning ability, nutritional care literacy, and nursing competence. Nutritional care literacy played a mediating role in the relationship between self-directed learning ability and nursing competence. The findings not only provide a novel strategy for cultivating nursing professionals and improving nurse disease care abilities, but also offer a new perspective for nursing educators and managers.
Collapse
Affiliation(s)
- Yanhong Peng
- Department of Nursing, The Second Affiliated Hospital, Hengyang Medical School, University of South China, Hengyang, China
| | - Lingling Tan
- Department of Nursing, The Second Affiliated Hospital, Hengyang Medical School, University of South China, Hengyang, China
| | - Ke Zhang
- School of Nursing, University of South China, Hengyang, China
| | - Na Zhu
- Department of Nursing, The Second Affiliated Hospital, Hengyang Medical School, University of South China, Hengyang, China
| | - Hongjian Dong
- Department of Nursing, The Second Affiliated Hospital, Hengyang Medical School, University of South China, Hengyang, China.
| | - Hong Gao
- Department of Nursing, The Second Affiliated Hospital, Hengyang Medical School, University of South China, Hengyang, China.
| |
Collapse
|
8
|
Mancin S, Stallone P, Siro V, Pastore M, Cattani D, Lopane D, Dacomi A, Tartaglia FC, Bellone A, Serazzi F, Laffoucriere G, Coldani C, Tomaiuolo G, Mazzoleni B. Validating nasogastric tube placement with pH testing: A randomized controlled trial protocol. Contemp Clin Trials Commun 2024; 39:101312. [PMID: 38845620 PMCID: PMC11153049 DOI: 10.1016/j.conctc.2024.101312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Accepted: 05/21/2024] [Indexed: 06/09/2024] Open
Abstract
Background Enteral nutrition (EN) is preferred when oral feeding is not possible. The use of the Nasogastric Tube (NGT) ensures rapid and low-risk nutrient administration. However, confirming the placement through chest radiography, besides delaying the initiation of nutritional therapy, exposes patients to radiation. The pH test of gastric aspirate provides a quicker check for NGT placement, but its reliability is compromised by challenges related to aspirating gastric secretions. Study objective The main objective of this study is to assess the high-performance placement of NGTs for nutritional purposes, optimizing the evaluation of correct insertion through pH testing using an electronic pH meter. Additionally, the study aims to evaluate patient tolerance to the intervention. Materials and methods This single-center RCT will include 150 EN candidate patients divided into three groups. Each group will use distinct NGTs, evaluating placement through pH testing and chest radiography for safety. Tolerance, complications related to NGT placement, and costs will be assessed, with data collected anonymously through a secure electronic database. Ethical considerations authorization no. 3624, Territorial Ethical Committee Lombardy 5, October 20, 2023. Implications and perspectives This protocol introduces innovative technologies, such as advanced NGTs and an electronic pH meter, aiming to optimize enteral nutrition management. This RCT focuses on replacing X-rays as the primary method for verifying NGT placement, thereby reducing costs, time, and patient exposure to radiation. Data analysis may provide insights into managing patients on pH-altering medication. Implementing innovative technologies has the potential to reduce errors and improve economic efficiency and process sustainability.
Collapse
Affiliation(s)
- Stefano Mancin
- Department of Biomedicine and Prevention, University of Rome “Tor Vergata”, Rome, Italy
| | - Pietro Stallone
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| | - Valeria Siro
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| | - Manuela Pastore
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| | - Daniela Cattani
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
- IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Diego Lopane
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
- IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Alessandra Dacomi
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
- IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | | | - Alessandro Bellone
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| | - Francesca Serazzi
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| | - Georges Laffoucriere
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| | - Chiara Coldani
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
- IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Giuseppina Tomaiuolo
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
- IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Beatrice Mazzoleni
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| |
Collapse
|
9
|
Smith LD, Hoy H, Whitmore S. Increasing the Volume of Delivered Enteral Feeds Using a Volume-Based Feeding Protocol in a Neuroscience Intensive Care Unit. Crit Care Nurse 2024; 44:54-64. [PMID: 38821527 DOI: 10.4037/ccn2024622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2024]
Abstract
BACKGROUND Iatrogenic malnutrition is a significant burden to patients, clinicians, and health care systems. Compared with well-nourished patients, underfed patients (those who receive less than 80% of their daily energy requirement) have more adverse outcomes related to nutritional status. Volume-based protocols allow for catch-up titrations, are consistently superior to rate-based protocols, and can be implemented in most settings. LOCAL PROBLEM This project was conducted in an 8-bed neuroscience intensive care unit in which up to 41% of patients who required enteral feeding were underfed. METHODS This quality improvement clinical practice change project used a before-and-after design to evaluate (1) the effect of implementing a volume-based feeding protocol on the delivery of enteral feeds and (2) the effect of a nutrition-based project on staff members' attitudes regarding nutrition in critical care. The effectiveness of a volume-based feeding titration protocol was compared with that of a rate-based feeding protocol for achieving delivery of at least 80% of prescribed nutrition per 24-hour period. Staff members' attitudes were assessed using a survey before and after the project. RESULTS During 241 enteral feeding days (n = 40 patients), the percentage of delivered enteral feeding volume and the percentage of days patients received at least 80% of the prescribed volume increased after volume-based feeding was implemented. After project implementation, 74 staff members reported increased emphasis on nutrition delivery in their practice and a higher level of agreement that nutrition is a priority when caring for critically ill patients. CONCLUSIONS Using a volume-based feeding protocol with supplemental staff education resulted in improved delivery of prescribed enteral feeding.
Collapse
Affiliation(s)
- L Douglas Smith
- L. Douglas Smith Jr is the lead critical care advanced practice provider and critical care nurse practitioner, HCA Healthcare Intensivist Services, HCA Healthcare TriStar Centennial Medical Center, Nashville, Tennessee, and a faculty member at Vanderbilt University School of Nursing, Nashville
| | - Haley Hoy
- Haley Hoy is a professor, University of Alabama in Huntsville College of Nursing, Huntsville, Alabama, and a lung transplant nurse practitioner at Vanderbilt University Medical Center, Nashville
| | - Sage Whitmore
- Sage Whitmore is the Medical Director for the intensive care unit and a staff intensivist, HCA Intensivist Services, HCA TriStar Centennial Medical Center
| |
Collapse
|
10
|
Wong A, Huang Y, Banks MD, Sowa PM, Bauer JD. A Conceptual Study on Characterizing the Complexity of Nutritional Interventions for Malnourished Older Adults in Hospital Settings: An Umbrella Review Approach. Healthcare (Basel) 2024; 12:765. [PMID: 38610187 PMCID: PMC11011329 DOI: 10.3390/healthcare12070765] [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: 01/23/2024] [Revised: 03/28/2024] [Accepted: 03/29/2024] [Indexed: 04/14/2024] Open
Abstract
INTRODUCTION Malnutrition is a widespread and intricate issue among hospitalized adults, necessitating a wide variety of nutritional strategies to address its root causes and repercussions. The primary objective of this study is to systematically categorize nutritional interventions into simple or complex, based on their resource allocation, strategies employed, and predictors of intervention complexity in the context of adult malnutrition in hospital settings. METHODS A conceptual evaluation of 100 nutritional intervention studies for adult malnutrition was conducted based on data from a recent umbrella review (patient population of mean age > 60 years). The complexity of interventions was categorized using the Medical Research Council 2021 Framework for Complex Interventions. A logistic regression analysis was employed to recognize variables predicting the complexity of interventions. RESULTS Interventions were divided into three principal categories: education and training (ET), exogenous nutrient provision (EN), and environment and services (ES). Most interventions (66%) addressed two or more of these areas. A majority of interventions were delivered in a hospital (n = 75) or a hospital-to-community setting (n = 25), with 64 studies being classified as complex interventions. The logistic regression analysis revealed three variables associated with intervention complexity: the number of strategies utilized, the targeted areas, and the involvement of healthcare professionals. Complex interventions were more likely to be tailored to individual needs and engage multiple healthcare providers. CONCLUSIONS The study underlines the importance of considering intervention complexity in addressing adult malnutrition. Findings advocate for a comprehensive approach to characterizing and evaluating nutritional interventions in future research. Subsequent investigations should explore optimal balances between intervention complexity and resource allocation, and assess the effectiveness of complex interventions across various settings, while considering novel approaches like telehealth.
Collapse
Affiliation(s)
- Alvin Wong
- Department of Dietetics, Changi General Hospital, 2 Simei Street 3, Singapore 529889, Singapore
| | - Yingxiao Huang
- School of Human Movement and Nutrition Sciences, University of Queensland, St. Lucia, QLD 4072, Australia
| | - Merrilyn D. Banks
- Centre for the Business and Economics of Health, The University of Queensland, St. Lucia, QLD 4067, Australia
| | - P. Marcin Sowa
- Department of Nutrition and Dietetics, Royal Brisbane and Women’s Hospital, Herston, QLD 4029, Australia
| | - Judy D. Bauer
- Department of Nutrition, Dietetics and Food, Monash University, Notting Hill, VIC 3168, Australia
| |
Collapse
|
11
|
Zhou B, Zhang Y, Hiesmayr M, Gao X, Huang Y, Liu S, Shen R, Zhao Y, Cui Y, Zhang L, Wang X, on behalf of the nutritionDay Chinese Working Group. Dietary Provision, GLIM-Defined Malnutrition and Their Association with Clinical Outcome: Results from the First Decade of nutritionDay in China. Nutrients 2024; 16:569. [PMID: 38398893 PMCID: PMC10893253 DOI: 10.3390/nu16040569] [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: 01/04/2024] [Revised: 02/04/2024] [Accepted: 02/16/2024] [Indexed: 02/25/2024] Open
Abstract
Malnutrition is a common and serious issue that worsens patient outcomes. The effects of dietary provision on the clinical outcomes of patients of different nutritional status needs to be verified. This study aimed to identify dietary provision in patients with eaten quantities of meal consumption and investigate the effects of dietary provision and different nutritional statuses defined by the GLIM criteria on clinical outcomes based on data from the nutritionDay surveys in China. A total of 5821 adult in-patients from 2010 to 2020 were included in this study's descriptive and Cox regression analyses. Rehabilitation and home discharge of 30-day outcomes were considered a good outcome. The prevalence of malnutrition defined by the GLIM criteria was 22.8%. On nutritionDay, 51.8% of all patients received dietary provisions, including hospital food and a special diet. In multivariable models adjusting for other variables, the patients receiving dietary provision had a nearly 1.5 higher chance of a good 30-day outcome than those who did not. Malnourished patients receiving dietary provision had a 1.58 (95% CI [1.36-1.83], p < 0.001) higher chance of having a good 30-day outcome and had a shortened length of hospital stay after nutritionDay (median: 7 days, 95% CI [6-8]) compared to those not receiving dietary provision (median: 11 days, 95% CI [10-13]). These results highlight the potential impacts of the dietary provision and nutritional status of in-patients on follow-up outcomes and provide knowledge on implementing targeted nutrition care.
Collapse
Affiliation(s)
- Bei Zhou
- Department of General Surgery, Jinling Hospital, Medical School of Nanjing University, 305 East Zhongshan Road, Nanjing 210002, China; (B.Z.); (Y.Z.); (X.G.)
- Department of Nutrition, Acupuncture, Moxibustion and Massage College, Health Preservation and Rehabilitation College, Nanjing University of Chinese Medicine, 138 Xianlin Road, Nanjing 210023, China
| | - Yupeng Zhang
- Department of General Surgery, Jinling Hospital, Medical School of Nanjing University, 305 East Zhongshan Road, Nanjing 210002, China; (B.Z.); (Y.Z.); (X.G.)
| | - Michael Hiesmayr
- Center for Medical Data Science, Section for Medical Statistics, Medical University Vienna, Spitalgasse 23, A-1090 Vienna, Austria;
| | - Xuejin Gao
- Department of General Surgery, Jinling Hospital, Medical School of Nanjing University, 305 East Zhongshan Road, Nanjing 210002, China; (B.Z.); (Y.Z.); (X.G.)
| | - Yingchun Huang
- Department of General Surgery, Jinling Hospital, Medical School of Nanjing University, 305 East Zhongshan Road, Nanjing 210002, China; (B.Z.); (Y.Z.); (X.G.)
| | - Sitong Liu
- Department of General Surgery, Jinling Hospital, Medical School of Nanjing University, 305 East Zhongshan Road, Nanjing 210002, China; (B.Z.); (Y.Z.); (X.G.)
| | - Ruting Shen
- Department of General Surgery, Jinling Hospital, Medical School of Nanjing University, 305 East Zhongshan Road, Nanjing 210002, China; (B.Z.); (Y.Z.); (X.G.)
| | - Yang Zhao
- Department of Biostatistics, School of Public Health, Nanjing Medical University, 101 Longmian Avenue, Nanjing 211166, China;
| | - Yao Cui
- Department of Nutrition, Pizhou Hospital, Xuzhou Medical University, Xuzhou 221004, China;
| | - Li Zhang
- Department of General Surgery, Jinling Hospital, Medical School of Nanjing University, 305 East Zhongshan Road, Nanjing 210002, China; (B.Z.); (Y.Z.); (X.G.)
| | - Xinying Wang
- Department of General Surgery, Jinling Hospital, Medical School of Nanjing University, 305 East Zhongshan Road, Nanjing 210002, China; (B.Z.); (Y.Z.); (X.G.)
| | | |
Collapse
|
12
|
Guo L, Zhao LQ, Chen JY, Li M. The Impact of Nursing Interventions on the Treatment Outcomes of Renal Cell Carcinoma with Postoperative Interleukin-2 and Recombinant Human Interferon. J Multidiscip Healthc 2024; 17:735-741. [PMID: 38390433 PMCID: PMC10882275 DOI: 10.2147/jmdh.s447537] [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: 10/31/2023] [Accepted: 01/30/2024] [Indexed: 02/24/2024] Open
Abstract
Objective This study investigates the impact of nursing interventions on treatment outcomes and adverse reaction rates in renal cell carcinoma (RCC) patients treated postoperatively with Interleukin-2 and recombinant human Interferon. Methods In a retrospective analysis of 90 RCC patients, 43 received standard care (control group), while 47 received additional nursing interventions (intervention group), including psychological care, vital signs monitoring, dietary care, adverse reaction management, and post-discharge care. Patients with concurrent major diseases or other malignancies were excluded. Key assessments included clinical symptom improvement, treatment efficacy, and postoperative adverse reactions. Results Among the 90 participants, no significant demographic differences were found between the two groups. The intervention group showed significant improvements in fever resolution, leukocyte normalization, and shorter hospital stays. The overall treatment effectiveness was similar in both groups (90.7% in the intervention group vs 91.5% in the control group). However, the intervention group experienced significantly fewer postoperative adverse reactions, including fever, gastrointestinal symptoms, bone marrow suppression, and neurological abnormalities (6.3% vs 23.2%). Conclusion The study suggests that nursing interventions can improve treatment outcomes by reducing postoperative adverse reactions in RCC patients receiving postoperative Interleukin-2 and recombinant human Interferon. The overall effectiveness of treatment and care was comparable between the groups. Further extensive studies are needed to confirm these findings and fully understand the impact of nursing interventions on RCC patient outcomes.
Collapse
Affiliation(s)
- Li Guo
- Third Department of General Surgery (Breast Armor Surgery), Ezhou Central Hospital, Ezhou City, 436000, People's Republic of China
| | - Li-Qin Zhao
- Department of Oncology, Ezhou Central Hospital, Ezhou City, 436000, People's Republic of China
| | - Jin-Yu Chen
- Department of Oncology, Ezhou Central Hospital, Ezhou City, 436000, People's Republic of China
| | - Ming Li
- Department of Oncology, Ezhou Central Hospital, Ezhou City, 436000, People's Republic of China
| |
Collapse
|
13
|
Chou HC, Cheng SF, Jennifer Yeh SC, Tang PL. Effectiveness of a multicomponent activity and horticultural intervention for the hospitalized older adults: A randomized controlled trial: Effectiveness of Intervention for the Hospitalized Older Adults. Geriatr Nurs 2024; 55:112-118. [PMID: 37979470 DOI: 10.1016/j.gerinurse.2023.10.024] [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: 09/07/2023] [Revised: 10/22/2023] [Accepted: 10/23/2023] [Indexed: 11/20/2023]
Abstract
This study evaluated the effectiveness of different intervention programs in improving function among hospitalized older individuals using the Comprehensive Geriatric Assessment (CGA). A randomized controlled trial consisted of three groups: routine care, horticulture, and multicomponent activities (n = 32 each). Horticultural and multicomponent activity interventions showed beneficial effects on the CGA in hospitalized older individuals, particularly regarding cognitive function and quality-of-life. Additionally, horticultural activities significantly contributed to the perception of older adults' health status. We recommend to select older patients in geriatric wards with long-term hospitalization and adjust the frequency of activities or choose a single intervention program to provide long-term and effective intervention effects.
Collapse
Affiliation(s)
- Hsueh-Chih Chou
- Department of Nursing, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan (ROC); Department of Business Management, National Sun Yat-Sen University, Kaohsiung, Taiwan (ROC)
| | - Su-Fen Cheng
- Department of Nursing, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan (ROC)
| | - Shu-Chuan Jennifer Yeh
- Department of Business Management, National Sun Yat-Sen University, Kaohsiung, Taiwan (ROC)
| | - Pei-Ling Tang
- School of Nursing, Fooyin University, Kaohsiung, Taiwan (ROC).
| |
Collapse
|
14
|
Lucyna Ś, Elżbieta W, Anna KK, Judyta P. Nutritional Status of the Elderly Residing in a 24-Hour Medical Care Facility After Nutritional Intervention. Gerontol Geriatr Med 2024; 10:23337214231224574. [PMID: 38223549 PMCID: PMC10785718 DOI: 10.1177/23337214231224574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Revised: 12/15/2023] [Accepted: 12/18/2023] [Indexed: 01/16/2024] Open
Abstract
Malnutrition is a significant issue among elderly individuals in 24-hour care facilities, leading to increased morbidity. The aim of the study was to compare the nutritional status before and after nutritional intervention based on selected indicators of nutritional status among residents of a 24-hour care institution. The study included a group of 104 people aged 65 to 97 years. Nutritional status was assessed before and after the nutritional intervention based on indicators: levels of prealbumin, albumin, transferrin, total lymphocyte count, BMI, and MNA scale. The nutritional intervention consisted of administering oral nutritional supplements (ONS) to patients, regardless of nutritional status. The method of retrospective analysis of patients' medical records was used. Statistical analysis was performed using IBM SPSS Statistics 24 for Windows. Improvements in nutritional status occurred among patients with malnutrition based on MNA and prealbumin indices, and in groups of patients with moderate or mild malnutrition as determined by transferrin, prealbumin and albumin. The mean levels of nutritional indices significantly increased: MNA (p = .001), BMI (p = .001), prealbumin (p = .001), and albumin (p < .001). The use of ONS resulted in better nutritional status parameters based on MNA, albumin and prealbumin. These indices may be predictors of reducing the risk of various disorders among the elderly.
Collapse
Affiliation(s)
- Ścisło Lucyna
- Jagiellonian University Medical College, Krakow, Poland
| | | | | | - Pluta Judyta
- Jagiellonian University Medical College, Krakow, Poland
| |
Collapse
|
15
|
Zhang D, Tay LBG, Lim SF, Ang JYH, Tong CCY, Tang CYL, Brennan-Cook J. Improving nutrition care and diet intake for hospitalised older people at risk of malnutrition through a nurse-driven mealtime assistance bundle. Int J Older People Nurs 2024; 19:e12590. [PMID: 37990475 DOI: 10.1111/opn.12590] [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: 06/02/2023] [Revised: 10/23/2023] [Accepted: 10/25/2023] [Indexed: 11/23/2023]
Abstract
BACKGROUND Poor dietary intake is common in hospitalised older people. A targeted mealtime intervention is needed to improve nutrition care and dietary intake, especially for those at risk of malnutrition. OBJECTIVES This quality improvement project designed, implemented and evaluated a mealtime assistance bundle consisting of care measures driven by the hospital nursing team. The aims were to improve the mealtime care process to promote dietary intake of the hospitalised older people and to improve nursing staff's knowledge, attitude and practice in malnutrition. METHODS This project adopted a pre-post design, targeting older people aged 65 years and above, who were admitted to a general medical unit in a regional hospital in Singapore. A mealtime assistance bundle consisting of seven care measures, using the acronym CANFEED, was implemented for older adults at risk of malnutrition. Outcome measures on the amount of dietary intake during meals through chart reviews and surveys of nursing staff using Malnutrition Knowledge, Attitudes and perceived Practices (M-KAP) questionnaire were performed before and after implementation. RESULTS There were fewer older adults with poor intake in the post-implementation group than the pre-implementation group. Among those at risk of malnutrition, older adults in the post-implementation group had higher average intake of all provided meals as well as the protein-dense main dish. Significant improvements were noted in the total scores rated by the nursing staff in both the Knowledge-Attitude subscale and Practice subscale of the M-KAP questionnaire. CONCLUSIONS Integrating a nurse-driven mealtime assistance bundle into usual care may have positive outcomes on nutritional intake of hospitalised older people at risk of malnutrition, and on knowledge, attitude and practice of hospital nurses in nutrition care. IMPLICATIONS FOR PRACTICE Nurses play a critical role in nutrition care for hospitalised older people. Continuing efforts to improve nutritional intake of hospitalised older people should focus on staff education, building a multidisciplinary food-promoting culture and patient, family and community empowerment. More efficient clinical processes incorporating information technology with the EMR to support better nutrition care of the hospitalised older people are needed.
Collapse
Affiliation(s)
- Di Zhang
- Nursing Division, Sengkang General Hospital, Singapore, Singapore
| | - Laura Bee Gek Tay
- Department of Geriatric Medicine, Sengkang General Hospital, Singapore, Singapore
| | - Su Fee Lim
- Nursing Division, Singapore General Hospital, Singapore, Singapore
| | | | | | | | | |
Collapse
|
16
|
Wong A, Huang Y, Sowa PM, Banks MD, Bauer JD. An Umbrella Review and Meta-analysis of Interventions, Excluding Enteral and Parenteral Nutrition, Initiated in the Hospital for Adults with or at Risk of Malnutrition. Am J Clin Nutr 2023; 118:672-696. [PMID: 37437779 DOI: 10.1016/j.ajcnut.2023.07.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Revised: 06/12/2023] [Accepted: 07/03/2023] [Indexed: 07/14/2023] Open
Abstract
BACKGROUND Multiple systematic reviews and meta-analyses (SRMAs) on various nutritional interventions in hospitalized patients with or at risk of malnutrition are available, but disagreements among findings raise questions about their validity in guiding practice. OBJECTIVES We conducted an umbrella review (a systematic review of systematic reviews in which all appropriate studies included in SRMAs are combined) to assess the quality of reviews, identify the types of interventions available (excluding enteral and parenteral nutrition), and re-analyze the effectiveness of interventions. METHODS The databases MEDLINE/PubMed, CINAHL, Embase, The Cochrane Library, and Google Scholar were searched. AMSTAR-2 was used for quality assessment and GRADE for certainty of evidence. Updated meta-analyses with risk of bias (ROB) by Cochrane ROB 2.0 were performed. Pooled effects were reported as relative risk (RR), with zero-events and publication bias adjustments, and trial sequential analysis (TSA) performed for mortality, readmissions, complications, length of stay, and quality of life. RESULTS A total of 66 randomized controlled trials were cited by the 19 SRMAs included in this umbrella review, and their data extracted and analyzed. Most clinical outcomes were discordant with variable effect sizes in both directions. In trials with low ROB, interventions targeting nutritional intake reduce mortality at 30 d (15 studies, n: 4156, RR: 0.72, 95% CI: 0.55, 0.94, P: 0.02, I2: 6%, Certainty: High), 6 mo (27 studies, n: 6387, RR: 0.81, 95% CI: 0.71, 0.92, P = 0.001, I2: 4%, Certainty: Moderate), and 12 mo (27 studies, n: 6387, RR: 0.80, 95% CI: 0.67, 0.95, P: 0.01, I2: 33%, Certainty: Moderate), with TSA verifying an adequate sample size and robustness of the meta-analysis. CONCLUSION Existing evidence is sufficient to show that nutritional intervention is effective for mortality outcomes at 30 d, 6 mo, and 12 mo. Future clinical trials should focus on the effect of nutritional interventions on other clinical outcomes. TRIAL REGISTRATION NUMBER The protocol is registered on PROSPERO (CRD42022341031).
Collapse
Affiliation(s)
- Alvin Wong
- Department of Dietetics, Changi General Hospital, Singapore, Singapore; School of Human Movement and Nutrition Sciences, University of Queensland, St. Lucia, QLD, Australia.
| | - Yingxiao Huang
- Department of Dietetics, Changi General Hospital, Singapore, Singapore
| | - Przemyslaw M Sowa
- Centre for the Business and Economics of Health, The University of Queensland, St Lucia, QLD, Australia
| | - Merrilyn D Banks
- Department of Nutrition and Dietetics, Royal Brisbane and Women's Hospital, Herston, QLD, Australia
| | - Judith D Bauer
- School of Human Movement and Nutrition Sciences, University of Queensland, St. Lucia, QLD, Australia; Department of Nutrition, Dietetics and Food, Monash University, Notting Hill, VIC, Australia
| |
Collapse
|
17
|
Varsi C, Andersen LF, Koksvik GT, Severinsen F, Paulsen MM. Intervention-related, contextual and personal factors affecting the implementation of an evidence-based digital system for prevention and treatment of malnutrition in elderly institutionalized patients: a qualitative study. BMC Health Serv Res 2023; 23:245. [PMID: 36915076 PMCID: PMC10012554 DOI: 10.1186/s12913-023-09227-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Accepted: 02/28/2023] [Indexed: 03/15/2023] Open
Abstract
BACKGROUND Malnutrition in elderly institutionalized patients is a significant challenge associated with adverse health outcomes. The 'MyFood' decision support system was designed to prevent and treat malnutrition and has previously been studied in a hospital setting. The aim of this study was to explore the experiences of nursing staff regarding the implementation of MyFood in settings treating elderly patients. METHODS The study was conducted in two settings treating elderly patients in Norway. Nursing staff received training in how to follow-up patients with MyFood. Qualitative interviews were conducted with 12 nursing staff. The Consolidated Framework for Implementation Research (CFIR) was used to guide the data collection and the thematic data analysis. RESULTS The implementation of a digital decision support system to prevent and treat malnutrition into settings treating elderly patients was found to be affected by intervention-related, contextual, and personal factors. Although nursing staff experienced several advantages, the leadership engagement was low and hampered the implementation. CONCLUSION Nursing staff experienced several advantages with implementing a digital decision support system for the prevention and treatment of malnutrition in institutionalized elderly patients, including quality improvements and time savings. The results indicate that the leadership engagement was weak and that some nursing staff experienced low self-efficacy in digital competence. Future improvements include increasing the level of training, using MyFood throughout the patient course and involving the patient's next-of-kin. TRIAL REGISTRATION The study was acknowledged by The Norwegian Centre for Research Data (NSD), ref. number 135175.
Collapse
Affiliation(s)
- Cecilie Varsi
- Faculty of Health and Social Sciences, University of South-Eastern Norway, box 4, Borre, 3199, Norway
| | - Lene Frost Andersen
- Department of Nutrition, Institute of Basic Medical Sciences, University of Oslo, box 1110, Blindern, Oslo, 0317, Norway
| | - Gunhild Tellebon Koksvik
- Department of Nutrition, Institute of Basic Medical Sciences, University of Oslo, box 1110, Blindern, Oslo, 0317, Norway
| | - Frida Severinsen
- Department of Nutrition, Institute of Basic Medical Sciences, University of Oslo, box 1110, Blindern, Oslo, 0317, Norway
| | - Mari Mohn Paulsen
- Department of Nutrition, Institute of Basic Medical Sciences, University of Oslo, box 1110, Blindern, Oslo, 0317, Norway.
| |
Collapse
|
18
|
de Frel DL, Assendelft WJJ, Hondmann S, Janssen VR, Molema JJW, Trines SA, de Vries IAC, Schalij MJ, Atsma DE. An omission in guidelines. Cardiovascular disease prevention should also focus on dietary policies for healthcare facilities. Clin Nutr 2023; 42:18-21. [PMID: 36473424 DOI: 10.1016/j.clnu.2022.11.010] [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: 08/12/2022] [Revised: 11/05/2022] [Accepted: 11/09/2022] [Indexed: 11/18/2022]
Abstract
Suboptimal diet is a major modifiable risk factor in cardiovascular disease. Governments, individuals, educational institutes, healthcare facilities and the industry all share the responsibility to improve dietary habits. Healthcare facilities in particular present a unique opportunity to convey the importance of healthy nutrition to patients, visitors and staff. Guidelines on cardiovascular disease do include policy suggestions for population-based approaches to diet in a broad list of settings. Regrettably, healthcare facilities are not explicitly included in this list. The authors propose to explicitly include healthcare facilities as a setting for policy suggestions in the current and future ESC Guidelines for cardiovascular disease prevention in clinical practice.
Collapse
Affiliation(s)
- Daan L de Frel
- Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, the Netherlands
| | - Willem J J Assendelft
- Department of Primary and Community Care, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Sara Hondmann
- Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, the Netherlands
| | - Veronica R Janssen
- Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, the Netherlands
| | - Johanna J W Molema
- Department of Healthy Living, The Netherlands Organisation for Applied Scientific Research TNO, Leiden, the Netherlands
| | - Serge A Trines
- Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, the Netherlands
| | - Iris A C de Vries
- Association Arts en Leefstijl (Physician and Lifestyle), Utrecht, the Netherlands
| | - Martin J Schalij
- Executive Board of Directors, Leiden University Medical Center, Leiden, the Netherlands
| | - Douwe E Atsma
- Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, the Netherlands; Association Arts en Leefstijl (Physician and Lifestyle), Utrecht, the Netherlands; National EHealth Living Lab, Leiden University Medical Center, Leiden, the Netherlands.
| |
Collapse
|
19
|
Gan T, Cheng HL, Tse MYM. A systematic review of nurse-led dietary interventions for cancer patients and survivors. Asia Pac J Oncol Nurs 2022; 9:81-87. [PMID: 35529414 PMCID: PMC9072171 DOI: 10.1016/j.apjon.2021.12.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Accepted: 12/17/2021] [Indexed: 11/02/2022] Open
Abstract
Dietary problems are frequently reported in cancer patients and survivors which may reduce quality of life and cancer survival. Nurses' role in dietary management is recognized as important, but review evidence on nurse-led dietary interventions for cancer patients and survivors is lacking. This review aims to summarize evidence on nurse-led dietary interventions for cancer patients and survivors. Ten electronic databases (PubMed, CINAHL, CENTRAL, EMBASE, Web of Science, Ovid, CNKI, Wan Fang, CQVIP, Index to Taiwan Periodical Literature System) were searched from inception dates to November 11, 2021, using the key search terms "cancer/nutrition/nurse-led/intervention." Eligible studies were experimental studies on nurse-led dietary interventions for improving dietary intake in cancer patients and survivors published in peer-reviewed journals in English or Chinese. The methodological quality of the included studies was evaluated using the revised Cochrane risk-of-bias assessment tool. Data were extracted and summarized descriptively. Three randomized controlled trials on nurse-led dietary counseling published between 2005 and 2018 were included, with an overall high risk of bias. Two studies found positive intervention effects in improving fruit and vegetable intake, while the other study demonstrated an increase in energy intake. This is the first systematic review to summarize the evidence on nurse-led dietary interventions for cancer patients and survivors. Although available studies are limited, a positive trend was identified in that nurse-led dietary interventions are effective in increasing dietary intake in cancer patients and survivors. Additional studies in this field are required to further explore nurses' role in the development of nutritional oncology care.
Collapse
Affiliation(s)
- Ting Gan
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong SAR, China
| | - Hui-Lin Cheng
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong SAR, China
| | - Mun Yee Mimi Tse
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong SAR, China
| |
Collapse
|
20
|
Everink IHJ, van Haastregt JCM, Manders M, de van der Schueren MAE, Schols JMGA. Malnutrition Prevalence Rates among Dutch Nursing Home Residents: What Has Changed over One Decade? A Comparison of the Years 2009, 2013 and 2018. J Nutr Health Aging 2021; 25:999-1005. [PMID: 34545920 DOI: 10.1007/s12603-021-1668-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
OBJECTIVES To assess changes in prevalence of malnutrition and its associated factors among people living in Dutch nursing homes in 2009, 2013 and 2018. DESIGN Secondary data analysis of the International Prevalence Measurement of Care Quality (LPZ) study. SETTING Dutch nursing homes. PARTICIPANTS Residents living at a psychogeriatric or somatic ward in Dutch nursing homes in 2009, 2013 or 2018. MEASUREMENTS weight and height, unintentional weight loss over the last month and last six months, age, sex, length of stay up to the measurement day, care dependency, and the presence of various diseases (dementia, diabetes mellitus, stroke, diseases of the respiratory system, respiratory diseases and pressure ulcers). RESULTS In total, 14,317 residents were included in this study with a mean age of 82.2, 70.9 female and 66.8% was living on a psychogeriatric ward. Results of this study show relative stability in background characteristics of the nursing home population over the last decade. In the total sample, 16.7% was malnourished and these percentages were 16.6% in 2009, 17.5% in 2013 and 16.3% in 2018. Multiple binary logistic regression analyses revealed having a pressure ulcer, female sex and living on a psychogeriatric department to be positively associated and having diabetes mellitus to be negatively associated with malnutrition throughout the years. These associations were strong and similar across years. CONCLUSION Even though much attention has been paid to prevent malnutrition in Dutch nursing homes over the last decades, results show a relatively stable malnutrition prevalence rate of around 16%. This leads to the question if nursing staff is able to sufficiently recognize residents with (a risk of) malnutrition, and if they are aware of interventions they could perform to decrease this rate.
Collapse
Affiliation(s)
- I H J Everink
- Irma Everink, Maastricht University, Maastricht, Nederland,
| | | | | | | | | |
Collapse
|