[The role of the coordinating nurse in a transverse clinical nutrition unit]

Malnutrition is a common pathology, often underdiagnosed, and is associated with numerous chronic diseases. Transversal clinical nutrition units (TCNU) are being implemented to improve the screening and management of malnutrition. The coordinating nurse plays a key role within a TCNU: organizing and coordinating personalized care pathways for malnourished patients, especially those with complex pathologies requiring multidisciplinary care. This article outlines the responsibilities of the coordinating nurse based on the experience of the TCNU established at the Pitié-Salpêtrière Hospital (Assistance Publique-Hôpitaux de Paris).

Improving oncology nurses' knowledge, self-confidence, and self-efficacy in nutritional assessment and counseling for patients with cancer: A quasi-experimental design

OBJECTIVE

Our objective was to assess the effectiveness of a structured educational program on improving oncology nurses' knowledge, self-confidence, and self-efficacy in nutritional assessment and counseling for patients with cancer.

METHODS

A pretest-posttest quasi-experimental design was used. A sample of 60 nurses from oncology units participated as an experimental group (n = 30) and a control group (n = 30). The participants completed a knowledge test before completing the educational program. Self-confidence and self-efficacy also were assessed pre- and postintervention.

RESULTS

There was a significant difference between the experimental (mean [M] = 26.00, SD = 8.00) and control (M = 10.00, SD = 3.75) groups regarding knowledge after the interventional sessions (t = -16.00, P = 0.001). Furthermore, the results indicated a significant difference (t = -24.00, P = 0.001) between the experimental group (M = 60.50, SD = 13.10) and the control group (M = 36.50, SD = 7.60) regarding self- confidence in managing cancer patients. Finally, there was a significant difference between the experimental group (M = 33.50, SD = 3.10) and control group (M = 23.25, SD = 2.75) regarding self-efficacy (t = -10.25, P = 0.001).

CONCLUSIONS

The educational program improved the oncology nurses' knowledge, self-confidence, and self-efficacy in relation to nutritional assessment and counseling. Improving nurses' competencies will improve the quality of care provided to the patients and patient health outcomes.

Part 3: Impact of systemic conditions and medications on oral health

The people who are treated in the community setting will often have multiple comorbidities. Systemic medical conditions can have a negative impact on oral health. In addition, the medications used to treat systemic conditions may also themselves cause oral symptoms. As a large proportion of patients treated by the community nursing team will be elderly, this paper will focus on common geriatric conditions that can display oral or dental symptoms. The effects of medications will be discussed and linked to oral complaints patients may express. The primary aims are to give a broad overview of the oral effects of ageing, of illness and of polypharmacy and advise on how these can be best managed by the nursing team.

Food for thought: delivering effective nutritional care

Janet Scammell, Associate Professor (Nursing), Bournemouth University, asks whether nurse education places enough emphasis on the importance of ensuring good nutrition and hydration for patients.

Treating malnutrition in the community

Malnutrition is a clinical and public health problem. It has adverse effects on the physical and psycho-social wellbeing of individuals by predisposing to disease, negatively affecting its outcome and reducing the likelihood of independence. An estimated 3 million people in the UK are affected by malnutrition, most of whom live in the community ( BAPEN, 2011 ). Despite the scale of this problem, it remains under-detected, under-treated, underresourced and often overlooked by those involved in the care of at risks individuals such as the elderly. In most cases malnutrition is a treatable condition that can be managed by optimising food intake and using oral nutritional supplements (ONS) where necessary. The main focus of this article is on the dangers of malnutrition for older people in the community and the use of ONS in the treatment and management of malnutrition.

[All the bodies of anorexia]

Anorexia is an active struggle against hunger. In this fight, the body is a real battlefield where the therapies used aim to re-establish peace. Hence the importance of an integrative 'body to body' approach between patient and caregiver.

Malnutrition and dementia

What was the nature of the CPD activity and/or practice-related feedback and/or event or experience in your practice? The CPD article outlined the effects dementia may have on a person's ability to eat and drink safely. It discussed assessment tools to identify patients at risk of malnutrition and management strategies to help maintain nutritional intake.

Food and drink message has to work down from the top

FRESH GUIDANCE aimed at reducing poor nutrition and hydration in patients places more responsibility on senior nurses and clinical commissioners to ensure that messages trickle down to staff at all levels.

[Nurses' attitudes towards nutritional care and malnutrition in hospitalised older people: A Survey in the Liguria Region]

AIM

Evaluate nurses' attitudes towards nutritional assistance in elderly hospitalized individuals, using the scale "The Staff Attitudes To Nutritional Geriatric Nursing Care Scale (SANN-G Scale)", recently validated in Italian.

METHODS

A descriptive survey was carried out, involving all head nurses and nurses of wards within University Hospital San Martino Hospital in Genoa and ASL3 Genovese Villa Scassi. A comparison was carried out using the Kruscall-Wallis test between wards, in order to determine whether there were significant differences in attitudes with respect to nutritional assistance. Results were compared between individuals who had follow a lecture on nutritional assistance and those who had not, using the test Mann Whitney.

RESULTS

110 questionnaires were delivered of these 103 were filled in (94%). Only 26% of the sample shows to have a strong positive attitude with respect nutritional assitance in elderly people. No significant differences were found either between wards and the other or between those who nurse had lecturer and those who have not.

CONCLUSIONS

The study revealed a substantial negative attitude with respect to nutritional assitance and malnutrition in the elderly, confirming that aspects related to nutrition of the elderly are not properly taken into account in comparison to other nursing care activities. Our results are similar to those of the internationl literature. There is therefore a need also in Italy to increase awareness of professionals on these issues.

Measuring the quality of nutritional care

Despite various campaigns and initiatives, and publication of numerous standards, malnutrition in healthcare settings often goes unrecognised and untreated. This negatively affects patients' experiences and outcomes, and has financial implications for the NHS. The British Association for Parenteral and Enteral Nutrition has launched a new online tool that helps trusts measure the quality of the nutritional care they provide. This article describes the tool and explains its structure, how organisations and nurses can access and use it, and the benefits of implementing this resource as a routine part of clinical care.

Knowledge and Attitudes of Nursing Staff Towards Malnutrition Care in Nursing Homes: A Multicentre Cross-Sectional Study

BACKGROUND

The international literature shows that there are considerable deficits in nutritional care provision in nursing homes. Limited knowledge and negative attitudes can contribute to these deficits but international studies on knowledge and attitudes among nursing staff are rare.

OBJECTIVE

The study aimed to assess the knowledge and attitudes of registered nurses and nurse aides towards malnutrition care in nursing homes.

DESIGN

This study followed a multicentre, cross sectional design.

SETTING AND PARTICIPANTS

The study was performed in 66 Austrian nursing homes with 1152 participants.

MEASUREMENTS

The validated Knowledge of Malnutrition-Geriatric (KoM-G) questionnaire and the Staff Attitudes to Nutritional Nursing Care Geriatric (SANN-G) scale were used for data collection.

RESULTS

On average, 60.6% of the respondents answered the questions correctly, whereas registered nurses knew significantly more (65.6%) than nurse aides (57.3%). The question that was answered correctly by most dealt with the factors that positively affect oral nutritional intake (87.2%) while the question which was incorrectly answered by most was on the professions involved in malnutrition treatment (26.1%). 39.2% of respondents had positive attitudes towards nutritional care. Registered nurses displayed more positive attitudes (48.1%) than nurse aides (33.6%). The most positive attitudes were shown in the 'Intervention' subscale while the least positive attitudes were indicated in the 'Norms' subscale. A medium positive correlation between knowledge and attitudes was found (r=.423, p<0.000).

CONCLUSION

This study identified specific knowledge deficits and areas of negative attitudes in registered nurses and nurse aides, which will enable tailored training programmes to be developed.

Giving nutrition support to critically ill adults

Patients who become critically ill can have problems maintaining nutritional intake and it can be challenging for nurses to provide nutritional support. No one assessment method can identify each patient's risk of malnutrition, so nurses need to look at different aspects in their nutritional assessment and refer for specialist help from dietitians and nutrition support teams when needed. This article focuses on how severe physiological stress affects patients who are critically ill and impacts on their nutritional requirements. A nursing nutritional assessment is explored, as are nutritional support methods that may be used to manage these patients' nutritional needs.

Managing malnutrition in patients with dementia

As dementia progresses, an individual may experience increasing difficulties in eating and drinking safely. Evidence suggests that admission to hospital may exacerbate these problems. This article aims to familiarise readers with some of the issues associated with providing good nutritional care for a patient with dementia in hospital. Strategies to address the maintenance of oral intake are suggested. The article also explores the use of artificial nutrition in dementia, with examples to clarify when its use may be helpful.

Evaluation of a pilot volunteer feeding assistance program: influences on the dietary intakes of elderly hospitalised patients and lessons learnt

OBJECTIVES

Malnutrition is a serious concern in hospitals and is known to be associated with increased complications for patients, increased hospital costs and length of stay. Trained volunteers that assist 'at risk' and malnourished patients at lunch meals have been shown to effectively increase nutritional intake in a suburban hospital in Sydney. The pilot study reported here aimed to evaluate and share learnings from a similar, newly implemented program, comparing energy and macronutrient intakes on days with no volunteer assistance, to days with volunteers.

DESIGN

Dietary intakes were determined by visual estimation of meal trays before and after meals, for two days without volunteers, and two days with volunteer assistance at lunch. Macronutrient and energy intakes were compared and data such as weight, height, diet type and medical history were obtained from medical records. Questionnaires were completed by nurses and volunteers in regards to their views and experiences with the program.

SETTING

Hospital based.

RESULTS

Eight patients (83±4.5 years) participated in the study. When volunteers were present at lunch, the average macronutrient and energy intakes increased, though not statistically significantly. The mean increases were 316 kJ (p=0.175) for energy, 3.1 g (p=0.468) for protein, 1.4 g (p=0.418) for fat and 11.6 g (p=0.084) for carbohydrates. Non-significant increases in macronutrients were also noted for the average daily intakes.

CONCLUSION

Although not statistically significant, energy and macronutrient intakes increased when volunteers were present. The implementation of a volunteer feeding assistance program is one strategy to assist dietary intakes but requires a ready team of volunteers, training, acceptance and significant time to develop.

[Nutrition and frail elderly at risk]

Good health for elderly people depends on some extent on their nutritional status. During the completion of a master's degree in nursing sciences, a study highlighted the need to develop measuring tools for screening for undernutrition in the elderly in community nursing practice. A programme for raising awareness of the consequences of undernutrition in elderly people is an area to develop through broader frailty screening in primary care.

The prevalence of malnutrition in elderly residents in a warden-assisted setting compared with a home-living environment

Malnutrition in elderly people is associated with many adverse clinical outcomes. However, few studies exist investigating malnutrition in the community setting. This study aimed to report the prevalence of malnutrition in elderly people living in warden-assisted (WA) accommodation compared with those living at home. A total of 20 WA and 20 home-living (HL) participants were assessed using hand-grip strength and the Mini Nutritional Assessment (MNA). Some 30% of the WA group were malnourished, compared with 10% of the HL group. This study demonstrates an alarmingly large proportion of individuals in WA accommodation to be either malnourished or at risk of malnutrition. This is a relatively small study, and further research into the key factors influencing malnutrition and interventions to minimise malnutrition with WA accommodation are clearly warranted.

Nutrition support protocols and their influence on the delivery of enteral nutrition: a systematic review

BACKGROUND

Malnutrition remains prevalent in critically ill adults and is associated with poor outcomes and increased cost of hospitalization.

AIM

To (a) determine whether implementation of a nutrition support protocol improves delivery of nutrients in critically ill patients, and (b) evaluate whether patients receiving nutrition support based on a protocol have better outcomes than those who do not.

METHODS

CINHAL and PUBMED databases were searched utilizing keywords "model," "nutrition," intensive care," "algorithm," "critical care," "protocol," and "feeding guidelines." Selection criteria included original studies published in English with publication date between January 1, 2005, and December 31, 2010; a critically ill adult population; and level 1 or 2 studies. Studies were collected and reviewed by a single reviewer. Data extraction and quality assessment were assured utilizing a standardized form. A narrative description of results was provided due to variability in methods and outcome measures of included studies.

RESULTS

Ninety-nine studies emerged and 22 studies were considered for inclusion. Four studies were selected. Use of a nutrition support protocol was found to lead to increased efficacy in the delivery of nutrients via the enteral route.

LINKING EVIDENCE TO ACTION

The use of a nutrition support protocol appears to increase the efficacy of enteral nutrition delivery. Further research is needed to determine the effect of increased enteral nutrition adequacy on patient outcomes. The use of an evidenced-based protocol is recommended to improve protein and energy delivery in the critically ill.

Patient and family views of nutritional status

Providing adequate food in hospitals remains a concern for those involved in healthcare as well as patients and relatives. We conducted a small-scale survey to explore relatives' and patients' perceptions about the risk of developing malnutrition in hospital and to gauge whether further more in-depth audit was required.

Accurate assessment patient weigh

Measuring patient weight is considered a routine assessment that is frequently delegated to unregistered staff. Yet patient weight is a fundamental part of nutrition assessment and may be used to calculate drug dosages and assess fluid balance. It is vital that staff carrying out this measurement are trained and have access to appropriate equipment that is regularly calibrated.

Preventing malnutrition in home-dwelling elderly individuals

The aim of this article is to provide an overview of the role of the nurse in the identification and prevention of malnutrition in home dwelling elderly individuals. It will examine the causes and prevalence of malnutrition outlining the factors that may place older home-dwelling people at risk of developing this serious nutritional disorder. The remainder of the article will provide an in-depth focussed discussion on the role of the community nurse in the assessment and prevention of malnutrition, with recommendations for the improvement of clinical practice.

Management of patients with complications of cirrhosis

Cirrhosis results from repeated hepatocellular injury over time, leading to portal hypertension and the development of ascites, hepatic encephalopathy, and varices. Despite improvements in medical care for patients with cirrhosis, mortality from infection, renal failure, and hepatocellular carcinoma remain high.

Parenteral nutrition: considerations for practice

Malnutrition in the UK is estimated to affect 3 million people in the UK, costing the economy pound 13 billion a year. The effects can adversely affect an individual's wellbeing by exacerbating illness or reducing the prospect of a speedy recovery. The early identification of this actual or potential risk is recognised by using a validated nutritional screening tool as part of the patient assessment. Where risks are identified a structured plan should be put in place utilising oral and enteral techniques in nutritional support. However, for a number of patients these routes of feeding may not be an option, or may not fully meet the patient's nutritional requirements. It is in these circumstances that parenteral feeding may be considered under the supervision of a nutrition team. The careful selection of the parenteral solution alongside the most appropriate venous device to deliver the nutrition can assist in the effectiveness of this treatment and help in reducing the potential complications associated with this route.