Post-Discharge Nutrition Care Instructions for Malnourished Adults

Malnutrition remains an insidious yet common ailment among hospitalized adults, with prevalence estimates ranging from 4-45%. Multiple studies confirm the adverse effects of malnutrition, which include prolonged length of stay, readmissions, higher hospitalization costs, and mortality. Malnutrition is frequently associated with chronic disease. For nutrition interventions to be successful, they must continue to support the long-term nutritional needs of patients beyond the hospital stay. Few studies, however, examine the receipt of recommendations for oral nutrition supplementation (ONS) or basic nutrition care instructions at the time of discharge. There is a need to better understand what post-discharge nutrition care instructions are documented in the electronic medical record (EMR) and how they are communicated to patients once they leave the hospital. This study sought to describe the malnourished adult patient population and the standard of nutrition-focused discharge care they receive at Christiana Hospital in Newark, DE. The investigation revealed that a majority of these patients received inappropriate or inadequate nutrition care instructions at time of discharge. Preliminary survey data suggest that some patients may be unaware of their malnutrition diagnosis, and may receive care instructions that are never documented. Clinician education and redesign of nutrition care options in the EMR may aid in the provision of discharge instructions to treat and prevent malnutrition after patients leave the hospital

Analysis of Nutrition Care Chronic Renal Failure Patients with Health Technology Assessment

Declined in nutritional status of hospitalized Chronic Renal Failure (CRF) patients were due to nutrient intake inadequate which required special attention from the Hospital Nutrition Service Team. This study analyzed the nutritional service on hospitalized CRF patients in Dr. Hasan Sadikin Hospital, Bandung using Health Technology Assessment. The study was conducted in 2014. The study design mixed method with concurrent embedded strategies. The hospital management, nutritionist and hospitalized CRF patients were qualitative subjects, selected using purposive sampling. Quantitative subjects selected using total sampling were 25 patients. Food weighing were used to measure food waste. The nutritional services technology aspects especially nutritional care using PAGT has not been entirely done. Nutritional monitoring and evaluation have not been well programmed and scheduled. The collaboration of nutritional care team have not been optimal. The food service mechanism are quite good while its portions are standardized yet. According to patient\u27s point of view towards food service quality, the food have less variety and taste. Total of cost damage from food waste are Rp.18.099,00 in a year. The lack of technological and organizational aspects can reduce the food service quality. According to the patient, the lack of food service quality will increase the food waste and total cost damage

Assessing Perceptions Toward Implementation of the Nutrition Care Process among Registered Dietitians in Northeast Tennessee.

The purpose of this study was to survey registered dietitians in Northeast Tennessee to determine attitudes toward implementation of the nutrition care process prior to and following education about the nutrition care process and/or implementation of the nutrition care process in their respective healthcare facilities. Approximately 100 registered dietitians were involved in the study. Data were collected through electronic submission and written inquiries. The findings of the study identified that there was a need for further research regarding implementation of the nutrition care process and that negative attitudes, opinions, and barriers were broken down by education, implementation, and exposure to the nutrition care process

Nutrition Care Manual

Developed by the Academy of Nutrition and Dietetics, Nutrition Care Manual serves as an evidence-based, point-of-care tool for students, educators, and professionals. The content covers the most common nutrition issues, professional background information, treatment plans, and patient education information. However, the user interface is confusing with few paths for logical search or navigation and lacks many of the common features users expect from most electronic resources, such as permalinks or mobile viewing. While the content and flexibility meet a previously unfulfilled need in allied health resources, the interface problems hinder maximum utilization of the content quickly

A realist synthesis of educational interventions to improve nutrition care competencies and delivery by doctors and other healthcare professionals

Objective: To determine what, how, for whom, why, and in what circumstances educational interventions improve the delivery of nutrition care by doctors and other healthcare professionals work. Design: Realist synthesis following a published protocol and reported following Realist and Meta-narrative Evidence Synthesis: Evolving Standards (RAMESES) guidelines. A multidisciplinary team searched MEDLINE, CINAHL, ERIC, EMBASE, PsyINFO, Sociological Abstracts, Web of Science, Google Scholar and Science Direct for published and unpublished (grey) literature. The team identified studies with varied designs; appraised their ability to answer the review question; identified relationships between contexts, mechanisms and outcomes (CMOs); and entered them into a spreadsheet configured for the purpose. The final synthesis identified commonalities across CMO configurations. Results: Over half of the 46 studies from which we extracted data originated from the USA. Interventions that improved the delivery of nutrition care improved skills and attitudes rather than just knowledge; provided opportunities for superiors to model nutrition care; removed barriers to nutrition care in health systems; provided participants with local, practically relevant tools and messages; and incorporated non-traditional, innovative teaching strategies. Operating in contexts where student and qualified healthcare professionals provided nutrition care in developed and developing countries, these interventions yielded health outcomes by triggering a range of mechanisms, which included feeling competent, feeling confident and comfortable, having greater self-efficacy, being less inhibited by barriers in healthcare systems and feeling that nutrition care was accepted and recognised. Conclusions: These findings show how important it is to move education for nutrition care beyond the simple acquisition of knowledge. They show how educational interventions embedded within systems of healthcare can improve patients’ health by helping health students and professionals to appreciate the importance of delivering nutrition care and feel competent to deliver it

Patient safety and nutrition: is there a connection?

Nutrition care is not always recognised as a patient safety issue. This article explores the origins of the patient safety initiative and seeks to identify possible connections between nutrition care and patient safety. Examples of tools that can be used to improve the safety of nutrition care are provided. This is also a call to action as patient safety data for nutrition care in the South African context are lacking and much can be learned from worldwide patient safety initiatives. Keywords: dietetic students, Three-Factor Eating Questionnaire, Eating Attitudes Test 26, body mass index, eating behaviour, eating disorder

Interdisciplinary Nutritional Management and Care for Older Adults

This open access book aims to primarily support nurses as leaders and champions of multimodal, Interdisciplinary nutrition care for older adults. A structured approach to fundamentals of nutrition care across Interdisciplinary settings is combined with additional short chapters about special topics in geriatric nutrition. The book is designed to provide highly accessible information on evidence-based management and care for older adults, with a focus on practical guidance and advice across acute, rehabilitation, and primary and secondary malnutrition prevention settings.The cost of malnutrition in England alone has been estimated to be £19.6 billion per year, or more than 15% of the total public expenditure on health and social care. ^65 years. The importance and benefit of specialised nutrition care, delivered by experts in field, is well established for those with complex nutrition care needs. However, despite the substantial adverse impact of malnutrition on patient and healthcare outcomes, specialised management of this condition is often under-resourced, overlooked and under-prioritised by both older adults and their treating teams. As an alternative, timely, efficient, and effective supportive nutrition care opportunities may be appropriately implemented by nurses and non-specialist Interdisciplinary healthcare team members, working together with nutrition specialists and the older adults they care for. Practical, low-risk opportunities should be considered across nutrition screening, assessment, intervention, and monitoring domains for many patients with, or at risk of malnutrition. Whilst a variety of team members may contribute to supportive nutrition care, the nursing profession provide a clear focal point. Nurses across diverse settings provide the backbone for Interdisciplinary teamwork and essential patient care. The nursing profession should consequently be considered best placed to administer Interdisciplinary, multimodal nutrition care, wherever specialist nutrition care referrals are unlikely to add value or are simply not available. As such, the book is a valuable resource for all healthcare providers dedicated to working with older patients to improve nutrition care.

NUTRITION CARE FOR LONG-TERM CARE RESIDENTS WITH DEMENTIA IN URBAN AND RURAL CONTEXTS: AN EVIDENCE BASED PRACTICE EXAMINATION OF THE ROLE OF CARE AIDES AND REGISTERED DIETITIANS

This doctoral dissertation contributes to the body of knowledge pertaining to nutrition care for persons with dementia. The aging population adds to the increased risk for and prevalence of dementia globally. Alongside this is a recognition of the need for care strategies for persons with dementia, and preventive strategies to delay onset of dementia or to delay secondary or tertiary comorbidity associated with dementia. Of strong interest is the field of nutrition, in terms of dietary strategies for primary prevention of dementia, for secondary and tertiary prevention of comorbidities, and for medical nutrition therapies to treat those with dementia, across the spectrum of dementing illnesses and degree of severity. Over the course of three related studies, nutrition care for long-term care (LTC residents was addressed using an evidence-based practice lens. Study 1 investigated care aides’ perception of nutrition care for urban and rural LTC residents with dementia. Key findings included the complexity of operationalizing person centered care into nutrition care activities, the mechanistic focus on feeding, and many organizational factors that direct nutrition care for care aides and residents with dementia. Study 2 examined the role of registered dietitians (RDs) in providing nutrition care for residents with dementia in urban and rural LTC. The key finding in this study was the downstream role of RDs in dementia care. As opposed to a more upstream preventive model of care, RDs were consulted or involved only at late stages or when comorbid decline had occurred, limiting their abilities to use their specialized nutrition knowledge and skills effectively. The 3rd study was an umbrella review of the peer-reviewed body of systematic reviews on nutrition care for residents with dementia in LTC. The major findings of this study include the lack of consistency in terms of nutritional outcomes considered and intervention tested, as well as a considerable gap in the published literature regarding both care aides and RDs. Taken together, these studies make a valuable contribution to the growing body of research on nutrition care and dementia. There is a need to continue to work with RDs and care aides in developing and testing interventions that can enhance both the physical health and quality of life for LTC residents with dementia

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

Determination of Reliability of the Nutrition Care Process Evaluation Instrument

Objective: At the time of this study, no known validated tool existed that was specifically developed to assess dietetic students’ clinical judgment during interprofessional simulations. To fill this gap, the author developed the Nutrition Care Process Evaluation Instrument to measure clinical judgment of dietetics students during interprofessional simulations at the University of Kansas Medical Center. Methods: Through a pilot study, the Nutrition Care Process Evaluation Instrument was tested to determine reliability when measuring simulation participants’ clinical judgment during three separate patient scenarios. Study subjects (n=16) were pooled from Dietetic Intern students who participated in interprofessional simulations as a requirement of the Dietetics and Nutrition 826 Medical Nutrition Therapy course. During the simulations, one rater completed the validated assessment tool, the Lasater Clinical Judgment Rubric, while two other raters completed the newly developed Nutrition Care Process Evaluation Instrument. Results: Matched by student and scenario, inter-rater reliability was determined using Cohen’s Kappa between raters who completed the Nutrition Care Process Evaluation Instrument. Exploratory analysis was also completed using Spearman’s rank-order correlation coefficient to determine the strength of association between raters using both the validated and new tool. Discussion: Reliability of the Nutrition Care Process Evaluation Instrument was not fully established, possibly due to the small sample size, vast differences in raters, issues with scheduling, and the subjective nature of the assessment. Additionally, little association was seen between scores provided on both tools, likely due to the differing contents of each. Further research is needed to fully determine the reliability and validity of the Nutrition Care Process Evaluation Instrument