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Assessment and documentation of patients' nutritional status: perceptions of registered nurses and their chief nurses
Karlstad University, Faculty of Social and Life Sciences, Department of Nursing.ORCID iD: 0000-0002-2667-4025
Karlstad University, Faculty of Social and Life Sciences, Department of Nursing.ORCID iD: 0000-0003-3385-3731
Karlstad University, Faculty of Social and Life Sciences, Department of Nursing. (Avdelningen för omvårdnad)ORCID iD: 0000-0002-9608-336X
Karlstad University, Faculty of Social and Life Sciences, Department of Nursing.
2008 (English)In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 17, no 16, 2125-2136 p.Article in journal (Refereed) Published
Abstract [en]

To study, within municipal care and county council care, (1) chief nurses' and registered nurses' perceptions of patient nutritional status assessment and nutritional assessment/screening tools, (2) registered nurses' perceptions of documentation in relation to nutrition and advantages and disadvantages with a documentation model.

BACKGROUND:

Chief nurses and registered nurses have a responsibility to identify malnourished patients and those at risk of malnutrition.

DESIGN AND METHODS:

In this descriptive study, 15 chief nurses in municipal care and 27 chief nurses in county council care were interviewed by telephone via a semi-structured interview guide. One hundred and thirty-one registered nurses (response rate 72%) from 14 municipalities and 28 hospital wards responded to the questionnaire, all in one county.

RESULTS:

According to the majority of chief nurses and registered nurses, only certain patients were assessed, on admission and/or during the stay. Nutritional assessment/screening tools and nutritional guidelines were seldom used. Most of the registered nurses documented nausea/vomiting, ability to eat and drink, diarrhoea and difficulties in chewing and swallowing, while energy intake and body mass index were rarely documented. However, the majority documented their judgement about the patient's nutritional condition. The registered nurses perceived the VIPS model (Swedish nursing documentation model) as a guideline as well as a model obstructing the information exchange. Differences were found between nurses (chief nurses/registered nurses) in municipal care and county council care, but not between registered nurses and their chief nurses.

CONCLUSIONS:

All patients are not nutritionally assessed and important nutritional parameters are not documented. Nutritionally compromised patients may remain unidentified and not properly cared for.

RELEVANCE TO CLINICAL PRACTICE:

Assessment and documentation of the patients' nutritional status should be routinely performed in a more structured way in both municipal care and county council care. There is a need for increased nutritional nursing knowledge.

Place, publisher, year, edition, pages
2008. Vol. 17, no 16, 2125-2136 p.
Keyword [en]
content analysis, nursing, nutrition, nutritional screening, nutritional tools, the VIPS-model
National Category
Nursing
Research subject
Nursing Science
Identifiers
URN: urn:nbn:se:kau:diva-2834DOI: 10.1111/j.1365-2702.2007.02202.xPubMedID: 18510576OAI: oai:DiVA.org:kau-2834DiVA: diva2:37838
Available from: 2008-10-14 Created: 2008-10-14 Last updated: 2016-04-13Bibliographically approved
In thesis
1. Nutritional Nursing Care: Nurses’ interactions with the patient, the team and the organization
Open this publication in new window or tab >>Nutritional Nursing Care: Nurses’ interactions with the patient, the team and the organization
2008 (English)Doctoral thesis, comprehensive summary (Other scientific)
Abstract [en]

The overall aim of the thesis was to gain a deeper understanding of nutritional nursing care in municipal care and county council care, with specific focus on enteral nutrition (EN) in intensive care.

Quantitative and qualitative methods were used. Telephone interviews regarding assessment of the nutritional status of patients were carried out with special medical nurses (CNs) (n = 14) in municipalities in one county and first line managers (CNs) (n = 27) in one county council. Registered nurses (RNs) in municipalities (n = 74) and county councils (n = 57) answered a questionnaire about nutritional assessment and documentation (I). RNs (n = 44) at three different intensive care units answered a questionnaire about responsibility, knowledge, documentation and nursing interventions regarding EN. Observations (n = 40) on nursing care interventions for patients with EN were carried out (II). RNs (n = 8), enrolled nurses (n = 4) (III) and patients (n = 14) (IV) were interviewed and nutritional nursing care was observed (III-IV) at an intensive care unit.

The results showed that assessment of nutritional status was not performed on all patients, according to RNs/CNs. Malnourished patients were estimated to occur to a varied extent. Sixty-six percent of RNs/CNs answered that there were no guidelines for nutritional care and 13% that they did not know if there were any. RNs saw the VIPS model as a guide in nursing care, but also as an obstacle to information exchange (I). A majority of RNs answered that there were guidelines for EN. There were differences between the RNs’ opinions about their responsibility, knowledge and documentation. Deviations from recommended nursing care interventions occurred (II). The developed substantive theory of nurses (RNs and enrolled nurses) concerns and strategies of nutritional nursing care for patients with EN, includes the core category ”to have and to hold nutritional control – balancing between individual care and routine care” and the categories ”knowing the patient”, ”facilitating the patients’ involvement”, ”being a nurse in the team”, ”having professional confidence” and ”having a supportive organization”. In order for RNs and enrolled nurses to have a sense of control over the patients’ care in relation to nutrition, a balance between routine care and individual care was required (III). The developed substantive theory regarding the patients’ experiences of nutritional care includes the core category ”grasping nutrition during the recovery process”.  The core category is reflected in, and dependent on, the categories ”facing nutritional changes”, ”making sense of the nutritional situation” and ”being involved with nutritional care”. The patients alternated emotionally between worry, fear and failure, and relief and hope. The patients experienced a turning point and felt an improvement in their condition when their appetite returned, when the stomach and gut were functioning and when the feeding tube was removed (IV).

The conclusion is that quality and safety in relation to nutritional nursing care is dependent on the interactions between the nurse and patient, between the nurse and the team, and the nurse and the organization.

Place, publisher, year, edition, pages
Karlstad: Karlstads universitet, 2008. 107 p.
Series
Karlstad University Studies, ISSN 1403-8099 ; 2008:41
Keyword
assessment, documentation, enteral nutrition, intensive care, intervention, malnutrition and nutrition
National Category
Nursing
Research subject
Nursing Science
Identifiers
urn:nbn:se:kau:diva-2843 (URN)978-91-7063-201-3 (ISBN)
Public defence
2008-12-05, Lagerlöfsalen, 1A 305, Karlstads universitet, Karlstad, 09:00 (Swedish)
Opponent
Supervisors
Available from: 2008-11-18 Created: 2008-10-15 Last updated: 2015-01-29Bibliographically approved

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