Barriers to nutritional care for the undernourished hospitalised elderly: perspectives of nurses

Abstract

Aims and objectivesTo identify what nurses experience as barriers to ensuring adequate nutritional care for the undernourished hospitalized elderly.BackgroundUndernutrition occurs frequently among the hospitalised elderly and can result in a variety of negative consequences if not treated. Nevertheless, undernutrition is often unrecognised and undertreated. Nurses have a great responsibility for nutritional care, as this is part of the patient's basic needs. Exploring nurses' experiences of preventing and treating undernourishment among older patients in hospitals is therefore highly relevant.DesignA focus group study was employed based on a hermeneutic phenomenological methodological approach.MethodsFour focus group interviews with totally 16 nurses working in one large university hospital in Norway were conducted in spring 2012. The nurses were recruited from seven somatic wards, all with a high proportion of older (≥70 years) inpatients. The data were analysed in the three interpretative contexts: self-understanding, a critical common-sense understanding and a theoretical understanding.ResultsWe identified five themes that reflect barriers the nurses experience in relation to ensuring adequate nutritional care for the undernourished elderly: loneliness in nutritional care, a need for competence in nutritional care, low flexibility in food service practices, system failure in nutritional care and nutritional care is being ignored.ConclusionsThe results imply that nutritional care at the university hospital has its limits within the hospital structure and organisation, but also regarding the nurses' competence. Moreover, the barriers revealed that the undernourished elderly are not identified and treated properly as stipulated in the recommendations in the national guidelines on the prevention and treatment of undernutrition.Relevance to clinical practiceThe barriers revealed in this study are valuable when considering improvements to nutritional care practices on hospital wards to enable undernourished older inpatients to be identified and treated properly.

Rutiner for å vurdere ernærings=status i hjemme=sykepleien

“…Moreover, several of the respondents were not aware of the above-mentioned guidelines (37). The health care personnel in our survey mentioned time as being the key obstacle to achieving good routines for assessing nutrition.…”

Knowledge of Heatlh Effects of Dietary Fibre Among Nurses and the General Population in Croatia: Comparative Analysis

“…Analysis of nursing experiences indicates that patients frequently ask them to provide dietary information. Studies show that nurses are in constant contact with patients and continuously communicate with them (O'Mahony et al, 2011) and often receiving dietary questions from patients, but nurses are often busy with other tasks, such as documentation and medication (Eide et al, 2015). Nurses accompany patients throughout their health care to prevent and treat disease, so their knowledge about diet and dietary fibre is key to successful diet therapy, which is an essential part of a patient's non-pharmacological treatment (Rodrigues-Fisher, Bourguignon, & Good, 1993).…”

A Dietary Assessment App for Hospitalized Patients at Nutritional Risk: Development and Evaluation of the MyFood App (Preprint)

“…Norwegian studies among healthcare professionals have reported that only half or less of the patients identified to be at nutritional risk receive nutritional treatment [16,17]. A barrier to adequate nutritional care for malnourished patients in hospitals is the absence of routines, as demonstrated in qualitative studies among nurses in Norway and Sweden [18,19]. Nurses report lack of tools to estimate the patient's needs and the content of energy and protein in the hospital menus [10].…”

“…Nurses report lack of tools to estimate the patient's needs and the content of energy and protein in the hospital menus [10]. They also experience insufficient knowledge and skills to identify and treat malnourished patients [18,20].…”