Nutrition Therapy in the Transition between Hospital and Home: An Investigation of Barriers

Abstract

Aims and Objectives. This study aimed to investigate barriers for nutrition therapy in the transition between hospital and home and hereby to identify areas for potential improvements. Background. Though the focus on nutritional risk is improving in hospital, there seems to be less effort to maintain or even improve nutritional status after discharge and during the rehabilitation period. Design. Qualitative focus group interviews. Methods. Semistructured focus group interviews with experienced multiprofessional staff from hospital, home care, nursing homes, and general practise. The study was done in the county of Aalborg with about 280.000 inhabitants regarding homecare and general practise as well as Aalborg University Hospital, Denmark. Results. Interviews were generated with 41 professionals from hospital, general practise, and home care. Barriers identified between settings included the following aspects: economic, organisation, and education. The impression of professionals was that few patients are discharged with nutrition therapy, compared to who could benefit from nutrition therapy after discharge. Most often, reasons were a short in-hospital stay and lack of knowledge and interest. Moreover, lack of clinical guidelines throughout all settings, time consumption, lack of transparency regarding economy and workflows, and lack of assistance from experts regarding complicated nutritional problems were identified. Conclusions. Many barriers were found in hospital as well as in the community and general practise. These were most often practical as well as organizational. Improvements of clinical guidelines and instructions and improvement of knowledge and communication at all levels are needed. Relevance to Clinical Practise. This study emphasizes that responsibility needs to be taken for patients whom are still at nutritional risk at discharge, and even before hospitalization. Nurses and doctors in and outside hospital are in need of improved knowledge, standard care plans, and instructions.

Handling the inpatient's hospital ‘Career’ – Are nurses laying the groundwork for healthy meal and nutritional care transitions?

“…'s () finding that nurses are good at documenting technological and organizational care strategies, but less so at documenting their own understanding. This is comparable to a Danish study by Holst and Rasmussen () who noted generally poor organization of meal care, including a lack of documentation. The discrepancies between social‐bodily and text‐based care may, moreover, be one of the main challenges to the effective management of the inpatient meal and nutritional career and hence the methods and opportunities for mobilizing patient resources that are at nurses’ disposal in relation to inpatient meal and nutritional care.…”

“…The nurses experience a lack of knowledge, which was also found in a study by Holst and Rasmussen (), who identified an insufficient lack of logging knowledge about meal and nutrition care. However, nurses recognize the importance of logging information and actions, which can also be supported by a study by Andersson Willman, Sjöström‐Strand & Borglin () that found that nurses regard the logging of information as an aspect of patient care.…”

“…The focus on the processes of transition and patient phases is supported by a Danish study that concludes that undernutrition among older hospitalized adults is a problem that needs to be addressed before, during, and after hospitalization (Holst & Rasmussen, ). Moreover, owing to the encompassing consequences of being an undernourished older adult, it seems highly relevant to address issues in a patients’ meal and nutrition ‘career’ in this framing due to the phases being defining for the transition and hence the nutritional career that occur within total institutions.…”

More-2-Eat: evaluation protocol of a multi-site implementation of the Integrated Nutrition Pathway for Acute Care

“…Patients report many barriers to food intake [18] and effective low-technology solutions could be a feasible way to address these issues. Physician and nurse attitudes, knowledge and nutrition care activities demonstrate that education and training are needed to promote and sustain best practice [14,[19][20][21][22][23][24][25][26][27]. It is anticipated that improving care processes in hospital would also prevent iatrogenic malnutrition.…”

“…Focusing mealtimes on food intake and ensuring that staff is available to assist with mealtime activities are also important [28,30,[32][33][34][35][36]. Continuing nutrition care for malnourished patients post discharge has also been recommended [14,27,36]. In response to these best practice recommendations and to improve nutrition care practice, a treatment algorithm for hospital use in medical and surgical patients was created.…”