Stuck in tradition‐A qualitative study on barriers for implementation of evidence‐based nutritional care perceived by nursing staff

O'Connell, Malene Barfod; Jensen, Pia Søe; Andersen, Signe Lindgård; Fernbrant, Cecilia; Nørholm, Vibeke; Petersen, Helle Vendel

doi:10.1111/jocn.14020

Cited by 34 publications

(41 citation statements)

References 36 publications

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“…This is in line with the findings in another study where healthcare providers in nursing homes experienced that the quality of the psychosocial aspects of the nutritional care was constrained by the demands of routine-driven, task-oriented practices (39) . Lack of time was repeatedly identified as an issue among our participants and is a well-established barrier for quality nutritional care (20,21,40,41) . Studies have reported that healthcare professionals experience a tension between 'person-centredness' and 'the system' because hectic work and structural barriers negatively affect their ability to provide quality person-centred nutritional care (19,20,(39)(40)(41) .…”

Section: Discussionmentioning

confidence: 94%

“…However, moving from rhetoric about person-centred nutritional care in research reports, guidelines and policy documents to actually implementing it in practice appears to be challenging (14,15) . Despite the considerable interest shown in personcentred nutritional care for older persons in recent years (9,11,16,17) , delivery of the care still often lack consideration for the older person's needs and preferences (18)(19)(20)(21) . Problems such as poor communication of nutritional information (18,22) , insufficient knowledge about older person's nutritional needs and lack of attention to their nutritional problems have been described (20,21) .…”

Section: Introductionmentioning

confidence: 99%

“…Despite the considerable interest shown in personcentred nutritional care for older persons in recent years (9,11,16,17) , delivery of the care still often lack consideration for the older person's needs and preferences (18)(19)(20)(21) . Problems such as poor communication of nutritional information (18,22) , insufficient knowledge about older person's nutritional needs and lack of attention to their nutritional problems have been described (20,21) . Studies report that older persons and their family experience a lack of participation in care and care planning (23)(24)(25) .…”

Section: Introductionmentioning

confidence: 99%

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Hospital nurses and home care providers’ experiences of participation in nutritional care among older persons and their family caregivers: a qualitative study

Hestevik

Molin

Bergland

et al. 2019

J Human Nutrition Diet

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Background A person‐centred approach to nutritional care has the potential to increase an older person’s role in making informed decisions about their own care and possibly improving their quality of life. However, despite the considerable interest shown in person‐centred nutritional care in recent years, delivery of such care still appears to lack consideration for older persons’ needs and preferences. The present study aimed to explore healthcare professionals’ views on how older persons and their family caregivers participate in decisions about their own nutritional care and possible barriers for that participation. Methods Semi‐structured in‐depth interviews with 23 healthcare professionals in acute geriatric care and home care were conducted. Data were analysed thematically. Results The analysis of the interviews resulted in three main themes: (i) lack of shared decision‐making in nutritional care; (ii) conflict between patient’s preferences and standard nutritional care procedures; and (iii) the value of family caregivers who are seldom involved in nutritional care. Conclusions Healthcare professionals were aware of the importance of actively engaging older persons and their family members in the nutritional care to achieve positive outcomes. However, they encountered individual and structural barriers, including resistance from patients and family caregivers, conflicts between the patients’ nutritional wishes and standard nutritional procedures, a wish to shield the family caregivers from the stress of caring for a sick relative, and lack of time and caring structures that facilitate the older persons and their family’s active participation.

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Section: Discussionmentioning

confidence: 94%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Hospital nurses and home care providers’ experiences of participation in nutritional care among older persons and their family caregivers: a qualitative study

Hestevik

Molin

Bergland

et al. 2019

J Human Nutrition Diet

View full text Add to dashboard Cite

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“…Some evidence‐based guidelines and screening protocols are not put in practice if they are considered as a barrier to stop the patient flows (Kirk & Nilsen, ). Other barriers identified in previous studies also included insufficient collaboration between nursing staff and doctors (O′Connell et al, ).…”

Section: Discussionmentioning

confidence: 99%

Selecting and quantifying low‐value nursing care in clinical practice: A questionnaire survey

Osorio

Zuriguel‐Pérez

Lecumberri

et al. 2019

Journal of Clinical Nursing

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Aims and objectives To evaluate the opinion of hospital nurses on a group of recommendations aimed at reducing low‐value nursing care and, based on these results, to detect low‐value practices probably existing in the hospital. Background Low‐value nursing care refers to clinical practices with poor or no benefit for patients that may be harmful and a waste of resources. Detecting these practices and understanding nurses' perceptions are essential to developing effective interventions to reduce them. Methods We conducted a survey in a tertiary hospital. STROBE guidelines were followed. The questionnaire appraised nurses' agreement, subjective adherence and perception of usefulness of a group of recommendations to reduce low‐value nursing care from Choosing Wisely and other initiatives. Practices described in recommendations with an agreement over 70% and a subjective adherence under 70% were categorised as low‐value practices probably existing in the hospital. Results A total of 265 nurses from eight areas of care participated in the survey. The response rate by area ranged between 2%–55%. From the 38 recommendations evaluated, agreement was 96% (95% confidence interval [95%CI], 95%–97%), median subjective adherence was 80% (95%CI, 80%–85%), and usefulness was 90% (95%CI, 89%–92%). Based on these results, we detected seven (0–15) low‐value practices probably existing in our hospital, mostly on general practice, pregnancy care and wound care. Conclusions We found a great understanding of low‐value care between nurses, given the high agreement to recommendations and perception of usefulness. However, several low‐value practices may be present in nursing care, requiring actions to reduce them, for instance, reviewing institutional protocols and involving patients in de‐implementation. Relevance to clinical practice Hospitals and other settings should be aware of low‐value practices and take actions to identify and reduce them. A survey may be a simple and helpful way to start this process.

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“…The authors found that nurses in general considered nutrition important, however, when the nurses ranked providing nutrition care (like serving meals rich in proteins and calories), they found it a less important task (Boaz et al, ). Other studies have explored nurses’ barriers in nutritional care, and nurses explained they lacked time, resources and ward facilities to provide the necessary care (O'Connell et al, ; Papier, Lachter, Hyams, & Chermesh, ). Thus, patient experiences in the current study stress the need for interventions enabling nursing staff to have education about nutrition and how to provide individual counselling and care about nutrition to patients during hospitalisation.…”

Section: Critical Interpretation and Discussionmentioning

confidence: 99%

Food and heart—the nutritional jungle: Patients’ experiences of dietary habits and nutritional counselling after coronary artery bypass grafting

Elbrønd

Højskov

Missel

et al. 2019

Journal of Clinical Nursing

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Aims and objectives The aim of the study was to examine patients’ experience of dietary habits and nutritional counselling in the early period during hospitalisation after coronary artery bypass surgery (CABG). Background Undergoing CABG, patients have two different nutritional needs, extra proteins and calories for the first period after surgery and a heart‐healthy diet when the recovery period is over. These needs can be difficult to manage for the patients. Design Qualitative study. Methods Interviews were conducted and analysed within a phenomenological‐hermeneutic frame inspired by the French philosopher Paul Ricoeur. Patients undergoing CABG were interviewed 4–5 days after surgery at Odense University Hospital from March to May, 2017. The study adhered to the COREQ guidelines. Results In total, 15 patients were interviewed (mean age 65 years, 87% men). After analysing the interviews following themes emerged, “Different needs—the nutritional jungle”, “Food and heart—the lacking attention,” and “The force of habits—being under the influence from spouses on dietary habits”. Conclusion The interviewed patients had no or only a little knowledge about how to eat after heart surgery. In general, they experienced a lack of attention to nutritional counselling by the nursing staff during hospitalisation. Furthermore, the health behaviour of men seems to be different from women's, and therefore, interventions aiming at optimising men's health might be prioritised. Finally, spouses have a great influence on eating habits, why they should be involved in nutritional counselling. Relevance to clinical practice This study provides important and relevant knowledge about patients’ lacking knowledge about nutrition. When planning nutritional measures, whether it is promoting healing after heart surgery or preventing progression of arteriosclerosis, the study contributes with suggestions as to which factors should be considered in this process—men's health behaviour and spouses’ influence on dietary habits in the household.

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Stuck in tradition‐A qualitative study on barriers for implementation of evidence‐based nutritional care perceived by nursing staff

Cited by 34 publications

References 36 publications

Hospital nurses and home care providers’ experiences of participation in nutritional care among older persons and their family caregivers: a qualitative study

Hospital nurses and home care providers’ experiences of participation in nutritional care among older persons and their family caregivers: a qualitative study

Selecting and quantifying low‐value nursing care in clinical practice: A questionnaire survey

Food and heart—the nutritional jungle: Patients’ experiences of dietary habits and nutritional counselling after coronary artery bypass grafting

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