Using clinical quality databases to monitor the quality of fundamental care: Example with weight status after severe traumatic brain injury

Abstract

Aims and objectives:To determine weight status and risk of overweight up to 1 year after severe traumatic brain injury (TBI) as basis for defining nursing-sensitive indicators of fundamental nutritional nursing care in a clinical quality database.Background: Patients' nutritional needs are recognised as fundamental care during hospitalisation, but less attention has been given to nutritional status after discharge.Design: Nationwide cohort study. The STROBE checklist was used to ensure reporting quality. Methods: Data were retrieved from the Danish Head Trauma Database, a clinical quality database aiming at improving the quality of neurorehabilitation. Individuals aged ≥ 15 years with severe TBI 2011-2015 (N = 424) were included. Normal weight, underweight and overweight were described according to the body mass index (BMI) at admission to subacute rehabilitation, at discharge and at 1 year postinjury. The probability of transition between weight groups from admission to 1 year postinjury was calculated. Multivariable binominal regression analyses compared risk of overweight between age groups. Results: The prevalence of underweight decreased from 13% at admission to 6% and 3% at discharge and 1 year postinjury, respectively. The prevalence of overweight was stable at 26%-27% at admission and discharge and increased to 44% at 1 year postinjury. Of the individuals not overweight at admission, 28% became overweight by 1 year postinjury. Overweight was significantly more prevalent in older compared to younger individuals. The risk of becoming overweight among those not overweight at admission did not differ between age groups. Conclusion: Underweight individuals achieved normal weight during inpatient rehabilitation. By 1 year postinjury, individuals were increasingly overweight. Relevance to clinical practice: Weight status has potential as nursing-sensitive indicators that may be included in clinical quality databases to inform the organisational and policy level on the state of fundamental nutritional nursing care. The inclusion emphasise requested responsibilities of nursing care. This facilitates health economic attention and influences nursing professional execution.

To what extent Unfinished Nursing Care tools coincide with the discrete elements of The Fundamentals of Care Framework? A comparative analysis based on a systematic review

“…We have undertaken this research exercise as how The Framework should be measured is still an open question for educators, researchers and clinicians (Feo et al, 2019) despite some documented attempts (Muntlin Athlin, 2018; Odgaard et al, 2020; Parr et al, 2018). For what concerns UNC, studies validating tools have been documented since the initial phase just after the establishment of the concepts as a first research outcome (Kalisch et al, 2009; Schubert et al, 2007), creating a solid body of knowledge in the last 15 years, mainly in the US and in Europe.…”

“…Detecting relational and psychological needs is a real challenge while physical needs are more concrete and traceable. Previously, in mapping the Nursing Minimum Data Set and clinical database capacity to trace The Framework dimensions, some elements, such as safety, prevention and medication, comfort and eating and drinking, have been reported as being considered more often (Muntlin Athlin et al, 2018; Odgaard et al, 2020). Furthermore, by taking into account all The Framework dimensions, the UNC tool that is best capable to detect discrete elements is the Perceived Implicit Rationing of Nursing Care (Gurkova et al, 2019; Jones, 2014; Jones et al, 2015).…”

Body composition measures may help target fundamental nutritional nursing efforts in rehabilitating patients with acquired brain injury

“…While sufficient muscle mass seems important, high and increasing BMI has been found in a substantial number of patients with ABI in the postrehabilitation period (Dreer et al., 2018 ; Duraski et al., 2014 ; Odgaard et al., 2020 ). In our primary study, we found that the group “overweight/obese” defined by BMI, slightly increased from admission to 4 weeks stay (submitted).…”