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Nurses’ knowledge, attitudes and practices in the provision of nutritional care

Nurses’ knowledge, attitudes and practices in the provision of nutritional care

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An essay for the 2011 Undergraduate Awards (Ireland) Competition by Antoinette Fletcher. Originally submitted for Bachelor of Science in General Nursing at University of Limerick, with lecturer Eileen Carey in the category of Nursing
An essay for the 2011 Undergraduate Awards (Ireland) Competition by Antoinette Fletcher. Originally submitted for Bachelor of Science in General Nursing at University of Limerick, with lecturer Eileen Carey in the category of Nursing

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Published by: Undergraduate Awards on Aug 31, 2012
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05/13/2014

 
Nurses’
knowledge, attitudes and practices in the provision of nutritional careAbstract
Nutrition is one of the primary responsibilities of all registered nurses (Persenius et al2008). Malnutrition has
serious consequences for an individual‟s
quality of life (Fieldand Smith 2008). A condition such as malnutrition has to be identified before it canbe treated, therefore the importance of nutritional screening as a means of identifying,evaluating, and treating individuals at risk of malnutrition cannot be underestimated(Elia et al 2005). This paper critically discusses nutritional screening, nutritionalscreening tools, nurses
‟ knowledge,
attitudes and practices to nutrition and debates thechallenges and opportunities encountered by nurses when providing nutritional care topatients.
Introduction
Nutrition is a primary responsibility of all registered nurses (Persenius et al 2008). Agood nutritional status consists of a diet comprised of carbohydrates, proteins, fats anddairy products. An excess, deficiency, or imbalance of any of these essentialcomponents which comprise a balanced diet can lead to a poor nutritional status andcause malnutrition (Lewis et al 2004). Malnutrition is a lack of necessary andappropriate food substances and in clinical practice includes both undernutrition andovernutrition (Kozier et al 2008). Malnutrition can have serious consequences for an
individual‟s quality of life including, malfunction of all systems of the body, as body
cells rely on energy derived from food consumption (Field and Smith 2008).
 
The literature states that a condition such as malnutrition has to be identified before itcan be treated; therefore nutritional screening is recommended as a means of identifying, evaluating, and treating individuals at risk of malnutrition (Elia et al2005). Dougherty and Lister (2008) report that identifying patients nutritionallycompromised or at risk of malnutrition is the first step to providing nutritional care.Furthermore, Redfern and Ross (2006) refer to nutritional screening as a first - linefiltering process used to quantify risk using checklists, questionnaires, or scaled
 
instruments. This literature review critically discusses nutritional screening, the use of 
nutritional screening tools, nurses‟ knowledge of 
 
nutrition, nurses‟ attit
ude andpractices to nutrition and the challenges and opportunities encountered whenproviding nutritional care to patients. The following section explores nutritionalscreening, its use in clinical practice and the impact it is having on identifying thosepatients who are at risk of malnutrition.
Guidelines for Nutritional Screening
 European Society for Clinical Nutrition and Metabolism (ESPEN) 2002 and theNational Institute for Health and Clinical Excellence (NICE) 2006 are theinternational guidelines which guide the nutritional care of patients in the clinicalsetting in Ireland. Recommendations from the ESPEN (2002) (Figure 1) and theNICE (2006) (Figure 2) guidelines are presented.Figure 1: ESPEN (2002) Guidelines
 
 
Every healthcare setting
should have a policy for identifying patients atnutritional risk (Kondrup et al 2003).
 
 
It recommends screening patients, monitoring progress and definingoutcomes, communicating results and auditing outcomes (Kondrup et al2003).
 
 
It suggests that all hospitals should have specific policies and guidelines todeal with nutritional screening (Kondrup et al 2003).
 
 
Figure 2: NICE (2006) GuidelinesPatients classified as being at risk of malnutrition include those who have eaten veryHowever, Elia et al (2005) found that, 60%-85% of patients in UK hospitals, 64% in aNorwegian hospital and 73% in a Singaporean hospital were not detected as beingmalnourished nor did they have referrals sent for further investigations and treatments(Elia et al 2005). This would indicate that there is a widespread need for nutritionalscreening to narrow the gap between what the ideal clinical practice should be andwhat is actually happening in clinical practice.At a national level guidelines on nutritional screening such as those alreadymentioned above have not yet been published. According to the DOHC (2009) nogold standard exists for identifying those who are at risk. The Health ServiceExecutive (HSE) has endorsed the nutritional screening of individuals who arecommenced on nutritional supplements using the Malnutrition Universal ScreeningTool (MUST); however, there seems to be no nutritional screening programmeestablished for the general population (DOHC 2009). A report published by theDOHC (2008) regarding a survey on lifestyles, attitudes and nutrition in Irelandplaces emphasis on obesity levels in Ireland and weight management, with no
 
 
That all patients should be nutritionally screened on admission to hospitaland screening should be repeated weekly where there is clinical concern(NICE 2006).
 
 
All acute hospitals should have at least one clinical nurse specialist innutrition and all healthcare professionals involved in direct patient careshould receive adequate education and training in relation to nutritionalcare (NICE 2006).
 
 
A consideration of factors such as: a body mass index (BMI) of less than18.5, unintentional weight loss which is greater than 10% in the last three tosix months and a combination of a BMI less than 20 and a 5% unintentionalweight loss in the past three to six months - may be indicative of malnutrition (NICE 2006).
 
 
Monitoring those identified as at risk which includes: those who have eaten very
little in the past five days, those with poor absorptive capacity, those whohave high nutritional losses and individuals with increased nutritional needs(NICE 2006).
 

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