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

Abstract

This qualitative study examined hospital nurses' methods in handling meal and nutrition care during inpatient time, with an underlying focus on undernourished older adult. Observations and interviews were used to document nurses' methods through the span of a transition (defined by an entry, passage, and exit). The study finds inconsistencies in care methods due to institutional processes restricting both mealtime care and nutritional logging of information throughout hospitalization. It is concluded that the consequences of these inconsistencies must be recognized and that new approaches to meals and nutritional care should be introduced in order to provide greater flexibility. Based on the assumption that mobilizing patient resources is pivotal for meal and nutritional care, it is argued that it may be important to mobilize patient resources during mealtime and in nutritional logging of information in order to increase the visibility of meal and nutritional care in patient transitions within the institution and across settings. Both nurses' methods and institutions developmental initiatives regarding meal and nutritional care need to accommodate the differences between what in this paper is defined as social-bodily care and text-based care. This could be met through care methods that take place with, more than for the patient.

Patients’ Experiences with Nutritional Care during Hospitalization and Proposals for Improvement

“…Some patients found that diet recording could improve the nutritional care and dialog with staff about its importance. This is supported by other studies, suggesting to include patients in the diet registration process [32,43]. One study mentioned that patients' awareness and feeling of responsibility were improved if patients were included in the diet recording.…”

“…One study mentioned that patients' awareness and feeling of responsibility were improved if patients were included in the diet recording. Furthermore, it would help nurses remember that the diet should be registered [32]. Other studies have found that developing standards for nurses and teaching them about nutritional care may improve nutritional care [30,44].…”

“…Barriers for implementing nutritional care and interventions among health professionals at the hospital were lack of resources, unclear distribution of responsibility for nutritional care tasks, lack of knowledge and competences, low priority as well as lack of flexibility of food service [26][27][28][29][30][31]. These reasons may explain why health-care professionals use their subjective clinical judgement to assess whether a patient is at nutritional risk or not, even though this often is insufficient [32].…”