Improving Nutrition Care, Delivery, and Intakes Among Hospitalised Patients: A Mixed Methods, Integrated Knowledge Translation Study

Abstract

Malnutrition is a common and complex problem in hospitals. This study used an integrated knowledge translation approach to develop, implement, and evaluate a multifaceted, tailored intervention to improve nutrition care, delivery, and intake among acute medical inpatients. This observational, pre-post study was conducted in a medical ward at a public hospital in Australia. The intervention was co-developed with key stakeholders and targeted three levels: individuals (nutrition intake magnets at patient bedsides), the ward (multidisciplinary hospital staff training), and the organisation (foodservice system changes). Observational data were collected pre- and post-intervention on patient demographics, food intakes, and the mealtime environment. Data were entered into SPSS and analysed using descriptive and inferential statistics. Ethical approval was gained through the hospital and university ethics committees. A total of 207 patients were observed; 116 pre- and 91 post-intervention. After intervention implementation, patients’ mean energy and protein intakes (in proportion to their estimated requirements) were significantly higher and the number of patients eating adequately doubled (p < 0.05). In summary, a multifaceted, pragmatic intervention, tailored to the study context and developed and implemented alongside hospital staff and patients, seemed to be effective in improving nutrition practices and patient nutrition intakes on an acute medical ward.

Multidisciplinary Provision of Food and Nutritional Care to Hospitalized Adult In-Patients: A Scoping Review

“…Poor communication and teamwork (within and between disciplines) Proposed change processes and ongoing communication to establish adequate monitoring and feedback processes Ottrey et al (2019) 60 Australia To explore the relationships, roles, and responsibilities of staff involved at hospital mealtimes, and their impact on nutrition care Qualitative Study Observations and interviews Hospital staff focused. (Ward not specified) Mealtimes, and the influences on meal provision Nurses, dietitians, speech pathologists, physiotherapists, occupational therapists, social workers, food and support services, and administration staff Multidisciplinary perspectives via interviews Three themes describing Ward culture and staff relationships reported: Defining mealtime roles and maintaining boundaries Balancing the need for teamwork and having time and space Effective communication supports role completion and problem-solving Roberts et al (2019) 61 Australia To develop, implement, and evaluate a multifaceted, tailored intervention to improve nutrition care, delivery, and intake among acute medical inpatients Pre-post observational study Acute Medical Unit Food intakes, and the mealtime environment Nurses, patients, doctors, and foodservice staff Multidisciplinary co-development of intervention with key stakeholders which was a multifaceted and targeted individual, Ward, and organizational levels Multidisciplinary hospital staff training Significantly higher patients’ mean energy and protein intakes and the number of patients eating adequately doubled Implementation alongside hospital staff and patients reported being effective in improving nutrition practices and patient nutrition intakes on an acute medical ward Increased awareness of nutrition among staff groups and a change in Ward culture regarding nutrition were reported Sykes et al (2019) 30 Australia To improve mealtime assistance (MTA) where needed to patients on a general medical Ward Collaborative best practice implementation study (audit, feedback, and re-audit). Observation, combined focus groups of nursing and food service staff Medical Ward Meal delivery Nutritional assessment Meal environment Meal assistance …”

“…Studies adopted a range of research designs including clinical audit studies, 29 , 33 , 37 quasi‐experimental studies 34 , 35 , 58 randomized cluster trials, 52 pilot studies, 36 , 40 , 46 prospective or controlled prospective (cohort study or before and after comparative intervention) studies, 41 , 48 pre-post observational, 61 and quantitative 39 and qualitative studies. 44 , 45 , 47 , 50 , 51 , 54–57 , 59 , 60 …”

“… 23 Fifteen studies reported on the forms and products of nutritional care, such as changes in the meal environment, including meal support and eating support, to meet patients’ nutritional needs. 35 , 38–40 , 42 , 44 , 47 , 48 , 51 , 53–55 , 58 , 60 , 61 Eight studies specified on nutritional care processes such as malnutrition risk screening, nutritional assessment, and documentation. 33 , 43 , 45 , 46 , 52 , 56 , 57 , 59 Similarly, eight studies reported on both the forms and nutritional care processes.…”

“…This also included the patients’ nutritional adequacy, documentation, and records of nutritional assessments, as well as nurses’ nutritional knowledge base, which resulted in the development of an audit. 29 Similarly, Roberts et al, 61 reported on a multifaceted intervention in which nutritional barriers were assessed. In response, color-coded nutrition intake magnets were placed at patient bedsides to identify those at risk of malnutrition.…”

Development and Process Evaluation of a Complex Intervention for Improving Nutrition among Hospitalised Patients: A Mixed Methods Study

“…Clinical effectiveness of the intervention (i.e., outcomes of pre/post implementation evaluation) is reported elsewhere [20].…”