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Promoting nurses' behaviour change in nutritional care

Malnutrition is a serious and widespread health problem in community-dwelling older adults who receive care in hospital and at home. Hospital and home care nurses and nursing assistants have a key role in the delivery of high-quality multidisciplinary nutritional care. Nursing nutritional care in current practice, however, is still suboptimal, which impacts its quality and continuity. There appear to be at least two reasons for this. First, there is a lack of evidence for nutritional care interventions to be carried out by nurses. Second, there are several factors, that influence nurses’ and nursing assistants’ current behaviour, such as lack of knowledge, moderate awareness of the importance and neutral attitudes. This results in a lack of attention towards nutritional care. Therefore, there is a need to generate more evidence and to focus on targeting the factors that influence nurses’ and nursing assistants’ current behaviour to eventually promote behaviour change. To increase the likelihood of successfully changing their behaviour, an evidence-based educational intervention is appropriate. This might lead to enhancing nutritional care and positively impact nutritional status, health and well-being of community-dwelling older adults. The general objectives of this thesis are: 1) To understand the current state of evidence regarding nutrition-related interventions and factors that influence current behaviour in nutritional care for older adults provided by hospital and home care nurses and nursing assistants to prevent and treat malnutrition. 2) To develop an educational intervention for hospital and home care nurses and nursing assistants to promote behaviour change by affecting factors that influence current behaviour in nutritional care for older adults and to describe the intervention development and feasibility.

Protein intake, nutritional status and outcomes in ICU survivors

Perceptions, experiences, barriers and facilitators regarding nutritional intake of patients with chronic limb threatening ischemia

Objective: Patients with chronic limb threatening ischemia (CLTI) are at high risk for amputation and other cardiovascular adverse events. Nutrition-related symptoms and malnutrition are common in the CLTI population, and lead to worse clinical outcomes. Understanding of the factors influencing nutritional intake is required to determine whether optimization of nutritional intake in this population requires interventions. Therefore, this study aimed to describe perceptions and experiences on nutrition of patients with CLTI, and to identify perceived barriers and facilitators influencing their nutritional intake.Methods: In this phenomenological qualitative study, individual semi-structured, face-to-face interviews were conducted with patients with CLTI who lived independently. Interviews were transcribed verbatim, and reflexive thematic analysis was performed.Results: Twelve participants were interviewed. Five themes were generated: (1) lack of nutritional risk perception, (2) role of nutrition for health, functioning and surviving, (3) multiple factors influencing nutritional intake, (4) limited nutritional advice, and (5) no intention to change current nutritional intake.Conclusion: Patients with CLTI perceive nutritional intake as a necessity to survive and function. Patients express limited risk perception regarding adequate nutritional intake and undernutrition. Nutritional intake is mainly based on non-health related factors, as habits and taste, and multiple barriers hinder nutritional intake. Patients received no or only limited nutritional advice. Together this leads to an expressed lack of intention to change nutritional intake. Findings of this study stress the urgency for patient-centered nutritional support, to increase nutrition-related knowledge and motivation, to prevent or treat undernutrition, and may improve clinical outcomes in patients with CLTI.

Development of a microlearning intervention regarding nursing nutritional care for older adults: A multi-methods study

Background: Nutritional care for older adults provided by hospital and home care nurses and nursing assistants is suboptimal. This is due to several factors including professionals' lack of knowledge and low prioritisation. Affecting these factors may promote nurses' and nursing assistants' behavioral change and eventually improve nutritional care. To increase the likelihood of successfully targeting these factors, an evidence-based educational intervention is needed. Objectives: To develop an educational intervention for hospital and home care nurses and nursing assistants to promote behaviour change by affecting factors that influence current behaviour in nutritional care for older adults. In this paper, we describe the intervention development process. Design: A multi-methods approach using literature and expert input. Settings: Hospital and home care. Participants: Older adults, nurses, nursing assistants, experts, and other professionals involved in nutritional care. Methods: The educational intervention was based on five principles: 1) interaction between intervention and users, 2) targeting users on both individual and team level, 3) supporting direct and easy transfer to the workplace, and continuous learning, 4) facilitating learning within an appropriate period, and 5) fitting with the context. Consistent with these principles, the research team focussed on developing a microlearning intervention and they established consensus on seven features of the intervention: content, provider, mode of delivery, setting, recipient, intensity, and duration. Results: The intervention consisted of 30 statements about nursing nutritional care for older adults, which nurses and nursing assistants were asked to confirm or reject, followed by corresponding explanations. These can be presented in a snack-sized way, this means one statement per day, five times a week over a period of six weeks through an online platform. Conclusions: Based on a well-founded and comprehensive procedure, the microlearning intervention was developed. This intervention has the potential to contribute to nursing nutritional care for older adults.

Poor nutritional status, risk of sarcopenia and nutrition related complaints are prevalent in COVID-19 patients during and after hospital admission

BACKGROUND AND AIMS: Patients with COVID-19 infection presents with a broad clinical spectrum of symptoms and complications. As a consequence nutritional requirements are not met, resulting in weight- and muscle loss, and malnutrition. The aim of the present study is to delineate nutritional complaints, the (course of the) nutritional status and risk of sarcopenia of COVID-19 patients, during hospitalisation and after discharge.METHODS: In this prospective observational study in 407 hospital admitted COVID-19 patients in four university and peripheral hospitals, data were collected during dietetic consultations. Presence of nutrition related complaints (decreased appetite, loss of smell, changed taste, loss of taste, chewing and swallowing problems, nausea, vomiting, feeling of being full, stool frequency and consistency, gastric retention, need for help with food intake due to weakness and shortness of breath and nutritional status (weight loss, BMI, risk of sarcopenia with SARC-F ≥4 points) before, during hospital stay and after discharge were, where possible, collected.RESULTS: Included patients were most men (69%), median age of 64.8 ± 12.4 years, 60% were admitted to ICU at any time point during hospitalisation with a median LOS of 15 days and an in-hospital mortality rate of 21%. The most commonly reported complaints were: decreased appetite (58%), feeling of being full (49%) and shortness of breath (43%). One in three patients experienced changed taste, loss of taste and/or loss of smell. Prior to hospital admission, 67% of the patients was overweight (BMI >25 kg/m2), 35% of the patients was characterised as malnourished, mainly caused by considerable weight loss. Serious acute weight loss (>5 kg) was showed in 22% of the patents during the hospital stay; most of these patients (85%) were admitted to the ICU at any point in time. A high risk of sarcopenia (SARC-F ≥ 4 points) was scored in 73% of the patients during hospital admission.CONCLUSION: In conclusion, one in five hospital admitted COVID-19 patients suffered from serious acute weight loss and 73% had a high risk of sarcopenia. Moreover, almost all patients had one or more nutritional complaints. Of these complaints, decreased appetite, feeling of being full, shortness of breath and changed taste and loss of taste were the most predominant nutrition related complaints. These symptoms have serious repercussions on nutritional status. Although nutritional complaints persisted a long time after discharge, only a small group of patients received dietetic treatment after hospital discharge in recovery phase. Clinicians should consider the risks of acute malnutrition and sarcopenia in COVID-19 patients and investigate multidisciplinary treatment including dietetics during hospital stay and after discharge.

The course of physical fitness and nutritional status in patients following prehabilitation before esophageal cancer surgery: Results from the PRIOR study

Introduction: This study evaluates the course of physical fitness and nutritional status during curative therapy for esophageal cancer, after implementation of a prehabilitation program. Additionally, the impact of baseline physical fitness level and severe postoperative complications on the course of individual patients were explored. Materials and methods: This multicenter, observational cohort study included patients with esophageal cancer following curative treatment. Prehabilitation, consisting of supervised exercise training and nutritional counseling was offered as standard care to patients after neoadjuvant therapy, prior to surgery. Primary outcome measures included change of exercise capacity, hand grip strength, self-reported physical functioning, Body Mass Index, and malnutrition risk from diagnosis to 2–6 months postoperatively. Analyses over time were performed using linear mixed models, and linear mixed regression models to investigate the impact of baseline level and severe postoperative complications. Results: Hundred sixty-eight patients were included (mean age 65.9 ± 8.6 years; 78.0 % male). All parameters (except for malnutrition risk) showed a decline during neoadjuvant therapy (p < .05), an improvement during prehabilitation (p < .005) and a decline postoperatively (p < .001), with a high heterogeneity between patients. Change in the outcomes from baseline to postoperatively was not different for patients with or without a severe complication. Better baseline physical fitness and nutritional status were significantly associated with a greater decline postoperatively (p < .001). Conclusion: This study demonstrates a notable decline during neoadjuvant therapy, that fully recovers during prehabilitation, and a subsequent long lasting decline postoperatively. The heterogeneity in the course of physical fitness and nutritional status underlines the importance of individualized monitoring.