Malnutrition, especially among the elderly in the healthcare environment, is a prevalent problem in The Netherlands, affecting both patients and the healthcare budget. Although oral nutritional supplements (ONS) are often used to restore the nutritional status of a patient, the evaluated current available literature failed to show a coherent picture of the effectiveness of ONS in malnourished patients. In the present study, we used a qualitative research approach to gain insight in the treatment of malnutrition via ONS and food snacks in a single non-academic teaching hospital. Twelve semi-structured interviews with stakeholders (such as dieticians, nurses, care-assistants, physician) were held. Results indicated opportunities for further improvement, for example through the introduction of a screening tool for malnutrition in cognitive impaired patients, better timing for handing out the daily meal plan forms, and improved range and provision of snacks. The stakeholders indicated that taste and physical properties of ONS, but also social environment as well as the physical/mental state and motivation of a patient are important facilitators which should be considered during the prescription. In conclusion, to optimize treatment of malnutrition using ONS and food snacks, the above mentioned opportunities to better match the needs of malnourished patients have to be tackled. Involvement of the different stakeholders within the healthcare facility will be important to implement required changes in nutritional practice.
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Objective To explore predictors of district nursing care utilisation for community-living (older) people in the Netherlands using claims data. To cope with growing demands in district nursing care, knowledge about the current utilisation of district nursing care is important. Setting District nursing care as a part of primary care. Participants In this nationwide study, claims data were used from the Dutch risk adjustment system and national information system of health insurers. Samples were drawn of 5500 pairs of community-living people using district nursing care (cases) and people not using district nursing care (controls) for two groups: all ages and aged 75+ years (total N=22 000). Outcome measures The outcome was district nursing care utilisation and the 114 potential predictors included predisposing factors (eg, age), enabling factors (eg, socioeconomic status) and need factors (various healthcare costs). The random forest algorithm was used to predict district nursing care utilisation. The performance of the models and importance of predictors were calculated. Results For the population of people aged 75+ years, most important predictors were older age, and high costs for general practitioner consultations, aid devices, pharmaceutical care, ambulance transportation and occupational therapy. For the total population, older age, and high costs for pharmaceutical care and aid devices were the most important predictors. Conclusions People in need of district nursing care are older, visit the general practitioner more often, and use more and/or expensive medications and aid devices. Therefore, close collaboration between the district nurse, general practitioner and the community pharmacist is important. Additional analyses including data regarding health status are recommended. Further research is needed to provide an evidence base for district nursing care to optimise the care for those with high care needs, and guide practice and policymakers’ decision-making.
Background. To improve nutritional care for community-dwelling older adults before, during, and after hospitalization, factors influencing nurses’ current behavior should be targeted. The aim of this study was to obtain expert consensus on which factors influencing the behavior of hospital and home care nurses are most relevant, modifiable, and feasible to influence. Method. In a two-round Delphi study, nine pre-selected factors were rated by 26 experts. Results. Eight factors were rated as relevant, modifiable, and feasible to influence: (1) lack of sufficient knowledge, (2) mainly neutral attitude, (3) low prioritization, (4) ambiguous motivation to routinely use guidelines and screening tools, (5) moderate awareness about risk factors, (6) lack of sense of involving informal caregivers, (7) ambiguous motivation to follow education and training, and (8) strong focus on medical nutrition. Conclusion. The expert panel reached consensus on eight factors influencing nurses’ current behavior. To enhance nutritional care to prevent malnutrition in older adults, strategies are needed for targeting these factors in nursing practice, education, and research.
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