Nurturing and nourishing: the nurses' role in nutritional care

Aims. Researchers collaborated with clinicians, consumers and dietitians to develop a policy defining how nurses could support their patients' nutritional care. Background. A high prevalence of hospital malnutrition has been reported in Australia, Europe and the UK. A patient's nutritional status can deteriorate during admission. Malnutrition can increase complications, length of stay, mortality rates and health care costs. As the nursing role has become increasingly complex, traditional nurturing activities such as serving the patients' meals have devolved to other categories of staff leaving the role of nurses in their patients' nutritional care ill-defined. Design. The research team systematically reviewed relevant research literature using the principles of qualitative metasynthesis to identify appropriate nursing strategies that would assist in reducing the prevalence of hospital malnutrition. Method. The policy was developed using a systematic review approach: devising a clinical question, searching the literature, appraising research evidence, analysing existing policy documents, synthesising evidence into dominant themes and once the policy was drafted, initiating a wide ranging consultation and ratification process. Results. A literature search located 147 articles. Forty articles were identified as being within the scope of the clinical question. Most were reports of audits or observation studies. The dominant themes were developed into standards that assisted nurses in supporting the oral nutrition of their patients. These included the following: a focussed mealtime, management of mealtime environments, management of staff mealtimes and a designated nutrition support nurse in each clinical area to monitor and evaluate the implementation of the policy. Conclusions. There is a distinct role for nurses that will assist in reducing the prevalence of hospital malnutrition but successful implementation can only occur with the support of the multidisciplinary team. Relevance to clinical practice. This policy provides a framework to define and invigorate nursing's role in supporting the patient's nutrition care.