Factors influencing the delivery of nutritional care by nurses for hospitalised medical patients with malnutrition; a qualitative study

ObjectivesTo describe an insight into nursing nutritional care delivery in the hospital from the perspectives of observed nursing care and an exploration of multidisciplinary attitudes and experiences with patient participation in nutritional care. BackgroundThe prevalence of malnutrition in hospitalised patients continues to be high. Nurses' essential role in the identification and treatment of malnutrition is an important aspect of the fundamentals of care. Nurses have a key role in providing optimal nutritional care in the hospital. A systematic nursing approach, combined with an active role for patients, is required to effectively counteract malnutrition. DesignA multicentre qualitative study using ethnographic observations and focus groups. MethodsDirect observation of nutritional care was conducted on two nursing wards; nurses and inpatients were observed; and data were thematically analysed based on the fundamentals of care framework. Subsequently, six focus groups were held on three nursing wards with nurses, dietitians and nutrition assistants (n = 34). Data were analysed using open, axial and selective coding. The COREQ guidelines were used for reporting the study. ResultsDuring 54 days, representing 183 h, 39 nurses were observed in two medical wards. Three activities in nutritional care delivery were identified from observing nurses and patients: (1) screening and assessment/at-risk determination, (2) nutritional care plans and (3) monitoring and evaluating outcomes and transition-of-care planning. In addition, the focus groups identified barriers, facilitators, needs and expectations for optimal nursing nutritional care delivery. ConclusionsThis study provides an understanding of the difficulties in the delivery of nursing nutritional care. Patient participation in the nutritional care process is rare. Evidence-based strategies are required to improve the knowledge and skills of nurses and patients to participate in (mal)nutrition care. RelevanceThe findings of this study are used for the development of a nursing nutrition intervention to optimise patient participation in (mal)nutrition care. Patient or public contributionDuring the study, patients were not involved with the observations of care and/or with the interviews; the researchers observed the nutritional care delivery at medical wards acting as passive participants. Nurses, nutrition assistants and dietitians were after the focus groups asked for feedback on the transcripts of the interviews.

Automated summary

This study explores nursing nutritional care delivery in hospitals through observations of nursing care and discussions with multidisciplinary professionals. It highlights the crucial role of nurses in identifying and treating malnutrition and emphasizes the importance of a systematic nursing approach combined with patient participation to counteract malnutrition effectively.