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Nurses’ nutrition competence
Detailed assessment and treatment of malnutrition in patients are the dieticians’ areas of clinical expertise. Although nurses are more likely to meet the patients first, that ensures their opportunity to perform the nutritional screening. However, despite the complexity of the problem prevailing in many hospitals, the nurses seem to lack training in identifying malnutrition (Duerksen et al., 2014).
Challenges impeding nurses in conducting regular nutritional screening include lack of time and insufficient training. The medical professionals often emphasize the importance of the nutritional screening, but it can be sometimes overlooked in the daily practice. According to Green and James (2013), in some hospitals, nurses overlooked the routine screening for malnutrition. The reasons for this include both the lack of education and training in nurses leading to them underestimating the issue of malnutrition. The other barrier is that guidelines prescribe nurses to conduct the nutritional screening for each patient admitted to their care. However, it can be quite challenging on the daily basis on the par with the other tasks (Green & James, 2013).
Education and training
Education and training can facilitate the routine of the nutritional screening for the nurses. The awareness of causes and dangers of malnutrition will enhance the willingness to perform the nutritional screening. The training aspect should include teaching nurses how to use screening tools and how to recognize that the patient is malnourished (Green & James, 2013).
Whether the nurses’ nutrition competence is impeded or encouraged depends on screening tools in use. If the tools are complicated, the nurses are not always confident in using it, regardless of the training. When speaking of screening tools, it is hard to address the issue on the generalized level. Different tools are used in different hospitals, which is why the hospitals’ management needs a consistent policy of regulating the issue at the local level. Nevertheless, nurses appear to be more responsive to the importance of nutritional screening when there is an opportunity for training and support (Green & James, 2013).
The results of the implementation of the nutritional guidelines to the practice in different hospitals’ universities in Norway discovered that nutritional screening is one of the most time-consuming procedures. Therefore, nurses who are not competent about all the dangers of malnutrition and do not have skills to perform the screening faster, sometimes prefer to neglect it. Another reason is the lack of qualified dieticians, which means that the results of screenings cannot always be transferred for the further analysis (Tangvik et al., 2012).
Therefore, the task is to teach nurses the guidelines that can be followed on the daily basis. Nurses’ training in nutritional screening is essential since they are the first to meet the patient, they check on the patient more regularly. It allows them to monitor the patient’s diet and indicators of the nutritional screening (Duerksen et al., 2014).
Malnutrition triggers identification
Malnutrition often remains untreated because it was not recognized in time. Nevertheless, there are factors triggering identification. With the lack of time and dietitians’ service at hospitals, the primary task of the nurses is to estimate the nutrition risks of the patient rather than complete a thorough nutritional assessment. Estimating nutrition risks is a simplified procedure that requires asking a patient questions to conclude whether the detailed nutritional screening is needed. Given the fact that nurses contact with the admitted patients on the daily basis, they would be more effective (Duerksen et al., 2014).
Malnourished patients are affected by the lack of nutrition on the physical, as well as psychological aspects. Depending on the factors of gender, age, reason for hospitalization, etc., there are different levels of impairment caused by malnutrition. Weakened immune response, slow healing of wounds, possible injuries such as pressure ulcers, problems with body thermoregulation are the symptoms of malnutrition at the cellular level (Barker, Gout, & Crowe, 2011).
General weakness caused by insufficient nutrition results in muscle and fat mass loss and reduced functioning of the respiratory and cardiac organs (Barker, Gout, & Crowe, 2011). Psychological aspect of malnutrition involves fatigue that sometimes results in depression. Development of malnutrition in patients is commonly linked to prolonged staying at the hospital. Therefore, patients receiving longer treatment should be regularly screened for the nutrition risks (Duerksen et al., 2014).
Nevertheless, the identification of malnutrition is quite essential for its treatment. According to Barker, Gout, and Crowe (2011), its prevalence in Western countries now reaches the levels of between 20% and 50%. It leads to the increase in production of the new tools and equipment for nutrition risk screening, allowing identifying more accurately malnutrition in hospitalized patients (Barker, Gout, & Crowe, 2011).
However, among the highlights of the experiment described by Tangvik et al. (2012), the researchers concluded that even with an improved competence in nutritional screening, the percentage of patients receiving nutritional care did not increase. Screening procedures and nutritional care usually belong to the set of responsibilities of nurses and physicians. Therefore, the means of controlling them performing their responsibilities need to be introduced. It means that the problem of malnutrition needs to be addressed at all the levels of medical care (Tangvik et al., 2012).
Barker, L. A., Gout, B. S., & Crowe, T. C. (2011). Hospital malnutrition: prevalence, identification, and impact on patients and the healthcare system. International journal of environmental research and public health, 8(2), 514-527.
Duerksen, D. R., Keller, H. H., Vesnaver, E., Laporte, M., Jeejeebhoy, K., Payette, H.,… & Allard, J. (2014). Nurses’ Perceptions Regarding the Prevalence, Detection, and Causes of Malnutrition in Canadian Hospitals Results of a Canadian Malnutrition Task Force Survey. Journal of Parenteral and Enteral Nutrition, 20(10), 1-7.
Green, S. M., & James, E. P. (2013). Barriers and facilitators to undertaking nutritional screening of patients: a systematic review. Journal of Human Nutrition and Dietetics, 26(3), 211-221.
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Tangvik, R. J., Guttormsen, A. B., Tell, G. S., & Ranhoff, A. H. (2012). Implementation of nutritional guidelines in a university hospital monitored by repeated point prevalence surveys. European journal of clinical nutrition, 66(3), 388-393.