Everyone's problem but nobody's job : staff perceptions and explanations for poor nutritional intake in older medical patients

Abstract

Aim: Up to 60% of older medical patients are malnourished with further decline during hospital stay. There is limited
evidence for effective nutrition intervention. Staff focus groups were conducted to improve understanding of
potential contextual and cultural barriers to feeding older adults in hospital.

Methods: Three focus groups involved 22 staff working on the acute medical wards of a large tertiary teaching
hospital. Staff disciplines were nursing, dietetics, speech pathology, occupational therapy, physiotherapy, pharmacy.
A semistructured topic guide was used by the same facilitator to prompt discussions on hospital nutrition care
including barriers. Focus groups were tape-recorded, transcribed and analysed thematically.

Results: All staff recognised malnutrition to be an important problem in older patients during hospital stay and
identified patient-level barriers to nutrition care such as non-compliance to feeding plans and hospital-level barriers
including nursing staff shortages. Differences between disciplines revealed a lack of a coordinated approach,
including poor knowledge of nutrition care processes, poor interdisciplinary communication, and a lack of a sense
of shared responsibility/coordinated approach to nutrition care. All staff talked about competing activities at meal
times and felt disempowered to prioritise nutrition in the acute medical setting. Staff agreed education and ‘extra
hands’ would address most barriers but did not consider organisational change.

Conclusions: Redesigning the model of care to reprioritise meal-time activities and redefine multidisciplinary roles
and responsibilities would support coordinated nutrition care. However, effectiveness may also depend on hospitalwide
leadership and support to empower staff and increase accountability within a team-led approach.