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

Ross, Lynda J., Mudge, Alison M., Young, Adrienne M., & Banks, Merrilyn D. (2011) Everyone's problem but nobody's job : staff perceptions and explanations for poor nutritional intake in older medical patients. Nutrition and Dietetics, 68(1), pp. 41-46.

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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.

Impact and interest:

13 citations in Scopus
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12 citations in Web of Science®

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ID Code: 52641
Item Type: Journal Article
Keywords: attitude of health personnel, elderly, focus group, malnutrition, patient care, qualitative research
DOI: 10.1111/j.1747-0080.2010.01495.x
ISSN: 1446-6368
Subjects: Australian and New Zealand Standard Research Classification > MEDICAL AND HEALTH SCIENCES (110000) > NUTRITION AND DIETETICS (111100)
Divisions: Current > QUT Faculties and Divisions > Faculty of Health
Current > Institutes > Institute of Health and Biomedical Innovation
Current > Schools > School of Exercise & Nutrition Sciences
Copyright Owner: Copyright 2011 Dietitians Association of Australia
Deposited On: 23 Jul 2012 08:46
Last Modified: 26 Aug 2014 23:18

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