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  See discussions, stats, and author profiles for this publication at: Malnutrition and the role of nurses: a nursingissue  Article   in  Australian nursing & midwifery journal · February 2014 Source: PubMed CITATION 1 READS 1,427 1 author:Some of the authors of this publication are also working on these related projects: The Indigenous Australian Malnutrition Project   View projectNatasha MorrisBaker IDI Heart and Diabetes Institute 20   PUBLICATIONS   14   CITATIONS   SEE PROFILE All content following this page was uploaded by Natasha Morris on 13 November 2014. The user has requested enhancement of the downloaded file. All in-text references underlined in blue are added to the srcinal documentand are linked to publications on ResearchGate, letting you access and read them immediately.  PAGE 33 February 2014 Volume 21, No. 7. Clinical View Natasha Franklin Malnutrition and the role of nurses: A nursing issue Nutrition and malnutrition The importance of nutrition has long been recognised as quintessential by nurses for the health and wellbeing of patients, but despite this, nutritional assessment and management remains a problematic issue in nursing (Estes et al. 2013). Malnutrition is a significant clinical issue for patients in hospital as it is estimated as high as 34 to 43% in Australian hospitals and this figure is reported as high as 72% in ‘at-risk’ pa-tients, such as residents in aged care facili-ties (National Health and Medical Research Council [NHMRC] 2013; Dietitians Associa-tion of Australia [DAA] 2008). Malnutrition increases hospital stays; is associated with increased readmission rates; increased risk of falls and infection; delayed wound heal-ing; post-operative and treatment com-plications; decreased quality of life; and a significant contributor towards mortality (DAA 2008). Malnutrition is a significant risk-factor for chronic diseases, such as cardiovascular disease and type 2 diabe-tes mellitus (NHMRC 2013). The financial burden of malnutrition has been estimated at $1,745 per admission per patient in Australia but the costs are thought to be higher than this amount due to insufficient and inadequate malnutrition screening and reporting (Rowell & Jackson 2011). Nursing and malnutrition screening Nurses are in the prime position to per-form malnutrition screening as part of their holistic patient admission assessment (Dudeck 2010). Several studies however, acknowledge nutrition assessment and malnutrition screening is infrequently and inconsistently performed by nurses and some of the reoccurring reasons for this are due to lack of compliance with malnutrition screening; confusion regard-ing the screening role of nurses, uncer-tainty of malnutrition screening protocols, competing task priorities, value of clinical  judgement, recognition of evidence-based practice, discrepancy amongst nurses regarding attitudes and practices, degree of competence, lack of education and training, and organisational culture (Green & James 2013; Porter et al. 2009; Tannen & Lohrmann 2012; Pradignac et al. 2011; Raja et al. 2008). In Australian hospitals, the Malnutrition Screening Tool (MST) and the Malnutrition Universal Screening Tool (MUST) are the two most commonly used screening tools. However, malnutri-tion screening is more often than not based on ‘clinical judgement’ rather than using an evidence-based tool (Raja et al. 2008). Utilisation of malnutrition screen-ing tools can be viewed as; tedious, time consuming, not an admission priority, not necessary, and not necessarily the role of nurses, but of the dietitians (Green & James 2013; Porter et al. 2009). Hospitals that have clearer policies, processes and referral systems regarding the nutritional management of patients, and that have nurse unit managers leading malnutrition screening have higher screening compli-ance rates (Green & James 2013; Tannen & Lohrmann 2012). A lack of educa-tion and training are central reasons why malnutrition screening does not occur, including correct screening assessment practices (Pradignac et al. 2011). Com-munication and physical mobility have been common cited reasons for not weighing and therefore screening patients, when arguably, these groups of patients are at higher-risk of malnutrition (Tannen & Lohrmann 2012; Porter et al. 2009). Hospitals that have dedicated nurses that are in essence ‘nutrition champions’ have higher rates of malnutrition screening, but further education and training is required for correct screening of patients (Tannen & Lohrmann 2012). At an individual level, one of the biggest barriers for malnutri-tion screening is the lack of understanding and recognition for a necessary admission assessment, and a lack of engagement or interest by nurses to screen malnourished patients (Raja et al. 2008). Nurses have a pivotal and essential role in the nutritional care of patients and have a duty of care to screen patients for malnu-trition. Florence Nightingale (1820-1910, p. 54) summarises the important role nurses have in regards to the nutritional assessment and management of their pa-tients by stating, “I would have this to say to the nurse, have a rule of thought about your patient’s diet; consider, remember how much he has had, and how much they ought to have today.” References Green, SM., James, E.P. 2013. “Barriers and facilita-tors to undertaking nutritional screening of patients: a systematic review”. Journal of Human Nutrition and  Diet  . 26(3). 211-221.Dietitians Association Australia. 2008. Malnutri-tion., viewed 29/11/2013.Dudeck, S.G. 2010. Nutrition Essentials for Nursing Practice  . 6th edn. Lippincott & Williams. China.National Health and Medical Research Council. 2013. Eat for Health. Australian Dietary Guidelines. Provid-ing the scientific evidence for healthier Australian diets. Australian Government. Department of Health and Ageing., viewed 29/11/2013.Nightingale, F. 1820-1910. Notes on nursing: what  it is, and what it is not. Churchill Livingstone, 1980. Edinburgh, New York.Pradignac, A., Petitdemange, A.M., Sery, V., Hubsch, A., Ayed, C.B., and Schlienger, J-L. 2011. Nutritional education program for the nursing staff may improve hospitalized patients’ nutritional assessment and management. Clinical Nutrition . 31. 862-867.Porter, J. Raja, R. Cant, R. Aroni, R. 2009. Explor-ing issues influencing the use of the Malnutrtion Universal Screening Tool by nurses in two Australian hospitals. Journal of Human Nutrition and Dietetics  . 22(3). pp. 203-209.Raja, R. Gibson, S. Turner, A. Winderlich, J. Porter, J. Cant, R. Aroni, R. 2008. Nurses’ views and practices regarding use of validated nutrition screening tools.  Australian Journal of Advanced Nursing  . (1). 26-33. Rowell, DS. Jackson, TJ. 2011. Additional costs of inpa-tient malnutrition, Victoria, Australia, 2003-2004. Euro- pean Journal of Health Economics  . 12(4). 353-361. Tannen, A & Lohrmann, C. 2013. Malnutrition in Austrian hospital patients. Prevalence, risk-factors, nursing interventons, and quality indicators: a descriptive multicentre study. J ournal of Advanced Nursing  . 69(8), pp. 1840-1849. Natasha Franklin MNUR, CCRN BN, AFACHM PhD student Baker IDI Central AustraliaBellberry Indigenous Health Research Recipient   C o p y r i g h t o f A u s t r a l i a n N u r s i n g & M i d w i f e r y J o u r n a l i s t h e p r o p e r t y o f A u s t r a l i a n N u r s i n g   & M i d w i f e r y F e d e r a t i o n a n d i t s c o n t e n t m a y n o t b e c o p i e d o r e m a i l e d t o m u l t i p l e s i t e s o r   p o s t e d t o a l i s t s e r v w i t h o u t t h e c o p y r i g h t h o l d e r ' s e x p r e s s w r i t t e n p e r m i s s i o n . H o w e v e r , u s e r s  m a y p r i n t , d o w n l o a d , o r e m a i l a r t i c l e s f o r i n d i v i d u a l u s e .  View publication statsView publication stats
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