Barriers to Nutritional Care for Undernourished Elderly Patients

Introduction

The older adults are seen to require effective care support from nurses and carers as due to old age and health complications they are unable to take their own care. The nurses require being efficient in offering proper care to elderly individuals so that dignified care and support as per the needs of the patients can be provided. The evidence-based care in adult nursing is essential as it builds an effective work-based learning environment where less error in care services and improved quality care are provided to service users (Boltz et al. 2016; Wilson et al. 2015). As a nurse to offer care for the elderly patients in Reyward ward, the topic chosen for discussion is barriers to nutritional care for undernourished elderly people in the hospital. The topic has been chosen because nutrition is seen to be a key part of care for the older adults in the general medical ward but it is not being effectively met due to which many undernourished adults are seen to be reported in the ward. The discussion as well as mentioning the barriers which are leading nurses to be unable to deliver proper nutrition to the undernourished hospitalised adults would help in the context of the current practice to understand the changes to be made so that better nutritious health of the elderly can be achieved. Additionally, seeking nursing dissertation help to address these barriers and improve care strategies is crucial. The selected research piece is to be criticised with the help of CASP tool so that the strength and limitation of the findings and recommendations in the article can be understood in context to the current area of practice.

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Discussion

The evidence-based practice is mentioned as the approach implemented to develop quality decision and provide quality nursing care which is based on clinical expertise regarding current and relevant information (Green et al. 2016). In this respect, to develop evidence-based information from the selected research according to the CASP tool the article needs to have a clarified aim and objective. The CASP tool is to be used for analysing the research as it helps to systematically develop a sense of information gathered from the article to implement them in practice (Buccheri and Sharifi, 2017). The present research mentions that it has a clarified aim and objective which is evident as it is mentioned that the study is framed with the aim and objective of identifying experiences of nurses which acts as a barrier for them to ensure adequate nutritional care for the undernourished elder adults in hospital (Eide et al. 2015). The clarified aim and objective of the study is essential as it helped me to understand whether the research is relevant to be studied in relation to the current practice area.

The presence of a detailed literature review is that it helps the reader to develop proper context of the problem that is being focussed in the study as well as determine the reason behind the conduction of the study (Presti, 2016). The literature review of the study informs that lack of assistance by the nurses during eating meals to the elderly service users is creating barriers for nurses to provide nutrition to the patients (Eide et al. 2015). This is because without assistance the elderly may be skipping meals or not eating the entire meals. The fact is evident as in the present setting it is seen that through proper assistance is provided by the nurses to elderly service users to help them eat meals but individual assistance could not be achieved. Thus, it may be leading few of the elderly service users to avoid intake of proper meals making them face malnutrition even after access services from nurses.

The literature review of the selected research further informs that education and training of the nursing staff along with cooperation between nurses is to be done so that the nurses have effective information and skills to ensure proper nutrition is achieved by the elder individual in the hospital (Eide et al. 2015). The fact is already seen to be understood in the current practice area as all the nurses in the placement are provided effective education and included in the training as well as they cooperate to ensure effective nutrition to the adults. However, still effective changes to promote nutrition of the elderly are not being achieved. Thus, the research is being further explored to identify and develop concept of the actual barriers which are acting to avoid effective nutrition to the elderly adults in the current practice.

In the study, the hermeneutic phenomenological methodological approach is being used (Eide et al. 2015). The benefit of phenomenological approach is that it provides detailed information and understanding regarding a single phenomenon (Efendi et al. 2016). Thus, the use of the approach in the study makes it strength as the key barriers experienced by the nurses regarding only nutritional care for the elderly in hospital settings can be easily identified. The current research implemented focus group method for collecting data (Eide et al. 2015). The benefit of using focus group is that it helps the researcher to gather detailed information about feelings, opinions and perceptions of any particular groups. Moreover, it is effective to save time as well as money spent on executing individual interviews (Carey and Asbury, 2016). Thus, the use of focus group data collection method acts as strength for the study. The purposive sampling method is used in the current research for gathering participants (Eide et al. 2015). The benefit of purposive sampling is that it helps in gathering data which can be generalised meaning that the information present in the research is not confined to be considered in a single setting only (Roberts et al. 2016). Thus, use of the sampling method acts as strength of the study as it helped the study to represent information which can be generalised. This, in turn, makes the research appropriate to be used in the current practice as the information developed can be considered to determine barriers experienced by nurses in Reyward ward settings which are creating malnutrition issue among the elderly patients.

The finding of the study informs that loneliness of the nurses to offer nutritional care to the elderly individuals acts as barrier for proper nutrition to the hospitalised elderly patients. This is because loneliness made them frustrated and helpless to provide proper nutrition as they have less assistance and participation from the physicians for deciding nutritional care of the elderly patients. The study further informed that physicians often carelessly nodded to the nutritional diet chart developed by the nurses without involving for assessing and analysing it with dieticians or others (Eide et al. 2015). The fact is relevant to be considered in creating barriers to nutrition for elderly in the current practice area as similarly physicians in Reyward ward are found to show less involvement and nodded to the agreement regarding whatever nutritional care chart being prepared by the nurses. As mentioned by Rasmussen et al. (2018), effective involvement of the multi-disciplinary team where health practitioners along with dieticians and nurses collaborate with for ensuring effective nutrition to the elderly is found to successful in delivering proper nutrition to the elderly service users. This is because effective discussion and use of clinical expertise of each multi-disciplinary team members lead to develop an effective nutritional care plan for the service users. Thus, it indicates that effective involvement of doctors along with the multi-disciplinary team is required in framing an effective nutritional care plan to ensure proper nutrition to the elderly.

The findings further mentioned that nurses lacked information and skill regarding the way to estimate nutritional needs and evaluate nutritional status of elderly hospitalised patients. This informs that they lack effective competency to deliver successful care to elderly (Eide et al. 2015). The lack of competency of the nurses to deliver care often leads them to fail to execute their tasks in a proper way they do not have required knowledge and skill as needed for the purpose (Halvorsen et al. 2016). The research findings also inform that nurses failed to provide proper nutrition to the elderly service users as they were unable to understand individual nutritional requirements for each patient (Eide et al. 2015). In the context of the current practice, it is seen that the nurses also lack information and skills regarding the way to develop proper nutritional chart for individual elderly patients so that their care needs can be met properly. Thus, the findings of the study are evident in regard to the current context in the sense that nurses due to lack of effective competence of delivering nutrition to the elder service users are facing barriers for providing nutrition.

The research informs that lack of proper variety in the foods being served to the elderly people is creating barriers to nutrition among them. This is because patients being have limited food choices and intake of same foods for longer time makes them bored orienting them to show avoidance in eating whole meal required for their effective nutrition (Eide et al. 2015). The fact is evident in the current context regarding malnutrition among elderly patients as in the placement it is seen that no choices to patients are provided for choosing meals. Moreover, they are been provided with meals that are tasteless and repetitive as understood from the feedback received from the patients and their families. Thus, this lack of choice and repetitive meals are found to create barriers for nurses to provide effective nutrition to the elderly.

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The study findings informs that inability of the nurses to raise the issue of nutritional care as priority compared to other nursing services creates barriers for nurses to achieve effective nutrition among the elderly (Eide et al. 2015). This relates to the current practice as it informs that nurses may be facing barrier to resolve malnutrition among the elderly because they are unable make nutritional care a priority care. The study also mentions that inadequate presence of documentation and apparatus to check body weight and other nutritional parameters among the patients in the hospital is creating barriers for the nurses to resolve malnutrition among the elderly (Eide et al. 2015). The fact is relevant to the current practice as it indicates that effective documentation is required and proper presence of equipment is needed so that to monitor the nutrition of the elderly to resolve the issue of malnutrition.

The findings further mentions that lack of presence of a system for monitoring and ensuring proper nutritional care of the elderly patients is creating barriers for the nurses to deliver proper nutrition to the individuals. This is because the nurses without proper monitoring system are unable to ascertain the impact of the nutrition provided to the patients. Thus, it makes them unaware if any changes are required in diet to avoid the barriers to successful nutrition (Eide et al. 2015). It is relevant in the current practice as it is informed that may be there is lack of effective monitoring system of the nutritional health of the adults due to which in the setting nurses are still facing barriers to resolve malnutrition among the elderly patients. Thus, proper focus of the hospital management is required in this case so that barriers to provide nutrition to the elderly by the nurses can be resolved.

The current research mentions that to provide effective nutritional care to the elderly service users for resolving the issue of malnutrition the national guidelines are to be more strictly followed by the hospital (Eide et al. 2015). Thus, it mentions that in the current practice area the management of the hospital requires to take improvised steps in changing their nutrition management ways for the elderly by more intricately following the national guidelines. This is required so that barrier faced by nurses to achieve proper nutrition among the malnourished elderly patients can be resolved. The study also mentions that creating improvement in diet routines and nutritional care of the service users are able to improve their nutrition (Eide et al. 2015). It related with the current practice in the sense that it informs the nurses as well as the management to implement variety of foods in the diet routine of the service users so that repetitive eating can be avoided as the service users are able to select from proper meals to ensuring effective gain of nutrition to improve their health.

Conclusion

The above discussion mentions that nutrition is a key care focus for the elderly but nurses in the Reyward ward are seen to be unable to ensure proper nutritious care. Thus, the selected research piece is criticised to develop evidence regarding the barriers faced by the nurses in delivering proper nutritious care to the undernourished elderly patients. The CASP tool is used for criticising the research as it helps in systematic information development. The article mentions that nurses experiences barriers to provide nutrition to the adults due to lack of support from health practitioners, incompetency, lower variety of foods being provided and others. The barriers are seen to be also faced in the Reyward ward which leads to understand that the evidence developed from the study was evident. The recommendations developed from the article to be implemented include training of nurses, abiding by national guidelines for nutritional care, improvement in diet routines and others.

References

Boltz, M., Capezuti, E., Fulmer, T.T. and Zwicker, D. eds., 2016. Evidence-based geriatric nursing protocols for best practice. Springer Publishing Company.

Buccheri, R.K. and Sharifi, C., 2017. Critical Appraisal Tools and Reporting Guidelines for Evidence‐Based Practice. Worldviews on Evidence‐Based Nursing, 14(6), pp.463-472.

Carey, M.A. and Asbury, J.E., 2016. Focus group research. London: Routledge.

Efendi, F., Chen, C.M., Nursalam, N., Indarwati, R. and Ulfiana, E., 2016. Lived experience of Indonesian nurses in Japan: A phenomenological study. Japan Journal of Nursing Science, 13(2), pp.284-293

Eide, H.D., Halvorsen, K. and Almendingen, K., 2015. Barriers to nutritional care for the undernourished hospitalised elderly: perspectives of nurses. Journal of clinical nursing, 24(5-6), pp.696-706.

Green, R.C., Goddard, K.A., Jarvik, G.P., Amendola, L.M., Appelbaum, P.S., Berg, J.S., Bernhardt, B.A., Biesecker, L.G., Biswas, S., Blout, C.L. and Bowling, K.M., 2016. Clinical sequencing exploratory research consortium: accelerating evidence-based practice of genomic medicine. The American Journal of Human Genetics, 98(6), pp.1051-1066.

Halvorsen, K., Eide, H.K., Sortland, K. and Almendingen, K., 2016. Documentation and communication of nutritional care for elderly hospitalized patients: perspectives of nurses and undergraduate nurses in hospitals and nursing homes. BMC nursing, 15(1), p.70.

Presti, C.R., 2016. The flipped learning approach in nursing education: A literature review. Journal of Nursing Education, 55(5), pp.252-257.

Rasmussen, N.M., Belqaid, K., Lugnet, K., Nielsen, A.L., Rasmussen, H.H. and Beck, A.M., 2018. Effectiveness of multidisciplinary nutritional support in older hospitalised patients: A systematic review and meta-analyses. Clinical nutrition ESPEN, 27, pp.44-52.

Roberts, S., McInnes, E., Wallis, M., Bucknall, T., Banks, M. and Chaboyer, W., 2016. Nurses’ perceptions of a pressure ulcer prevention care bundle: a qualitative descriptive study. BMC nursing, 15(1), p.64.

Wilson, M., Sleutel, M., Newcomb, P., Behan, D., Walsh, J., Wells, J.N. and Baldwin, K.M., 2015. Empowering nurses with evidence‐based practice environments: Surveying Magnet®, Pathway to Excellence®, and non‐magnet facilities in one healthcare system. Worldviews on Evidence‐Based Nursing, 12(1), pp.12-21.

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