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Eglseer, D.
Malnutrition in Hospitals - The Quality of Nutritional Care Focusing on Education and Malnutrition Screening
Doktoratsstudium der Sozial- und Wirtschaftswissenschaften; Gesundheits- und Pflegewissenschaft; [ Dissertation ] Medical University of Graz; 2019. pp. 193
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- Authors Med Uni Graz:
- Eglseer Doris
- Advisor:
- Lohrmann Christa
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- Abstract:
- Introduction Malnutrition is a serious problem in hospitals with prevalence rates up to 40 %. It is associated with severe negative consequences for the affected patients, including poor wound healing, more complications, higher morbidity and a diminished quality of life. In addition, malnutrition is related to higher mortality, leads to longer lengths of hospital stays and, therefore, to additional healthcare costs. Several professional associations and expert groups have published guidelines for the identification and treatment of patients with (risk of) malnutrition. These guidelines state that the nutritional management of malnourished patients should be standardized and structured and should start with malnutrition risk screening as a crucial starting point for the successful nutritional management. To improve nutritional care in hospitals, it is necessary to deal with existing structures, such as the education of healthcare staff on malnutrition or malnutrition screening. Aim The overall aim of this doctoral thesis was to gain insight into the quality of nutritional care in hospitals regarding malnutrition, and especially into education of healthcare staff and the use of malnutrition screening tools in hospitals. Methods A cross-sectional study using a web-based online survey was conducted to gather information about the extent and content of nutrition education and education on malnutrition in older adults in basic nursing and medical education programs. To evaluate the association between quality indicators on the structure, process and outcome levels of nutritional care, a cross-sectional multi-centre study was performed. To determine the effect of the use of a valid and reliable malnutrition screening tool on the quality of nutritional care a controlled pretest-posttest study and a mixed methods study were conducted. Results The first study showed that about 30 % of the participating nursing education institutions and about 50 % of the participating medical education institutions in Europe did not address the topic of malnutrition in their curricula. The results of study two demonstrated that 45 % of the participating hospitals had an evidence-based guideline for malnutrition. However, only one-fifth of the patients admitted to the hospital were screened for malnutrition with a valid and reliable screening tool. An association between the availability of guidelines and the use of a malnutrition screening tool could be shown. Furthermore, the results show that wards with a validated screening tool have a lower prevalence of malnutrition and provide more nutritional interventions to the patients. Study three showed that the use of a valid and reliable malnutrition screening tool effectively improved the knowledge, attitudes and perceived practices of healthcare staff. These results are confirmed by the results of the fourth study. The use of the screening tool positively correlated with significant improvements in terms of the number of nutritional interventions and the frequency of documentation of the diagnosis and the patient’s weight and height. The content of the interviews revealed that nearly all professionals involved perceived the overall screening process positively. Conclusion The results of the studies presented in this thesis show that there are shortcomings in education and clinical practice regarding malnutrition and malnutrition screening in hospitals, but that an investment in good quality nutritional care provides benefits for patients, healthcare professionals and institutions.