Differences in nutritional care in pressure ulcer patients whether or not using nutritional guidelines.
OBJECTIVE
Malnutrition, characterized by a loss of lean body mass, enhances the risk of pressure ulcers (PUs). Because the intrinsic risk factor nutritional status in PU development can be influenced by practitioners' interventions, the use of clinical guidelines might be a satisfactory management approach. This study investigated the influence of using nutritional guidelines in daily practice on the actual nutritional care that PU (prone) patients receive, and barriers with regard to providing nutritional support were also explored.


METHODS
A cross-sectional study was carried out in 1087 hospitals, nursing homes, and home care organizations in the Netherlands, Germany, and the United Kingdom. Because this study focused on comparing nutritional care in daily practice in PU (prone) patients using and not using nutritional guidelines, for the analyses two groups (health care organizations with and without guidelines) were identified. Differences between groups were tested using chi-square test and by analysis of variance.


RESULTS
Respondents from 363 organizations participated in the study, of which 66.1% used nutritional guidelines for PU care in practice. Significant differences between organizations with nutritional guidelines versus organizations without guidelines were mostly on nutritional screening (P = 0.001) and the extent of nutritional assessments that included significantly more weight history recalls, weight measurements, and body mass index measurements (all P < 0.05). The most important barrier to providing nutritional support for PU (prone) patients in both groups was knowledge and skills.


CONCLUSIONS
Using a nutritional guideline in PU care contributes to the amount of nutritional screening conducted in daily practice and to the content and extent of the assessment.
Meijers
Judith M M
JM
Faculty of Health, Medicine and Life Sciences, Department of Health Care and Nursing Sciences, Maastricht University, The Netherlands. j.meijers@zw.unimaas.nl <j.meijers@zw.unimaas.nl>
Schols
Jos M G A
JM
Jackson
Pam A
PA
Langer
Gero
G
Clark
Michael
M
Halfens
Ruud J G
RJ
D000704:Analysis of Variance; D015992:Body Mass Index; D016009:Chi-Square Distribution; D003430:Cross-Sectional Studies; D005260:Female; D005858:Germany / Q000453:epidemiology; D007722:Health Knowledge, Attitudes, Practice; D006699:Home Care Services / Q000592:standards; D006760:Hospitalization; D006801:Humans; D008297:Male; D044342:Malnutrition / Q000150:complications / Q000628:therapy*; D008403:Mass Screening; D009426:Netherlands / Q000453:epidemiology; D009735:Nursing Homes / Q000592:standards; D015596:Nutrition Assessment; D018673:Nutrition Policy; D009752:Nutritional Status; D018529:Nutritional Support; D010346:Patient Care Management / Q000592:standards*; D017410:Practice Guidelines as Topic; D003668:Pressure Ulcer / Q000453:epidemiology* / Q000209:etiology / Q000517:prevention & control; D011787:Quality of Health Care; D011795:Surveys and Questionnaires; D006113:United Kingdom / Q000453:epidemiology