title: Barriers to nutritional care for the undernourished hospitalised elderly: perspectives of nurses.
abstract: OBJECTIVE
  To identify what nurses experience as barriers to ensuring adequate nutritional care for the undernourished hospitalized elderly.
  
  
  BACKGROUND
  Undernutrition occurs frequently among the hospitalised elderly and can result in a variety of negative consequences if not treated. Nevertheless, undernutrition is often unrecognised and undertreated. Nurses have a great responsibility for nutritional care, as this is part of the patient's basic needs. Exploring nurses' experiences of preventing and treating undernourishment among older patients in hospitals is therefore highly relevant.
  
  
  METHODS
  A focus group study was employed based on a hermeneutic phenomenological methodological approach.
  
  
  METHODS
  Four focus group interviews with totally 16 nurses working in one large university hospital in Norway were conducted in spring 2012. The nurses were recruited from seven somatic wards, all with a high proportion of older (≥70 years) inpatients. The data were analysed in the three interpretative contexts: self-understanding, a critical common-sense understanding and a theoretical understanding.
  
  
  RESULTS
  We identified five themes that reflect barriers the nurses experience in relation to ensuring adequate nutritional care for the undernourished elderly: loneliness in nutritional care, a need for competence in nutritional care, low flexibility in food service practices, system failure in nutritional care and nutritional care is being ignored.
  
  
  CONCLUSIONS
  The results imply that nutritional care at the university hospital has its limits within the hospital structure and organisation, but also regarding the nurses' competence. Moreover, the barriers revealed that the undernourished elderly are not identified and treated properly as stipulated in the recommendations in the national guidelines on the prevention and treatment of undernutrition.
  
  
  CONCLUSIONS
  The barriers revealed in this study are valuable when considering improvements to nutritional care practices on hospital wards to enable undernourished older inpatients to be identified and treated properly.
authors.affiliation: Division of Medicine, Akershus University Hospital and Institute of Clinical Medicine, University of Oslo, Lørenskog, Norway; Department of Health, Nutrition and Management, Faculty of Health Sciences, Oslo and Akershus University College of Applied Sciences, Oslo, Norway.
authors.forename: Helene Dahl
authors.initials: HD
authors.lastname: Eide
authors.forename: Kristin
authors.initials: K
authors.lastname: Halvorsen
authors.forename: Kari
authors.initials: K
authors.lastname: Almendingen
mesh_terms: D000328:Adult; D001291:Attitude of Health Personnel; D005260:Female; D017144:Focus Groups; D006297:Health Services Accessibility; D006760:Hospitalization; D006785:Hospitals, University; D006801:Humans; D008297:Male; D044342:Malnutrition / Q000175:diagnosis / Q000209:etiology / Q000628:therapy*; D008875:Middle Aged; D009664:Norway; D009741:Nursing Staff, Hospital; D018529:Nutritional Support; D055815:Young Adult
keywords: elderly; experiences; focus groups; hermeneutics; hospital care; nurses; nutrition; phenomenology; qualitative study