Improving nutritional care: innovation and good practice.
OBJECTIVE
This paper presents examples of good practice in nutritional screening and care and identifies methods used to overcome contextual constraints and discusses the implications for nursing practice in hospitals.


BACKGROUND
Nutritional screening is an important step in identifying those at risk of malnutrition, but does not produce improved nutritional care unless it results in a care plan that is acted on. The importance of nutrition and implications for clinical care make it imperative to improve practice.


METHODS
Qualitative investigation.


METHODS
Between January 2011-February 2012, focus groups were held using a semi-structured discussion guide with nine groups of health professionals (n = 80) from one hospital: four with nurses, three with doctors and two with dietitians. Discussions were audio-recorded, transcribed and coded into themes and sub-themes, which were then depicted in a thematic map and illustrated with verbatim quotes.


RESULTS
Three strategies for sustaining effective nutritional practice emerged: establishing routines to ensure screening was undertaken; re-organizing aspects of care to promote good practice; developing innovative approaches. Issues to be addressed were the perceived disconnection between mandatory screening and the delivery of effective care, a requirement for nutrition education, organizational constraints of a large university hospital and the complexities of multidisciplinary working.


CONCLUSIONS
Professionals seeking to improve nutritional care in hospitals need to understand the interaction of system and person to facilitate change. Nursing staff need to be able to exercise autonomy and the hospital system must offer enough flexibility to allow wards to organize nutritional screening and care in a way that meets the needs of individual patients.
University Hospital Southampton NHS Foundation Trust, NIHR Wellcome Trust Southampton Clinical Research Facility, NIHR Southampton Biomedical Research Centre, UK; NIHR Southampton Respiratory Biomedical Research Unit, MP 218 Southampton Centre for Biomedical Research, University Hospital Southampton NHS Foundation Trust, UK.
Carol
C
Chapman
Mary
M
Barker
Wendy
W
Lawrence
D000328:Adult; D001291:Attitude of Health Personnel; D004059:Diffusion of Innovation; D005260:Female; D017144:Focus Groups; D006282:Health Personnel / Q000523:psychology*; D006801:Humans; D008297:Male; D044342:Malnutrition / Q000175:diagnosis* / Q000451:nursing*; D008875:Middle Aged; D015404:Nursing Methodology Research; D015596:Nutrition Assessment; D018529:Nutritional Support / Q000451:nursing* / Q000592:standards*; D017410:Practice Guidelines as Topic; D006113:United Kingdom
critical theory; nursing practice; nutritional care; qualitative research; screening