Malnutrition in Healthcare Centers

Malnutrition is caused by increased catabolism or insufficient delivery of nutrients in the body. Malnutrition in hospitalized patients is one of the most common challenges in contemporary health care facilities regardless of a countrys per capital income. Though it is not easy to accurately estimate the prevalence of hospital malnutrition, researchers have for the last four decades used different criteria including conducting worldwide studies on different populations around the world (1). These studies have focused on critical demographic populations including educational levels, socioeconomic status, severity levels, and age groups among others. Unfortunately, malnutrition has been associated with infectious and non-infectious illnesses and is one of the primary factors that contribute to prolonged stay in hospitals, high mortality, and morbidity rates, and increased rates of hospital readmission (2). Based on current anthropometric studies, the prevalence of patient malnutrition in different countries around the world is approximately 20 per cent to 50 per cent (3). When the problem of over-nutrition is brought into context, the rate of malnutrition can be as high as 76 per cent.

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From the start, it is important to note that it is very difficult to measure ones nutrition intake accurately. This is because diet is affected by many different things and is hugely variable. However, hospitalized patients diet is strictly controlled due to factors such as the prescribed medications, medical conditions, and their access to foods and cooking facilities. To manage patients diet, Food Record Charts (FRCs) that aims at quantitatively recording all foods and drinks that patients consume has been developed. FRCs are used to frequently help monitor patients dietary intakes within a hospital setting to determine dietetic interventions and nutritional care plans (4). The effectiveness of FRCs is determined by the validity of FRCs to accurately estimate dietary intakes and the preciseness of its completion by the nursing staff in charge of patients diets.

A study reported that there was a need to further develop FRCs and train nursing staff to ensure that FRCs are accurately and consistently completed so that accurate estimation of patients diet intake to better inform nutritional care (2). The investigators undertook weighed plate wastage to measure foods and drinks of hospitalized patients with FRCs on two adult acute wards within a hospital in Scotland. In both wards, FRCs were used to list food items served at each meal and the pattern of consumption for each patient recorded. They collected data for 27 patients from the two selected wards. The study found that most of the FRCs were incomplete and some category of meals were missing in either of the two wards. Discrepancies were also found to exist between food items observed and weighed to those documented in the FRCs. For example, 34% of the FRCs misclassified the type of spread and 20% of the FRCs wrongly classified the drinks.

One of the many reasons why FRCs fails is due to lack of adequate nutrition knowledge for medical practitioners (5). A study reported that though health care practitioners recognize nutrition knowledge as important, there is a perception that training on nutrition and dietetics remains deficit in most hospitals. The researchers interviewed 391 trainees from all 19 UK deaneries (6). These respondents perceived the acquisition of nutrition knowledge as highly important in their daily practice. However, most of the respondents reported deficiencies in the availability of nutrition training resources and opportunities and their curriculums nutrition learning outcomes. The researchers findings is a justification of the fact that mechanisms for preventing malnutrition cannot work if nurses and other healthcare workers lack nutrition knowledge. In a different study (1) the researchers reported that the awareness of malnutrition by medical and nursing professionals was very low. These and many other research findings are not adequately equipped to deal with cases of malnutrition in hospitals. It is the duty of a nurse to refer a patient to a dietitian so that he can receive nutritional care (7). Therefore, it is a matter of genuine concern when medical nurses cannot refer malnourished patients to dieticians because they cannot such patients.

An Australian study reported that in a Melbourne tertiary teaching hospital, the level of malnutrition was identified in 23 per cent of the 275 patients who were assessed (6). The researchers reported that malnourished patients length of stay in hospital was 4.5 days more than well-nourished patients. Using Subjective Global Assessment (SGA) the researchers assessed the nutritional status of a different hospital and reported a 42% malnutrition rate and only 15% of these patients were referred to diet specialist.

According to another study, there exist different nutrition screening tools that are used in hospitals (8). However, most of these tools are yet to be validated for the patient population, care outcomes, or their desired outcomes and it is therefore not clear whether they can be used to prevent malnutrition by identifying patients who are in need of further nutrition assessment (9). Some of these tools include Nutrition Risk Screening 2002, Subjective Global Assessment, Mini Nutrition Assessment, Malnutrition Screening Tool, Malnutrition Universal Screening Tool, and the Nutritional Assessment Questionnaire CITATION Wee09 \l 1033 (10). To prevent malnutrition in health care centers, it is important that medical nurses understand how these tools work and to which populations they are best applicable.

According to Fessler, malnutrition in hospitals is a serious issue and affects patients of all ages (4). Fessler believes that for malnutrition assessment tools to work, there is a need medical nurses who are charged with patients care need nutrition expertise. Currently, the training and nutritional educational resources of many physicians around the world are limited (11). Over recent years, hospitals and medical schools have begun to implement some changes, but still not sufficient (12). Notably, effective systems such as referral processes, food delivery, and communication are some of the critical areas that need to be improved. Well-organized communication systems between, and within different hospital departments is essential for patient-centered care in hospitals.

Conclusion

From the foregoing, the efficacy of malnutrition mechanism is not because of lack of proper malnutrition assessment tools, but lack of sufficient nutrition management expertise. If FRCs were used effectively, cases of malnutrition will be minimized. As shown in the literature review, consistent and accurate completion of FRCs is important for detecting whether vulnerable patients have adequate nutrition intake. Staff training on the importance of FRCs and development of key skills for visually estimating portion sizes served to and consume by hospitalized patients are important areas that need to be addressed. There is also a need for a full implementation of protected mealtimes where patients are assisted with eating and drinking while they are monitored and every activity recorded.

References

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