Improving Documentation of Nutritional Care in A Nursing Home: An Evaluation of A Participatory Action Research Project

Christine Hillestad Hestevik, Ella Heyerdahl, Bjørg Lysne Garaas, Gerd Sylvi Sellevold, Marianne Molin, Christine Hillestad Hestevik, Ella Heyerdahl, Bjørg Lysne Garaas, Gerd Sylvi Sellevold, Marianne Molin

Abstract

Background: Nursing home patients at nutritional risk are often not identified, nor given entitled nutritional treatment. One approach proven suitable to facilitate change in clinical practise is participatory action research (PAR). This is a process which involves research participants in reflection, planning, action, observation, assessing and re-planning, targeted to bring about change. The aim of the present study was to evaluate whether a PAR project resulted in improved documentation of nutritional care in a nursing home ward. Method and sample: A quantitative evaluation. Documentation of the nutritional information was collected from medical records of residents in a nursing home ward at baseline and five months into the project period.

Results: Increased documentation of individual nutritional treatment measures was found from baseline to the follow-up. The number of residents with a nutritional care plan (NCP) also increased significantly. On the other hand, the study identified a significant decrease in the proportion of residents with documented weight and nutritional status.

Conclusion: The evaluation found several improvements in the documentation of nutritional care practice in the nursing home ward as a result of the PAR project, indicating that a PAR approach is suitable to bring about change in practice.

Keywords: documentation; evaluation; nursing home; nutrition; older people; participatory action research.

Conflict of interest statement

The authors declare that they have no competing interest.

References

    1. Landi F., Calvani R., Tosato M., Martone A.M., Ortolani E., Savera G., Sisto A., Marzetti E. Anorexia of Aging: Risk Factors, Consequences, and Potential Treatments. Nutrients. 2016;8:69. doi: 10.3390/nu8020069.
    1. Volkert D., Beck A.M., Cederholm T., Cruz-Jentoft A., Goisser S., Hooper L., Kiesswetter E., Maggio M., Raynaud-Simon A., Sieber C.C., et al. ESPEN guideline on clinical nutrition and hydration in geriatrics. Clin. Nutr. 2019;38:10–47. doi: 10.1016/j.clnu.2018.05.024.
    1. Borgström Bolmsjö B., Jakobsson U., Mölstad S., Östgren C.J., Midlöv P. The nutritional situation in Swedish nursing homes—A longitudinal study. Arch. Gerontol. Geriatr. 2015;60:128–133. doi: 10.1016/j.archger.2014.10.021.
    1. Namasivayam A.M., Steele C.M. Malnutrition and Dysphagia in long-term care: A systematic review. J. Nutr. Gerontol. Geriatr. 2015;34:1–21. doi: 10.1080/21551197.2014.1002656.
    1. Cereda E., Pedrolli C., Klersy C., Bonardi C., Quarleri L., Cappello S., Turri A., Rondanelli M., Caccialanza R. Nutritional status in older persons according to healthcare setting: A systematic review and meta-analysis of prevalence data using MNA((R)) Clin. Nutr. 2016;35:1282–1290. doi: 10.1016/j.clnu.2016.03.008.
    1. Agarwal E., Marshall S., Miller M., Isenring E. Optimising nutrition in residential aged care: A narrative review. Maturitas. 2016;92:70–78. doi: 10.1016/j.maturitas.2016.06.013.
    1. Starr K.N.P., McDonald S.R., Bales C.W. Nutritional Vulnerability in Older Adults: A Continuum of Concerns. Curr. Nutr. Rep. 2015;4:176–184. doi: 10.1007/s13668-015-0118-6.
    1. Selbaek G., Engedal K., Bergh S. The prevalence and course of neuropsychiatric symptoms in nursing home patients with dementia: A systematic review. J. Am. Med. Dir. Assoc. 2013;14:161–169. doi: 10.1016/j.jamda.2012.09.027.
    1. Volkert D., Chourdakis M., Faxen-Irving G., Fruhwald T., Landi F., Suominen M.H., Vandewoude M., Wirth R., Schneider S.M. ESPEN guidelines on nutrition in dementia. Clin. Nutr. 2015;34:1052–1073. doi: 10.1016/j.clnu.2015.09.004.
    1. Eide H.D., Halvorsen K., Almendingen K. Barriers to nutritional care for the undernourished hospitalised elderly: Perspectives of nurses. J. Clin. Nurs. 2015;24:696–706. doi: 10.1111/jocn.12562.
    1. Halvorsen K., Eide H.K., Sortland K., Almendingen K. Documentation and communication of nutritional care for elderly hospitalized patients: Perspectives of nurses and undergraduate nurses in hospitals and nursing homes. BMC Nurs. 2016;15:70. doi: 10.1186/s12912-016-0193-z.
    1. Bonetti L., Terzoni S., Lusignani M., Negri M., Froldi M., Destrebecq A. Prevalence of malnutrition among older people in medical and surgical wards in hospital and quality of nutritional care: A multicenter, cross-sectional study. J. Clin. Nurs. 2017;26:5082–5092. doi: 10.1111/jocn.14051.
    1. Dunn H., Moore T. ‘You can’t be forcing food down ‘em’: Nursing home carers’ perceptions of residents’ dining needs. J. Health Psychol. 2016;21:619–627. doi: 10.1177/1359105314532971.
    1. O′Connell M.B., Jensen P.S., Andersen S.L., Fernbrant C., Nørholm V., Petersen H.V. Stuck in tradition-A qualitative study on barriers for implementation of evidence-based nutritional care perceived by nursing staff. J. Clin. Nurs. 2018;27:705–714. doi: 10.1111/jocn.14020.
    1. Tegleborg P., Jacobsen I.H., Kragelund L. Aksjonsforskningsmetodens styrker og utfordringer. Erfaringer fra et sykeplejefagligt forskningsprosjekt. Nord. Sygeplejeforskning Nord. Nurs. Res. 2015;5:106–120.
    1. Ullrich S., McCutcheon H., Parker B. Reclaiming time for nursing practice in nutritional care: Outcomes of implementing Protected Mealtimes in a residential aged care setting. J. Clin. Nurs. 2011;20:1339–1348. doi: 10.1111/j.1365-2702.2010.03598.x.
    1. Törmä J., Winblad U., Saletti A., Cederholm T. The effects of nutritional guideline implementation on nursing home staff performance: A controlled trial. Scand. J. Caring Sci. 2018;32:622–633. doi: 10.1111/scs.12487.
    1. Hummelvoll J.K., Eriksson B.G., Cutcliffe J.R. Local experience—Central knowledge? Nord. Nurs. Res. 2015;5:283–295.
    1. Glasson J.B., Chang E.M., Bidewell J.W. The value of participatory action research in clinical nursing practice. Int. J. Nurs. Pract. 2008;14:34–39. doi: 10.1111/j.1440-172X.2007.00665.x.
    1. Sellevold G.S. Refleksjonsgruppe som verktøy i kvalitetsarbeid. In: Bergland Å., Moser I., editors. Kvalitetsarbeid i Helsetjenester til Eldre. Volume 1. Cappelen Damm AS; Oslo, Norway: 2013. pp. 120–138.
    1. Guttormsen A.B., Hensrud A., Irtun Ø., Mowé M., Sørbye L.W., Thoresen L., Øien H., Alhaug J., Smedshaug G.B. Nasjonale Faglige Retningslinjer for Forebygging og Behandling av Underernæring. [National Professional Guidelines on Prevention and Treatment of Malnutrition] The Norwegian Directorate of Health; Oslo, Norway: 2013. IS-1580.
    1. Castle N.G., Ferguson J.C. What is nursing home quality and how is it measured? Gerontologist. 2010;50:426–442. doi: 10.1093/geront/gnq052.
    1. Agenda Kaupang AS . Kartlegging og bruk av objektive kvalitetsindikatorer i norske kommuner [Mapping the Use of Quality Indicators in Norwegian Municipalities] KS; Bærum, Norway: 2014. FoU-prosjekt nr. 144030; R8481.
    1. Drageset J., Eide G.E., Corbett A. Health-related quality of life among cognitively intact nursing home residents with and without cancer—A 6-year longitudinal study. Patient Relat. Outcome Meas. 2017;8:63–69. doi: 10.2147/PROM.S125500.
    1. Beattie E., O’reilly M., Strange E., Franklin S., Isenring E. How much do residential aged care staff members know about the nutritional needs of residents? Int. J. Older People Nurs. 2014;9:54–64. doi: 10.1111/opn.12016.
    1. Mowe M., Bosaeus I., Rasmussen H.H., Kondrup J., Unosson M., Rothenberg E., Irtun O., Scandinavian Nutrition G. Insufficient nutritional knowledge among health care workers? Clin. Nutr. 2008;27:196–202. doi: 10.1016/j.clnu.2007.10.014.
    1. Bettio F., Verashchagina A. Provisions and Providers in 33 European Countries. European Comission; Luxenbourg: 2012. Long-Term Care for the elderly.
    1. Bogen H., Lien L. Handlingsrommet for Vellykket Sykefraværsarbeid i Sykehjem From Absence to Presence. Scope for Action for Successful Sick-Leave-Work in Nursing Homes. Fafo; Oslo, Norway: 2015. Fra fravær til nærvær. In Fafo-rapport 2015:12.
    1. Gautun H., Øien H., Bratt C. Konsekvenser av Mangel på Sykepleiere i Hjemmesykepleien og Sykehjem Shortage of Staff is Self-Reinforcing. The Consequences of Shortage of Nurses in Home Care and Nursing Homes. NOVA; Oslo, Norway: 2016. Underbemanning er selvforsterkende. In NOVA Rapport 6/16.
    1. Wilson V., Mccormack B., Ives G. Developing healthcare practice through action learning: Individual and group journeys. Act. Learn. Res. Pract. 2008;5:21–38. doi: 10.1080/14767330701880226.
    1. Schnelle J.F., Bates-Jensen B.M., Chu L., Simmons S.F. Accuracy of nursing home medical record information about care-process delivery: Implications for staff management and improvement. J. Am. Geriatr. Soc. 2004;52:1378–1383. doi: 10.1111/j.1532-5415.2004.52372.x.
    1. Helsetilsynet . Samlerapport fra Tilsyn i 2010 Med Kommunenes sosial-og Helsetjenester til Eldre. Helsetilsynet; Oslo, Norway: 2011. Krevende oppgaver med svak styring. In report 5/2011.
    1. Low L.F., Fletcher J., Goodenough B., Jeon Y.H., Etherton-Beer C., MacAndrew M., Beattie E. A Systematic Review of Interventions to Change Staff Care Practices in Order to Improve Resident Outcomes in Nursing Homes. PLoS ONE. 2015;10:e0140711. doi: 10.1371/journal.pone.0140711.
    1. Ministry of Health and Care Services . Meld. St. 10 (2012–2013). God kvalitet—Trygge Tjenester. Kvalitet og Pasientsikkerhet i Helse-og Omsorgstjenesten High Quality-Safe Services. Quality and Patient Safety in Health and Care Services. Ministry of Health and Care Services; Oslo, Norway: 2012. Omsorgsdepartementet. .
    1. Vanek V.W., Ayers P., Charney P., Kraft M., Mitchell R., Plogsted S., Soden J., Van Way C.W., 3rd, Wessel J., Winter J., et al. Follow-Up Survey on Functionality of Nutrition Documentation and Ordering Nutrition Therapy in Currently Available Electronic Health Record Systems. Nutr. Clin. Pract. 2016;31:401–415. doi: 10.1177/0884533616629619.
    1. Charalambous L., Goldberg S. ‘Gaps, mishaps and overlaps’. Nursing documentation: How does it affect care? J. Res. Nurs. 2016;21:638–648. doi: 10.1177/1744987116678900.
    1. Gautun H., Syse A. Samhandlingsreformen. Hvordan tar de Kommunale Helse-og Omsorgstjenestene i mot det økte Antallet Pasienter som Skrives ut fra Sykehusene? The Coordination Reform. How Are the Municipal Health Services Receiving the Increased Number of Patients Discharged from Hospitals? NOVA; Oslo, Norway: 2013. NOVA Rapport 8/2013.
    1. Lovdata . In: Helsepersonelloven The Healthcare Personnel Act. Lovdata, editor. Volume LOV-1999-07-02-64 Lovdata; Oslo, Norway: 1999.
    1. The Norwegian Directorate of Health God Ernæringspraksis—Det juridiske Grunnlaget [Quality Nutritional Care Practice—The Legal Framwork] [(accessed on 5 November 2018)]; Available online: .
    1. Kjerholt M., Wagner L., Lindhardt T., Delmar C., Clemensen J. Participatory Action Research in clinical nursing practice in a medical ward—Challenges and barriers. Nord. Sygeplejeforskning Nord. Nurs. Res. 2016;6:34–48. doi: 10.18261/issn.1892-2686-2016-01-04.
    1. Tripp D. Action research: A methodological introduction. Educ. Pesqui. 2005;31:443–466. doi: 10.1590/S1517-97022005000300009.
    1. Helsedirektoratet Veileder for utvikling av Kunnskapsbaserte Retningslinjer [Recommendations for the Development of Evidence-Based Guidelines] [(accessed on 20 October 2015)];2012 IS-1870. Available online: .

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