AIMS AND OBJECTIVES:

To develop evidence-based guidelines for adult patients in order to prevent urinary retention and to minimise bladder damage and urinary tract infection.

BACKGROUND:

Urinary retention causing bladder damage is a well known complication in patients during hospital care. The most common treatment for urinary retention is an indwelling urinary catheter, which causes 80% of hospital-acquired urinary tract infections. Appropriate use of bladder ultrasonography can reduce the rate of bladder damage as well as the need to use an indwelling urinary catheter. It can also lead to a decrease in the rate of urinary tract infections, a lower risk of spread of multiresistant Gram-negative bacteria, and lower hospital costs.

DESIGN:

An expert group was established, and a literature review was performed.

METHODS:

On the basis of literature findings and consensus in the expert group, guidelines for clinical situations were constructed.

RESULTS:

The main points of the guidelines are the following: identification of risk factors for urinary retention, managing patients at risk of urinary retention, strategies for patients with urinary retention and patient documentation and information.

CONCLUSION:

Using literature review and consensus technique based on a multiprofessional group of experts, evidence-based guidelines have been developed. Although consensus was reached, there are parts of the guidelines where the knowledge is weak.

RELEVANCE TO CLINICAL PRACTICE:

These guidelines are designed to be easy to use in clinical work and could be an important step towards minimising bladder damage and hospital-acquired urinary tract infections and their serious consequences, such as bacteraemia and the spread of multidrug-resistant bacteria in hospitals.

Aim.  To identify risk factors for being at nutritional risk, by means of a nutritional screening, in a population based sample of 75-year-old people living in three county councils in Sweden.

Background.  Undernutrition in older people is known to contribute to poor health. The instrument ‘Nutritional Form For the Elderly’ (NUFFE) helps to identify those at nutritional risk.

Method.  The screening instrument ‘Nutritional Form For the Elderly’, background variables and health related questions were mail distributed. A total of 1461 persons (75 years old) were included in the study. Descriptive statistical methods were used in the analyses.

Results.  One percent of the participants had high risk, 21.3% medium and 77.7% low risk for undernutrition. Medium or high risk was predicted by: living alone, receiving help and impaired perceived health. Low Body Mass Index was associated with low risk for undernutrition.

Conclusion.  By using a simple nutritional screening instrument, significant risk factors were highlighted.

Relevance to practice.  This instrument can identify older people at nutritional risk and is easy to use. Older people living alone have an increased risk of undernutrition. Body Mass Index (BMI) should be used with caution as one and only indicator of nutritional risk in older people.

Aim: The aim was to test the hypothesis that education provided to staff regarding nutritional needs and individualizing nutritional care will improve the nutritional status and functional capacity of elderly people newly admitted to resident homes.

Design: Pre- and posttest, quasi experimental.

Setting: Resident homes.

Subjects: Sixty-two residents (20 men, 42 women) in the experimental group and 53 (14 men, 39 women) in the control group were consecutively included. Mean age was 85 years.

Methods: On admission and after 4 months, nutritional status was assessed using a combination of anthropometry (weight index, arm muscle circumference and triceps skinfold thickness) and biochemical measurements (serum albumin and transthyretin). Functional capacity and overall cognitive function were also assessed. In the experimental unit, the staff received education about nutritional needs and individualized nutritional care.

Results: After 4 months the number of residents assessed as protein energy malnourished decreased from 20 to seven in the experimental (p = 0.004), and from 17 to 10 in the control group (p = 0.1). In the experimental group, motor activity (p = 0.006) and cognitive function (p = 0.02) increased. In the control group, motor activity decreased (p = 0.02).

Conclusions: The results indicate that the intervention had effects, as the number of protein energy malnourished residents decreased in the experimental group and motor activity and cognitive function improved. No such improvements were seen in the control group.

Aims and objectivities: The aims were to test internal consistency and interrater reliability of Mini Nutritional Assessment during implementation of Mini Nutritional Assessment in community residential homes and to test sensitivity, specificity and diagnostic predictivity of Mini Nutritional Assessment-short form vs. Mini Nutritional Assessment.

Background: There is a need in clinical practice to assess nutritional status in older people and to identify those who could benefit from early intervention.

Methods: The two-step Mini Nutritional Assessment procedure (Mini Nutritional Assessment-short form and Mini Nutritional Assessment) was used in 127 older people admitted to eight residential homes. In three of those homes (A, B and C), registered nurses simultaneously performed the assessment procedure, after receiving education and training. The intention was to offer the registered nurses a tool for independent practice use.

Results: Internal consistency was 0·68 (Cronbach's alpha) (n = 127). In residential home A, B and C, the registered nurses carried out Mini Nutritional Assessment in 45 residents out of 68. The agreement level between the author's and the registered nurses' assessments was 62% (kappa 0·41). In residential home A, B and C, the agreement level was 89%, 89% and 44%, respectively. Sensitivity, specificity and diagnostic predictivity of Mini Nutritional Assessment-short form vs. Mini Nutritional Assessment were 89%, 82% and 92%, respectively.

Conclusions: The two-step Mini Nutritional Assessment procedure seems to be a useful tool to identify residents in need of nutritional interventions, despite the registered nurses not carrying out Mini Nutritional Assessment in all residents and the low agreement in residential home C. It indicates that to implement and use Mini Nutritional Assessment in nursing care demands the creating necessary staff resources, such as adequate staffing, sufficient education and continual supervision.

Relevance to clinical practice: Because of the high sensitivity of Mini Nutritional Assessment-short form and Mini Nutritional Assessment, Mini Nutritional Assessment-short form alone might be sufficient for practice use, as its simplicity might increase its usefulness.

Aim.  The aim of this study was to examine attitudes of the nursing staff in geriatric care towards factors of importance for nutritional nursing care.

Background.  Studies show that nutritional risk assessment is seldom performed on older patients as routine and very few patients have a nutritional care plan. Patients in long-term care who are easy to feed are also found to be looked upon more positively than those with high feeding needs.

Methods.  A total of 252 registered nurses and nurse aids working at geriatric rehabilitation and medical care clinics and resident homes participated in the study. Attitudes were examined using the Staff Attitudes to Nutritional Nursing Care Geriatric scale. The scale includes 18 items and was designed as a one to five-point Lickert-type scale. It gives a total score and five subscales representing the dimensions ‘Norms’, ‘Habits’, ‘Assessment’, ‘Intervention’ and ‘Individualization’. A higher score indicates a more positive attitude.

Results.  Of all nursing staff, 53% displayed a positive attitude towards factors of importance for nutritional nursing care and the rest displayed a neutral or negative attitude. The ‘Intervention’ dimension, dealing with nutritional problems and how to manage them, reflected the highest level of positive attitudes, which represents 71% of the nursing staff. The ‘Norms’ dimension had the lowest relative frequency of positive attitudes, 27%. The registered nurses held significantly more positive attitudes than the nurse aids did.

Conclusions.  Nutritional issues comprise an important and time-consuming responsibility in geriatric care; however, nursing staff do not show an unequivocal positive attitude regarding this responsibility. The consequences this entails for the older patient need to be examined further.

Relevance to clinical practice.  Nursing staff play an important role in caring for patients who are malnourished or at risk for malnutrition. Positive attitudes might hinder the development of undernourishment or the further worsening of an already undernourished patient's condition.

The aim was to describe nutritional status and socio-demographic and medical data in people whowere newly admitted to community residential homes (cohort 2), and to compare the results with a previous studyperformed in the same municipality four years earlier (cohort 1). One hundred and twenty-seven people, 65 yearsof age, or older, newly admitted to residential homes in a municipality in the southern part of Sweden, wereconsecutively included. Nutritional status was assessed, using a combination of anthropometry and serum proteinmeasurements and by Mini Nutritional Assessment (MNA). The results showed that 32 % of the residents incohort 2 were assessed as protein-energy malnourished (PEM), compared with 38 % in cohort 1. Body massindex, psychological stress or acute disease, and reduced fluid intake were items in MNA which had power topredict PEM. Residents in cohort 2, diagnosed as having severe medical diseases, increased as well as residentswith neuropsychological problems. Simultaneously, the number living in residential homes decreased, ascompared to cohort 1. These differences indicate that the admission criteria have changed between cohorts 1 and 2.

The aim of this study was to adapt the instrument ‘Good Nursing Care Scale for Patients' to Swedish conditions as a measure of patients’ satisfaction, as well as estimating its reliability and validity. Following a pilot test, discussions in the author group, testing for readability among patients and judgement of content validity by a panel of experts, the final version was reduced to 72 items focusing on good caring. The refined instrument was assessed for internal consistency in 447 surgical in-patients, for 2 week test–retest reliability in 100 patients and subjected to orthogonal principal components factor analysis with varimax rotation, followed by second-order factor analysis. The internal consistency item–item correlation coefficient ranged from 0.15 to 0.91, correlation between each item and the total scale was ≥0.30 for 70 items, Cronbach's alpha coefficient for the final scale was 0.79 and test–retest reliability was 0.75. An orthogonal principal components factor analysis with varimax rotation was conducted on the final 71 items and the 15 first-order factors with eigenvalues ≥1 explained 66% of the total variance. A second-order factor analysis of these 15 factors as items resulted in a seven-factor solution. The total variance explained by the seven factors was 79%. Cronbach's alpha coefficient for the seven factors ranged between 0.32 and 0.95. The instrument seems reliable and valid to assess the patients’ satisfaction with what happened during their hospital stay. To confirm the factor structure and improve factor consistency additional development and testing is suggested.

Fulfilling nutritional requirements in residents with eating problems can be a challenge for both the person in need of help and for the caregiver. In helping and supporting these residents, a positive attitude is assumed to be as important as practical skill. The aim of this study was to test the hypothesis that nutritional education and implementation of a nutritional programme would change the attitudes towards nutritional nursing care among nursing staff with daily experience of serving food and helping residents in municipal care. The study was carried out as a before and after experimental design. An attitude scale, staff attitudes to nutritional nursing care (SANN scale), was developed and used. The response on the scale gives a total SANN-score and scores in five underlying dimensions: self ability, individualization, importance of food, assessment and secured food intake. Nursing staff at eight different residential units (n = 176) responded to the attitude scale and, of these, staff at three of the units entered the study as the experimental group. After responding to the attitude scale, nutritional education was introduced and a nutritional programme was implemented in the experimental units. One year later, attitudes were measured a second time (n = 192). Of these, 151 had also responded on the first occasion. Education and implementation of a nutritional programme did not significantly change attitudes. Overall, nursing staff responded with positive attitudes towards nutritional nursing care. Most of the positive attitudes concerned items within the dimension importance of food. In contrast, items within self ability showed the lowest number of staff with positive attitudes.

BACKGROUND:

As nutritional preventative measures are more effective in elderly people assessed as non protein-energy malnourished (non-PEM) than such interventions are in those who are malnourished, early detection of those at risk of malnutrition is important.

OBJECTIVE:

This study tests the hypothesis that health problems measured by the Nottingham Health Profile (NHP) can predict residents at risk of malnutrition.

DESIGN:

Nutritional status was assessed in 261 residents newly admitted to municipal care using a combination of anthropometry and serum protein measurements. From this sample, 20 non-PEM residents, simultaneously assessed as moderately malnourished according to a subjective method, were consecutively included. Using a paired matched design, 20 other non-PEM residents, who were simultaneously subjectively assessed as well nourished, completed the pairs.

RESULTS:

Univariate logistic regression analyses showed that the dimensions of emotional reactions, energy, pain, physical mobility and sleep had significant power to predict residents at risk of malnutrition. In the multiple logistic regression analysis, energy had the highest explanatory power.

CONCLUSION:

Non-PEM residents, assessed as moderately malnourished according to the Subjective Global Assessment, perceived significantly greater health problems than non-PEM residents subjectively assessed as well nourished. Measurement of health problems adds important information to that used in early detection of residents at risk of malnutrition.