Porter J, Raja R, Cant R, Aroni R
Eastern Health, Victoria, Australia.
J Hum Nutr Diet. 2009 Jun;22(3):203-9. doi: 10.1111/j.1365-277X.2008.00932.x. Epub 2009 Jan 19.
Nutrition screening using evidence-based clinical practice is important for identifying patients whose nutritional status may be compromised, so that they receive appropriate treatment. Introduction of the Malnutrition Universal Screening Tool ('MUST') in two wards in two Melbourne hospitals resulted in low screening completion rates by nursing staff. Nurses' screening practices were explored to understand personal and workplace barriers to compliance.
Surveys of patients' medical records and focus groups with nurses were used to gather data. Audio-recorded group narratives were transcribed verbatim, and then coded thematically to develop understandings of response patterns.
A survey of admitted patients (n = 46) showed low screening rates by ward (17% and 62%). Eighteen nurses in two wards participated in three focus groups. The five main themes that emerged were: 'screening role', 'task priorities', 'recognition of evidence-based practice', 'uncertainty of protocols' and 'degree of competence'. Screening completion was limited by workloads, uncertainty about screening policy and also individuals' skill in use of the tool.
Application of 'MUST' can be facilitated by increasing nurses' competence through training and by the provision of ongoing support. When implementing nutrition risk screening, dietitians' roles should include continually working with nurses to identify and reduce the barriers that prevent the adoption of universal screening. Enhancement of collaboration is essential to ensure that optimal nutrition care occurs.
运用循证临床实践进行营养筛查对于识别营养状况可能受到影响的患者十分重要，以便他们能得到恰当治疗。在墨尔本的两家医院的两个病房引入营养不良通用筛查工具（“MUST”）后，护士的筛查完成率较低。对护士的筛查实践进行了探究，以了解个人及工作场所中影响依从性的障碍。
通过对患者病历进行调查以及与护士开展焦点小组讨论来收集数据。对录音的小组叙述进行逐字转录，然后进行主题编码，以深入了解回答模式。
一项对住院患者（n = 46）的调查显示，各病房的筛查率较低（分别为17%和62%）。两个病房的18名护士参与了三个焦点小组。出现的五个主要主题为：“筛查角色”“任务优先级”“对循证实践的认知”“方案的不确定性”以及“能力程度”。筛查的完成受到工作量、筛查政策的不确定性以及个人使用该工具的技能的限制。
可通过培训提高护士的能力并提供持续支持来促进“MUST”的应用。在实施营养风险筛查时，营养师的角色应包括持续与护士合作，以识别并减少阻碍采用通用筛查的障碍。加强协作对于确保提供最佳营养护理至关重要。
