Royal Prince Alfred Hospital, Nutrition & Dietetics, Sydney, Australia.
Royal Prince Alfred Hospital, Nutrition & Dietetics, Sydney, Australia.
Clin Nutr. 2018 Dec;37(6 Pt A):1992-2000. doi: 10.1016/j.clnu.2017.09.005. Epub 2017 Sep 27.
Prevalence of malnutrition and a myriad of barriers to adequate oral diet in hospitalised patients warrants further investment to improve the patient mealtime experience. The aim of this study was to explore barriers and enablers to implementing effective mealtime interventions and develop a process framework to guide clinicians and researchers in the area.
Potential experts in the area of hospital mealtime intervention were identified as having published in this field of work within the Australasian setting. Further information was sought by email and telephone communication on professional background; research experience; interest; and capacity to participate. Recruited participants were surveyed using a modified Delphi method to establish opinion and experience in the area of mealtime interventions. Results were collated and content was coded using a thematic analysis approach by the primary researcher and two additional reviewers.
Thirty-two Australian authors in the area of mealtime interventions within the hospital environment were identified from publication. Twenty-one participants were able to be contacted and nineteen of these consented to enrol in the study. Participants included those from a dietetic (n = 14), nursing (n = 4) and medical (n = 1) background. Participants were deemed to have expert knowledge if they had significant involvement in the published research and demonstrated a deep level of understanding of hospital mealtime interventions. All participants provided key insights into barriers to oral intake in the hospital environment and suggestions for interventions to address these barriers. From the survey, an eight step framework to guide mealtime interventions was developed.
Hospital mealtime interventions are complex processes. Interventions should be implemented after careful consideration of the local context and baseline data; and tailored to address barriers. Roles and responsibilities for nutrition care should be clear and consistent. Implementation planning is recommended to ensure that an ongoing process is in place to engage executive support and staff involvement, foster project team resilience and ensure sustainability of interventions.
住院患者营养不良的普遍存在和各种口服饮食障碍，需要进一步投资以改善患者的用餐体验。本研究旨在探讨实施有效用餐干预措施的障碍和促进因素，并为临床医生和研究人员开发一个指导框架。
确定在澳大利亚地区的医院用餐干预领域有发表过相关工作的潜在专家。通过电子邮件和电话进一步了解其专业背景、研究经验、兴趣和参与能力。通过改良德尔菲法对招募的参与者进行调查，以确定他们在用餐干预领域的意见和经验。将结果汇总，并由主要研究人员和另外两名评审员使用主题分析方法对内容进行编码。
从发表的文献中确定了 32 名澳大利亚作者在医院环境中的用餐干预领域。能够联系到 21 名参与者，其中 19 名同意参加研究。参与者包括营养师（n=14）、护士（n=4）和医生（n=1）。如果参与者在已发表的研究中具有重要参与度，并表现出对医院用餐干预的深入理解，则被认为具有专家知识。所有参与者都对医院环境中口服摄入的障碍提供了关键见解，并提出了干预这些障碍的建议。通过调查，开发了一个指导用餐干预的八步框架。
医院用餐干预是一个复杂的过程。在实施干预措施之前，应仔细考虑当地情况和基线数据，并针对障碍进行定制。营养护理的角色和责任应明确且一致。建议进行实施计划，以确保有一个持续的过程来获得行政支持和员工参与，培养项目团队的韧性，并确保干预措施的可持续性。
