Catherine McAuley School of Nursing and Midwifery, College of Medicine and Health, Brookfield, University College Cork, Cork, Ireland.
South Tipperary General Hospital, Clonmel, Ireland.
J Clin Nurs. 2021 Oct;30(19-20):2935-2947. doi: 10.1111/jocn.15800. Epub 2021 May 4.
To examine mealtime and patient factors associated with meal completion among hospitalised older patients. We also considered contextual factors such as staffing levels and ward communication.
Sub-optimum nutrition is a modifiable risk factor for hospital associated decline (HAD) in older patients. Yet, the quality of mealtime experiences can be overlooked within ward routinised practice.
Cross sectional, descriptive observation study.
We undertook structured observation of mealtimes examining patient positioning, mealtime set-up and feeding assistance. The outcome was meal completion categorised as 0, 25%, 50%, 75% or 100%. Data were collected on patient characteristics and ward context. We used mixed-effects ordinal regression models to examine patient and mealtime factors associated with higher meal completion producing odds ratios (OR) and 95% confidence intervals (CI). The study was reported as per STROBE guidelines.
We included 60 patients with a median age of 82 years (IQR 76-87) and clinical frailty score of 5 IQR (4-6). Of the 279 meals, 51% were eaten completely, 6% three quarters, 15% half, 18% a quarter and 10% were not eaten at all. Mealtime predictors with a weak association with less-meal completion were requiring assistance, special diets, lying in bed, and red tray (indicator of nutrition risk), but were not statistically significant. Significant patient-level factors were higher values for frailty (OR 0.34 [0.11-1.04]) and Malnutrition Universal Screening Tool (OR 0.22 [0.08-0.62]). The average nurse-to-patient ratio was 1:5.5.
Patient factors were the strongest predictors for meal completion, but mealtime factors had a subtle influence. The nursing teams' capacity to prioritise mealtimes above competing demands is important as part of a comprehensive nutrition strategy.
Nurses are central to optimising nutrition for frail older patients. It requires ward leadership to instil a culture of prioritising assisted mealtimes, improved communication, greater autonomy to tailor nutrition strategies and safe staffing levels.
检查与住院老年患者完成进餐相关的进餐时间和患者因素。我们还考虑了人员配备水平和病房沟通等环境因素。
营养不足是导致老年患者住院相关衰退（HAD）的可改变风险因素。然而，在病房常规实践中，可能会忽略进餐体验的质量。
横断面、描述性观察研究。
我们对用餐时间进行了结构化观察，检查了患者的体位、用餐设置和喂养辅助。结果是将进餐完成情况分类为 0、25%、50%、75%或 100%。收集了患者特征和病房环境的数据。我们使用混合效应有序回归模型来检查与更高进餐完成率相关的患者和进餐时间因素，产生优势比（OR）和 95%置信区间（CI）。该研究按照 STROBE 指南进行报告。
我们纳入了 60 名年龄中位数为 82 岁（IQR 76-87）、临床虚弱评分 5（IQR 4-6）的患者。在 279 餐中，51%的患者完全进食，6%的患者进食四分之三，15%的患者进食一半，18%的患者进食四分之一，10%的患者根本没有进食。与进餐完成率较低相关的进餐时间预测因素包括需要帮助、特殊饮食、卧床、红色托盘（营养风险指标），但没有统计学意义。显著的患者水平因素是虚弱程度较高（OR 0.34[0.11-1.04]）和营养不良通用筛查工具（OR 0.22[0.08-0.62]）。平均护士与患者比例为 1:5.5。
患者因素是进餐完成的最强预测因素，但进餐时间因素有微妙影响。护理团队在竞争需求之上优先考虑进餐时间的能力非常重要，这是全面营养策略的一部分。
护士是优化虚弱老年患者营养的核心。病房领导需要树立一种优先考虑辅助进餐时间、改善沟通、更大程度地自主制定营养策略和安全人员配备水平的文化。
