Miller Colette, Jones Stephanie P, Bangee Munirah, Martinez-Garduno Cintia Mayel, Brady Marian C, Cadilhac Dominique A, Dale Simeon, McInnes Elizabeth, Middleton Sandy, Watkins Caroline L, Lightbody C Elizabeth
Stroke Research Team, School of Nursing & Midwifery, University of Central Lancashire, Preston, PR1 2HE, UK.
Nursing Research Institute - St Vincent's Health Network Sydney, St Vincent's Hospital Melbourne & Australian Catholic University, Sydney, Australia.
BMC Nurs. 2023 Oct 27;22(1):403. doi: 10.1186/s12912-023-01575-4.
Dehydration and malnutrition are common in hospitalised patients following stroke leading to poor outcomes including increased mortality. Little is known about hydration and nutrition care practices in hospital to avoid dehydration or malnutrition, and how these practices vary in different countries. This study sought to capture how the hydration and nutrition needs of patients' post-stroke are assessed and managed in the United Kingdom (UK) and Australia (AUS).
To examine and compare current in-hospital hydration and nutrition care practice for patients with stroke in the UK and Australia.
A cross-sectional survey was conducted between April and November 2019. Questionnaires were mailed to stroke specialist nurses in UK and Australian hospitals providing post-stroke inpatient acute care or rehabilitation. Non-respondents were contacted up to five times.
We received 150/174 (86%) completed surveys from hospitals in the UK, and 120/162 (74%) in Australia. Of the 270 responding hospitals, 96% reported undertaking assessment of hydration status during an admission, with nurses most likely to complete assessments (85%). The most common methods of admission assessment were visual assessment of the patient (UK 62%; AUS 58%), weight (UK 52%; AUS 52%), and body mass index (UK 47%; AUS 42%). Almost all (99%) sites reported that nutrition status was assessed at some point during admission, and these were mainly completed by nurses (91%). Use of standardised nutrition screening tools were more common in the UK (91%) than Australia (60%). Similar proportions of hydration management decisions were made by physicians (UK 84%; AUS 83%), and nutrition management decisions by dietitians (UK 98%; AUS 97%).
Despite broadly similar hydration and nutrition care practices after stroke in the UK and Australia, some variability was identified. Although nutrition assessment was more often informed by structured screening tools, the routine assessment of hydration was generally not. Nurses were responsible for assessment and monitoring, while dietitians and physicians undertook decision-making regarding management. Hydration care could be improved through the development of standardised assessment tools. This study highlights the need for increased implementation and use of evidence-based protocols in stroke hydration and nutrition care to improve patient outcomes.
中风后住院患者中脱水和营养不良很常见，会导致包括死亡率增加在内的不良后果。对于医院中避免脱水或营养不良的水合作用和营养护理措施，以及这些措施在不同国家如何不同，人们知之甚少。本研究旨在了解英国（UK）和澳大利亚（AUS）中风后患者的水合作用和营养需求是如何评估和管理的。
研究并比较英国和澳大利亚目前针对中风患者的住院水合作用和营养护理措施。
于2019年4月至11月进行了一项横断面调查。问卷邮寄给了英国和澳大利亚提供中风后住院急性护理或康复服务的医院的中风专科护士。对未回复者最多联系5次。
我们收到了来自英国医院的150/174份（86%）完成的调查问卷，以及来自澳大利亚医院的120/162份（74%）。在270家回复的医院中，96%报告在入院时对水合状态进行评估，护士最有可能完成评估（85%）。入院评估最常用的方法是对患者进行视觉评估（英国62%；澳大利亚58%）、体重（英国52%；澳大利亚52%）和体重指数（英国47%；澳大利亚42%）。几乎所有（99%）的机构报告在入院期间的某个时间点对营养状况进行了评估，这些主要由护士完成（91%）。英国（91%）比澳大利亚（60%）更普遍使用标准化营养筛查工具。水合管理决策由医生做出的比例相似（英国84%；澳大利亚83%），营养管理决策由营养师做出的比例相似（英国98%；澳大利亚97%）。
尽管英国和澳大利亚中风后的水合作用和营养护理措施大致相似，但仍发现了一些差异。虽然营养评估更多地依据结构化筛查工具，但水合作用的常规评估通常并非如此。护士负责评估和监测，而营养师和医生负责管理决策。通过开发标准化评估工具可以改善水合护理。本研究强调需要在中风水合作用和营养护理中更多地实施和使用循证方案，以改善患者预后。
