11th INTERNATIONAL NURSING RESEARCH CONFERENCE
Madrid, November 14th – 16th 2007
PAPER TITLE: A Nutritional Nursing Care Model introduced to Elderly People admitted to Resident Homes
AUTHOR/S: Lennart Christensson, RN, PhD and Kerstin Wikby, RN PhD.
WORK PLACE: School of Health Sciences, Department of Nursing, Jönköping University.
ADDRESS: Box 1026, 551 11 Jönköping, Sweden
TELEPHONE: +46 36 101249 FAX: +46 36 101250
E-MAIL: lennart.christensson@hhj.hj.se
Malnutrition among the elderly is a multidimensional concept, involving medical, psychological and social factors. Fulfilling nutritional requirements in residents with eating problems is often a challenge for both the person in need of help and for the care giver.
Objectives: The primary objective of this study was to determine whether educating care givers have effects on the improvement of nutritional status among elderly people, newly admitted to resident homes.
Methods: The study was based on an earlier single-case study, where a model for nutritional nursing care was developed. In this study a pre-post test design was used, including 62 residents in the experimental (20 men, 42 women) and 53 in the control group (14 men, 39 women). The residents were newly admitted to a resident home and were consecutively included in the study. Mean age was 85 years. At admission and after four months protein-energy malnutrition (PEM) was assessed, using a combination of anthropometry (weight index, arm muscle circumference and triceps skinfold thickness) and biochemical measurements (serum protein and transthyretin). Functional capacity and overall cognitive function were also assessed. In the experimental unit, a nutritional nursing care model was introduced and the staff received education about nutritional needs, and how to individualise nutritional care.
Findings: Twenty residents in the experimental and 17 in the control group were assessed as PEM at admission. After four months the number of residents assessed as PEM decreased to seven in the experimental (p=0.004), and to ten in the control group (p=0.1). Motor activity (p=0.006) and cognitive function (p=0.02) increased in the experimental group, while motor activity decreased in the control group (p=0.02). The care givers in the experimental group estimated the extra work, caused by the changed way of work during the meals, to 11/2 minute per resident and day.
Discussion: Individualised actions directed towards PEM residents are in line with the recommendation by the European Society of Parenteral and Enteral Nutrition (ESPEN) and with the Swedish goals of nursing action. Nursing actions towards nutritional problems include more than merely to offer a standard care plan, such as giving oral supplementation. As the nutritional problems often demands a deeper analysis of the underlying causes, individualized nursing actions may be a more optimal approach. This study shows that implementing an individualised nutritional programme increase nutritional status, motor activity and cognitive function in PEM residents. The nutritional care programme was implemented with a minimum of extra work.