Date of Award

2006

Degree Type

Thesis

Degree Name

Bachelor of Nursing Honours

School

School of Nursing, Midwifery and Postgraduate Medicine

Faculty

Faculty of Computing, Health and Science

First Advisor

Sue Nikoletti

Second Advisor

Jeanne Young

Abstract

Decreased nutritional status of older hospitalised patients has been identified as a significant problem. The prevalence of malnutrition in older people has been reported to be between 17% and 65% in acute hospital settings. This has led to the recognition of a need for a valid instrument to adequately assess nutritional status. Tools developed to date still require much time and expertise to implement, limiting their use within the practical setting. Nurses are in an ideal position to conduct nutritional assessments. They possess clinical knowledge which can be utilised to provide individualised and timely assessment. To. date, the literature does not indicate that any specific comparison between nurses' clinical judgement and a nutritional assessment tool has been conducted to verify the reliability of nurses' clinical judgement in the assessment of nutritional status with older patients in an acute clinical setting. The purpose of this study was to compare nurses' clinical judgement with a validated assessment tool the Short Form-Mini Nutritional Assessment in assessing the nutritional status of older patients in the acute clinical setting. This was to determine whether nurses' clinical judgement can accurately assess older patients' nutritional status. The study used a descriptive comparative design. The sample consisted of 138 patients aged 65 years and over in a major teaching hospital in Perth, Western Australia. The assessment tool was used by the investigator to assess the nutritional status of the patients. Nurses were asked to assess the same patients using their clinical judgement. Assessments were rated as 0 (normal) or 1 (possible malnutrition). Eligible patients were invited to participate and consent was obtained from participants or their relative prior to commencement of any assessment. Findings from this study indicate that nurses failed to assess 33% of patients as having possible malnutrition compared with the MNA-SF (using the lower cut off score of 10 for possible malnutrition). A total of 35% (n= 48) of patients were assessed by nurses as having a possible risk of malnutrition compared with 60% (n= 83) of patients assessed using the MNA-SF (using the lower cut off score of 10 for possible malnutrition). Nurses agreed with the tool for just over 50% of all assessments. Analysis by the kappa statistic showed that the strength of agreement between nurses' clinical judgment and the MNA -SF, using the cut off score of 10, was fair (0.222; 95% CI, of 0.08 to 0.36). The strength of agreement for the majority of comparisons between nurses' clinical judgment and the MNA-SF by demographic variables within this study was found to be poor. The discrepancy between nurse and tool assessments within this study warrants an evaluation and development of nutritional education for nurses to assist them in their assessment of older patients' nutritional status. Additionally, the findings of this study indicate that the implementation of an assessment tool may be useful to assist nurses in assessing their patients' nutritional status. Further research is recommended to identify an appropriate nutritional assessment tool for the acute clinical setting.

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