Elsevier

Clinical Nutrition

Volume 27, Issue 2, April 2008, Pages 196-202
Clinical Nutrition

Original article
Insufficient nutritional knowledge among health care workers?

https://doi.org/10.1016/j.clnu.2007.10.014Get rights and content

Summary

Background & aims

Though a great interest and willingness to nutrition therapy, there is an insufficient practice compared to the proposed ESPEN guidelines for nutrition therapy. The aim of this questionnaire was to study doctors and nurses' self-reported knowledge in nutritional practice, with focus on ESPEN's guidelines in nutritional screening, assessment and treatment.

Methods

A questionnaire about different aspects of nutritional practice was answered by 4512 doctors and nurses in Denmark, Sweden and Norway.

Results

The most common cause for insufficient nutritional practice was lack of nutritional knowledge. Twenty-five percent found it difficult to identify patient in need of nutritional therapy, 39% lacked techniques for identifying malnourished patients, and 53% found it difficult to calculate the patients' energy requirement and 66% lacked national guidelines for clinical nutrition. Twenty-eight percent answered that insufficient nutrition practice could lead to complications and prolonged hospital stay. Those that answered that their nutritional knowledge was good had also a better nutritional practice.

Conclusion

The self-reported nutritional knowledge was inadequate among Scandinavian doctors and nurses. Increased nutritional knowledge seems to improve the nutritional practice. A combination of an integrated nutrition curriculum during the education, together with post-graduated education for both physicians and nurses should be established.

Introduction

Nutrition is a vital component of health promotion and disease prevention. However, a high prevalence of undernutrition and inadequate nutritional support are common among institutionalised patients in Europe.1 Insufficient nutritional intake and inflammatory stress metabolism in chronic diseases, in addition to inadequate nutritional therapy for severe diseased patients, can cause this poor nutritional status. Undernutrition influences negatively every organ of the patient's body, with consequences like reduced quality of life, increased morbidity and enhanced mortality.2 A great deal of this undernutrition can be prevented and treated if special attention is paid to patient care, and if guidelines for nutrition risk screening is followed. Due to the lack of widely accepted screening system, European Society of Parenteral and Enteral nutrition (ESPEN) have proposed a set of standards used as a guideline to detect and prevent undernutrition. These standards include screening of all patients, assessment of some patients, starting the treatment, monitoring the outcome, and communication of the results and creating a patient care plan.3

We have in a previous paper showed a large discrepancy between attitudes to nutritional screening and treatment compared nutritional practice, in three Scandinavian countries.4 Though a great interest and willingness to nutrition therapy, this questionnaire study showed an insufficient practice compared to the proposed ESPEN guidelines for nutrition screening. One possible explanation for this discrepancy is the lack of knowledge. In a paper some years ago, the reason for not identifying malnourished patients could be due to an insufficient knowledge among doctors in identifying and treating undernourished patients.5

The aim of this questionnaire was to study doctors and nurses' self-reported knowledge and attitudes about nutritional practice, with focus on ESPEN's guidelines in nutritional screening, assessment and treatment.

Section snippets

Participants and methods

In April–June 2004, a questionnaire about nutritional attitudes and routines was sent to 6000 doctors and 6000 nurses in Denmark, Sweden and Norway. The methods are presented in detail elsewhere.4 We included doctors and nurses working at units where nutritional problems were supposed to be common: internal medicine ward, digestive department, oncology unit, department of general surgery and gastrointestinal surgery, in addition to units for orthopaedic surgery and anaesthesiology.

The

Results

All together, 4512 answered the questionnaire about thoughts of personal nutritional knowledge (1753 doctors, N: 584, S: 619, D: 550 and 2759 nurses, N: 889, S: 907, D: 963).

The response rate was quite similar in all countries (≈37%), but the nurse group had a higher response rate compared to doctors (46% vs. 30%).

In this study, the respondents answered that insufficient knowledge was the most common cause of inadequate nutritional practice, from 67% in Norway to 48% among the Danish

Discussion

This study shows self-perceived skills of nutritional knowledge among Scandinavian doctors and nurses. A great number pointed out that insufficient knowledge was the main barrier for good nutritional management. This insufficient knowledge was present for all three main areas in relation to the ESPEN guidelines concerning good clinical nutritional practice: screening of patient on admission; assessment of undernourished patient and initiating nutritional treatment.3

We selected a specific group

Conclusion

This survey shows that knowledge in nutritional practice like screening, assessment and treatment are inadequate among Scandinavian doctors and nurses, even though recommendation from European Council and ESPEN guidelines. Although this study does not reveal the actual nutritional knowledge, there is evidence to believe that the focus on nutritional education should be increased to improve the skills in clinical nutrition.18 This study showed that those who reported better nutritional knowledge

Conflict of interest statement

There was no conflict of interests in the preparation of the manuscript.

Acknowledgement

This study was supported by an unrestricted grant by Fresenius Kabi. The study sponsor has no role in study design, data collection, interpretation the data or writing the manuscript.

UNI-C (The Danish IT Centre for Education and Research) provided support regarding data registration and statistics and Health Care Consulting assisted in preparing questionnaires, data analyses and co-ordination of the study in Scandinavia.

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On behalf of the Scandinavian Nutrition Group (SNG): Anne Marie Bech, Copenhagen, Denmark; Anne Berit Guttormsen, Bergen, Norway; Ulla Johansson, Hudiksvall, Sweden; Hanne Kristensen, Aalborg, Denmark; Karin Ladefoged, Denmark; Jørgen Larsson, Huddinge, Sweden; Karen Lindorff-Larsen, Aalborg, Denmark; Michael Staun, Copenhagen, Denmark; Christina Stene, Malmø, Sweden; Lene Thoresen, Trondheim, Norway; Anne Wengler, Copenhagen, Denmark; Hilde Wøien, Oslo, Norway.

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