Elsevier

Nurse Education Today

Volume 68, September 2018, Pages 13-18
Nurse Education Today

Is the topic of malnutrition in older adults addressed in the European nursing curricula? A MaNuEL study

https://doi.org/10.1016/j.nedt.2018.05.015Get rights and content

Abstract

Background

The lack of sufficient knowledge of health care professionals is one main barrier to implementing adequate nutritional interventions. Until now, it is not known to which extent European nurses are exposed to the topic of malnutrition in older adults during their education.

Objective

To determine whether formal nursing degree programs in Europe address the topic of nutrition and, specifically, malnutrition in older adults.

Design

A cross-sectional study was conducted using an online-survey.

Participants

The online-survey link was e-mailed to 926 nursing education institutions in 31 European countries.

Methods

This study was conducted as part of the Healthy Diet for Healthy Life Joint Programming Initiative, Malnutrition in the Elderly Knowledge Hub (MaNuEL) project. Descriptive analyses were performed using SPSS. Associations were calculated using the chi-square tests and Fisher's exact test.

Results

The response rate of our survey was 14.2% (131 institutions). Of these, 113 (86.3%) addressed the topic of nutrition in their educational programs, and 73.7% addressed the topic of malnutrition in older adults. Malnutrition screening (70.8%), causes (67.2%) and consequences (68.7%) of malnutrition were frequently-addressed topics of content. Topics that were rarely addressed included nutritional support in intensive care units (ICU) (23.7%), cooperation in multidisciplinary nutrition teams (28.2%), dietary counselling (32.1%) and the responsibilities of various professions in nutritional support (35.1%). The topic of malnutrition in older adults is taught by nurses in 52.7%, by dietitians in 23.7%, by nutritional scientists in 18.3%, and physicians in 19.8% of the institutions.

Conclusions

The topics of malnutrition and malnutrition screening are currently not included in the content of nutrition courses taught at nearly 30% of the European educational institutions for nurses. Nursing educators urgently need to improve curriculum content with respect to the topic of malnutrition in older adults to enable nurses to provide high-quality nutritional care of older persons.

Introduction

The prevalence of malnutrition ranges from 20 to 50% in hospitalized patients and can reach up to 70% in nursing home residents (Bell et al., 2013; Pirlich et al., 2006; Roller et al., 2016). The literature describes numerous negative consequences of malnutrition, including negative health-related outcomes, such as poor wound-healing, infections, complications and hospital readmissions (Felder et al., 2015; Norman et al., 2008). In addition, malnutrition places a considerable cost burden on the health care systems (Freijer et al., 2013; Khalatban-Soltani, 2015).

Nevertheless, malnutrition is often poorly recognized and undertreated (Correia et al., 2014). There are many explanations as to why nutritional interventions are not implemented and conducted. The Council of Europe identified the lack of sufficient education with regard to nutrition among all staff groups as one major barrier (Europe, 2002). In a recently published study, nurses were interviewed and asked their opinions about barriers that prevented them from providing good nutritional care (Eide et al., 2015). The authors of this study found that the lack of sufficient knowledge and skills was the main reason given that adequate interventions were not implemented. In other studies, negative attitudes towards nutrition were reported to play an important role (Bauer et al., 2015). Nurses are often not familiar with the current guidelines and are unsure which methods they should use to conduct nutritional screening of clients (Eide et al., 2015). On the other hand, the results of other studies have shown that nurses working in clinical practice want to receive education on malnutrition, but often do not have access to appropriate educational programs (Duerksen et al., 2016).

For nurses to be able to provide optimal nutritional care for older adults, they must be educated about malnutrition while receiving their basic formal education and training (DiMaria-Ghalili et al., 2014). Based on international guidelines on the management of malnutrition, the inclusion of the following content in the nursing curricula is crucial: malnutrition screening, nutritional interventions that can be supported by nurses (e.g., provision of oral nutritional supplements or energy-protein enriched food), monitoring of nutritional intake and multidisciplinary cooperation.

In a comprehensive literature review of publications indexed in the medical databases MEDLINE (PubMed), CINAHL and EMBASE, which was conducted by the authors in September and October 2016, not a single study was found that dealt with malnutrition in the context of the education of European nurses. One survey carried out in the U.S. in nursing schools was identified (Stotts et al., 1987), but this survey was conducted >30 years ago and only surveyed the level of general nutrition education rather than education on malnutrition in older adults.

At present, the extent to which European nurses are exposed to the topic of malnutrition in older adults during their basic education has not been researched. Therefore, the aim of this study was to determine the provisions and content of nutrition education and, particularly, education about malnutrition in older adults in formal nursing educational programs throughout Europe.

Section snippets

Design

This study was conducted as part of the Healthy Diet for Healthy Life Joint Programming Initiative, Malnutrition in the Elderly Knowledge Hub (MaNuEL) project, which aims to build research capacity on malnutrition in older persons in Europe (Visser et al., 2017). We selected a cross-sectional study design and used a web-based online survey to gather extensive information about curricula content on nutrition, and especially malnutrition in basic educational programs for nurses.

Questionnaire

An online

Results

A total of 191 (20.6%) out of 926 institutions filled out the online questionnaire. Of those 191 questionnaires, 131 (68.6%) were completely filled out and included in the data analysis. The response rate of universities was 10.1% (n = 44), the response rate of universities of applied sciences was 75.5% (n = 37) and the response rate of nursing schools was 11.2% (n = 49). One institution listed its institution type as “other”. No responses at all were received from institutions located in

Discussion

To our best knowledge, this study is the first to evaluate the provision and content of nutrition education in the formal education of nurses in European countries. The results of this study provide insights into how the topic of nutrition, and specifically malnutrition in older adults, is currently addressed in formal nursing education programs. Our results show that 13.7% of the participating educational institutions do not include courses on nutrition in their curricula of the nurse

Conclusions

Our survey results revealed that the topic of malnutrition in older adults and malnutrition screening is not taught in nearly 30% of the participating institutions that offer basic nursing education.

In the future, the existing curricula should be analysed in detail. One priority of future studies should be to conduct an analysis of the effectiveness of educational interventions in nursing education and nursing practices regarding malnutrition in older adults. Because a lack of malnutrition

Acknowledgements

We would like to express our thanks to Isabell Kravanja, BScN, who supported this study as a student assistant. The preparation of this paper was supported by the MAlNUtrition in the ELderly (MaNuEL) knowledge hub. This work is supported by the Joint Programming Initiative ‘Healthy Diet for a Healthy Life’. The funding agencies supporting this work are: Austria: Federal Ministry of Science, Research and Economy (BMWFW-10.420/0004-WF/V/3c/2016); France: Ecole Supérieure d'Agricultires (ESA);

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