A New Approach to the Prevention of Malnutrition and Pressure Injury in the Clinical Setting

Abstract

Malnutrition is a significant problem in the hospital setting, contributing to adverse outcomes for patients, such as increased risks of complications and death, and also for the health care system, through increased hospital costs and length of stay. Malnutrition is also an identified risk factor for pressure injury. Nutritional intervention for pressure injury prevention is therefore an important consideration in the hospital setting, to avoid substantial costs and patient burden associated with pressure injury. Adopting a suitable framework for intervention planning in the clinical setting may improve the likelihood of its success. Public health nutrition, whilst having a different focus to clinical dietetics, may give new insight into nutrition intervention planning in the hospital setting. Public health nutrition focuses on the prevention of nutrition related health conditions by addressing upstream determinants of the problem at a broader population level. In contrast, clinical dietetics traditionally focuses on the treatment of established nutrition related conditions by providing individualised dietetic care. However, there is an increasing focus on preventative care in hospitals, particularly in relation to pressure injury prevention. Given a considerable proportion of pressure injuries in hospitals may be attributable to malnutrition, adopting a public health nutrition framework for intervention planning may be suitable in the clinical setting. That is, applying a nutrition intervention at a broader hospital population level, to address upstream determinants of pressure injury (i.e. malnutrition) in order for its prevention. This thesis therefore explores the utility of a public health nutrition framework, the bi-cycle model (Hughes and Margetts 2011), for intervention planning and delivery in the clinical setting.