Abstract
BackgroundMany patients are admitted to hospital and are already malnourished. Gaps in practice have identified that care processes for these patients can be improved. Hospital staff, including management, needs to work towards optimizing nutrition care in hospitals to improve the prevention, detection and treatment of malnutrition. The objective of this study was to understand how staff members perceived and described the necessary ingredients to support change efforts required to improve nutrition care in their hospital.MethodsA qualitative study was conducted using purposive sampling techniques to recruit participants for focus groups (FG) (n = 11) and key informant interviews (n = 40) with a variety of hospital staff and management. Discussions based on a semi-structured schedule were conducted at five diverse hospitals from four provinces in Canada as part of the More-2-Eat implementation project. One researcher conducted 2-day site visits over a two-month period to complete all interviews and FGs. Interviews were transcribed verbatim while key points and quotes were taken from FGs. Transcripts were coded line-by-line with initial thematic analysis completed by the primary author. Other authors (n = 3) confirmed the themes by reviewing a subset of transcripts and the draft themes. Themes were then refined and further detailed. Member checking of site summaries was completed with site champions.ResultsParticipants (n = 133) included nurses, physicians, food service workers, dietitians, and hospital management, among others. Discussion regarding ways to improve nutrition care in each specific site facilitated the thought process during FG and interviews. Five main themes were identified: building a reason to change; involving relevant people in the change process; embedding change into current practice; accounting for climate; and building strong relationships within the hospital team.ConclusionsHospital staff need a reason to change their nutrition care practices and a significant change driver is perceived and experienced benefit to the patient. Participants described key ingredients to support successful change and specifically engaging the interdisciplinary team to effect sustainable improvements in nutrition care.Trial registrationRetrospectively registered ClinicalTrials.gov Identifier: NCT02800304, June 7, 2016.
Highlights
Many patients are admitted to hospital and are already malnourished
As part of the M2E project, five hospitals in Canada are changing their nutrition care processes to align with Integrated Nutrition Pathway for Acute Care (INPAC)
A pragmatic approach was taken throughout the developmental phase of M2E due to the need to promptly understand context, as well as the barriers and facilitators to change required for sites to progress with their implementation efforts. Overview This was a qualitative descriptive study using thematic analysis with data collected at five diverse M2E hospitals, including: Royal Alexandra Hospital; Niagara Health, Greater Niagara General Site; The Ottawa Hospital; Concordia Hospital; and Pasqua Hospital Regina Qu’Appelle Health Region
Summary
Gaps in practice have identified that care processes for these patients can be improved. Hospital staff, including management, needs to work towards optimizing nutrition care in hospitals to improve the prevention, detection and treatment of malnutrition. The objective of this study was to understand how staff members perceived and described the necessary ingredients to support change efforts required to improve nutrition care in their hospital. Few studies have attempted to describe how to improve hospital nutrition care practices and embed those practices in the unit routine [13]. An interdisciplinary approach is needed to improve the prevention, detection and treatment of hospital malnutrition [14, 15]. As part of the M2E project, five hospitals in Canada are changing their nutrition care processes to align with INPAC. All methods are described in a prior publication [20]
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