Pilot Process and Outcome Evaluation of the Introduction of a Clinical Nutrition Pathway in the Care of In-Hospital Renal Patients

Abstract

Our objective was to investigate the effect of in-service education and the use of a clinical decision-making pathway on nurses' knowledge related to nutritional needs of renal patients and referrals to a dietitian. This was a before-and-after evaluation study of the effect of the implementation of a clinical nutrition pathway on nurses' knowledge and dietitian referrals. The setting was a renal in-patient unit in southeast Queensland, Australia. There were two groups of participants. Part 1 consisted of 53 registered nurses working in the renal unit of a regional general hospital, and Part 2 consisted of the medical records of two cohorts of more than 100 patients admitted to the renal unit. A clinical nutrition pathway and a resource package were developed to support nurses' decision-making related to the nutritional care of renal patients. Thirty-minute in-service education sessions were conducted to explain the use of the pathway, and to develop nurses' confidence in dietary decision-making for renal patients. The main outcome measures consisted of the nurses' knowledge of nutritional interventions with renal patients and the frequency of dietitian referrals. The nurses' knowledge increased, and referrals to dietitians remained constant. In-service education and access to unit-based resources, including a decision-support clinical nutrition pathway, improved nurses' knowledge of nutritional care for renal patients. Nurses continued to refer patients for dietitian consultation after the intervention.