Abstract
BackgroundDespite the long-term consequences of malnutrition in hospitalised patients, nutritional practice guidelines for adults, particularly in the recovery phase are rarely implemented in community based primary health care settings.AimThis study aimed at assessing the current practice to establish preparedness for effective implementation of the 2016 South African Enteral Nutrition Practice Guidelines for Adults.SettingThis study was conducted in a district hospital in KwaZulu-Natal, a community health centre, two primary health care (PHC) clinics and one household.MethodsNon-participant observations were conducted to observe 10 purposefully selected health care professionals involved in nutritional therapy provision to adults, a patient on home enteral nutrition (HEN) and a family caregiver. Content analysis helped identify predominant themes that emerged in the study.ResultsObservation results showed that the national enteral nutritional (EN) therapy practice guidelines were not available in all health care institutions. Health care professionals were not aware of them and the care users confirmed that they attended HEN related follow-up care at institutions that prescribed and inserted their feeding tubes. Two major themes that emerged in this study include positive factors and negative factors that influence implementation of the guideline.ConclusionThe study identified factors that can have significant influence on the implementation of the national enteral nutritional therapy practice guidelines, a necessary step for changing clinical practice and thus clinical outcomes of patients. The EN/HEN training and the provision of necessary resources are needed to improve the situation. More research on the strategies for the dissemination of guidelines is essential to improve awareness and thus adoption and implementation.
Highlights
Research has shown that ill patients, especially in the acute phase, suffer extensive catabolism with resultant malnutrition, which continues to be underdiagnosed and managed during the patient’s hospital stay.[1,2,3] Patients are estimated to be receiving one-third to one-half of the current recommendation for protein delivery, 1.2–2.0 g/kg per day, which increases the risk of malnutrition.[1,2,4] Regrettably, international studies show an average delivery of 0.6 g/kg per day of protein during the first two weeks following admission
Based on the purpose of the study, non-participant observations were conducted to gain a better understanding of the practice environment and context related to the implementation of the national enteral nutritional practice guidelines for adults
The observed physical structure of the district hospital (DH) has a potential of providing a comprehensive assessment and rehabilitation of adult patients regarding home enteral nutrition (HEN) needs
Summary
Research has shown that ill patients, especially in the acute phase, suffer extensive catabolism with resultant malnutrition, which continues to be underdiagnosed and managed during the patient’s hospital stay.[1,2,3] Patients are estimated to be receiving one-third to one-half of the current recommendation for protein delivery, 1.2–2.0 g/kg per day, which increases the risk of malnutrition.[1,2,4] Regrettably, international studies show an average delivery of 0.6 g/kg per day of protein during the first two weeks following admission. Enteral nutritional (EN) therapy has proven effective in providing nutrients for individuals to nutritionally-at-risk ill patients who are unable to meet their nutritional requirements It is widely used in subacute, rehabilitation, long-term care and home settings.[6] When implemented appropriately, EN has improved clinical outcomes, reduced infection rates, number of hospital admissions and health care costs.[7,8,9] the development of percutaneous endoscopic http://www.phcfm.org. Despite the long-term consequences of malnutrition in hospitalised patients, nutritional practice guidelines for adults, in the recovery phase are rarely implemented in community based primary health care settings
Sign-in/Register to view highlights & summary 
Published Version (
Free)
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call