Unintentional weight loss in older adults : nutrition-related knowledge, perceptions and practices of nursing staff working in long-term care facilities in the Cape Metropole

De Haas, Johanna Cornelia (2016-03)

Thesis (MNutr)--Stellenbosch University, 2016.

Thesis

ENGLISH SUMMARY : Introduction: Unintentional weight loss (UWL) is common in older adults, with a 50-60% prevalence in long-term care facilities (LTCFs). UWL negatively impacts on quality of life and leads to increased morbidity, increased mortality and higher cost of care. Nursing staff are the primary care providers for older adults in LTCFs and key in the early identification and management of UWL. Objectives: The study aims to determine the knowledge, perceptions and practices of nursing staff regarding the identification and management of UWL in older adults residing in LTCFs in the Cape Metropole. Data from different categories of nursing staff and facilities types were compared, and barriers to managing UWL were identified. Methods: A cross-sectional, descriptive study design with an analytical component was used and simple random sampling applied to select LTCFs in the Cape Metropole. A self-administered questionnaire was designed and pilot tested as a research instrument to investigate the knowledge, practices and perceptions of nursing staff with regards to the study objectives. An interviewer-administered facility questionnaire was completed with management staff of facilities to obtain background information and for cross-control purposes. Results: Nursing staff (N=108) from eight subsidised and seven non-subsidised LTCFs (n=60 and n=48 staff respectively) consented to participate and included professional nurses (n=27), staff nurses (n=20), nursing auxiliaries (n=27) and caregivers (n=34). Nursing staff obtained a mean knowledge score of 62%. Even though sub-categories of nursing staff with higher qualifications levels scored statistically significantly better (p=<0.001), all nursing staff categories had insufficient knowledge (38%) regarding weight loss. Most nursing staff (73.2-100%) had positive perceptions regarding the identification and management of UWL, although almost half had misperceptions that malnutrition is uncommon in institutionalised older adults (45.8%) and that it is normal for older adults to have a poor appetite (45.4%). Poor practices that do not support the identification and management of UWL were identified. Half of participants reported that residents had limited choices with regards to meals and that plate waste was reported only once more than ½ or ¾ of a meal was not consumed. Although 87% of participants indicated that residents were weighed, it was only done regularly by 60.6% of those nursing staff and only 22.2% could correctly identify a significant weight loss. Nutrition screening and assessment tools were rarely used (3.8-16.8%). There was no statistically significant difference between knowledge scores of nursing staff working at different facility types and only a significant difference (p<0.05) in a minority of perception statements among the different categories of nursing staff, and nursing staff working at different facility types. Conclusion: Overall, nursing staff had positive perceptions regarding UWL, but many did not show sufficient knowledge, nor did facilities apply necessary procedures to support best practices for the effective identification and management of UWL in older adults residing in LTCFs in the Cape Metropole. Nursing staff must be empowered through continuous education and supported with applied standard procedures to enable early identification and addressing of UWL and malnutrition in older adults residing in LTCFs.

AFRIKAANSE OPSOMMING : Inleiding: Onbeplande gewigsverlies (OGV) is algemeen by ouer volwassenes, met ʼn voorkoms van 50-60% in langtermyn versorgingseenhede (LVEe). OGV het ʼn negatiewe impak op lewenskwaliteit en lei tot verhoogde morbiditeit, verhoogde mortaliteit en hoër versorgings-onkostes. Verpleegpersoneel is die primêre versorgers van ouer volwassenes in LVEe en onmisbaar in vroeë identifisering en bestuur van OGV. Doelwitte: Die studie poog om kennis, persepsies en praktyke van verpleegpersoneel te bepaal rondom die identifisering en bestuur van OGV in ouer volwassenes wat in LVEe in die Kaapse Metropool tuisgaan. Data van die verskillende kategorieë verpleegpersoneel en eenheidstipes is vergelyk, en hindernisse om OGV te bestuur is geïdentifiseer. Metode: ʼn Dwarssnit, beskrywende studie-ontwerp met ‘n analitiese komponent is gebruik en eenvoudige ewekansige steekproefneming is toegepas om LVEe in die Kaapse Metropool te selekteer. ʼn Self-geadministreerde vraelys is ontwerp en in ʼn loodsstudie as navorsinginstrument getoets om verpleegpersoneel se kennis, praktyke en persepsies met betrekking tot die studie-doelwitte te bepaal. ʼn Onderhoudvoerder-geadministreerde versorgingseenheidvraelys is saam met bestuurspersoneel van LVEe voltooi vir die verkryging van agtergrondinligting en vir kruiskontrole. Resultate: Verpleegpersoneel (N=108) van agt gesubsidieerde en sewe ongesubsidieerde LVEe (n=60 en n=48 personeel onderskeidelik) het ingestem tot deelname en het professionele verpleegkundiges (n=27), stafverpleegsters (n=20), verpleegassistente (n=27) en versorgers (n=34) ingesluit. Verpleegpersoneel het ʼn gemiddelde punt van 62% vir hul kennis behaal. Alhoewel sub-kategorieë van verpleegpersoneel met hoër kwalifikasievlakke statisties betekenisvol beter punte (p=<0.001) behaal het, het alle verpleegpersoneel-kategorieë onvoldoende kennis aangaande gewigsverlies (38%) gehad. Die meeste verpleegpersoneel (73.2-100%) het positiewe persepsies ten opsigte van die identifisering en bestuur van OGV gehad, hoewel bykans die helfte die wanpersepsie gehad het dat wanvoeding ongewoon is in geïnstitusionaliseerde ouer volwassenes (45.8%) en dat dit normaal is dat ouer volwassenes ʼn swak aptyt het (45.4%). Swak praktyke wat nie die identifisering en bestuur van OVG ondersteun nie, is geïdentifiseer. Die helfte van deelnemers het gerapporteer dat inwoners beperkte keuses het ten opsigte van maaltye en dat bordkwisting eers gerapporteer word indien meer as die ½ of ¾ van ʼn maaltyd nie ingeneem word nie. Alhoewel 87% van deelnemers aangedui het dat inwoners geweeg word, is dit net deur 60.6% van hierdie verpleegpersoneel gereeld gedoen en slegs 22.2% kon ‘n betekenisvolle gewigsverlies korrek identifiseer. Voedingsifting- en assesseringsinstrumente is selde gebruik (3.8-16.8%). Daar was geen statisties betekenisvolle verskil tussen die kennis puntetelling van verpleegpersoneel wat werksaam was by verskillende versorgingseenheidstipes nie. ʼn Betekenisvolle verskil (p<0.05) is tussen enkele persepsies onder die verskillende kategorieë van verpleegpersoneel, en verpleegpersoneel werksaam by onderskeie tipes versorgingseenhede gevind. Samevatting Verpleegpersoneel het oor die algemeen positiewe persepsies getoon ten opsigte van OGV, maar baie het onvoldoende kennis gehad. Boonop het versorgingseenhede nie die nodige prosedures toegepas om die beste praktyke vir die effektiewe identifisering en bestuur van OGV in ouer volwassenes, wat in LVEe in die Kaapse Metropool woon, te ondersteun nie. Verpleegpersoneel moet deur voortgesette onderrig bemagtig en deur die toegepassing van standaardprosedures ondersteun word, om dit moontlik te maak om OGV vroegtydig te identifiseer, en sodoende wanvoeding in ouer volwassenes woonagtig in LVEe aan te spreek.

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