‘The transit of the food trolley’– malnutrition in older people and nurses’ perception of the problem

Scand J Caring Sci; 2013; 27; 440–448 ‘The transit of the food trolley’– malnutrition in older people and nurses’ perception of the problem Aims: To investigate how the issue of malnutrition in institutionalised older people is perceived by nurses in a Teaching Hospital in Italy and how some aspects that can prevent malnutrition are dealt with. Background: Malnutrition in institutionalised older people is still a significant and unresolved problem. Many studies have been published on the inadequacy of nutritional care. Nurses play a strategic and key role in the prevention of malnutrition. Knowing how nurses perceive the problem of malnutrition and how they deal with aspects that can prevent malnutrition can be an important starting point for implementing strategies that will improve overall nutritional care. Methods: A Focus Group (FGs) study was conducted in a Teaching Hospital in the north‐west of Italy with 33 nurses, who were still working or had worked with older people. The FGs were audio‐taped and transcribed verbatim. Data collection was stopped when we achieved saturation. Two researchers independently analysed the transcription for content analysis and negotiated the emerging categories. Results: Although nurses perceived malnutrition as a significant issue, it was often considered of secondary importance compared with other aspects of care. Food choice, although available, is often limited to very few options, diets are standardised and monotonous and patients must choose ‘sight unseen’. Time constraints and understaffing were the obstacles for the identification of the need for nutritional care. Organisational and managerial decision‐making did not ensure the provision of high‐quality nutritional care. Patients’ nutritional status was often not assessed, and tools such as the Mini Nutritional Assessment were not mentioned by the participants. Conclusion: Our study substantially confirmed what is reported in the literature. However, it is necessary to raise nurses’ awareness around poor nutritional care to prevent malnutrition in institutionalised older people.