Which Physicians Are Best Prepared to Advise Seniors about Nutrition? A Pilot Survey in Israel

Physicians' knowledge and attitudes can profoundly impact the quality of nutritional care provided to older patients. We assessed physicians' knowledge and attitudes concerning nutritional care for older adults and its correlates. Questionnaires were mailed to 898 physicians in the second largest HMO in Israel: the response rate was 26.5%. Questionnaires assessed aspects of geriatric nutrition, such as food choices, functioning, and medical conditions. Results indicated highest knowledge of nutritional issues for family physicians and for those who were younger (<50 age) and female. Although 68% believed it is important for physicians to explain nutritional issues to older patients, this role was also deemed important for dietitians (83%) and nurses (59%). A variety of factors influencing geriatric nutrition, especially functional and medical conditions, were identified; likewise, nutrition was perceived as influencing various health conditions. Although the low response rate limits generalizability, it appears that physicians in this survey recognized the impact of proper nutrition health and take responsibility for explaining nutrition to their older patients.     

Validation of the General Nutrition Knowledge Questionnaire in an Australian community sample

Aim:  To validate the General Nutrition Knowledge Questionnaire developed by Parmenter and Wardle (1999) in an Australian community sample. This questionnaire differs from previous assessments of knowledge because it incorporates a broad range of nutrition concepts, including knowledge of dietary recommendations, healthy food choices, nutrient sources and some diet–disease relationships.
Methods:  The original questionnaire was developed in the UK, and thus modified to suit the current Dietary Guidelines for Australians and current public health nutrition recommendations. A total of 156 people, of which 116 were community members, completed the questionnaire (113 items). As an indication of concurrent validity, a subsample of nutrition and dietetic students were included (n = 40). As a measure of test–retest reliability, a subsample (n = 57), including students and community members, answered the questionnaire on two occasions, two weeks apart.
Results:  Both overall internal reliability of the questionnaire items (Cronbach's alpha = 0.92) and test–retest reliability (r = 0.87) were high. The nutrition and dietetic students, hypothesised to have higher knowledge levels, scored consistently higher than the general community sample, indicating good concurrent validity.
Conclusion:  A test of a modified version of the General Nutrition Knowledge Questionnaire found it to be a valid and reliable measure of nutrition knowledge, appropriate for use in a section of the Australian community. The validated tool may be used in the future for the comprehensive assessment of general nutrition knowledge; however, further testing in differing sections of Australian society may be warranted.     

Nutrition-related knowledge, beliefs and practices of Australian nursing staff

Objective: The purpose of the study was to examine the general food and nutrition‐related beliefs and knowledge of nursing professionals attending post‐partum women. Design: Data were collected by self‐administered questionnaire. Subjects: Three hundred and sixty‐two hospital‐based nursing staff responsible for the care of post‐parturient women. Setting: Eight metropolitan and regional hospitals in Queensland and three maternity hospitals in Canberra. Main outcome measures: Beliefs, opinions and intentions relating to food, nutrition and weight; knowledge of requirements of core foods; and sources of nutrition information. Statistical analysis: Standard statistical tests were used to measure frequencies and assess bivariate relationships. Results: Almost all participants (97.8%) were confident they could give good advice to their patients about a healthy balanced diet. The majority (65.5%) reported providing such advice at least weekly, 27.9% daily, and 19.5% rarely or never gave nutritional advice. The food‐related beliefs of most participants (>85%) were in line with current knowledge for 78% of questions. However, their knowledge of core food requirements for adults was inadequate; only 0.6% gave correct answers to all four food intake questions, 16.8% gave three correct answers, 62% two and 20.7% one correct answer. The most commonly cited sources of nutrition information were professional training (51.4%), reading (38.7%), media (14.9%), self‐education and work‐related experience (10.8%), dietitian (10.5%), school (7.5%), family (6.4%) and dieting (5.0%). Conclusion: Nursing staff frequently provide nutritional advice to post‐partum women. There is a need to ensure such information is accurate. Further research should explore ways in which this can be achieved.     

An evaluation of a community dietetics intervention on the management of malnutrition for healthcare professionals

Background: Healthcare professionals working in the community setting have limited knowledge of the evidence‐based management of malnutrition. The present study aimed to evaluate a community dietetics intervention, which included an education programme for healthcare professionals in conjunction with the introduction of a community dietetics service for patients ‘at risk’ of malnutrition. Changes in nutritional knowledge and the reported management of malnourished patients were investigated and the acceptability of the intervention was explored. Methods: An education programme, incorporating ‘Malnutrition Universal Screening Tool (MUST)’ training, was implemented in eight of 10 eligible primary care practices (14 general practitioners and nine practice nurses attended), in seven private nursing homes (20 staff nurses attended) and two health centres (53 community nurses attended) in conjunction with a community dietetics service for patients at risk of malnutrition. Nutritional knowledge was assessed before, immediately after, and 6 months after the intervention using self‐administered, multiple‐choice questionnaires. Reported changes in practice and the acceptability of the education programme were considered using self‐administered questionnaires 6 months after the intervention. Results: A significant increase in nutritional knowledge 6 months after the intervention was observed (P < 0.001). The management of malnutrition was reported to be improved, with 69% (38/55) of healthcare professionals reporting to weigh patients ‘more frequently’, whereas 80% (43/54) reported giving dietary advice to prevent or treat malnutrition. Eighty‐percent (44/55) of healthcare professionals stated that ‘MUST’ was an acceptable nutrition screening tool. Conclusion: An education programme supported by a community dietetics service for patients ‘at risk’ of malnutrition increased the nutritional knowledge and improved the reported management of malnourished patients in the community by healthcare professionals.     

Nurses’ knowledge and attitudes regarding nutrition in the elderly

Background-aims  Nurses in the community are in contact with the elderly at different levels of care. The aim of this study was to assess nurses’ knowledge and attitudes regarding nutritional-care for the elderly, and the impact of their attitude on the quality of assessment-care they provide to this growing population in need of nutritional-care. Methods  A structured questionnaire was distributed by mail to 600 nurses working in Maccabi-Health-Care-Services (MHS). The questionnaire assessed different aspects of elderly nutrition. Results  The vast majority (91%) of the participants reported treating elderly in their practice. Religious nurses and the nurses with an individual orientation specialty reported more positive attitudes about nutritional-care for the elderly than others did (p=0.05). Nurses with a bachelor’s degree had better attitudes than registered nurses about the importance of nutrition for the elderly (p< 0.01). Younger nurses were found to be more knowledgeable than older ones (p< 0.04). The nurses perceived nutrition as influencing different health conditions, and 85% pointed to the importance of feeding at the end of life. Conclusions  Nurses working in the community recognize the impact of proper nutrition on elderly patients’ health, but need more training in screening for nutritional problems in the elderly.     

Health providers' knowledge on transfusion-transmitted viral hepatitis

OBJECTIVE: Training health providers is a strategy for improving health care quality that need to be technically correct and comply with the conceptual universe of the trainees. A pilot study was carried out to explore the consistency of knowledge on blood transmission of viral hepatitis among primary care providers. METHODS: A non-identified questionnaire was applied to 190 providers attending a public health training program in 2003 and 2004. Answers were compared according to two groups: physicians, nurses and dentists (115 subjects) and other health providers (66 subjects). Frequencies of correct and incorrect answers were compared through Chi-square test (chi2). Nine respondents did not inform their occupation. RESULTS: The study population mainly comprised women (80%) aged 20 to 60 years from Northeastern (27.4%), Southeastern (35.3%), and Midwestern (37.3%) regions. Blood transfusion was associated with hepatitis B and C for 57.5% of the respondents; hemophilia was associated with hepatitis B and C for 55.7% of the respondents, while 74% considered to be incorrect the statement: "viral hepatitis cannot be transmitted through blood" and 16.4% considered it correct. The number of correct answers regarding blood transfusion was greater in the group of physicians, nurses and dentists than other providers (chi2=1.2; p=0.2741). CONCLUSIONS: These findings were compared with current data on viral hepatitis transmission and the consistency of the answers concerning different risk factors was evaluated. These providers' knowledge on blood transmission of these conditions shows inconsistencies that may jeopardize the effectiveness of prevention and control programs.     

Sustained benefits of a community dietetics intervention designed to improve oral nutritional supplement prescribing practices

Background: Healthcare professionals working in the community do not always prescribe oral nutritional supplements (ONS) according to best practice guidelines for the management of malnutrition. The present study aimed to determine the impact of a community dietetics intervention on ONS prescribing practices and expenditure 1 year later. Methods: The intervention involved general practitioners (GPs), practice nurses, nurses in local nursing homes and community nurses. It comprised an education programme together with the provision of a new community dietetics service. Changes in health care professionals’ nutrition care practices were determined by examining community dietetics records. ONS prescribing volume and expenditure on ONS were assessed using data from the Primary Care Reimbursement Service of the Irish Health Service Executive. Results: Seven out of 10 principal GPs participated in the nutrition education programme. One year later, screening for malnutrition risk was better, dietary advice was provided more often, referral to the community dietetics service improved and ONS were prescribed for a greater proportion of patients at ‘high risk’ of malnutrition than before (88% versus 37%; P < 0.001). There was a trend towards fewer patients being prescribed ONS (18% reduction; P = 0.074) and there was no significant change in expenditure on ONS by participating GPs (3% reduction; P = 0.499), despite a 28% increase nationally by GPs on ONS. Conclusions: The community dietetics intervention improved ONS prescribing practices by GPs and nurses, in accordance with best practice guidelines, without increasing expenditure on ONS during the year after intervention.     

Evaluating rural nurses for preparation in implementing nutrition interventions.

With the increase in wellness programs, earlier hospital discharges, higher health care costs, and more home health care, rural nurses are required to generalize their practices and draw from a more extensive knowledge base. The purpose of this study was to examine nursing interventions, specifically nutrition education practices, based on nutrition knowledge that is used in health promotion. A stratified random sample of rural nurses from hospitals, nursing homes, and community health agencies in North Dakota was invited to participate in this study. Data were obtained via questionnaires. The questionnaire consisted of two parts: the first analyzing demographic data and the second analyzing nutrition knowledge. Nutrition information requests were received by 90.9 percent of the practicing registered nurses. The community/public health nurses had the highest nutrition knowledge scores while medical-surgical hospital nurses had the lowest nutrition knowledge scores. With nutrition information and education being a frequently sought intervention by the rural health client, it would seem that registered nurses should be highly prepared and knowledgeable to meet these clients' needs.     

Development of a screening tool for assessing risk of undernutrition in patients in the community

Background: This study was undertaken to develop a simple tool for assessing risk of undernutrition for use by the primary health care team.
Methods: We devised a list of 25 questions that might be predictive of nutritional risk. Community nurses administered the questions, which required only yes/no answers, to 507 patients in their care. Within 4 days a dietitian carried out a full nutritional assessment. Discriminant analysis was used to determine which questions were predictive of nutritional risk as assessed by a dietitian. Multiple regression analysis was used to derive a simple equation to assign weightings to those questions.
Results: Five hundred and seven patients completed the study. Nine questions were found to be associated with nutritional risk as assessed by a dietitian. The final tool, which has three categories of scores: 0–6=not at risk; 7–16=possible/probable risk; 517=malnourished, has a positive predictive value of 94.6% and a negative predictive value of 81.1%.
Conclusion: This simple tool can be used to assess risk of undernutrition in patients in primary care, to increase awareness of the importance of nutrition in patients in the community and to ensure that patients are given appropriate dietary advice and/or referred to a dietitian.     

A quality improvement nutrition screening and intervention program available to Home and Community Care eligible clients

Objective:  To develop and implement a nutrition screening and dietetic referral system for Home and Community Care (HACC) eligible clients.
Design:  Quality improvement project utilising a prospective, observational design.
Setting:  Sixteen Australian organisations caring for HACC eligible clients.
Subjects:  One thousand one hundred and forty-five HACC eligible clients (mean age 76.5 ± 7.2 years) were screened for nutritional risk during 2003–2005.
Interventions:  Nutrition screening was conducted by trained project officers, allied health staff, community care coordinators and nursing staff using a modified version of the malnutrition screening tool (MST). Dietitians performed a nutrition assessment using the scored Patient Generated-Subjective Global Assessment (PG-SGA) and provided individualised nutrition counselling for those identified to be at risk of malnutrition and agreeing to treatment.
Results:  According to the MST, 170 clients (15%) were identified as being at risk of malnutrition. Of these, 75 (44%) agreed to the dietetic referral and PG-SGA assessment, and 57 were subsequently assessed as malnourished (PG-SGA category B or C), suggesting a malnutrition prevalence between 5% and 11%. Of the 34 malnourished clients receiving multiple dietetic reviews (mean 4.1 ± 2.0 per client), 28 improved, with 17 achieving a well-nourished PG-SGA A rating.
Conclusion:  The development and implementation of a nutrition screening and referral system can identify HACC eligible clients who would benefit from services provided by a dietitian. Further research should identify the reasons why some HACC eligible clients are reluctant to be referred to a dietitian.     

Establishing an innovative model of nutrition and dietetic care for a mental health service through collaboration with non-nutrition healthcare workers

Aim:  To describe the process of the development of the Web-based resources to extend nutrition care to mental health patients through existing non-nutrition mental healthcare professionals (case-managers).
Methods:  A formative approach was used to identify nutrition-related issues faced by both patients and staff through a synthesis of literature review, professional experience and clinical observations. Decision-making tools to assist case-managers in selecting resources were developed to guide case-managers' choice of effective evidence-based health education materials on the hospital intranet. Practical training was provided for case-managers during their orientation to the new website and the tools and resources it housed.
Results:  A Web-based nutrition site was created on the Royal Brisbane and Women's Hospital intranet. The website consisted of a Nutrition Referral Action Plan (a patient support triaging flowchart), a Nutrition Support Action Plan (action-based nutrition support tool to guide resource selection) and thirteen action-based nutrition education resources.
Conclusion:  By maximising established patient contact through existing health professionals, a Web-based approach to nutrition service delivery was an innovative method for delivering patient information. This collaborative action-based strategy has the potential to raise the nutrition profile in mental health and extend nutrition services to at-risk patients not previously receiving nutrition care.     

Recognition by medical and nursing professionals of malnutrition and risk of malnutrition in elderly hospitalised patients

Objective:  To determine the prevalence of malnutrition in a population of elderly hospitalised patients and to explore health professionals' perceptions and awareness of signs and risks of malnutrition and treatment options available.
Subjects and design:  One hundred elderly patients and 57 health professionals from medical wards of a tertiary teaching hospital. Quantitative and qualitative study design using a validated malnutrition assessment tool (Mini Nutritional Assessment) and researcher-designed questionnaire to assess health professionals' knowledge of nutrition risk factors.
Main outcome measures:  Mini Nutritional Assessment score, nutrition risk category and themes in health professionals' knowledge and awareness of malnutrition and its risk factors.
Results:  Thirty per cent of patients were identified as malnourished while 61% were at risk of malnutrition. Documentation by health professionals of two major risk factors for malnutrition—recent loss of weight and appetite—were poor with only 19% and 53% of patients with actual loss of weight or appetite, respectively, identified by staff and only 7% and 9% of these patients, respectively, referred for dietetic assessment. While health professionals' knowledge of important medical risk factors for malnutrition was good, their knowledge of malnutrition risk factors such as recent loss of weight and loss of appetite was poor. Medical staff focused on biochemical factors when assessing nutrition status, while nursing staff focused on skin integrity and turgor.
Conclusion:  Malnutrition in elderly hospitalised patients remains a significant problem with low rates of recognition and referral by medical and nursing staff. Considerable scope exists to develop training and education tools and to implement an appropriate nutrition screening policy to improve referral rates to dietitians.     

Evaluation of practices and knowledge among primary health care professionals in relation to child development surveillance

In the present study, the practices and knowledge of 40 physicians and 40 nurses from municipal health care units (UMS) and 40 physicians and 40 nurses from the Family Health Program (FHP) in Belém, Pará State, Brazil, all of whom working in primary health care, were evaluated in relation to child development surveillance. Measures of knowledge of child development showed an average of 63.7% correct answers for UMS physicians, 57.3% for FHP physicians, 62.1% for FHP nurses, and 54.3% for UMS nurses. Only 21.8% of mothers attending appointments mentioned that the health care professional had asked about their children s development, 27.6% of mothers reported that the health care professional had asked about or observed the child s development, and 14.4% mothers reported having received instructions on how to stimulate their children s development. According to this study, primary health care physicians and nurses in the municipality of Belém showed gaps in their knowledge of child development. Child development surveillance is not being conducted satisfactorily in primary health care in the municipality of Belém. It is thus necessary to raise the awareness of health care professionals concerning the problem and provide them with appropriate training.     

Contribution of Australian cardiologists, general practitioners and dietitians to adult cardiac patients' dietary behavioural change

Aim:  To investigate the use of behavioural change techniques by cardiologists, general practitioners and dietitians in adult cardiac patients within 12 months of their cardiac event.
Method:  Quantitative cross-sectional surveys. Frequency analyses were conducted on the respondents' answers to questionnaire items. Chi-squared test of independence compared responses of the three professional groups on the questionnaire items. Analyses of variance were conducted to explore the impact of the independent variables: age, sex and time worked on the behavioural change techniques used by the respondents.
Results:  The respondents included 248 general practitioners (30% response), 189 cardiologists (47% response) and 180 dietitians (60% response). General practitioners and cardiologists acted mainly as advocates for dietary change in the dietary management process. Dietitians provided nutrition knowledge and a range of techniques to assist dietary behavioural change. Cardiologists and dietitians shared little nutrition information with general practitioners (cardiologists with general practitioners = 8%, dietitians with general practitioners = 49%).
Conclusion:  The present study shows that cardiac patients may have insufficient access to knowledge of nutrition and techniques to assist them with dietary behavioural change.     

Comparison of nutrition knowledge among health professionals,patients with eating disorders and the general population

Aim: To investigate and compare the level of nutrition knowledge of health professionals, patients with eating disorders and individuals without an eating disorder as controls. Methods: Participants were recruited online through an Australian and New Zealand professional eating disorder organisation and community eating disorder organisations and a university in Australia. Assessment was conducted online using the General Nutrition Knowledge Questionnaire and SCOFF. Demographic data were also collected. Results: Dietitians had greater nutrition knowledge than all other health professionals, except medical doctors. Psychologists and dietitians had similar knowledge for choosing everyday foods. Dietitians had greater nutrition knowledge than eating disorder patients and controls in all areas of nutrition knowledge, while other health professionals had similar knowledge to patients. Patients with eating disorders had greater knowledge of sources of nutrients than controls. Conclusions: Australian health professionals exhibited higher levels of nutrition knowledge than health professionals in previous studies in other countries. However, non‐dietitian health professionals had similar levels of knowledge to individuals with eating disorders. Training and continuing education in nutrition is needed so health professionals can confidently identify when a patient has misleading information about nutrition and either correct the misinformation or refer the patient on to a qualified dietitian.     

Sportsmen’s Attitude towards Dietary Supplements and Nutrition Knowledge: An Investigation in Selected Roman Area Gyms

The non-professional sport environment is a grey zone not as widely assessed as that of elite athletes. The purpose of this research was to investigate the dietary supplementation habits and the nutrition knowledge on sport (NKS) in a sample of gym users. The level of adequacy of NKS was set at ≥60% of correct answers. Almost half (46.4%) of respondents stated they used food supplements, in particular multivitamins (31.0%), amino acid pills (29.5%), minerals (29.1%), and protein powders (28.7%). Supplements were used to increase muscle mass (36.9%) and to repair muscle (35.1%). Gym trainers were the preferred source of information on the use of supplements, especially in males (84%). The NKS correct response rate was 57.1% and the proportion of respondents with a sufficient level of NKS was 47.3%. The prevalence of correct answers was highest in males (61.5%) and for respondents with the highest educational attainment levels (44.5% and 53%). This study demonstrated that non-professional sportsmen do not have sufficient knowledge of nutrition and that the gym environment does not facilitate the circulation of the correct information on the role of supplementation. Considering the importance of nutrition for sportsmen, it is necessary to put in place actions aimed at increasing the knowledge of nutrition of gym users and their trainers.     

Good food in family day care: Improving nutrition and food safety in family day care

Aim:  To determine the effectiveness of a nutrition and food safety intervention in family day care schemes.
Methods:  Staff and carers from seven Sydney family day care schemes completed a nutrition and food safety knowledge questionnaire and diet history about food and drinks offered to children in care before and after attending workshops and receiving advice and resources. Participating schemes' nutrition and food safety policies were assessed before and after intervention. At baseline, 18 staff members and 104 carers were interviewed. Diet histories were collected for 20 infants and 103 one-to-five-year olds. Post intervention, 21 staff and 102 carers were interviewed and diet histories collected for 22 infants and 102 one-to-five-year olds. Baseline and post-intervention data were compared using the χ²-test for categorical data (or the Fisher's exact test when expected values were below five), and t -tests for independent samples for normally distributed means.
Results:  Nutrition and food safety knowledge and the number (from one to seven) and quality of appropriate policies improved post intervention. Changes in mean per cent nutrition scores for infants (78.2% to 83.4%) and for one-to-five-year olds (68.8% to 75.2%; P  < 0.01) indicated improvements in nutritional quality of food and drinks offered during care.
Conclusion:  Health promotion strategies can improve food and drinks offered in family day care and make a sustainable contribution to children's access to safe and nutritious food.     

Nurses' knowledge of current guidelines for infant feeding and weaning

Background Poor infant feeding practices are common causes of nonorganic failure to thrive and may exacerbate the effects of many chronic conditions. It is important therefore that parents receive correct and consistent feeding advice from health professionals. The aim of this study was to determine whether hospital paediatric nursing staff are familiar with the recommendations of the Department of Health (DOH) Weaning Report ( DOH, 1994 ). Methods A total of 127 members of nursing staff (79%) at Derbyshire Children's Hospital were interviewed. Knowledge of recommended practices for the introduction and use of cow's milk, gluten, milk products, mashed foods, vitamin supplements and drinks was assessed. Results Overall, 42 people (33%) answered all questions correctly. In each clinical area, six outpatient (64%), 19 special care baby unit (61%) and 17 ward (20%) staff provided correct answers to all questions. No significant difference was found between staff at each grade in the number of questions answered correctly. Conclusions Knowledge of national infant feeding and weaning guidelines was limited suggesting that DOH recommendations are not widely understood or recognized. Further nutrition education and local dissemination of information is required if nurses are to continue to advise parents on aspects of infant feeding.