Malnutrition in Older Hospitalised Patients Essay

Malnutrition has significantly increased in the ageing population resulting in a major health problem in the United Kingdom and is a cause and consequence of ill health. This essay will seek to critique three research papers based on Malnutrition in older hospitalised patient. It will include evaluation of strengths, limitations of the research and a reflection on how the researched was undertaken.Malnutrition in Older Hospitalised Patients Essay

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Evidence has shown that malnutrition cost the National Health Service around thirteen billons a year resulting in one of the highest spend in health care (British Association for Parenteral and Enteral Nutrition, 2009).Dunne (2009) also states that one in five people ranging from 65 and over will be affected by malnutrition by the year 2020. Malnutrition is therefore “a state in which a deficiency of nutrients such as energy, protein, vitamins, and mineral causes measurable adverse effects on body composition function or clinical outcome” (National Institute for health and Clinical Excellence, 2006). In light of the information above, this had stimulated an interest to conduct a research to analyse what is being done and what can be done to reduce the prevalence of malnutrition in older patient.Malnutrition in Older Hospitalised Patients Essay

Whilst out in placement, I witness nutrition fell low on the list of nursing priorities of care, not by choice but nurses have so many tasks to complete in a given day. I observe both nurses and health care assistant struggled to cope during meal times and expressed their frustration on the subject on few occasion. Also looking at it from a professional stand point, malnutrition can affect every system in the body leading patients to become vulnerable to illness. This can lead to complication and in the worst case death, it also increases patient’s length of stay in hospital and readmission of patients to hospital. It is vital that information that is used to address malnutrition is extracted from evidence based sources as this aims to provide care in a suitable and efficient way to patient (Craig & Smyth, 2007).Malnutrition in Older Hospitalised Patients Essay

I used critical appraisal skills programme to analyse my research paper as this model helped me to ascertain the relevance and importance a particular research topic relates to practice as well as conduct a systematic review of the article .It assess whether the three research paper was worth reading and helped me to make sense of the qualitative information (Cutcliffe & Ward, 2007).Malnutrition in Older Hospitalised Patients Essay

I obtained my three research paper by using search engine such as CINAHL, INTERNURSE and PUBMED. I searched CINAHL (2007 to 2013), INTERNURSE (2005 to 2013) and PUBMED (2007 to 2013) for articles published in English. The search strategy will be explained in details in the reflection section part of the essay and will be demonstrated in Table 1 and Table 2. Table three comprises of the three research which can be found in the appendix. Reflection is seen as an important aspect of nursing, as it improves the quality of care we give to patient as well as it can enhance practice and greater competence. Ghaye, Gillespie and Lillyman (2000) point out that, reflection is a central part of experiential learning and the improvement of practical knowledge. I have chosen to use Rolfe et al model over John’s model because it gave me a better understanding in comparison with John model. It consists of three simple questions which are what, so what and now what. This helped me to organise my thought process. In the next sections of the essay two tables will be shown to depict my search strategy along with the critical appraisal of the three research paper.Malnutrition in Older Hospitalised Patients Essay

SEARCH STRATEGY

Table 1. Inclusion and exclusion criteria

Inclusion

Exclusion

Boolean operator

Peer Reviewed

Time period (2007 – 2013)

Table 2. Identifying and selecting relevant articles

Database used

Keywords / Search

terms used

Hits

Boolean

Operators

Advanced search

Titles read

Abstracts read

Studies read

Studies of relevance

Cinahl

malnutrition, hospital, food , nutrition , patient

6461

And

11

11

11

Internurse

Malnutrition , Nutrition, patient , hospital, food

1

And

PubMed

Malnutrition

112389

10

10

10

The first research paper was written by Angela Dickinson, Carol Welch, Laurie Ager, entitled No longer hungry in hospital: Improving the hospital mealtime experience for older people through action research, published in the year 2007. The title reflected the content of the research and was clear, specific and concise. It seeks to draw the reader attention to the exact area of study conducted. Marshall (2005) states that a research article should accurately and succinctly reflect the content of the work allowing the reader to be stimulated by the content. This is important as a title that is long and ambiguous can lead to misunderstanding and somewhat misleading.Malnutrition in Older Hospitalised Patients Essay

The abstract was excellent, in that it was succinct, containing no jargon and clearly written in a coherent manner that gave a satisfactory overview of the study. It was able to stand on its own as it includes brief summary of the Aims and objectives of the research, the background surrounding the study, the methods used, results collated, the conclusion and the relevance to clinical practice. Paratoo, (2006) points out that the information provided in an abstracts should aids readers to decide whether to obtain the entire article or not.

Although evidence shown that ethical approval was granted, no mention of consent of the subjects taken part in the research as in accordance with the Nursing and midwifery council code of professional conduct (2008) which states that consent should be obtained before undertaking any task. Also the authors stipulated that they were unaware of other studies available that addresses meal time care in the way they have carried out the research. A more thorough search could have been conducted to rule out this assumption as this research paper might just be adding to knowledge and understanding already available or it could have been compared and contrasted to better understand the issue or to establish new truths Malnutrition in Older Hospitalised Patients Essay

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The second research paper was written by Heaven, B, Bamford, C, May, C and Moynihan P entitled Food work and feeding assistance on hospital ward and published in the year 2012. The Authors gave a timely overview into the prevalence of malnutrition in the introduction extracted from reputable sources and demonstrate a good critiquing ability by identifying a gap in a previous related study of which they concluded that little is recounted on the practicalities of the provision of food in hospital and how feeding assistance is seen alongside other nursing priorities which lead them to justified their rationale for undertaking the research. Wigen (2003) states that an introduction should illuminate the rational for the research and highlight any previous research that was conducted on the similar topic.Malnutrition in Older Hospitalised Patients Essay

The Authors used a qualitative paradigm research that made it straight forward to follow and was applicable for the intended research. Methods such as interview and focus group was utilised to investigate malnutrition in older hospitalised patient. They provide evidences illustrating that interviews, allowed them to get close to their subject to glean information and to clarify questions that were not fully understand. The focus group they find helped them create an atmosphere where discussion and brain storming can occur to establish the problems surrounding malnutrition in older hospitalised patient and finding measures that can help to resolve the problem. Ellis (2010) suggests that the relationship between the researcher and the researched is part of the research process and is essential to gain the insider perspective that qualitative research seeks to pursue. In addition qualitative research is more suited for nursing as it can focus more on the care a patient receive as well as their experiences (Jolley , 2010).Malnutrition in Older Hospitalised Patients Essay

Malnutrition costs the UK health economy £19bn a year and affects one in four people admitted to care settings (Elia, 2015). It is most prevalent in the community but nutritional status often deteriorates when patients are admitted to hospital because of acute injury or illness that can impair swallowing, appetite and gastric absorption. When patients are unwell and do not feel like eating it can be a challenge to help them meet their nutritional needs.Malnutrition in Older Hospitalised Patients Essay

Patients with malnutrition will have a deficit of vitamins, protein, minerals and energy and this will have an adverse effect on the body. Complications associated with malnutrition include poor wound healing, skin breakdown, increased risk of sepsis and hospital-acquired infections, such as chest and urinary tract infections (Elia and Russell, 2009). Provision of adequate nutrition and hydration is a hallmark of good, compassionate care but remains neglected in many areas of healthcare (Leach et al, 2013).Malnutrition in Older Hospitalised Patients Essay

The Hospital Food Standards Panel report (Department of Health, 2014) recommends that all NHS hospitals adhere to and be compliant with the Ten Key Characteristics of Good Nutritional Care (Council of Europe, 2003); this includes ensuring an environment that is conducive to patients being able to enjoy their meals uninterrupted. Good nutrition and hydration is part of the Care Quality Commission’s Fundamental Standards (CQC, 2015) and all care settings are expected to demonstrate how they put nutrition and hydration at the heart of patient care.Malnutrition in Older Hospitalised Patients Essay

Delirium in older patients is often misdiagnosed by nurses and doctors because the signs and symptoms of delirium are similar to dementia. Although a hyperactive part of delirium is easier to identify than a hypoactive part, older patients are often left untreated due to lack of the ability to identify delirium and distinguish it from dementia. It is Registered Psychiatric Nurses’ (RPNs) responsibility to notify any abnormal signs and symptoms to a physician so that older patients can receive appropriate care. RPNs can identify risks and prevent hospitalized older patients from injuring themselves while they are experiencing delirium. Fracturing of major bones from a fall is usually the result of undiagnosed delirium. When RPNs recognize these signs and symptoms, hospitalized older patients can be protected from many complications. Understanding the consequences of delirium can assist RPNs in making the right decisions for their older patients. Assessment tools to detect delirium in hospitalized older patients with dementia are suggested in this paper. Physical and chemical restraints are the ethical issues that challenge many RPNs because they must consider the Registered Psychiatric Nurses of Canada (RPNC) Code of Ethics, as well as the Standards of Psychiatric Nursing Practice. A delirium room is introduced as a solution to this ethical dilemma that RPNs are confronting. The nursing process is the guide that RPNs follow when they are considering the interventions for their older patients with dementia who are experiencing delirium. When RPNs minimize the potential risks and/or negative outcomes of delirium, the older patients’ dignity is preserved as well as their overall health and well-being.Malnutrition in Older Hospitalised Patients Essay
Delirium in Hospitalized Older Patients with Dementia
There are many diseases that a nurse or doctor cannot diagnose due to lack of an ability to identify signs and symptoms of certain diseases. Delirium is one of them. Delirium is often misdiagnosed and mistreated, especially in hospitalized older patients with dementia. When Registered Psychiatric Nurses (RPNs) cannot recognize delirium, these patients do not receive the proper interventions that they need. In order to treat and prevent the severity of delirium, it is vital for RPNs to be able to distinguish delirium and its’ signs and symptoms. Understanding the contributing risk factors and future consequences, and applying nursing implications according to the Registered Psychiatric Nurses’ Code of Ethics and their standards of practice is crucial when treating patients.Malnutrition in Older Hospitalised Patients Essay

RPNs must have knowledge about delirium so that they can treat their older patients appropriately. Delirium is defined as “an acute but temporary state of fluctuation levels of consciousness and pervasive impairment in mental, behavioural, and emotional functioning” (Balas et al, 2012, p. 15). The onset of delirium occurs suddenly and lasts for hours to days. According to Fick & Mion (2007), “[d]elirium is difficult to assess in older adults with dementia and in hospitalized older adults due to overlapping features of delirium and dementia and the uncertainty of the patient’s baseline mental status” (p. 1). The hyperactive symptoms of delirium such as “agitated, restlessness, and paranoid, and often suffer from delusions and hallucinations” (Phillips, 2013, p. 9) can be similar to the signs and symptoms of dementia. Furthermore, hypoactive symptoms of delirium, such as lethargy and decreased level of consciousness, can be overlooked by nurses and doctors. Because these older patients are lying in bed quietly, many nurses fail to recognize this type of delirium (Balas et al, 2012). Fick & Mion (2007) inform that “lethargy or hypo-alertness in NOT NORMAL in older adults with dementia” (p. 2). These patients must receive treatment for this type of delirium. According to Phillips (2012), Confusion Assessment Method (CAM) is an effective tool for RPNs to use because this tool provides accuracy in identifying delirium in older patients with dementia. CAM helps RPNs to determine the four clinical phases which are “acute onset and wavering course, inattention, disorganized thinking, and altered level of consciousness” (Phillips, 2012, p. 10). RPNs must be trained in order to use this tool effectively. In addition, RPNs must investigate the causes of delirium in order to prevent negative outcomes. Phillips (2012) informs that surgical intervention, infection, electrolyte imbalance, dehydration, malnutrition, acute illness or trauma, polypharmacy, and advanced age are the contributing risk factors that lead to manifestations of delirium in hospitalized older patients. It is important for RPNs to recognize these signs and symptoms of delirium in order for these patients to receive safe and appropriate treatment.Malnutrition in Older Hospitalised Patients Essay

The consequences of delirium are unpleasant for those older adults who have experienced and recovered from it. They do not fully return to their normal psychological and physiological state. The uncontrollable behaviours such as calling out, climbing out of bed, pulling off intravenous tubing line, and striking out to caregivers, place these older patients at risk for multiple injuries. Falling and breaking major bones lead to a delay in the healing process because nurses have failed to recognize and prevent these risks. Moreover, “[l]onger stays, higher costs, increased mortality, greater use of continuous sedation, and physical restraints, increased unintended removal of catheters, and self-extubation, functional decline, new institutionalization, and new onset of cognitive impairment” are the negative outcomes of delirium (Balas et al, 2012, p. 15). Physical restraints are applied to delirious older patients to prevent falls. However, a study demonstrates that “physical restraints restrict persons in their human rights, do not protect them from harm but are always harmful and should be avoided” (Heinze et al, 2011, p. 1033). The authors further explain that older patients are at risk for urinary incontinence, constipation, malnutrition, decreased muscle strength and lost balance due to lack of activity and place them at risk for cardiovascular disease and cardiopulmonary dysfunction. The most frequent complications are pressure ulcers and aspiration and breathing problems and contractures (Heinze et al, 2011, p. 1034).Malnutrition in Older Hospitalised Patients Essay Delirious older patients feel isolated in a confined area, embarrassed due to loss of dignity and respect. In addition to physical restraints, administration of haloperidol (antipsychotic medication) is a form of chemical restraint use to treat patients with delirium. Older patients are more likely to experience “hypotension, sedation, dysphoria, acute dystonia, parkinsonism, and restlessness and agitation or akathisia” (Mott et al, 2005, p. 97). Furthermore, they could also experience rare symptoms such as neuroleptic malignant syndrome, and extrapyramidal side-effects (Mott et al, 2005). In fact, antipsychotic medications usually take days to weeks to reach their therapeutic effects. For this reason, using this medication to treat delirium, an acute temporary onset symptom, is not the best option. When administering any medication to older patients, RPNs must also consider that their older patients’ functioning vital organs are declining. For example, the stomach, liver, and kidneys alter the absorption, metabolism, distribution, and excretion of administered medications. Older patients are at risk of drugs toxicities, overdose, and other adverse effects. Older patients are less likely to have these complications when RPNs understand and are aware of these negative outcomes.Malnutrition in Older Hospitalised Patients Essay

When trying to make an informed decision regarding patient care, RPNs must adhere to the Registered Psychiatric Nurses of Canada (RPNC) Code of ethics. “Respect for the inherent worth, right of choice, and dignity of persons” (RPNC, 2010, p. 5) is the ethical code that applies to issue of physical and chemical restraints. Also, RPNs have a professional responsibility to practice according to the Standards of Psychiatric Nursing. The issues regarding physical and chemical restraints challenge many RPNs because the Code of Ethics says to “uphold the person’s legal and moral right to refuse treatment and to choose to live at risk as long as those decisions are in keeping with law” (2010, p. 5). However, RPNs also have the responsibility to protect their patients from self-harm and hazardous environments. Delirious older patients are not capable of making the decision for themselves. RPNs must determine many alternative options that benefit their patients without using physical and chemical restraints, while protecting their patients from multiple injuries. Malnutrition in Older Hospitalised Patients Essay A solution that can be effective in treating older patients with delirium is to create a safe, low stimulated environment for them. Having a Delirium Room (DR) is a method that could be used to observe acute delirious patients. Flaherty & Little explain that “[t]he rationale for the structure of the DR was based on the goal of providing constant nursing observation and safer management of individuals with delirium without the use of one-to-one sitters, according to the concept that delirium can be managed without the use of physical restraints and minimal use of psychotropic medications” (2011, p. 295). The DR room is the closest room to the main nursing station which provides twenty-four hour observation and care to patients with delirium. Furthermore, assessment, nursing diagnoses, planning which includes goals and outcome criteria, implementation, and evaluation are the nursing processes that guide RPNs to effectively care for their older patients. By asking the patients’ primary caregiver about the patients’ normal behaviours an RPN can determine the baseline and the current mental status of his/her patient . Seeking data by-proxy can help RPNs detect and differentiate delirium from dementia and is an important part of the nursing assessment. Finding out that the delirious older patients are at risk for falls, self-harm, and other complications are nursing diagnoses. Once RPNs determine these risks, they must create a care plan by setting goals and outcome criteria for their patients. Treating and preventing older patients with delirium by lowering their beds, padding side rails, lowering environmental stimuli, avoid using physical restraints and minimizing the use of the chemicals are nursing implications that promote their patients’ dignity and recovery process. Evaluating the effectiveness of nursing implementations and patient’s outcomes allows the RPN to consider the intervention and whether to continue on with the care plan or modify it and/or change it. RPNs must apply the RPNC Code of Ethics to their practice in order to ethically treat their older patients.Malnutrition in Older Hospitalised Patients Essay

In conclusion, by having the knowledge and skill to recognize the signs and symptoms of delirium in older patients with dementia, RPNs are able to provide effective interventions for their older patients. Understanding the consequences and the contributing risk factors that are more likely to occur to older patients allow RPNs to critically think about their action. The RPNC Code of Ethics and the Standards of Practice guide RPNs to care for their older patients with ethical manners. Nursing process helps RPNs to consider and make an informed decision based on the data. By adhering to these Codes of Ethics and the nursing process, RPNs are not only promoting their psychological and physical health but also promoting their quality of life.

It is essential that all patients receive adequate food and drink appropriate to their needs (Nursing and Midwifery Council, 2015) and while many will be able to manage independently, some patients will need assistance.Malnutrition in Older Hospitalised Patients Essay

All patients admitted to care settings should have nutritional screening performed within the first 24 hours (CQC, 2015; National Institute for Health and Care Excellence, 2006) using a validated tool such as the Malnutrition Universal Screening Tool (MUST). This is essential as it helps to ascertain whether a patient needs help and informs their nutritional plan of care.

There are a number of patients who have medical conditions that mean that they may need assistance with eating and drinking; these are summarised in Box 1.Malnutrition in Older Hospitalised Patients Essay

Box 1. Medical conditions that may affect eating and drinking

Swallowing complications: may be associated with conditions such as stroke, Parkinson’s disease, motor neurone disease and multiple sclerosis

Cancer: some patients with cancer have increased energy requirements but they may feel unable to eat due to nausea, vomiting, pain or gastrointestinal obstruction. Patients prescribed chemotherapy often experience a change in taste which can affect their appetite

Surgery: people who have had surgery require extra energy to help heal wounds but they can sometimes find eating difficult due to pain and nausea

Other: people with severe learning disabilities, visual impairment or dementia, and older people who have an acute delirium, need specialist support to ensure they are adequately nourished

Preparing for mealtimes
Nurses should assist patients to make appropriate meal choices; for example, if they can only eat soft food due to poor dentition they should be made aware which foods on the menu are soft and easy to chew. Nurses should not choose food for patients without consultation; if they are unable to choose for themselves, their nurse should speak to a carer or relative to find out their likes and dislikes where possible.Malnutrition in Older Hospitalised Patients Essay

As part of the assessment process, it is important to know whether patients have any special dietary needs. For example, a patient who has swallowing difficulties (dysphagia) may need a texture modified diet (National Patient Safety Agency, 2011) as giving food that is difficult to swallow may lead to choking. This information should be obtained when admitting the patient to hospital and shared with the multidisciplinary team; refer to local policies for further guidance.Malnutrition in Older Hospitalised Patients Essay

Protected mealtimes
It is best practice for clinical areas to follow a protected mealtime policy. During protected mealtimes, all non-urgent clinical activity should stop and staff should take the time to help patients to eat and drink in a relaxed, and unhurried atmosphere (Council of Europe, 2003).

While this can often be challenging in practice, especially in a busy acute environment, staff should make every effort to ensure that patients are able to eat and drink their meals without unnecessary interruptions.

Many organisations encourage family and carers to come in at mealtimes to assist their relative with eating and drinking. This is good practice, particularly for patients with dementia or learning disabilities as they may be more willing to accept help from a person they know.

Equipment assessment
The use of red tableware such as red trays, jugs and beakers can help to highlight patients who need help with eating and drinking. This assessment should ideally be made at the same time as the nutritional screening and included as part of their care plan (Fig 1a). This is an ongoing process and should be reviewed regularly.Malnutrition in Older Hospitalised Patients Essay

Adapted cutlery such as easy-grip handles and other equipment such as plate guards and nonslip mats can be useful for patients who have restricted use of their hands or who have had a stroke and can only manage to eat with one hand (Fig 1b). These are usually provided by an occupational therapist.

The author took ethical issues into consideration as appropriate measures were put in place to obtain consent and prevent physical harm, hunger, discomfort or psychological suffering by not carrying out observation on feeding assistance. Ellis, 2010 highlights that ethics should saturate all that nurses do in the delivery of health and social care.

However the implication of using method such as interviews can sometimes be hard to replicate as people tend to give their views, attitude, ideals ,pre-existing ideas and their beliefs which does not necessary explains the point to why malnutrition does occur (Ellis, 2010). In addition, they can be take up vast amount of time and can be expensive (Jolley, 2010).Malnutrition in Older Hospitalised Patients Essay

The third research paper was written by Vanderwee, K, Clays, E, Bocquaert, I, Verhaeghe, S, Lardennois, M, Gobert, M and Defloor, T, entitled Malnutrition and Nutrition care practices in hospital wards for older people, published in the year 2010. This research was conducted in a hospital ward for older people in Belgium. Although the research was not conducted in the UK, this paper gave insights that suggest that malnutrition in older hospitalised patient is not only a reoccurring problem in the UK but a wide spread problem.Malnutrition in Older Hospitalised Patients Essay

The sample selection process was adequately described, stating the intended process of the research by using precision in information provided such as, the time period the research was carried out, the age restriction of patient involved in the research process. Consent was also obtained and adhered as specified by the Department of health (2009) which states that consent must be given unless stated or proven otherwise that they do not have the mental capacity to do so.

The authors did an exceptional job in the discussion by highlighting information that was already known about the topic extracted from a wide range of credible evidence based sources that support the importance of nutrition. It contains the findings of the research which identify a balance argument into the meaning of the result and provide recommendation that was developed from the finding. Lastly, it highlights some thought-provoking lines of enquiry for future studies to be undertaken to tackle the problem and to extend knowledge of malnutrition in older hospitalised patient. .

The limitation of this study indicates that the authors use a cross sectional study where all information of nutrition status and nutritional care practices of the ward was collated at the same time. Hence, no casual connection could be identified and patients and health care professionals could not express their views on malnutrition, leading to results that could not be quantified. (ref give reason as to why quantitative study)The author or researcher could have carried out a longitudinal study to research and analyse the impact that malnutrition has on older hospitalised patient .Ref (back up the benefits of longitudinal study) .Malnutrition in Older Hospitalised Patients Essay

Collectively, these three research paper provide concrete evidence on the prevalence of Malnutrition and the dire consequent it has on the aging population and Health Service. They mention the benefits that can be derived from the prevention of malnutrition and practical steps that need to put in place to help tack malnutrition extracted from NICE guidelines (2006). A general consensus among the authors of the respective paper that for true progress to be achieve in preventing malnutrition all health professional needs to understands the pervasiveness of malnutrition in hospital and the effect patient nutrition care may have on whole clinical outcome. Lastly they conclude that nutrition intervention greatly improved clinical outcome and reduce cost of care, predominantly in patient 65 years of age and above and challenge health care professional to address the barriers and change the paradigm of nutrition care.Malnutrition in Older Hospitalised Patients Essay

However, authors from one of the research paper went as far as to say that health professional have often failed to prioritise understanding the enormity of malnutrition in their respective hospital and the impact on cost and quality of care and was backed up by the Bapen ,2009 ) that states that nurses are at time removes from the task of assisting patient at meal time and has been delegated to less qualified staff which further strengthen the notion that mealtime care is unskilled and not important.Malnutrition in Older Hospitalised Patients Essay

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My first challenge in conducting a research was to identify a topic or area of interest. This was obtained by looking at websites such as Royal College of Nursing, talking with my lecturers, students and staffs on placement as well as reflecting on issues that I was personally interested in. After Collating all the information, I sift through interests, experiences and ideas that had been discussed eventually leading me to conduct a research on Malnutrition and consolidated by the use of the Rolfe et al reflective model.Malnutrition in Older Hospitalised Patients Essay

I undertake my research by using a selection of different sources such as Cinahl, internurse, PubMed, Cochrane library but instantaneously found out using these data base on their own can produce a wide variety of information. The search strategies was very instrumental as it helped me to effectively narrow my search down to a manageable number and furthermore it was less time consuming .The search strategy includes Boolean operator, key words that encapsulate malnutrition , peer reviewed and limiters of inclusion and exclusion outline in table 1 and table 2 . For example, when I type malnutrition into Cinahl without using the search strategy I obtained an exhaustive result of 6461. I did another search this time with a more specific aim and objective of a topic and the usage of the different search strategy which includes peer reviewed article , date restrictions (2007- 2013) which eliminate old article , key words (malnutrition and nutrition, hospital and older people) this refined my search down to 11 papers.Malnutrition in Older Hospitalised Patients Essay

My aim is to obtained three paper for my research ,so I read through the abstract eliminating paper that had no relevance to my chosen topic . I also found that the Abstract was a good indicator to identify relevant keywords to help with my search. I was now short of one paper so I check the Cochrane library which did not produce any relevant article followed by PubMed which produced 112389 at first. I included my search strategy using key words such as malnutrition, older people, hospital, feeding and a time period of 5 years, this further reduced my number down to 10 hits .I also examine the abstract with a critical eye and scan through literature to find the appropriate research articles. Although I did not use wild card and truncation I know the importance of their uses and I am quite positive they will come in handy in the future.Malnutrition in Older Hospitalised Patients Essay

Part of the aim of this assignment was to gain information and understanding of malnutrition in older hospitalised patient by examining the evidence that is already available and seek to find new knowledge on what can be done to reduce malnutrition among the target group. This has put me in good stead as I have gain tremendous amount of insight into the evidence I found from the three research article as well information glean from books and journals that can be applied into practice. For example It was interesting to read nutrition now 2007, who took on a proactive approach in dealing with malnutrition by educating all members of the multidisplinary team to better understand the primacy of good nutritional care and the pivotal role they play in providing it and also implementing ways to work effectively as a team to eliminate the problem of malnutrition. Age concern (2006) also implemented seven steps to end the scandal of malnutrition in hospital, evidence was also shown how various hospital took on the initiative, saw a significant improvement in their quest to reduce malnutrition in their hospitals. The ultimate key is to systematically recognise patients who are malnourished or at risk and quickly intervene (Dunne, 2009)Malnutrition in Older Hospitalised Patients Essay

The implication of the research papers showed that although research had been carried out and the accessibility of validated screening tools malnutrition still continues to go unnoticed and untreated in many older hospitalised patients (Bapen, 2009).

As a student nurse it is important that refection is part of my daily routine as this can enhance my effectiveness as an individual that enhances the quality of care I give to patient. I identify that malnutrition is every one responsibility and requires the collaboration of a multidisplinary team to leverage success in tackling malnutrition and that preventing malnutrition is a pivotal role in my nursing practice Malnutrition in Older Hospitalised Patients Essay

Undertaking this assignment I was able to identify my shortfall and limitation and has taught me effectively ways to conduct a search and access academically evidence based resources. This illustrated to me the importance of not taking information at face value but adhering to the correct procedure to obtain articles and examining articles with a critical and analytical mind to decide the credibility of the article. As the profession Nursing, cannot agree to any research at face value and need to be able to ascertain strengths and limitations of the research when evaluating the information available on the research topic (Ryan et al 2007).Malnutrition in Older Hospitalised Patients Essay