The effectiveness of nutrition education delivered in the inpatient setting on behaviour change post patient discharge
An optimum diet is an important element in recovery from illness and surgery. In the hospital dietitians routinely provide nutrition education directly to inpatients. This education is often instructional in nature and is delivered at the bedside, on or close to patient discharge. The nutrition education provided pertains to the patient’s specific condition with individualised dietary instructions that if followed are likely to result in improved nutritional wellbeing and better health outcomes. However, although this type of discharge instruction occurs daily throughout New Zealand hospitals, there are few studies to indicate whether this educational technique is effective. Concern has been voiced by some community dietitians, who see patients in their own homes after discharge, that patients report having no recollection of the nutrition education provided to them as an inpatient. Researchers have found that the ward environment is often too distracting for patients to concentrate on the nutritional education provided at the bedside by hospital dietitians. Aims: This study investigated 1) whether nutritional education delivered in the inpatient setting is recalled by the patient; 2) whether the acquisition of the education translates to effective behaviour change once a patient returns home and; 3) explores the preferred location for nutrition education. Method: A detailed systematic literature review of past research was conducted. Potential participants were identified by Waitemata District Health Board’s (DHB) clinical dietitians. Adult gastrointestinal disease patients and oral nutrition support patients between May 2012 and August 2012 were eligible for inclusion in the study. A clinical notes audit was conducted on proposed participants’ files to identify the content of the nutrition education they received. Participants were then phoned to ask if they would participate in the study. A telephone questionnaire that collected both qualitative and quantitative data was developed and tested. The questionnaire asked consenting participants if they recalled receiving the nutrition education and the educations content; and if they were actively practising the nutrition education. The questionnaire also asked participants their preferred location for nutrition education. Results: The literature review identified seven relevant studies. Eighty-nine participants completed the questionnaire for this research. Sixty-eight percent of participants reported that they were actively practising the education they learnt from the nutrition education (p<0.05). Of those who did not practise the education (n=28), 12 could not remember the dietitian providing the education, and this finding was associated with older age. Fifty-one percent of participants said the inpatient setting was their preferred location for nutrition education. Those who could remember the dietitian but could not recall the education (n=8) stated the hospital environment provided too many distractions to concentrate. A further group (n=8) could remember receiving the nutrition education and its content, but were not actively practising it. Conclusion: This study indicates that the inpatient environment is an important and effective place for nutrition education. Seven recommendations to help improve the proportion of patient’s actively practising nutrition education were developed from the findings including: assessing the patient’s motivation to make changes, reducing distractions in the ward environment, using evidence-based techniques to enhance recall and continuing to refer older adults or cognitively impaired patients for community follow-up. Ethical approval for the study was granted by the Chair of the Multi-region Ethics Committee on 24 May 2012 (reference: MEC/12/EXP/068).
Advisor: Chesters, Janice
Degree Name: Master of Dietetics
Degree Discipline: Department of Human Nutrition
Publisher: University of Otago
Keywords: nutrition; dietitian; dietician; education; counselling; counseling; setting; location; inpatient; discharge
Research Type: Thesis