Introduction The incidence of malnutrition remains high and is often undetected in hospitals. Patients with cirrhosis are often malnourished and this has a significant negative effect on outcome; its early management is therefore vital. Nutritional screening in the UK is generally undertaken by nursing staff. No surveys have been undertaken to assess the relationship between nutritional knowledge/attitudes and the practice of nutritional screening among nursing staff nor have attempts been made to identify any barriers to screening. A survey of nursing staff and ward managers on the liver transplant centres in the UK was, therefore, undertaken.
Methods A questionnaire was sent to all nursing staff on five of the UK liver transplant units. The 20 questions accessed three domains of information (1) general and specialist nursing education and training; (2) nutritional training; experience, practise and views of nutritional screening; and (3) potential barriers to nutritional screening. A yes/no quiz comprising 30 questions of varying complexity designed to assess knowledge of nutritional principles was also included. A separate questionnaire was sent to the ward managers. It comprised 27 questions relating to key factors which might affect the completion of nutritional screening tools by nursing teams, including information on nurse:bed ratios, nursing skill mix, staff sickness levels and use of bank/agency nursing staff. Details of managers' length of service and training in the nutritional aspects of patient care were also explored.
Results Response rates varied between centres but averaged 60% (n=69). The majority of nurses (60%) reported that 75–100% of patients on their wards are actively screened. The major obstacles to screening were lack of time (49%), lack of skilled staff (17%) and the perception that screening would be futile in patients who did not appear malnourished (11%). There was no relationship between nutritional screening level and nurses' experience of working in the NHS or on a specialist liver unit, the amount and type of nutritional training they had received, ward staff resourcing/time pressures, their nutritional quiz score, the size of the ward or the nurse:bed ratio. However, centres with less experienced ward managers reported higher usage of bank/agency staff and lower nutritional screening levels.
Conclusion Many of the factors which it was intuitively felt might affect nutritional screening levels by nurses did not do so. Instead the role of the ward managers proved key in this respect. Thus, nutritional screening by nursing staff could be improved by (1) raising the priority of nutritional education with ward managers; and (2) supporting less experienced ward managers in their handling of staff sickness levels to reduce bank/agency staff levels.
Competing interests None declared.
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