Lennart Christensson

Evaluation of nutritional assessment techniques in elderly people newly admitted to municipal care

Objectives: To evaluate the Subjective Global Assessment (SGA) and the Mini Nutritional Assessment (MNA) with regard to validity using a combination of anthropometric and serum-protein measurements as standard criteria to assess protein-energy malnutrition (PEM).Design: Cross-sectional study with consecutive selection of residents aged ≥65 y.Setting: A municipality in the south of Sweden.Subjects: During a year, starting in October 1996, 148 females and 113 males, aged ≥65–104 y of age, newly admitted to special types of housing for the elderly, were included in the study.Results: According to SGA, 53% were assessed as malnourished or moderately malnourished on admission. The corresponding figure from MNA was 79% malnourished or at risk of malnutrition. Both tools indicated that anthropometric values and serum proteins were significantly lower in residents classified as being malnourished (P<0.05). Sensitivity in detecting PEM was in SGA 0.93 and in MNA 0.96 and specificity was 0.61 and 0.26, respectively. Using regression analysis, weight index and serum albumin were the best objective nutritional parameters in predicting the SGA- and MNA classifications. Item ‘muscle wasting’ in SGA and ‘self-experienced health status’ in MNA showed most predictive power concerning the odds of being assessed as malnourished.Conclusions: SGA was shown to be the more useful tool in detecting residents with established malnutrition and MNA in detecting residents who need preventive nutritional measures.

What actions promote a positive ethical climate? A critical incident study of nurses’ perceptions

Few qualitative studies explore the phenomenon of positive ethical climate and what actions are perceived as promoting it. Therefore, the aim of this study was to explore and describe actions that acute care ward nurses perceive as promoting a positive ethical climate. The critical incident technique was used. Interviews were conducted with 20 nurses at wards where the ethical climate was considered positive, according to a previous study. Meeting the needs of patients and next of kin in a considerate way, as well as receiving and giving support and information within the work group, promoted a positive ethical climate. Likewise, working as a team with a standard for behaviour within the work group promoted a positive ethical climate. Future research should investigate other conditions that might also promote a positive ethical climate.

Implementation of a nutritional programme in elderly people admitted to resident homes

AIM The aim was to test the hypothesis that education provided to staff regarding nutritional needs and individualizing nutritional care will improve the nutritional status and functional capacity of elderly people newly admitted to resident homes. DESIGN Pre- and posttest, quasi experimental. SETTING Resident homes. SUBJECTS Sixty-two residents (20 men, 42 women) in the experimental group and 53 (14 men, 39 women) in the control group were consecutively included. Mean age was 85 years. METHODS On admission and after 4 months, nutritional status was assessed using a combination of anthropometry (weight index, arm muscle circumference and triceps skinfold thickness) and biochemical measurements (serum albumin and transthyretin). Functional capacity and overall cognitive function were also assessed. In the experimental unit, the staff received education about nutritional needs and individualized nutritional care. RESULTS After 4 months the number of residents assessed as protein energy malnourished decreased from 20 to seven in the experimental (p = 0.004), and from 17 to 10 in the control group (p = 0.1). In the experimental group, motor activity (p = 0.006) and cognitive function (p = 0.02) increased. In the control group, motor activity decreased (p = 0.02). CONCLUSIONS The results indicate that the intervention had effects, as the number of protein energy malnourished residents decreased in the experimental group and motor activity and cognitive function improved. No such improvements were seen in the control group.

Urinary retention in older patients in connection with hip fracture surgery

AIM AND OBJECTIVE The aim of this study was to examine the presence of urinary retention in older patients with hip fracture and to describe what actions nurses performed to detect, prevent and treat urinary retention. BACKGROUND The incidence of urinary retention in patients with hip fracture is described as being as high as 82% before surgery and 56% after. Urinary retention is traditionally treated with an indwelling urethral catheter or intermittent catheterisation. Urinary retention and treatment with an indwelling urethral catheter are associated with high risks. DESIGN A prospective, descriptive study. METHODS The study included 48 patients, 65 years or older who were recovering from hip fracture and receiving hospital care at a geriatric rehabilitation clinic. Six months before the study, a programme for the early detection, prevention and treatment of urinary retention was implemented. The presence of urinary retention, bacteriuria, the patients cognitive function, use of ultra-sound bladder scan and type of treatment whether the patient suffered from urinary retention were examined during the study period. RESULTS Urinary retention was found in 18 (38%) of the patients. No patients were examined using ultrasound bladder scan according to the programme, and the mean time of indwelling urethral catheter was three times longer than the programme suggested. The patients who were treated with intermittent catheterisation had had voiding satisfaction earlier and had not had repeated urinary retention compared to patients with indwelling urethral catheter. CONCLUSION In most patients, the programme was not followed and urinary retention was commonly present. RELEVANCE TO CLINICAL PRACTICE There is knowledge on how to reduce the presence of urinary retention, but the great challenge is how to implement this knowledge.

Guidelines for preventing urinary retention and bladder damage during hospital care

AIMS AND OBJECTIVES To develop evidence-based guidelines for adult patients in order to prevent urinary retention and to minimise bladder damage and urinary tract infection. BACKGROUND Urinary retention causing bladder damage is a well known complication in patients during hospital care. The most common treatment for urinary retention is an indwelling urinary catheter, which causes 80% of hospital-acquired urinary tract infections. Appropriate use of bladder ultrasonography can reduce the rate of bladder damage as well as the need to use an indwelling urinary catheter. It can also lead to a decrease in the rate of urinary tract infections, a lower risk of spread of multiresistant Gram-negative bacteria, and lower hospital costs. DESIGN An expert group was established, and a literature review was performed. METHODS On the basis of literature findings and consensus in the expert group, guidelines for clinical situations were constructed. RESULTS The main points of the guidelines are the following: identification of risk factors for urinary retention, managing patients at risk of urinary retention, strategies for patients with urinary retention and patient documentation and information. CONCLUSION Using literature review and consensus technique based on a multiprofessional group of experts, evidence-based guidelines have been developed. Although consensus was reached, there are parts of the guidelines where the knowledge is weak. RELEVANCE TO CLINICAL PRACTICE These guidelines are designed to be easy to use in clinical work and could be an important step towards minimising bladder damage and hospital-acquired urinary tract infections and their serious consequences, such as bacteraemia and the spread of multidrug-resistant bacteria in hospitals.

Using quality improvement methods to implement guidelines to decrease the proportion of urinary retention in orthopaedic care

In patients treated with indwelling urethral catheter (IUC), complications such as catheter associated urinary tract infections are common, while underuse of IUC may cause harmful urinary retention ...