Nurses’ knowledge about malnutrition in older people: A multicenter cross-sectional study

Highlights

• Malnutrition is an unsolved problem among older people

• It is important for nurses to have adequate nurses’ knowledge to prevent malnutrition.

• The Italian version of the Knowledge of Malnutrition-Geriatric confirmed its reliability and validity.

• The Knowledge of Malnutrition-Geriatric is a useful tool for investigating nurses’ knowledge and for implementing corrective strategies.

Abstract

Objectives

Malnutrition, among older people, has a prevalence of 22% in hospitals, 17.5% in nursing homes, and 8.7% in home care. Adequate knowledge among health care staff is necessary for risk identification and adequate intervention. The aim of this study was to translate and validate the Knowledge of Malnutrition-Geriatric (KoM-G) questionnaire in Italian and to investigate the malnutrition knowledge of registered nurses working in hospitals, nursing homes, home care, and palliative care in Italy.

Method

The KoM-G questionnaire was translated and validated in terms of content validity, internal consistency, and interrater reliability. Subsequently, a multicenter cross-sectional study in different settings was performed.

Results

The KoM-G ITA questionnaire showed excellent content validity, internal consistency, and good intrarater reliability. There were 511 nurses who completed the questionnaire. On average, 61.9% of the respondents answered the questions correctly.

Conclusion

The level of knowledge about malnutrition in nurses is adequate. Training courses and management protocols should be implemented to improve nursing care for malnourished older people.

Introduction

According to the Global Leadership Initiative on Malnutrition (GLIM), malnutrition is defined by both phenotypic (weight loss, low body mass index [BMI], and reduced muscle mass) and etiologic criteria (reduced food intake or assimilation and inflammation) [1].

Older people have a higher risk for malnutrition. Factors influencing this risk are poor nutritional intake, decay of general conditions, loss of appetite, chewing difficulties, infections, pain, fatigue, loneliness or depression, and changes in their gastrointestinal tract and in their metabolism and production of hormones. Multiple diseases and multiple drugs, specifically analgesics and antibiotics, also affect this risk [2]. A recent systematic review found a 22% prevalence rate of malnutrition among older people in hospitals, 17.5% in nursing homes, and 8.7% in home care [3]. A study among older people in Italian hospitals showed that 20% were malnourished and 50% were at risk for malnutrition [4].

Malnutrition consequences are manifold. Malnutrition does not only lead to decreased quality of life and autonomy in everyday activities of the affected individual, it also increases the risk for bone fractures, the rates of pressure ulcers, and the susceptibility to infections. Malnourished older people have a longer healing time for ulcers, which leads to longer hospital stays, higher social costs, and higher mortality rates [5], [6], [7], [8], [9].

To prevent the serious consequences of malnutrition, a potential malnutrition risk needs to be assessed early and adequate interventions should be initiated [10]. Nevertheless, some studies showed that nutritional care in health care institutions is not adequate [11,12]. Proper nutritional care is affected by many factors such as the availability of guidelines, the education and knowledge of health care staff [13], [14], [15], [16], and the patient-to-staff ratio [17,18]. Several authors have pointed out that knowledge and attitudes of health care staff play a fundamental role in the provision of adequate nutritional care [13,[19], [20], [21]]. However, many studies shown that nurses have an inadequate knowledge about nutritional problems [4,18,22].

In international literature, several questionnaires are available for the measurement of knowledge among nursing staff. The Knowledge of Malnutrition–Geriatric (KoM-G) questionnaire had systematically been developed and psychometrically tested and is intended to measure nurses’ knowledge in nursing homes [22,23]. In 2015, Bauer-Schönherr et al, reported that 60% of registered nurses (RNs) and nurse assistants answered the KoM-G questionnaire correctly [22,23]. Results showed a significant difference in knowledge between RNs and nurse assistants (65.6% of RNs correctly answered the KoM-G questionnaire). Furthermore, nursing staff with training in nutrition had significantly better knowledge (65.2% of correct answers) than nursing staff without training in nutrition (59.6% of correct answers) [22,23]. The questions with the lowest percentage of correct answers were related to the health professional's involvement in malnutrition care, which obtained only 26.1% correct answers, and about the “normal” healthy BMI in older residents, which obtained 31.6% correct answers. The percentage of correct answers and median values did not differ significantly regarding sex, age, and years of working experience [22]. Literature explained that a lack of knowledge of the important concepts of malnutrition can lead to an underestimation of the phenomenon and to behaviors that do not prevent the onset of malnutrition. Therefore, it is important to measure the level of the health professional's knowledge on these matters to implement targeted training interventions and, therefore, to promote better care [24,25].

To our knowledge, there are no validated tools that can investigate nurses’ knowledge in different care settings in Italy. Therefore, this study aimed to translate and validate the KoM-G to the Italian language and to investigate malnutrition knowledge of RNs working in different health care settings in Italy.