Nursing Interventions for Improving Nutritional Status and Outcomes of Stroke Patients: Descriptive Reviews of Processes and Outcomes

Authors

  • Lin Perry RN, PhD, MSc, RNT,

    Corresponding author
    • Professor of Nursing Research and Practice Development, Faculty of Nursing, Midwifery and Health, University of Technology Sydney, Australia
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  • Sharon Hamilton RN, PhD, MA, BA(Hons),

    1. Reader in Nursing; Director of the Centre for Health and Social Care Evaluation, School of Health and Social Care, Teesside University, Middlesbrough, UK
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  • Jane Williams PhD, PgCert Health R&D, MSc, RGN,

    1. Medicine for Older People, Rehabilitation and Stroke, Portsmouth Hospitals NHS Trust, Portsmouth, UK
    2. Consultant Nurse in Stroke Care and Chief of Service, Medicine for Older People, Rehabilitation and Stroke, Portsmouth Hospitals NHS Trust, Queen Alexandra Hospital, Hampshire, UK
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  • Susan Jones BSc(Hons), RGN

    1. School of Health and Social Care, Teesside University, Middlesbrough, UK
    2. Research Associate, School of Health and Social Care, Teesside University, Middlesbrough, UK
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  • This study was supported by a small fund made available through the National Stroke Nursing Forum.

Address correspondence to Dr. Lin Perry, G74, East Wing Edmund Blacket Building, Prince of Wales Hospital, Barker St, Randwick NSW 2031, Australia; Lin.Perry@uts.edu.au

ABSTRACT

Background

Stroke produces many effects that impact eating. Nutrition is fundamental for recovery and rehabilitation, but the nursing nutritional role and associated outcomes have not been delineated.

Aims

(1) To identify nursing interventions intended to improve nutritional status and related outcomes of stroke survivors, and (2) To examine the outcomes of identified nursing interventions on nutrition-related outcomes, including dietary intake, functional status, complications, activities of daily living, mortality, and quality of life for stroke survivors.

Methods

A modified version of Cochrane literature searching and review methods was used to identify studies that described and evaluated nursing nutritional interventions for adult stroke patients in hospital and community settings. A minimum of 10 years content of seven databases and nine journals was searched to March 2011. Findings were presented descriptively.

Results

In total 27 papers from 26 studies were included: 5 randomized controlled trials, 5 clinical trials, 6 quasi-experiments, 4 case studies, and 6 qualitative/observational studies. Stroke nursing nutritional care encompassed screening of nutritional status and swallowing function; assessment of nutritional characteristics and preferences; referral; mealtime organization, supervision and monitoring; mealtime assistance and feeding skills. Nurses individualized care, coordinated or managed meal delivery and enteral feeding systems, were responsible for the dining environment and conduct of mealtimes; they taught staff, patients, and carers. There was little indication of integrated or psychosocial nursing nutritional care, or concepts, theories or models of nursing nutritional care. Many interventions were described but not evaluated. Little high quality evidence was of available.

Conclusions

This review indicated the parameters of nursing nutritional care, and provided a framework for future research. A functional, supportive, and educational nursing nutritional role was described but little evidence was of sufficient quality to support policy and practice development or inform education. Nutritional care was revealed as an essential but under-recognized element of stroke nursing.

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