Assessment of nutritional status in clinical settings
Malnutrition in clinical settings
Malnourished patients can be found in all healthcare settings, including home care, long-term care and acute care settings. The causes of malnutrition are varied but, among the patient groups at greatest risk in clinical settings (i.e. the elderly, surgical patients and other long-stay patients), they will most commonly be linked to the metabolic response to trauma, the pathology of specific diseases, the contribution of ill-health to the ability to self-care, and poor meal provision (Baldwin et al., 2007). The exact prevalence of malnutrition is unknown, although studies in the UK, USA and Australia have consistently highlighted that 33–40% of patients are malnourished, with some groups (e.g. patients with gastrointestinal and head and neck cancers) being significantly more at risk (Barker et al., 2011).
Tools for nutritional screening
Nutritional screening represents the essential first step for the identification of patients who are at risk or potentially at risk of malnutrition. This enables an appropriate nutritional intervention to be employed. To be effective, a screening tool must be a rapid, simple and general procedure that can be used by nursing, medical or other staff on first contact with a patient. To provide adequate indication of nutritional risk, tools need to incorporate more than a simple measure of body mass index (Söderhamn et al., 2011; Elia & Stratton, 2012). Screening may need to be repeated regularly because a patient's clinical condition and nutritional problems can change. Two screening tools are in common use: the Malnutrition Universal Screening Tool (MUST) (Porter et al., 2009) and the Mini Nutritional Assessment (MNA) (Tsai et al., 2011, 2013), although other examples are also in use (Tammam et al., 2009; McCarthy et al., 2012).
Barriers to nutritional screening
Although of critical importance to the care of patients with long-term ill-health, those at risk of malnutrition or who are unable to consistently manage self-care, nutritional screening and monitoring are not always a part of healthcare plans. Malnutrition remains a hidden problem. This is not only partly explained by poor access to equipment such as weighing scales or stadiometers, but also arises as a result of a lack of knowledge among nursing staff (Porter et al., 2009). Not all countries have a mandatory requirement for nutritional screening on hospital admission. There is a need for greater clarity, dissemination and application of existing nutritional screening tools (Green et al., 2014).
Benefits of nutritional screening
The early detection of malnutrition can be achieved through routine screening upon hospital admission and at intervals throughout a long-term period of clinical intervention or management. The use of simple, easily administered screening tools is sufficient to identify those who will benefit from dietary support measures and nutrition interventions (Leslie et al., 2013). Simple tools that can be used by nursing staff enable referral to specialists (Murphy & Girot, 2013). There is extensive evidence that appropriate nutritional support can shorten hospital stays, improve clinical outcomes and prevent complications such as infection or pressure ulcers (Stratton & Elia, 2007; Merriweather et al., 2014).
This editorial is co-published in Journal of Clinical Nursing (JOCN) and Journal of Human Nutrition and Dietetics (JHN). The authors jointly hold the copyright of this article.