Biomedical subjects
Publications and source records attributed to H Arrowsmith.
When a patient is unable to take a nutritionally adequate diet orally and is malnourished or likely to become malnourished, nasogastric (NG) feeding is normally the first choice of artificial nutritional support. This article describes the initiation of NG feeding and, using a problem-solving approach, explains the nursing care of a patient receiving a NG feed.
A feeding gastrostomy should be considered for patients who require enteral tube feeding for more than 2 weeks. This article describes three types of gastrostomy: percutaneous endoscopic gastrostomy; replacement/surgically placed gastrostomy; and skin level/button gastrostomy. The choice of tube and method of insertion are governed by the patient's clinical condition and lifestyle. General guidelines on the decision to initiate gastrostomy feeding are given, together with indications, insertion and nursing management for each tube.
Malnutrition in hospital is not a new concept. Studies carried out over 20 years ago identified that 50% of surgical patients (Hill et al, 1977) and 44% of medical patients (Bistrian et al, 1976) showed evidence of malnutrition. A more recent study demonstrated that the problem still exists (McWhirter and Pennington, 1994). This research showed that 40% of patients were undernourished on admission to hospital and 78% of these suffered further deterioration in their nutritional status during their hospital stay. This article, the first in the series, aims to identify patient groups which are likely to become malnourished during hospitalization and outlines how nurses and doctors can detect malnutrition and/or potential malnutrition in patients. The consequences of malnutrition and the current issues surrounding the reported problems of patients who do not receive enough food and drink while in hospital (Association of Community Health Councils, 1997) are discussed. The article also explores what measures can be taken to improve patients nutritional intake while in hospital. It describes the way forward in terms of clinical practice, current projects and the information and training available to nurses and other members of the multidisciplinary team. The author's overall aim is to improve healthcare professionals' knowledge within this field and to raise the profile of nutritional care.
This article looks at the referral of a patient (Mr H) for parenteral nutrition and the subsequent insertion of a peripherally inserted central catheter (PICC) by the nutrition nurse (NN). It explores the issues directly related to the PICC insertion including the route of intravenous access, the ability of the NN to insert the PICC, preparation, communication and consent, and prevention of the mechanical and septic complications of insertion. This case study demonstrates a good technical mastery of PICC insertion in relation to the issues raised. Mr H was satisfied with his care, offering positive feedback at follow-up visits to clinic. Critical analysis of the case study also revealed implications for further development of the role of the NN in ordering the check X-ray and the development of evidence-based standards and guidelines related to this procedure.
Malnutrition remains a problem in hospital and community patients, the consequences of which have deleterious effects on the sick individual and cost implications for healthcare providers. Provision of nutritional support has been shown to improve patient outcome in those at risk of malnutrition; therefore, the detection and treatment of malnutrition is paramount. Nurses have been identified as being in an ideal position to carry out routine nutritional screening to detect patients at risk of malnutrition and hence refer to the dietitian for detailed nutritional assessment and provision of nutritional support. Therefore, many nutritional screening tools have been developed to guide nurses in basic nutritional screening. However, for a tool to be effective certain criteria must be met including ease of use, cost-effectiveness, the presence of an action plan and prior testing for validity, reliability, sensitivity and specificity. Six such tools are critically evaluated in this article to establish whether they meet these criteria. Surprisingly, none of the screening tools demonstrated a beneficial effect on clinical outcome or met all of the above criteria. It is therefore essential that these tools are refined and retested before becoming part of established nursing practice.