Malnutrition or nutritional related issues are a documented risk for the readmission rate in primary care practice. Reducing avoidable readmissions or admissions from primary care practice caused by nutrition related factors would seem to be an appropriate goal for patients and families, health care professionals and health care providers (Poletick & Holly 2010).

Multiple factors contribute to avoidable hospital readmissions. They may result from poor quality of care or from poor transitions between different providers and care settings. Likewise, such readmissions may occur if patients are discharged from hospitals or other health care settings prematurely, are discharged to inappropriate settings, or do not receive adequate information or resources to ensure continued progression (Haggerty, 2003).

An increase in the quality of nursing documentation within the nutritional area as well as an increase in the level of knowledge and clarification of the attitude and the routines within the nutritional areas among nurses, has been suggested as a method to reduce avoidable readmissions and admissions caused by nutritional issues (Bjørvell, 2002)).

Nursing documentation attempts to show what happens in the nursing process and what decision-making is based on by presenting information about admission, nursing diagnoses, interventions, and the evaluation of progress and outcome. Nursing documentation needs to hold valid and reliable information and comply with established standards, because nursing documentation is a vital component of safe, ethical and effective nursing practice (Idvall 2002, Karkkainen 2005, Urquhart 2009). Valid and reliable nursing documentation in clinical practice requires a structured and standardized clinical language based on terminology from nursing science, so that nursing care can be communicated accurately among nurses and other health care providers (Rutherford et.al., 2008)

Studies indicate that an increase in the quality of nursing documentation improves patient outcomes (Nilsson 2000, Urquhart 2009, Voutilainen 2004). Furthermore, several studies suggests that the quality of nursing documentation may have significance in regard to patients being admitted or readmitted to the hospital, indicating that high quality nursing documentation could be a method to prevent avoidable admissions or readmissions (Urquhart 2009). Nursing documentation has however received some criticism in recent years. The critique comes from nurses, doctors and researchers who point out that nursing documentation is time consuming, lacks useful information, produces too much text and suffers from a lack of structure. Several studies describe the lack of specifically nutrition-related information in the patients’ nursing records (Rasmussen 2004, Persenius 2008). Nurses have indicated that they do know that nutrition is important, but they have difficulties identifying what needs to be documented about patients’ nutritional care, what is relevant and what is important (Wang 2011), potentially leading to inadequate nursing documentation based on irrelevant and unsystematically patient observations. Hence, nurses need more specific guidance in order to collect information, to assess the patients’ needs, prepare a plan for nursing care, carry out nursing interventions and evaluate the outcome of the interventions. If nurses do not know which terminology to use about nutritional care, it is obviously difficult to identify areas that are of importance to the patient and need to be documented, and thereby be able to initiate interventions that can potentially prevent admission or readmissions.

In order to do so there is an urgent need to identify the level of knowledge within the nutritional area among nurses, their attitudes towards nutrition and nursing documentation and their routines in their daily care of their patients with nutritional issues and documentation thereof, so that potential gaps, their willingness, confidence and prioritization of these areas can be mapped.

A multisite collaboration is initiated in order to assess if the results from both studies are generalized cross-country or perhaps culturally or geographically conditional. The multisite collaboration consists of both distribution of a questionnaire and focus group interviews. The answers and results of both the questionnaire and focus group interviews will be used to identify issues within the nutritional area and the documentation of nutritional issues that are in need of extra training, education, overall focus or feed-back.

To map the level of knowledge, attitudes and routines towards nutrition and documentation among nurses in primary health care, in order to identify factors that contribute to and/or limit nursing documentation.

OBJECTIVES:

To identify nurses level of knowledge, their routines and attitudes towards nutrition and documentation.

To determine and explore the underlying causes of nurses reaction patterns in regard to documentation and nutrition.

Awaiting information from the PI