The Importance of Nutrition in Wound Healing in Irish Hospitals - Research Proposal Example

Running Head: An Exploration of Nurses' Attitudes to the Importance of Nutrition in Wound Healing in Irish Hospitals [Instructor] [Date] Abstract Various research surveys have been carried out in diverse hospitals all over the world, to develop an understanding about the incidences of clinical and subclinical cases of malnutrition. It was reported that like other forms of injuries and infections; lack of nutrition and care can also influence the process of healing and recovery. In case of wound, the basic requirement of nutritional assessment and provision of nutritional support may be taken superficially, secondarily or ignored completely. Proper guidelines and its implementation are mandatory to carry out the process for improving nutritional requirements, healing and thereby reducing the rate of morbidity and mortality. Nutritional factors are therefore one of the biggest parameters which needs constant research and assessment, as it varies with the geographical distribution and food habits of the individuals, in addition, it requires co-operation of the staff, patient and his associates. This study focuses on the importance of nutrition in the wound healing process and the attitude of nurses in Irish hospitals towards this important issue. The literature review showed that patients perceive their nurses to be caring and responsive when they are tender and compassionate towards them. However, no direct relation has as yet been established between nutrition planning and length of hospital stay, in terms of impact that nutrition planning has on the health outcome of the patients. The need for post operative care in the case of wound healing has been fully established through the literature review. It is manifested that the level of care that a patient receives determines the prospects of recovery.' It is therefore essential for nurses to understand this aspect of patient care, especially in the case of nurses' attitude towards wound healing and nutrition for the patient undergone surgery. It is imperative to understand that nursing practice is not only confined to the development of congenial nurse-patient relationship but should also have an in-depth understanding of nutritional requirement of the patient in the hospital. It gives an impact on the psychology of the patient and helps the patient to confide on nurse, building a confidence and trust in nurse's practice. This trust in turn helps in sooner recovery of patients from the ailments. It is very imperative to justify nutritional screening in hospitalized population as under nutrition in this segment of population is the matter of much concern because of its relation to morbidity and mortality. If this is the case of older or aged individual it becomes more complex, because biological progression accompanied by several socioeconomic issues has a great impact on nutritional status. Aging decreases food intake because of physiological decline in appetite followed by weight loss, anorexia and chronic or acute diseases, poor dental health, altered sense of smell and taste, achlorhydria and reduced physical activities. All these factors cause accumulation of fat and thin body mass. The condition becomes more devastating when the elderly group is facing poverty, isolation, depression, dementia, poor visual perspicacity. The present research proposal is based on the exploration of nurse's attitude to the importance of nutrition in wound healing in hospitalized individuals. The study encompasses the survey and information gathered from the Irish hospitals. Chapter 1 Introduction Wounds or trauma involving musculoskeletal injuries are devastating and impair routine work. This brings loss of skeletal muscle mass and realistic abilities. It is uninvited and is the outcome of physical inactivity. Immobility mediates protein catabolism under the condition of catastrophic measures such as severe illness or wound, (Brillon, 1995). Whatsoever be the etiologic reason, the consequence of inactivity is apparent and debilitating. Wound injuries encompass fractures, dislocations, musculoskeletal damages of soft tissues (muscles, ligaments, tendons and nerves). It characteristically comprises wounds of upper limb (shoulder and hand), lower limb (hip to foot) and spine. The treatment may involve surgery (manipulation, external fixation or internal fixations) or non-surgical methods (plaster casts, braces, splints, crutches and slings) (Information for Trauma and Orthopaedics patients). The pathological condition of orthopaedic trauma and associated bed rest even in healthy patients shows decline in the muscle mass. It is manifested that complex interaction of stimuli like physical activity and signalling of hormones especially insulin, growth hormone directs muscle deposition. During these conditions, it is essential that muscle protein synthesis should occur, therefore, nutritional amino-acid supplements must be provided. It is recognized that amino acid maintain skeletal muscle mass in clinically mandated inactivity (Ferrando, 1999). Improper nutritional condition or malnutrition is an extremely pertinent pathological condition in the elderly that causes loss of independence, lower quality of life, higher incidences of hospitalizations and in severe condition may lead to death. The consequences of malnutrition can be understood as older persons with, body-mass index < 20 kg/m2, 1-year mortality rates becomes 50% (Ferrando, 1999). Reasons for malnutrition could be multifactorial and this impedes the diagnosis. Literature review emphasize that till date not one method has been devised for the diagnosis of malnutrition, which holds true for the elderly and younger populations. To diagnose malnutrition all the factors related with medical grounds, psychological grounds and social reasons must be taken into consideration. Insightful clinical valuation of nutrition status needs the exploration of a person's medical history, anthropometric measurements, laboratory tests, and dietary interviews, thus being a complex and time-consuming procedure. It is essential to develop a reliable screening tool for an early detection of malnourished old population and those who are at risk. Malnutrition is considered as a deficiency, overload or discrepancy of energy, protein and all other nutrients, badly disturbing the body functions (Elia, 2003). The studies provide the view that in early 1990s, the Mini Nutritional Assessment, MNA was developed for nutrition screening. Since then, it became the most recognized and extensive screening tool and for convenience it is translated into many different languages. The MNA shows extrapolative significance with regard to functionality, morbidity, and mortality of the elderly in diverse situations, especially in community, nursing home and hospitals (Nutrition in Clinical Practice, 2008). During the process of inactivity, the loss of lean body mass is the outcome of a persistent imbalance between muscle protein formation and breakdown. The situation is further exacerbated during stress. In wound injuries the stress response is linked with severity of illness or trauma or intrinsic loss of homeostatic balance. This encompasses the proficient amplification of protein catabolism rate because of cortisol, epinephrine, and glucagon circulation in the body (Brillon, 1995). The nurses and health care workers play a crucial role in assisting the patient in day-to-day activities, in post operative care and in rehabilitation of the patient. During this process of care and assistance it is imperative for the care takers and the nursing staff to keep a check on the quality of food intake of the patient. Malnutrition brings adverse consequences, it becomes important for the hospital staff to constantly assess and screen the patients' nutrition for better health and recovery. Malnourished elderly population are at greater risk of falls, stretchable hospital stays, post operative complications, prone to infections, pressure ulcers, healing of wounds and impaired muscle and respiratory function and even become fatal causing death of individual (Davidson, 2004). The outlook towards the importance of nutrition in the healing process and also in rehabilitation of wound patients has been proved in several studies. This is one area where nurse's approach towards wound healing and nutrition play imperative role in wound patients. Patient's level of satisfaction with health care services in the case of wound is linked to pre-operative and post operative care and includes the information that is imparted about the importance of nutrition in wound healing, treatments and side effects. An important goal in wound healing treatment is to provide a patient with adequate information that will enable proper management of the illness (Miaskowski & Rostad, 2000). Nurses are now accepted as an integral part of the patient care and therefore, are able to enjoy many rights and autonomy that was not available to them in the past. Since the nurses are more in contact with the patients before, during and after their illness, they are better able to plan and monitor the patient progress during various stages of illness. They can therefore be able to give more accurate assessments as to the role of various interventions and methods that help improve the patients' health during the course of stay. Even in non-hospital settings, the nurses are more in contact with their patient and are able to assess more efficiently the various changes taking place in the patient, and signs pertaining to it or otherwise. Therefore, nurses are now an important contributor to the overall health of the patient and can help identify earlier cases of nutritional deficiencies in all clinical settings. The study aims to highlight how nurses can help prevent many complications of health that take place due to lack of nutrition, which can help speed up recovery with minimal of complications for the patients. The final part concludes the findings and the various proposals that can be undertaken to improve the situation of malnutrition among the cases hospitalized for wound injury. Identifying the Research Issue Nutrition plays a pivotal role in the successful healing process of the patient's wounds. It is the responsibility of nurses to acquaint the patient in need for after care by providing information on diet, activity levels, medication and other regimens that must be adhered to in order to ensure recovery. However, patient's perception of satisfactory nutrition procedures cannot be up to the mark because patients and health personnel tend to view satisfactory care and nutrition from different perspectives. (Turner and Pol 2004). Patients who received surgical treatment for head and neck wounds felt that the information they had been given during the process of diagnosis and hospitalization was not adequate. In the case of elderly patients, nutrition to a familiar home environment was preferred! This is the matter of utmost concern. The nature of the information patients require also differs at different stages of the wound healing diagnosis and/or treatment process. During the initial stages, patients prefer to receive more generalized information. Irish hospital nurses are trained about the key significance of nutrition in the wound healing process, which affects patient's wound healing process and enhances recovery. In the case of elderly patients, nutrition to a familiar home environment was preferred. Literature Review The level of satisfaction of patients who experienced rapid healing process due to the adequate intake of nutrition during their stay have usually spoken about the positive attitude of the nurses in the Irish Hospitals towards the importance of nutrition during the entire healing process.'The negativity and depression associated with postoperative wound care can be effectively addressed if a good support system is provided for the wound patient. In case of elderly patients, the possibility of healing in an unsupported environment after nutritional care also loom large, this is also likely with wound patients who suffer extreme depression and for whom the likelihood of complications is high. The thrust of the NHS objective is to improve the quality of patient care by developing a detailed framework to evaluate critical care competency (Derdiarian, 2003) and improve team efforts and patient interactions with nurses and care takers. In Irish Hospitals need to analyze the problems and to reach the solution is being performed on the regular basis. This enhances patient recovery rates with appropriate nutrition intake. The constant interaction with the patient with the care takers and the nursing staff enhances the knowledge of the patient about self care and about the nutrition the patient is taking. Hitherto, effectiveness of advanced care nurses has been assessed mostly through their skill in the performance of procedures, while the attitude of nursing is rapidly evolving into a much more comprehensive mode, encompassing interpersonal and communication skills.' In relation to wound in particular, surgery requires patients to re-learn self-care skills, especially about elimination. Therefore, the nurse's role begins much before the surgery itself co-operation of the patient is improved through psychotherapeutic interactions between the nurses and the patient; this enhances the patient's chances of recovery without complications (Tierney, 2001). Additionally Irish nurses play an important role in helping patients through the post surgery nutrition procedures and in becoming proficient in effective self-care. They also function as the patients' advocates in communicating their needs effectively to their care takers and family members. Above all, the Irish nurse's most important contribution to the wound patient lies in the knowledge, information and assistance they impart to the patient in self-care activities. Patient's perception of quality care received at hospitals is dependent upon the degree to which they perceive that nurses are compassionate and caring about them, and the degree to which they are willing to be frank and reveal how knowledgeable they are about the patient's condition. Most patients prefer honesty and transparency in discussions about their health and want to be fully informed and participate in all discussions, decisions and deliberations about their medical condition. (Donabedian, 2000). It is essential to understand that the physical make up of the body parts have changed as a result of wound injury, most patients are self-conscious about it and feel abnormal, leading to anxiety and depression. They are unable to cope, especially when they are not provided full information about their condition and options for treatment. Since the kind of social adjustments to be made after wound procedures will be determined largely by the degree of understanding a patient receives from friends and family members, it is vital that family members are also included in pre- and postoperative counselling sessions (Tierney, 2001). Ostomy self care is achieved through helping the patient adjust to a changed body image and integrating with other ostomy groups in order to draw strength and support. The formation of a wound can have a negative effect on a person's quality of life (Brown, 2005) and patient may experience negative feeling about self-esteem and helplessness and loss of independence due to change in body functions, which will bring about a change in bodily image (Glavassevich et al, 2004). Based on the above literature review, the indispensable value of skilled nursing care in the case of wounds is indisputably established. The literature review also demonstrates that the nutrition information that is provided can be achieved without much patient participation. There appears to be a paucity of research into the areas such as - how does the quality of nutrition information impact upon the patient's chances of recovery' How does participation of patient in the nutrition information process aid recovery' The fact that many patients have found that information given to them at nutrition is not adequate to face the problems that crop up once the patient has been transferred home is established through studies that have been done in this area. Moreover, the literature also shows that patients desire different kinds of information at different times - during the initial stages of diagnosis, they need more information which is general and broad based - such as treatment options, after surgery, their needs are very specific and nature of information imparted during this time must also be specific and tailored to meet the needs of the patients. It is extremely important that nurses treat patients on an individual basis, and offers them personalized care according to their health conditions since the perception of care acts as a tonic and leaves a psychological impact on patient's mind which is crucial during the entire process of wound healing and rehabilitation. An Irish nurse's contribution is thus invaluable, not only from a physical training point of view in teaching the patient to use the pouches and bags in aiding the mental and emotional adjustment of the patient. However, one important area of limitation was noted in the studies above; pertaining to the area of patient care takers and their nutrition information. The question that remains unaddressed in studies is how relevant is the nutrition information in terms of helping care takers in their efforts to assist patients and care for them' Preliminary studies in the area of nutrition instructions needs experience, once the patient has been brought back home nutritional factors faces shortfalls which need to be addressed. It is also manifested that most patients report that they were visited by a wound specialist before leaving the hospital, there is a general level of dissatisfaction with the nature of services rendered by hospitals related to the nutrition and what so ever information they are provided with is inadequate and insufficient to curb the wound healing Therefore, this literature review, which was undertaken into the subject of wound care - the nurse's outlook and the nutrition procedures for wound patients, has revealed an area where there is a paucity of research. The study is therefore proposed to be undertaken in order to establish the parameters for nutrition instructions that are relevant in the context of their care after transferring from hospital to home. However, in the literature review of wound healing process facilitated with adequate nutrition and the relevant factors affecting patient's wound healing process with aftercare; there occurs a lack of research on the need to educate both patients and caregivers with effective nutrition instructions. There are different factors involved in the wound healing process and similarly the nurses have to take care about different steps in the nutrition of wound healing. For e.g. 1. Intrinsic and extrinsic factors that can affect wound healing encompassing high and low risk factors. 2. Tissue perfusion another key factor in nutrition of wound healing. 3. Obesity adds another approach to the needs or requirements of the patient and similarly presents challenges to nurses treating the patients of nutrition of wound healing patients. A complete understanding of wound healing and allied potential problems of obese patients and knowledge of interventions is required. It has been established that written instructions combined with oral ones are effective, the reason for this is the fact that those written instructions are also available to caregivers to read, unlike oral instructions administered solely to the patient, which the caregiver may not have accessed. In view of the importance that has been ascribed to the attitude of community and caregiver support, as demonstrated in the above literature review, it would be relevant and useful to conduct a research study to assess the need to include both patients and caregivers in the nutrition process. Since the after care of wound patients is dependent upon the services rendered by caregivers and family members and the caregiver may not always be a qualified nurse practitioner, it would be in the interest of the patient as whole' if nutrition instructions also included the patient's family members or care givers. Research problem, Research Question, aims and objectives of proposed study The main objective of the literature reviewed is to assess the prevalence of nutritional deficiencies among older patients including post menopausal women and how nutritional deficiencies affect the course of outcome of various hospital stays, illness and recovery, general health and morbidity and mortality issues. In this regard, a study is proposed to emphasize the importance of the lack of information about the nutritional assessment within the hospital staff especially nurses. The introduction of various health nutritional assessment tools, which are specifically targeted for the elderly population, what areas do these nutritional assessment tools cover will be taken into consideration. This study would be relevant and useful in the context of the studies that are already being carried out in the area of nutrition and patient's wound healing process and is going to be a great help to corroborate and enhance the results that have been derived in those studies. This study shall focus on the attitude of nurses in Irish Hospitals towards the importance of nutrition in wound healing of the patients. Research methodology For this an extensive literature review was undertaken with the help of the libraries, Internet sources, books and journals. Since now most of the medical libraries are also available on the Internet, it became a prime tool for search. The main sites that were looked into were Google, the New England Journal of Medicine, Nursing Journals, Obesity Journal, the online based and international journals as well as online editions of books. Mostly these researches were composed of two separate disciplines, the medical journals and the nursing journals. The approach therefore, was also different in the articles that were recovered. The medical journals for example, contained more information about research findings and how nutritional assessments can be carried out and prevented and modes of treatment in lieu with different surgical and medical conditions. The nursing journals were more oriented towards care of patient with nutritional deficiencies, how to identify these patients and the use of various tools in nutritional assessments. These journals have also shown an extensive list of pressure ulcers and other complications that arise due to prolonged bed rest conditions. It is also highlighted that the nutritional assessment in a variety of surroundings and how a nurse holds the autonomy to correct them and observe them during the course of treatment. The nursing and medical journal both however, showed some common themes that are also reflected in the current paper. Firstly, the nutritional deficiencies have been prevalent for the last three decades with no improvement. Second, there is a global incidence of malnutrition among the elderly. Third, this tendency is higher in osteoporotic individuals. Fourthly, a very small percentage of health personnel are aware of importance of nutritional intervention in the hospital or other forms of health care. Fifth, the lack of realization of the importance of health assessment and how it should be carried out periodically. Finally the lack of understanding and application of tools of nutritional assessment in the daily routines, and how they can improve outcomes was one of the themes of these journal resources. Moreover, studies have not been able to establish a definite correlation in respect to the rate of nutrition intake or relapses in relation to nutrition planning (Shepperd, 2004). However, in the case of patients admitted for acute care, it has been established that supported nutrition provides a lower nutrition intake rate as compared to non-supported nutrition, without healing occurring in the interim in aged patients. It is evident that nutrition instructions play a vital role in the rehabilitation of wound patients. Irish nurse have kept a compassionate and professional attitude towards patients who required care and love during their healing process. The lack of information provided to patients has been established by the studies as being a causal factor in increasing depression and anxiety among patients. Therefore, the provision of an effective support system will be very helpful in ensuring positive results in the case of wound patients after nutrition. The value of community support in accelerating the recovery process after nutrition was also corroborated in another study that indicated that' Qualitative data analysis that will guide by work of Miles and Huberman will be employ in all this research. The National Health Service have outlined objectives to achieve team competencies for patient centred health care services, including the combined accessibility to technological facilities such as endoscopies that are available at diverse hospitals. Therefore, the critical care and nurse's attitude towards the importance of nutrition in the healing process towards wound healing and nutrition play a vital attitude in rehabilitating patients and helping them in the process of adjustment, not only physically but also mentally and emotionally. The quality of nutrition instructions that are provided to a patient at the end of the duration of hospital stay in order to facilitate wound healing and to gauge the are crucial in terms of the attitudes and importance of the nutrition in wound healing in Irish hospitals that affect patient's wound healing process. The data reveal one main theme: health-promoting nursing practice indicate that nurses struggle to describe their understanding of health promotion, their understanding will be limited and the strategies also describe to conduct health promotion. The degree to which the nurse is responsive to the patient's individual needs will also determine the extent to which the service is perceived. It is obvious that patient recovery seems to be impacted by the level of knowledge that is imparted to them by the nurses in the Irish Hospitals during the nutrition intake process. The availability of a familiar environment was rated high on the list of factors that affected patient's wound healing process along with the nutrition process. Overall health nurses behaviour towards patients especially towards wound healing will report to occur infrequently, being added on if the nurses have the time. Factors relating to education, organizational and management issues are identified as key barriers prohibiting health-promoting nursing practice. Outcome of the study: The research findings indicate that nurses struggled to describe their understanding of health promotion related to wound healings and this concern affects the patients a lot, their understanding was limited and the strategies described to conduct health promotion were narrow and focused on the each individual aspect. This requires postoperative nursing care; in order to adequately train patients in the independent use of their appliances to enhance self-care skills. A surgical procedure utilizing laparoscopy is likely to aid in faster recovery (Remzi, 2000) and the services of a good nurse are invaluable in successfully carrying out the necessary procedures. Communication style is therefore vital in ensuring patient cantered care, as demonstrated in a study that contrasted the communication styles of practitioners and physicians. Effective communication reduces errors and encourages self discipline in catering to the patient's best interests (Tierney, 2001) critical care nurses in Irish Hospitals need to use analytical and problem solving skills on a regular basis in order to improve patient recovery rates with the adequate intake of nutrition. The vital nature of the Irish nurse in wound healing is demonstrated through reduction in the complications after surgery. As patients do not understand the complexities and skills involved in administering good physical care and their view of quality in the care they receive is likely to be based upon the interpersonal relations they share with the health care personnel. They also help patient to find economical pouching and topical treatment alternatives and put patients in touch with ostomy groups to aid in their recovery through group therapy. Many health care plans no longer cover ostomy equipment, so the Irish nurse's contribution is invaluable in buying equipment at reasonable costs. The risk of complications in post surgery to the wound healing has been shown to range between 10 to 67%, after care, will enhance the patient's recovery. Psychotherapy given to the patient by the nurse help the patient to overcome their feelings of inferiority and social alienation after a wound injury. A skilled nurse can help to impart proper training to a patient on the important aspect of self-care, which will help the patient to develop a feeling of self-reliance, and independence, which contributes to the speedy recovery. The nurse's approach and explanation to the patient towards the importance of nutrition in the healing processing in pre-operative wound procedure for proper wound healing and in the post-operative situation to help the patient's recovery in terms of emotional and mental adjustment together with the physical adjustments is a vital. This whole study also identified that patient's perception of quality care received at hospitals is dependent upon the degree to which they perceive that nurses are compassionate and caring about them, and the degree to which they are willing to be frank and reveal how knowledgeable they are about the patient's condition. From a patient point of view, health care assumes an intensely personal outlook and is judged directly based on how responsive health care personnel are to their individual needs and concerns. Their perceptions and descriptions of health promotion related to wound healing patients were more in keeping with the traditional health education approach. This is capable of providing benefit only to certain cases but not for the wound healing patients in Irish hospital. It is imperative that nurses must recognize that health promotion is a broad concept and they should have to treat every individual patient according to the requirement. Nurses must be educated to recognize health-promoting opportunities in the acute setting, as well as how to plan for and conduct health promotion more in practice so that the knowledge imparted is in terms of gain related to wound healing. 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