The effect of a tailored multifaceted implementation strategy of nutritional guidelines for stroke patients

Abstract

Aims. This paper is a report of a study which aimed to determine whether evidence based recommendations on nutritional management of the Clinical Nursing Rehabilitation Guideline Stroke (CNRG), implemented by using a multifaceted implementation strategy, improved nurses’ attitude and competence and patient nutritional status. Background. The prevalence of malnutrition in patients with stroke is high and studies have shown this prevalence to increase during the first week of admission to the hospital. Recently, the Clinical Nursing Rehabilitation Guideline Stroke (CNRG) was published which gives a systematic and objective overview of the nursing rehabilitation interventions for stroke patients. Despite that knowledge, the recommendations of the CNRG-Stroke are hardly seen in practice. A multi faceted implementation strategy, recognizing barriers to implementation and focusing on facilitators, has been recommended for the implementation of nursing guidelines. Methods. A quasi experimental study was conducted with a convenience sample of 40 nurses, who worked on a neurology ward of a top clinical hospital, and 128 stroke patients admitted on this neurology ward during the study period. Results. The evolution strategy was chosen to implement the CNRG-Stroke. After the implementation process nurses showed a more positive attitude, competence improved significantly in the nutritional management, the Short Nutritional Assessment Questionnaire (SNAQ) was significantly more present. A significant change was found in nurses’ registration of risk of malnourished patients. There is a positive change in the way nurses conduct the SNAQ score and the appropriate interventions. The nutritional status of patients and SNAQ scores showed no significant change. There was a significant decrease in the number not taken SNAQ scores, length and weight. Conclusion. The study shows that the measurement and recording of a stroke patient’s nutritional status must claim the ongoing attention of nurses. The continuing education of nurses and other professionals will increase the awareness of the importance of nutritional management. This study shows that a tailored multifaceted implementation strategy was valuable because it enabled a reasoned, logical approach to the implementation of the CNRG-Stroke recommendations. Recommendations. With regards to the positive trend of the findings of this study a multicentre and longer implementation timescales may show significant improvements in the use guidelines. In relation to nursing practice, it is highly important that the nutritional management of patients needs be increasingly emphasised. Once nurses are working, the hospital management should facilitate ongoing education to improve the care and outcomes of all patients.