| dc.description.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. | |
