Abstract
Malnutrition has become an acknowledged problem in hospital patients, and certain patient groups including the elderly, patients with malignant disease, patients with diseases of the gastrointestional tract and those with multiple injuries have been recognised as being particularly at risk. An investigation into the role of the nurse in the nutritional care of patients, showed that they have a poor knowledge of the nutritional needs of their patients and pay little attention to those aspects of care which help patients to consume an adequate diet. The low priority given to the feeding of patients can be partly explained by changes in nursing structure, nursing education and organisation of care which have occurred over the last 50 years. If the nutritional care of patients is to improve, and the incidence of malnutrition decline, then nurses must learn some of the basic Nightingale principles and take responsibility for the nutritional status of patients under their care. A new Nutritional Care Programme was developed to provide nurses with the means of identifying nutritionally 'at risk' patients on admission to hospital, and to monitor the adequacy of their diet throughout the course of their clinical management. The Nutritional Screening Programme (NSP) developed to screen for 'at risk' factors in all patients admitted to hospital, was found to identify a similar group of patients to that identified by anthropometric and biochemical methods. Unlike these latter methods of assessment, the NSP could be used on a large number of patients, took a minimal amount of time, could be used by unskilled personnel and was cost effective. A dietary questionnaire and nutritional ready-reckoner was developed to monitor nutritional intake in 'at risk' individuals. The values for nutrient intake obtained by this new method of dietary assessment, were not significantly different from those obtained by the weighed inventory method. Where differences were found, these were not clinically significance. The Nutritional Care Programme provides nurses with the tools to become more involved and responsible for the nutritional care of their patients and also provides a means by which further nutritional knowledge can be gained.