Assessment of Nutrition Care, Food Service Quality, and Nutrition Status of Hospitalized Patients at Nakuru Level Five Hospital, Kenya

Abstract

Hospital malnutrition is a significant problem in both developed and developing countries. Globally, 462 million adults are undernourished (World Health Organization, 2014) whereas, malnutrition among adult patients within the hospital setting has been vastly reported to range between 30% and 50%. Hospital malnutrition is associated with many adverse outcomes including higher rates of infection, increased severity of illnesses, longer length of stays, increased health care costs, and higher mortality rates. Malnutrition is reported to be common amongst inpatients due to the poor quality of nutrition care and food service. Intensification of both nutritional care and food service quality is therefore required to reduce the prevalence of hospital-acquired malnutrition. The main objective of this study was to assess nutrition care, food service quality, and nutrition status of hospitalized patients in medical and surgical wards at the Nakuru Level Five Hospital, Kenya. A descriptive cross-sectional study design was used. Data was collected from Nakuru Level Five Hospital which was purposively selected. A total of 188 adult patients and 15 key informants were interviewed. The key informants included the chief nutritionist; nutritionists, nurses, and doctors from both surgical and medical wards; kitchen nutritionist, and chief cateress. Both the adult patients and the health care staff were consecutively and purposively sampled respectively. A consecutive sampling of the patients entailed every patient meeting the inclusion criteria being selected until the required sample size was achieved while the key informants were purposively sampled since they met the requirements of being health care staff and their roles were directly or indirectly related to the medical and surgical wards. Semi-structured questionnaires were used to collect data on demographic, socio-economic, education and household characteristics, and nutrition assessment, patient’s satisfaction with hospital food and food service and nutrition care services, patients experience and challenges, patient’s expectation of nutritionists, supplementation of hospital food and food frequency intake was collected. Key informant interviews were used to collect information from 15 health care staff on their perception and satisfaction levels on nutrition care and food service quality and basic factors that potentially affect nutrition status. The study participants were 188 patients; male patients were 103 (54.79%); with 49 (49.49%) and 54(60.67%) from the medical and surgical ward respectively. Females patients were 85(45.21%); with 50 (50.51%) and 35(39.33%) from the medical and surgical ward respectively. The results showed the majority of the patients had normal Body Mass Index (BMI) xvii 105(55.85%) and Mid Upper Arm Circumference (MUAC) 129(68.62%). However, nutrition assessment within the hospital setting was lacking and not prioritized as a fundamental routine exercise with only 24 participants (12.77%) having their weight taken at admission, this directly affected nutrition care quality. The mean length of stay for male respondents was significantly higher than female participants (p-value = 0.0027). The mean length of stay for patients at the surgical ward was longer compared to those in the medical ward, however, this difference was not significant (p-value = 0.0817). In addition, undernourished patients stayed longer in the hospital (mean length of stay of 4 weeks). The patients were satisfied with different aspects of food and food service. However, both patients 108(57.44%) and health care staff, 8(53%) of the health workers were dissatisfied with food variety and one major reason for supplementation of hospital food by patients was lack of variety with (60.11%) of the patients reporting this. Most of the patients (> 50%) had lower satisfaction with nutrition care quality particularly elements of nutrition care. Data from health care staff revealed there was a disconnect and poor collaborative working relationships among health care teams, less autonomous nutrition practice, poor patient-centered culture, inadequate staffing; less managerial support actions by the hospital administrations, and inadequate tools, equipment, and resources to ensure the quality of care. In conclusion, most patients had a normal nutritional status but nutritional assessment and screening were lacking. There was general satisfaction with food and food service but most patients and healthcare staff were dissatisfied with food variety. Most patients were also dissatisfied with the nutrition care services and there was a limited collaboration among the healthcare teams. Therefore, food service and nutrition care should be prioritized and recognized within the hospital as a fundamental part of any hospital routine. All health care teams should be involved in patient’s nutrition care and support. Therefore, emphasis on nutrition support teams, inter-disciplinary teams, patient-centered care culture, autonomy, and resource availability should be reinforced in both national and hospital guidelines and integrated within the institutional objectives and strategies as this will enable more positive patient experiences of food service and nutrition care.