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health science journal ealth science journal h short research article keywords clinical nutrition nurses knowledge nutrition knowledge level of corresponding author nurses nurdan yalcin stanbul universitesi hemirelik fakultesi abide i ...

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              HEALTH SCIENCE JOURNAL                                                                                              
                EALTH SCIENCE JOURNAL 
              H                                                                                                                   
                                              SHORT RESEARCH ARTICLE            
                                                                               Keywords: Clinical nutrition, nurses, knowledge 
              Nutrition Knowledge Level of                                      
                                                                               Corresponding author: 
              Nurses                                                           Nurdan Yalcin 
                                                                               İstanbul Üniversitesi Hemşirelik Fakültesi Abide-i Hürriyet 
                              1               2                                cad. 34381 Şişli / İstanbul  
              Nurdan Yalcin  , Alper Cihan  , Haldun Gundogdu                  E-mail: yalcinnur@yahoo.com
              3               4
               , Ayse Ocakci    
              1.  Research Assistant, Msc, Istanbul University, 
                  Nursing Faculty, Istanbul  
              2.  Professor, Director of Distance Education 
                  Department, Istanbul University 
              3.  Associate Professor, Surgery Department of 
                  Ataturk Teaching Hospital, Ankara  
              4.  Professor, Marmara University Faculty of 
                  Health Sciences, Istanbul 
                   
              Abstract 
              Background:  Concern  is  growing  about  the 
              malnutrition,      nutrition     therapy      and     its 
              complications. Reduced involvement of nurses in 
              patients’  nutritional  care  may  be  one  of  the 
              contributing factors. The most common cause for 
              insufficient   nutritional    practice    is   lack   of 
              nutritional knowledge. 
              The  purpose  of  the  study  was  to  determine 
              knowledge-based  nutrition  competencies  of 
              nurses. 
              Method  and  Material:  A  sample  of  302  nurses 
              from  different  hospitals  in  Zonguldak  in  Turkey 
              and  who  were  selected  randomly  completed  a 
              questionnaire.  
              Results: The mean clinical nutrition knowledge of 
              all participants was obtained as 49.44±10.95 over 
              100  points.  Nurses  who  conducted  nutritional 
              assessment activities had a statistically significant 
              higher knowledge scores compared to the those 
              who did not (p=0.012). 
              Conclusions:  The  nurse  education  institutions 
              should  review  their  curriculum  regarding  the 
              education about clinical nutrition and a systematic 
              continuing nutrition education program should be 
              arranged. 
               
              Yalcin N, Cihan A, Gundogdu H, Ocakci A. Nutrition Knowledge Level of Nurses.Health Science Journal.2013;7 (1):99-108 
                                                                                                                             Page | 99 
             HEALTH SCIENCE JOURNAL                                                                                        VOLUME 7 (2013),ISSUE1 
              EALTH SCIENCE JOURNAL                                                                                        
             H                                               
                                                                         applying, assessing, caring nutrition. in addition to 
             Introduction                                                routine patient care such as the administration of 
                         alnutrition is a crucial health problem         ordered therapies, following-up and monitoring of 
                         that  often  occurs  even  in  healthy          vital  signs.  However,  many  studies  showed  that 
             M 
                         societies,  but  it  occurs  much  more         nurses   have    inadequate    knowledge  about 
             frequently  among  hospitalized  patients  and                       2,6,7,9-11
                                                                         nutrition.        It  was determined that nutrition 
                    1
             elders.   Reduced  involvement  of  nurses  in              was not sufficiently in the curriculum of nursing 
             patients’  nutritional  care  may  be  one  of  the         schools, and it seems that generally this subject is 
             contributing factors. The most common cause for                                                         2,4,9,12
                                                                         not considered seriously in health services.      It 
             insufficient  nutritional  practice   is   lack  of         was also stated that lack of knowledge regarding 
             nutritional   knowledge.2,3   The    health    care         nutrition,  the  rates  of  monitoring  malnutrition 
             professionals are required to have knowledge and            were  low  and  the  nutritional  requirements  of 
             skills  about  nutrition  and  should  be  capable  to      patients were not adequately provided.4,2  
             prevent  the  deterioration  of  nutrition  and  have       In many studies physicians and nurses were found 
             the  ability  to  cure  the  formed  malnutrition.2         to   have   insufficient   levels  of   nutritional 
             Recognition  of  malnutrition  and  initiation  of          knowledge and that there was a great need for 
             adequate  nutritional  support  care  of  critical                                             2,3,4,10-17
                                                                         nutrition education for along time.        
             importance in general clinical care. Nurses, who               As  there  are  only  few  published  data  about 
             provide  holistic  care  for  patients  to  promote         nutritional knowledge of nurses in Turkey, the aim 
             recovery from illness in clinical settings,  should         of  the  current  study  was  to  determine  the 
             provide  appropriate  nutritional  care  to  their          nutrition knowledge level of the nurses working at 
             patients. Considering nurse role as primary care            three hospitals in Zonguldak, Turkey. 
             providers,  nurses  are  in  the  best  position  to         
             ensure good nutrition for a patient. Appropriate            Method and material  
             knowledge and sincere concern about nutritional             The  research  was  conducted  among  randomly 
             care  by  nurses  is  necessary  to  improve  the           selected  302  nurses  working  in  three  major 
             hospitalized  patient’s  nutritional  status  and  to       hospitals in Zonguldak, Turkey. The research data 
             prevent malnutrition. Florence Nightingale (1859)           were collected by means of a questionnaire. The 
             suggested  nurses  to  take  special  care  about           questionnaire was developed specifically for this 
             nutrition,  too.  She  said  that  ''Every  careful         study, based on literature and professional clinical 
             observer  of  the  sick  will  agree  with  this,  that     experience. To test face validity, content validity 
             thousands of patients are annually starved in the           and  clarity,  5  specialists  in  the  field  of  clinical 
             midst  of  plenty  from  want  of  attention  to  the       nutrition  in  Turkey  who  are  members  of  the 
             ways which alone make it possible  for them to              educational  committee  of  Turkish  Society  of 
             take food. I would say to the nurse, have a rule of         Parenteral  and  Enteral  Nutrition  were  asked  to 
             thought about your patient's diet. Consider and             judge  whether  the  questions  appeared  to  be 
             remember how much he has had and how much                   reasonable, covering relevant and important data 
             he  ought  to  have  today''.  This  is  a  common          with  clarity.  This  resulted  in  minor  linguistic 
                                      2,4-8
             opinion of many writers.                                    changes  and  layout  changes.  A  pilot  test  was 
                Since malnutrition is a serious factor affecting         conducted  with  eight  nurses  who  were  not 
             the  disease  process,  nutritional  and  metabolic         involved  in  the  study,  but  worked  in  the  same 
             support  should  be  a  continuous  and  important          areas.  On  the  basis  of  their  comments,  the 
             part of patient care.  A nurse is responsible for           questionnaire was revised for clarity and ease of 
             observing food intake, assessing nutritional status         use.  
             of patients, giving education about nutrition, and 
              
             Published by Department of Nursing A , Technological Educational Institute of Athens 
                                                                                            E-ISSN:1791-809x │ hsj.gr       Page | 100 
             HEALTH SCIENCE JOURNAL                                                                                 
              EALTH SCIENCE JOURNAL 
             H                                                                                                      
             The questionnaire contained three sections. In the        questions were answered correctly by more than 
             first  section  there  were  questions  about  the        70.0% of the nurses (questions 9 and 17) while 3 
             demographic  characteristics,  the  history  of           questions  were  answered  by  less  than  20.0% 
             education  and  practices  in  institutional  and         (questions  10,  11,  16).  The  best  known  item 
             working areas of the applicants.  In the second           (answered  correctly  at  the  highest  rate)  by  the 
             section,  opinions  relating  to  basic  subjects  in     nurses was that “symptoms of catheter infection” 
             clinical  nutrition  were  to  be  expressed.  In  the    (79.5%). This was followed by the enteral access 
             third section, 20 multiple choice questions were          types  (72.5%),  and  the  nutrition  support  team 
             asked  under  5  main  sections  to  assess  the          (68.2%). 
             attitudes and knowledge of nurses about clinical             The  nurses  involved  in  the  research  had  the 
             nutrition; the assessment of the nutritional status       least  knowledge  about  the  complications  of 
             of  the  patient,  planning  nutritional  support,        enteral  nutrition  support  (17,2%).  Two  other 
             practicing  nutritional  therapy,  and  observation       items that nurses had little knowledge about were 
             and   assessment  of  the  patient  receiving             that  enteral  nutrition  support  methods  (18,9%) 
             nutritional support.                                      and      osmolarity      rates     to      prevent 
                The Medical Ethics Committee of the Research           thromboembolism in periferic vens (19,5%). 
             and  Training  Hospital  of  University  of  the             The    nurses   who  conducted  nutritional 
             Zonguldak Karaelmas gave their approval. Consent          assessment  activities  had  a  greater  knowledge 
             also was obtained from the director of the nursing        score (52.42±15.7) than who did not (47.54±16.4) 
             department and ward nurse managers.                       (p=0.012, Table 2). It was observed that the higher 
                After the data was transferred to the “SPSS for        knowledge level of the nurses is, the more they 
             Windows”  program,  the  knowledge  scores  of            examined patients and noticed malnutrition. 
             participants were calculated over 100 and mean               The  educational  status  and  the  knowledge 
             values  were  displayed  as  “arithmetic  mean±           scores  of  the  nurses  were  presented  in  Table3. 
             deviation”.  The  achieved  results  were  analyzed       Nurses,  who  had  graduate  degree  (32.1%), 
             with the ANOVA One Way Post Hoc Tukey Test,               obtained  the  highest  score  with  54.37±14.04. 
             Correlation  Pearson  Test,  and  Student-t  Test         There  was  statistical  significance  among  the 
             between  groups  with  the  interval  of  95%             groups  (p=0.000)  and  it  was  observed  that  the 
             confidence.                                               difference  was  result  from  the  low  knowledge 
                                                                       scores of the secondary graduates. 
             Results                                                      There was no statistically significant difference 
             The  average  age  of  respondents  was  27.9  ±5.5       between     nutrition   knowledge    scores    and 
             years,  with  the  majority  of  respondents  aged        attending  a  nutrition  course  during  formal 
             between 23 and 30 years. Thirthy-four per cent of         education (p=0.289, Table 4).  
             nurses had an undergraduate degree and 32.2 % a              One hundred and twenty nine nurses (47 %) 
             graduate  degree.    Most  of  the  respondents           believed  that  nutrition  education  was  not 
             (47.35%)  had  been  working  as  a  nurse  for  0-4      considered important in nursing schools. Also one 
             years.                                                    hundred and forty four nurses (42%) stated that 
                The   mean  nutrition  knowledge  of  all              they completely agreed with the presence of the 
             participants  was  obtained  as  49.44±10.95  over        relation between diseases and nutrition. 
             100  points.  Questions  asked  and  percentage  of       Only one nurse (0.3%) had nutrition knowledge by 
             nurses with correct answers was given in Table 1.         participating  some  certification  programmes. 
             As  can  be  seen  in  Table  1,  only  2  of  the  20    Eighteen  nurses  (6.0%)  explained  that  they  had 
              
             Yalcin N, Cihan A, Gundogdu H, Ocakci A. Nutrition Knowledge Level of Nurses.Health Science Journal.2013;7 (1):99-108 
                                                                                                               Page | 101 
                   HEALTH SCIENCE JOURNAL                                                                                                                         VOLUME 7 (2013),ISSUE1 
                     EALTH SCIENCE JOURNAL                                                                                                                         
                   H                                                                      
                   their knowledge by reading academic publications                                            The knowledge level of nurses was found to be 
                   and attending meetings. Most of the nurses (59.3                                        higher  (p=0.006)  due  to  the  nutrition  education 
                   %) explained that they had their knowledge from                                         received and higher level of professionalism in the 
                   their  experience.  The  others  (34.4%)  had  “no                                      application of their knowledge, when there was a 
                   knowledge” in this field  (Table  5).  No  statistical                                  nutrition  team  in  hospital  they  work. Yet,  the 
                   significance  was  found  between  these  results                                       increase in knowledge scores was not found to be 
                   when the one nurse who had participated in a                                            in  correlation  with  the  increase  in  professional 
                   course was excluded (r =0.080).                                                         experience. Crogan and Evans6 also reported that 
                       There  was  no  significant  difference  between                                    clinical experience didn’t increase the level of the 
                   years of nursing experience and clinical nutrition                                      nutritional  knowledge  and  it  was  showed  that 
                   knowledge scores (p=0.827, Table 6).                                                    there was a correlation between the educational 
                       It    was  observed  that  nurses  working  in                                      substructure and the nutrition knowledge score.  
                   hospitals  which  had  a  nutrition  team  reached                                      Long-term nursing experience without any special 
                   53.11±1.4,  whereas  nurses  working  in  hospitals                                     education  on  nutrition  and  with  no  working 
                   which  had  not  a  nutrition  team  reached                                            experience  in  this  field  does  not  increase  the 
                   47.59±1.24  and  the  differences  between  the                                         nutrition  knowledge.  When  examined  from  a 
                   groups were statistically significant (p=0.006).                                        general  point  of  view,  a  difference  in  clinical 
                                                                                                           nutrition level could not be found between nurses 
                                                                                                           having worked four years vs. 20 years. In contrast, 
                   Discussion                                                                              a  majority  of  the  nurses  explained  that  they 
                   In the current study, the mean general knowledge                                        gained  their  knowledge  about  clinical  nutrition 
                   score was 49.44±10.95 per cent. It was also shown                                       from  their  professional  experiences.  This  may 
                   by  various  authors  that  nurses,  had  a  poor                                       emphasize  that  education  is  better  than 
                   knowledge  of  nutrition  Schaller  and  James18                                        conventional clinical experience when it comes to 
                   reported a mean score of 60 per cent (SD = 8.4)                                         clinical nutrition. 
                   for  Australian  nurses.  Crogan  et  al.,9  reported  a                                    However,  many  other  studies  showed  that 
                   mean score of 60 per cent (SD =11). Warber et                                           nurses        have       inadequate           knowledge  about 
                   al.,10 reported a mean score of 66 (SD = 8). Given                                      nutrition recommended that there is a need for 
                   the previous research, the mean knowledge score                                         increased  nutritional  nursing  knowledge  and 
                   of  nurses at 49.44 per cent must be considered                                         nutrition  education  should  be  emphasised  in 
                   low to moderate.                                                                        nursing-school            programs           and            continuing 
                                                                                                                          2,11,16
                       Nurses who conducted nutritional assessment                                         education.               
                   activities had a greater knowledge score than who                                           In the opinion of 47.7% of the nurses surveyed, 
                   did not (p=0.012). It was observed that the higher                                      nutrition was not given enough importance during 
                   knowledge level of the nurses is, the more they                                         their  education  in  Turkey.  Without  a  good 
                   examined  patients  and  noticed  malnutrition.                                         knowledge            base        nurses         cannot          provide 
                   Similar  to  these  findings  Crogan  and  Evans6                                       appropriate nutritional.19 It is apparent that there 
                   expressed          in     their      study       that       nutritional                 has been too little emphasis on clinical nutrition in 
                   assessment activities were directly correlated with                                     Turkish universities. 
                   the knowledge about nutrition.                                                              Different  studies  showed  the  inadequacy  of 
                       Nurses with higher education levels achieved                                        education  regarding  nutrition  in  medical  and 
                   higher  scores  than  others  (p=0.001).  This  was                                     nursing  programs  and  the  requirement  of 
                   similar  to  the  findings  of    Crogan  et  al.,9  and                                expanded content of nutrition in the curricula.12,15 
                                       11
                   Özcelik et al.,                                                                         Nutrition  education    is  less  emphasized  in  the 
                                                                                                           nursing  college  and  only  a  few  colleges  offered 
                    
                   Published by Department of Nursing A , Technological Educational Institute of Athens 
                                                                                                                                       E-ISSN:1791-809x │ hsj.gr       Page | 102 
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...Health science journal ealth h short research article keywords clinical nutrition nurses knowledge level of corresponding author nurdan yalcin stanbul universitesi hemirelik fakultesi abide i hurriyet cad ili alper cihan haldun gundogdu e mail yalcinnur yahoo com ayse ocakci assistant msc istanbul university nursing faculty professor director distance education department associate surgery ataturk teaching hospital ankara marmara sciences abstract background concern is growing about the malnutrition therapy and its complications reduced involvement in patients nutritional care may be one contributing factors most common cause for insufficient practice lack purpose study was to determine based competencies method material a sample from different hospitals zonguldak turkey who were selected randomly completed questionnaire results mean all participants obtained as over points conducted assessment activities had statistically significant higher scores compared those did not p conclusions ...

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