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Protected mealtimes for adults with cancer in a hematology-oncology setting: an evidence-based implementation project
Benazir Naseer1, Solano S G Tan, Seri S Ramli
11National University Cancer Institute Singapore (NCIS), Nursing Evidence Implementation Group, Singapore 2Singapore National University Hospital (NUH), Centre for Evidence-Based Nursing: a Joanna Briggs Institute Centre of Excellence, Singapore.
Background:
Patients with cancer are often at risk or suffer from some form of malnutrition, which could be attributed to their disease progression or the adverse effects of cancer treatment. Protected mealtime and offering assistance during mealtime may not improve their nutritional status but would allow them to enjoy their meal and improve patient satisfaction.
Objectives:
The aim of this project was to promote best practice in protecting mealtimes in hematology-oncology patients.
Methods:
The current project adopted a clinical audit methodology using the Joanna Briggs Institute Practical Application of Clinical Evidence System tool. Four audit criteria that represent best practice recommendations for protected mealtimes were used. A pre-implementation audit was conducted followed by introduction of multiple interventions identified from the Getting Research into Practice analysis. A post implementation audit was conducted to determine the change of practice. In addition, a sustaining audit was conducted at six months after implementing the follow-up plan.
Results:
The four criteria showed an improvement: nurses ensured a pleasant eating environment around the patient cubicle (from 43% to 93% compliance), all nurses received education on mealtime care (no change - 100% sustenance), nurses conducted an assessment of the patients on admission on their ability to eat (from 95% to 100% compliance) and minimized unnecessary clinical interventions during mealtimes (92% to 89% compliance). The decline of 3% in the compliance rate of the last criterion could be attributed to the high turnover of patients during the post implementation audit period. The post implementation results at six months showed audit results being sustained at 100% compliance in all criteria.
Conclusion:
The results of this project demonstrated that improvement in best practice is possible in a busy oncology ward in the presence of great leadership, teamwork, empowerment and role modeling.