Nutrition Education improves

supplement distribution & fosters a

collaborative team approach for
optimal patient care
By: Jess Ansello, Dietetic Intern
ARAMARK Healthcare Distance Dietetic
Internship
Mentor: Siva Panchamoorthy,
MS. RD. CSG. LD.
Clinical Nutrition Manager
ABC Hospital
Research Question
Will a nutrition education on snacks and
supplements improve overall distribution of
these products to patients at ABC Hospital
and help to foster collaborative patient care?



Hypothesis
A provided in-service would increase the
knowledge and awareness of supplements and
snacks and help nurses better understand the
importance of distributing them. It is theorized
this education will lead to an increase in
snack/supplement distribution and nutritional
knowledge amongst the nursing department.
This intervention will begin to foster greater
collaboration amongst the departments.

How does this relate to
Emerging Trends in
Dietetics?
Recent studies have focused on this
team approach for optimal patient care
This has lead to more cross training
amongst departments
Studies have shown a reduction in
malnourishment due to an increase in
snack/supplement distribution



Introduction
ABC Hospital located in Massachusetts
Department of Public Health & Department of Mental
Health Units

Mission Statement: To provide comprehensive
treatment, care, and comfort to adults with medical
and mental illnesses

R.N. Nutrition screening: within 24 hours of admission
(Joint Commission standard)
R.D. will see patient within 2 days (if + trigger)
R.D. will determine coding for assessment, diagnosis,
intervention, monitoring & evaluations

Intervention: Supplements, based on needs
Examples: Snacks (puddings, yogurts, juices,
crackers)
Supplements (Ensure, CIB, TwoCalHN, Glucerna)

Distribution process: Patient Services delivers
supplements to designated units & nursing staff
distributes snacks/supplements to patients at
designated times (10am, 2pm & HS)

Problem: Units are not always distributing
snacks/supplements &
poor communication between departments
Literature Review Summary
Nurses lack nutrition knowledge, but have a
willingness to learn
Nutrition Educations improved nutritional
knowledge of Nursing staff and Medical
students as evidenced by improved post
test scores
Oral Supplementation showed a reduction in
malnutrition and therefore an improvement
in patients nutritional status
Geriatric population: desirable improvement
in nutritional status and protein and
kilocalorie intake
Nursing and dietetics collaboration lead
to increased intake of supplements by
patients and prevented unwanted food
waste

In this research study: It is theorized that
increased nutrition education of
snacks/supplements and their benefits will
improve the distribution of
snacks/supplements, improve post test
scores and foster interdisciplinary
communication between the nursing and
nutrition department

Methodology
Experimental Research Design
Initial Data Collection: Tally system over a 2
week period to determine which unit is in need
of nutrition education based on poor
snack/supplement distribution
Place of education: At determined Unit A3 at
ABC Hospital
Intervention: 20 minute Nutrition Education
Topic: Benefits of snacks/oral supplements
Emphasis on collaborative care, a team approach



Subject Recruitment: Convenience sample
Attributes: Medical professionals
Age: early 20s-50s
Years of medical experience: 1-20+ years
Job titles: Charge Nurse, Registered Nurse,
Nursing Assistant
1
st
Method of evaluation: Pre-test & Post-
test, Case study format, multiple choice
answers
2
nd
Method of evaluation: Tally system 3
rd

week to determine if focused unit has
improved in distribution of
snack/supplements

Resources: Educational session 20 minutes
in length (at one given time period)
Researchers presentation notes
Supplements for taste testing
Pens
Pre-tests and Post-tests

Statistical Evaluation: Quantitative data
Organized on Microsoft Excel & in Graph
Format

Simple statistical tests (mean) to
determine improvement in pre-test vs.
post-test scores

No funding will be needed for this project
Results
Pre-test averaged 35% and post-test
averaged 45%, showing an
improvement in scores after the
nutrition education.

0%
5%
10%
15%
20%
25%
30%
35%
40%
45%
50%
Pre-test Scores Post-test Scores
Graph I. Test Scores before & after
educational awareness session
0%
5%
10%
15%
20%
25%
30%
35%
40%
45%
50%
Pre-test Scores Post-test Scores
0%
5%
10%
15%
20%
25%
30%
35%
40%
45%
50%
Pre-test Scores Post-test Scores 0%
5%
10%
15%
20%
25%
30%
35%
40%
45%
50%
Pre-test Scores Post-test Scores
Results
3
rd
week of snack/supplement distribution
showed a vast improvement

4 vs. 11 to 12 snacks/supplements

Nursing Department:

Willingness to learn about nutrition topic
Increased lines of communication between
the nursing and nutrition department
Table 1. Fall 2013 Data Collection 1
st

week
Winter 2014 Data Collection 2
nd
week
Unit Week 1 Week 2
# of undistributed snack
bags
# of undistributed snack
bags
A3 12 11
C3 8 5
D2 6 4
D3 5 5
E2 3 6
E3 3 6
E4 1 8
Discussion
Finding of Results/Strengths:
Participants willing to learn nutrition information
Showed improvement in post-test scores
Showed improvement in snack/supplement distribution
Increased communication between departments
Hypothesis proven correct

Limitations
Small sample size (10 participants)
2
nd
nursing shift did not receive a Nutrition Education
Hectic schedules might have led to rushed answers &
falsely low test scores
Participants did not have to reiterate information, can
be useful in retaining information


Conclusion
How could this study be beneficial for future Dietetic
Practice?

Greater longevity
Ability to track patients nutritional success with
oral supplements

Case study design: focus on 1 patient before and
after nutrition supplementation
Data collection: anthropometrics, biochemical data

Add a component of food waste tracking to
determine if nutrition education would have an
impact

Continued series of educational sessions to ensure
constant communication between departments

References
Yalcin N, Cihan A, Gundogdu H, Ocakci A. Nutrition Knowledge Level of Nurses.
Health Science Journal.2013;7(1):99-108.
Harrtig KL, McCarthy MS, Perry N, Shannon J, Tindle D. Collaborative Nutrition
Initiatives Promote Enhanced Patient Outcomes. Nursing Currents. 2012;2(2):1-
12.
Roberts M, Potter J, McColl J, Reilly J. Can prescription of sip-feed supplements
increase energy intake in hospitalized older people with medical problems? BJM.
2003; 90:425-429.
Milne A, Avenell A, Potter J. Meta-analysis: protein and energy supplementation
in older people. American College of Physicians. 2006;144.
http://annals.org/article.aspx?articleid=719239. Accessed December 6, 2013.
Kowanko I. The role of the nurse in food service: A literature review and
recommendations. IJNP. 1997;3(2):73-78.
Kim H, Choue R. Nurses positive attitudes to nutritional management but limited
knowledge of nutritional assessment in Korea. Int Nurs Rev. 2009;56(3):333-9.
doi: 10.1111/j.1466-7657.2009.00717.x.
Barrett J, Gifford C, Morey J, Risser D, Salisbury M. Enhancing patient safety
through teamwork training. J Risk Mgmt. 2009;21(4):61-69.
Boaz M, Rychani L, Barami K, et al. Nurses and nutrition: a survey of knowledge
and attitudes regarding nutrition assessment and care of hospitalized elderly
patients. J Contin Educ Nurs. 2013;44(8):61-69. doi: 10.3928/00220124-
20130603-89.
Ray S, Udumyan R, Rajput-Ray M, et al. Evaluation of a novel nutrition education
intervention for medical students from across England. BJM. Open
2012;2:e000417. doi:10.1136/bmjopen-2011-000417.

Questions?