Evidence-Based Management of Elderly Malnourished Patients in Hospital

This essay discusses evidence-based practice in adult nursing, specifically focusing on the management of malnourished elderly patients. It begins by defining evidence-based practice and its importance in improving patient outcomes. The essay then details the literature search process, including databases used (PubMed, SpringerLink, NCBI, NICE) and search terms. It further elaborates on the NICE database and its reliability for data collection. The discussion section addresses malnutrition in elderly patients, its causes, and the role of adult nursing in providing quality care. The essay highlights the importance of addressing malnutrition to prevent adverse health outcomes and improve the well-being of elderly patients. The assignment concludes by emphasizing the integration of research evidence, clinical expertise, and patient values in effective nursing practice.

Introducing evidence based
practice for nursing Adult
Nursing

Table of Contents
INTRODUCTION...........................................................................................................................1
SEARCH..........................................................................................................................................2
DISCUSSION..................................................................................................................................3
CONCLUSION................................................................................................................................6
IMPLICATION OF PRACTICE.....................................................................................................6
REFERENCES................................................................................................................................8
APPENDICES.................................................................................................................................9

INTRODUCTION
Evidence based practice is defined the integration of the best research which is based on
evidence with the clinical expertise and the value of patient. In this, when they are applied by the
healthcare professional which help to lead ultimately that helpful to improve the patient outcome.
In the original model, there are some of the fundamental aspect are followed which have three
components that help to improve and balance the flow of evidence based practice which worked
as model in the healthcare setting. Moreover, there are some of the best evidence which is
usually found in clinically relevant research that has been conducted using the methodology.
Clinical expertise that is refers as the clinical cumulated education and experience which is based
on the various nurses that provide different knowledge that is based on the clinical skills.
Moreover, the patient value which show the unique preference that allow the user to make the
concern which is associated with the patient to a clinical encounter. However, the integration of
these three component that defined as the clinical decision evidence based on the various aspect
of knowledge and skills (Berg-Weger and et. al., 2020).
This is effective and tend to follow the various aspect which is related with the integration
that is effective achieved by carrying out the five following step which is associated with the
evidence based practice. There are some of example which is associated with evidence based
practice in the daily practice of the nursing. Infection control which is predominantly used in the
healthcare setting which help to promote when the hospital for the treatment is the hospital
acquired infections (Rabi and et. al., 2020). Oxygen is usually used in the patient who is
suffering from the COPD is also an aspect which is followed by nurses in order to monitor and
inspect. This is also a relevance which prepared and based on different aspect which follow the
terms and behaviour that provide effectiveness in evidence based practice. Moreover, the main
aim and the purpose of the evidence based practice is to use of the best evidence that is available
to make the patient care decision. Most of the best evidence which have the stem from the output
of research beyond the research which mainly include the clinical expertise as well as the patient
preference and their values. In this report, the discussion is based on the various aspect of
evidence based practice which is follow under the adult nursing (Fardell and et. al., 2018).
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SEARCH
The major of the search term which is used within the evidence based practice is helpful in
making the understanding towards the search strategy. There are various of database are used
which mainly include PubMed, SpringerLink, NCBI, NICE and many more which is useful and
helpful to promote the search behaviour within the normal range which is based on the evidence
based practice. The adult nursing is the vast topic which is prepared by the healthcare setting
with the main motive which is helpful to promote the improvement within the healthcare setting
which is based on quality of life and quality of care (Farrell and et. al., 2017). The search
strategy is helpful and play a vital role in the implementation of evidence based strategy within
the healthcare helpful to improve the practice which is associated with the healthcare
professional which include doctor, nurse practitioner and many more. As per this, there are
various aspect which is followed under various circumstance that follow with the various aspect
with the measurable and accountable strategy of search. In order to perform a literature review
which basically involve the searching and compiling of the article which is based on the various
database. It is usually carried out with the identification of knowledge gaps in the various
particular way that is helpful and generate the aspect which is based on evidence based practice
towards the adult nursing (Mangin and et. al., 2018).
The search strategy which is based on the various background in the study, support
methodologies and provide the context or the comparison which is based on the discussion and
many more. One of the essential reason which is based on the literature search is to carry enough
information which is helpful to formulate the valid research question which is applied in the
evidence based practice is that they need and concept which create the understanding of topic
and their essentialities within the healthcare setting. The NICE database have several information
which comes under the collective feature which is related with evidence based practice with the
aspect of adult nursing (Mariam and et. al., 2017).
With contrast with the search strategy, there are major of database which is used to follow
various method that show the aspect and reliability which is productive and reliable for the
prominent search. In this, the NICE database is probably reliable and validated databased for the
collection and the selection of data in the appropriate ways (Mathieson and et. al., 2019).
A search strategy can refer to the organisational structure that can be effective in
delivering of effective database management. This can include the key concepts for the search
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question that can provide accurate results. This can include the search that can allow the possible
terms along with keywords and phrase. This also includes the subject heading and search terms
that can be effective and allow to deliver the needed information to implement the search with
more efficient manner. In this, there are various database for which there is need to adapt
different search strategy for every database. This can include different search strategies which
research covers within different area. In this, to search the effective database for the collection of
information that can allow to perform the research in effective way. In this, there is need to
ensure about using the search terms which can be able to search different keywords that can
allow to deliver the effective results. for effective response search strategy can used through
adopting the searching for exact phrases and may include the searching subject headings and
others. Through suing different synonyms terms it can allow to use the most prominent database
which can be effective and allow to provide better information related to the research terms and
topics (Erickson, 2020).
PICO model can also allow to get help in the search concept that can be effective and allow
to deliver the effective information through using database. This can have extra implication for
securing the data and prominent information that can be reliable for inducing effective data
regarding the search terms. This model can be effective and allow to provide better and effective
response toward the search terms for the efficient search techniques (Stuart, 2018). This may
include the search strategies through using the combination of text and subject headings.
Adult nursing term is vast in nature which can implement the effective response for better
collection of data that allow to deliver the quality information that can help in getting better and
effective response through using database (Ribbink and et. al., 2019). Adult nursing should
ensure about different search term which can includes the information that can provide efficient
information regarding the enrolled information within database. Through using the effective
search strategies can provide efficient information regarding prominent data for effective
gathering of data through using different search terms for the better and effective response
towards the research.
DISCUSSION
Adult nursing is highly effective in delivering healthcare services to the elderly patient
where they are eligible to delivery required quality of care and services to the elderly patient for
their better and improved health. The malnutrition generally occurs when the people does not
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consume a diet which gives them with an appropriate quantity as well as the balance of the
required nutrients. The reduced quality of diet is particularly linked with the variety of adverse
well-being issues such as dysfunctionality of immune system, reduced density of bone, the heart
related illness, anaemia and many other illnesses. The malnutrition is specially concerning
among older adults due to various factors which can enhances the susceptibility, containing the
chronic illness, the loss of appetite, the side effects of the drugs used which are resulting from the
impaired sense of both taste as well as smell (Lelli and et. al., 2019). Reduced cognition, the
socio-economic factors and the psychological modifications which can occurs at the part of
ageing process. There are varieties of the strategies which have been improved to aid treat as
well as prevent the malnutrition. There are particular things which commonly includes the diet,
the supplements of nutrition, the meal delivery programs, the education as well as counselling
about nutrition. There are various interventions which are available as well as there are
uncertainty around which of these such programs that are specifically offered towards the older
people who are residing in the community and generally have been assessed as at the risk of
developing devoid of nutritional or it can be diagnosed as malnourished (DIMARIA-GHALILI
and COATES, 2021). It has been estimated that about 3 million people in the UK are
particularly comes under the category of poorly nourished or at the greater risk of becoming so,
with most 93% are preferably living at homes.
The prevalence of the undernourished among the older people can varies by setting as well
as has been reported in a meta-analysis of about 240 studies as approximately about 3% of them
among the community dwelling the older people, about 6% among those are attending the
outpatients as well as 8.7% in between those who are receiving the home care services, but with
considerable heterogeneity among the analysis (Häseler-Ouart and et. al., 2021). The
malnutrition is generally greatly prevalent in the care organizations and an excavation
determination of the information from the older adults including the age 65 years and above in
the care organizations across the countries reported that 39% were at the risk of undernourished
(Guinhut and et. al., 2021). The nutritional status is particularly estimated to be worsened during
the admission in the care organization that is approximately about 60 % of the older people for a
variety of reasons containing the impacts of its acute illness, the cognitive impairment due to
dementia. It can also involve the reduced moods as well as medications, the reduced dentitions,
the low appetite.
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The prevalence of the undernourished among the care homes are also great with the estimate
range from 14% till 30%. In this, the causes of the undernourished among the older adult patients
are specifically multifactorial. The decreased sensations of taste and smell as well, the reduced
appetite, an altered dietary choice as well as the habits can particularly contributes towards the
insufficient intake of dietary components (Tarazona-Santabalbina and et. al., 2019). An acute
illness as well as the medications can generally exacerbate the anorexia, the impairments of the
visual as well as the gastrointestinal conditions. In this, the nutritional within the older adults
may be influenced by their living as well as eating alone, access to shops, the caring for their
specific partners, capability as well as motivation towards cook and many other (Gritsenko and
et. al., 2020). In this, there are various psychological factors which can involves the depression,
dementia, loneliness is specifically recognized to have a bad impact over the dietary intake
among the older adults in all the settings. The undernourished patients generally involve a
serious consequence such as the well-being, society and the social care services. Adult nursing
staff should ensure about the delivery of care and services which can be effective in delivery of
quality care for better health for the elderly patient with malnourishment. The undernourished is
particularly linked with the enhanced risks of the frailty, the falls, dependence on the daily
activities, the admissions in the care organization and many others. In addition to this, based on
the partly as well as limited conflicting information and the limitations of the existing analysis
above, it still remains unclear which of the following interventions are specifically most effective
among which of the following groups of patients (Burgos and et. al., 2020).
It can also involve some of the specific situations or conditions such as acute
undernourished, the specific illnesses such as dementia or it can involve the specific aetiologies
of the undernourishment can need the most specific approaches. In this, the etiologic relevance
of various different potential causes as well as therefore, the priority of different diagnostic
measures will remain unclear. The treatment is specifically based on the individually identified
causative factors is probably only very rare performed. It can involve more knowledge about the
most relevant causes as well as their most common pathophysiology would enhance the potential
for causation-oriented treatments. In addition to this, it can contribute to increase the awareness
of undernourishment as well as its preventive approaches among the older patients with their
respective issues (Saffel-Shrier, Johnson and Francis, 2019). In regarding to the most general
characteristics of intervention, an individualised, the multi-modal as well as the multi-
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disciplinary strategies which seems to be promising and must be pursued further. In this, in terms
of the very particular interventions, the fortification of the foods, extra snacks as well as the
finger food components are quite promising options but it can require elevated quality
reassessment through various other analysis which specifically provides the more reliable
information. In this, the possible aiding impacts of all the various kinds of food change
containing an organoleptic improvements or the change in texture requires to be tested in
explorative trails and in resultant sufficiently powered elevated quality of trails. Further studies
are also required to determine which of the following methods of delivering the counselling of
dietary are more appropriate as well as the cost effective for various different participants and the
care settings as well (Martínez-Velilla and et. al., 2021).
CONCLUSION
From the above discussion, it can conclude that there is need for effective management of
the elderly malnourished patient for better and effective response where adult nursing plays an
important role in delivery of care services and better improvement of individual health. In this,
there are different search strategy has been used to reach the database for effective data
collection. This can be effective and allow to deliver the effective management strategy that can
allow to deliver the effective and better health for the elderly patient. In this, to effectively
managing the elderly malnourished patient, there is need to ensure about the psychological factor
which may include the depression, loneliness, dementia while dietary intake for better health of
patient within adult nursing. This includes the information about the serious consequences when
adult nursing is not effect provided to the elderly patient with malnourishment. In this, there is
discussion about different factors which can includes the factor and different consequences that
can be there when adult nursing is not provided for the management of elderly malnourished
patient who is admitted within hospital. There is also discussion about the most effective
management strategy that can be highly effective to deliver better healthcare and treatment to get
rid form any issue that can cause different negative impact on the elderly patient with
malnourished. It also concludes that when adult nursing is not implemented for better delivery of
care then there can be various serious consequences can arise which can have negative impact on
patient social care services, on society and well-being.
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IMPLICATION OF PRACTICE
Through implementing the adult nursing, there is high positive impact on the patient health.
This allow to deliver the quality service to the patient through taking care about the better
practice that can enable them to deliver the quality services within hospital. This is effective and
allow to provide better implication of nursing intervention that may include psychological factor
which have high impact on the patient health. This can allow to deliver the effective response for
the better delivery of services through using the adult nursing. Adult nursing concept is highly
effective where nursing staff can effectively get enable to take care of adults where patient is
above 18 and they should have the effective response and experience within delivery of
healthcare services and care for better health improvement within hospital. There is implication
about focusing on the improvement of appetite. There is also implication of drug which are
effective and create different taste that affect individual taste along with smell. There is also
different implication of results that can be effective and allow to deliver the better and effective
response. This can allow to provide better impact and deliver quality services. There is also
implication of different methods which can be effective and allow to manage the medical
condition more effectively. Through using the adult nursing, nursing staff are able to take care
about the social impact along with psychological perspective which are effective and can
influence patient health through implication of different strategy for providing better health and
wellbeing.
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REFERENCES
Books and Journals
Berg-Weger and et. al., 2020. Loneliness and social isolation in older adults during the Covid-19
pandemic: Implications for gerontological social work.
Burgos, R and et. al., 2020. Disease-related malnutrition in hospitalized chronic patients with
complex needs. Clinical Nutrition, 39(5), pp.1447-1453.
DIMARIA-GHALILI, R.A. and COATES, M.C., 2021. Malnutrition and Feeding
Problems. Ham's Primary Care Geriatrics E-Book: A Case-Based Approach, p.284.
Erickson, K.L.B., 2020. Innovations in care of the elderly hip fracture patient; a nightmare no
more. Nurs Clin North Am, 55, pp.149-161.
Fardell and et. al., 2018. Narrative review of the educational, vocational, and financial needs of
adolescents and young adults with cancer: recommendations for support and
research. Journal of adolescent and young adult oncology, 7(2), pp.143-147.
Farrell and et. al., 2017. Deprescribing antihyperglycemic agents in older persons: evidence-
based clinical practice guideline. Canadian family physician, 63(11), pp.832-843.
Gritsenko, K and et. al., 2020. Preoperative frailty assessment combined with prehabilitation and
nutrition strategies: Emerging concepts and clinical outcomes. Best Practice & Research
Clinical Anaesthesiology, 34(2), pp.199-212.
Guinhut, M and et. al., 2021. Extremely severe anorexia nervosa: hospital course of 354 adult
patients in a clinical nutrition-eating disorders-unit. Clinical Nutrition, 40(4), pp.1954-
1965.
Häseler-Ouart, K and et. al., 2021. Geriatric assessment for older adults admitted to the
emergency department: A systematic review and meta-analysis. Experimental
Gerontology, 144, p.111184.
Lelli, D and et. al., 2019. Nutritional status and functional outcomes in older adults admitted to
geriatric rehabilitations: the SAFARI study. Journal of the American College of
Nutrition, 38(5), pp.441-446.
Mangin and et. al., 2018. International Group for Reducing Inappropriate Medication Use &
Polypharmacy (IGRIMUP): position statement and 10 recommendations for
action. Drugs & aging, 35(7), pp.575-587.
Mariam and et. al., 2017. Prevalence of diabetic foot ulcer and associated factors among adult
diabetic patients who attend the diabetic follow-up clinic at the University of Gondar
Referral Hospital, North West Ethiopia, 2016: institutional-based cross-sectional
study. Journal of diabetes research, 2017.
Martínez-Velilla, N and et. al., 2021. Effects of a Tailored Exercise Intervention in Acutely
Hospitalized Oldest Old Diabetic Adults: An Ancillary Analysis. The Journal of
Clinical Endocrinology & Metabolism, 106(2), pp.e899-e906.
Mathieson and et. al., 2019. Strategies, facilitators and barriers to implementation of evidence-
based practice in community nursing: a systematic mixed-studies review and qualitative
synthesis. Primary health care research & development, 20.
Rabi and et. al., 2020. Hypertension Canada’s 2020 comprehensive guidelines for the prevention,
diagnosis, risk assessment, and treatment of hypertension in adults and
children. Canadian Journal of Cardiology, 36(5), pp.596-624.
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Ribbink, M.E and et. al., 2019. Determinants of post-acute care costs in acutely hospitalized
older adults: the hospital-adl study. Journal of the American Medical Directors
Association, 20(10), pp.1300-1306.
Saffel-Shrier, S., Johnson, M.A. and Francis, S.L., 2019. Position of the Academy of Nutrition
and Dietetics and the Society for Nutrition Education and Behavior: food and nutrition
programs for community-residing older adults. Journal of nutrition education and
behavior, 51(7), pp.781-797.
Stuart, E., 2018. Physical, social and psychological causes of malnutrition in older adults. Journal
of Community Nursing, 32(1), pp.14-16.
Tarazona-Santabalbina, F.J and et. al., 2019. A daily multidisciplinary assessment of older adults
undergoing elective colorectal cancer surgery is associated with reduced delirium and
geriatric syndromes. Journal of geriatric oncology, 10(2), pp.298-303.
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APPENDICES
Date
Searched
NICE
database
Search Strategy
Used
(Keywords,
phrases, subject
terms)
Limits
(Date,
Filter
Source,
etc.)
Evidence Type
(Guidance and
Policy,
Primary
Research, etc.)
No. of
Results
Notes
Last month Evidence based
practice in adult
nursing.
Evidence based
practice in
nursing.
Role of evidence
based practice in
the nursing
Date- last
five years.
Source-
NICE
handbooks
Guidance-
provide the
aspect which is
beneficial for
evidence based
practice.
17651 Evidence based
practice are used
in healthcare
setting by adult
nurses to improve
the quality of
health and life.
10