Nurses’ views and practices regarding use of validated nutrition screening tools

Abstract

Objective: To explore nurses’ views and practices regarding use of the Malnutrition Screening Tool (MST) and the Malnutrition Universal Screening Tool (MUST) in acute hospital wards.

Design: The study used a combined methods design with both qualitative and quantitative techniques including focus groups and survey of patient records.

Setting: Four medical or surgical wards in three hospitals within a single health service in Melbourne, Victoria, Australia.

Subjects: Registered nurses (n=54).

Main outcome measures: Audit results and themes from narrative data.

Results: The initial screening rate was 25% and 61% on spot audit of two wards using the MUST, with only 4% (2/47) of patients screened in two wards using the MST. Application of screening was limited by priority of other nursing duties, a nurse’s skill in use of a tool, and interpretation of patients’ weight status. Some nurses applied individual judgment rather than a tool to assess malnutrition risk. After nurse education and support over four months in wards using the MUST, compliance improved to 46% and 70%, Barriers were identified in use of either tool.

Conclusions: Implementation of evidence‑based screening tools within patient admission procedures does not automatically translate into nursing practice. Nurses’ time and nutrition screening knowledge were the main barriers to efficient screening. This suggests a need for induction programs for new staff and increased feedback to nurses regarding screening practice. A nutrition screening team might provide leadership and advocate for such screening practice and enable development of an audit cycle, including regular performance reporting, to increase compliance.