define nutrition in nursing

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14.1 Nutrition Introduction

Learning objectives.

Describe variables that influence nutrition
Identify factors related to nutrition across the life span
Assess a patient’s nutritional status
Outline specific nursing interventions to promote nutrition
Base your decisions on the action of nutrients, signs of excess and deficiency, and specific foods associated with each nutrient
Base your decisions on the interpretation of diagnostic tests and lab values indicative of a disturbance in nutrition
Give examples of appropriate vitamin use across the life span
Identify evidence-based practices related to nutrition

Nurses promote healthy nutrition to prevent disease, assist patients to recover from illness and surgery, and teach patients how to optimally manage chronic illness with healthy food choices. Healthy nutrition helps to prevent obesity and chronic diseases, such as diabetes mellitus and cardiovascular disease. By proactively encouraging healthy eating habits, nurses provide the tools for patients to maintain their health, knowing it is easier to stay healthy than to become healthy after disease sets in. When patients are recovering from illness or surgery, nurses use strategies to promote good nutrition even when a patient has a poor appetite or nausea. If a patient develops chronic disease, the nurse provides education about prescribed diets that can help manage the disease, such as a low carbohydrate diet for patients with diabetes or a low fat, low salt, low cholesterol diet for patients with cardiovascular disease.

Nurses also advocate for patients with conditions that can cause nutritional deficits. For example, a nurse may be the first to notice that a patient is having difficulty swallowing at mealtime and advocates for a swallow study to prevent aspiration. A nurse may also notice other psychosocial risk factors that place a patient at risk for poor nutrition in their home environment and make appropriate referrals to enhance their nutritional status. Nurses also administer alternative forms of nutrition, such as enteral (tube) feedings or parenteral (intravenous) feedings.

This chapter will review basic information about the digestive system, essential nutrients, nutritional guidelines, and then discuss the application of the nursing process to addressing patients’ nutritional status.

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Clin Med (Lond)
v.21(3); 2021 May

‘Food for thought’: The importance of nutrition to patient care and the role of the junior doctor

Jessica c frost.

A Oxford University Hospitals NHS Foundation Trust, Oxford, UK

* joint first authors

Alexander J Baldwin

Good nutrition is an integral component of patient care. Not only does eating correctly provide substantial physical benefits, it also ensures psychological comfort throughout admission. Nevertheless, our formative years as medical students, and now as junior doctors, have shown us that patient nutrition is frequently neglected both in the clinical setting and in the subject matter of our education.

Amid the coronavirus pandemic, this is especially problematic; older, frailer patients, with multiple comorbidities and higher rates of malnutrition, are faring much worse with the virus. Combined with the fact that 40% of patients admitted to hospital are malnourished to some degree, we are looking at a huge population of potential COVID-19 patients facing a further decline in nutritional status and higher mortality as a result of this, making attention to nutrition more important than ever.

As junior doctors, we have a role in the nutritional assessment of and support for our patients by ensuring that all patients are suitably assessed using a scoring tool with the appropriate ensuing actions taken. We must also ensure that our knowledge regarding nutritional assessment and support is adequate and aim to supplement this via additional learning to meet the minimum requirements for our curriculum.

In recent years, also termed by the World Health Organization as the ‘United Nations decade of action on nutrition’ (2016–2025), collective acknowledgement of the concept of ‘food as medicine’ has led to nutrition and dietetics rapidly gaining attention both inside and outside of the hospital. 1 However, despite a growing appreciation for the subject, malnutrition on the wards remains commonplace; as many as 60% of patients continue to face a decline in nutritional status following admission. 2 Strict feeding windows, inflexible menus, understaffing and insufficient help for those unable to feed themselves all contribute to the caloric and nutrient deficiencies that patients can face. This is compounded by the psychological impact of admission, which often results in reduced appetite, inadequate absorption of food, difficulties swallowing, or worsening cognition and confusion, not to mention the physiological effects of illness itself. 3

The following cases, drawn from personal experience on an acute medical unit, reflect commonly encountered scenarios for the junior doctor and highlight the dynamic nature of nutritional status, and why continual re-assessment is required to prevent its deterioration.

60-year-old patient with dysphagia.
Admitted with an oesophageal food bolus obstruction.
Kept ‘nil by mouth’ (NBM) overnight, with plans for oesophago-gastroduodenoscopy (OGD) the next morning.
Unable to fully remove the food bolus with OGD, so remained NBM with a plan to re-scope later that afternoon under general anaesthesia.
Unfortunately, this was delayed by another day.
After repeat OGD, at which point the patient had been NBM for more than 48 hours, she was required to remain NBM until Speech and Language Therapy (SALT) assessment.
Elderly patient with cognitive impairment.
Admitted delirious with aspiration pneumonia.
Body mass index (BMI) of 17.5 kg/m 2 .
Kept NBM until SALT assessment.
No SALT input over the weekend, so remained NBM until the following Monday with no plan in place for their nutrition.
Patient was difficult to cannulate and pulled out all intravenous access.
Patient was also not a suitable candidate for nasogastric (NG) feeding.
Long stay elderly patient on geriatric ward, medically fit for discharge (MFFD), awaiting package of care.
Thin and wasted with dry scaly skin.
Nurses noted that the patient had not been finishing meals.
BMI 18 kg/m2.
No Malnutrition Universal Screening Tool (MUST) score documented.
Not on oral nutrition supplements, no use of food charts and no referral to dietetics.
Middle-aged patient with high BMI, hypertension and type 2 diabetes.
Admitted with COVID-19.
Due to the illness, they had not eaten for the previous few days.
Following admission, the patient became increasingly unwell. Their oxygen requirement increased, and they were subsequently admitted to the intensive care unit for intubation and ventilation.
Subsequent nutritional requirements were met via NG tube.

As illustrated by cases 1 and 2, it is not uncommon for patients who are already nutritionally compromised to experience repeated periods of fasting secondary to procedural delays. These patients need frequent assessment of nutritional status, as well as discussion about alternative methods of hydration, nutrition and medication, and a clear NBM care plan, which should be specific about artificial hydration and electrolyte requirements. 3 If the patient in question is not suitable for NG feeding, a decision about ‘at risk’ feeding needs to be made. In scenarios similar to case 2, where the patient suffers a terminal event in an end-stage disease, it is also important to consider whether palliation may be more appropriate. It is also important to bear in mind that re-introduction of food is not without risk; any patient with a BMI of <18.5 kg/m 2 and little to no intake for >5 days, as in cases 2 and 3, are in danger of potentially fatal metabolic shifts in fluid and electrolytes on refeeding. 4 As junior doctors, we need to do what we can to minimise excessive fasting on the ward and ensure that the nutrition team are contacted for support early, especially if NG feeding is required. Enquiry into pre-hospital intake of food is required to further assess this refeeding and malnutrition risk. For patients at high risk of refeeding syndrome, calorie intake should be cautiously increased as advised by the dietetic team, with daily measurement of potassium, phosphate and magnesium levels. Thiamine replacement is also essential. 4

Case 3 also highlights the importance of nutritionally screening patients on admission, and weekly thereafter, using a validated tool to ensure that any nutritional decline is noticed and appropriately actioned. Just because a patient is deemed ‘MFFD’ does not mean nutrition should be overlooked. This patient would have a MUST score of at least 2, which puts them in the high-risk category and mandates further action (for example, through prescription of oral nutrition supplements or implementation of a food chart). If a patient has a MUST score of 4 or a score that is increasing, if weight drops by 1 kg/week, or if intake remains minimal on the ward, a full dietetic assessment should be sought.

Case 4 demonstrates the need for additional nutritional support for COVID-19 patients to help reduce morbidity and mortality associated with the virus, which has been highlighted by multiple nutrition societies worldwide including the European Society for Clinical Nutrition and Metabolism (ESPEN). 5 The patient in question has a calculated MUST score of 3 due to acute illness and lack of nutritional intake, and warrants dietitian input for consideration of enteral (and potentially parenteral) nutrition therapy. The take home message here is that malnutrition does not discriminate; younger or obese patients, and those with an acute illness, can also be at risk of malnutrition.

In the midst of the coronavirus pandemic, attention to nutrition has become more important than ever. We know that older, frailer patients, with multiple comorbidities and higher rates of malnutrition, are faring much worse with the illness. 5 Unfortunately, the majority of patients requiring admission with COVID-19 fit into this category, and have pre-existing comorbidities, such as diabetes and cardiovascular disease, both of which are associated with a higher risk of malnutrition. 3,6 The infection itself is also known to cause a massive reduction in food intake as a result of virus-related anorexia, diarrhoea and vomiting. Combined with the fact that 40% of patients admitted to hospital are already malnourished to some degree, we are looking at a huge population of potential COVID-19 patients facing a further decline in nutritional status and higher mortality as a result of this. 2

The COVID-19 pandemic has also imposed additional barriers to the optimisation of patient nutrition. Increased caseloads, redeployment, unfamiliar rules and regimens, remote working and the challenges of personal protective equipment have meant that nutritional screening and assessment has not been a top priority on the wards. 6 So, how can we, as junior doctors, help to alleviate this nutritional burden on our NHS, during COVID-19 times and going forward?

Paying attention to our patients is the key. Although measurement of water and fat-soluble vitamins can demonstrate specific deficiencies and malabsorption, there is ultimately no single biochemical investigation that can provide concrete evidence of a patient's nutritional state. Medical professionals can become too reliant on albumin, despite the evidence proving that this negative acute-phase protein is affected by multiple factors such as catabolism, sepsis, chronic inflammation, haemodilution, decreased hepatic synthesis or increased excretion, thus rendering it redundant as a marker of nutritional status. 4

A thorough history (specifically eliciting evidence of weight loss, decreased food intake, reduced appetite or dysphagia) can be helpful. It is also important to note how the patient appears physically. Are they particularly frail and cachectic, obese or oedematous? Careful fluid balance is critical, given that fluid overload or loss can have a confounding effect on measured weight. 4 Shameer Mehta, in her recent paper on nutritional status and COVID-19, describes how even a single question (‘Can the patient finish their meals?’) can form the basis of effective nutritional screening. 7 Making simple observations is something everyone is capable of, regardless of profession or grade. Electronic ward round entries, involving automatically generated prompts, can be programmed to subsequently generate a pre-defined plan for patients; depending on individual risk, resulting actions include repeating the screening 5 days later, initiating volunteer-assisted feeding, prescribing oral nutritional supplement drinks or referring to a dietitian.

Ultimately, measurement of weight is essential and usually obtainable. In extremely sick and bedbound patients, where use of a hoist is not feasible, mid-upper arm circumference (MUAC) can be a valuable indicator of malnutrition. Not only can it provide an estimate of BMI, it can also be used to estimate weight change over a period of time. For example, if MUAC changes by 10%, then it is a good estimation that weight has also changed by 10% or more. 8 Given that MUST scores are our most valuable resource for identifying malnourished patients, we should start looking to technologise these too. The ability to document patient weight, height and BMI on mobile devices would enable nutritional care to become an integrated part of daily practice on the wards, facilitating ward round routine.

The rate of completion of MUST is also an ideal subject for a junior doctor to audit and implement meaningful change via education and intervention. 9 Our own local data demonstrated a lack of consistency in the completion of nutritional screening, and evidence suggests this is the case across a significant proportion of NHS trusts. 10–12 One key issue was that the majority of patients who were too unwell, or unable to be weighed, were not being scored, despite the fact that a subjective score based on clinical judgement would be completely appropriate for these cases and definitely better than no score at all!

Ultimately, nutritional review by a consultant (including daily assessment of food and fluid balance charts) needs to be integrated into the ward round pro forma so that it becomes as commonplace, and as easy, as daily antibiotic or analgesia checks. Other easy steps we can all take include the appropriate prescription and adjustment of oral nutrition supplements and careful monitoring of hydration status and suitable fluid replacement. Furthermore, the documentation of patient weight on discharge summaries would enable any nutritional decline or concerns to be flagged up to healthcare professionals in the community. By familiarising ourselves with the criteria for dietitian referrals and expediting these when required, we could hopefully prevent an even greater nutritional decline among those most vulnerable. 13 Regardless of specialty, there are openings for all doctors (from foundation doctor to consultant) to advocate lifestyle changes to patients or, at the very least, signpost to relevant services or online resources that would undoubtedly have a positive impact on both individual and population health.

Finally, there is undoubtedly a need for more teaching on nutritional assessment, as well as guidance on the prevention of and treatment of malnutrition, and for this to be integrated into the core curriculum of both medical schools and foundation doctors. 2,9,14,15 For now, the onus remains on ourselves as healthcare professionals to take an interest in the subject and become familiar with the multitude of resources available that cover the basic principles of hospital nutrition so that we can better aid our patients. NHS e-Learning for Healthcare (e-LfH) and British Association for Parenteral and Enteral Nutrition (BAPEN) both offer free nutritional modules for junior doctors that provide simple tools on how to assess nutritional status, fluid management and what to do when caring for patients with nutritional needs, which can also be used towards a foundation trainee's mandatory teaching log.

Ultimately, the battle against malnutrition requires a collective effort; doctors, nurses, medical and nursing students, volunteers and catering staff all have an essential role to play. Nutrition is an underrated and underutilised tool in the hospital arsenal, and one that has the power to prevent a significant number of chronic diseases, as well as the ability to lessen mortality, reduce morbidity and accelerate recovery. It may have taken a pandemic for us to fully appreciate how crucial it is that the nutritional needs of the population are met, especially for those most vulnerable, but Mehta is not alone in viewing this as a unique opportunity for change. 7,15 COVID-19 is as good a reason as any to start making nutritional care a part of routine practice on the wards, and has highlighted the need for us to shift our emphasis from tangible medical and surgical treatments to a collective culture focusing on the prevention and maintenance of health. However, the challenge remains in us as healthcare professionals, as a team, accepting responsibility and sustaining this for the months and years to come.

Six steps to optimal nutrition care

Did you know:

Patients diagnosed with malnutrition stay in the hospital three times longer than other patients?
Surgical patients with malnutrition are four times more likely to develop pressure ulcers?
Nurses are the healthcare professionals who typically conduct nutrition screening as part of admission assessment?

Today, we know that disease-related malnutrition is prevalent and linked to poor patient outcomes, higher readmission rates, and increased costs. Nurses can and should participate in identifying, preventing, and treating malnutrition. (See Nurse’s role in nutrition care .) This entails a partnership between registered dietitians (RDs) and registered nurses (RNs), with clear interdisciplinary communication throughout the patient’s care trajectory.

Nurse’s role in nutrition care

If you think dietitians are responsible for patients’ nutrition care, think again. In the early part of nursing’s era, nurses were responsible for preparing patients’ meals and assessing and monitoring the impact of nutrient intake (or lack thereof) on their recovery and well-being.

Today nurses still play a key role in nutritional care. Although we are no longer responsible for over-seeing food preparation and delivery, nutrition continues to be an essential domain of nursing practice.

All nurses who provide patient care are responsible for addressing patients’ nutritional needs. This can take the form of:

conducting nutrition screening
performing assessment and intervention
providing mealtime assistance and nutrition support therapy
monitoring, managing, or evaluating the impact of nutrient and dietary therapies.

To provide optimal nutrition care and ensure each patient is assessed for malnutrition, the multidisciplinary care team (including the RD) should take a logical stepwise approach. The six steps in the American Society for Parenteral and Enteral Nutrition’s (A.S.P.E.N.) Adult Nutrition Care Pathway, described below, require documentation in an electronic health record that’s robust enough to allow efficient assessment, intervention, and communication across the entire healthcare team. (See nutritioncare.org/malnutrition .)

Step 1: Nutrition screening

The Joint Commission requires nutrition screening for all hospital patients within 24 hours of admission to identify those who may be malnourished or at risk for malnutrition. Assessment findings determine if the patient requires a detailed nutrition assessment. In most cases, nurses perform this screening as part of the general admission assessment.

Step 2: At-risk determination

Adults with any of the following may be considered to be at risk for malnutrition:

involuntary loss of 10% or more of usual body weight within 6 months, or involuntary loss of 5% or more of usual body weight in 1 month
involuntary loss or gain of 10 lb within 6 months
body mass index below 18.5 kg/m2 or above 25 kg/m2
chronic disease
increased metabolic requirements
altered diet or diet schedule
inadequate nutritional in-take, including not receiving food or nutrition products for more than 7 days.

Once you identify an at-risk patient, be sure to communicate this finding to the RD.

Step 3: Nutrition assessment

A comprehensive approach to diagnosing nutrition problems, nutrition assessment relies on a combination of medical, nutrition, and medication histories; physical examination findings; anthropometric measurements; and laboratory data. When conducting a nutrition assessment, check the patient for:

trouble chewing
swallowing disorders
weight history
height and weight measurement
skin integrity
electrolyte abnormalities
hand-grip strength (have the patient squeeze your hand).

Generally, an RD or a member of the nutrition support service performs a more in-depth nutrition assessment. This assessment delineates the malnutrition diagnosis and serves as the basis for the nutrition plan of care.

Step 4: Malnutrition diagnosis

In 2012, the A.S.P.E.N./Academy of Nutrition and Dietetics Malnutrition workgroup identified six malnutrition characteristics to assess. Two or more of the following findings warrants a malnutrition diagnosis, with severity defined further through specific thresholds or parameters:

weight loss
inadequate energy intake
muscle mass loss
subcutaneous fat loss
fluid accumulation
reduced hand-grip strength.

Step 5: Nutrition care plan

The nutrition care plan is a formal statement of nutritional goals and interventions prescribed for the patient, based on nutrition assessment data. The plan includes statements of nutritional goals and monitoring and evaluation parameters, the most appropriate administration route for nutrition therapy, nutrition access method, anticipated duration of therapy, and training and counseling goals and methods.

Nutrition interventions may include optimizing the patient’s oral intake, providing oral nutrition supplements, and administering enteral and parenteral nutrition. Nurses play a key role in implementing these interventions.

Step 6: Monitoring and transition-of-care planning

The patient’s nutritional status, nutrition goals, and safety and efficacy of interventions need to be monitored on a continual basis, particularly with transition-of-care planning. Be sure to communicate the patient’s nutrition care plan during care transitions. Too often, nutrition interventions stop when a patient is discharged from the hospital; in many cases, the patient needs to be readmitted with worsening malnutrition. Using a transition-of-care plan by nurses (such the A.S.P.E.N. Nutrition Care Pathway) can help prevent readmission of vulnerable patients.

Three forms of malnutrition

Malnutrition is an acute, subacute, or chronic state of nutrition in which a combination of varying degrees of overnutrition or undernutrition (with or without inflammatory activity) have caused a change in body composition and diminished function.

Malnutrition occurs in three forms:

starvation-related malnutrition, as in chronic starvation without inflammation (for instance, anorexia nervosa)
chronic disease-related malnutrition, as in malnutrition with chronic disease and mild to moderate inflammation (for example, organ failure, pancreatic cancer, rheumatoid arthritis, or sarcopenic obesity)
acute disease- or injury-related malnutrition with acute and severe inflammation (such as a major infection, burns, trauma, or closed head injury).

American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.) Board of Directors and Nurses Standards Revision Task Force; DiMaria-Ghalili RA, Bankhead R, Fisher AA, et al. Standards of practice for nutrition support nurses. Nutr Clin Pract . 2007;22(4):458-65

Barker LA, Gout BS, Crowe TC. Hospital malnutrition: prevalence, identification and impact on patients and the healthcare system. Int J Environ Res Public Health. 2011;8(2):514-27.

Englert DM, Crocker KS, Stotts NA. Nutrition education in schools of nursing in the United States. Part 1. The evolution of nutrition education in schools of nursing. JPEN J Parenter Enteral Nutr . 1986 ; 10(5):522-7.

Fry DE, Pine M, Jones BL, Meimban RJ. Patient characteristics and the occurrence of never events. Arch Surg. 2010;145(2):148-51.

Guenter P, DiMaria-Ghalli RA. Survey of nurses’ nutrition screening and assessment practices in hospitalized patients. MedSurg Matters. 2013;22(5):10-3.

Mueller C, Compher C, Ellen DM; American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.) Board of Directors. A.S.P.E.N. clinical guidelines: nutrition screening, assessment, and intervention in adults. J Parent Ent Nutr . 2011;35(1):16-24.

Nightingale F. Notes on Nursing: What It Is and What It Is Not . London: Harrison; 1860.

Patel V, Romano M, Corkins MR, et al.; American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.). Nutrition screening and assessment in hospitalized patients: a survey of current practice in the United States. Nutr Clin Pract . 2014;29(4):483-90.

Tappenden KA, Quatrara B, Parkhurst ML, et al. Critical role of nutrition in improving quality of care: an interdisciplinary call to action to address adult hospital malnutrition. JPEN J Parenter Enteral Nutr. 2013;37(4):482-97.

Snider JT, Linthicum MT, Wu Y, et al. Economic burden of community-based disease-associated malnutrition in the United States. JPEN J Parenter Enteral Nutr. 2014;38(2 Suppl):77S-85S.

White JV, Guenter P, Jensen G, et al.; Academy Malnutrition Work Group; A.S.P.E.N. Malnutrition Task Force; A.S.P.E.N. Board of Directors. Consensus statement: Academy of Nutrition and Dietetics and American Society for Parenteral and Enteral Nutrition: characteristics recommended for the identification and documentation of adult malnutrition (undernutrition). JPEN J Parenter Enteral Nutr . 2012;36(3):275-83.

1 Comment .

Getting in some top exceptional fiber from non-starchy veggies can clear up this problem. Though if that’s not enough, typically psyllium husk powder will paintings or taking a probiotic.

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OJIN Homepage
Table of Contents
Volume 19 - 2014
Number 3: September 2014
Healthy Eating for Healthy Nurses

Healthy Eating for Healthy Nurses: Nutrition Basics to Promote Health for Nurses and Patients

Denise Reed is a Clinical Assistant Professor in Dietetics at Ashland University in Ashland, Ohio. Prior to becoming an instructor in dietetics she worked for many years as a clinical nutrition manager and critical care dietitian for a Level 2 trauma hospital. While in clinical dietetics, Denise chaired and served on multiple medical staff committees and was responsible for clinical nutrition policy development for the institution. Denise is active in professional organizations such as the Academy of Nutrition and Dietetics and the American Society of Parenteral and Enteral Nutrition. She continues to work in clinical dietetics and takes an active role in providing practical nutrition education to practicing nurses as well as nursing students.

Nurses care for people each day in many settings such as hospitals, physician offices, schools, and public health facilities. Such positions often require nurses to work variable and long hours, exposing them to the stressors of caring for people who are ill. These stressors can support poor food choices that adversely affect the health and well-being of the nurse. Nurses are also an integral part of providing nutrition related information to patients. As such, patients may be very cognizant of the health habits of their nurses. Eating for good health is one way that nurses can reduce the impact of stressors on the body and positively influence their health, allowing them to better care for patients and themselves. This article reviews two common nutrition related areas of concern to nurses, stressors, inflammation, and nutrition and sleep and eating patterns , that can lead to obesity. Knowledge and attitudes about nutrition education are also discussed briefly. Finally, the article offers a review of nutrition basics for nurses and suggestions to avoid potential food pitfalls common for nurses.

Key words: Nutrition, nutrition education, nurses, stressors, inflammation, oxidative stress, sleep, polyunsaturated fats, antioxidants, obesity, meal planning.

Nurses can benefit from good, sound nutrition to help them lead healthy lives. Nurses play an integral role in healthcare whether they are working at the patient bedside, caring for patients in a physician office, or providing care and education as part of public health. They are caregivers, lifesavers, cheerleaders, confidants, trusted resources, and so much more. This is why it is so important for nurses to take care of themselves as well. Nurses can benefit from good, sound nutrition to help them lead healthy lives.

As nurses care for people, they may face multiple occupational and personal stressors, such as caring for patients who are seriously ill, sleep deprivation due to variable and long work schedules, and addressing family responsibilities. It is not difficult to imagine why nurses often place the health of others before their own health, but this is where a change in thought is required. When healthcare professionals, such as nurses, care for their own health, it is reasonable to think that this will help them to better care for patients. Good nutrition is a simple yet integral part of healthy behavior that can be easily incorporated into the daily routine of a nurse. For example, healthy food choices may help to manage stressors, maintain weight at a healthy level, and improve energy levels.

Research has demonstrated that nurses have concerns about both providing complex nutritional information to patients and patient perceptions of their body image. In addition to the importance of nutrition for the good health of nurses, it is often nurses who provide nutrition assessment and/or education to patients. In this role, they provide information about nutrition to patients, but also serve as role models. Research has demonstrated that nurses have concerns about both providing complex nutritional information to patients and patient perceptions of their body image ( Bjerrum, Tewes, & Pedersen, 2011 ; Ilmonen, Isolauri, & Laitinen, 2012 ).

Eating for good health is one important way that nurses can reduce the impact of stressors on the body and positively influence their health, hopefully improving their satisfaction with both work and life in general. This article reviews two common nutrition related areas of concern to nurses, stressors, inflammation, and nutrition and sleep and eating patterns, that can lead to obesity. Knowledge and attitudes about nutrition education are also briefly discussed. Finally, the article offers a review of nutrition basics for nurses and suggestions to avoid potential food pitfalls common for nurses.

Stressors, Inflammation, and Nutrition

Impact of Stressors and Inflammation

...healthy food choices may help to manage stressors, maintain weight at a healthy level, and improve energy levels. Most people experience stressors throughout life in both professional and personal settings. Stressors can be psychological and physiological. One explanation for stressors is a pathological process that is a reaction of the body against external and abnormal conditions that require physiological regulation ( Romeo, Warnberg, Gomez-Martinez, Diaz, & Marcos, 2008 ). When a person undergoes a stressful event or situation, changes will occur within the body. These physiological changes may have some positive effects in the short term, such as boosting the immune system, but the long term effects can lead to impaired immune functions and changes in hormone secretion ( Romeo et al., 2008 ).

One belief is that stressors can influence nutrition intakes and body composition. Chronic distress from one or more stressors has been associated with increasing appetite and increasing preference for high fat and high sugar foods ( Barrington, Beresford, McGregor, White, 2014 ). These behaviors tend to feed into one another, making a vicious cycle that is difficult to break unless the stressor is removed. If stress levels remain high, a person often feels hungry and eats more, especially more of the foods that are high in sugar and fat. High sugar and high fat foods tend to have greater calorie levels, but less beneficial nutrients such as vitamins and minerals. This pattern leads to a greater likelihood of fat deposition to cause obesity. The final part of this cycle is that obesity is linked to the development of other chronic conditions such as cardiovascular disease, Type 2 diabetes, and osteoarthritis ( CDC, 2012 ).

...stressors can influence nutrition intakes and body composition. Obesity is now classified as a disease and is currently rampant in the United States ( American Medical Association, 2013 ). In 2012, the Centers for Disease Control and Prevention (CDC) estimate that approximately 34.9% of adults in the United States are obese ( CDC, 2012 ). This affects the cost of healthcare, as individuals who are obese have medical costs that are significantly higher than people of normal weight (CDC, 2008). Obesity is classified as an actual physiological stressed state that involves physical, psychosocial, and emotional influences. ( Dandona, Aljada, Chaudhuri, Mohanty, & Garg, 2005 )

When the human body is in a continual stressed state, such as with obesity, this can lead to an increase in chronic inflammation. Overweight and obese patients are a physical stressor to nurses when providing patient care as the nurse is often responsible for moving or lifting these patients. This may lead to increased occupational injuries for nurses. However, obesity is a personal concern for nurses as well, due to poor nutrition habits and other lifestyle choices. The effects of poor nutrition in nurses will be discussed later in the article.

One outcome of chronic inflammation is oxidative stress. Oxidative stress occurs when an overproduction of byproducts from normal cellular metabolism causes damage to components of the human body such as deoxyribonucleic acid (DNA), lipids, and proteins ( Sies, Stahl, & Sevanian, 2005 ). This is very poor for the body and can affect metabolism and how food is utilized as a fuel.

Impact of Nutrition on Inflammation and Oxidative Stress

The key to good nutrition, and the modulation of stressors and inflammation, is to have healthy nutrient intakes before any chronic conditions develop. Nutrients are very powerful in the body and can help to decrease inflammation and subsequent oxidative stress ( Sies et al., 2005 ). Examples of nutrients thought to be beneficial to decrease the effects of stressors and inflammation are antioxidants and fatty acids. Conversely, an intake of foods high in other fats and sugars, as described in this cycle above, do not support the modulation of stressors and inflammation ( Barrington et al., 2014 ). This section briefly describes the potential impact of these nutrients on stressors and inflammation.

Antioxidants . Foods high in antioxidants are especially effective in decreasing inflammation and subsequent oxidative stress. An antioxidant is anything that can prevent or inhibit oxidation ( Benzie, 2000 ). Antioxidant nutrients include Vitamin C, Vitamin E, and carotenoids.

Foods that are rich in antioxidants are predominantly fruits and vegetables, but also include some nuts and oils. For example, citrus fruits are high in Vitamin C; almonds and sunflower oil are good sources of Vitamin E; and orange or yellow vegetables are high in carotenoids. Research suggests that obtaining antioxidants directly from food sources offers more protection against development of chronic diseases, as opposed to supplementing one’s diet with purified antioxidants such as supplements ( Rink et al., 2013 ). There are many theories about why this increased protection occurs, but most likely it is due to the synergistic effect that results from multiple nutrients available from food. In other words, taking just one vitamin or mineral in the form of a supplement may be less effective than eating food filled with many nutrients that help one another to be absorbed and used by the human body ( Rink et al., 2013 ).

Fatty acids . Antioxidants are not the only defense to inflammation and oxidative stress. It is just as important to include some fatty acids in the diet. It is likely that most people have heard that it is necessary to eat fish every week, but why is this recommended? Fish, especially fatty fish like tuna and salmon, are good sources of eicosapentaenoic acid (EPA) and docosahexanoic acid (DHA) ( Vannice & Rasmussen, 2014 ). EPA and DHA are otherwise known as omega-3 polyunsaturated fatty acids. In the body, these polyunsaturated fatty acids can help modulate inflammation and increase cell growth, hence also fighting oxidative stress. Research indicates that consuming two servings (3 ounce portions) of fish each week is effective in decreasing inflammation ( Vannice & Rasmussen, 2014 ). This reduction in inflammation in turn has positive effects in the body, such as decreasing blood pressure and decreasing risk of developing cardiovascular diseases ( Houston, 2013 ).

Fats and sugars . On the other hand, foods such as red meat or other foods high in fat and sugar are not considered very beneficial to health. As stated previously, the presence of life stressors tends to be associated with an increased intake of high fat and high sugar foods which lead to obesity ( Barrington et al., 2014 ). Therefore, it is prudent to limit intake of high fat and high sugar foods as part of the daily diet. An analysis of data from the Nurses’ Health Study looked at red meat intake, inflammation, and glucose metabolism ( Ley et al., 2014 ). The study showed that a greater intake of red meat was associated with higher levels of inflammatory markers in the blood. Another interesting outcome was that substituting an alternative protein source (e.g., poultry, fish or legumes) for a serving of red meat caused a decline in the inflammatory markers in the blood ( Ley et al., 2014 ). Red meat does not have to be entirely eliminated from the diet, but this study does suggest increased inclusion of protein sources other than red meat in the diet.

Sleep and Eating Patterns

...long hours and variable shifts impact the sleep cycle of a nurse and this variability does not have a positive effect on personal health. Nursing is a twenty-four hour, seven days a week profession. Certainly there are some exceptions to this rule, but most nurses work weekends, holidays, and variable shifts. This means that many nurses are required to work evening and night shifts, often twelve hour shifts, and even variable schedules (when a nurse may work daytime hours one day and a few days later work all night). These long hours and variable shifts impact the sleep cycle of a nurse and this variability does not have a positive effect on personal health. The full impact of poor sleeping patterns is beyond the scope of this article, but this section will consider how poor sleeping patterns may interact with nutrition.

Quality sleep (at least 7-8 hours) is as important to health as nutrition and exercise ( Ohlmann & O’Sullivan, 2009 ). Sleep is needed to repair the physical body and maintain emotional balance. Circadian rhythms regulate many biological processes such as sleep-wake cycles, hormone secretion, and energy metabolism ( Pan, Schernhammer, Sun, & Hu, 2011 ). These circadian rhythms are controlled by a biological clock which is located in the brain and is influenced by natural dark and light cycles. Severely or consistently interrupted circadian rhythms may lead to adverse health effects.

Research has demonstrated that lack of sleep with disruption of circadian rhythms may have significant health related outcomes, such as chronic diseases and/or obesity. Research has demonstrated that lack of sleep with disruption of circadian rhythms may have significant health related outcomes, such as chronic diseases and/or obesity. In a study conducted by Pan et al. ( 2011 ) regarding rotating night shift work and risk of Type 2 diabetes, researchers found that women with more years of rotating night shift work were more likely to have a higher body mass index (BMI) and were at increased risk of developing Type 2 diabetes. This research indicated that the disruption to circadian rhythms during a rotating night shift schedule may have been associated with a decrease in leptin; an increase in glucose and insulin levels; and an increase in arterial blood pressure ( Scheer, Hilton, Mantzoros, & Shea, 2009 ). Further research has demonstrated that when sleep is restricted, leptin levels decrease and ghrelin levels increase ( Ohlmann & O’Sullivan, 2009 ). Leptin is a hormone responsible for promoting satiety, or a sense of feeling full, whereas ghrelin is a hormone responsible for stimulating appetite. These types of hormonal patterns or imbalances are likely responsible for the patterns of increased intakes of calorie-dense, high carbohydrate foods experienced when a person has not had adequate sleep. Similar to the cycle described above related to stressors and consumption of high fat and/or high sugar foods, this irregular sleep and subsequent hormone imbalance pattern also contributes to obesity and development of chronic diseases. Thus the nurse who frequently works variable shifts, or does not get adequate sleep due to long working shifts, is at increased risk of hormonally developing poor eating patterns and adiposity or obesity ( Pan et al., 2011 ; Ohlmann & O’Sullivan, 2009 ; Scheer et al., 2009 ).

Sleep deprivation not only has negative effects on health. It may also impact a person’s work ability, also a serious concern for nurses who must care for patients with accuracy and excellent judgment. A nurse who is continually sleep deprived may be making more mistakes, errors that could be life threatening for a patient. Signs of sleep deprivation include depending on an alarm clock to wake up, being addicted to caffeine or other stimulants, making frequent mistakes, feeling depressed or uptight, and frequent illness ( Ohlmann & O’Sullivan, 2009 ).

One way to decrease sleep deprivation is exercise, which tends to improve sleep quality. Recognizing the desire for high calorie, high carbohydrate, and/or high caffeine foods when sleep deprived is important as well. When this behavior or craving is acknowledged, healthier food selections can be made – choices that will help combat feelings associated with sleep deprivation. It can be helpful to eat routine meals that are well balanced (e.g., a meal that contains lean protein, high fiber carbohydrates and foods rich in vitamins and minerals like fruits and vegetables). Even when working night shift, the goal should be routine meal patterns in order to avoid excessive nutrition intakes and reliance on stimulating foods such as caffeine. Most importantly, make sleep a priority.

It is important to remember that quality sleep, along with exercise and healthy food choices, all contribute to personal health. It is important to remember that quality sleep, along with exercise and healthy food choices, all contribute to personal health. However, the topic of nutrition and health is not exclusive to either a nurse’s personal or professional life; there is overlap in these roles. Nurses consider nutrition and health on a personal level, but also in the realm of education for patients. The next section briefly discusses some research related to nurses’ knowledge and attitude about nutrition education.

Nurses’ Knowledge and Attitudes about Nutrition Education

Nutrition is a vital piece of healthcare, and providing nutrition education rests on the shoulders of all healthcare providers. Other healthcare professionals such as physicians and dietitians provide nutrition education, but the nurse is expected to support and reinforce nutrition education. For example, nurses need to know nutrition basics for practice applications such as completing nutrition screening for hospital admission or counseling a new mother on the benefits of breastfeeding.

Nutrition is a part of nursing curricula, whether as a stand-alone course or integrated into multiple courses. The increase in chronic disease rates has led to nurses providing even more nutrition education as part of patient care. The question then arises – how knowledgeable do nurses feel about nutrition and are they comfortable providing nutrition education? Ilmonen et al. ( 2012 ) studied nutrition education practices of nurses in mother and child health clinics. The majority of nurses reported nutrition as part of their nursing education, but they did not feel it was sufficient. They expressed a need for more extensive nutrition education to support their nursing practice. In this same study, approximately 60% of the nurses reported nutrition counseling was challenging because of inadequate knowledge of nutrition and difficulties in cooperating with clients. These findings support the need for further nutrition training and education for nurses. In another study, a training program with a significant nutrition focus was provided to nurses from each ward within a hospital ( Bjerrum et al., 2011 ). After the training program, nurses reported increased awareness about the importance of ensuring nutrition for patients and they seemed more aware of the complexity of nutrition problems.

...nurses and other healthcare professionals need to feel comfortable discussing the treatment and management of obesity with patients. One of the largest health related epidemics in the United States today is obesity ( Jensen et al, 2013 ). Obesity is a topic that nurses are frequently required to address with patients, especially when dealing with the management of chronic conditions such as diabetes or cardiovascular disease. A study by Brown and Thompson (2007) found that primary care nurses felt obesity was an awkward and sensitive issue to discuss with patients. This study also found that nurses were challenged to establish trusting relationships with patients when discussing obesity management. Educating obese or overweight people on how to manage weight has been a sensitive topic for many years. As far back as 1998, a study published by Wright found that nurses reported discomfort when advising patients who are overweight. These studies support the idea that obesity remains a stigmatized condition by the public, yet obesity rates continue to increase. With the newer idea that obesity is characterized as a chronic condition or disease ( Jensen et al, 2013 ), nurses and other healthcare professionals need to feel comfortable discussing the treatment and management of obesity with patients.

It is not unreasonable to think that the body weight of nurses may affect how nurses provide care to patients or how patients perceive the care a nurse provides. One study found that people in the public were less confident in an overweight nurse’s ability to provide education on diet and exercise and were more confident to receive diet and exercise education from a normal weight nurse ( Hicks et al., 2008 ). It is concerning that some research indicates that body size and/or weight does affect the public’s perception of ability to provide medical care and education because this may not be directly related to a healthcare provider’s knowledge of a subject ( Hicks et al., 2008 ).

Nurses and other healthcare providers are cognizant of their weight and image. Research has indicated that nurses with a higher BMI have reported feeling self-conscious about their own body size when discussing obesity with patients; nurses with a higher BMI reported feeling guilt that they were not good role models for patients (Brown & Thompson, 2007). On the other hand, nurses with a lower BMI had concerns that they lacked empathy or authentic experience when discussing obesity with patients (Brown & Thompson, 2007). In order to provide successful nutrition education, it is important to establish a trusting relationship between the patient and the nurse, preferably without a focus on the weight of the nurse.

In sum, nurses are an integral part of the healthcare team, and as such it is imperative to provide appropriate, additional nutrition education for nurses to help them have confidence and be successful in their role as a significant patient educator. The following section offers some basic information about nutrition for nurses that can be helpful as they speak with patients about nutrition-related health concerns and as they make personal food choices.

Nutrition Basics for Nurses

Nurses, and other healthcare providers, encounter barriers to healthy eating just as patients do. Nutrition can be difficult to understand today because there is so much information available. There are hundreds of books, websites, diet plans, television shows, and apps – it is hard to know which are based on valid, evidenced-based nutrition principles and which are not. Nurses are required to learn about nutrition, either while taking coursework for a nursing degree or when learning how to screen patients for nutrition problems. Yet, in my practice working alongside many nurses, I have noticed that it often seems to be challenging for them to translate that nutrition knowledge as part of a personal healthy lifestyle. Nurses, and other healthcare providers, encounter barriers to healthy eating just as patients do.

The concept of nutrition has many facets. To get the most benefit from healthy eating habits, it is important to incorporate all of these facets daily. Several basic nutritional principles, such as consistency, portion size, and variety, can help nurses and patients alike to make healthier food choices.

Consistent Intake

One of the most critical points of healthy nutrition is to have consistent nutrition intakes. This means that most days a person should eat routine meals and/or snacks. When the human body is consistently fed, it will better utilize the nutrients instead of storing nutrients for possible later use, which often translates to more fat stores or adiposity ( Mahan, Escott-Stump, & Raymond, 2012 ). This principle applies regardless of work shift – day or night. If a nurse works night shift, routine meals and snacks should be eaten during awake time just as if the nurse was working the day shift.

Portion Size and Caloric Intake

Another key to success is portion size and knowing just how much is appropriate to eat. One of the most common mistakes with meal planning is inaccurate portions and the belief that more calories are needed than are actually necessary for health. Many equations exist to calculate individual calories; most will factor in height, weight, age, and physical activity level ( Mahan et al., 2012 ). When calculating calories, it is important to know what variables (e.g., height, weight, age) go into the equation and that the equation has been validated to more accurately estimate energy needs. There is no perfect equation for calculating calories, so the recommended daily calories obtained from any equation should only be used as a reference point to provide guidance. The best way to have calories calculated is to meet with a registered dietitian who will have the knowledge necessary to ensure that the calories recommended are truly appropriate for a particular individual.

There are many ways to measure portion sizes, but the following points may make this task a bit simpler. First, food labels are there to provide information to the consumer, so it is important to use them. The portion size of a food can be found on the Nutrition Facts panel ( Food and Drug Administration [FDA], 2014 ). All other nutrition information listed on the Nutrition Facts panel pertains to the portion size listed for that food item. This allows the consumer to know how many calories, and how much protein, fat, carbohydrates, and other nutrients, are eaten with the reported portion of the food. Second, a common error may occur if a person eats more than the portion size listed on the Nutrition Facts panel. This must be accounted for by the consumer calculating portion size. For example, a person may wish to make a sandwich with two slices of bread. On the Nutrition Facts panel the serving size is listed as one slice, and in that one slice of bread there are 110 calories. When the sandwich is made with two slices of bread, this will provide 220 calories because there are two servings of bread in the sandwich. All other food items within the sandwich, between the two slices of bread, will contribute calories as well. This concept appears simple, but frequently the serving size is overlooked. Many more overall calories; and grams of fat and carbohydrate are consumed unknowingly, leading to excessive calorie intakes. Excessive nutrition and calorie intakes add up to increased risk of obesity.

Variety and Preparation

Variety is essential to meal planning, to balance meals and help control portion sizes. Variety means that vegetables, fruits, grains or starches, dairy, and meat should be included in the daily meal plan. This clearly implies that eating unlimited amounts of any particular food is not recommended ( Mahan et al., 2012 ).

Grains or starches should be in the form of whole grains that are higher in fiber such as whole wheat bread, brown rice, or whole grain pasta. Dairy should be low fat or fat free such as skim milk or yogurt made with non-fat milk. Meats should be lean and prepared in cooking methods other than frying such as boneless skinless chicken breasts or pork tenderloin. It is beneficial to eat whole fruit instead of fruit juice. Both fruit and fruit juice count as a serving of fruit, but an apple has much more fiber, vitamins and minerals than a small serving of apple juice. Also, the apple will provide a better sensation of feeling full. It is appropriate to enjoy vegetables both raw and cooked, but be careful to not add extra calories with butter or cheese sauces.

Fruits, vegetables and fish are high in antioxidants that can help to reduce inflammation and oxidative stress ( Sies et al., 2005 ). It is a good idea to eat a variety of fruits and vegetables if possible because incorporating choices of different colors (e.g., orange, red, green, purple) offers a variety of nutrients that are beneficial for health. Foods considered rich antioxidant sources include spinach, cantaloupe, sweet potatoes, sunflower seeds, and peanuts.

A study by Rink et al. ( 2013 ) demonstrated that when subjects consumed five or more servings of fruits and vegetables per day they saw higher plasma and serum concentrations of antioxidants and lower biomarkers of oxidative stress. This finding is significant because it offers a relatively easy way to decrease the oxidative stress response in the body. Eating more fruits and vegetables will also tend to decrease caloric intake while helping a person to feel full and satisfied.

In order to get the most benefit from fish, it must not be fried. Frying fish increases the fat and calories, but it does not increase the amount of beneficial fatty acid compounds in the fish. Studies indicate that using fish to replace other high fat meats in the diet does help to decrease inflammation ( Vannice & Rasmussen, 2014 ). Consider substituting other non-meat protein sources for high fat meats. Using lean meats and legumes, such as black beans or soybeans, instead of high fat meats helps to decrease calorie intake and may help to decrease inflammation ( Ley et al., 2014 ). For example, try to have a black bean burger instead of a ground beef burger.

Tips to Avoid Potential Food Pitfalls

Awareness of a few simple strategies can help resist temptation and encourage healthy eating habits at work. Deciding to eat healthy takes commitment and planning. Nurses can be challenged by this due to long work shifts or working nights and weekends. But there are several actions that nurses can take to avoid the potential food pitfalls associated with occupational stressors such as shiftwork. Food pitfalls common in healthcare settings may include going to the cafeteria or local fast food restaurant to purchase food for meals and breaks, which often encourages overconsumption or an unbalanced meal. Another food pitfall is visiting the vending machine or gift shop to get that sweet food or calorie rich coffee that is “needed” to get over a stressful patient situation. A food pitfall can even be the “thank you” treats brought in by patients and clients or food provided by product vendors. Awareness of a few simple strategies can help resist temptation and encourage healthy eating habits at work.

Planning and Packing

To eat healthy when working a twelve hour shift or when going into the physician or public health office for the day, the nurse can benefit by having a plan for his or her meals. This is best accomplished by packing the majority of food that will be eaten during the work day. Packing meals allows the nurse to control the ingredients within the meal, assure that there is an adequate variety of food available, and helps the nurse to avoid food pitfalls.

Drinking Water

It is also important to take water to drink. Many calories are mindlessly consumed from beverages such as soda, cappuccino, or sports drinks. Water has no calories and is very good for the body.

Having One Treat

Certainly it is acceptable to indulge slightly and have a small serving of a treat brought in by a patient who appreciates the care received from a nurse. But, it is not a healthy choice to eat multiple servings of the treat and risk very excessive calorie intake. Make a plan to share the kindness (i.e., treat) with all of the office or facility staff to remove and reduce temptation to over consume.

It is time for nurses to take care of themselves and one facet of that care is good nutrition. Nursing is a tough job requiring extensive knowledge, quick thinking, patience and compassion. Nurses work long hours in rigorous demanding environments and with people they often do not even know until a particular moment of medical distress. The presence of physical and psychological stressors is certainly a major component of being a nurse. All of these factors can put nurses at risk of developing inflammation, oxidative stress, and obesity. This in turn often leads to chronic health conditions such as diabetes and cardiovascular diseases. These are the same diseases about which nurses are often trying to educate patients on a routine basis.

Nurses are on the front line in healthcare; as they adopt healthy living practices, the patients they care for may be more inclined to adopt healthy choices as well. It is time for nurses to take care of themselves and one facet of that care is good nutrition. As discussed in this article, there are many ways to achieve a healthy diet. But the bottom line is that consistency of nutrition intakes, portion sizes, and variety are integral strategies for managing personal nutrition and health. Empowering nurses with knowledge about how nutrition impacts the human body and how healthy food choices can improve their personal health will hopefully help them to embrace positive eating habits. When nurses have healthy habits, such as a varied diet and adequate sleep, they, too, can feel better and decrease risk of developing chronic diseases.

Nurses are on the front line in healthcare; as they adopt healthy living practices, the patients they care for may be more inclined to adopt healthy choices as well. The goal of any healthcare provider is to improve the lives of other people. Nurses can do that even more effectively by taking the lead and deciding that healthy living is as important to them as it is for the people they care for on a daily basis.

Denise Reed MS, RD, LD Email: [email protected]

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September 30, 2014

DOI : 10.3912/OJIN.Vol19No03Man07

https://doi.org/10.3912/OJIN.Vol19No03Man07

Citation: Reed, D., (September 30, 2014) "Healthy Eating for Healthy Nurses: Nutrition Basics to Promote Health for Nurses and Patients" OJIN: The Online Journal of Issues in Nursing Vol. 19, No. 3, Manuscript 7.

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14.1 Nutrition Introduction

Open Resources for Nursing (Open RN)

Learning Objectives

Describe risk factors for nutritional deficiencies
Identify cues related to nutrition balance
Identify diagnostic tests and lab values indicative of a disturbance in nutrition, fluid, and electrolyte disturbances
Identify essential nutrients
Identify supplements to enhance nutrition alterations
Contribute to a plan of care for clients with an alteration in nutrition

Nurses promote healthy nutrition to prevent disease, assist clients to recover from illness and surgery, and teach clients how to optimally manage chronic illness with healthy food choices. Healthy nutrition helps to prevent obesity and chronic diseases, such as diabetes mellitus and cardiovascular disease. By proactively encouraging healthy eating habits, nurses provide the tools for clients to maintain their health, knowing it is easier to stay healthy than to become healthy after disease sets in. When clients are recovering from illness or surgery, nurses use strategies to promote good nutrition even when a client has a poor appetite or nausea. If a client develops chronic disease, the nurse provides education about prescribed diets that can help manage the disease, such as a low carbohydrate diet for clients with diabetes or a low fat, low salt, low cholesterol diet for clients with cardiovascular disease.

Nurses also advocate for clients with conditions that can cause nutritional deficits. For example, a nurse may be the first to notice that a client is having difficulty swallowing at mealtime and advocates for a swallow study to prevent aspiration. A nurse may also notice other psychosocial risk factors that place a client at risk for poor nutrition in their home environment and make appropriate referrals to enhance their nutritional status. Nurses also administer alternative forms of nutrition, such as enteral (tube) feedings or parenteral (intravenous) feedings.

Nutrition for Nurses

(2 reviews)

Emerald Charity Bilbrew, Fayetteville Technical Community College

Jody Vogelzang, Grand Valley State University

Kelli Whittington, Southern Illinois University

ISBN 13: 9781961584389

Publisher: OpenStax

Language: English

Formats Available

Conditions of use.

Learn more about reviews.

Reviewed by Kristen Council, Assistant Professor, Huntington University on 8/26/24

The book does an excellent job of addressing disease process and the nutritional interventions and needs based on various body systems. There is very little content on cultural considerations and it is difficult to connect the lifespan information... read more

Comprehensiveness rating: 4 see less

Content Accuracy rating: 5

The book is accurate and unbiased.

Relevance/Longevity rating: 5

This is what nursing students need to understand how nutrition impacts wellness and disease processes.

Clarity rating: 5

Easy to read in language that is understandable to a new nursing student.

Consistency rating: 5

The modules/chapters are laid out in a consistent manner. The content is consistent and understandable in terminology and framework.

Modularity rating: 5

The sections are excellent. They are divided in a way that is easy to navigate and consistent throughout.

Organization/Structure/Flow rating: 5

The organization is very easy to understand and navigate.

Interface rating: 5

There are no interface issues that I noted

Grammatical Errors rating: 5

The text is grammatically correct throughout.

Cultural Relevance rating: 4

The text is not insensitive in any way. I wish that it discussed cultural nutritional impacts on health and wellness more. The educator may have to provide supplemental resources for the student to understand how cultural food preferences may impact wellness or cause nutritional deficiencies.

This is an excellent text to support nursing students in understanding the impact of nutrition on various body systems.

Reviewed by Lisa Kuppler-Lee, Nursing Faculty, Radford University on 8/13/24

Comprehensiveness rating: 5 see less

The text addresses nutrition in conjunction with all body systems as well the lifespan from infancy to the older adult including nutrition in pregnancy. The 1st 4 chapters cover basic nutritional information, micro and macronutrients, and digestive process. Appropriate body system diagrams along with glossary of terms are included in each chapter. Unfolding case studies, many starting with pregnancy, are part of the chapters with questions to stimulate thinking. The text addresses interactions between medications and nutritional intake including alcohol. All chapter have multiple choice questions at the end of chapter as well as key terms & listing of suggested readings. Chapter reference listing at end of text along with all inclusive index. Also, text has appendix of frequency used nutrition apps such as Weight Watchers, NOOM, Kidney Diet for example.

Text is accurate and error free.

This text is designed to be easily updated. The chapters can be changed as needed with information added or deleted.

The text is very clear to understand with up-to-date terminology.

Each body system is assigned 2 separate chapters. The 1st chapter looks at applying clinical judgement to the specific system while the 2nd chapter focuses on nutritional considerations with the lifespan and illness.

This text can be utilized as a separate Nutritional course or it can be used as part of medical-surgical course.

The topics are presented in a clear format.

Text is easy to navigate online or as PDF. Charts and diagrams are easy to follow and do not distract from the text.

No grammatical errors noted within text.

Cultural Relevance rating: 5

Impact of various ethnic diets is included in the text under appropriate body system. Alternate dietary recommendations meeting ethnic requirements as well promoting wellness are discussed. The unfolding case studies, starting with pregnancy, often address issues involving various background situations i.e. ethnic, financial, adolescence pregnancy. Appropriate handling and interventions are discussed in these situations.

Chapter 1: Introduction to Nutrition for Nurses
Chapter 2: A Holistic View of Macronutrients
Chapter 3: A Holistic View of Micronutrients
Chapter 4: The Digestive Process
Chapter 5: Applying Clinical Judgment to Promote Nutrition for Neurological Wellness
Chapter 6: Special Nutritional Considerations for Neurological Health
Chapter 7: Applying Clinical Judgment to Promote Nutrition for Endocrine Wellness
Chapter 8: Special Nutritional Considerations for Endocrine Health
Chapter 9: Applying Clinical Judgment to Promote Nutrition for Hematologic Wellness
Chapter 10: Special Nutritional Considerations for Hematologic Health
Chapter 11: Applying Clinical Judgment to Promote Nutrition forCardiovascular Wellness
Chapter 12: Special Nutritional Considerations for Cardiovascular Health
Chapter 13: Applying Clinical Judgment to Promote Nutrition for Pulmonary Wellness
Chapter 14: Special Nutritional Considerations for Pulmonary Health
Chapter 15: Applying Clinical Judgment to Promote Nutrition for Renal Wellness
Chapter 16: Special Nutritional Considerations for Renal Health
Chapter 17: Applying Clinical Judgment to Promote Nutrition for Gastrointestinal Wellness
Chapter 18: Special Nutritional Considerations for Gastrointestinal Health
Chapter 19: Applying Clinical Judgment to Promote Nutrition for Musculoskeletal and Integumentary Wellness
Chapter 20: Special Nutritional Considerations for Musculoskeletal and Integumentary Health
Appendix A: Apps Frequently Used to Support Nutrition Wellness

Ancillary Material

About the book.

Nutrition for Nurses is structured to support the flexible integration of nutrition content across both system-based and nursing competency-based curricula. It can be used whether nutrition is taught as a standalone course or part of another nursing course. The table of contents for Nutrition for Nurses presents content in 20 chapters, organized into 9 thematic units.

The text emphasizes evidence-based practice and holistic assessment to facilitate the integration of nutritional awareness for pre-licensure nursing students in the provision of client-centered care. Nutrition for Nurses helps students develop sound clinical judgment as well as a deep understanding of the impact of nutrition on body systems across the lifespan.

Written and reviewed by highly experienced faculty, Nutrition for Nurses includes a detailed narrative, extensive features and learning resources, and ample student support. The presentation utilizes concepts promoting the development of clinical judgment by building upon the systematic model developed by the National Council of State Boards of Nursing (NCSBN).

About the Contributors

Dr. Bilbrew holds an ASN from Southern Union State Community College, a BSN in Nursing from Jacksonville University, an MSN in Nursing Leadership and Management from Jacksonville University, a Post Master’s in Nursing Education from Walden University, and a Doctor in Nursing Practice in Nursing Leadership in Healthcare Systems from Regis University. Dr. Bilbrew has been a nurse for more than 20 years and is certified in the specialty of medical-surgical nursing. She is a Lead Instructor of Nursing at Fayetteville Technical Community College where she teaches courses in the Associate Degree Nursing Program that include clinical, lab, online, classroom, and preceptorship components. Dr. Bilbrew is a member of the Academy of Medical-Surgical Nurses (AMSN) and has served on multiple volunteer committees, including the Legislative Committee, where she advocates for changes in laws for the advancement of nursing and betterment of the care and safety of clients. She is a member of the National League for Nursing (NLN), a charter member of the Omega Upsilon Chapter of the Sigma Theta Tau International Honor Society of Nursing, and a peer reviewer for the Accreditation Commission for Education in Nursing (ACEN).

Dr. Vogelzang holds a BS in dietetics from Michigan State University, an MS in Health Science from Grand Valley State University, an MA in Biology from Miami University of Ohio, and a PhD in Health Services specializing in community health from Walden University. Dr. Vogelzang is a registered dietitian and health education specialist and an expert in community health who has spent the last two decades teaching in higher education. As a practitioner, Dr. Vogelzang is especially well-rounded, working in the community setting with infants, children, pregnant women, and chronically ill adults and older adults and in palliative and hospice care. In 2016, Dr. Vogelzang was the founding director of a coordinated graduate program in clinical dietetics. She is a nationally recognized speaker and researcher. Her peers have formally recognized her for excellence in professional practice—Excellence in Public Health Nutrition (AND) and Achievements in Public Health Nutrition (APA). Dr. Vogelzang has also been recognized for her dedication to the high standards of the nutrition and dietetics profession through active participation, leadership, and devotion to serving others in nutrition and dietetics as well as allied health fields (AND Medallion Award). She regularly volunteers in professional and community organizations locally, nationally, and internationally.

Dr. Whittington holds a BS in Nursing from Middle Tennessee University, an MS in Nursing from Southern Illinois University, and a PhD in Workforce Education from Southern Illinois University. She is Program Director of Nursing, School of Health Science, at Southern Illinois University. Dr. Whittington’s nursing career spans more than 30 years, with practice in the acute care setting. Her nursing experience includes ICU, oncology, management, and administration. Her nursing education career began in 1993 with an adjunct clinical position at the community college level. Throughout her nursing education experience, she has taught nurses across all academic levels, from certified nurse assistants through bachelor’s-prepared registered nurses, culminating with doctorally prepared registered nurses. She currently teaches nutrition courses to accelerated, traditional, and RN-to-BSN students. Dr. Whittington is a member of the Illinois Nurses Association, Illinois Organization of Nurse Leaders, Registered Nurse Education League, and Sigma Theta Tau International Honor Society of Nursing. She is the recipient of the Emerson Excellence in Teaching Award (2019), the visiting scholar award from Michigan State University (2009), and an Illinois Nurse Educator Fellowship (2023). Dr. Whittington is a Certified Nurse Educator.

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Introduction

Chapter outline.

Good nutrition is fundamental to improving and maintaining health regardless of age or current health status (Centers for Disease Control and Prevention [CDC], 2021). Accordingly, nurses must be knowledgeable and prepared to incorporate nutrition science into their practice. Traditionally, the science of nutrition had focused on nutrient intake and biochemical processing only. However, food intake serves other various purposes, from celebrating milestones to providing comfort when stressed or grieving. Over time, food and food preparation has evolved to center around pleasure and convenience rather than simply a means of sustenance. Consequently, nurses must integrate these social and cultural factors with evidence-based nutritional guidelines to help their clients meet their physical, psychological, and social needs.

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Access for free at https://openstax.org/books/nutrition/pages/1-introduction

Authors: Emerald Charity Bilbrew, Jody Vogelzang, Kelli Whittington
Publisher/website: OpenStax
Book title: Nutrition for Nurses
Publication date: Mar 20, 2024
Location: Houston, Texas
Book URL: https://openstax.org/books/nutrition/pages/1-introduction
Section URL: https://openstax.org/books/nutrition/pages/1-introduction

© May 15, 2024 OpenStax. Textbook content produced by OpenStax is licensed under a Creative Commons Attribution License . The OpenStax name, OpenStax logo, OpenStax book covers, OpenStax CNX name, and OpenStax CNX logo are not subject to the Creative Commons license and may not be reproduced without the prior and express written consent of Rice University.

COMMENTS

Chapter 14 Nutrition - Nursing Fundamentals - NCBI Bookshelf
Identify factors related to nutrition across the life span. Assess a patient’s nutritional status. Outline specific nursing interventions to promote nutrition. Base your decisions on the action of nutrients, signs of excess and deficiency, and specific foods associated with each nutrient.
1.2: What Is Nutrition? - Medicine ... - Medicine LibreTexts
Nutrition is the intake of food to meet the needs of the body. Accordingly, nutrients are substances found in foods and beverages that are essential for survival. Nurses must understand the components of nutrition and its impact on bodily functions to provide effective nursing care.
1.1 What Is Nutrition? - Nutrition for Nurses - OpenStax
Nutrition is the intake of food to meet the needs of the body. Accordingly, nutrients are substances found in foods and beverages that are essential for survival. Nurses must understand the components of nutrition and its impact on bodily functions to provide effective nursing care.
14.1 Nutrition Introduction – Nursing Fundamentals
Learning Objectives. Describe variables that influence nutrition. Identify factors related to nutrition across the life span. Assess a patient’s nutritional status. Outline specific nursing interventions to promote nutrition.
‘Food for thought’: The importance of nutrition to patient ...
Good nutrition is an integral component of patient care. Not only does eating correctly provide substantial physical benefits, it also ensures psychological comfort throughout admission.
Six steps to optimal nutrition care - American Nurse Journal
Learn how nurses can identify, prevent, and treat malnutrition in hospital patients using a stepwise approach. The article explains the roles of nurses and dietitians, the signs and symptoms of malnutrition, and the components of a nutrition care plan.
Healthy Eating for Healthy Nurses: Nutrition Basics to ...
This article reviews how stressors, inflammation, and obesity can affect nurses' health and well-being, and how nutrition can help. It also offers nutrition tips and suggestions for nurses to avoid food pitfalls and provide nutrition education to patients.
14.1 Nutrition Introduction – Nursing Fundamentals 2e
This chapter will review basic information about the digestive system, essential nutrients, nutritional guidelines, and then discuss the application of the nursing process to address clients’ nutritional status.
Nutrition for Nurses - Open Textbook Library
A free online textbook for nursing students that covers nutrition across the lifespan and body systems. Learn about evidence-based practice, holistic assessment, and special nutritional considerations for various health conditions.
Ch. 1 Introduction - Nutrition for Nurses - OpenStax
Over time, food and food preparation has evolved to center around pleasure and convenience rather than simply a means of sustenance. Consequently, nurses must integrate these social and cultural factors with evidence-based nutritional guidelines to help their clients meet their physical, psychological, and social needs.

14.1 Nutrition Introduction

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‘Food for thought’: The importance of nutrition to patient care and the role of the junior doctor

Alexander J Baldwin

Six steps to optimal nutrition care

Nurse’s role in nutrition care

Step 1: Nutrition screening

Step 2: At-risk determination

Step 3: Nutrition assessment

Step 4: Malnutrition diagnosis

Step 5: Nutrition care plan

Step 6: Monitoring and transition-of-care planning

Three forms of malnutrition

1 Comment .

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14.1 Nutrition Introduction

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Nutrition for Nurses

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Table of Contents

Ancillary Material

About the Contributors

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Introduction

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