Nurses’ and other healthcare professionals’ representations of malnutrition among patients in a psychiatric setting: The missing link between knowledge and practice?

Abstract

Nurses play an important role in identifying nutritional risk among their patients and in referring them to the physician or the dietician. However, systematic screening is rare, mostly because of lack of time and awareness among nurses, which lead to suboptimal detection of malnutrition. But studies also showed nurses’ positive attitudes towards nutritional care and a good level of knowledge about malnutrition. The goal of this study was to qualitatively examine the social representations of malnutrition among caregivers working in a large psychiatric hospital. Three trained dieticians conducted semi-structured, one on one, 30-minute interviews using an open-ended 7-item guide. The sample included 8 psychiatric nurses, 8 nursing aids and 8 physicians. Each interview was audio-recorded and transcribed verbatim. Content analysis was performed and social representations were structured around the four main concepts that emerged: 1) Images and personal definitions of malnutrition, 2) Knowledge, 3) Professional practices and 4) Professional training. Most respondents shared the image of extreme thinness to describe malnutrition. Theoretical knowledge was found to be good, but the respondents failed to relate it to their patients, apart from cases of anorexia nervosa. It seems that caregivers’ social representations of malnutrition are incompatible with the signs displayed by patients at nutritional risk. This could contribute to explaining why nutritional risk assessment is rarely performed routinely. Social representations on malnutrition should be taken into account when addressing issues about screening for malnutrition.