CLINICAL ISSUES

A successful way for performing nutritional nursing assessment

in older patients
Ulrika Soderhamn and Olle Soderhamn

Aim. The aim of this study was to obtain increased knowledge and understanding about what can be promoting and facilitating
for nurses to perform nutritional nursing assessment in older patients.
Background. The frequency of older patients at nutritional risk or suffering from undernutrition is high in hospitals. Studies
have shown frequent lack of awareness about signs of undernutrition as all patients are, for example, not weighed. Nurses
descriptions about nutritional problems have also been found to be often vague and unspecific.
Design. A qualitative design was used.
Methods. Ten conveniently chosen registered nurses, working with older patients in two hospitals in western Sweden were
interviewed. Four of the interviews were performed during 2003 and six during 2006. The interviews were analysed according
to a Gadamerian-based hermeneutic research method.
Results. The analyses revealed that promoting aspects for performing nutritional nursing assessment in older patients were to get
information by dialogues, by observations and controls, by collaboration with other caregivers and professionals and by
performing continuous follow-ups. Necessary conditions, beside knowledge and consciousness about nutritional issues, were to
have interest, give time to listen to the patients story and furthermore, be sensitive to the patients wishes, be able to assess the
patients motivation to eat and have an ethical awareness.
Conclusions. A successful way that promoted the performance of nutritional nursing assessment in older patients was to use
different approaches as interactive dialogues, observations, controls and collaboration in team. Such a nutritional nursing
assessment was an ongoing process during the patients hospital stay.
Relevance to clinical practice. These results highlight that nurses have an important role in identifying eating problems in older
patients, which has to be a prioritised issue in the care of older people.
Key words: aged, hermeneutics, nurses, nutritional risk, qualitative design, undernutrition
Accepted for publication: 13 January 2008

Introduction
The frequency of older patients at nutritional risk or suffering
from undernutrition is high in hospitals (Westergren et al.
2002, Kagansky et al. 2005, Shum et al. 2005). To identify,
assess and treat these patients is of great importance, because
undernutrition is a risk factor for higher incidence of
Authors: Ulrika Soderhamn, MSc PhD RN, Senior lecturer, University
of Agder, Faculty of Health and Sport, Arendal, Norway; Olle
Soderhamn, MSc PhD RNT, Professor, Faculty of Health and Sport,
University of Agder, Arendal, Norway and Department of Nursing,
Health and Culture, University West, Trollhattan, Sweden

complications and increased mortality, length of hospital

stay and costs (Correia & Waitzberg 2003). Undernutrition is
also known to contribute to poor health and decreased
quality of life for older patients (Chen et al. 2001). Undernourished patients are largely unrecognised (Elia et al. 2005)
and, therefore, the nutritional care should be highlighted and
prioritised.
Correspondence: Ulrika Soderhamn, Senior lecturer, Faculty of
Health and Sport, University of Agder, PO Box 604, NO-4809
Arendal, Norway. Telephone: +47 37004089.
E-mail: [email protected]

 2008 The Authors. Journal compilation  2008 Blackwell Publishing Ltd, Journal of Clinical Nursing, 18, 431439
doi: 10.1111/j.1365-2702.2008.02378.x

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U Soderhamn and O Soderhamn

Identifying, assessing and treating older patients nutritional problems is a challenge for all staff groups involved
in the patients care. According to Beck et al. (2001),
barriers for identification of undernutrition are for examples: lack of sufficient knowledge about nutrition among the
staff groups, lack of co-operation between the staff groups
and that the patients are not given the possibility to
influence their own nutritional care. Nurses are in an ideal
position to talk with patients about their eating and eating
problems because they are near the patients and are meeting
them directly after the admission to the hospital ward. In
the nurses admission dialogue, questions about weight,
appetite, food intake and eating should be raised to
highlight unintentional weight loss, poor appetite, insufficient food intake (Evans-Stoner 1997, Chen et al. 2001,
Mowe & Bhmer 2002), mouth or swallowing problems
(Andersson et al. 2002, Soini et al. 2005) or other problems
that can make the eating difficult. Studies have shown that
there is often lack of awareness about signs of undernutrition in hospitals, since for example all patients are not
weighed (Bruun et al. 1999, Campbell et al. 2002,
Rasmussen et al. 2004). Furthermore, weight loss and
food intake are seldom registered in the patients records
(Rasmussen et al. 2004). Nurses descriptions about nutritional problems have been found to be often vague and
unspecific (Kumlien & Axelsson 2002). A systematic
assessment of determining the patients needs can also be
absent, e.g. regarding the nursing process and nutritional
nursing care plans (Soini et al. 2005). Consequently, it is
important that nurses have knowledge about how to detect
and assess eating problems in older patients.

Aim
The aim of this study was to obtain increased knowledge and
understanding about what can be promoting and facilitating
for nurses to perform nutritional nursing assessment in older
patients.

Objectives and methods

To be aware of how nurses think about older patients
nutritional problems and how they are performing a nutritional nursing assessment, a qualitative research approach
was considered as appropriate to capture these phenomena.
To obtain understanding for the nurses assessment process, a
Gadamerian-based hermeneutic research method (Fleming
et al. 2003) was chosen. Hermeneutics is about how to
dman 1994) with a focus on
interpret and understand (O
understanding the meaning of, for example, a text (Palmer
432

1969) to establish context and meaning for what people do

(Patton 2002).
The basic of all hermeneutic preconditions is ones own
pre-understanding, which comes from being concerned with
the same subject (Gadamer 2004). In this study the preunderstanding of the authors is constituted by their professional knowledge as registered nurses and researchers with
specific interest in the care of older patients.
A condition for understanding is to have a dialogue with
the text. The interpreter puts questions to the text. A text also
puts questions and the interpreter must try to find these
questions. To understand a text means to understand the
questions. This is the horizon of the questions within which
dman 1994, Gadamer
the sense of the text is determined (O
2004).
Gadamer means that a horizon is the range of visions that
includes everything that can be seen from a particular point,
for example from the horizon of the text and from the
horizon of the interpreter. A horizon is expressing the breadth
of vision that the interpreter must have. To find these
horizons mean that the interpreter learns to look beyond
what is close at hand and see it better in a larger whole and
truer proportion. The understanding of the phenomenon is
then always the fusion of the horizons (Gadamer 2004).
When the horizons are fused, the interpretation is belonging
to what it interprets. The result becomes a whole, greater
than the sum of the parts (Weinsheimer 1985).
To understand the content, the whole of a text, you have to
see the details. The movement of understanding is constantly
from the whole to the part and back to the whole. To find the
harmony of all the details with the whole is the criterion of
correct understanding. The task of hermeneutics is, accordingly, to clarify this miracle of understanding (Gadamer
2004).

Participants
A convenience sample (Polit & Beck 2004) of 10 registered
nurses in western Sweden, working with older patients in two
hospitals (hospital I and II) was asked to participate in the
study. Five nurses worked at two general geriatric rehabilitation wards, one in each hospital, and five worked at one
stroke rehabilitation ward in hospital II (see Table 1). The
head nurse at the ward in hospital I was informed about the
study by the first author. Written information about the study
was distributed to the nurses by the first author and those
nurses who gave consent to participate were then contacted
and informed orally and times were settled for the interviews.
The head nurses in the two wards at hospital II were
contacted by the first author and informed about the study.

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Clinical issues

Nutritional nursing assessment in older patients

Table 1 Background variables about the

study participants

Nurse
Nurse
Nurse
Nurse
Nurse
Nurse
Nurse
Nurse
Nurse
Nurse

A
B
C
D
E
F
G
H
I
J

Sex

Age
(years)

Experience
as a registered
nurse (years)

Hospital

Hospital ward

Female
Female
Female
Female
Female
Female
Female
Female
Female
Female

49
27
37
46
41
25
39
42
33
43

27
6
2
7
1
1
3
6
05
1

I
I
I
I
II
II
II
II
II
II

General geriatric rehabilitation

General geriatric rehabilitation
General geriatric rehabilitation
General geriatric rehabilitation
Stroke rehabilitation
Stroke rehabilitation
Stroke rehabilitation
General geriatric rehabilitation
Stroke rehabilitation
Stroke rehabilitation

They also distributed the written information to the nurses.

Agreements were performed between the head nurses and the
first author about appropriate time for interviews. Oral
information about the study was given to the nurses, who
agreed to participate, in connection with the interviews. The
participants were all interested in nutritional nursing. The
registered nurses at the hospital wards where this study was
performed (hereafter referred to as nurses) worked together
with enrolled nurses in teams. Background variables of the
participating nurses were asked in connection with the
interviews and are displayed in Table 1.

Data collection
Four interviews (in hospital I) were performed during 2003
and six interviews (in hospital II) during 2006. This time
span was because of the authors other responsibilities not
connected to this study. The nurses were interviewed in
their working places in a separate room. The interviews
were open-ended. The participants were requested to
narrate an event they had experienced, when they performed
a nutritional assessment of an older patient and, at first,
begin with a short description of the chosen patient
containing background variables as sex and medical diagnoses. Follow-up questions were raised when elucidations
were needed. The tape-recorded interviews, which lasted up
to 20 minutes, were conducted and transcribed verbatim by
the first author.

Ethical considerations
The participants received oral and written information
about the study and gave their consent to participate. The
participants and their patients confidentiality is ensured
because no names are reported and the quotations of what
they have said are not connected to anybody of them. The

study was approved by the Research Ethics Committee of

western Sweden (Medical Faculty, Goteborg University,
527-01).
O

Data analysis
A modified form of the stages developed by Fleming et al.
(2003), according to Gadamers ideas, was used in the
analyses of the interviews:
The first step was to perform a deciding upon the appropriateness of the research question in relation to the
underpinning methodological assumptions, because the
initial research question is essential and influences
the whole research process.
The second step was an identification of pre-understandings. The researchers have to identify and reflect on their
own pre-understandings concerning the study phenomenon. This will make it possible to move beyond the preunderstandings to get new understanding and be able to
transcend in a horizon.
The third step was to gain an understanding through dialogue with the participants through the text. To understand
the meaning of the text gained from the participants, a
conversation must go on between the researchers and the
participants through the text. The questions that were
raised to the text were what could be promoting or facilitating for the nurses regarding the performance of a
nutritional nursing assessment. The starting point should
be to gain an understanding of the whole text. In the next
phase, every single sentence or section should be investigated to expose its meaning for understanding of the subject matter. This stage will facilitate identification of
themes and these should then be challenged by and also
challenge the researchers pre-understandings. Every sentence or section is then related to the meaning of the whole
text and the meaning of the text will so be expanded. The

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U Soderhamn and O Soderhamn

understanding will appear through the fusion of the horizons of the participants and the researchers.
The fourth step was to establish trustworthiness.
Researchers, following a Gadamerian approach, are
responsible for establishing the trustworthiness of the research process and the truthfulness of the analysis. The
understanding can only be achieved by consensus of the
whole and the parts of the text. Therefore, the responsibility is to provide sufficient details of the processes as well
as the findings in the research report.

facilitate the performance of the assessment. The nutritional

issues that could be discussed covered a wide scope of
important issues such as weight loss, possibilities for social
contacts, mobility, possibilities to cook, appetite, eating and
eating problems and in what way eating problems were
influenced by illness and disease. To have information about
these particular issues gave a possibility for the nurse to
reflect over if the patient had a sufficient intake of
nutritional requirements or if he/she could be at risk for
undernutrition and, furthermore, how to proceed further in
the assessment process:

Results

She had dropped 10 kg recentlyI started to talk a little with her

The study participants had a median age of 40 years. Their

experiences as registered nurses reached a median age of
25 years with a range of 0527 years (Table 1). The
analyses resulted in the following themes that were promoting or facilitating for the nurses in performing nutritional
nursing assessment in older patients: information by dialogues, information by observations and controls, collaboration with other caregivers and professionals, continuous
follow-ups and necessary conditions.

Information by dialogues
An important source for the nurse to obtain information
about the patients nutritional needs and problems was to let
him or her tell about them in the admission dialogue. If it was
difficult to obtain information from the patient, the next of
kin could be a possible source to get information from and in
that way the nurse gets a picture of the patients eating at
home:
We understood, after having talked a lot with the next of kin, that it
was not easy to get the patient to tell so much, because she thought
that she ate enough. But it appeared that she drank [just] a little every
day and she had eaten one day in the week when someone came with
food to her.

To have knowledge and be conscious of nutritional issues

and to know the importance and relevance of these issues
for the particular individual older patient promoted the
nutritional nursing assessment. This was shown when the
nurse had an individual holistic patient view and discussed
with the patient about his or her situation before admission
to the hospital. It was also reflected in the current situation
and how the nurse wanted to find out how and why the
identified nutritional problems influenced the patients
eating ability and its possible association with illness and
disorders. To have a routine for which particular specific
issues that should be discussed in the dialogue could also
434

about this and then it was clear that she had dropped about five kg
only the last weeksI tried to ask herwhat she thought was the
reason for this. I asked her about the household at home and she told
that she the last days before admission had almost not been able to
eat anythingShe had no relatives in the neighbourhoodalmost all
of her old friends were goneShe had earlier been very active, but
now she could not move due to her back [she had fallen down and
hurt her back and got vertebra compressions] and her poor vision.
The pain from her back gave her nausea

Information by observations and controls

Facilitating the performance of the nutritional nursing
assessment was also to get information about actual eating
problems by performing observations and controls. An
observation could, for example, be about the body constitution. Controls could be to measure weight and height and
record food and fluid intake. To have some admission
controls as a routine or a norm at the ward was a way to
highlight the patients eating ability and could be seen as help
for the nurse to go further into the nutritional nursing
assessment process. Examples of such routines were to test
the ability to swallow in a patient who had got a stroke and
to check the mouth status. Another example, that gives
information about how much the patient eats and if it is
sufficient, was to record fluid and food intake some days and
estimate the energy intake and put it in relation to the
patients nutritional requirements:
She was extremely thinThe mouth is always controlledand she
had no teeth and her dentures had not fitted for yearsand it was a
lot of fungus in the mouth
We took an admission weight and she weighed 48 kg and the height
was 170 cm and I thought directly that it was a low weightWe
recorded the intake and registered the food and fluidI estimated her
needs of energy and fluid [showing the paper with instructions about
how to estimate energy and fluid needs]

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Clinical issues

However, it was also obvious that a nutritional routine in the

ward was not a guarantee for the nurse to get nutritional
information. When the nursing staff had to register many
patients food and fluid intake simultaneously, it was not
always possible to control the situation, i.e. to record
everything the patients were eating and drinking correctly.
Further, a routine had also to be firmly established to be
followed:
We recorded the food and fluid intake in two, three days and nights
but not more, because it seems that nobody is able to fill them out
[the nutritional lists] and then it falls into nothing.

Estimating Body Mass Index (BMI) was a source to obtain

information about the patients nutritional status. But the
BMI value should not be interpreted literary. A patient could
have overweight and all the same be in need of nutritional
supplements. If the BMI value was interpreted literary and
was found to be in the normal reference interval and,
therefore, interpreted to be satisfactory, it could be seen as an
obstacle to go further and detect other specific nutritional
needs and problems:
We have talked a lot of this...about estimating the BMI. We do not do
it so frequently anymoreYou can have a good BMI or a high BMI
and still need nutritional interventions

But in a patient with a serious acute illness, nutritional

observations can be of low priority and, therefore, this could
be regarded as an obstacle for performing a proper nutritional nursing assessment:
if a patient is tired and in a serious condition, yes then it is not the
highest priority.

Collaboration with other caregivers and professionals

Collaboration between other caregivers and professionals
promoted the assessing of the patients nutritional problems.
Collaboration could be seen between the nurse and the
enrolled nurse. To highlight a patients eating ability, the
nurse could organise an enrolled nurse into performing
specific tasks. This arrangement was seen as a possibility for
the nurse to enhance the amount of information about the
patients eating and, thus, facilitate the nutritional assessment
process of that particular patient. However, if this arrangement did not work out, it could be seen as a hindrance for a
nutritional nursing assessment to take place:
If we have a patient who is in need of attention, we try to arrange that
a specific person serves food to her, because then you can ask if she
[the patient] ate the food or how much, even when nutritional record
is not used. Yes, it is about so we are doing itBut sometimes one

Nutritional nursing assessment in older patients

hears from the enrolled nurse that the patient has eaten badly some
days. Some days! One gets quite alarmed then!

There was also collaboration between the nurse and the

physician. Eating problems because of mood changes in the
patient or swallow problems give the nurse a reason to
discuss the identified problems with the physician:
She had eaten very poorly. She was very depressedShe got
medication for depression and this helped her.

Moreover, the nurse could initiate contact with a speech

therapist, so the swallow problems could be further assessed.
A dietician could be counselled to get help with the
estimation of the patients nutritional requirements and to
get some suggestions of food of proper nutritional value.
That a nurse and an enrolled nurse in the same ward were
continuously informed about nutritional issues gave them
opportunities to have a counselling role regarding the nutritional nursing in the ward, for examples concerning choice of
food and supplements. The patients eating was in that way
highlighted and this promoted that the patients eating ability
was observed, assessed and that interventions were performed:
Then we have the ones responsible for nutrition, an enrolled nurse
and a nurse at the ward, who is attending meetingsand gets new
informationso we can always ask them.

Continuous follow-ups
The nurse watched the patients development. Further
dialogues with and observations of the patient were promoting for a continuous assessment process, because it supplied
the nurse with information about the effects of the interventions and how the nutritional status of the patient changed.
The nurse also felt a responsibility for that the patient had a
continuous and proper nutritional intake. If the patient could
not eat, the nurse was concerned about that the patient got
parenteral infusion or tube feeding.
To use a nutritional nursing care plan highlighted the
nurses nutritional assessment and was seen as a help for the
nurse to follow up the interventions and perform evaluations.
This facilitates the continuation of the nursing assessment
process. To use a specific nutritional record, where the
amounts of the fluid and food intake were registered, was
also a help to get information about the patients fluid and
energy intake and thereby a possibility to follow changes:
when checking [food and fluid intake] we saw that his nutritional
requirements [when eating energy and protein enriched food] were
satisfyingand do further follow ups during the hospital stay in
order to see that he does not drop his weight or energy intake

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U Soderhamn and O Soderhamn

Necessary conditions
Besides having knowledge and consciousness about nutritional issues regarding the older patient it emerged that having
interest and giving time for dialogue and listen to the patients
story were very important aspects. These conditions can be
seen as determining for promoting and facilitating a high
quality of the nutritional nursing assessments and, accordingly, of the nutritional interventions. But absence of these
conditions can on the other hand be considered to be obstacles
for performing a proper nutritional nursing assessment:
A reflection concerning a patient who ate so poorly and became so
much better and got a good appetiteThat I succeed with this
patient, I think, was depending on that I had time at the admission
dialogue and that we actually talked about the reasons to his
problemsIt depends on how much time you have and of course of
interest on the part of the nurses.

To be sensitive to the patients wishes and be able to assess

the patients motivation to eat was also very important. The
nurse should also be aware that the patient can experience the
eating as a psychological stressor. Moreover, an ethical
awareness was also a necessary perspective for the nurse in
the nutritional nursing assessment of the older patient:
I thought that it could be so that it was a pressure for him

also conducted the interviews, which is an ideal situation to

avoid misunderstanding or misinterpreting during the transcription process (Easton et al. 2000). The interviews were
then interpreted as one text. Fleming et al. (2003) have
developed the five-step Gadamerian-based research method
for nursing research. Four of these five steps were chosen in
the analysis, because step three and four in the method were
rather similar and therefore treated as just one step.
The responsibility of the researcher is to establish trustworthiness and truthfulness, with the components credibility
and confirmability, of the research process and the analysis
(Fleming et al. 2003). Trustworthiness in this study has been
realised by describing the steps in the analysis. Credibility has
been ensured by showing quotations, i.e. the perspectives of
the participants have been shown to the reader. Confirmability can be considered by returning to the text at all stages
in the research process and this has been taken in account in
this study. However, no external judges have been used. The
truthfulness of a Gadamerian-analysis can be shown when
the conditions under which the results emerged are presented
(Fleming et al. 2003). Many possible interpretations can be
found, but according to Stoltz et al. (2005), this is, hopefully,
a most probable interpretation that emerged from the
horizons of the text and the interpreters with their
pre-understanding included.

regarding this with the food. He felt that he was forced to eat. He
thought that the food did not taste and he did not want to eat. He
became fed through a percutaneous tube; it was what he wanted and
then he knew that he got the nutritional requirements he needed and
he could eat more for pleasure...Then it changed and after two, three
weeks he could eat well again

Discussion
To obtain knowledge and understanding of the studied
phenomenon, i.e. what may be promoting and facilitating for
nurses in performing nutritional assessment of older patients, a
hermeneutic research approach was considered to be suitable.

Methodological considerations
That the participants were requested to narrate an event they
had experienced concerning a nutritional assessment of an
older patient was a way to obtain knowledge and understanding about the nurses own nutritional knowledge used in
practice. It is also important that the initial research question
is considered to be suitable for the chosen method (Fleming
et al. 2003, Stoltz et al. 2005), which was the case here. The
interviews were transcribed verbatim by the first author, who

436

The results
The nurses in this study were found to have a lot of
knowledge for performing a nutritional nursing assessment of
an older patient. A possible reason can be that these nurses
had a real interest for nutritional issues in older patients and
that nutritional issues were to some extent highlighted in
their hospital wards. That nurses with relatively short
professional experience had knowledge about nutritional
issues may also indicate that these issues had been addressed
in their education. However, other has highlighted nurses
insufficient knowledge about theoretical and practical aspects
of nutrition (Kondrup et al. 2002) and that the nutritional
nursing knowledge has not consistently been used in practice
(Kowanko et al. 1999).
The findings showed what could be promoting and
facilitating to perform a nutritional nursing assessment. A
knowledge-based dialogue between the patient and the nurse
was an example of what could promote the nutritional
nursing assessment. But it was also revealed that necessary
conditions have to be present, e.g. to have interest and give
time for listening to the patients story and, furthermore,
be sensitive to the patients wishes. This shows that an

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Clinical issues

interaction between the nurses and the patient is important to

identify the patients nutritional problems, because the
patient is given the possibility to really talk about his or her
nutritional problems. According to Parse (1998), it is possible
to understand another person when being with that person
face-to-face in true presence. With an attentive presence, the
nurse can follow the persons thoughts and move beyond and
help the patient to find a solution of the particular problem.
This is in line with Telford et al. (20062007), who
concluded in a study that the nurse had a crucial role in
identifying people at nutritional risk by listening to the
persons story and so be able to understand and support him
or her concerning the particular nutritional problems. Florin
et al. (2005) found that patients could identify more severe
nutritional problems than their nurses did. This supports the
importance of having an interactive dialogue with the patient.
In this way the patient can also be really involved in his or her
own care. Pedersen (2005) found that care based on older
patients being actively involved in their nutritional care was a
way to improve their food intake and thereby prevent
undernutrition. Not giving the patients the possibility to
influence their own nutritional care is a barrier for proper
nutritional care (Beck et al. 2001).
The nurses nutritional nursing assessment of an older
patient was also found to be an ongoing process. According
to Evans-Stoner (1997), the nutritional admission assessment
must be continued by further daily assessments. A reason for
this is that it is known that the prevalence of hospitalised
patients at nutritional risk is high (Kondrup et al. 2002,
Westergren et al. 2002) and that many patients nutritional
status decline during the hospital stays (Kowanko 1997,
Rasmussen et al. 2004). This supports that a continuous
nutritional nursing assessment process during the hospital
stay must have high priority.
It was shown that the nurses used nutritional nursing care
plans that highlighted the patients nutritional problems and
the nurses assessments. To use nursing care plans is to work
according to the nursing process. Reasons for nurses not
using and documenting in nutritional care plans can include
difficulties in identifying at-risk patients and in setting up care
plans (Beck et al. 2002) and this can be considered as a
possible obstacle for performing nutritional assessments. To
use a screening instrument included in the admission dialogue
can also be a help for the nurse to identify older patients at
risk for undernutrition (Soderhamn & Soderhamn 2002,
Kondrup et al. 2003). Nobody of the participants in this
study used a screening instrument for identifying their
patients nutritional problems.
The nurses in this study worked in teams with other
caregivers and professionals which showed that collaboration

Nutritional nursing assessment in older patients

between staff groups promoted the performing of the

nutritional nursing assessment. This is in line with Beck
et al. (2001) who focused the importance of cooperation
between different staff groups regarding nutritional issues
and saw a lack of such cooperation as a barrier for proper
nutritional care in hospital.
That the nurses in this study used different approaches
when getting nutritional information gave them better
possibilities to perform nutritional nursing assessments of
their older patients. This can be compared with the findings
in a study by Odencrants et al. (2007), who found that the
nurse can establish a holistic approach to the assessment of
nutritional status by using a wide scope of observations and
intuition.
Necessary conditions as knowledge, interest and time
had to be present to perform a nutritional assessment. A
discussion among nurses about how to highlight, organise
and prioritise the nutritional care of the older patients in a
hospital ward is of determined importance. Nutritional
education must also have high priority in nursing education and in continuing education for nurses in clinical
settings. Sufficient time has to be giving to the admission
dialogue.

Limitations
There is a limited possibility to do generalisations in a more
quantitative sense about the findings in this study, because of
the qualitative design and that only a few participants were
interviewed. But the purpose with this study was not to
obtain findings to do generalisations about most nurses
nutritional nursing assessments of older patients, but rather
to obtain a more comprehensive understanding of the
phenomenon in focus. There is, however, a possibility to do
generalisations on the level of the phenomenon studied. The
revealed findings show that nutritional nursing assessment of
older patients in this study is a phenomenon that is very
similar to nursing assessment in general. It seems also
reasonable that the findings can be transferred to other
similar contexts and other patient groups.
One weakness, however, was that many of the participated
nurses had little experiences as registered nurses. Another
weakness was that very few additional questions were asked
to the participants during the interviews to get a deeper
understanding of the phenomenon. But this can also be
considered as strength, because the interviewer did not
influence the participants.
Further studies are needed to get more comprehensive
knowledge about what can promote nurses nutritional
assessments of older patients.

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U Soderhamn and O Soderhamn

Conclusions
A successful way that promoted the performance of nutritional
nursing assessment in older patients was to use different
approaches as interactive dialogues, observations, controls
and collaboration in team. Such a nutritional nursing assessment was an ongoing process during the patients hospital stay.
The results highlight that nurses have an important role in
identifying eating problems in older patients, which has to be a
prioritised issue in the care of older people.

Acknowledgements
The authors would like to thank the nurses for their
willingness to participate. The study has been funded by
grants from Fyrbodal Research Institute, Sweden.

Contributions
Study design: US; data collection and analysis: US and
manuscript preparation: US, OS.

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