The barriers to surgical patients' oral intake in the acute hospital setting : a thesis presented in partial fulfilment of the requirements for the degree of Master of Science in Nutrition and Dietetics, Massey University, Albany, New Zealand

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Background: Hospital patients worldwide often do not eat all of their meals, resulting in suboptimal food intakes. These patients are more likely to experience numerous undesirable health outcomes as a consequence of not meeting their nutritional requirements. Aim: To investigate the barriers to surgical patients’ oral intake in an acute hospital setting in New Zealand (NZ). Objectives: To conduct a pilot study to test the usability of the validated Patient Mealtime and Nutrition Care Survey (PMNCS) in a NZ setting, and to adapt the PMNCS to include the most relevant barriers to oral intake in NZ. Further, to conduct a feasibility study to test the effectiveness of the NZ-PMNCS independently, and paired with patient meal observations to confirm the effectiveness of the tool. Methods/Design: A single-centre cross-sectional study conducted at North Shore Hospital, NZ. A sample of 100 surgical in-patients participated in the pilot study and 65 patients in the feasibility study. Results: The most frequently reported barriers were food brought into the hospital by visitors (81.5%) and a loss of appetite (70.8%). Six barrier domains were explored revealing significant findings for: younger (<65 years) compared to older (≥65 years) age associated with more hunger domain barriers (1.47 ± 0.81 versus 0.90 ± 0.67, P=0.003); longer (>5 days) versus shorter (≤5 days) length of stay associated with more food quality domain barriers (1.20 ± 1.26 versus 0.40 ± 0.81, P=0.003). Comparing the NZ-PMNCS and meal observation results showed that patients consuming ≤½ of their meals more frequently reported inability to make informed menu choices (50.0%)(P=0.027) and that consumption of their prescribed nutritional supplements affected their food intake negatively (50%)(P=0.001). Conclusion: Compared to earlier studies using previous versions of the PMNCS, the NZ-PMNCS captured similar results in the NZ hospital setting. Key issues identified include a younger age being associated with experiencing more hunger domain barriers, and patients consuming less food experienced difficulty choosing menu options and found prescribed nutritional supplements interfered with their food intake. The NZ-PMNCS was practical to use and feasible in identifying barriers to food intake. These findings could contribute to changing practices to improve hospital food intake. Keywords: barriers, oral intake, foodservice, surgical patients, hospital
Surgery, Nutritional aspects, Hospital patients, Nutrition, Diet therapy