Investigate student nurses knowledge and understanding of nutrition
Knowledge of nutrition is cited as a fundamental component of nursing educational curriculum, and is usually incorporated into their school programmes (La Trobe University, 2003). Schaller and James (2005) claimed that majority of nurses that are still in school are tutored about clinical nutrition from the perspective of health in general, by integrating public health nutrition in its totality, that is health promotion and prevention. It is believed that being aware of the essential dietary concepts is one of the most crucial training student nurses should undergo to create an atmosphere of excellent curative goals and good dietary counselling (Schaller and James, 2005). However, it has been reported by (Harminder and Slhgh, 2006) that nurses have inadequate knowledge of nutrition and are less concerned about evaluating patients' nutritional status. The idea of training nurses in nutrition is supported by the registered body in charge of the diet of patient in the United States (American Dietetic Association (1998), the Department of Health (1994) and the dietetic association (1994) in the UK). In addition the UK government sustained this initiative by putting in place a policy that focus on educating health care practitioners on nutrition which include nurses and midwives in the United Kingdom (Department of health, 1994).
Wynder and Andres (1994) have declared that nutrition is a major manageable risk factor that could have an impact on a patient wellbeing; this is why its role is very crucial in health promotion and eradication of disease. Bearing in mind that it is the sole job of a nutritionist as well as a dietician to counsel patients' on the necessary diet for healthy living, nurses are also expected to provide adequate nutrition education to patients and also to be familiar with the necessary danger associated with poor nutrition (Lindseth, 1990; Wilt et al., 1990; Gibbons et al., 2000). It was discovered by (LIndseth, 1990; Lindseth, 1994; Crogan et al., 2001) that imparting nutrition knowledge to student nurses at undergraduate level is quite inadequate while there is restriction in the update of nutrition knowledge practising registered nurses receive. Barrowclough and Ford (2001) claimed that knowledge of nutrition is acquired by a lot of practising midwives through the media rather than through the appropriate education they ought to have received before they were qualified as a nurse in the United Kingdom. Lyu et al., (1998) also declared that nutrition education is less emphasized in schools of nursing in Korea and only few of them have incorporated nutrition courses into their scheme of work. This development could result into carelessness on the part of the graduate nurses on management of patient nutritional status (Kim and Choue, 2009), since less emphasis was placed on impacting the knowledge during their school training.
Nutrition education was considered by Sapp and Jensen, (1997) to change people's habit with respect to their level of age, but was said not to be enough for dietary change (Hendrie et al., 2008). This view was supported by Bandura, (1986) who accepted that knowledge is needed to turn around people's ways and action and is very important in influencing dietary behaviour. Worsley (2002) also claimed that reaction to attitudinal changes may be different from the acquired knowledge of nutrition due to the way the messages is understood and utilised by the public. This view led to the development of a well planned attitude and health belief model. It was declared by Janz and Becker (1984) that this model was developed to envisage precautionary health behaviours and its behavioural response to healing in chronically sick patients. This model explores how beliefs impact on behaviour (Abraham and Sheeran, 2005). In the context of nursing, what the nurses puts into practice depends on how vulnerable they recognize the patient in their care to be to the illness. This includes the nurses' belief about the susceptibility to the illness and its predisposing factor, the anticipated severity of that incidence, the advantage of implementing self-protection and safety of the patient, and the barrier to its implementation. Where such health beliefs are understood from the Nutrition and health education or perceived symptoms perspective, it can help in stimulating healthy behavioural change (Naidoo and Wills, 2009). Nutrition education was claimed in recent studies to influence dietary habit which could be in form of reduction of cholesterol intake (Levy et al., 1993), buying nourishing and healthy food choices (Turrell and Kavanagh, 2006), reduction of fatty food intake (Kristal et al., 1990), increase intake of fruit and vegetables (Van et al., 2008; Ball et al., 2006), and weight reduction (Klohe-lehman et al., 2006).
Temple (1999) claimed that further study determined that there was minute knowledge of nutrition education among students in medical school and practicing health professionals. This view was supported by (Kushner, 1995; Mihalynuk et al., 2003) where they both emphasized that a lot of study carried out on medical practitioners' shows that there is lack of self-reliance in the fundamental diet therapy they give to patients, which was as a result of insufficient nutrition training they received when they were in the medical school. Starnek et al. (1997) found out that the training of nurses in lifelong care services about nutrition of the elderly was quite insufficient and suggested that more attention should be given to improving nurses' knowledge about older persons' nutritional needs. This view was supported by (Kowanko et al., 1999) where they highlighted that several nurses lacked the comprehensive facts about how to care for their patient nutrition which was associated with lack of time and too many other tasks to tackle at a time. They later suggested that sufficient knowledge about nutrition must be incorporated into the training of nurses for optimum care delivery. Crogan et al. (2001) also demonstrated in their study about the competencies of nurses' nutritional awareness in tackling protein energy malnutrition (PEM) among inhabitants in nursing home. They discovered that nurses lack skills as to how residents' diet is being handled and they suggested that an educational seminar provision to all nurses can help to deal with the issue. A survey carried out by Mowe et al. (2008) on healthcare professionals found out that an inadequate nutritional knowledge among health professionals could lead to bad nutritional practice which can result into impediment and delay in patient discharge from hospital. This is the reason why an exploration of the nutritional knowledge of upcoming nurses is very essential.
The aim of this study is to investigate student nurses knowledge and understanding of nutritional needs for themselves and patients in general.
To explore student nurses level of knowledge about nutrition.
To establish the level of awareness of nutrition among student nurses within the context of healthy eating both for themselves and its application to the patient they care for.
The study will be carried out among student nurses within a University, and a quantitative design approach will be employed. The study will commence around September 2010 and last until December 2010. Nutrition knowledge will be assessed using a validated common nutrition knowledge questionnaire (Hendrie et al., 2008). The validity and reliability of the questionnaire was recognized by the unique authors' Parmenter and Wardle (1999), where the construct and the content validity were ascertained and the reliability of the nutrition knowledge test gave an excellent result that ranges from 0.7-0.97. This was verified by the use of a standardised Cronbach's alpha coefficient. A sample of 250 University nursing students aged 18 years old and above will self-administer a questionnaire and complete them inside the lecture theatre where they receive lectures. The students will not be permitted to take the questionnaires out of the lecture room for confidentiality reasons and no identifying characteristics will be included in the questionnaire. The questionnaire is sub-divided into four sections of 113 questions relating to information on nutrition. This will include thirteen questions about nutritional recommendation, seventy question about sources of nutrients, ten questions about different food items and twenty questions about food related illnesses. The answers for each question in each section will be summed up to give a section score. Then the four sections scores will be added together to give an overall general knowledge mark out of 113 questions about nutrition knowledge. A mark that is high will reveal that there is increase nutrition knowledge in that subject for each numbers of correct question answered for each section.
The sample size was calculated for an estimation of 80% by using a standard calculator provided on the web (Crichton, 1993).
The questionnaire includes a variety of fixed choice answers which include 'more, same, less, don't know', 'yes, no, not sure', 'high, low, not sure,' 'agree, disagree, not sure' or an option of four diverse food choices. The demographic questions like gender, marital status and age will also be included into the questionnaire.
The data collected will be coded and entered into SPSS (version 17.0). An overall score will be achieved by using the (SPSS version 17.0) software and descriptive statistics will be employed to analyse the demographic data, and an overall knowledge score will be calculated for each participant. The variation in the knowledge of nutrition among participants will be clarified by using a multiple regression analyses.
The study will be self -funded and the help of the nursing students' course directors will be asked. This will be done to guarantee easy access to the student beforehand so as to avoid disrupting any of their lecture schedules.
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