EMPIRICAL STUDIES doi: 10.1111/j.1471-6712.2012.01043.x ‘The transit of the food trolley’ – malnutrition in older people and nurses’ perception of the problem Loris Bonetti RN, MSN (PhD Student and Head Nurse), Annamaria Bagnasco RN, MEdSc, PhD (PhD Researcher), Giuseppe Aleo MA (Lecturer) and Loredana Sasso RN, MEdSc, MSN (Associate Professor) Department of Health Sciences, University of Genoa, Genoa, Italy Scand J Caring Sci; 2012 ‘The transit of the food trolley’ – malnutrition in older people and nurses’ perception of the problem Aims: To investigate how the issue of malnutrition in institutionalised older people is perceived by nurses in a Teaching Hospital in Italy and how some aspects that can prevent malnutrition are dealt with. Background: Malnutrition in institutionalised older people is still a significant and unresolved problem. Many studies have been published on the inadequacy of nutritional care. Nurses play a strategic and key role in the prevention of malnutrition. Knowing how nurses perceive the problem of malnutrition and how they deal with aspects that can prevent malnutrition can be an important starting point for implementing strategies that will improve overall nutri- tional care. Methods: A Focus Group (FGs) study was conducted in a Teaching Hospital in the north-west of Italy with 33 nur- ses, who were still working or had worked with older people. The FGs were audio-taped and transcribed verba- tim. Data collection was stopped when we achieved satu- ration. Two researchers independently analysed the transcription for content analysis and negotiated the emerging categories. Results: Although nurses perceived malnutrition as a sig- nificant issue, it was often considered of secondary importance compared with other aspects of care. Food choice, although available, is often limited to very few options, diets are standardised and monotonous and patients must choose ‘sight unseen’. Time constraints and understaffing were the obstacles for the identification of the need for nutritional care. Organisational and mana- gerial decision-making did not ensure the provision of high-quality nutritional care. Patients’ nutritional status was often not assessed, and tools such as the Mini Nutri- tional Assessment were not mentioned by the participants. Conclusion: Our study substantially confirmed what is reported in the literature. However, it is necessary to raise nurses’ awareness around poor nutritional care to prevent malnutrition in institutionalised older people. Keywords: hospital malnutrition, older people, nursing, focus groups, nutritional care, qualitative research. Submitted 29 February 2012, Accepted 14 June 2012 Introduction Malnutrition is a critical issue when caring for older people. The most frequent type of malnutrition in this population is protein-energy malnutrition, characterised by an insufficient intake and/or an excessive protein- energy consumption, which if protracted leads to a state of malnutrition (1, 2). Chen et al. (3) define malnutrition in older people as a poor or inadequate nutritional status, characterised by insufficient food intake, reduced appetite and loss of muscular mass and body weight. Protein-energy malnutrition in older people, as shown by several studies, has a negative effect on many clinically significant outcomes, such as increased mortality rates, longer stay in hospital, higher risks of infection, wounds taking longer to heal and higher risk of developing pres- sure wounds. All these aspects produce considerable harm to patients and increase healthcare costs (4–6). A recent study conducted in Belgium (7) confirms that nutritional care is still inadequate. The authors report a prevalence of malnutrition in hospitalised older people of 31.9%. The same study mentions a survey conducted by the Council of Europe in 1999, underlining that very little has changed since then in the quality of nutritional care (8). Studies conducted in Italy report similar prevalence of malnutri- tion and inadequacies in nutritional care (9, 10). Extensive literature is available from which strategies could be adopted to prevent malnutrition in institutiona- lised older people. A first fundamental aspect, where Correspondence to: Dr. Annamaria Bagnasco, Department of Health Sciences, University of Genoa, Via A. Pastore,1, 16132 Genoa, Italy. E-mail: annamaria.bagnasco@unige.it Ó 2012 The Authors Scandinavian Journal of Caring Sciences Ó 2012 Nordic College of Caring Science 1