Nutrition in nursing education

The need to reorient health services from curative care towards preventive care is emphasised in both global and national reports (1,2). Similarly, a focus shift from disease and care towards health and behaviour is implied by the concept of ‘positive health’ (3,4). Preventive care involves health promotion, addressing risk factors for chronic diseases, such as an unhealthy diet, physical inactivity, smoking, and excessive alcohol consumption (5). Diet is an essential element of basic nursing care (6) and competency profiles of nurses include a health promotor role (7–9). Thus, dietary behaviour change support entails a role for nurses. This involves not only detection of dietary problems but also addressing diet in conversations with patients, motivating patients to change dietary behaviour, and supporting patients in goal setting and action planning to change dietary behaviour (8,10). Nevertheless, most nurses do not incorporate dietary behaviour change support in their routines to the fullest potential (11–14).

Research investigated which factors affect dietary behaviour change support by nurses. Studies point out that nurses’ knowledge and attitude, role perception, nurse-patient encounter, and cooperation and organizational context had influence. A lack of dietary knowledge was a prominent nurse-related barrier (11,15,16). Besides, limited undernutrition awareness could impede nurses from monitoring undernutrition (14). Another barrier for providing dietary care was confusion and insecurity regarding dietary care responsibilities (11,14,15), while perceiving dietary care provision or dietary behaviour change support as their responsibility was enabling (14–18). Since diet might be a sensitive topic, nurses struggled with dealing with patient autonomy, while tailoring the approach and having a relationship with a patient were helpful (15,19,20). Besides, having communication skills was considered a necessary condition for dietary behaviour change support (15,16,18). Influence of cooperation and organizational context was also studied. Supportive was the expectation throughout the organisation that nutritional screening was undertaken (11,21). Unsupportive was a lack of time (11,14–17,19–21). A cooperation-related barrier was limited referral options to dieticians (21) or a lack of awareness of dietetic service provision and the referral process (17).

So far, only few studies focused on dietary behaviour change support by nurses. Many studies we found on dietary care concentrated on undernutrition monitoring and treatment (11,14,21). Overall, current understanding remains incomplete regarding factors influencing dietary behaviour change support by Dutch nurses. Thus, further investigation of nurse-perceived factors is warranted. Factors influencing dietary behaviour change support might be categorised using behavioural models such as the COM-B model (22) or the more elaborate Theoretical Domains Framework (23). Furthermore, strategies to reduce nurse-perceived barriers and fulfil nurses’ needs should be developed. Education could be one of the strategies, as a call to action posed that dietary competencies should be incorporated into nursing education and follow-up education (24). Diet and behaviour change receive limited attention in current nursing curricula (24). For example, dietary education constituted only 0.4% of the Bachelor of Nursing programmes in the Netherlands in 2019 (25,26). Accordingly, education targeted at current and future nurses is needed on the following topics relevant for the professional practice: a) diet and health, b) dietary behaviour change, c) professional dilemmas in dietary care, and d) interprofessional collaboration.

To contribute to preventive care, nurse-perceived factors influencing dietary behaviour change support among patients will be identified. Subsequently, diet and related topics relevant for the nursing practice will be integrated in nursing education. Thus, training materials will be developed and evaluated to train (future) nurses in supporting dietary behaviour change of patients. The themes of interest are a) diet and health, b) dietary behaviour change, c) professional dilemmas in dietary care, and d) interprofessional collaboration. The project aims:

1. To explore which factors influence dietary behaviour change support among patients by nurses, and to formulate relevant learning outcomes for education; 
2. To develop learning strategies for (future) nurses to improve competences for using health promotion and behaviour change techniques related to dietary behaviour; 
3. To evaluate process and effect of the education developed in the project.  

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