Sithabile Bhebhe is a registered nurse and midwife – before taking the management roles has practiced in acute surgical/ medical wards in tertiary teaching hospitals. Her nursing experience include a variety of managerial position, including Hospital Clinical Facilitator, Nurse Educator, Health Services Manager in Student Affairs Department, After Hours Hospital Manager, Nurse Unit Manager.
Malnutrition is prevalent globally and burdens health service delivery through financial costs, acquired hospital pressure injury and infections. Consequently, a review of a health policy on nutrition is pivotal in protecting public health and safety through the empowerment of registered nurses at all levels of health settings to provide adequate information relating to food and health status to enable consumers to make informed decisions. At present, nursing faculties reflect a lack of structured promotive and preventative information to empower patients with information on both decision-making and adjustment of lifestyle. This is further exacerbated by multiculturism and preferences of the society on what they want to consume to fit their lifestyle. Currently, in the nursing disciplines, there are numerous screening and assessment tools that exist for nurses to identify risks and diagnose nutrition to allow nurses to refer a patient to a dietician. However, screening alone is not adequate for the patient to make an informed choice, but nutritional promotive and preventative information health information is required.
Promotive, preventative and curative health information and education in all levels of the health settings is fundamental to personal and societal development. The delivery of information and education lays a solid foundation for opportunities to make informed decisions, think critically and be self-reliant by the health consumer. Since 1960, Australian diets have changed and influenced multicultural cuisine, and the lifestyles of communities have greatly changed to that of sedentary living. In Australia, it is estimated that 11.2 million adults and one million children were overweight or obese in 2014 (AIHW, 2016). Moreover, several research studies do confirm that nurses, along with midwives, are prone to being overweight/obese as compared to the general population. There is also evidence that the nursing workforce is not healthy. Hence, it is pivotal to reintroduce nutrition subjects in the nursing training. A health policy allows decision-making in clinical governance and ensures that curriculum developers can make optimal decisions. Hence, conscientizing curriculum developers and clinical leadership for empowering registered nurses with dietary and nutritional qualifications is essential to managing obesity and nutrition in the new era.
Implementing a health policy to address obesity and malnutrition improves resource advocacy, advances nursing practice, and fosters interdisciplinary collaboration for comprehensive care. Moreover, the implementation of these policies makes it easier to establish accessible health promotion clinics near hospitals, ensuring preventive and promotive healthcare services.
Advocacy of Advanced registered nurse in patient nutrition management.
With the increase in obesity and malnutrition, it is imperative for nursing faculty to adapt to the nutritional needs of an evolving society. This is because assisting patients with chronic medical conditions such as obesity and malnutrition is challenging and complex. As a result, it requires nurses with an advanced expert knowledge base of both decision- making and clinical competencies to recognise and implement strategies that lessen the economic costs both to the patient and the hospital. The Nursing and Midwifery Board of Australia (2013) defines Advanced practice nursing (APN) as the term used to define a level of nursing practice that uses comprehensive skills and experience in nursing. This is congruent with the World Health Organization and the International Council of Nurses, which identify APNs as having seven key areas of competence focused on advanced expert nursing knowledge.
The seven key areas are as follows:
- Health and patients’ disease management. – Clinical reasoning and diagnostic skills
- Relationship with patients – the ability to initiate and evaluate therapeutic management plans
- Coaching and teacher role- training patients and staff
- Professional role through advanced specialised education
- Management role-leadership and clinical governance towards management of obesity and malnutrition.
- Research – quality improvement
- Monitoring and quality improvement in a culture respectful to the needs of the patients.
The minimum qualification for an APN is a Master of Nursing, whereas, for a registered nurse, the minimum qualification is a Bachelor of Nursing. The APN works autonomously without direct supervision and can order investigations as part of planning and managing the patient. This reduces the workload for both registered nurses and medical doctors. There is evidence in nursing faculties that APNs are more effective in the management and follow- up of chronic patients. They can control risks earlier and reduce the complications of chronic conditions through the health empowerment of patients and healthy accessibility through collaboration with health teams and resources for the management of patients. The APN, therefore, can be the focal person for registered nurses and enrolled nurses in the management of patients with obesity and malnutrition. They can train and support registered nurses to implement nursing care plans that are unique and focus on each patient’s needs based on expert knowledge and skills.