v. Title: Addressing the on-going nutritional care of paediatric out – patients
Supervisors: Professor Margaret Fletcher (University of the West of England) and Professor Julian Hamilton Shield (UHBristol)
This project will be registered at the University of the West of England
Abstract
This PhD requires experience of the clinical care of children and would particularly suit a paediatric dietitian. Despite the current focus on the nutritional needs and provision for patients in the NHS, the majority of children are cared for on an out-patient basis, receiving little or no nutrition input unless they have specific conditions. Building on work completed to date by the Bristol Royal Hospital for Children dietetic and nursing teams, the student will work with these teams to develop a robust, validated nutritional screening tool for out-patient use and a care algorithm adaptable to any service configuration.
The anticipated stages of this include:
- Refine and validate a nutritional screening tool for out-patient use
- Develop and evaluate a care plan /algorithm for children identified as medium to high nutritional risk,
- Evaluate the effect of introducing the screening and subsequent processes
- Developing a toolkit to support community staff working with identified families
- Determine the need for more formal training of staff
The study involves working alongside an ongoing programme of implementation and evaluation of in-patient nutritional screening, and across disciplinary boundaries and the Primary/Specialist care interface.
Project summary
10-20% of children admitted to hospital or reviewed in outpatients show signs of under nutrition, which generally remains unchanged at discharge and worsened when length of stay is extended. A further 20% to 30% are overweight or obese at presentation to hospital.
The majority of paediatric patients are managed as outpatients, yet these have little if any attention paid to their nutritional status except in extreme cases or for specific conditions such as cystic fibrosis, metabolic disorders and those requiring enteral tube feeding. Most patients fall outside these groups, yet may have as much total contact time with hospital staff as the majority of inpatients. Moreover, many will subsequently be admitted and optimising their nutritional status is important for minimising length of stay and recovery time.
The Care Quality Commission outcome 5 ‘Meeting nutritional needs’ saw nutritional screening in hospital placed high on the political agenda, but current validated tools for nutritional screening in children are new and have significant flaws. Poor provision for assessing and managing paediatric out –patients’ nutritional status remains to be addressed universally. A simple, sensitive, highly specific tool for out-patient use is needed, and the use of existing staff resources needs optimising to support patients identified with specific nutritional needs, where such support is not routinely part of specialist care.
Study Outline
Building on work completed at Bristol Royal Hospital for Children (BRHC), the student will work with dietetic and nursing teams to develop a robust, validated nutritional screening tool for out-patient use and a care algorithm which can be adapted to work in any service configuration.
The anticipated stages of this include:
- Refine and validate an out-patient nutritional screening tool
- Develop and evaluate a care plan /algorithm for children identified as medium to high nutritional risk
- Evaluate the effect of introducing the nutritional screening and subsequent processes
- Developing a toolkit to support community staff working with identified families
- Determine the need for more formal training of staff
The study will involve working across the disciplinary boundaries and across the Primary/Specialist care interface.
The successful candidate will work closely with Lisa Cooke, Head of Paediatric Dietetics, and Professors Margaret Fletcher (Clinical Nursing), and Julian Hamilton-Shields (Paediatric Diabetes and Metabolic Endocrinology).
Applicants must have a good honours degree (2.1 or equivalent) in a health related area, preferably HPC registration (dietitian) and have evidence of further study at Masters level or equivalent. Knowledge of the nutritional care and assessment of children is essential. Basic research and audit skills are a pre-requisite, research training or experience is desirable.
You will be required to undergo enhanced Criminal Records Bureau check. Excellent training and supported in your development as an independent researcher will be provided.