Attitudes, Knowledge, Self-efficacy, and Behaviors of Nurses in Nutritional Care for Older People

NCT05691595 | Completed DMC

• 1 other identifier: 74/INT/2022
• Study Type: observational
• Target: 179
• Locations: 1 country
• Sites: 2

Brief Summary

Even if awareness among nurses regarding the importance of nutritional care for older people has increased in recent years, nurses continue to underestimate the necessary approach to prevent malnutrition. Therefore, some authors have argued the critical importance of understanding which factors can influence nurses' caring behaviors during real situations and affect the prevention and management of malnutrition under actual working conditions. Specifically, the relationship between nurses' attitudes, knowledge, and self-efficacy in nutritional care for older people has not been described yet. Understanding these relationships can provide a framework to enhance adequate caring behaviors, mitigating the negative attitudes. Considering that self-efficacy has been previously theorized in several populations as the mediator of the relationship from knowledge and attitudes to specific behaviors, the investigators hypothesized that knowledge and attitudes in the specific area of nursing nutritional care have moderately positive effects on nursing caring behaviors in nutritional care only through the mediation of nursing self-efficacy. The study design is a multi-phase, descriptive observational cross-sectional, multicentric study, collecting data using a web-survey.

Conditions

Nutrition Disorders in Old Age

Keywords

Nurses; Attitudes; Knowledge; Self-efficacy; Nutritional care; Elderly

Outcome Measures

Primary Outcomes (3)

• To describe the relationship of attitudes (measured using the SANN-G scale) with knowledge and self-efficacy of nurses in delivering nutritional care for older people

  The attitudes will be measured with the Staff Attitudes to Nutritional Nursing Care Geriatric scale (SANN-G scale). The SANN G scale consists of 18 statements, which the respondent can answer on a five-point Likert scale from 'Strongly Agree' to 'Strongly Disagree'. The SANN-G scale is based on the theory of planned behavior by Ajzen (1991). The original scale investigates the attitudes of nurses to five factors related to nutritional care, identified in the literature as critical for high-quality care. The authors of the original instrument also validated the cut-off for a positive attitude to each factor. The five factors, with their ranges and cut-offs for positive attitudes, are: norms, habits, assessment, intervention, individualization.

  June 2022 - December 2023

• To describe the relationship of knowledge (measured using the KoM-G scale) with attitudes and self-efficacy of nurses in delivering nutritional care for older people

  The knowledge will be measured with the Knowledge of Malnutrition- Geriatric (KoM-G), a questionnaire that consists of 19 multiple-choice questions about malnutrition in older people, with six possible answers, one of which is "I don't know". Each of the other five answers can be right or wrong. The question is considered correct if all the answers are correctly marked. A correct answer assigns 6 points; an incorrect answer is 1 point. The score goes from a minimum of 19 points to a maximum of 114 points; no cut-off will be specified). The Italian version of the tool showed good psychometric properties (ICC coefficient for the total scores=0.981; Kuder-Richardson 20 test=0.914).

  June 2022 - December 2023

• To describe the relationship of self-efficacy (measured using the SE-NNC scale) with attitudes and knowledge of nurses in delivering nutritional care for older people.

  The self-efficacy of nurses to assess nutritional care will be measured using the self-efficacy scale for nursing nutrition care (SE-NNC). SE-NNC is a self-report tool encompassing 27 items and measuring self-efficacy in boosting knowledge (regarding nutritional care), assessment and evidence utilization, and care delivery. Each domain requires to be computed standardizing the responses in a 0-100 score, where the higher self-efficacy scores indicate greater self-efficacy levels. A total self-efficacy score might be computed. In the validation study, the SE-NNC showed adequate internal consistency for each domain and the overall scale (Cronbach's α ranged from 0.879 to 0.963).

  June 2022 - December 2023

Other Outcomes (1)

• To develop, test, and validate the "Nursing Nutritional Care Behaviors Scale" (B-NNC Scale)

  June 2022 - December 2023

Interventions

Online survey data collection OTHER

The data will be collected via a web-survey created with the SurveyMonkey® software. The web-survey will be distributed among nurses at IRCCS Policlinico San Donato (San Donato Milanese, Italy) and ASST Grande Ospedale Metropolitano Niguarda (Milan, Italy).

Eligibility Criteria

• Age: 18 Years+
• Sex: all
• Healthy Volunteers: Yes
• Age Groups: Adult (18-64), Older Adult (65+)
• Sampling Method: Non-Probability Sample

Study Population

In general, the study sampling is comprised of nurses with more than six months of experience working in the same ward and who have solid background in nutritional care intervention for the elderly.

You may qualify if:

• to be a nurse;
• aged ≥ 18 years;
• full-time work contract;
• work experience: more than six months of experience in the same ward;
• work experience in nutritional care for older people (people aged 60 years and older).

You may not qualify if:

• not available to participate in the study;
• not compiling the informed consent (via the same web-survey);
• working in critical care settings (e.g., intensive care units, emergency demertments);
• working in outpatient settings.

Sponsors & Collaborators

• IRCCS Policlinico S. Donato: lead
• ASST Grande Ospedale Metropolitano Niguarda: collaborator

Study Sites (2)

IRCCS Policlinico San Donato

San Donato Milanese, Milan, 20097, Italy

Location

ASST Grande Ospedale Metropolitano Niguarda

Milan, 20162, Italy

Location

Related Publications (29)

• Ayre, C., & Scally, A. J. (2014). Critical values for Lawshe's content validity ratio: revisiting the original methods of calculation. Measurement and evaluation in counseling and development, 47(1), 79-86.

  BACKGROUND

• Bachrach-Lindstrom M, Jensen S, Lundin R, Christensson L. Attitudes of nursing staff working with older people towards nutritional nursing care. J Clin Nurs. 2007 Nov;16(11):2007-14. doi: 10.1111/j.1365-2702.2006.01868.x. Epub 2007 Apr 5.

  PMID: 17419794 BACKGROUND

• Bandura A. Guide for constructing self-efficacy scales. Self-efficacy beliefs Adolesc. 2006. doi:10.1017/CBO9781107415324.004

  BACKGROUND

• Bassola B, Tommasi V, Bonetti L, Bauer S, Lusignani M. Nurses' knowledge about malnutrition in older people: A multicenter cross-sectional study. Nutrition. 2020 Oct;78:110947. doi: 10.1016/j.nut.2020.110947. Epub 2020 Jul 18.

  PMID: 32861178 BACKGROUND

• Bauer S, Halfens RJ, Lohrmann C. Knowledge and Attitudes of Nursing Staff Towards Malnutrition Care in Nursing Homes: A Multicentre Cross-Sectional Study. J Nutr Health Aging. 2015 Aug;19(7):734-40. doi: 10.1007/s12603-015-0535-7.

  PMID: 26193856 BACKGROUND

• Bjerrum M, Tewes M, Pedersen P. Nurses' self-reported knowledge about and attitude to nutrition -- before and after a training programme. Scand J Caring Sci. 2012 Mar;26(1):81-9. doi: 10.1111/j.1471-6712.2011.00906.x. Epub 2011 Jul 1.

  PMID: 21718341 BACKGROUND

• Boaz M, Rychani L, Barami K, Houri Z, Yosef R, Siag A, Berlovitz Y, Leibovitz E. Nurses and nutrition: a survey of knowledge and attitudes regarding nutrition assessment and care of hospitalized elderly patients. J Contin Educ Nurs. 2013 Aug;44(8):357-64. doi: 10.3928/00220124-20130603-89. Epub 2013 Jun 10.

  PMID: 23758072 BACKGROUND

• Bollo M, Terzoni S, Ferrara P, Destrebecq A, Bonetti L. Nursing students' attitudes towards nutritional care of older people: A multicentre cross-sectional survey incorporating a pre post design. Nurse Educ Today. 2019 Jul;78:19-24. doi: 10.1016/j.nedt.2019.03.016. Epub 2019 Apr 17.

  PMID: 31029954 BACKGROUND

• Bonetti L, Bagnasco A, Aleo G, Sasso L. 'The transit of the food trolley'- malnutrition in older people and nurses' perception of the problem. Scand J Caring Sci. 2013 Jun;27(2):440-8. doi: 10.1111/j.1471-6712.2012.01043.x. Epub 2012 Jul 30.

  PMID: 22846143 BACKGROUND

• Bonetti L, Terzoni S, Lusignani M, Negri M, Froldi M, Destrebecq A. Prevalence of malnutrition among older people in medical and surgical wards in hospital and quality of nutritional care: A multicenter, cross-sectional study. J Clin Nurs. 2017 Dec;26(23-24):5082-5092. doi: 10.1111/jocn.14051. Epub 2017 Sep 29.

  PMID: 28833723 BACKGROUND

• Casanova N, Bagnasco A, Bonetti L, Sasso L. [Nurses' attitudes towards nutritional care and malnutrition in hospitalised older people: A Survey in the Liguria Region]. Prof Inferm. 2015 Oct-Dec;68(4):219-26. doi: 10.7429/pi.2015.684219. Italian.

  PMID: 26752313 BACKGROUND

• Cereda E, Pedrolli C, Klersy C, Bonardi C, Quarleri L, Cappello S, Turri A, Rondanelli M, Caccialanza R. Nutritional status in older persons according to healthcare setting: A systematic review and meta-analysis of prevalence data using MNA(R). Clin Nutr. 2016 Dec;35(6):1282-1290. doi: 10.1016/j.clnu.2016.03.008. Epub 2016 Apr 6.

  PMID: 27086194 BACKGROUND

• Dellafiore F, Caruso R, Arrigoni C, Magon A, Baroni I, Alotto G, Quaccini C, Bianchi M, Bonetti L. The development of a self-efficacy scale for nurses to assess the nutritional care of older adults: A multi-phase study. Clin Nutr. 2021 Mar;40(3):1260-1267. doi: 10.1016/j.clnu.2020.08.008. Epub 2020 Aug 14.

  PMID: 32839036 BACKGROUND

• DiMaria-Ghalili RA, Mirtallo JM, Tobin BW, Hark L, Van Horn L, Palmer CA. Challenges and opportunities for nutrition education and training in the health care professions: intraprofessional and interprofessional call to action. Am J Clin Nutr. 2014 May;99(5 Suppl):1184S-93S. doi: 10.3945/ajcn.113.073536. Epub 2014 Mar 19.

  PMID: 24646823 BACKGROUND

• Donini LM, Stephan BCM, Rosano A, Molfino A, Poggiogalle E, Lenzi A, Siervo M, Muscaritoli M. What Are the Risk Factors for Malnutrition in Older-Aged Institutionalized Adults? Nutrients. 2020 Sep 18;12(9):2857. doi: 10.3390/nu12092857.

  PMID: 32961917 BACKGROUND

• Edwards D, Carrier J, Hopkinson J. Assistance at mealtimes in hospital settings and rehabilitation units for patients (>65years) from the perspective of patients, families and healthcare professionals: A mixed methods systematic review. Int J Nurs Stud. 2017 Apr;69:100-118. doi: 10.1016/j.ijnurstu.2017.01.013. Epub 2017 Jan 30.

  PMID: 28199923 BACKGROUND

• Eide HD, Halvorsen K, Almendingen K. Barriers to nutritional care for the undernourished hospitalised elderly: perspectives of nurses. J Clin Nurs. 2015 Mar;24(5-6):696-706. doi: 10.1111/jocn.12562. Epub 2014 Mar 20.

  PMID: 24646060 BACKGROUND

• Fletcher A, Carey E. Knowledge, attitudes and practices in the provision of nutritional care. Br J Nurs. 2011 May 27-Jun 9;20(10):615-6, 618-20. doi: 10.12968/bjon.2011.20.10.615.

  PMID: 21646993 BACKGROUND

• Green SM, James EP. Barriers and facilitators to undertaking nutritional screening of patients: a systematic review. J Hum Nutr Diet. 2013 Jun;26(3):211-21. doi: 10.1111/jhn.12011. Epub 2013 Jan 19.

  PMID: 23331465 BACKGROUND

• Hestevik CH, Heyerdahl E, Lysne Garaas B, Sellevold GS, Molin M. Improving Documentation of Nutritional Care in A Nursing Home: An Evaluation of A Participatory Action Research Project. Geriatrics (Basel). 2019 Mar 20;4(1):29. doi: 10.3390/geriatrics4010029.

  PMID: 30897707 BACKGROUND

• Hulley SB, Cummings SR, Browner WS, Grady D, Newman TB. Designing clinical research: an epidemiologic approach. 4th ed. Philadelphia, PA: Lippincott Williams & Wilkins; 2013. Appendix 6C, page 79

  BACKGROUND

• Marinho R, Pessoa A, Lopes M, Rosinhas J, Pinho J, Silveira J, Amado A, Silva S, Oliveira BMPM, Marinho A, Jager-Wittenaar H. High prevalence of malnutrition in Internal Medicine wards - a multicentre ANUMEDI study. Eur J Intern Med. 2020 Jun;76:82-88. doi: 10.1016/j.ejim.2020.02.031. Epub 2020 Mar 9.

  PMID: 32165113 BACKGROUND

• Plaza CM, Draugalis JR, Retterer J, Herrier RN. Curricular evaluation using self-efficacy measurements. Am J Pharm Educ. 2002;66(1):51-54

  BACKGROUND

• Relph WL. Addressing the nutritional needs of older patients. Nurs Older People. 2016 Apr;28(3):16-9. doi: 10.7748/nop.28.3.16.s22.

  PMID: 27029988 BACKGROUND

• Rentero Redondo L, Iniesta Navalon C, Gascon Canovas JJ, Tomas Jimenez C, Sanchez Alvarez C. [MALNUTRITION IN THE ELDERLY PATIENT TO HOSPITAL ADMISSION, AN OLD PROBLEM UNSOLVED]. Nutr Hosp. 2015 Nov 1;32(5):2169-77. doi: 10.3305/nh.2015.32.5.9712. Spanish.

  PMID: 26545674 BACKGROUND

• Vanderwee K, Clays E, Bocquaert I, Verhaeghe S, Lardennois M, Gobert M, Defloor T. Malnutrition and nutritional care practices in hospital wards for older people. J Adv Nurs. 2011 Apr;67(4):736-46. doi: 10.1111/j.1365-2648.2010.05531.x. Epub 2010 Dec 12.

  PMID: 21143622 BACKGROUND

• Vanderwee K, Clays E, Bocquaert I, Gobert M, Folens B, Defloor T. Malnutrition and associated factors in elderly hospital patients: a Belgian cross-sectional, multi-centre study. Clin Nutr. 2010 Aug;29(4):469-76. doi: 10.1016/j.clnu.2009.12.013. Epub 2010 Jan 25.

  PMID: 20097458 BACKGROUND

• Willis H. Causes, assessment and treatment of malnutrition in older people. Nurs Older People. 2017 Feb 28;29(2):20-25. doi: 10.7748/nop.2017.e883.

  PMID: 28244345 BACKGROUND

• Yordy BM, Roberts S, Taggart HM. Quality Improvement in Clinical Nutrition: Screening and Mealtime Protection for the Hospitalized Patient. Clin Nurse Spec. 2017 May/Jun;31(3):149-156. doi: 10.1097/NUR.0000000000000292.

  PMID: 28383333 BACKGROUND

MeSH Terms

Conditions

Behavior

Study Officials

• Rosario Caruso

  IRCCS Policlinico S. Donato

  STUDY DIRECTOR

Study Design

• Study Type: observational
• Observational Model: OTHER
• Time Perspective: CROSS SECTIONAL
• Sponsor Type: OTHER
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: Principal Investigator

Study Record Dates

• First Submitted: January 10, 2023
• First Posted: January 20, 2023
• Study Start: June 1, 2022
• Primary Completion: September 30, 2025
• Study Completion: October 1, 2025
• Last Updated: October 2, 2025

Record last verified: 2025-10

Data Sharing

• IPD Sharing: Will share
• Shared Documents: STUDY PROTOCOL, SAP
• Time Frame: December 2023
• Access Criteria: Direct request to the Principal Investigator and IRCCS Policlinico San Donato (a Zenodo repository will be created with all the raw data)

Locations

IT (2)