Practical aspects of nutritional support: an advanced practice guide.

Practical aspects of nutritional support: an advanced practice guide

Worthington P, Saunders (Elsevier), Philadelphia, 2004, 608 pages, $68.20, ISBN 0-7216-6964-6

Practical aspects of nutritional support: an advanced practice guide is written by Patricia H. Worthington who is the Nutrition Support Clinical Specialist at the Thomas Jefferson University Hospital in Philadelphia. She has been supported by many other experts in her faculty to ensure a broad knowledge base to cover nutritional issues of gestation, lactation, infancy to adolescence, diabetes, interaction of pharmacology, and medical and surgical illness. I found it easy to read and was pleased to have important information accurately set out in useful tables. While the book is written from a nursing perspective the information is of great value to all medical professionals who have contact with patients about nutrition in the clinical setting. It would be a useful, broad-based reference for dietitians working in an unspecialised practice.

Nutritional education is important for medical and nursing practice even though the general public tends to turn to dietitians for their nutritional advice in the Australian culture. They are unsure of the knowledge that doctors have and frequently ask, 'when will they speak to a dietitian?'. There is a public perception of the importance of being given the correct nutritional advice. There is great value for emphasising the importance of nutrition as a nursing skill because nurses spend most time with patients and have the opportunity to ensure the correct knowledge is transmitted to the patient for the particular situation. It would be excellent if nurses had confidence of the knowledge setout in this book. Nutrition is important for all patients. They are constantly concerned about how their illness will influence their nutritional state and how they can best adjust their diet to improve their health as a consequence of a recent diagnosis. They need to know about technical nutritional therapies such as enteral nutrition and parenteral nutrition which sometimes requires invasive procedures for delivery. Most of our teaching hospitals have nurse practitioners who provide the nursing expertise for gestational and lactating women, for those with diabetes, for those requiring enteral and parenteral nutrition and for patients requiring other specialised medical services. Dietitians may be more involved with many specific illness groups such as renal medicine and gastrointestinal diseases. In the district hospitals and smaller medical institutions doctors and senior nurses are relied on for this knowledge. The more unspecialised the hospital is the greater the importance of a broad-based reference for a modern approach to nutritional issues.

There are some very interesting chapters. The chapter 'Managing symptoms that affect nutritional intake during illness' approaches common symptoms from a practical and refreshing direction. It outlines a mixture of approaches to symptoms such as anorexia, nausea, constipation, dry mouth and taste perception, which review advice from the way food is presented, to the use of herbal therapies and modern pharmaceutical approach. They are the advices that an experienced nurse may try without consultation and with good effect.

Obesity is considered in the chapter titled 'The role of nutrition in health promotion and disease prevention'. A knowledge-based, health promotional approach rather than an emphasis on managing the individual has much appeal. This is an important nutritional problem which requires much consideration and it is refreshing that it is considered under this banner because it will be difficult to help the individual without influencing the community's culture. Involving all health professionals including nurses, in changing the culture towards a healthy lifestyle of dietary intake and exercise, will be important if this approach is to be successful. The management of obesity requires a broad education of all health professionals with sound principles. How many know what the low glycaemic index foods are? How can we explain the complexities of blood lipids to patients? What is an ideal body weight?

This reference is the work of a single hospital and therefore suffers from being slightly parochial. There was no description of peripheral parenteral nutrition to provide full nutritional support for prolonged periods which is now widely used. Our hospital uses midlines but these are not mentioned as a means of delivery. Despite this minor issue I believe this book has an important usefulness for many health professionals coping with face-to-face management of patients with a broad spectrum of disorders. This book will be a useful quick reference for dietitians in general practice but is probably not sufficiently detailed for those in specialised practice. It should be available for medical and nursing staff in a prominent place on the bookshelf of medical and surgical wards and in emergency departments.

Ross C. Smith

Associate Professor of Surgery

University of Sydney 

Royal North Shore Hospital