Are practice nurses an effective means of delivering dietary advice as part of health promotion in primary health care? Evaluation of practice nurse training in Somerset

The introduction of the CP contract in April 1990 has given the primary health care team greater incentive to carry out health promotion activities. One area of health promotion which many practice nurses (PNs) have undertaken is the provision of dietary advice to patients in both preventive and disease management roles. The present study looks at nutrition training of PNs within Somerset FHSA. The aim was to evaluate the efficacy of the dietary training provided and also the quality of information being imparted to clients in terms of accuracy, the ability to tailor advice to suit individuals and that the information is positive. Four different methods were used. 1. Basic questionnaire to assess how useful PNs found the nutrition training and how applicable it was in their role as health educators (n=83). From these 83 PNs, three smaller groups were randomly selected to take part in further investigations. 2. A case study questionnaire to assess nutritional knowledge (n=10). 3. Tape-recorded dietary interviews (n=10). 4. Observation interviews by a community dietitian (CD) (n=10). There was a 78% response rate to the initial questionnaire. Of the PNs 74% rated their previous nutritional knowledge as 'average', whereas after training 72% perceived their knowledge to be 'good'. When discussing dietary issues with patients, after training, 33% of PNs described their confidence to be 'average', 64% 'good' and 3% 'excellent'. Only one PN felt the information in the training was too detailed. Of the PNs 31% requested input on additional topics and also the opportunity to sit in with a clinical dietitian. Six case study questionnaires were returned. In questions requiring a specific answer on healthy eating issues, 50% of PNs gave the correct response and in most cases this was greater than 80%. However when asked what advice they would give a hypothetical patient there was still a tendency to offer 'blanket' healthy eating advice rather than tailoring it to the patient. Tape-recorded interviews proved to be unpopular and so these nurses agreed to observation interviews. Fourteen PNs were visited who saw a total of 17 patients and three groups. Using an assessment checklist each PN was given a score of 0-5 where 0 = 'of very little value to understanding' and 5 = 'very comprehensive advice'. Scares obtained by the PNs were 2 (n = 2), 3 (n = 12), 4 (n = 3) and 5 (n Results Results obtained from this small study would suggest that given adequate training, practice nurses can increase their knowledge and skills to enable them to deliver basic healthy eating advice. It was highlighted by the PNs however that this initial training should be followed up by regular study days to ensure PNs are kept up to date and have access to expert nutrition advice when needed. This will ensure that nutrition information is based on sound scientific and dietetic principles. In conclusion PNs can be a resource to help promote healthy eating.