Using intervention mapping to develop an outpatient nursing nutritional intervention to improve nutritional status in undernourished patients planned for surgery

Table 6 The five components of the Outpatient Nursing Nutritional Intervention (ONNI)

Component	Content
1) Determine causes of undernutrition	Possible causes of undernutrition were: a) bad appetite, b) decreased intake, c) gastrointestinal problems, d) insufficient physical activity, e) pain, or f) poor oral health
2) Perform a nutritional care plan	A: provide tailored advice related to possible cause (s) B: provide leaflets on ‘energy and protein enriched nutrition’^a and ‘tempting food’ C: refer the patient to the dietician in case of MUST score ≥ 2^a
3) Self-monitoring of nutrient intake and eating pattern	A: explain the patient how the food diary works and how to record daily intake within the diary B: instruct the patient to monitor food intake for 2 days in the dairy
4) Counselling and encouragement	A: counsel the patient on eating patterns and encourage the patient to improve nutrient intake B: advice the patient to inform caregivers and/or involve caregivers during the consult C: plan a telephone follow-up meeting with the patient to be held after approximately 1 week
5) Follow- up meeting^b	A: evaluate how causes of undernutrition did work out B: evaluate the food diary on total intake and the nutrients that were consumed C: counsel and provide tailored advice on energy and protein enrich products and on causes of undernutrition

^aactivities of usual care, and was therefore included in the ONNI; ^bperformed by the nurse of the outpatient clinic or, in case of MUST score ≥ 2, by the dietician

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