The purpose of this study was to describe nutritional screening practices in hospital settings in Virginia. A questionnaire was mailed to each of the chief clinical dietitians employed at 123 Virginia hospitals listed in the 1994 American Hospital Guide (22). Ninety-one (74%) responses were received. Twenty-five (27.5 %) of the hospitals included in the survey were considered large hospitals with more than 300 licensed beds and 66 (72.5 %) were small hospitals with 300 or fewer licensed beds. Re-screening of patients occurred in 40 (60.6 %) of the small hospitals while 8 (32 %) of the large hospitals had re-screening policies. Computers were used for nutritional screening in 17 (68 %) of the large hospitals and 13 (19.7 %) of the small hospitals. Dietetic technicians participated in screening in 10 (40 %) of the large hospitals and in 11 (16.9 %) of the small hospitals. Dietetic students participated in screening in 8 (32 %) of the large hospitals and they participated in 3 (4.5 %) of the small hospitals. Hemoglobin was used in 6 (24 %) of the large hospitals to determine a patients nutritional risk. It was used in 34 (51.5 %) of the small hospitals. Hematocrit was used in 36 (54.5 %) of the small hospitals and in 5 (20 %) of the large hospitals. All of these associations between large and small hospitals were significantly different (p < .05 ) as determined by Chi square analysis. Since there were no other significant associations between large and small hospitals, the reminder of the results were treated as one group of hospitals. Seventy-five (82.4 %) of the hospitals represented in the survey had written screening policies and a standard form was used in 59 (64.8 0/0) of them. Fifteen (16.50/0) of the hospitals surveyed had written screening policies for specialty units; 8 (8.8 %) also had specific forms. The three most common items included in the routine nutritional screening were weight, height, and lab results. Weight and height also were the items most often missing or not available when a routine screening was performed. Albumin was used as an abnormal finding to determine nutritional risk in 79 (86.8 %) of the hospitals; while weight loss was used in 82 (90.1 %) of the hospitals and weight for height was used in 69 (75.8 010) hospitals. / Master of Science

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Adolescent obesity is a growing health concern in the United States due to its increasing prevalence and comorbidities that can reduce longevity and increase morbidity. Advanced practice nurses (APNs) providing care in school-based health centers (SBHC) located in marginalized communities are uniquely positioned to work with adolescent students challenged with obesity. The management of adolescent obesity requires advanced skills and knowledge to promote healthy lifestyles, prevent obesity, and to directly address the many factors that contribute to the condition. The purpose of this project was to develop an education program for APNs to prepare them to work with students in prevention and control of adolescent obesity in the SBHC. The Shuler nurse practitioner practice model provided the framework to guide the project. A literature search yielded evidence-based care guidelines for adolescent obesity that were used to develop the education program. The program was provided to a panel of 5 clinical experts made up of 2 APNs and 3 pediatricians who work with adolescents who are obese. The panel evaluated the program using a 5-item, Likert-style questionnaire covering the 5 objectives of the program. Results ranged from a mean score of 3.4 to 4.0, indicating that the expert panel agreed or strongly agreed that the program met the objectives. This education program was provided to the SBHC administration and will be implemented in the next school term. The project may promote positive social change through increased APN knowledge of clinical practice guidelines for managing adolescent obesity and through improved adolescent health.