“We are all in the gutter, but some of us are looking at the stars.”  

 ― Oscar WildeLady Windermere's Fan

Perhaps an analogy with something slightly more aseptic would be appropriate, but Oscar Wilde makes a valid point: How easy is it to see the stars from the gutter...?

The NCEPOD report – A Mixed Bag [1] - gave pretty damning statistics with regard to parenteral nutrition (PN) care in the UK, suggesting only 19.5% of adult patients received “good practice” care and demonstrating that, at that time, only 40% of hospitals had a dedicated Nutrition Team.

Combine this with the annual cost of malnutrition in England estimated at £19.6 billion,[2] a lack of PN-specific training for healthcare professionals (HCPs) at degree level and a perception of complexity and risk associated with PN, is it any wonder that there is a lack of confidence when it comes to PN care?

So, how do we turn this around...?


Moe Carrick, Founder and Principal of “Momentum” - a service delivering professional training and coaching – has developed “5 steps to changing perception”:

1.      Acknowledge the perception Perhaps this step is already in-hand? A study carried out by the British Specialist Nutrition Association (BSNA) in 2015 showed that less than 60% of HCPs surveyed felt “very confident” when it came to all aspects of assessment and monitoring of patients on Parenteral Nutrition.

2.      Reveal the intention you have

What do you want to gain…? Confidence in your practice? A voice within the Nutrition Team? Engagement of your colleagues and managers to drive the service forward?

Set SMART (Specific, Measurable, Achievable, Realistic and Timed) objectives and follow the guiding PRINCE2 project management principle – a project must have a defined start AND a defined end!

4.      Offer continued steady progress

More long-term learning opportunities are available to develop knowledge and expertise in the PN field, with the ESPEN Life Long Learning (LLL) program in Clinical Nutrition and Metabolism offering an extremely effective educational program for health professionals with an interest in clinical nutrition. It offers on-line training modules and live courses which can lead to the award of a Diploma in Clinical Nutrition and Metabolism – offering the opportunity to gain accreditation for continued commitment to learning and specialising.

5.      Ask for future feedback

We naturally assess our own performance internally, but seeking external feedback is equally important. Engaging the people we work with will further strengthen the original intention.

3.      Ask for compassion and give self-compassion

Large industry events – for example the annual BAPEN (British Association of Parenteral and Enteral Nutrition) and NNNG (National Nurses Nutrition Group) conference – offer a host of learning opportunities across all areas of nutritional care in a formal setting.   However, smaller working groups offer much more intimate opportunities to learn and be honest about the challenges you face – the BPNG (British Pharmaceutical Nutrition Group) run annual training days on PN care, aimed across the board from beginners to more advanced practitioners, whilst the BDA (British Dietetic Association) organises more regional working groups and study days. These organisations welcome and encourage professionals from other areas, but are heavily reliant on membership and attendance, so we must continue to support them!

Ultimately, time and resource are inevitable barriers, but just consider committing small actions to the 5 steps above... could it help you reach up to the sky to achieve your goals?


BSNA will be exhibiting at the BSG Annual Meeting 2017 from Tuesday 20 June – Thursday 22 June in Manchester to continue our discussion of PN. If you’re going to be attending do come and say hi! #BSG2017

For more information on the learning and support opportunities mentioned above, please see the following:

ESPEN LLL        http://www.bapen.org.uk/resour...

BPNG               http://www.bpng.co.uk/contact_...

BAPEN             http://www.bapen.org.uk/

NNNG              http://www.nnng.org.uk/

BDA                 https://www.bda.uk.com/

[1] NCEPOD. A Mixed Bag. 2010. Available at: http://www.ncepod.org.uk/2010r...      

[2] Elia M. 2015. The cost of malnutrition in England and potential cost savings from nutritional interventions. Malnutrition Action Group of BAPEN and the National Institute for Health Research Southampton Biomedical Research Centre