Can the patient perspective contribute to quality of nutritional care?

Scand J Caring Sci; 2011; 25; 176–184
Can the patient perspective contribute to quality of nutritional care? Aim: Undernutrition has been seen in hospitalized patients at all times. Nurses have a central position in the nutritional care of the patient. Despite guidelines for nutritional practise and care, 20–55% of patients are still at risk of complications to insufficient nutrition intake. The aim of this study was to obtain knowledge of hospitalized patient’s experiences of being undernourished, to understand implications this might have to quality of nutritional nursing care. Methods: Qualitative interviews were undertaken in 12 hospitalized patients at severe nutritional risk. Findings: Pain, no appetite, bad taste and side effects to medication were among reasons for poor eating. Nurses practically did not address or question symptoms that could influence poor eating and were only to a low degree involved at patient initiative. The patients appeared to divide into two groups; One ‘Passive group’, characterized with fatigue, lack of concentration and short term memory, were found insusceptible to increase nutrition intake by motivation and guidance. The overall motivation in the other ‘Active’ group was the setting of and achievement of goals, which had to be clear, communicated and followed up by nurses and physicians. This group furthermore found self‐determination and active involvement determinant for a positive and fruitful cooperation between staff and themselves. Conclusions: Nurses were in progressive about clarifying why patients did not eat. Patients highly regarded nutrition registration when followed up, however, this was only practised to a low degree. Severely undernourished patients could be divided in two groups. The ‘Passive group’ should be attended to systematically. Artificial nutrition is often needed in this group. The ‘Active group’ should be cared for with individual, active involvement from nurses. Nurses should be able to distinct which nutritional care for which patient, and act upon it.     

NEEDLE‐STICK INJURY: A NOVEL INTERVENTION TO REDUCE THE OCCUPATIONAL HEALTH AND SAFETY RISK IN THE HAEMODIALYSIS SETTING

Needle‐stick injury (NSI) is a major occupational health and safety issue facing healthcare professionals. The administration of erythropoiesis‐stimulating agents (ESA) in haemodialysis patients represents a major cause for injections. The purpose of this initiative was to familiarise nursing staff with needle‐free administration of an ESA in haemodialysis patients to reduce the risk of NSI. Epoetin beta comes in a commercial presentation with a detached needle. Epoetin beta was administered to 10 haemodialysis patients via the venous bubble trap short line of the haemodialysis circuit. An audit was conducted that included a retrospective assessment of NSI for the previous six months; and a prospective assessment for eight weeks to assess whether there is a nursing staff preference for needle‐free administration of ESA. There were no reports of NSI in the needle‐free group. Haemoglobin levels were maintained. Ninety‐one percent of the nursing staff preferred needle‐free administration of ESA. In conclusion, the commercial presentation of epoetin beta with the detached needle presents an opportunity to reduce the potential risk of NSI in haemodialysis units.     

Dietary Intake of Modernizing Samoans: Implications for Risk of Cardiovascular Disease

Objective To describe the dietary intake of American and Western Samoans, with emphasis on nutrients conventionally related to risk factors for cardiovascular disease.Design Cross-sectional dietary survey. Intake estimates were based on 24-hour recall interviews.Subject Community-based samples of 946 men and women (455 American Samoans, 491 Western Samoans) aged 25 to 55 years.Statistical analyses Tests of differences in means (t tests) and proportions (Chi² tests). Correlation and multivariate linear regression analyses were conducted to describe correlates of energy and nutrient intakes.Results Few differences were noted between the energy and nutrient intakes of men and women, but substantial differences were found between residents of American Samoa and those of the less modernized country of Western Samoa. American Samoans consumed significantly more energy as carbohydrate (47% vs 44%) and protein (18% vs 13%) and less as fat (36% vs 46%) and saturated fat (16% vs 30%). Energy-adjusted intakes of cholesterol and sodium were higher among American Samoans. These differences persisted after adjustment for age, gender, years of education, occupation, and categories of a 10-point material lifestyle score. Samoans in the lowest category of material lifestyle had significantly lower energy-adjusted intakes of protein, cholesterol, and sodium and higher intakes of saturated fat than those in the upper 2 categories. Additional analyses described the contribution of specific foods to the intakes of energy and macronutrients.Conclusions/applications The observed energy and nutrient intake patterns are consistent with previously reported levels of obesity and risk factors for cardiovascular disease among Samoans and suggest dietary modification for those at highest risk. Dietetics practitioners who counsel Samoan and other Pacific Islander clients should be aware of these intake patterns, which seem particularly malleable to levels of personal income. More generally, results from this study illustrate that the food choices of certain ethnic groups may be profoundly affected by the process of modernization within a country or by migration to a more economically developed locale. J Am Diet Assoc. 1999;99:184–190.     

Regaining familiarity with own body after treatment for operable lung cancer – a qualitative longitudinal exploration

Little is known about the experiences of operable lung cancer patients during treatment in a clinical setting based on fast‐track surgery. The study aimed to explore (1) the embodied meaning of illness in patients with operable lung cancer during treatment to 4 months after surgery and (2) patterns of change over time that may affect the patients’ daily lives. Twenty patients referred for lung cancer surgery were interviewed three times, corresponding to potential critical transition points following surgery: hospitalisation; hospital‐to‐home transition; and resumption of daily life activities. Data collection, analysis and interpretation followed a phenomenological hermeneutical approach inspired by Ricoeur and the theoretical framework was grounded in Merleau‐Ponty's phenomenology of perception. The findings reveal the process patients went through in regaining familiarity with their own body after lung cancer treatment. Through the post‐operative trajectory the patients’ resumption of daily activities involved adjusting to a new awareness of everyday life, physical restrictions and their perception of themselves. The findings are expressed in four sub‐themes: (1) perceptions of embodied alterations; (2) transformation of embodied structures in the transition from hospital to home was unexpectedly challenging; (3) embodied perceptions of the intersubjective world; and (4) transforming embodied disruptions into bodily awareness. Patients experienced a smooth treatment trajectory regarding physical consequences of illness and treatment which might be due to the fast‐track surgery. Clinicians should be aware of patients’ experiences of illness to facilitate patient reconstitution of own identity.