Halvorsen Kristin, Eide Helene Kjøllesdal, Sortland Kjersti, Almendingen Kari
Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo and Akershus University College of Applied Sciences, Oslo, Norway.
Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo and Akershus University College of Applied Sciences, Oslo, Norway ; Division of Medicine, Akershus University Hospital and Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
BMC Nurs. 2016 Dec 1;15:70. doi: 10.1186/s12912-016-0193-z. eCollection 2016.
Nutritional care is a basic human right for all people. Nevertheless, undernourishment is known to be a frequent and serious health care problem among elderly hospitalized patients in Western Europe. Nutritional documentation contributes to ensuring proper nutritional treatment and care. Only a few studies have explored how nurses document nutritional care in hospitals, and between hospitals and nursing homes. Available research suggests that documentation practices are unsatisfactory. The aim of this study was to explore how nurses document nutritional treatment and care for elderly patients in hospitals and how nurses and undergraduate nurses communicate information about patients' nutritional status when elderly patients are transferred between hospital and nursing homes.
A qualitative study was conducted using a phenomenological-hermeneutic approach. Data was collected in focus group interviews with 16 nurses in one large university hospital, and 11 nurses and 16 undergraduate nurses in five nursing homes associated with the university hospital. Participants from the university hospital represented a total of seven surgical and medical wards, all of which transferred patients to the associated nursing homes. The catchment area of the hospital and the nursing homes represented approximately 10% of the Norwegian population in heterogenic urban and rural municipalities. Data were coded and analysed thematically within the three contexts: self-understanding, critical common sense, and theoretical understanding.
The results were summarized under three main themes 1) inadequate documentation of nutritional status on hospital admission, 2) inadequate and unsystematic documentation of nutritional information during hospital stay, 3) limited communication of nutritional information between hospital and nursing homes. The three main themes included seven sub-themes, which reflected the lack of nutritional screening and unsystematic documentation on admission and during hospital stay. Further the sub-themes elucidated poor exchange of information between hospital and nursing homes regarding the nutritional status of patients.
Overall, the documentation of nutritional treatment and care for elderly patients was inadequate in the hospital and between health care settings. Inappropriate documentation can create a negative nutritional spiral that leads to increased risk of severe health related complications for elderly patients. Moreover, it hinders nutritional follow-up across health care settings.
营养护理是所有人的一项基本人权。然而，众所周知，在西欧，营养不良是老年住院患者中常见且严重的医疗保健问题。营养记录有助于确保适当的营养治疗和护理。只有少数研究探讨了护士在医院以及医院与疗养院之间如何记录营养护理情况。现有研究表明，记录做法并不理想。本研究的目的是探讨护士如何记录医院中老年患者的营养治疗和护理情况，以及当老年患者在医院和疗养院之间转移时，护士和本科实习护士如何就患者的营养状况交流信息。
采用现象学 - 诠释学方法进行定性研究。通过焦点小组访谈收集数据，访谈对象包括一所大型大学医院的16名护士，以及与该大学医院相关的五所疗养院的11名护士和16名本科实习护士。大学医院的参与者代表了总共七个外科和内科病房，所有这些病房都会将患者转至相关的疗养院。医院和疗养院的服务区域覆盖了挪威城乡异质地区约10%的人口。在自我理解、批判性常识和理论理解这三个背景下对数据进行编码和主题分析。
结果归纳为三个主要主题：1）入院时营养状况记录不足，2）住院期间营养信息记录不充分且不系统，3）医院与疗养院之间营养信息交流有限。这三个主要主题包括七个子主题，反映了入院时和住院期间缺乏营养筛查以及记录不系统的情况。此外，这些子主题还阐明了医院和疗养院之间在患者营养状况方面信息交流不畅的问题。
总体而言,医院以及不同医疗环境之间老年患者营养治疗和护理的记录不充分。不恰当的记录可能会形成负面的营养螺旋，导致老年患者出现严重健康相关并发症的风险增加。此外，它还阻碍了跨医疗环境的营养随访。
