Centre for Care Research, Department of Health Science in Gjøvik, Faculty of Medicine and Health Science, NTNU - Norwegian University of Science and Technology, Gjøvik, Norway.
Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, NTNU - Norwegian University of Science and Technology, Trondheim, Norway.
Int J Nurs Stud. 2024 Dec;160:104860. doi: 10.1016/j.ijnurstu.2024.104860. Epub 2024 Oct 1.
Numerous formal strategies, screening tools, and interventions have been used to prevent malnutrition in long-term care patients. Despite these efforts, the proportion of screened patients is low, and a large proportion are malnourished. Previous research has revealed that healthcare professionals use a broad approach in their nutritional care but has also emphasised the need for further investigation into these approaches.
To explore how healthcare professionals working in long-term care experience and apply nutritional care.
A descriptive, exploratory, qualitative design containing 240 h of participant observation, 12 focus groups and 2 individual interviews.
SETTING(S): Twelve nursing homes and home care units in three Norwegian municipalities.
Participant observation of interactions between healthcare professionals and patients. Forty-three registered nurses participated in focus group or individual interviews.
The data were analysed using inductive thematic analysis.
The analysis identified three themes: The first theme, limited significance of nutritional screening, showed that healthcare professionals experienced the limited value of nutritional screening, as it often did not capture patients' nutritional challenges. They also perceived nutritional screening as unsuitable for patients at the end of their lives, those with overweight-related complications, or undergoing rehabilitation. In addition, nutritional screening was perceived as something healthcare professionals did for their managers or administrators, not because it was crucial to providing good nutritional care. The second theme, provision of individualised food, captures the healthcare professionals' efforts in adapting and preparing food according to the patient's preferences. Facilitation to enable patients to make individual food choices and the use of food cards or lists were two approaches to individualising nutrition care. The third theme, making meals more than about food, elucidated how healthcare professionals used meals to help patients cope with their situations and experience social belonging. Conversations about or around meals were used to provide patients with a sense of belonging to their past or present situation. The meals were also used as a diversion strategy for patients with unrest, as arenas for daily activity training, and for meaningful social interactions between patients around the tables.
Nutritional screening and prevention of malnutrition are only one part of healthcare professionals' nutritional care. Individualised food and meals that create coping, a sense of belonging, and social experiences are equally important parts of their care. Emphasising healthcare professional's person-centred approach to nutritional care would be beneficial, as it could strengthen and further develop long-term nutritional care services.
为了预防长期护理患者的营养不良，已经使用了许多正式的策略、筛查工具和干预措施。尽管做出了这些努力，接受筛查的患者比例仍然很低，而且很大一部分患者都存在营养不良的情况。先前的研究表明，医疗保健专业人员在营养护理方面采用了广泛的方法，但也强调需要进一步研究这些方法。
探讨长期护理医护人员的营养护理体验和应用情况。
包含 240 小时的参与者观察、12 个焦点小组和 2 个个人访谈的描述性、探索性、定性设计。
挪威三个城市的 12 家疗养院和家庭护理单位。
观察医护人员与患者之间的互动。43 名注册护士参加了焦点小组或个人访谈。
使用归纳主题分析对数据进行分析。
分析确定了三个主题：第一个主题，营养筛查的意义有限，表明医护人员认为营养筛查的价值有限，因为它往往无法捕捉到患者的营养挑战。他们还认为营养筛查不适合生命末期的患者、超重相关并发症患者或正在康复的患者。此外，营养筛查被视为医护人员为他们的经理或管理人员做的事情，而不是因为它对提供良好的营养护理至关重要。第二个主题，提供个性化的食物，捕捉到医护人员根据患者的喜好调整和准备食物的努力。促进患者做出个人的食物选择以及使用食物卡或清单是两种个性化营养护理的方法。第三个主题，使饮食不仅仅是关于食物，阐明了医护人员如何使用饮食帮助患者应对他们的情况并体验社会归属感。围绕饮食进行的对话被用来为患者提供对过去或现在情况的归属感。这些饭菜也被用作有不安情绪的患者的转移策略，作为日常活动训练的竞技场，以及为餐桌周围的患者提供有意义的社交互动。
营养筛查和预防营养不良只是医护人员营养护理的一部分。个性化的食物和饮食可以帮助患者应对、获得归属感和社交体验，这同样是他们护理的重要组成部分。强调医护人员以人为本的营养护理方法将是有益的，因为它可以加强和进一步发展长期营养护理服务。
