Elliott Andrea, Noble Kia, Flynn Daphne, Bauer Judy, Gibson Simone
Department of Nutrition, Dietetics and Food, School of Clinical Sciences, Monash University, Notting Hill, Victoria, Australia.
Dietetics and Nutrition Department, Alfred Health, Prahran, Victoria, Australia.
J Hum Nutr Diet. 2025 Feb;38(1):e70003. doi: 10.1111/jhn.70003.
Recent studies show a high prevalence in hospital populations and best practice evidence indicates that people living with obesity should receive dietetic advice. However, patients often do not receive this care in acute settings. Understanding the experiences of people living with obesity is crucial to designing successful strategies for management.
This qualitative study aimed to understand the experience of nutrition care for patients living with obesity in the acute hospital setting and to redesign an optimised patient journey using a design approach. Using patient journey mapping, nutrition care across the inpatient admission was explored. A lived experience perspective was applied to reflect on the patient journey and interactions of patients with dietetic services in the acute setting. A co-creation session was conducted with dietitians and consumers to redesign the patient journey.
The patient journey revealed that for patients living with obesity, discussions about weight were absent from the journey from all healthcare professionals. For patients receiving dietetic care, the Nutrition Care Process was followed; nutrition intervention focused on acute nutrition issues with increased energy and protein prescription: a lack of goal setting and absence of discharge planning. The redesign of the nutrition care journey identified pivot points in the pathway to support engagement in obesity-related care.
The findings from this study provide new insights into current nutrition care for people living with obesity in the acute setting. These findings can inform future education, research and advocacy for practice changes to improve dietetic care for people living with obesity.
近期研究表明，肥胖在医院人群中普遍存在，最佳实践证据表明肥胖患者应接受饮食建议。然而，在急性病环境中，患者往往无法获得这种护理。了解肥胖患者的经历对于制定成功的管理策略至关重要。
这项定性研究旨在了解急性医院环境中肥胖患者的营养护理体验，并采用设计方法重新设计优化的患者就医流程。通过患者就医流程映射，探索了住院期间的营养护理情况。应用生活体验视角来反思患者就医流程以及急性病环境中患者与饮食服务的互动。与营养师和消费者共同开展了一次共创会议，以重新设计患者就医流程。
患者就医流程显示，对于肥胖患者而言，所有医护人员在整个就医过程中都未提及体重问题。对于接受饮食护理的患者，遵循了营养护理流程；营养干预侧重于急性营养问题，增加了能量和蛋白质的处方量，但缺乏目标设定且没有出院计划。营养护理流程的重新设计确定了该流程中的关键点，以支持患者参与肥胖相关护理。
本研究结果为急性病环境中肥胖患者当前的营养护理提供了新的见解。这些发现可为未来的教育、研究及倡导实践变革提供参考，以改善肥胖患者的饮食护理。
