An appealing meal: Creating conditions for older persons' mealtimes - a focus group study with healthcare professionals.

BACKGROUND: Healthcare professionals' knowledge and attitudes may have an impact on older persons' nutritional status. Therefore, it is important to explore different healthcare professionals' perspectives on older persons' meals. AIM: The aim of this study was to describe healthcare professionals' understanding of and views on the mealtime experience of older persons in municipal care. METHODS: Seven focus group discussions with various healthcare professionals (nurse assistants, registered nurses and occupational therapists) (n = 52) working in nursing homes and/or home care for older persons were conducted and analysed using interpretive description. The COREQ checklist was used for reporting the findings. RESULTS: The results revealed a striving to create conditions for an appealing meal, regardless of profession. This overall theme, 'An appealing meal - creating conditions for older persons' mealtimes', consisted of four sub-themes: 'Food is crucial', 'The mealtime as a social interaction', 'Identifying the individual older person's needs' and 'Integrating different perspectives of meal-related situations among the team'. CONCLUSION: The findings show that the different professionals strive to prioritise meals in the everyday care of older persons, but at same time there is a lack of a common view on how to prioritise meal-related issues. This indicates that the care may be fragmented, being based on each professional's duties and interpretation of responsibility for older persons' meals, rather than constituting comprehensive integrated person-centred care provided by a multidisciplinary team. RELEVANCE TO CLINICAL PRACTICE: To enhance older persons' mealtimes, we need to map how mealtimes are valued and implemented in clinical practice and approached in healthcare professionals' education. Education on older person's nutritional needs should be team-based, and not focus on the perspective of a single profession.

Lifestyle advice and lifestyle change: to what degree does lifestyle advice of healthcare professionals reach the population, focusing on gender, age and education?

Health promotion practice in health care has a high priority in the endeavour to achieve equal opportunities for health and diversity in health among the population. The purpose of the study was to investigate whether there is any connection between the lifestyle advice given by healthcare professionals and the lifestyle change of the population, focusing on age, gender and education level. The study is based on the data from a national population survey in Sweden in which 52 595 patients who had attended health care were interviewed by phone. The participants were asked whether healthcare professionals had raised the subject of lifestyle during the visit and whether the advice they gave had contributed to a lifestyle change. The results indicated that lifestyle issues were raised with 32.2% of those who attended health care, particularly among men, younger patients and those with a high education level. When lifestyle issues were raised, the advice contributed to 39.2% of patients making a lifestyle change, to a higher extent among men, older patients and those with a low education level. The study shows that lifestyle advice given by healthcare professionals, during both emergency and outpatient healthcare visits, is an important contributor to patients' lifestyle change.

Patients' experiences of lifestyle discussions based on motivational interviewing: a qualitative study.

BACKGROUND: According to World Health Organization about 75% of cardiovascular diseases and type 2 diabetes and 40% of all cases of cancer could be prevented if the risk factors tobacco use, unhealthy diets, physical inactivity and harmful use of alcohol could be eliminated. Patients often need help in monitoring themselves to make the proper lifestyle changes and it is important that adequate support is provided to enable the patients to take control over their health. Motivational interviewing is a framework that can help to facilitate this movement. The aim of this study was to describe how patients in primary health care settings experience lifestyle discussions based on motivational interviewing. METHODS: This study has a descriptive design and qualitative content analysis was used as the method. Sixteen patients who had each visited a registered nurse for lifestyle discussions were interviewed. RESULTS: The results show that the lifestyle discussions could enable self-determination in the process of lifestyle change but that certain conditions were required. Mutual interaction between the patient and the nurse that contributes to a sense of well-being in the patients was a necessary condition for the lifestyle discussion to be helpful. When the discussion resulted in a new way of thinking about lifestyle and when patient initiative was encouraged, the discussion could contribute to change. The patient's free will to make a lifestyle change and the nurse's sensitivity in the discussions created fertile soil for change. CONCLUSIONS: This study focuses on MI-based discussions, and the result shows that a subset of patients, who self-reported that they are motivated and aware of their role in making lifestyle changes, appreciate these strategies. However, it is not known whether discussions would be experienced in the same way if RNs used another method or if patients who were less motivated, engaged, or aware of their role in making lifestyle changes were interviewed.

Assessment of nutritional status and meal-related situations among patients with chronic obstructive pulmonary disease in Primary health care - obese patients; a challenge for the future.

AIMS AND OBJECTIVES: To describe nutritional status, meal related situations, food habits and food preferences of patients with chronic obstructive pulmonary disease (COPD) in a Primary health care (PHC) setting. BACKGROUND: To date, guidelines have mainly focused on underweight patients with COPD, as a low body mass index (BMI) is a risk factor for mortality. However, in recent years there has been an increase in the number of overweight patients with COPD, and therefore nutritional management must be developed to cover problems related to both under and overweight. DESIGN: Descriptive. METHODS: One hundred and three patients from PHC centres representing COPD stages 2 and 3 were included. The Mini Nutritional Assessment (MNA) was used to collect nutritional status data while semi-structured interviews provided information on food and meal related situations. RESULTS: Mean age was 69 (± 5)years and 45% were women. Among all patients mean BMI was 27 and 14% had a BMI ≤ 21 kg/m(2) . More women (31%) than men (26%) had a BMI ≥ 30 kg/m(2) . According to the MNA screening score, 86% of the patients were assessed as normal or not at risk of malnutrition. The total MNA assessment score revealed that 10 patients were at risk of malnutrition or malnourishment. Problems with meal related situations were mostly associated with eating, and only a small number reported difficulties with shopping or preparing food. CONCLUSIONS: In PHC, more patients with COPD were obese than malnourished and their self-reported nutritional status was not always accurate. RELEVANCE TO CLINICAL PRACTICE: It is challenging to identify the patient's nutritional status, individualize nutritional care and educate obese patients with COPD at PHC centres. It is necessary to develop screening instruments to assess the risk of both obesity and malnutrition.

Nutritional status, gender and marital status in patients with chronic obstructive pulmonary disease.

AIM AND OBJECTIVES: To describe and compare nutritional status, pulmonary function, gender and marital status in patients with chronic obstructive pulmonary disease. BACKGROUND: Chronic obstructive pulmonary disease is a chronic illness that can lead to poor nutritional status due to an increased energy requirements related to laboured breathing. Inadequate nutritional intake has often been described in this patient group. Nutritional support for patients with chronic obstructive pulmonary disease who suffer from nutritional problems is essential, both for their sense of well-being and for their survival with chronic obstructive pulmonary disease. DESIGN: The study design was descriptive and comparative. METHODS: Quantitative data collection was carried out among 81 patients with chronic obstructive pulmonary disease (47 women and 34 men) with an average age of 65 years (SD 3·5). The Mini Nutritional Assessment was used to assess nutritional status. RESULTS: Participants who lived alone had worse nutritional status than those who did not live alone, and female participants had worse nutritional status than their male counterparts. No significant correlation was found between pulmonary function and nutritional status. CONCLUSIONS: This study contributes knowledge of a potential correlation between nutritional status, gender and marital status in patients with chronic obstructive pulmonary disease. Women with chronic obstructive pulmonary disease may be at an increased risk of malnutrition. Despite the previous results showing malnutrition and underweight to be common, the present study found that many of the participants were overweight, which may reflect a global health trend regardless of disease. RELEVANCE TO CLINICAL PRACTICE: Early identification of patients at risk of malnutrition is important. Registered nurses should be aware that patients with chronic obstructive pulmonary disease who are female or who live alone may be at an increased risk of nutritional problems. Patients with chronic obstructive pulmonary disease must be offered information and support for individually adapted measures at an early stage in order to avoid nutritional problems, regardless of under- and overweight.

Primary healthcare nurses' experiences with motivational interviewing in health promotion practice.

AIM: The aim of the study was to describe primary healthcare nurses' experiences with motivational interviewing as a method for health promotion practice. BACKGROUND: A person's lifestyle has a major effect on his or her health. Motivational interviewing is one way of working with lifestyle changes in health promotion practice. The basic plan of motivational interviewing is to help people understand their lifestyle problems and make positive lifestyle changes. Motivational interviewing has been proven to be more effective than conventional methods in increasing patient motivation. DESIGN: This study has a descriptive design and uses a qualitative method. METHODS: Twenty nurses who worked in primary health care and actively used motivational interviewing in their work were interviewed. Qualitative content analysis was used to process the data. RESULTS: The primary healthcare nurses' experiences with motivational interviewing as a method of health promotion practice demonstrate that motivational interviewing is a demanding, enriching and useful method that promotes awareness and guidance in the care relationship. The results also show that motivational interviewing is a valuable tool for primary healthcare nurses' health promotion practice. CONCLUSION: This study shows that motivational interviewing places several different demands on nurses who use this method. Those who work with motivational interviewing must make an effort to incorporate this new method to avoid falling back into the former practice of simply giving advice. Maintaining an open mind while implementing motivational interviewing in real healthcare settings is crucial for nurses to increase this method's effectiveness. RELEVANCE TO CLINICAL PRACTICE: The nurses in the study had a positive experience with motivational interviewing, which can contribute to the increased use, adaption and development of motivational interviewing among primary healthcare professionals. Increased motivational interviewing knowledge and skills would also contribute to promotion of health lifestyle practices.

Nurse-led multidisciplinary programme for patients with COPD in primary health care: a controlled trial.

AIM: To investigate the effects of a nurse-led multidisciplinary programme (NMP) of pulmonary rehabilitation in primary health care with regard to functional capacity, quality of life (QoL), and exacerbations among patients with chronic obstructive pulmonary disease (COPD). METHOD: A 1-year longitudinal study with a quasi-experimental design was undertaken in patients with COPD, 49 in the intervention group and 54 in the control group. Functional capacity was assessed using the 6-minute walking test, and quality of life (QoL) was assessed using the Clinical COPD Questionnaire. Exacerbations were calculated by examination of patient records. RESULTS: No significant differences were found between the groups in functional capacity and QoL after 1 year. The exacerbations decreased in the intervention group (n = -0.2) and increased in the control group (n = 0.3) during the year after NMP. The mean difference of change in exacerbation frequency between the groups was statistically significant after one year (p=0.009). CONCLUSIONS: The NMP in primary care produced a significant reduction in exacerbation frequency, but functional capacity and QoL were unchanged. More and larger studies are needed to evaluate potential benefits in functional capacity and QoL.

"The meal is an activity involving at least two people"-Experiences of meals by older persons in need of elderly care.

Aim: A shift of focus on older persons' nutrition has occurred, from focusing on nutrition status to focusing on the whole meal. There is lack of studies on how older persons experience meals. Knowledge is needed to enhance a meal with dignity and pleasure, but also to prevent deterioration in nutrition. The aim was to describe meals from the perspective of older persons in need of elderly care. Design: A descriptive qualitative study. Method: Semi-structured interviews (N = 18) were conducted and analysed using thematic analyses. Result: Three themes were identified: The meal is an activity which involves at least two persons, The meal relates to habits and traditions and The meal seldom gives possibilities to make individual choices. It was obvious that older persons who live in nursing homes miss the opportunity to decide what to eat, when to eat and with whom to eat. Attention must be paid to listening to older persons to enhance mealtime with dignity and autonomy.

Nutritional status and patient characteristics for hospitalised older patients with chronic obstructive pulmonary disease.

AIM: The aim of the study was to describe and compare nutritional status and social and medical characteristics among older patients with chronic obstructive pulmonary disease admitted to an acute care hospital ward for respiratory medicine. BACKGROUND: Chronic obstructive pulmonary disease is a condition associated with risk of developing malnutrition. A body mass index <20 is predictive of hospitalisation for acute exacerbations of chronic obstructive pulmonary disease. Knowledge about patient characteristics is crucial for the identification of malnourished patients and the development of nursing care for these patients. DESIGN: Quantitative descriptive study. METHODS: Thirty-three hospitalised women and 17 men with a mean age of 75.7 years (SD 6.9) were consecutively included. A very severe case of chronic obstructive pulmonary disease was indicated in 28 out of 39 patients who underwent a lung function test. Data were collected with measurement of nutritional status using Mini Nutritional Assessment, anthropometry and lung function. RESULTS: Nearly half of the patients (48%) were identified as malnourished, an equal part as at risk for malnutrition and two patients as well nourished. The mean Mini Nutritional Assessment score of 17.2 (SD 3.99) for all patients was near the Mini Nutritional Assessment cut-off score (i.e. 17) for malnutrition. Patients identified as malnourished had a mean body mass index of 18.9 and those at risk for malnutrition had a mean of 23.4. It was more common for those identified as malnourished to live singly, to not live in own property and to be dependent on daily community service. Seven patients identified as malnourished died during the data collection period. CONCLUSIONS: This study provides important knowledge about further risks of impaired nutritional status among older patients with chronic obstructive pulmonary disease. RELEVANCE TO CLINICAL PRACTICE: This knowledge can provide registered nurses with the necessary knowledge to make them aware of certain patients needing particular kinds of attention.

Holding It Together-Patients' Perspectives on Postoperative Recovery When Using an e-Assessed Follow-Up: Qualitative Study.

BACKGROUND: There is an emerging trend to perform surgeries as day surgery. After a day surgery, most of the recovery period takes place at home, and patients are responsible for their own recovery. It has been suggested that electronic health (eHealth) technologies can support patients in this process. A mobile app has recently been developed to assess and follow up on postoperative recovery after a day surgery. OBJECTIVE: The aim of this study was to explore experiences associated with postoperative recovery after a day surgery in patients using a mobile app to assess the quality of their recovery. METHODS: This is a qualitative interview study with an explorative and descriptive design. Participants were recruited from 4 different day surgery units in different parts of Sweden. The study included 18 participants aged >17 years who had undergone day surgery and used the Recovery Assessment by Phone Points, a mobile app for follow-up on postoperative recovery after day surgery. Participants were purposively selected to ensure maximum variation. Semistructured individual interviews were conducted. Data were analyzed using thematic analysis. RESULTS: A total of two themes and six subthemes emerged from the data: (1) the theme Give it all you've got with the subthemes Believing in own capacity, Being prepared, and Taking action, where participants described their possibilities of participating and themselves contributing to improving their postoperative recovery; and (2) the theme The importance of feeling safe and sound with the subthemes Feeling safe and reassured, Not being acknowledged, and Not being left alone, which describe the importance of support from health care professionals and next of kin. CONCLUSIONS: It is important that patients feel safe, reassured, and acknowledged during their postoperative recovery. They can achieve this themselves with sufficient support and information from the health care organization and their next of kin. Using a mobile app, both for assessment and to enable contact with the day surgery unit during the postoperative recovery period, can improve care and create a feeling of not being alone after surgery. We propose that postoperative recovery starts in the prerecovery phase when patients prepare for their recovery to get the best possible outcome from their surgery.

Living with chronic obstructive pulmonary disease (COPD): part II. RNs' experience of nursing care for patients with COPD and impaired nutritional status.

This study is the second part of a project with the main purpose of obtaining a deeper understanding of the consequences of living with chronic obstructive pulmonary disease (COPD) concerning meal-related situations and an impaired nutritional status. COPD is a slowly progressive lung disease that results in several complications, including malnutrition. Nutritional status is an important part of COPD treatment, and there are criteria recommended for nutritional assessment and interventions among patients with COPD. Despite this, patients with extreme malnutrition and unnoticed weight loss are reported. The aim of the study was to investigate how Registered Nurses (RNs) in primary care describe nutritional assessment practices and interventions in COPD patients with impaired nutritional status. An interview approach using semistructured questions and case vignettes was chosen. The sample included 19 RNs working specifically with COPD patients. Data from interviews were analysed using qualitative content analysis, and nine categories corresponding to the aim were identified. The RNs reported that their assessment of nutritional status was based largely on intuition. Assessment also included detection of the patients' current beliefs and being sensible about information provision - When and How. Interventions were supportive eating interventions, practical and cognitive participation, and making patients aware of the illness trajectory. An overall category that influenced nursing was respecting patients' feelings of shame and guilt about a self-inflicted disease. It seems that RNs use intuition because of a lack of knowledge of systematic methods of nutritional assessment. The findings also indicate that the RNs attempted to build a relationship of trust with the patients rather than provide early information on sensitive topics (e.g. nutritional information). The study reports areas of nursing care for COPD patients that must be improved in the future.

Living with chronic obstructive pulmonary disease: part I. Struggling with meal-related situations: experiences among persons with COPD.

Reduced nutritional intake with low and decreased body weight can be a component of normal ageing. There is, however, also a greater risk for reduced nutritional intake within certain diagnoses, especially for chronic diseases. Malnutrition in chronic obstructive pulmonary disease (COPD) is caused by many factors. The relationship between COPD and low values of body mass index (BMI) is a known independent risk for mortality. For optimal support and care with special focus on nutritional status and interventions, caregivers need more knowledge about the meal-related situations (i.e. shopping for food, cooking and eating) of COPD patients. The aim of this study was to describe experiences of meal-related situations as viewed from the individual's perspective. The sample included eight women and five men with COPD recruited from five primary health clinics. The participants' average age was 68.9 years, with values of forced expiratory volume in 1 second (FEV(1) percentage) ranging from 18 to 69 and BMI values from 15 to 40. A descriptive design with qualitative interviews and self-reported diaries were used and the data were later analysed using content analysis. Findings showed consistency between informants' COPD, nutritional status and descriptions of experiences in meal-related situations. Findings were disease-specific but were also found to be general- and age-related. Respondents described physical influences and positive and negative feelings in their meal-related situations. Feelings of dependence, level of activity, transport of food, having company or being alone, appetite, hunger and need of time were also mentioned. Most research reports reduced nutritional status from a medical perspective. To our knowledge, no study has reported the positive and negative feelings that arise when eating in persons with COPD. Malnutrition for persons with COPD is not only caused by eating difficulties: eating is an integral part of social situations as shown in this study.