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| 63. |
- Odencrants, Sigrid, et al.
(author)
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Living with chronic obstructive pulmonary disease (COPD) : Part II. RNs' experience of nursing care for patients with COPD and impaired nutritional status
- 2007
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In: Scandinavian Journal of Caring Sciences. - Oxford : Blackwell. - 0283-9318 .- 1471-6712. ; 21:1, s. 56-63
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Journal article (peer-reviewed)abstract
- 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
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| 64. |
- Odencrants, Sigrid, et al.
(author)
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Nutritional status and patient characteristics for hospitalised older patients with chronic obstructive pulmonary disease
- 2008
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In: Journal of Clinical Nursing. - : Wiley. - 0962-1067 .- 1365-2702. ; 17:13, s. 1771-1778
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Journal article (peer-reviewed)abstract
- 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.
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| 65. |
- Petersson, Pia, 1961-, et al.
(author)
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The triumph of hope over experience : using patients' experiences to inform leg ulcer care through participatory action research
- 2009
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In: Journal of Nursing and Healthcare of Chronic Illness. - Oxford : Blackwell Publishing. - 1752-9816 .- 1752-9824. ; 1:1, s. 96-104
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Journal article (peer-reviewed)abstract
- Aims and objectives: The aim of this Participatory Action Research (PAR) project was to find out how the patients experienced their care in order to allow the practitioners to reflect about the patients’ view as a vehicle for a changed leg ulcer care practice. This paper reports on findings from the project and from the PAR process.Background: Great numbers of people suffer from chronic leg ulcers and many have to live with their illness for a long time. Even when the illness is controlled by medical treatment, the person with the chronic condition has to deal with physical, emotional, cognitive and social problems and usually has frequent and long-term encounters with practitioners. In one municipality in a southern part of Sweden researchers were engaged as consultants in a PAR project aiming to improve the care for persons with chronic leg ulcers.Method: Nine older persons with chronic leg ulcers, mainly treated in primary care, were asked about their experiences of the care. The analysis proceeded in several steps including a number of content analysis and reflective dialogues with practitioners and persons with chronic leg ulcers.Result: Although the persons with chronic leg ulcers experienced their encounters with practitioners as satisfying, findings illuminated low participation in their own care and low practitioner involvement in issues about their daily living with chronic illness. In addition, the PAR project did not succeed to proceed from problem identification towards development and change.Conclusion and relevance to clinical practice: Participation is about negotiation and transferring power and authority from practitioners towards patients and from researchers towards practitioners and patients. This is however difficult to achieve in practice. This project illuminated that success in performing a PAR project that brings sustainable change requires substantial work to involve practitioners in initiating and planning the research.
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| 70. |
- Quell, Robin, et al.
(author)
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Using tactile stimulation in a dementia care facility with plasma prolactine as an outcome measure : a pilot study
- 2008
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In: Archives: the international journal of medicine. - 1791-4000. ; I:3, s. 123-129
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Journal article (peer-reviewed)abstract
- BackgroundThere is poor scientific documentation supporting tactile stimulations’ benefit as a nursing intervention. It has been theorized that older adults with dementia experience high anxiety and stress levels. High prolactin levels are associated with psychosomatic reactions and have been used to measure stress levels in adults.AimTo evaluate tactile stimulation’s effectiveness on anxiety and stress in older adults, with dementia diagnosis or signs of dementia and living in a dementia care facility, as manifested by plasma prolactin levels.Materials and MethodsTactile stimulation was given weekly by trained staff members to half the residents of a Swedish dementia care facility.The subjects were randomly selected (n=20) and were tracked in the study for a minimum of 28 weeks. The remaining half elders made up the control team (n=20). Diagnostic groups were formed according the severity of dementia. Plasma prolactin levels were drawn at baseline and post intervention. Medications caused the exclusion of 12 residents and seven dropped out due to other causes. ResultsThere was no difference in plasma prolactin levels between the intervention (n=11) and control (n=12) group. A significant main effect between the diagnostic groups was found as well as a trend towards a positive correlation between age and plasma prolactin levels. There was no gender difference in plasma prolactin levels.ConclusionsOur hypothesis that reduced plasma prolactin levels could be detected in elders treated with tactile stimulation, indicating alleviated stress, was not supported by the preliminary results of the present study. Further evaluation of tactile stimulation with larger study groups and a better understanding of prolactin’s sensitivity, complexity and interaction with medications could contribute to the outcome and problems of the study. The use of neuropsychological assessment could enrich the research data and help the evaluation.
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