The trial title: "Operationalizing person-centered nutrition care across the life course."
Ordinary opponents
- First opponent: Linda Johansson, PhD, Senior Lecturer Nursing Science, Jönköping University, Sweden
- Second Opponent: Professor Jorun Rugkåsa, University of South-Eastern Norway and Akershus University Hospital, Norway
- Leader of the evaluation committee: Professor Kjell Sverre Pettersen, Faculty of Health Sciences, OsloMet
The leader of the public defense is Associate Professor Mari Myhrstad, Faculty of Health Sciences, OsloMet.
The main supervisor is Associate Professor Asta Bye, Faculty of Health Sciences, OsloMet.
The co-supervisors are:
- Associate Professor Jonas Debesay, Faculty of Health Sciences, OsloMet
- Associate Professor Marianne Molin, Faculty of Health Sciences, OsloMet
- Professor Astrid Bergland, Faculty of Health Sciences, OsloMet
Abstract
Malnutrition is a widespread problem among older persons that is associated with many negative consequences for the persons affected and society. Upon hospital discharge, older persons with malnutrition are more likely to experience adverse events and hospital re-admissions. Thus, accurate management of malnutrition in transitional care is of great importance.
However, studies exploring nutritional care practices report insufficient knowledge about older persons’ nutritional needs and preferences, lack of patient and family caregiver engagement and poor continuity of care when patients move between healthcare professionals and care settings. A person-centred approach to care has the potential to improve the quality of care and increase older persons’ possibility to make informed decisions concerning their life and care.
However, despite the considerable interest shown in person-centred care in recent years, delivery of care to older persons still seems to lack consideration for older persons’ needs and preferences. This also concerns delivery of nutritional care.
However, limited research could be identified on older persons’ and their family members’ needs and preferences concerning care and nutritional care in the transition between hospital and home-based services and on healthcare providers’ ability to deliver care accordingly. Thus, this study aims to explore health care and nutritional care provided to older people in hospital, at home and in the transition between these settings from the perspectives of older persons, their family caregivers and healthcare professionals.
Method
The study design in this thesis consists of two qualitative approaches, which are as follows:
- a meta-summary
- data from in-depth interviews.
For the metasummary, data from 13 qualitative studies were included, following specific selection criteria, and categorised into main themes.
In addition, semi-structured interviews with 15 older patients with a documented risk of malnutrition or malnourishment (Mini Nutritional Assessment [MNA]), 9 family caregivers and 23 healthcare professionals from acute geriatric hospital care and homecare were carried out. Data were analysed using thematic analysis.
Results
The older persons experienced that the care in general, and nutritional care specifically, lacked individualised considerations. Most of the patients were striving to maintain independence and control. However, they were not offered any self-management support from the care services, and they were dependent on informal caregiver support to cover their needs. They also experienced poor continuity of care between the services due to lacking information and not being involved in decisions.
They described an interaction with the care services that evoked feelings of disrespect and disempowerment. Family caregivers also experienced lacking necessary information and support, and some felt disempowered in the interaction with the care services. Still, the healthcare professionals in this study seemed to have rich knowledge and skills in how to provide nutritional care according to older persons’ needs.
However, they found it challenging to provide care according to the older persons’ needs and preferences due to the complexity of the patients’ nutritional problems and limited resources and constraints in the way nutritional care was organised. Lack of training and interdisciplinary support, combined with lack of routines for following up on nutritional problems and lack of time dedicated to food-related care, limited the carers’ ability to provide individualised nutritional care.
They also reported that they tended not to include the older persons and their families in planning and decisions regarding the nutritional care. They described several barriers for engaging them, including meeting resistance from patients and family caregivers, conflicts between the patients’ nutritional wishes and standard procedures, wanting to shield the family caregivers from the stress of caring for a sick relative and lack of time and caring structures that facilitate participation.
Conclusions
The results from this thesis show that there is a need and high potential for quality improvement in the delivery of health and nutritional care to older persons. The nutritional care in both hospital and homecare seemed to lack a person-centred approach that recognised and valued the older persons as whole persons, considering patient and family caregiver needs and wishes.
Strategies to improve communication and interaction between older patients, their families and the care services are needed. Healthcare organisations need to invest time and resources in developing caring cultures and structures that facilitate person-centred practices as this can ensure more accurate and efficient care in addition to improving the care experience for patients, their families and healthcare professionals.
