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To have and to hold nutritional control: Balancing between individual and routine care. A grounded theory study
Karlstad University, Faculty of Social and Life Sciences, Department of Nursing.ORCID iD: 0000-0002-2667-4025
Karlstad University, Faculty of Social and Life Sciences, Department of Nursing.
Karlstad University, Faculty of Social and Life Sciences, Department of Nursing.ORCID iD: 0000-0003-3385-3731
2009 (English)In: Intensive & Critical Care Nursing, ISSN 0964-3397, E-ISSN 1532-4036, Vol. 25, no 3, 155-162 p.Article in journal (Refereed) Published
Abstract [en]

OBJECTIVES:Gaining insight into nutritional processes can help nurses and other staff in their work. The aim was to provide a theoretical understanding of the concerns and strategies of nutritional nursing care for patients with enteral nutrition in intensive care units.

DESIGN: A grounded theory approach was used. Observations of patient's nutritional care and twelve interviews with eight registered nurses and four enrolled nurses were conducted.

SETTING: The study was carried out in one intensive care unit at a medium sized hospital in Sweden.

RESULTS: The substantive theory developed included the core category "To have and to hold nutritional control - balancing between individual care and routine care". The core category was reflected in and related to the categories "knowing the patient", "facilitating the patient's involvement", "being a nurse in a team", "having professional confidence" and "having a supportive organisation". Finding a balance between individual care and routine care was a way of enhancing the patient's well-being, security and quality of care.

CONCLUSION: To have and to hold nutritional control over the patient's nutrition was found to be a balancing act between individual care and routine care. Organisation and teamwork are both challenging and supporting the provision, maintenance and development of nutritional care.

Place, publisher, year, edition, pages
2009. Vol. 25, no 3, 155-162 p.
Keyword [en]
Enternal nutrition, Enrolled nurses, Grounded theory, Intensive care and registered nurses
National Category
Nursing
Research subject
Nursing Science
Identifiers
URN: urn:nbn:se:kau:diva-2837DOI: 10.1016/j.iccn.2009.03.002PubMedID: 19395264OAI: oai:DiVA.org:kau-2837DiVA: diva2:37840
Available from: 2008-11-18 Created: 2008-10-14 Last updated: 2016-04-13Bibliographically approved
In thesis
1. Nutritional Nursing Care: Nurses’ interactions with the patient, the team and the organization
Open this publication in new window or tab >>Nutritional Nursing Care: Nurses’ interactions with the patient, the team and the organization
2008 (English)Doctoral thesis, comprehensive summary (Other scientific)
Abstract [en]

The overall aim of the thesis was to gain a deeper understanding of nutritional nursing care in municipal care and county council care, with specific focus on enteral nutrition (EN) in intensive care.

Quantitative and qualitative methods were used. Telephone interviews regarding assessment of the nutritional status of patients were carried out with special medical nurses (CNs) (n = 14) in municipalities in one county and first line managers (CNs) (n = 27) in one county council. Registered nurses (RNs) in municipalities (n = 74) and county councils (n = 57) answered a questionnaire about nutritional assessment and documentation (I). RNs (n = 44) at three different intensive care units answered a questionnaire about responsibility, knowledge, documentation and nursing interventions regarding EN. Observations (n = 40) on nursing care interventions for patients with EN were carried out (II). RNs (n = 8), enrolled nurses (n = 4) (III) and patients (n = 14) (IV) were interviewed and nutritional nursing care was observed (III-IV) at an intensive care unit.

The results showed that assessment of nutritional status was not performed on all patients, according to RNs/CNs. Malnourished patients were estimated to occur to a varied extent. Sixty-six percent of RNs/CNs answered that there were no guidelines for nutritional care and 13% that they did not know if there were any. RNs saw the VIPS model as a guide in nursing care, but also as an obstacle to information exchange (I). A majority of RNs answered that there were guidelines for EN. There were differences between the RNs’ opinions about their responsibility, knowledge and documentation. Deviations from recommended nursing care interventions occurred (II). The developed substantive theory of nurses (RNs and enrolled nurses) concerns and strategies of nutritional nursing care for patients with EN, includes the core category ”to have and to hold nutritional control – balancing between individual care and routine care” and the categories ”knowing the patient”, ”facilitating the patients’ involvement”, ”being a nurse in the team”, ”having professional confidence” and ”having a supportive organization”. In order for RNs and enrolled nurses to have a sense of control over the patients’ care in relation to nutrition, a balance between routine care and individual care was required (III). The developed substantive theory regarding the patients’ experiences of nutritional care includes the core category ”grasping nutrition during the recovery process”.  The core category is reflected in, and dependent on, the categories ”facing nutritional changes”, ”making sense of the nutritional situation” and ”being involved with nutritional care”. The patients alternated emotionally between worry, fear and failure, and relief and hope. The patients experienced a turning point and felt an improvement in their condition when their appetite returned, when the stomach and gut were functioning and when the feeding tube was removed (IV).

The conclusion is that quality and safety in relation to nutritional nursing care is dependent on the interactions between the nurse and patient, between the nurse and the team, and the nurse and the organization.

Place, publisher, year, edition, pages
Karlstad: Karlstads universitet, 2008. 107 p.
Series
Karlstad University Studies, ISSN 1403-8099 ; 2008:41
Keyword
assessment, documentation, enteral nutrition, intensive care, intervention, malnutrition and nutrition
National Category
Nursing
Research subject
Nursing Science
Identifiers
urn:nbn:se:kau:diva-2843 (URN)978-91-7063-201-3 (ISBN)
Public defence
2008-12-05, Lagerlöfsalen, 1A 305, Karlstads universitet, Karlstad, 09:00 (Swedish)
Opponent
Supervisors
Available from: 2008-11-18 Created: 2008-10-15 Last updated: 2015-01-29Bibliographically approved

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