Healthcare professionals’ experiences of providing individualized nutritional care for Older People in hospital and home care: a qualitative study

Abstract

BackgroundRecent studies indicate inadequate nutritional care practices in healthcare institutions and identify several barriers to perform individualized nutritional care to older persons. Organisation of care can become rigid and standardised, thus failing to be respectful of and responsive to each person’s needs and preferences. There is limited research exploring health professionals’ views on how structure of care allows them to individualize nutritional care to older persons. In this study we aim to explore how healthcare professionals’ experience providing individualised nutritional care within the organisational frames of acute geriatric hospital care and home care.MethodsSemi-structured interviews with 23 healthcare professionals from hospital acute geriatric care and home care. Interviews were analyzed using thematic analysis.ResultsTwo main themes and six sub-themes emerged from the material. Theme 1: ‘Meeting patients with complex nutritional problems’ with the sub-themes: ‘It is much more complex than just not eating’ and ‘seeing nutrition as a part of the whole’. Theme 2: ‘The structure of the nutritional care’, with the sub-themes: ‘Nutritional routines: Much ado, but for what?’, ‘lack of time to individualize nutritional care’, ‘lack of interdisciplinary collaboration in nutritional care’ and ‘meeting challenging situations with limited resources in home care’.ConclusionsThe healthcare professionals described having a high focus on and priority of nutritional care when caring for older persons. They did however find it challenging to practice individualized nutritional care due to the complexity of the patients’ nutritional problems and constraints in the way nutritional care was organised. By describing the challenges the healthcare professionals face when trying to individualize the nutritional care, this study may provide important knowledge to health professionals and policy makers on how to decrease the gap between older patients’ preferences for care and nutritional care practice.

Direct health care costs associated to neurological diseases and different degrees of malnutrition

“…There is little evidence concerning how health professionals can, through the existing healthcare structure, individualize nutritional care for the elderly. A recently published article [16] shows that hospitals can, through a home care unit, improve patient health and reduce hospital costs, especially among patients with high or medium risk of malnutrition problems. Findings of this study could be used to evaluate future costs related to different interventions on the patients' monitoring strategies are consistent with the results found in this study.…”

Nutrition Support Therapies on the Medication Administration Record: Impacts on Staff Perception of Nutrition Care

“…Dietitians have a leadership role in the nutrition care process, and nurses have a large role in implementing and documenting that care 5,8,15,16 . Medication administration is an established process for nurses, and the MAR is an effective tool to administer and document medications in an orderly, scheduled manner 8,28,29 .…”

“…Additionally, the Centers for Medicaid Services recommends that EHR technology supports achieving meaningful use and the user is able to create a single reconciled list of medications, medication allergies, or problems 21 . Not all NSTs are able to be reconciled at transitions of care 8,15 . Most NSTs are not ordered, administered, and documented in a standardized manner, although there are reported cases of errors, errors of omission, near‐misses, and cases that involved death of patients 15,16,22–26 .…”

Type of Care and Living Situation Are Associated with Nutritional Care but Not Nutritional Status of Older Persons Receiving Home Care

“…Only 4.1% of older adults receiving professional care received warm meals from their care service, and more than 20% of them made use of meals on wheels, a service which delivers prepared meals for those older persons who are not able to do it by their own [ 4 ] ( Figure 1 B). Limited time during each visit is one of the main barriers for professional care staff to engage in nutritional care, which is especially relevant for those older adults in need of help with eating and drinking [ 15 , 35 , 36 ]. However, it cannot be distinguished in our study if the small contribution of care services in nutritional care is because of the limited time or the better physical functioning of these participants.…”