Hospital nurses and home care providers’ experiences of participation in nutritional care among older persons and their family caregivers: a qualitative study

Abstract

Background A person‐centred approach to nutritional care has the potential to increase an older person’s role in making informed decisions about their own care and possibly improving their quality of life. However, despite the considerable interest shown in person‐centred nutritional care in recent years, delivery of such care still appears to lack consideration for older persons’ needs and preferences. The present study aimed to explore healthcare professionals’ views on how older persons and their family caregivers participate in decisions about their own nutritional care and possible barriers for that participation. Methods Semi‐structured in‐depth interviews with 23 healthcare professionals in acute geriatric care and home care were conducted. Data were analysed thematically. Results The analysis of the interviews resulted in three main themes: (i) lack of shared decision‐making in nutritional care; (ii) conflict between patient’s preferences and standard nutritional care procedures; and (iii) the value of family caregivers who are seldom involved in nutritional care. Conclusions Healthcare professionals were aware of the importance of actively engaging older persons and their family members in the nutritional care to achieve positive outcomes. However, they encountered individual and structural barriers, including resistance from patients and family caregivers, conflicts between the patients’ nutritional wishes and standard nutritional procedures, a wish to shield the family caregivers from the stress of caring for a sick relative, and lack of time and caring structures that facilitate the older persons and their family’s active participation.

Balancing standardisation and individualisation in transitional care pathways: a meta-ethnography of the perspectives of older patients, informal caregivers and healthcare professionals

“…Although the services are supposed to be holistic and involve the older persons and informal caregivers in decisions about their care, the participants instead described a predetermined clinical pathway with a lack of personal choices regarding both time and place of services, such as hospital discharge, IC services and home care. The patients and informal caregivers called for better information, continuity and predictability, while the HCPs experienced limited professional discretion and structural barriers in daily care to meeting the patients' needs and preferences [39][40][41][42][43][44][45][46][47][48][49][50]. Lilleheie et al stated that patients were commonly discharged from hospitals at an early stage, not always involved in decisions regarding the next level of care and subject to scant information reporting in a system not integrated thoroughly around a patient's own journey.…”

Ethical challenges in home-based care: A systematic literature review

“…This means that healthcare personnel often have to deal with situations where patients' or relatives' views and wishes conflict with their own professional values and norms and what they think is the best care or treatment. 5,22,31,32,38,49 Healthcare personnel may sometimes judge that respect for autonomy conflicts with good care. 1 When safety is endangered, healthcare professionals are sometimes willing to put more pressure and take more control over patients with impaired decisional capacity.…”

The experience of family caregivers of patients receiving home nasogastric tube feeding in China: A descriptive qualitative study

“…pointed out that the transition in moving from the hospital to the home tends to be harder than they expect as a result of a lack of preparation with respect to providing necessary care to their family member. Hurried discharge teaching, 31 planning 32 and inadequate communication 12 were also reported to be associated with negative experiences. Therefore, a comprehensive discharge care plan is essential so that caregivers feel confident and safe.…”

“…Although HETF has been described as a lifeline, 11 it also means transferring responsibilities and risks from the hospital to the home. Studies found that actively engaging family caregivers is important in nutritional care to achieve positive outcomes 12 . Patients have a limited ability for self‐management and can receive therapy at home only if caregivers can guarantee the safety and efficacy of HETF 13 .…”

“…Studies found that actively engaging family caregivers is important in nutritional care to achieve positive outcomes. 12 Patients have a limited ability for self‐management and can receive therapy at home only if caregivers can guarantee the safety and efficacy of HETF. 13 However, caregivers have described the new lifestyle as a struggle and the hazards of caregiving can convert them into hidden patients.…”