Dissertations / Theses on the topic 'Nursing - Nutrition'

Syftet: Avsikten med denna studie var att belysa distriktssköterskans/sjuksköterskansattityd till nutrition i omvårdnad av äldre över 65 år med hemtjänst.Metod: Utifrån ostrukturerade fokusgruppsintervjuer fick sjuksköterskor i enkommun i Mellansverige diskutera nutrition som ett omvårdnadsproblem utifrån ettpatientfall. Intervjuerna analyserades med kvalitativ innehållsanalys.Resultat: Analysen resulterade i fyra teman, medvetenhet om personens behov,ansvar för den andre, kunskap om att möta behoven samt relationsetik.Sjuksköterskorna förmedlade en positiv syn på att arbeta med nutrition och de hadeen stor förståelse för vilka konsekvenser ett för dåligt energiintag har på den äldresvälbefinnande. De upplevde att de har ett stort ansvar och tillräckligt med kunskapför att möta nutritionsproblemen i omvårdnaden. De anser att alla äldre har ett egetval så hänsyn måste visas och respekt måste tas för deras vilja när det gäller nutrition,vården kring den enskilde måste vara den bästa tänkbara.Slutsats: Studien visar att sjuksköterskorna tar ett stort ansvar i nutritionsfrågorna.Allt från att tillgodose individens enskilda behov till att lära ut och stötta övrigpersonal i vården. Sjuksköterskorna upplever att de har den rätta kunskapen för attkunna hantera nutritionsproblem i vården. Kunskapen har ökat de senaste åren.Denna kunskap anser författarna ligger till grund för sjuksköterskans positiva syn tillnutrition i omvårdnaden.

Aim: The aim of this study was to illuminate the nurse’s attitudes to nutrition whencaring elderly people over 65 years of age in their homes.Method: With unstructured interviews in focus groups the nurses discussed nutritionas a care problem from a patient’s situation. The interviews were analysed withcontent analysis.Result: The analyse resulted in four subjects, awareness of the persons needs,responsibility for the other, knowledge of meeting needs and relations ethics. Thenurses had a positive attitude to work with nutrition tasks and they had a greatunderstanding for the consequences of a low energy intake and how it will influencethe wellness of the elderly. They experienced that they had a big responsibility andenough knowledge to meet the nutrition problems in the care of the elderly. Theyconsidered that the elderly had their own choice, consideration and respect must beenshown for their own wish when it comes to nutrition. The care always must be of thehighest quality for the single person.Conclusion: The study showed that the nurses had a great responsibility in nutritionquestions. That means everything from providing the individuals needs to educateand support the staff in the care. The nurses experienced they had the adequateknowledge to handle the nutrition problems in the care. The knowledge aboutnutrition among the nursing staff tends to increase in the past years. This knowledgethe authors consider be the basis of positive attitude to nutrition among the nursesinterviewed.

Background: Insufficient nutritional support is associated with prolonged hospitalisation, impaired wound healing and impaired survival for patients in intensive care. In severe sepsis and septic chock, calculation of nutritional need is complicated since the metabolism is affected by decease. Aim: The aim of the study was to investigate nutritional support and to examine the quality of nursing documentation of nutritional status and nutritional support in patient records in severe sepsis and septic chock.  Method: The study was conducted as a retrospective investigation where 64 patient records were studied. The quality of documentation was examined in 10 patient records using an examinational model.

Findings: Calculation of average nutritional support showed insufficient supply particularly in the two first days of intensive care. During the next five days nutritional supply was higher but individual variation was seen, why a clear picture of nutritional support is hard to detect. Examining the quality of nursing documentation revealed that most records contained nutritional status and treatment, while anamnesis, nutritional goals and nutritional diagnoses were rare. Conclusion: The study is of limited significance, but could be used to map out the present regimen of nutritional support. Future nursing research could include the caloric need and the amount of enteral support patients in severe sepsis and septic shock tolerates.

The American Academy of Pediatrics (2012); the American College of Obstetricians and Gynecologists (2016); and the Association of Women’s Health, Obstetric, and Neonatal Nurses (2015) endorses breastfeeding exclusively for six months, followed by continuation with complementary foods through age one year to achieve the most personal and public health benefits. However, while most mothers initiate breastfeeding, the majority do not meet their goals due to lack of support (CDC, 2016).

The Affordable Care Act mandates coverage for breastfeeding support, but federal, state, and insurance policies are not conducive to making such benefits accessible.

Electronic registration and medical record documentation allow for improved tracking and decreased risk to the facility.

This paper outlines the development and implementation of administrative practices in an existing Registered Nurse/Internationally Board-Certified Lactation Consultant (RN-IBCLC) led outpatient lactation clinic at a Baby Friendly (2012) designated facility with goals of increasing access to lactation support postpartum, improving patient outcomes, and realization of financial viability. Expected outcomes included identification of best practices and implementation strategies for the following: a. provider collaboration including outreach efforts to trigger referrals. b. number of dedicated hours per week to offer services. c. cost/benefit analysis. d. registration and documentation process. e. model of care. f. funding source.

Tests of change through plan-do-study-act (PDSA) cycles were based on the outcome of a gap analysis. Modifications to implementation were made dependent on PDSA cycle findings until optimized RN-IBCLC-led outpatient lactation clinic administrative practices for the facility and processes became streamlined.

Despite limited literature to guide administrative practices, the project met the aims of patient registration and electronic health record (EHR) documentation. However, extensive policy and systems barriers existed that prevented success in identifying a workable revenue stream despite the efforts of this investigator in collaboration with parent system-level managed care, finance, and compliance departments.

The solution agreed upon to provide sustainability to the program was to utilize outpatient lactation visits as a community benefit to quantify lost revenue of services provided and aid the hospital. Even though the lack of revenue equaled lack of department growth, the community benefit option added a layer of stability to the program as it stands.

This project provides a model for other organizations examining best practices in administrative and funding options for IBCLC-led outpatient lactation clinics. Thereby; creating sustainable breastfeeding support leading to improved health of mothers, babies, and the community.

A nutritional method commonly used to deliver feedings to premature infants is the use of a gavage tube. To measure for any undigested breastmilk or formula, a gastric aspirate is checked prior to the next feeding. There is a gap in practice as to what to do if these aspirates signify feeding intolerance. The project question centered on identifying evidence-based guidelines in the literature that would help to define best practices related to feeding intolerance of gavage-fed infants. The Johns Hopkins Nursing Evidence-Based Practice model and the Appraisal of Guidelines Research and Evaluation provided the frameworks for gathering and evaluating evidence as well as the process used in forming the practice guideline. The primary methods employed were a team approach that included a Neonatal Intensive Care Unit (NICU) Project Team and NICU expert opinion along with a literature review conducted by the doctor of nursing practice student. The NICU Project Team collected the NICU experts’ input via surveys they developed and distributed as well as e-mails to authors identified from the literature review. The surveys yielded a 76% response rate from the registered nurses and a 59% response rate from the medical providers. All data collected were shared and descriptive statistics were used to evaluate the data. One of the central research findings was that gastric aspirates should no longer be routinely obtained on stable infants and, if used in evaluating feeding intolerance, they must be used in combination with other indicators. An enteral feeding guideline was developed to reflect this finding that can be shared with other NICUs and nurseries in the United States and globally to decrease the morbidity and mortality of neonates.

Bland äldre patienter i Sverige är undernäring ett problem som växer sig allt större.

Forskning har visat att många äldre patienter riskerar att drabbas av ohälsa, minskat

välbefinnande och lägre egenvårds kapacitet vid undernäring (Johansson, 2004).

Syftet med denna litteraturstudie var att genom omvårdnadsforskning belysa

sjuksköterskors attityder och kunskaper till nutritionsbehov och

nutritionsbedömningar hos äldre patienter över 65 år. En systematisk litteraturstudie

valdes som metod, systematisk sökning, kritisk granskning, dataanalys samt

sammanställning av vetenskapliga artiklar inom problemområdet gjordes. I

dataanalysen framkom teman som sjuksköterskors attityd till nutrition,

nutritionsbehov och nutritionsbedömning av äldre patienter. Sjuksköterskors kunskap

och utbildning om nutritionens betydelse för patienternas välbefinnande. Resultatet i

denna studie visar att nutritionskunskap och utbildning bland sjuksköterskor i dag är

otillräcklig. Slutsatsen blir således, för att kunna fastställa och tillgodose äldre

patienter nutritionsstatus bör en ökad kompetens utveckling bland sjuksköterskor

ske.

The focus of this project was to determine if a relationship existed between weight loss as a result of follow-up visits and adherence as a result of follow-up visits in patients with BMI >26 kg/m² enrolled in the weight loss program during 12 weeks of treatment. The project was based on two clinical questions which include: In patients with BMI >26 kg/m ², how do follow-up visits affect weight loss during 12 weeks of treatment? In patients with BMI >26 kg/m², how do follow-up visits affect adherence during 12 weeks of treatment? The practice improvement project utilized a quantitative methodology with a correlational design. The primary investigator’s clinical questions were tested using two-way mixed analysis of variance (ANOVA) (within-subjects and between-subjects) and one-way ANOVA. The location of the project was at a weight loss clinic located in Southern California, and 156 patients’ charts were used for retrospective chart reviews and a sample of 156 participants answered the MOS-SAS (short version) questionnaire. The theoretical underpinnings for the practice improvement project included the Health belief model and Integrated theory of health behavior change. The results of the project concluded that weekly follow-up visits had significant impact on weight loss, specifically, in the first six weeks of the program. Results also showed weekly follow-up visits (M = 4.51, SD = .317, n = 91) produced significantly greater levels of adherence compared to bimonthly follow-up visits (M = 3.69, SD = .480, n = 61) during 12 weeks of treatment. The future nursing, practice, and research implications of the study include focusing on strong implementation of weekly follow-up visits, additional contact support, integrating weight loss teaching sessions, and determining perceived barriers to exercise adherence.