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The purpose of this study was to survey registered dietitians in Northeast Tennessee to determine attitudes toward implementation of the nutrition care process prior to and following education about the nutrition care process and/or implementation of the nutrition care process in their respective healthcare facilities. Approximately 100 registered dietitians were involved in the study. Data were collected through electronic submission and written inquiries. The findings of the study identified that there was a need for further research regarding implementation of the nutrition care process and that negative attitudes, opinions, and barriers were broken down by education, implementation, and exposure to the nutrition care process.

The aim of this thesis was to explore dietetic notes in Swedish patient records regarding content, language and the meaning of standardization. Firstly, an audit instrument for dietetic notes in patient records, Diet-NCP-Audit, was elaborated and tested. The instrument, a 14-item scoring questionnaire based on the four steps of the Nutrition Care Process (NCP), proved to have high content validity and moderate to high inter- and intra-rater reliability. The instrument was then used in an evaluation of the content, language and structure of 147 Swedish dietetic notes. Although the nutrition intervention and some information about the evaluation were well documented, the overall result showed a need for improvement in several aspects of documentation, such as nutrition prescriptions, goals and the connection between problem-etiology-symptom. After this, 30 of the audited dietetic notes were also included in a critical linguistic study exploring how the patients and dietitians were referred to in the notes. The dietetic notes contained several linguistic devices that impersonalized and passivized both the patient and the dietitian. Thus, the grammar of the dietetic notes did not enhance or reflect the patient-centered care and the active patient-caregiver relationship that is emphasized in most health care guidelines today. Finally, a focus group study was performed. Swedish dietitians’ experiences of the standardized Nutrition Care Process (NCP) and its connected terminology (NCPT) were explored and analyzed from the perspective of Habermas’ system and lifeworld concepts. While recognizing many advantages with the NCP and NCPT, dietitians also expressed difficulties in combining the structured and standardized process and terminology with a flexible, patient-centered approach in nutrition care. In summary, I argue that strategies for the improvement of dietetic documentation are needed. I also suggest that the NCP and NCPT play an essential role in dietetic professionalization. At the same time, however, this standardization may entail the risk of a reductionist view and difficulties regarding how to balance the different ideals of health care. Thus, there is a need for discussions concerning how to use and develop the NCP and dietetic language in a way that ensures the best possible care for the patient.

This study aimed to provide an in-depth understanding of the way in which the macro, meso, and micro levels of the health care system affects nutrition care practices of family physicians (FPs) and nurse practitioners (NPs). It also examined how current practices compare to the clinical practice guidelines on the management and prevention of obesity. Three different types of team-based primary care settings were included: 2 Family Health Teams, 3 Community Health Centres and 1 Nurse Practitioner-Led Clinic. Within each type of setting, six to eight FPs and NPs were interviewed (for a total n= 20). Site-specific documents and government reports were also analyzed. Findings suggest that the team-based nature improves nutrition care due to the accessibility to dietitians and cost-free service. Electronic Medical Records was an important enabler for chronic disease management. Duration of medical visits and increasing prevalence of complex patients were barriers for addressing nutrition and weight. Despite the importance of addressing obesity in primary care, the topic was approached in terms of chronic disease management rather than prevention. FPs and NPs spared the dietitian on site for patients who have more severe chronic conditions. Nevertheless, the presence of a dietitian on site increased the likelihood of primary care providers bringing up the topic of nutrition. Addressing site-specific barriers could improve nutrition care practices for weight management and chronic disease prevention in the primary care setting.

Bakgrund NCP är en systematisk, problemlösande metod med ett unikt standardiserat språk som används av yrkesverksamma dietister för dokumentation. Det bidrar till att dietisten agerar utifrån ett kritiskt tänkande där besluten för att hantera patientens nutritionsproblem sker utifrån kunskap av evidensbaserad erfarenhet. Dietisternas Riksförbund (DRF) uppmanar legitimerade dietister att arbeta enligt NCP. Syfte Studiens syfte var att studera svenska dietisters arbete med att ställa nutritionsdiagnoser enligt NCP. Metod En webbaserad enkät utformades. Yrkesverksamma dietister rekryterades via det sociala mediet Facebook samt via DRF:s hemsida. Insamlad data bearbetades i SPSS Statistics 22, och analyserades med Chi-2-test och Correlate Bivariate Spearman. Signifikansnivån bestämdes till p-värde < 0.05. Resultat 119 dietister deltog i studien varav 103 (87 %) skrev nutritionsdiagnoser. I genomsnitt hade dietisterna arbetat i 2 år (1-3 år) med NCP, och över hälften arbetade inom akutsjukvård. Analysen visade att det fanns ett samband mellan antal år dietisterna arbetat med NCP och hur många nutritionsdiagnoser de skrev (r=-0.197, p=0.046). Ett samband visades även mellan tiden dietisterna arbetat med NCP och tiden det tog att skriva nutritionsdiagnoser (r=-0.226, p=0.022). Av de 103 dietisterna som använde NCP ansåg 60 % att deras kunskap och erfarenhet kunde förbättras, 89 % tyckte att nutritionsdiagnoser var användbara. Engelskan i referensbladen tyckte 48 % till viss del var svårtolkad och (n=13) angav att översättning till svenska kunde underlätta arbetet. Det framgick att mer än hälften (53 %) av dietisterna ibland utformade PES-meningar utan att ha funnit passande tecken/symtom i referensbladet. Slutsats Svenska dietister önskar mer kunskap och utbildning i NCP och översättning av referensbladen till svenska skulle sannolikt kunna öka användandet av nutritionsdiagnoser. En vidare implementering av NCP i Sverige behövs. / Background The Nutrition care process is a systematic, problem-solving approach with a standardized language used by dietitians for documentation. It stimulates dietitians to critically appraise and take evidence-based decisions on a patient's nutritional problems. The Swedish Association of Clinical Dietitians (DRF) appeals qualified dietitians to work according the NCP. Objective The aim was to study Swedish dietitians’ work with nutrition diagnosis according to the NCP. Method(s) A web-based questionnaire was developed. Dietitians was recruited through the social media Facebook and the DRF website. The collected data were processed in SPSS, analyzed by Chi-2-test and Correlate Bivariate Spearman, with significance level at p < 0.05. Results A total of 119 dietitians responded to the questionnaire and 103 (87 %) of the respondents wrote nutrition diagnosis. The respondents had on average worked with the NCP for 2 years (range 1-3 years), and over half worked in hospitals. There was a correlation between years working according to the NCP and the number of written diagnosis (r=-0.197, p=0.046). Also, the time for writing a nutritional diagnosis was reduced as the experience of working with NCP increased (r=-0.226, p=0.022). It was 60 % that thought their knowledge and experience in NCP could be improved, 89 % stated that the NCP was useful. The English in the reference sheets 48 % of the respondents said partly was difficult to understand and (n=13) wanted them to be translated into Swedish. It showed that more than half (53 %) of the dietitians sometimes composed PES-statements without finding the appropriate signs/symptoms in the reference sheet. Conclusion Swedish dietitians consider themselves to be in need of more knowledge and training in the NCP, and translations of the reference sheets would possibly increase the use of nutrition diagnosis. A further implementation of the NCP is needed in Sweden.

Doctor of Philosophy / Department of Food, Nutrition, Dietetics, and Health / Tandalayo Kidd / HIV and nutrition status are interrelated. Nutrition problems associated with HIV or its treatment occur in nearly all people living with HIV (PLHIV) and can be indicative of the stage and progression of infection. On the other hand, adequate nutrition ensures good nutrition status, immune function, improved treatment outcome, and quality of life. The growing problems of HIV and AIDS in Indonesia require health professionals, including dietitians, to mobilize for HIV care and control. However, studies have demonstrated health care workers to have prejudicial attitudes towards PLHIV, which may further jeopardize the quality of care. The objective of this study was to implement the attribution theory to improve HIV-related knowledge and attitudes among dietetics students. It is hypothesized that given the opportunity to revisit the antecedent of their stigma, dietetic students might be able to improve their attitudes and emotional reactions to HIV. Results from the cross-sectional study confirmed the attribution theory, showing that the stigmatizing attitudes were influenced by both personal values and environmental factors. The study also found that greater knowledge about HIV was associated with a better attitude toward PLHIV. This and the fact that universities differed in how they educated dietetic students about HIV, raise questions on the current dietetic curriculum in Indonesia and the teaching conduct in each dietetic school. These notions were studied in the second study, using a qualitative approach to inquire lecturers and school administrators. Four major themes emerged from the analysis confirming that HIV discourse in dietetic schools in Indonesia is very limited since it is not mandatory in the curriculum, lecturers are reluctant to talk about HIV, and there is apparent restriction to work with the key population. The way the lecturers attribute HIV with blames of personal responsibility and fear of contagion, heavily influence their teaching conduct. The intervention model with transformative learning supported the hypothesis that given the opportunity to reflect and re-question their judgment, students were able to improve their knowledge and reduce their stigmatizing attitudes. Overall, these studies give a warning to policy makers in health and education sectors as well as the school administrators that dietetics students have negative attitudes towards PLHIV and this stigma is associated with lack of knowledge about HIV, hence the need to improve response from both sectors. This study also serves as a strong call to provide more opportunities to students to learn about HIV and to reach out to the patients and key population to instill better understanding and acceptance to HIV.

Bakgrund Cancer är en vanligt förekommande sjukdom globalt, vilken ofta behandlas med kemoterapi och radioterapi. Både behandlingarna och sjukdomen medför dock symtom och biverkningar som kan bidra till malnutrition samt ett kraftigt reducerat välmående för patienten. Sjuksköterskans omvårdnadsansvar omfattar att upptäcka, bedöma, förebygga, åtgärda och utvärdera undernäring - att deltaga i patientens nutritionsvård. Då malnutrition både kan leda till ökat lidande för individen samt en ökad belastning för samhället föreligger ett behov att fortsatt identifiera möjliga preventiva åtgärder för ett vanligt förekommande problem; malnutrition samt ätsvårigheter vid cancersjukdom. Syfte Syftet var att beskriva omvårdnadsåtgärder för att förebygga och behandla malnutrition och ätsvårigheter hos personer med cancer som genomgår kemoterapi och/eller radioterapi. Metod En icke-systematisk litteraturöversikt genomfördes med granskning av 15 originalartiklar av både kvantitativ och kvalitativ ansats, inhämtade från de akademiska databaserna PubMed och CINAHL. En sökstrategi togs fram baserat på relevanta sökord och kombinerades i sökblock. Utvalda studier kvalitetsgranskades i Sophiahemmet Högskolas bedömningsunderlag och sammanställdes sedan utefter tre kategorier med hjälp av en integrerad dataanalys. Resultat Tre huvudkategorier identifierades: Riskbedömning och utvärdering, Patientutbildning och information samt Närings- och måltidsinterventioner. Resultaten redovisade att viktiga aspekter för sjuksköterskan att implementera i arbetet med patienter med cancer var att utbilda och informera patienten om sjukdomen, behandlingen och biverkningar, tillämpa adekvata verktyg för bedömning av risk för undernäring, samt att använda multimodala näringsinterventioner med konkreta råd för symtomhantering, och individanpassade kostråd. Resultatet påvisar vikten av ett personcentrerat förhållningssätt för att inte bara förbättra fysiska aspekter utan även förbättra välmåendet hos patienten med cancer Slutsats Litteraturöversikten demonstrerar att sjuksköterskan kan använda sig av utbildning, bedömningsverktyg och näringsinterventioner som omvårdnadsåtgärder för att behandla och förebygga undernäring hos patienter med cancer som genomgår kemo- och/eller radioterapi. Resultaten kan förse sjuksköterskan med konkreta omvårdnadsåtgärder samt verktyg som kan bidra till att motverka undernäring under pågående onkologisk behandling. / Background Cancer is a commonly occurring disease globally, with treatment alternatives such as chemotherapy and radiotherapy. Although, the treatments and the disease entail symptoms and side effects that can contribute to malnutrition and a reduced well-being for the patient. The nurse’s responsibility is to detect, assess, prevent, support and evaluate malnutrition – to participate in the patient's nutrition care. Since malnutrition can lead to increased suffering for the individual and an increased burden for the society, there is a need to continuously identify potential preventive actions to a commonly occurring problem; malnutrition and eating difficulties in cancer. Aim The aim was to describe nursing measures to prevent and treat malnutrition and eating difficulties in people with cancer undergoing chemotherapy and/or radiotherapy. Method A non-systematic literature review was conducted, reviewing 15 original articles of both quantitative and qualitative approaches obtained from the academic databases PubMed and CINAHL. A search strategy was developed based on relevant keywords and combined in search blocks. The quality of the selected studies was reviewed in Sophiahemmet University’s assessment document and then compiled according to three categories with the help of an integrated data analysis. Results Three main categories were identified: Risk Assessment and Evaluation, Patient Education and Information, and Nutrition and Meal Interventions. The results reported that important aspects for the nurse to implement in the work with oncological patients were to educate and inform the patient about the disease, the treatment and its side effects, to apply adequate tools for assessing the risk of malnutrition and to deploy versatile nutritional interventions with advice for managing symptoms and individual dietary recommendations. The result demonstrates the importance of a person-centered approach to not just improve physical aspects but also to improve the well-being of the oncology patient. Conclusions The literature review demonstrates that the nurse can use education, assessment tools and nutritional interventions as nursing measures to treat and prevent malnutrition in patients with cancer undergoing chemotherapy and/or radiotherapy. These results can provide the nurse with concrete nursing measures and tools that can contribute to counteracting malnutrition during ongoing oncology treatment.

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Magister Scientiae (Nutrition Management) - MSc(NM) / Introduction: The provision of quality nutrition care services is needed to address the national burden of diseases, and to reduce under- and overnutrition in South Africa. Globally, there is a lack of information and data about the perceptions, experience of, and satisfaction with the quality of nutrition care services, both from patients and dietitians. Patients and dietitians are in the best position to provide useful information pertaining to their perception and experience of nutrition care service delivery. The aim of this study was to determine the perceptions of patients and dietitians on the quality of nutrition care service delivery in the Klipfontein/Mitchells Plain Sub-Structure (KMPSS). Methodology: This cross-sectional descriptive study design employed a mixed method approach. All patients consulted by the dietitians on the dates of data collection were conveniently sampled (n=120) across three Primary Health Care facilities in KMPSS (Hanover Park Community Health Centre (CHC), Mitchells Plain CHC and Heideveld Community Day Centre (CDC)) for participation in the quantitative component of the study. An interview-administered survey was used to gather information about patients’ perceptions and experiences of nutrition care services. For the qualitative component, an all-inclusive sample of the four dietitians’ employed in KMPSS participated in a Focus Group Discussion (FGD). The FGD included open-endAnalysis: The Statistical Package for Social Sciences (SPSS) software was used to generate descriptive statistics for the quantitative data. Thematic analysis was used for the transcriptions of the FGD audio-recordings. The themes and sub-themes was identified through summaries and key findings on the perceptions of the quality of nutrition care service delivery through views and opinions.ed questions developed by the researcher to explore the perceptions of the dietitians on the quality of nutrition care service delivery. Results: The quantitative results found that participants strongly agreed with positive statements regarding the dietitians’ interpersonal skills, manner in which they presented themselves, and communicating health information. Nearly 80% of the participants perceived dietitians as being well presented, courteous, friendly, and polite, created a comfortable environment and were always on time for their appointments. Eighty percent (80%) of the participants were also satisfied with the nutrition care services provided by the dietitians in KMPSS. The qualitative findings revealed that the dietitians’ had both negative and positive perceptions of the nutrition care service delivered within KMPSS. The dietitians’ expressed the need to improve the quality of nutrition care through management making and availability of necessary resources. This would enhance their work performance, communication and leadership skills. Conclusion: The key results and findings of this study concur with other research that has been done within the dietetics profession. There is a need to promote quality nutrition care in dietetics by utilizing perceptions and experiences of patients and dietitians. It is imperative for continuous quality improvement initiatives in nutrition care to improve patient health outcomes in South Africa.

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