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.

Diss. (sammanfattning) Stockholm : Karolinska institutet, 2007. / Härtill 4 uppsatser.

Thesis (M.S.)--University of Michigan, 1986.

Introduction: Crohn's disease is an illness of the digestive tract with an uncertain etiology which threatens the nutritional state of patients and in addition to other problems results in a worsening of the disease in reaction to primary treatment. The possibilities of optimizing the nutritional state are several: changing diet, enteral or parenteral nutrition or combination of both. It is necessary to arrange an entirely individual approach for ensuring the highest measure of attention and nutritional effectiveness. Methods: The influence of enteral nutrition was monitored during a course of Crohn's disease. 84 patients with malnutrition and with an active form of Crohn's disease were included in this study. They were divided into 2 groups according to the type and dosage of enteral nutrition. The first group included patients who used partial enteral nutrition in the form of sipping with an energy value of 1200 kcal daily. Patients covered the remaining energy needs with a low-residue diet enriched by soluble fiber. The second group included patients who were given exclusive oligomeric enteral nutrition with a nasojejunal tube for a period of eight weeks. The amount of enteral nutrition in both groups was individually adjusted and calculated, according to the Harris-Benedict equation. The...

Thesis (M.Sc.) - University of KwaZulu-Natal, Pietermaritzburg, 2009. / Full text also available online. Scroll down for electronic link.

O objetivo deste estudo foi identificar as condiÃÃes de saÃde e nutriÃÃo das crianÃas Tremembà menores de cinco anos. A populaÃÃo total estudada consistia de 216 crianÃas, residentes em diversas aldeias nos municÃpios de Itarema e AcaraÃ. Realizou-se para atingir os objetivos propostos um estudo descritivo com base populacional, observacional e transversal. A coleta de dados constou da obtenÃÃo das medidas antropomÃtricas das crianÃas para avaliaÃÃo nutricional; questionÃrios estruturados respondidos pelas mÃes e/ou responsÃveis para a aquisiÃÃo dos dados sÃcio-econÃmicos e de saÃde infantil e inquÃrito nutricional atravÃs do recordatÃrio de 24 h. Os resultados mostraram que aliadas Ãs precÃrias condiÃÃes sanitÃrias em que viviam, mais da metade das crianÃas convivia com pais que faziam uso do Ãlcool e/ou fumo. A metade das crianÃas nasceu em hospital, no entanto, mais de um terÃo teve o parto assistido por parteiras leigas. Mais da metade das mÃes realizou consultas prÃ-natais, sendo que a maioria delas realizou menos de seis consultas. A incidÃncia pontual de diarrÃia foi de 3,7% e a incidÃncia nos Ãltimos quinze dias anteriores à entrevista foi de 13,4%; a maioria dos casos ocorreu entre os maiores de 12 meses e a maior incidÃncia entre as crianÃas de 6 a 12 meses. Com relaÃÃo Ãs infecÃÃes respiratÃrias, mais de um terÃo das crianÃas apresentou tosse nos Ãltimos sete dias anteriores à entrevista. Quase a metade das crianÃas realizou entre 1 e 2 consultas mÃdicas, no trimestre anterior à entrevista, tendo como motivo à infecÃÃo respiratÃria. Menos de 10% da populaÃÃo estudada foi hospitalizada no ano anterior ao estudo, tendo sido a diarrÃia a principal causa de internaÃÃo. A prevalÃncia dos casos de desnutriÃÃo entre as crianÃas Tremembà menores de cinco anos de acordo com os Ãndices de altura/idade (A/I) foi de 22,1%; peso/idade (P/I) de 14,9% e peso/ altura (P/A) de 1,4 %. A duraÃÃo mediana da amamentaÃÃo foi de 12,2 meses, no entanto, entre as crianÃas atà seis meses de idade a prevalÃncia de aleitamento materno exclusivo foi de 10% e grande maioria, jà tinha recebido algum tipo de alimento antes de completar o primeiro mÃs de vida A dieta das crianÃas estudadas mostrou-se pouco variada, pobre em frutas, verduras e legumes; a maioria delas tinha dieta inadequada para carbohidratos, lipÃdios, proteÃnas e para as calorias. A metade das crianÃas nÃo apresentou adequaÃÃo para o cÃlcio; o ferro foi o nutriente que apresentou inadequaÃÃo para praticamente todas as crianÃas, em todas as faixas etÃrias. Conclui-se que hà necessidade de implementaÃÃo das aÃÃes materno-infantil para o grupo estudado, bem como aÃÃes educativas relacionadas à Ãrea de nutriÃÃo, no entanto, levando em consideraÃÃo Ãs peculiaridades da cultura local. / The objective of this research was to identify the health and nutrition conditions of the Tremembà children younger than 5 years old. The whole studied population consists of 216 children, who live in several villages from the cities of Itarema and AcaraÃ. To reach the proposed objectives, it was made a descriptive study with population, observation and transversal base. The data collect consisted of attainment of the anthropometric measure of the children for nutritional evaluation; structuralized questionnaires answered for the mothers and/or responsible for the acquisition of the partner-economic data and infantile health and nutritional inquiry by the 24h remembrance. The results had shown that allied to the precarious sanitary conditions where they lived, more than the half of the children it coexisted parents who made use of alcohol and/or tobacco. The half of the children was born in hospital, however, more than the third part had the childbirth attended for obstetricians laypeople. More of the half of the mothers it carried through prenatal consultations, being that the majority of them carried through less than six consultations. The prompt incidence of the diarrhea was of 3,7% and the incidence in last the fifteen previous days to the interviews was of 13,4%; the majority of the cases occurred among the greaters of 12 months and the biggest incidence enters the children of 6 to 12 months. With relation to the respiratory infections, more than the third part of the children presented cough in last the seven previous days to the interview, having as reason the respiratory infection. Less than 10% of the studied population the main cause of internment was hospitalized in the previous year to the study, having been the diarrhea. The prevalence of the malnutrition cases among the five year lesser Tremembà children in accordance with the height/age indices (H/A) was of 22,1%; weight/age (W/A) of 14,9% and weight/height (W/H) 1,4%. The medium duration of breast-feeding was of 12,2 months, however, among the children up to six months of age the prevalence of exclusive maternal suckling was of 10% and great majority, already it had received some type of food before completing the first month of life. The diet of the studied children revealed little varied, poor in fruits, verdures and vegetables; the majority of them had inadequate diet for carbohydrates, lipids, proteins, and for the calories. The half of the children did not present adequacy for calcium; the iron was the nutrient that presented inadequacy for practically all the children, in all the ages bands. It is concluded that it has necessity of implementation of the maternal-infantile actions for the studied group, as well as related educative actions to the nutrition area, however, taking in consideration the peculiarities of the local culture.

Diss. (sammanfattning) Uppsala : Univ., 2004. / Härtill 5 uppsatser.