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Living with chronic obstructive pulmonary disease: Part I. Struggling with meal-related situations: experiences among persons with COPD
Örebro University, School of Health and Medical Sciences.ORCID iD: 0000-0002-1991-1555
2005 (English)In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 19, no 3, p. 230-239Article in journal (Refereed) Published
Abstract [en]

Reduced nutritional intake with low and decreased body weight can be a component of normal ageing. There is, however, also a greater risk for reduced nutritional intake within certain diagnoses, especially for chronic diseases. Malnutrition in chronic obstructive pulmonary disease (COPD) is caused by many factors. The relationship between COPD and low values of body mass index (BMI) is a known independent risk for mortality. For optimal support and care with special focus on nutritional status and interventions, caregivers need more knowledge about the meal-related situations (i.e. shopping for food, cooking and eating) of COPD patients. The aim of this study was to describe experiences of meal-related situations as viewed from the individual's perspective. The sample included eight women and five men with COPD recruited from five primary health clinics. The participants' average age was 68.9 years, with values of forced expiratory volume in 1 second (FEV(1) percentage) ranging from 18 to 69 and BMI values from 15 to 40. A descriptive design with qualitative interviews and self-reported diaries were used and the data were later analysed using content analysis. Findings showed consistency between informants' COPD, nutritional status and descriptions of experiences in meal-related situations. Findings were disease-specific but were also found to be general- and age-related. Respondents described physical influences and positive and negative feelings in their meal-related situations. Feelings of dependence, level of activity, transport of food, having company or being alone, appetite, hunger and need of time were also mentioned. Most research reports reduced nutritional status from a medical perspective. To our knowledge, no study has reported the positive and negative feelings that arise when eating in persons with COPD. Malnutrition for persons with COPD is not only caused by eating difficulties: eating is an integral part of social situations as shown in this study.

Place, publisher, year, edition, pages
2005. Vol. 19, no 3, p. 230-239
National Category
Nursing
Research subject
Caring Sciences w. Medical Focus
Identifiers
URN: urn:nbn:se:oru:diva-2900PubMedID: 16101851OAI: oai:DiVA.org:oru-2900DiVA, id: diva2:135450
Available from: 2008-02-12 Created: 2008-02-12 Last updated: 2017-12-14Bibliographically approved
In thesis
1. The complexity of nutritional status for persons with chronic obstructive pulmonary disease: a nursing challenge
Open this publication in new window or tab >>The complexity of nutritional status for persons with chronic obstructive pulmonary disease: a nursing challenge
2008 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Chronic obstructive pulmonary disease (COPD) is one of the most widespread diseases globally. A commonly reported symptom is impaired nutritional status, which is often discussed in the literature as difficult to assess. Because nurses play a key role in the care of patients with COPD, knowledge needs to be supplemented with clinically relevant methods that can be used for identification of nutritional needs. The overall aim of this thesis is to investigate factors associated with the nutritional status of persons with COPD and to describe the assessment of nutritional status in different settings and for persons of varying ages.

Both qualitative and quantitative methods were used. Two studies with descriptive and exploratory designs (I, II) and two studies with comparative (III), and correlational design (IV). In three of the studies participants were persons with COPD (I, III, IV), whereas one involved registered nurses (RNs). Qualitative data were collected using diaries (I), vignettes (II) and interviews (I, II) and analyzed using qualitative content analysis. Data collection (III, IV) included body size and body composition measurements, assessment of nutritional status using the Mini Nutritional Assessment (MNA), the Malnutrition Universal Screening Tool (MUST), the Evaluation of Nutritional Status (ENS), and lung function measurements. These were analyzed using statistical methods.

The main findings from the interviews with 13 respondents in PHC in study I showed that eating difficulties alone do not cause reduced nutritional intake for persons with COPD. Eating is only one aspect in a chain of meal-related situations that involve additional physiological and psychological demands. Assessment of nutritional status, performed by 19 RNs, consisted mainly of single observations. For a half of the RNs it was more important to establish trustful relationships with patients than to give nutritional information, while the other RNs had different opinions on when it was best to provide nutritional information and assess nutritional status.

Study III findings showed poor nutritional status for nearly half of the 50 older participants. Many who were identified as malnourished lived alone and were dependent on daily community services. Six out of the 81 participants in Study IV were similarly identified as malnourished by each of the three instruments (MNA, MUST and ENS). There was a significant correlation between each of the instruments and body composition, assessed as fat-free mass index (FFMI). The MNA Short Form (MNA-SF) incorrectly identified thirteen participants’ nutritional status as not needing attention for their nutritional status. To be evaluated as ‘in need of qualified help with nutrition’ by the ENS the respondents needed to be identified as malnourished by the MNA.

A general conclusion is that nutritional status is complex for persons with COPD and is difficult to measure by currently recommended methods. Individuals’ experiences are important to elicit because some of their experiences, in combination with RNs’ judgement, might serve as a hindrance for nursing care and delay the sharing of important information. The methods currently recommended for identification of nutritional status should be used with caution, and assessment should not depend on one single method. The findings from this thesis can contribute to early accurate identification of nutritional status and prompt interventions that have importance for an improved disease trajectory and better quality of life for individuals with COPD.

Place, publisher, year, edition, pages
Örebro: Örebro universitet, 2008. p. 89
Series
Örebro Studies in Care Sciences, ISSN 1652-1153 ; 17
Keywords
assessment, chronic obstructive pulmonary disease, instruments, MNA, MUST, nursing, nutritional status
National Category
Nursing
Research subject
Caring Sciences w. Medical Focus
Identifiers
urn:nbn:se:oru:diva-1769 (URN)978-91-7668-577-8 (ISBN)
Public defence
2008-03-07, Hörsal 2, Prismahuset, Örebro universitet, Örebro, 13:00 (English)
Opponent
Supervisors
Available from: 2008-02-12 Created: 2008-02-12 Last updated: 2017-10-18Bibliographically approved
2. Måltidsrelaterade situationer och näringstillstånd ur patienters med kroniskt obstruktiv lungsjukdom och sjuksköterskors perspektiv
Open this publication in new window or tab >>Måltidsrelaterade situationer och näringstillstånd ur patienters med kroniskt obstruktiv lungsjukdom och sjuksköterskors perspektiv
2006 (Swedish)Licentiate thesis, comprehensive summary (Other academic)
Place, publisher, year, edition, pages
Örebro: Örebro universitet, 2006. p. 68
Series
Örebro Studies in Care Sciences, ISSN 1652-1153 ; 3
Keywords
COPD, nursing, nutritional status, nutritional assessment, experience, interview, diary, vignette technique, meal-related situation
National Category
Nursing
Research subject
Nursing Science
Identifiers
urn:nbn:se:oru:diva-36124 (URN)
Presentation
2005-03-31, Hörsal Musikhögskolan Örebro universitet, Fakultetsgatan 1, Örebro, 11:30 (Swedish)
Opponent
Supervisors
Available from: 2014-08-26 Created: 2014-08-26 Last updated: 2017-10-17Bibliographically approved

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