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The relationship between nutritional status and body composition among persons with chronic obstructive pulmonary disease
Örebro University, School of Health and Medical Sciences.ORCID iD: 0000-0002-1991-1555
Örebro University, School of Health and Medical Sciences.
Department of Health and Social Sciences, Dalarna University, Falun, Sweden.ORCID iD: 0000-0002-3964-196X
2008 (English)In: Journal of Nursing and Healthcare of Chronic Illness, ISSN 1752-9816, E-ISSN 1752-9824Article in journal (Refereed) Published
Place, publisher, year, edition, pages
2008.
National Category
Nursing
Research subject
Caring Sciences w. Medical Focus
Identifiers
URN: urn:nbn:se:oru:diva-2903DOI: 10.1111/j.1365-2702.2008.01008.xOAI: oai:DiVA.org:oru-2903DiVA, id: diva2:135453
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
Keyword
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

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Odencrants, SigridEhnfors, MargaretaEhrenberg, Anna

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