oru.sePublikationer
Change search
CiteExportLink to record
Permanent link

Direct link
Cite
Citation style
  • apa
  • ieee
  • modern-language-association-8th-edition
  • vancouver
  • Other style
More styles
Language
  • de-DE
  • en-GB
  • en-US
  • fi-FI
  • nn-NO
  • nn-NB
  • sv-SE
  • Other locale
More languages
Output format
  • html
  • text
  • asciidoc
  • rtf
The complexity of nutritional status for persons with chronic obstructive pulmonary disease: a nursing challenge
Örebro University, School of Health and Medical Sciences.ORCID iD: 0000-0002-1991-1555
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. , 89 p.
Series
Örebro Studies in Care Sciences, ISSN 1652-1153 ; 17
Keyword [en]
assessment, chronic obstructive pulmonary disease, instruments, MNA, MUST, nursing, nutritional status
National Category
Nursing
Research subject
Caring Sciences w. Medical Focus
Identifiers
URN: urn:nbn:se:oru:diva-1769ISBN: 978-91-7668-577-8 (print)OAI: oai:DiVA.org:oru-1769DiVA: diva2:135454
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: 2016-12-08Bibliographically approved
List of papers
1. Living with chronic obstructive pulmonary disease: Part I. Struggling with meal-related situations: experiences among persons with COPD
Open this publication in new window or tab >>Living with chronic obstructive pulmonary disease: Part I. Struggling with meal-related situations: experiences among persons with COPD
2005 (English)In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 19, no 3, 230-239 p.Article 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.

National Category
Nursing
Research subject
Caring Sciences w. Medical Focus
Identifiers
urn:nbn:se:oru:diva-2900 (URN)16101851 (PubMedID)
Available from: 2008-02-12 Created: 2008-02-12 Last updated: 2016-12-08Bibliographically approved
2. Living with chronic obstructive pulmonary disease (COPD): Part II. RNs' experience of nursing care for patients with COPD and impaired nutritional status
Open this publication in new window or tab >>Living with chronic obstructive pulmonary disease (COPD): Part II. RNs' experience of nursing care for patients with COPD and impaired nutritional status
2007 (English)In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 21, no 1, 56-63 p.Article in journal (Refereed) Published
Abstract [en]

This study is the second part of a project with the main purpose of obtaining a deeper understanding of the consequences of living with chronic obstructive pulmonary disease (COPD) concerning meal-related situations and an impaired nutritional status. COPD is a slowly progressive lung disease that results in several complications, including malnutrition. Nutritional status is an important part of COPD treatment, and there are criteria recommended for nutritional assessment and interventions among patients with COPD. Despite this, patients with extreme malnutrition and unnoticed weight loss are reported. The aim of the study was to investigate how Registered Nurses (RNs) in primary care describe nutritional assessment practices and interventions in COPD patients with impaired nutritional status. An interview approach using semistructured questions and case vignettes was chosen. The sample included 19 RNs working specifically with COPD patients. Data from interviews were analysed using qualitative content analysis, and nine categories corresponding to the aim were identified. The RNs reported that their assessment of nutritional status was based largely on intuition. Assessment also included detection of the patients' current beliefs and being sensible about information provision - When and How. Interventions were supportive eating interventions, practical and cognitive participation, and making patients aware of the illness trajectory. An overall category that influenced nursing was respecting patients' feelings of shame and guilt about a self-inflicted disease. It seems that RNs use intuition because of a lack of knowledge of systematic methods of nutritional assessment. The findings also indicate that the RNs attempted to build a relationship of trust with the patients rather than provide early information on sensitive topics (e.g. nutritional information). The study reports areas of nursing care for COPD patients that must be improved in the future

Place, publisher, year, edition, pages
Oxford: Blackwell, 2007
National Category
Social Sciences Interdisciplinary Nursing
Research subject
Caring Sciences w. Medical Focus
Identifiers
urn:nbn:se:oru:diva-2901 (URN)10.1111/j.1471-6712.2007.00441.x (DOI)17428215 (PubMedID)
Available from: 2008-02-12 Created: 2008-02-12 Last updated: 2016-12-08Bibliographically approved
3. Nutritional status and patient characteristics for hospitalized elderly patients with chronic obstructive pulmonary disease
Open this publication in new window or tab >>Nutritional status and patient characteristics for hospitalized elderly patients with chronic obstructive pulmonary disease
(English)Manuscript (Other academic)
National Category
Nursing
Research subject
Caring Sciences w. Medical Focus
Identifiers
urn:nbn:se:oru:diva-2902 (URN)
Available from: 2008-02-12 Created: 2008-02-12 Last updated: 2016-12-08Bibliographically approved
4. The relationship between nutritional status and body composition among persons with chronic obstructive pulmonary disease
Open this publication in new window or tab >>The relationship between nutritional status and body composition among persons with chronic obstructive pulmonary disease
2008 (English)In: Journal of Nursing and Healthcare of Chronic Illness, ISSN 1752-9816, E-ISSN 1752-9824Article in journal (Refereed) Published
National Category
Nursing
Research subject
Caring Sciences w. Medical Focus
Identifiers
urn:nbn:se:oru:diva-2903 (URN)10.1111/j.1365-2702.2008.01008.x (DOI)
Available from: 2008-02-12 Created: 2008-02-12 Last updated: 2016-12-08Bibliographically approved

Open Access in DiVA

cover(420 kB)1921 downloads
File information
File name COVER01.pdfFile size 420 kBChecksum MD5
4716f3e13e6ab2b873cacb0e8d0debb3f005366c5e81873c76a4110448dc231eec1277b3
Type coverMimetype application/pdf
kappa(420 kB)780 downloads
File information
File name FULLTEXT02.pdfFile size 420 kBChecksum SHA-512
d6936f2cdd9774fcdf699d238a4ecc87cc264dab9ecaeace2f0a063aed0b5a06dfac8ce6cb3b45e9ad444ed11d8a496a21ca95b87319ca101d0f7f99794c96dd
Type fulltextMimetype application/pdf

Search in DiVA

By author/editor
Odencrants, Sigrid
By organisation
School of Health and Medical Sciences
Nursing

Search outside of DiVA

GoogleGoogle Scholar
Total: 781 downloads
The number of downloads is the sum of all downloads of full texts. It may include eg previous versions that are now no longer available

Total: 2684 hits
CiteExportLink to record
Permanent link

Direct link
Cite
Citation style
  • apa
  • ieee
  • modern-language-association-8th-edition
  • vancouver
  • Other style
More styles
Language
  • de-DE
  • en-GB
  • en-US
  • fi-FI
  • nn-NO
  • nn-NB
  • sv-SE
  • Other locale
More languages
Output format
  • html
  • text
  • asciidoc
  • rtf