Can the patient perspective contribute to quality of nutritional care?

Undernutrition has been seen in hospitalized patients at all times. Nurses have a central position in the nutritional care of the patient. Despite guidelines for nutritional practise and care, 20-55% of patients are still at risk of complications to insufficient nutrition intake. The aim of this study was to obtain knowledge of hospitalized patient's experiences of being undernourished, to understand implications this might have to quality of nutritional nursing care.

Qualitative interviews were undertaken in 12 hospitalized patients at severe nutritional risk.

Pain, no appetite, bad taste and side effects to medication were among reasons for poor eating. Nurses practically did not address or question symptoms that could influence poor eating and were only to a low degree involved at patient initiative. The patients appeared to divide into two groups; One 'Passive group', characterized with fatigue, lack of concentration and short term memory, were found insusceptible to increase nutrition intake by motivation and guidance. The overall motivation in the other 'Active' group was the setting of and achievement of goals, which had to be clear, communicated and followed up by nurses and physicians. This group furthermore found self-determination and active involvement determinant for a positive and fruitful cooperation between staff and themselves.

Nurses were in progressive about clarifying why patients did not eat. Patients highly regarded nutrition registration when followed up, however, this was only practised to a low degree. Severely undernourished patients could be divided in two groups. The 'Passive group' should be attended to systematically. Artificial nutrition is often needed in this group. The 'Active group' should be cared for with individual, active involvement from nurses. Nurses should be able to distinct which nutritional care for which patient, and act upon it.