A Necessary Evil? Patients' Experiences Receiving Tube Feeding in Acute Care

Psychosocial impacts of being nil-by-mouth as an adult: A scoping review

AIM

To map existing evidence and identify gaps in the literature concerning psychosocial impacts of being nil by mouth (NBM) as an adult.

DESIGN

A scoping review of the literature was undertaken using JBI guidance. A protocol was registered on the Open Science Framework (osf.io/43g9y). Reporting was guided by Preferred Reporting Items for Systematic Reviews and Meta-Analysis extension for Scoping Reviews (PRISMA-ScR).

METHODS

A comprehensive search of six databases (CINAHL, Embase, MEDLINE, PsycINFO, SCOPUS and Web of Science) was performed for studies published up to February 2023, with no restriction to study type. A scope of the grey literature was also undertaken. Two authors independently assessed eligibility and extracted data. Descriptive statistical analysis and narrative synthesis were used, and patient and public involvement included in funding discussions.

RESULTS

A total of 23 papers were included in the review, consisting of 14 primary studies (7 qualitative and 7 quantitative) and 9 grey literature. Both global psychological distress and distress specific to being NBM (thirst, missing food and drink) were reported. Caregivers also experience distress from their family member being NBM. Furthermore, social impacts were reported for both patient and caregiver, primarily social isolation and subsequent low mood.

CONCLUSION

Furthermore, research is needed to understand the prevalence of this population, how best to measure psychosocial impacts and to explore whether (and how) psychosocial impacts change over time. Advancement in this area would enable better service development to optimize care for this patient group. WHAT IS KNOWN ABOUT THIS TOPIC?: Eating and drinking provides more than nutrition and hydration. A wide range of conditions can lead to recommendations for no longer eating and drinking (nil by mouth). Being nil by mouth (NBM) for short periods such as pre-operative fasting causes distress; however, little is understood about impact on longer-term abstinence from eating and drinking. WHAT THIS PAPER ADDS?: Psychosocial consequences of being nil by mouth (NBM)have been investigated by both quantitative and qualitative studies. Being NBM impacts both patients and caregivers in various psychosocial aspects, including distress and social isolation. Several gaps remain, however, regarding ways to measure psychosocial impact of being NBM.

Social representations of "non-eating" experienced by patients on exclusive enteral nutrition

BACKGROUND & AIMS

In a scenario where food is absent or restricted, as in the case of enteral nutrition (EN), eating becomes an experience filled with different meanings in the hospitalization process. This study aimed to understand the social representations of "non-eating" experienced by patients receiving EN.

METHOD

This was an empirical, qualitative, cross-sectional study. Hospitalized patients using EN for at least seven days and who were over 18 years of age participated in the study. The sample size was defined using the data saturation criterion. Patients were selected after an active search was conducted through the beds of a university hospital in the state of Minas Gerais, Brazil. The instruments used were (a) a semi-structured interview script and (b) the researcher's field journal. Data analysis was based on the thematic analysis of Braun and Clark, and the theoretical foundation was supported by the theory of social representations.

RESULTS

Nine patients were interviewed and four thematic categories were identified: (1) Perceptions related to the body in the experience of enteral nutrition, (2) The place of hunger and cravings in the body, (3) The price of healing, and (4) Communication with the team. The results indicate an experience largely associated with physical sensations, recognized by patients as aversive, with a tendency to a better adaptation to EN with longer use of the tube. Patients did not perceive physical hunger while the presence of "wanting" or "craving for" food, that is, the desire to taste and experience food, was reported by all, equating it to the experience of hunger. The main difficulties experienced by patients involve the absence or loss of communication with the health team and the reduction of autonomy, both in terms of mobility and the power of participation and decision-making regarding the treatment.

CONCLUSIONS

The experience of patients in EN is complex and permeated by several difficulties, such as the lack of pleasure and symbolism associated with food and eating. On the other hand, even in the face of adversity, those patients undergo treatment, to seek a "cure" for their condition. It is essential to highlight the lack of communication on the part of the health team as an important difficulty listed by the patients. These results are fundamental for the health teams to review and reconstruct the management related to the care of patients to improve their well-being.

Integration of patient-centered care in nutrition support decision-making: A case report

Patient-centered care considers a patient's unique needs, values, preferences, and the psychosocial situation at the heart of decisions related to healthcare. Dietitians have reported several barriers to the practice of patient-centered care, including a lack of time and support and a perception that patients are unable to participate. This is meaningful as decisions regarding nutrition therapy, specifically in adult populations with cancer, influence patient morbidity and mortality and a patient's quality of life. Patient-centered care is associated with improved decision-making, patient-provider communication, and quality of life in patients with cancer. This case report discusses and applies patient-centered care in conjunction with the best available evidence for an adult patient with a history of head and neck cancer admitted to a critical care unit. Nutrition support clinicians are equipped to use a patient-centered and evidence-based approach to help patients navigate through nutrition therapy decisions that may influence both clinical and quality of life outcomes. Further research should be done to determine the association between patient-centered care and quality of life outcomes in nutrition support practice.

Putting the Patient First: A Scoping Review of Patient Desires in Canada

Patient-centred care is a key priority for governments, providers and stakeholders, yet little is known about the care preferences of patient groups. We completed a scoping review that yielded 193 articles for analysis. Five health states were used to account for the diversity of possible preferences based on health needs. Five broad themes were identified and expressed differently across the health states, including personalized care, navigation, choice, holistic care and care continuity. Patients' perspectives must be considered to meet the diverse needs of targeted patient groups, which can inform health system planning, quality improvement initiatives and targeting of investments.

Why Don't We Tube Feed Hip Fracture Patients? Findings from the Implementation of an Enteral Tube Feeding Decision Support Tool

Background: This study aimed to report (i) the prevalence of enteral tube feeding (ETF), (ii) investigate whether implementing a decision support tool influenced ETF rates, and (iii) understand reasons influencing decisions to offer ETF. Methods: A pre/post evaluation included consecutive patients admitted to a hip fracture unit. Following baseline data collection, a published ETF Decision Support Tool was implemented by the multidisciplinary team to determine the necessity and influencing reasons for offering ETF. Results: Pre-post groups (n = 90,86) were well matched for age (83 vs. 84.5 years; p = 0.304) and gender (females 57 vs. 57; p = 0.683). ETF rates remained low across groups (pre/post n = 4,2; p = 0.683) despite high malnutrition prevalence (41.6% vs. 50.6%; p = 0.238). Diverse and conflicting reasons were identified regarding decisions to offer ETF. Conclusion: A complex interplay of factors influences the team decision-making process to offer ETF to nutritionally vulnerable patients. These demands are individualised, rather than algorithmic, involving shared decision-making and informed consent processes.

You Can't Touch…or Can You? Dietitians' Perceptions of Expressive Touch in Client Encounters

Purpose: We explored Registered Dietitians' (RDs') perceptions about expressive touch (ET) as a means to provide client-centred care, a practice unreported to date. For this study, ET is defined as relatively spontaneous, responsive, and affective contact by dietitians. Methods: This exploratory study used an explanatory sequential mixed-methods approach. RDs in Northern Ontario were surveyed (54% response, n = 135) and these results were further explored in interviews with a subset of participants (n = 17). Analysis included descriptive and association statistics and qualitative description. Results: Most RDs considered ET a useful tool for effective client communication (66%-77%), yet they were hesitant to enact the practice (81%). Analysis of interviews revealed ET to be "situationally beneficial" with uptake influenced by an interplay of factors, described as: perceived client openness to touch, the environment, and RD comfort with touch. Greater uptake was reported among RDs working with distressed clients and clients in ambulatory clinics and long-term care. ET practice was limited by personal safety concerns, unknown client customs, and client misinterpretation. Conclusion: ET was valued by many RDs as an enhancement to client-centred care. Selective use of ET is influenced by the context of dietetic practice and by perceived client and RD comfort with the use of ET.

Experiences of Chinese patients with Crohn's disease in the self-administration of nasogastric feeding: A descriptive qualitative study

BACKGROUND

Despite the increasing number of Crohn's disease patients self-administering nasogastric feeding as enteral nutrition support therapy, no studies have reported the experiences of self-administering nasogastric feeding from the perspective of these patients.

OBJECTIVES

To explore the initial trigger factors for the self-administration of nasogastric feeding by Crohn's disease patients and to understand the experiences of self-administration of nasogastric feeding, its effects on various aspects of life and work, and relevant challenges and coping mechanisms encountered during this therapy in order to improve the understanding of this group of patients among medical staff and the public.

DESIGN

This study adopted a descriptive qualitative method. Crohn's disease patients from several tertiary hospitals in Hangzhou, Zhejiang, were recruited to participate through purposive sampling combined with maximum variation and the snowballing technique. Data were collected using semi-structured interviews and analyzed using the conventional content analysis method.

RESULTS

A total of 11 Crohn's disease patients were interviewed. Four themes and eight subthemes emerged from the analysis: rejecting the self-administration of nasogastric feeding (being afraid of inserting the nasogastric tube, having concerns about nasogastric feeding), accepting the reality of nasogastric feeding (health being the most important, followed by having sources of support), nasogastric feeding as a double-edged sword (the disturbances and efficacies of nasogastric feeding), and nasogastric feeding as a part of life (becoming accustomed to tube insertion and taking nasogastric feeding for granted).

CONCLUSIONS

Apart from suffering from physical discomfort, diet and body image disturbances, and inconveniences in daily life, Crohn's disease patients who self-administered nasogastric feeding faced many psychological challenges. Many of these patients eventually adjusted to a life with nasogastric feeding, but not everyone achieved this state. Therefore, health care providers, including physicians and nurses, and the general public should collaborate to help these patients adapt to their "new lives" as soon as possible.