[Social representations associated with tube feeding among adult hospitalized patients]

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.

The Denied Pleasure of Eating: A Qualitative Study with Functionally Diverse People in Spain

This qualitative study explores the difficulties in experiencing eating-derived pleasure within a group of functionally diverse people, based on personal interviews and Grounded Theory. Understanding the feelings and subjective experiences of functionally diverse people can help develop new approaches to address their loss of pleasure and motivation regarding food intake. The study included 27 participants, aged between 18 and 75 years, all of whom had a functional deficiency that affected the occupational aspects of the eating process. Interviews were conducted in clinical settings and several centres for differently abled people. Four main themes emerged from the analysis: eating through obligation; fear of eating; the social life of food; and the importance of the taste and visual aesthetics of food. These themes underscore the importance of taking into account the phenomenological experiences of pleasure in the eating process.

Identificação do perfil nutricional e ocorrência de complicações gastrointestinais em pacientes hospitalizados submetidos à Terapia Nutricional Enteral

A terapia nutricional enteral (TNE) é muito importante para a recuperação e manutenção do estado nutricional dos pacientes, sendo sugerida a sua introdução precoce em até 24 a 48 horas após a admissão hospitalar. Mas, sabe-se que podem ocorrer intolerâncias gástricas, como diarreia e vômito, que podem comprometer a administração da dieta enteral. Diante disso, o objetivo do estudo foi identificar e avaliar o perfil nutricional, TNE precoce e complicações frequentes nos pacientes internados em instituição de atendimento na cidade de Barbacena-MG. Trata-se de um estudo clínico retrospectivo com revisão de prontuários de atendimento nutricional realizados nos anos de 2012 a 2013, totalizando 310 protocolos de pacientes com idade igual ou superior a 18 anos e com suporte de TNE por pelo menos três dias. A análise estatística foi realizada no software PASW Statistics 17. Dentre os avaliados, 53,55% eram desnutridos moderados, 15,16% desnutridos graves, 71,61% atingiram as necessidades nutricionais em até sete dias de TNE e 63,87% receberam TNE em até 48 horas. Entre as complicações prevaleceu à estase gástrica em 23,10% dos pacientes. Com relação à evolução, 35,16% dos pacientes tiveram alta hospitalar com alimentação por via oral, 11,94% permaneceram em nutrição enteral e 52,90% foram a óbito. Foi observada maior prevalência de desnutrição moderada, início da TNE precoce e ocorrência de estase gástrica.

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

BACKGROUND

Tube feeding (TF) is frequently prescribed for adults admitted to acute care facilities to prevent or ameliorate malnutrition, yet little is known about patients' needs and experiences with receiving this therapy. Patients' perspectives regarding the factors influencing their experiences, as well as their information and support needs, are required to inform healthcare providers' (HCPs') patient-centered practices.

METHODS

Based on an interpretive description qualitative approach, 12 unstructured face-to-face interviews were conducted with participants admitted to acute care hospitals in Northwestern Ontario, Canada.

RESULTS

Analysis of data revealed variations in participants' perceptions of the necessity for TF and the discomfort resulting from this therapy. Perceived necessity was influenced by interrelated themes: the meaning of TF (beyond necessity), the trust held in HCPs, and the resilience of participants in response to all that they were experiencing. Collectively, these findings are encompassed within the central theme, phrased as a question, about the experience of TF: "A necessary evil?" Participants' answers to this question revealed the nature of their overall response throughout TF therapy (ie, indifferent, resistant, relieved, or tolerant).

CONCLUSIONS

The range of perceptions and the complexity of patients' experiences during TF revealed in the data can inform HCPs' patient-centered approaches to TF care. Assessing and incorporating patients' values, beliefs, needs, and goals into, and exploring their choices in, nutrition care planning can promote resilience in response to TF therapy. HCPs may then well enhance patients' comfort and overall experience with TF therapy.

Pesquisas qualitativas em nutrição e alimentação

O artigo revê e comenta os estudos qualitativos e os que fazem interlocução com as Ciências Sociais e Humanas na área de alimentação e nutrição. Selecionaram-se 93 artigos nas publicações registradas na base de dados do SciELO, de uma listagem geral obtida com as palavras chaves alimentação e nutrição. Classificaram-se os conteúdos em cinco assuntos: dimensões sociais, culturais, cognitivas e psicológicas da alimentação e nutrição; educação/orientação nutricional; análise e avaliação de políticas e programas de alimentação e nutrição; profissão, formação de recursos humanos e estudos teórico-metodológicos. São tecidas considerações sobre a pesquisa qualitativa nos marcos das Ciências Sociais e Humanas sobre cada um dos assuntos. Conclui-se que as pesquisas qualitativas ampliaram positivamente a interlocução da Nutrição com as Ciências Sociais e Humanas, embora requeiram aperfeiçoamento teórico-metodológico para superar os estudos descritivos, adequando o seu entendimento. Foram verificadas a forte presença da Revista de Nutrição e de periódicos das áreas de Saúde Pública/Saúde Coletiva; a concentração em alguns autores e a necessidade de apoiar a formação em Ciências Sociais e Humanas na Nutrição e incentivar a prática da multidisciplinaridade para aperfeiçoar aquelas pesquisas.