Toward Evidence-based, Client-centred Nutrition Education Guidelines: Dietitian and Consumer Survey Results

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.

An Evidence-based Approach to Developing the Collaborative, Client-Centred Nutrition Education (3CNE) Framework and Practice Points

PURPOSE

The purpose of this, the third phase of a 3-phase research project, was to develop guidelines for client-centred nutrition education (NE).

METHODS

A 3-phase study was conducted using a progressive development design, where each phase informed the subsequent phase. Phase 1 was a national online survey of dietitians' perceptions of consumers' NE needs and preferences; results informed the Phase 2 national online survey of consumers about their NE needs and preferences. Phase 3 involved national 2-part teleconference consultations with dietitians to discuss implications of the Phase 2 findings for NE practice. This paper is the report of Phase 3.

RESULTS

Discussion group participants were 22 dietitians from around Canada who had been in practice for an average of 14.5 years. Discussions resulted in the development of the Collaborative Client-Centred Nutrition Education (3CNE) conceptual framework and related Practice Points that explicate the complexity of NE practice.

CONCLUSION

The 3CNE framework and Practice Points provide a means to inform precepting students and interns, and for use in planning for the professional development of practicing dietitians on providing client-centred NE.

A client-centered nutrition education model: Lessons learned from Texas WIC

OBJECTIVE

To examine the implementation of client-centered nutrition education in Texas Special Supplemental Program for Women, Infants, and Children as it relates to the Participant-Centered Education (PCE) model and identify additional components relevant to practical application.

METHODS

Implementation evaluation at Texas Special Supplemental Program for Women, Infants, and Children state and local agencies, including online surveys, telephone interviews, field observations/interviews, and meeting notes collected from 2009 to 2011. Data analyzed using deductive and inductive coding to investigate research questions.

RESULTS

The data aligned with the PCE model domains and suggested elements for practical application. Communication, training, evaluation, and client participation emerged as additional components to support client-centered nutrition education. The new model captures the way the domains influence each other and the importance of 2-way interactions between the client and the other domains.

CONCLUSIONS AND IMPLICATIONS

The findings document the model's potential usefulness for programs with similar audiences and goals. This research highlights an expanded PCE model to assist practitioners in implementation of similar client centered programs.