RESUMO
OBJECTIVES: Malnutrition in critically ill children contributes to morbidity and mortality. The French-speaking pediatric intensive care nutrition group (NutriSIP) aims to promote optimal nutrition through education and research. METHODS: The NutriSIP-designed NutriRéa-Ped study included a cross-sectional survey. This 62-item survey was sent to the nursing teams of all of the French-speaking pediatric intensive care units (PICUs) to evaluate nurses' nutrition knowledge and practices. One nurse per PICU was asked to answer and describe the practices of their team. RESULTS: Of 44 PICUs, 40 responded in Algeria, Belgium, Canada, France, Lebanon, Luxemburg, and Switzerland. The majority considered nutrition as a priority care but only 12 of the 40 (30%) had a nutrition support team, 26 of the 40 (65%) had written nutrition protocols, and 19 of 39 (49%) nursing teams felt confident with the nutrition goals. Nursing staff generally did not know how to determine nutritional requirements or to interpret malnutrition indices. They were also unaware of reduced preoperative fasting times and fast-track concepts. In 17 of 35 (49%) PICUs, the target start time for enteral feeding was within the first 24 hours; however, frequent interruptions occurred because of neuromuscular blockade, fasting for extubation or surgery, and high gastric residual volumes. Combined pediatric neonatal intensive care units were less likely to perform systematic nutritional assessment and to start enteral nutrition rapidly. CONCLUSIONS: We found a large variation in nursing practices around nutrition, exacerbated by the lack of nutritional guidelines but also because of the inadequate nursing knowledge around nutritional factors. These findings encourage the NutriSIP to improve nutrition through focused education programs and research.
Assuntos
Conhecimentos, Atitudes e Prática em Saúde , Unidades de Terapia Intensiva Pediátrica/estatística & dados numéricos , Recursos Humanos de Enfermagem Hospitalar/psicologia , Apoio Nutricional/enfermagem , Padrões de Prática em Enfermagem/estatística & dados numéricos , Adulto , Argélia , Bélgica , Canadá , Criança , Pré-Escolar , Enfermagem de Cuidados Críticos/métodos , Enfermagem de Cuidados Críticos/estatística & dados numéricos , Estudos Transversais , Nutrição Enteral/métodos , Nutrição Enteral/enfermagem , Nutrição Enteral/psicologia , Feminino , França , Humanos , Lactente , Recém-Nascido , Idioma , Líbano , Luxemburgo , Masculino , Enfermagem Neonatal/métodos , Enfermagem Neonatal/estatística & dados numéricos , Apoio Nutricional/métodos , Apoio Nutricional/psicologia , Inquéritos e Questionários , SuíçaRESUMO
Trata-se de investigar os significados atribuídos por pacientes portadores do vírus da hepatite C sobre a doença e o tratamento dietético. Para tanto, adota-se a metodologia da pesquisa qualitativa em que o sujeito interage com sua narrativa sobre o objeto de estudo e os pesquisadores analisam cuidadosamente seus enunciados. As acepções sobre o adoecer e as mudanças dos hábitos alimentares e de vida dos pacientes foram analisadas por meio da obtenção de entrevistas em profundidade. Ao trazer os sentidos expressos sobre a doença, cria-se a possibilidade de compreensão dos aspectos culturais sobre a alimentação, a nutrição e a dietética; um desafio para os profissionais de saúde e nutrição, que precisam relatar a seus pacientes a necessidade de seguir hábitos alimentares mais saudáveis, implicando alterações nem sempre simples de serem realizadas. Consideram-se hábitos e representações do ato da alimentação, como parte da identidade cultural do sujeito. Justifica-se este estudo pela necessidade de situar maior interação entre profissionais, estudantes de saúde e pacientes de modo a ampliar a compreensão dos fenômenos que cercam a experiência da doença pelos pacientes. Conclui-se que os pacientes de hepatite C atendidos no ambulatório do Hospital Universitário da cidade de Salvador e o profissional podem atingir os objetivos de aconselhamentos nutricionais, se trilharem direções dialógicas. Com isso, observou-se a adesão à orientação dietética sem rupturas bruscas e sofrimentos dos pacientes.
This paper investigates the meanings attributed by patients to hepatitis C on disease and dietary treatment. To this end, we adopt the methodology of qualitative research in which the individual interacts with his narrative on the subject of study and the researchers carefully examine their statements. The meanings of the illness and changes in dietary habits and life of the patients were analyzed by obtaining in-depth interviews. By bringing the senses expressed about the disease, it creates the possibility of understanding cultural factors on diet, nutrition and dietetics - a challenge for health professionals and nutrition, which need to report their patients the need to follow dietary healthier, involving changes not always simple to perform. Habits and representations of the act of feeding are considered part of the cultural identity of the subject. This study is justified by the need to place greater interaction among professionals, students, patients and health so as to broaden the understanding of the phenomena that surround the experience of illness by patients. We conclude that outpatients with hepatitis C at the University Hospital in the city of Salvador and the professional can achieve the goals of nutritional advice, if they follow dialogic lines. Thus, there was compliance with dietary counseling without sudden breaks and suffering of patients.
Assuntos
Comportamento Alimentar/ética , Comportamento Alimentar/etnologia , Comportamento Alimentar/psicologia , Hepatite C Crônica/prevenção & controle , Hepatite C Crônica/terapia , Hepatite C/prevenção & controle , Apoio Nutricional/psicologia , Brasil/epidemiologia , Brasil/etnologia , Comportamentos Relacionados com a Saúde/etnologia , Dietoterapia/tendências , Estilo de Vida , Nutricionistas/psicologia , Pessoal de Saúde/psicologiaRESUMO
PURPOSE OF REVIEW: To summarize current knowledge about nutritional aspects in the final stage of life, with emphasis on mechanisms and clinical diagnosis, ethical aspects and management. RECENT FINDINGS: The most recent advances on the subject include new mechanisms involved in the pathophysiology, use of therapeutic approach combined with n-3 fatty acids and the active intervention of the patient in decision making. SUMMARY: The nutritional deterioration in a patient who passes the last stages of his life constitutes a subject area to varied analysis and considerations. For this reason, there exist an increasing number of investigations, particularly in the areas of pathophysiology and of therapeutics. The aspects related to quality of life, cultural context and bioethics, add more complexity to the subject.
Assuntos
Estimulantes do Apetite/uso terapêutico , Estado Nutricional/fisiologia , Apoio Nutricional/métodos , Assistência Terminal/métodos , Doente Terminal , Anorexia/tratamento farmacológico , Anorexia/etiologia , Estimulantes do Apetite/efeitos adversos , Caquexia/tratamento farmacológico , Caquexia/etiologia , Humanos , Apoio Nutricional/ética , Apoio Nutricional/psicologia , Participação do Paciente , Qualidade de Vida , Assistência Terminal/ética , Assistência Terminal/psicologiaRESUMO
A survey to examine the extent to which infant food advertising could be shown measurably to influence infant feeding practice was carried out in S. Vincent in the eastern Caribbean. A questionaire was administered to mothers of about 200 children one to two uears old, nearly a complete sample in each of two towns. Infant food advertising was found to be uncommon. The typical infant feeding pattern, largely a combination of both breast and bottle feeding, had existed for decades. Despite the fact that this was not a very appropriate setting for such a study, and that there were a number of methodological constraints, the results of two multiple regression analyses suggested that the more a mother was influenced by infant food advertising, the sooner she began to bottle feed and the sooner she stopped breastfeeding. The cessation of all promotion of commercial infant foods to the public as well as to health professionals, is called for. (AU)