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Search Results: 1 - 10 of 4105 matches for " Albert Westergren "
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Action-Oriented Study Circles Facilitate Efforts in Nursing Homes to “Go from Feeding to Serving”: Conceptual Perspectives on Knowledge Translation and Workplace Learning
Albert Westergren
Journal of Aging Research , 2012, DOI: 10.1155/2012/627371
Abstract: Background. Action-oriented study circles (AOSC) have been found to improve nutrition in 24 nursing homes in Sweden. Little, however, is known about the conceptual use of knowledge (changes in staffs’ knowledge and behaviours). Methods. Qualitative and quantitative methods, structured questionnaires for evaluating participants’ (working in nursing homes) experiences from study circles ( ?? = 5 9 2 , 71 AOSC) and for comparisons between AOSC participants ( ?? = 7 4 ) and nonparticipants ( ?? = 1 1 5 ). Finally, a focus group interview was conducted with AOSC participants (in total ?? = 1 2 ). Statistical, conventional, and directed content analyses were used. Results. Participants experienced a statistically significant increase in their knowledge about eating and nutrition, when retrospectively comparing before participating and after, as well as in comparison to non-participants, and they felt that the management was engaged in and took care of ideas regarding food and mealtimes to a significantly greater extent than non-participants. The use of AOSC was successful judging from how staff members had changed their attitudes and behaviours toward feeding residents. Conclusions. AOSC facilitates professional development, better system performance, and, as shown in previous studies, better patient outcome. Based on a collaborative learning perspective, AOSC manages to integrate evidence, context, and facilitation in the efforts to achieve knowledge translation in a learning organisation. This study has implications also for other care settings implementing AOSC. 1. Background Promoting nutritional health equity among at risk older populations in nursing homes is of importance. Effective interventions that reduce the risk of undernutrition can help to ensure that people stay healthier in old age. Findings from a couple of studies indicate inequity between the nutritional care provided to patients in hospitals and elderly people in nursing homes. Two surveys conducted in 2007 indicate that patients in hospitals and at risk of undernutrition are more likely to get oral supplements (43–54%) [1] than elderly persons at risk of undernutrition in nursing homes (14–19%) [2]. It is plausible that appropriate nutritional care for older people in nursing homes requires educational interventions. This study is a part of a larger project that has shown, in a before–during–after controlled trial, that by implementing action oriented study circles (AOSC) for the staff in nursing homes, knowledge translation (KT) regarding eating and nutrition was achieved in terms of
Home-Living Elderly People's Views on Food and Meals
Ellinor Edfors,Albert Westergren
Journal of Aging Research , 2012, DOI: 10.1155/2012/761291
Abstract: Background. The aim of the study was to describe home-living elderly people's views on the importance of food and meals. Methods. Semistructured interviews with twelve elderly people. The interviews were analysed using qualitative content analysis. Results. Respondents described how their past influenced their present experiences and views on food and meals. Increased reliance on and need of support with food and meals frequently arose in connection with major changes in their life situations. Sudden events meant a breaking point with a transition from independence to dependence and a need for assistance from relatives and/or the community. With the perspective from the past and in the context of dependency, respondents described meals during the day, quality of food, buying, transporting, cooking, and eating food. Conclusions. Meeting the need for optimal nutritional status for older people living at home requires knowledge of individual preferences and habits, from both their earlier and current lives. It is important to pay attention to risk factors that could compromise an individual's ability to independently manage their diet, such as major life events and hospitalisation. Individual needs for self-determination and involvement should be considered in planning and development efforts for elderly people related to food and meals. 1. Introduction Malnutrition, which includes undernutrition as well as overweight/obesity, is a common problem among the elderly. The prevalence of undernutrition among home-living elderly people was found to be 14.5% according to the Mini Nutritional Assessment (MNA) [1]. Among elderly people who had recently moved to a residential home, 33–37% were malnourished according to the MNA [2]. The higher prevalence of undernutrition among elderly people admitted to residential homes highlights the importance of identifying elderly people who live at home and are at risk of malnutrition, to prevent the development and aggravation of undernutrition, followed by increased dependency on and need for institutional care [1]. In addition, among 70-year-old Swedes, 20% of the men and 24% of the women were obese ( B M I > 3 0 ) [3]. In Swedish nursing homes the prevalence of overweight was 22% and another 8% were obese [4]. Thus, obesity is also a frequent problem among the elderly. The consequences of undernutrition in elderly people include functional decline or frailty [5–7], decreased quality of life [8], increased health care utilisation and costs [9, 10], higher rates of adverse complications from other health conditions [11], and
Do study circles and a nutritional care policy improve nutritional care in a short- and long-term perspective in special accommodations?
Albert Westergren,Gita Hedin
Food & Nutrition Research , 2010, DOI: 10.3402/fnr.v54i0.5402
Abstract: Background: Disease-related malnutrition is a major health problem in the elderly population and management issues are under-explored. Objectives: What is the prevalence of undernutrition-risk (UN-risk), underweight, and overweight in special accommodations (SAs)? Do study circles and a nutritional care policy (NCP) improve the precision in nutritional care (NC) and decrease the prevalence of under- and overweight in a short- and/or long-term perspective?Design: Quasi-experimental pre- and post-intervention design with three experimental groups and one control group (CG). Setting: SAs. Participants: In 2005 (Time 1 – T1), 1726 (90.4%) residents agreed to participate; in 2007 (Time 2 – T2), 1,526 (81.8%); and in 2009 (Time 3 – T3), 1,459 (81.3%) residents participated. Interventions: Experimental groups: between T1 and T2 the first period of study circles was conducted in one municipality; between T2 and T3 a second period of study circles in another municipality was conducted; after T1 a NCP was implemented in one municipality. CG: residents in three municipalities. Measurements: Under- and overweight were defined based on BMI. Risk of undernutrition was defined as involving any of: involuntary weight loss, low BMI, and/or eating difficulties. The ‘precision in NC’ describes the relationship between nutritional treatment (protein- and energy-enriched food (PE-food) and/or oral supplements) and UN-risk. Results: The prevalence of UN-risk varied between 64 and 66%, underweight between 25 and 30%, and overweight between 30 and 33% in T1–T3. At T2 the prevalence of underweight was significantly lower in the first period study circle municipality, and at T3 in the second period study circle municipality compared to in the CG. The precision in NC was higher in a short-term perspective in the study circle municipalities and both in a short- and long-term perspective in the NCP municipality. At T3 between 54 and 70% of residents at UN-risk did not receive PE-food or oral supplements. Conclusions: Study circles give positive short-term effects and a NCP gives positive short- and long-term effects on NC. Whether a combination of study circles and the implementation of a NCP can give even better results is an area for future studies.
Nursing students gain tools for knowledge utilisation through a work and research integrated learning assignment – a qualitative study
Albert Westergren,Ellinor Edfors
Journal of Nursing Education and Practice , 2013, DOI: 10.5430/jnep.v3n1p60
Abstract: Background: By integrating education, research and collaboration with society, in a learning assignment, the level of nursing students learning can be enhanced. Aim: The purpose of this study was to explore nursing students’ experiences of participating in a work and research integrated learning assignment during their clinical practice courses. Methods: At the end of their nursing training, in their sixth semester, five nursing students were recruited to the study and interviewed after which the texts of interviews were analysed using content analysis. The participants had been involved in two studies, one during their second semester, where the risk of falling was assessed, and one during their sixth semester where the risk for under nutrition was assessed. Results: The students experienced that the two assignments enhanced their learning in how to work as a foreman/supervisor, how to inform and engage in dialogue, about using risk assessment, and further, gave them the opportunity to meet the people behind the diagnosis. Through assignments they could also identify the need for knowledge within the study focus, for instance, the risks for falling or the risk of undernourishment. Further, they described how they tried to live up to the ethical standards and that they had learned about using a scientific approach in their work. Conclusion: It is possible to integrate Research, Education and Collaboration in a learning assignment during Nursing education (RECN-assignment) by allowing nursing students to participate in an actual research project during their work integrated learning courses. Such an approach enhances nursing students learning about research and the area being studied in the actual research project.
Diagnostic performance of the Minimal Eating Observation and Nutrition Form - Version II (MEONF-II) and Nutritional Risk Screening 2002 (NRS 2002) among hospital inpatients - a cross-sectional study
Albert Westergren, Erika Norberg, Peter Hagell
BMC Nursing , 2011, DOI: 10.1186/1472-6955-10-24
Abstract: Eighty seven hospital inpatients were assessed for nutritional status with the 18-item MNA (considered as the gold standard), and screened with the NRS 2002 and the MEONF-II.The MEONF-II sensitivity (0.61), specificity (0.79), and accuracy (0.68) were acceptable. The corresponding figures for NRS 2002 were 0.37, 0.82 and 0.55, respectively. MEONF-II and NRS 2002 took five minutes each to complete. Assessors considered MEONF-II instructions and items to be easy to understand and complete (96-99%), and the items to be relevant (87%). For NRS 2002, the corresponding figures were 75-93% and 79%, respectively.The MEONF-II is an easy to use, relatively quick and sensitive screening tool to assess risk of undernutrition among hospital inpatients. With respect to user-friendliness and sensitivity the MEONF-II seems to perform better than the NRS 2002, although larger studies are needed for firm conclusions. The different scoring systems for undernutrition appear to identify overlapping but not identical patient groups. A potential limitation with the study is that the MNA was used as gold standard among patients younger than 65 years.Undernutrition is associated with poorer health, compromised ability to recover from medical conditions and increased mortality [1]. People at risk for or with manifest undernutrition therefore need to be identified in order to initiate prevention or interventions. Low Body Mass Index (BMI) and unintentional weight loss are considered key indicators of undernutrition [2], and together with change in food intake these indicators are associated with changes in function and clinical outcome [3]. This is reflected in commonly used nutritional screening tools such as the Nutritional Risk Screening 2002 (NRS 2002; [4]), the Mini Nutritional Assessment (MNA; [5,6] ), Malnutrition Universal Screening Tool (MUST; [7]) and the recently developed Minimal Eating Observation and Nutrition Form - Version II (MEONF-II; [8,9]).In Sweden, it is recommended that
Validity and user-friendliness of the minimal eating observation and nutrition form – version II (MEONF – II) for undernutrition risk screening
Christina Vallén,Peter Hagell,Albert Westergren
Food & Nutrition Research , 2011, DOI: 10.3402/fnr.v55i0.5801
Abstract: Objective: To analyze the criterion-related validity and user-friendliness of the Minimal Eating Observation and Nutrition Form – Version II (MEONF – II) and Malnutrition Universal Screening Tool (MUST) in relation to the Mini Nutritional Assessment (MNA). In addition, the effect of substituting body mass index (BMI) with calf circumference (CC) was explored for the MEONF-II. Methods: The study included 100 patients who were assessed for nutritional status with the MNA (full version), considered here to be the gold standard, and screened with the MUST and the MEONF-II. The MEONF-II includes assessments of involuntary weight loss, BMI (or calf circumference), eating difficulties, and presence of clinical signs of undernutrition. Results: The MEONF-II sensitivity (0.73) and specificity (0.88) were acceptable. Sensitivity and specificity for the MUST were 0.57 and 0.93, respectively. Replacing the BMI with CC in the MEONF-II gave similar results (sensitivity 0.68, specificity 0.90). Assessors considered MEONF-II instructions and items to be relevant, easy to understand and complete (100%), and the questions to be relevant (98%). MEONF-II and MUST took 8.8 and 4.7 minutes to complete, respectively, and both were considered relevant and easy to finish. In addition, MEONF-II was thought to reveal problems that allows for nursing interventions. Conclusions: The MEONF-II is an easy to use, relatively quick, and sensitive screening tool to assess risk of undernutrition among hospital inpatients, which allows for substituting BMI with CC in situations where measures of patient height and weight cannot be easily obtained. High sensitivity is of primary concern in nutritional screening and the MEONF-II outperforms the MUST in this regard.
Uncovering Indicators of the International Classification of Functioning, Disability, and Health from the 39-Item Parkinson's Disease Questionnaire
Maria H. Nilsson,Albert Westergren,Gunilla Carlsson,Peter Hagell
Parkinson's Disease , 2010, DOI: 10.4061/2010/984673
Abstract: The 39-item Parkinson's disease questionnaire (PDQ-39) is the most widely used patient-reported rating scale in Parkinson's disease (PD). However, recent studies have questioned its validity and it is unclear what scores represent. This study explored the possibility of regrouping PDQ-39 items into scales representing the International Classification of Functioning, Disability, and Health (ICF) components of Body Functions and Structures (BF), Activities and Participation (AP), and Environmental (E) factors. An iterative process using Rasch analysis produced five new items sets, two each for the BF and AP components and one representing E. Four of these were found to represent clinically meaningful variables: Emotional Impairment (BF), Gross Motor Disability (AP), Fine Motor Disability (AP), and Socioattitudinal Environment (E) with acceptable reliability (0.73–0.96) and fit to the Rasch model (total item-trait chi-square, 8.28–33.2; ). These new ICF-based scales offer a means to reanalyze PDQ-39 data from an ICF perspective and to study its health components using a widely available health status questionnaire for people with PD. 1. Introduction The International Classification of Functioning, Disability, and Health (ICF) provides a conceptualisation and classification of different components of health including biological, individual, and social perspectives [1]. The ICF contains two parts. The first part defines functioning and disability, which in turn consists of two components, Body Functions and Structures, and Activities and Participation. Body functions include physiological and psychological functions, and body structures refer to the anatomical integrity of the body. Activities are the execution of tasks or actions, whereas participation refers to the involvement in life situations. The second part conceptualizes contextual factors, which include environmental and personal factors. The environmental component is the facilitating or hindering impact of the physical, social, and attitudinal environment. Similarly, personal factors are recognized as having a facilitating or hindering impact but they are not further specified because of their vast social and cultural variation [1]. In addition to its use for clinical, educational, and research purposes, the ICF can be used to understand the content of different health outcome measures [2]. Linking such scales to the ICF can be valuable to allow clinical studies to relate to the ICF and for gaining a conceptual understanding of scale contents [3, 4], thereby serving as a base for their further
Cut-off scores for the Minimal Eating Observation and Nutrition Form – Version II (MEONF-II) among hospital inpatients
Albert Westergren,Erika Norberg,Christina Vallén,Peter Hagell
Food & Nutrition Research , 2011, DOI: 10.3402/fnr.v55i0.7289
Abstract: The newly developed Minimal Eating Observation and Nutrition Form – Version II (MEONF-II) has shown promising sensitivity and specificity in relation to the Mini Nutritional Assessment (MNA). However, the suggested MEONF-II cut-off scores for deciding low/moderate and high risk for undernutrition (UN) (>2 and >4, respectively) have not been decided based on statistical criteria but on clinical reasoning. The objective of this study was to identify the optimal cut-off scores for the MEONF-II in relation to the well-established MNA based on statistical criteria.Cross-sectional study.The study included 187 patients (mean age, 77.5 years) assessed for nutritional status with the MNA (full version), and screened with the MEONF-II. The MEONF-II includes assessments of involuntary weight loss, Body Mass Index (BMI) (or calf circumference), eating difficulties, and presence of clinical signs ofUN. MEONF-II data were analysed by Receiver Operating Characteristics (ROC) curves and the area under the curve (AUC); optimal cut-offs were identified by the Youden index (J=sensitivity + specificity–1).According to the MEONF-II, 41% were at moderate or high UN risk and according to the MNA, 50% were at risk or already undernourished. The suggested cut-off scores were supported by the Youden indices. The lower cut-off for MEONF-II, used to identify any level of risk for UN (>2; J=0.52) gave an overall accuracy of 76% and the AUC was 80%. The higher cut-off for identifying those with high risk for UN (>4; J=0.33) had an accuracy of 63% and the AUC was 70%.The suggested MEONF-II cut-off scores were statistically supported. This improves the confidence of its clinical use.
The Experiences of Elderly People Living at Home Related to Their Receiving Meals Distributed by a Municipality in Sweden
Zada Pajalic,Lena Persson,Albert Westergren,Berggren Vanja
Journal of Food Research (JFR) , 2012, DOI: 10.5539/jfr.v1n1p68
Abstract: The purpose of the study was to describe the experiences of elderly people, living at home who receive hot meals that are distributed by their municipality. Qualitative content analysis was used to analyse the (n=13) interviews. The results showed that feelings of dependency, loneliness and gratitude were expressed by the participants in the study related to their meals being delivered home. Dependency was expressed as not having influence over the food products the meals were made from. Loneliness was expressed as being isolated and being confined at home alone due to difficulties getting out of the house, which was associated with the costs of taxis transportation. Gratitude was expressed by the sincere thanks for the possibility of receiving traditional meals delivered daily. The major conclusion of the study was the indication that greater attention should be paid to meet both the practical and psychological needs of elderly people.
Public home care professionals’ experiences of being involved in food distribution to home-living elderly people in Sweden – a qualitative study with an action research approach
Zada Pajalic,Lena Persson,Albert Westergren,Kirsti Skovdahl
Journal of Nursing Education and Practice , 2012, DOI: 10.5430/jnep.v2n2p41
Abstract: Background: Research focusing on Food Distribution (FD) from various professionals’ and organisational perspectivesare lacking. The aim of this study was therefore to explore various professionals’ experiences of involvement in FD inorder to get comprehensive understanding of the organisation, responsibilities and roles. Methods: This qualitative study is a part of a larger project with an action research approach focusing on FD in themunicipal home service and care for home-living elderly persons in a municipality in southern Sweden. The data wascollected through participatory observations (n=90 occasions and in total 480 hours), repeated focus group interviews (n =4) with different professionals (n =10) involved in the FD process and one individual interview. The material was analysedby qualitative manifest and latent content analysis. Results: The study indicates that Food Distribution is a fragmentary intervention where a comprehensive perspective andclear roles of responsibility are lacking. The FD organisation seemed to be strictly divided and limited by constraintsregarding time and money. The fragmented organisation led partly to staff only taking responsibility for their part of thechain and no one having the full picture of and responsibility for the FD process, but also to some professionals takingmore responsibility than they were supposed to. Conclusions: The aim of the study was met by using an action research approach. The study was however limited by thatno home help officers were represented. The FD appeared as an extremely complex chain of different but connectedactivities. It is not merely the distribution of a product, i.e. the meal box. The fragmentation of FD means that staff onlytakes responsibility for their part of the chain, and that no one has the full picture of or responsibility for the FD process.Consequently, there is a need for an outline of responsibilities. The findings have implications for nursing, gerontology,and in the care for the elderly.
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