ABSTRACT
The relationship between an individual's social, psychological, and cultural environment and his or her nutritional status is one of both cause and effect. Cultural patterns, economic stability, and attitudes toward health and disease all affect an individual's eating behavior. Similarly, illness or treatments that interfere with usual nutritional behaviors can affect an individual's emotional well-being and social relationships. We have discussed some of the symbolic and social meanings of food and have described how these are challenged by the necessity for "artificial feedings." We have suggested that an understanding of the interaction among the cultural and social factors involved in eating is important in helping to provide comprehensive care to patients requiring nutritional intervention as part of treatment for a medical or surgical disease. In addition, we have presented a description of anorexia nervosa as an example of an illness in which the primary symptoms involve the use of deviant eating behaviors as a way to meet psychological needs. The psychosocial context of food and of obtaining nutrition seem in many ways to be quite obvious, but we must make a conscious effort not to take for granted or to overlook the impact the psychological, social, and cultural environment has upon our patients receiving nutritional therapies.
Subject(s)
Nutritional Physiological Phenomena , Sick Role , Social Environment , Adolescent , Adult , Anorexia Nervosa/psychology , Culture , Enteral Nutrition/psychology , Feeding Behavior , Female , Humans , Male , Parenteral Nutrition/psychologyABSTRACT
A comprehensive, interdisciplinary program for patients requiring home parenteral nutrition (HPN) is described. This program begins with an initial patient assessment, which includes medical prerequisites and evaluation of patient motivation and learning abilities, family supports, emotional status, and individual life-styles. The teaching phase involves instructing the patient in the tasks necessary to self-administer parenteral nutrition at home. Problems that can arise are presented, and patient self-monitoring for adverse reactions and problem solving is emphasized. Outpatient follow-up is provided by the interdisciplinary Nutrition Support Service in a clinic setting. Specific components of these visits in relation to physical and emotional adjustment to HPN are discussed. The Nutrition Support Service recognizes a long-term commitment to patients receiving HPN, and members of the team are available to assist patients when problems occur.
