The role of the dietitian in the management of malnutrition in the elderly: A systematic review of current practices.

AIM: The prevalence of age-related malnutrition is increasing in almost all Western countries. Because of their expertise, dietitians should have a central role in the management of malnutrition. This review aimed to synthesise the literature on the role of the dietitian in the management of malnutrition in the elderly in comparison with other health professionals. METHODS: In November 2018, a search of Embase, Medline Ovid, Cinahl Ebscohost, Cochrane Central, Web of Science and Google Scholar was undertaken using 'dietitian', 'elderly' and 'malnutrition' as the main search terms. Qualitative and quantitative empirical research studies that focussed on the role of dietitians as the (main) subject of the study were included. Data extraction and data synthesis were performed by the three authors using a thematic synthesis approach. RESULTS: Three themes emerged from the coding and synthesis of the 21 included studies. The first theme demonstrates that other health professionals' time for, and knowledge of, screening policies negatively affects the role of the dietitian. The second theme demonstrates that the importance of nutritional care is acknowledged. However, this does not always imply familiarity with dietetics nor does it always mean that other health professionals think involving dietitians is worth the effort. The third theme demonstrates that issues of workload appeared to be especially important in crossing or guarding role boundaries. CONCLUSIONS: The role of dietitians in managing age-related malnutrition is not always clear and coherent. Therefore, how dietitians shape their role to provide optimal management of malnutrition in the elderly is open to debate.

Quality of Life: The Interplay between Human Behaviour, Technology and the Environment.

Quality of life is an umbrella term for the quality of the various domains in life [...].

The role of ICU nurses in the spiritual aspects of end-of-life care in the ICU: an explorative study.

AIM: The aim of this study was to examine the role and responsibilities of intensive care unit (ICU) nurses regarding the spiritual aspects of end-of-life care in the ICU, from the chaplains' perspectives. METHOD: An explorative study including inductive thematic analysis was used. Two focus group interviews with in total eleven chaplains working in several Dutch ICUs were performed. RESULTS: The focus group interviews resulted in five themes: (i) awareness of ICU nurses, (ii) communication, (iii) nursing interventions, (iv) multidisciplinary care and (v) education. In total, twenty recommendations were formulated. CONCLUSIONS: This explorative study provides an overview of the perspectives of chaplains about the role of ICU nurses during end-of-life care, specified to spiritual care. Chaplains mentioned different roles, responsibilities and competences which are needed for ICU nurses to give spiritual care. These roles, responsibilities and competences included giving spiritual care to patients and families as standard care. Chaplains agreed that ICU nurses should start and maintain a dialogue with patient and families, but that it is also important to be aware of one's own spiritual background. However, education about spiritual care is needed to establish this. It could be recommended to educate ICU nurses during their ICU training or retraining about spiritual care and reflection.

The nursing role during end-of-life care in the intensive care unit related to the interaction between patient, family and professional: an integrative review.

AIM: The aim of this study was to explore how intensive care unit (ICU) nurses describe their role during End-of-Life Care (EOLC) in the ICU, related to the interaction between patient, family and professionals (care triad). METHOD: Three electronic databases, PubMed, CINAHL and EMBASE, and reference lists of included studies were searched for studies in English, Dutch or German between January 2002 and August 2015. Studies were included if they presented data about EOLC in the adult ICU, and the role of ICU nurses around EOLC. Quantitative and qualitative studies and opinion articles were extracted. Inductive content analysis was carried out to analyse and categorise the data. RESULTS: Twenty studies were included. Four categories emerged: care for the ICU patient, care for the family, environmental aspects of EOLC and organisational aspects of EOLC. Regarding the care triad, a gap exists between theoretical models and the actual care provided by ICU nurses during EOLC. The relational aspect of care, like aimed with care triad, is absent. CONCLUSION: The literature clearly indicates that the role of ICU nurses concerns care for the patient, family and environment. It described which care should be given, but it remains unclear how care should be given (attitude). Therefore, it is difficult for ICU nurses to provide this care. Further, it seems that care provided to family mainly consists of giving advice on how to care for the patient; care for family members themselves was only mentioned in a few studies. Therefore, it seems that family does not always receive adequate care yet, which may be helpful in preventing problems like depression, anxiety or post-traumatic stress disorder. It can be concluded that it is important for ICU nurses to be aware of the existing relationships; however, comparing the literature, care triad does not appear to be reached.

Partnership in health care: views of family caregivers on sharing care responsibility with government, clients and health insurers.

In this study, we asked family caregivers about their opinion on division of care responsibility between the government, family caregivers, clients, and health insurers. We investigated whether different clusters of respondents could be distinguished, using Latent Cluster Analysis, and what is the relation is with perceived stress and joy and with several background characteristics. Three clusters of respondents could be distinguished: a 'caring together', a 'caring individually', and a 'government-responsible caring' cluster. Family caregivers in cluster 1 attach great importance to both governmental responsibility and individual responsibility. Family caregivers who belong to cluster 2 want themselves to take full responsibility for caregiving, and caregivers in cluster 3 want the government to take most of the responsibility for caregiving. Unemployed caregivers and caregivers with lower educational attainment have a higher chance to belong to the 'caring individually' cluster and this group has relatively more self-reported stress. Policymakers and professionals should bear these three clusters in mind when developing care policy and care guiding practice.