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Access to nutritional care is frequently limited or denied to patients with disease-related malnutrition (DRM), to those with the inability to adequately feed themselves or to maintain their optimal healthy nutritional status which goes against the fundamental human right to food and health care. That is why the International Working Group for Patient's Right to nutritional care is committed to promote a human rights based approach (HRBA) in the field of clinical nutrition. Our group proposed to unite efforts by launching a global call to action against disease-related malnutrition through The International Declaration on the Human Right to Nutritional Care signed in the city of Vienna during the 44th ESPEN congress on September 5th 2022. The Vienna Declaration is a non-legally binding document that sets a shared vision and five principles for implementation of actions that would promote the access to nutritional care. Implementation programs of the Vienna Declaration should be promoted, based on international normative frameworks as The United Nations (UN) 2030 Agenda for Sustainable Development, the Rome Declaration of the Second International Conference on Nutrition and the Working Plan of the Decade of Action on Nutrition 2016-2025. In this paper, we present the general background of the Vienna Declaration, we set out an international normative framework for implementation programs, and shed a light on the progress made by some clinical nutrition societies. Through the Vienna Declaration, the global clinical nutrition network is highly motivated to appeal to public authorities, international governmental and non-governmental organizations and other scientific healthcare societies on the importance of optimal nutritional care for all patients.

Introduction: This essay presents the methodology for Group Bonding Nutritional Counseling (GBNC), which has been developed at the School of Nutrition at the University of Costa Rica in recent decades. In relation to GBNC, the objectives are: 1) To present the epistemological foundations; 2) To show the methodology on how to develop the group bonding nutritional counseling; and 3) To describe the desirable soft skills for the facilitator in a group bonding nutritional counseling process. GBNC’s conceptual approach is centered on the patient as a person exercising their autonomy and agency over their life, and how GBNC helps in the resolution of obstacles for better treatment adherence. GBNC´s methodological approach is based on Pichon-Rivière’s operative groups which was adapted for nutritional counseling. Proposition: GBNC goes beyond group interactive nutrition education and includes all the steps to nutritional care, including individual follow ups. GBNC’s methodology has robust theoretical background, as well as adequate settings for its implementation, evaluation, and use. Arguments for discussion: For the past decades, the School of Nutrition at the University of Costa Rica has developed the methodological framework for GBNC: from its theory foundation, useful soft skills for the facilitator to conduct, guide and support groups to focus on the task, and proficiently to handle the vectors of group dynamics. GBNC is useful for people to work on improving their health as it allows them to face daily barriers they encounter. Conclusions: GBNC has great methodological potential for group support in the treatment of adults with chronic diseases; it is inexpensive and improves time management and human resources in nutritional care. In addition, it allows patients to exercise their autonomy, agency, and problem-solving skills in a safe space, within the containment of the group and the nutritionist., Introducción: este ensayo presenta la metodología de la consulta nutricional grupal vincular (CNGV) desarrollada en las últimas décadas en la Escuela de Nutrición de la Universidad de Costa Rica. Los objetivos son los siguientes: 1) Presentar los fundamentos epistemológicos; 2) Exponer la metodología de la consulta nutricional grupal vincular; 3) Describir las habilidades blandas deseables de la persona facilitadora para dirigir un proceso de consulta nutricional grupal vincular. El enfoque conceptual de la CNGV se centra en la persona paciente -quien tiene autonomía y agencia sobre su vida-, apoyándola en la resolución de obstáculos a fin de lograr mayor adherencia al tratamiento. El enfoque metodológico se basa en el grupo operativo de Pichón-Rivière adaptado a la atención nutricional. Proposición: la CNGV va más allá de la educación nutricional grupal interactiva y cumple todos los pasos de la terapia nutricional, incluso el seguimiento a cada persona. Su metodología tiene antecedentes teóricos robustos, así como condiciones para su aplicación, evaluación y uso adecuado. Argumentos para la discusión: durante varias décadas, en la Escuela de Nutrición de la Universidad de Costa Rica, se ha desarrollado la propuesta metodológica de la CNGV: desde el fundamento teórico hasta las habilidades blandas necesarias de la persona facilitadora para guiar y ayudar al grupo a enfocarse en la tarea, bajo un manejo suficiente de los vectores de la dinámica grupal. Esta modalidad es útil para que las personas avancen en la construcción de su salud, pues las enfrenta con barreras cotidianas. Conclusiones: La CNGV posee un gran potencial metodológico en el tratamiento de adultos con enfermedades crónicas, es barata y optimiza el tiempo y los recursos humanos en la asistencia nutricional. Además, permite a las personas pacientes ejercer su autonomía, agencia y capacidad resolutiva en un espacio seguro y con contención tanto de pares como de la persona facilitadora.

Background: Food and nutrition are primary aspects of health and recovery at illness. Malnutrition among elderly living in Sweden and in other countries around the world has not received enough attention. Malnutrition and its consequences have gained attention from the healthcare institutions and guidelines are created by national and international organizations to discover and treat patients who suffer or are at risk of malnutrition. The nurse has a responsibility for nutritional care, which include identification, prevention and treatment of malnutrition. Malnutrition might be a health hazard, but it can be avoided if it is adequately managed by medical professionals. Aim: The aim of the study was to illuminate nurses´ experiences of nutritional care among elderly who suffer from malnutrition or are at risk of malnutrition. Method: The chosen method is to contribute to evidence-based nursing based on analysis of qualitative research. Eight qualitative studies from 2009-2019 were included in the study. The selected studies were quality checked, analyzed and compiled. Results: The analysis of the data material resulted in two main themes and eight sub-themes. The main themes that emerged was 1) Deficiencies in information transfer and documentation. 2) Incomplete nutritional care. The eight sub-themes were 1) Lack of routine and knowledge for journal writing. 2) Insufficient communication between health professionals. 3) Inadequate assessment of nutritional status and action taken. 4) Unfavorable surroundings affect meals. 5) Lack of time, resources and prioritizing of nutritional care. 6) Poor collaboration between healthcare professionals. 7) The need for nutritional knowledge and 8) Lack of involvement of the elderly. Conclusion: The results showed that the nurse's effort in nutritional care among elderly patients is important. There is, however, a need of education in both documentation and knowledge in nutrition to provide more adequate nutritional care. This c

Head and neck cancer (HNC) is the seventh highest cause of cancer mortality worldwide. Upwards of 50% of those affected experience malnutrition and this is associated with reduced survival. Evidence-based guidelines (EBGs) provide recommendations to help prevent and manage malnutrition. However, it is unclear how well these are implemented in practice. Therefore, the aim of this thesis was to explore the implementation of nutritional EBGs for individuals with HNC.

Ten years ago, European health care professional societies, health associations and members of the European Parliament convened in Brussels to discuss the necessary and urgent actions needed to improve access, initiation and follow up nutritional care for European citizens. As a response to this, in 2014 the Optimal Nutritional Care for All (ONCA) campaign was launched under the leadership of the European Nutritional for Health Alliance and its members. As of today this campaign has been rolled out in 18 European countries, whereby national multi-disciplinary platforms including patient groups work together to implement national nutritional care programs and develop good practices in care, research, education in order to increase awareness on malnutrition and improve nutritional care. This article describes the making of and evolution of the ONCA campaign, the outcomes and impact created, as well as opportunities to accelerate implementation of personalized nutritional care for all European citizens.

Malnutrition constitutes a serious and challenging problem in elderly care. In 2015, a Swedish regulation that aims to prevent and treat malnutrition came into effect. This study set out to explore associations between level of adoption of the regulation reported as: no, started, yes, in a previous survey, and registrations in a national quality registry. Registry data on screening and actions extracted from the first trimester in 2014 (n=18967), 2016 (n=20318) and 2017 (n= 25669) represented 209, 197 and 199 of 290 Swedish municipalities respectively. A repeated measures ANOVA showed that there was no effect on screened nutritional status, Pearson's chi-square that there were minor differences in types of actions, and regression analysis that the number of actions increased on average by 0.3 due to a higher level of adoption of the regulation. Over the years studied, five actions were prominent regardless of level of adoption or screened nutritional status. Hence, to date, no firm conclusions regarding effects of the regulation can be drawn. Despite the regulatory nature, it appear as if the regulation and the level of adoption reported so far is routine in theory, although not yet leveraged to an implemented practice visible in the quality registry but instead decoupled from practice., Correction in: HEALTH POLICY, Volume: 123, Issue: 8, Pages: 803-803, DOI: 10.1016/j.healthpol.2019.06.005

Background: Malnutrition and dehydration are widespread in older people, and obesity is an increasing problem. In clinical practice, it is often unclear which strategies are suitable and effective in counteracting these key health threats. Aim: To provide evidence-based recommendations for clinical nutrition and hydration in older persons in order to prevent and/or treat malnutrition and dehydration. Further, to address whether weight-reducing interventions are appropriate for overweight or obese older persons. Methods: This guideline was developed according to the standard operating procedure for ESPEN guidelines and consensus papers. A systematic literature search for systematic reviews and primary studies was performed based on 33 clinical questions in PICO format. Existing evidence was graded according to the SIGN grading system. Recommendations were developed and agreed in a multistage consensus process. Results: We provide eighty-two evidence-based recommendations for nutritional care in older persons, covering four main topics: Basic questions and general principles, recommendations for older persons with malnutrition or at risk of malnutrition, recommendations for older patients with specific diseases, and recommendations to prevent, identify and treat dehydration. Overall, we recommend that all older persons shall routinely be screened for malnutrition in order to identify an existing risk early. Oral nutrition can be supported by nursing interventions, education, nutritional counseling, food modification and oral nutritional supplements. Enteral nutrition should be initiated if oral, and parenteral if enteral nutrition is insufficient or impossible and the general prognosis is altogether favorable. Dietary restrictions should generally be avoided, and weight-reducing diets shall only be considered in obese older persons with weight-related health problems and combined with physical exercise. All older persons should be considered to be at risk of low-intak

The main aim of this thesis is to study local level outcomes regarding food service and nutritional care in Swedish elderly care in relation to the progress of national actions. Study I compared results from a repeated national survey using a questionnaire investigating the general structure and organisation of food service in elderly care. Study II built on data merged from a questionnaire, open comparison survey data and records from the quality registry Senior Alert to investigate nutritional care practice, focusing on quality indicators related to food service. Study III was a web-based questionnaire that described perceived facilitators in the process of adopting a national regulation that aims to prevent and treat malnutrition. Study IV explored associations between the level of adoption of the regulation and registrations in Senior Alert using registry data and results from a questionnaire. Differences were found primarily between rural and city municipality groups. The predominant food service organisation was public, but city municipalities reported a higher and increased use of private providers, chilled production and meal choices. The number of clinical/community dietitians had declined significantly between the surveys. Access to this profession was associated with being well-nourished. Food service dietitians and private providers were positively associated with meal satisfaction, while the food production system cook-chill was negatively associated. One year after the launch of the regulation, 50% of municipalities had adopted new routines. The odds for adoption were higher in municipalities where preventive work was already in progress, the regulation was considered helpful, and where facilitators had long experience of working in elderly care. The most important support factors for the adoption of new routines were cooperation between professions and well-defined goals. There was no significant difference in nutritional screening scores assoc

Bakgrund I Sverige lever runt 160,000 människor med demens, vilket är ett neurologiskt tillstånd där hjärnvävnad förtvinat. Detta leder till att fysiologiska och kognitiva funktioner försvagas. Omvårdnadsåtgärder relaterade till en person med demens fokuserar på att lindra symtom och tillhandahålla assistans gentemot den funktionella nedsättningen. Detta kan appliceras vid nutritionsintag då måltidssituationer kan bli en komplex uppgift för personer med demens, dessa åtgärder kan utföras ur ett personcentrerat spektra för att tillgodose individen. Syfte Syftet med litteraturöversikten var att utforska personcentrerade omvårdnadsåtgärder som en sjuksköterska kan applicera till olika omständigheter för att optimera nutritionsintaget hos personer med demens. Metod En litteraturöversikt sammanställd genom 11 stycken vetenskapliga artiklar. Resultat Fem omvårdnadsåtgärder som främjade nutritionsintag hos personer med demens var att under måltid lyssna till musik, erhålla personlig assistans för att underlätta måltidsintag, muntlig uppmaning som stöd, hur maten presenterades, träningsprogram vid måltid. Konklusion Ur denna översikt har omvårdnadsåtgärder framkommit som är till fördel för personen med demens i samband med nutritionsintag. När inte omvårdnadsåtgärder appliceras för måltidssituationen kan tillståndet hos personen med demens förvärras drastiskt genom exempelvis sjukdom och orörlighet, vilket ger försämrad livskvalitet. De omvårdnadsåtgärder som presenteras skulle genom enkla tillvägagångssätt kunna tillhandahållas av vårdgivare och anhöriga., Background In Sweden, around 160,000 people live with a dementia diagnosis, which is a neurological condition where brain tissue has faded. This will lead to a decrease in physiological and cognitive abilities. Nursing interventions related to a person with dementia focus on relieving symptoms and providing assistance towards the functional decrease. These interventions can be applied to nutritional intake since meal situations can be a complex task for people with dementia. To accommodate the individual, these actions can be performed from a person-centered spectra. Aim The aim of the literature review was to explore person-centered nursing measures that a nurse can apply for various factors to optimize nutrition intake in people with dementia. Method An overview compiled of 11 scientific articles. Findings Five interventions that benefited the nutritional intake for people with dementia were listen to music during the meal, receive personal assistance to aid food intake, verbal prompting as support, how the food was presented, training programs at mealtime. Conclusion From this overview, interventions have been identified that are beneficial to the person with dementia in connection with nutritional intake. When no interventions are applied to meals, the condition of the person with dementia could be worsened dramatically through, for example, disease and immobility, resulting in deterioration in quality of life. The interactions presented could be provided by caregivers and relatives through simple approaches.

Background: Shared decision making (SDM) holds great potential for improving the therapeutic efficiency and quality of nutritional treatment of dyslipidaemia by promoting patient involvement in decision making. Adoption of specific behaviours fostering SDM during consultations has yet to be studied in routine dietetic practice. Objective: Using a cross-sectional study design, we aimed to explore both dieticians’ and patients’ adoption of SDM behaviours in dietetic consultations regarding the nutritional treatment of dyslipidaemia. Methods: Twenty-six dieticians working in local health clinics in the Quebec City metropolitan area were each asked to identify one dyslipidaemic patient they would see in an upcoming consultation. Based on the Theory of Planned Behaviour (TPB), questionnaires were designed to study two targeted SDM behaviours: ‘to discuss nutritional treatment options for dyslipidaemia’ and ‘to discuss patients’ values and preferences about nutritional treatment options for dyslipidaemia’. These questionnaires were administered to the dietician–patient dyad individually before the consultation. Associations between TPB constructs (attitude, subjective norm and perceived behavioural control) towards behavioural intentions were analysed using Spearman’s partial correlations. Results: Thirteen unique patient-dietician dyads completed the study. Perceived behavioural control was the only TPB construct significantly associated with both dieticians’ and patients’ intentions to adopt the targeted SDM behaviours (P < 0.05). Conclusions: As perceived behavioural control seems to determine dieticians’ and patients’ adoption of SDM behaviours, interventions addressing barriers and reinforcing enablers of these behaviours are indicated. This exploratory study highlights issues that could be addressed in future research endeavours to expand the knowledge base relating to SDM adoption in dietetic practice.

Our initial Study/Product Aim(s) were as follows: 1) To determine under what conditions compliance with nutritional goals are not met in severely burned adults, 2) To find strategies to address identified gaps in feeding to incorporate into a checklist with easy clinical utility, and 3) To develop and test a system that incorporates the above strategies. The system will provide points in a checklist for provider attention and decision support guidelines for appropriate changes to meet cumulative and current nutritional goals. In the first year of this award, we have moved forward by collecting data from several hundred severely burned subjects treated in the ICU on nutritional provision from 3 of the 4 centers involved. We have also established the software package upon which the platform will be based. In the coming year, these data will be used to find the gaps in nutritional provision and develop a system to address these through decision support tools., The original document contains color images.

Background: Shared decision making (SDM) holds great potential for improving the therapeutic efficiency and quality of nutritional treatment of dyslipidaemia by promoting patient involvement in decision making. Adoption of specific behaviours fostering SDM during consultations has yet to be studied in routine dietetic practice. Objective: Using a cross-sectional study design, we aimed to explore both dieticians’ and patients’ adoption of SDM behaviours in dietetic consultations regarding the nutritional treatment of dyslipidaemia. Methods: Twenty-six dieticians working in local health clinics in the Quebec City metropolitan area were each asked to identify one dyslipidaemic patient they would see in an upcoming consultation. Based on the Theory of Planned Behaviour (TPB), questionnaires were designed to study two targeted SDM behaviours: ‘to discuss nutritional treatment options for dyslipidaemia’ and ‘to discuss patients’ values and preferences about nutritional treatment options for dyslipidaemia’. These questionnaires were administered to the dietician–patient dyad individually before the consultation. Associations between TPB constructs (attitude, subjective norm and perceived behavioural control) towards behavioural intentions were analysed using Spearman’s partial correlations. Results: Thirteen unique patient-dietician dyads completed the study. Perceived behavioural control was the only TPB construct significantly associated with both dieticians’ and patients’ intentions to adopt the targeted SDM behaviours (P < 0.05). Conclusions: As perceived behavioural control seems to determine dieticians’ and patients’ adoption of SDM behaviours, interventions addressing barriers and reinforcing enablers of these behaviours are indicated. This exploratory study highlights issues that could be addressed in future research endeavours to expand the knowledge base relating to SDM adoption in dietetic practice.

SAMMANFATTNINGBakgrund: När människan åldras så förändras inte bara kroppens utseende utan också dessnutritionsbehov. Äldre personer som är i kontakt med vården upplever att de inte får denhjälp de behöver med att anpassa nutritionsvården till sina individuella behov ochförutsättningar. När nutritionsvården inte kan anpassas till patienternas individuella behovså föreligger det risk för försämrad hälsa och ett ökat lidande. Patienterna upplever inte attsjuksköterskorna uppmärksammar deras upplevelser av nutritionsvården. Syfte: Syftet meddetta examensarbete är att beskriva sjuksköterskors upplevelser av att tillgodose äldresnäringsbehov. Metod: En kvalitativ litteraturstudie med induktiv ansats används för att fåfram sjuksköterskornas upplevelser. De vetenskapliga artiklarna analyseras enligt Evans(2002). Resultat: Resultatet visar att sjuksköterskorna efterfrågar mer utbildning omnutritionsvård för att utveckla sina kunskaper och därigenom kunna säkerställa en god ochsäker vård för de äldre patienterna. Sjuksköterskorna kan känna stolthet men även skam överderas egen insats av att utföra nutritionsvård. Slutsatser: Fortsatta studier kring patientersoch sjuksköterskors upplevelser behövs där deras svar ställs mot varandra för att tydligareupptäcka eventuella problem. Med tanke på att den äldre befolkningen ökar så behövs merkunskap om nutrition till de äldre personerna i samhället.Nyckelord: Kunskap, nutritionsvård, patient, samarbete, sjuksköterska, Background: As the human being comes of age, change appears not only in the physicalappearance but also in its nutritional requirements. Elder people who are in contact withhealth care feel that they do not get the help they needed to adapt nutritional care to theirindividual needs and circumstances. When nutritional care cannot be adapted to patients’individual needs, there are risks of impaired health and increased suffering. The patients donot experience that nurses notes their experiences of nutritional care. Aim: The purpose ofthis study is to describe nurses’ experiences of meeting the nutritional needs of the elderly.Method: A qualitative study of inductive approach is used to get nurses’ experiences. Thescientific articles are analyzed according to Evans (2002). Results: The results shows thatnurses want more education on nutritional care to develop their skills and thereby ensure agood and safe care for elderly patients. The nurses can feel pride but also shame related totheir own effort to perform nutritional care. Conclusions: Further studies on patients’ andnurses’ experiences are needed where their responses are set against each other in order tomore clearly identify possible problems. Given that the elderly population increases, morenutritional knowledge is needed for the elderly people in the community.Keywords: Cooperation, knowledge, nurse, nutritional care, patient

Elderly persons with a hip fracture often lack appetite. This can delay the recovery. Therefore, a study was conducted in which elderly with a hip fracture received intensive nutritional coaching by a dietician (10 contact moments) during 3 months if necessary combined with fluid nutrition. This coaching took place both in the hospital and in recovery care and in home situation. To test the usability of this nutritional intervention in the health care practice a process evaluation was carried out. The provided nutritional intervention turned out well applicable and was highly appreciated by patients. However, introducing this intensive nutritional care requires extra attention, particularly due to the lack of structural attention for nutrition in the existing health care.