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The struggle to balance system and lifeworld: Swedish dietitians’ experiences of a standardised nutrition care process and terminology
Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Food, Nutrition and Dietetics.
Karolinska Inst, Dept Learning Informat Management & Eth, Stockholm, Sweden; Karolinska Univ Hosp, Funct Area Clin Nutr, Stockholm, Sweden.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Clinical Nutrition and Metabolism.
Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Food, Nutrition and Dietetics.
2016 (English)In: Health Sociology Review, ISSN 1446-1242, E-ISSN 1839-3551, Vol. 25, no 3, 240-255 p.Article in journal (Refereed) Published
Abstract [en]

In this study, we explored Swedish dietitians’ experiences of a standardised Nutrition Care Process (NCP) and terminology from the perspective of Habermas’ concepts of system and lifeworld. Seven focus group discussions were analysed thematically. In thispaper, we argue that dietitians seem to mainly connect the NCP with a system perspective, highlighting aspects such as professionalism, measurability and clarity of the patient record as helpful outcomes from the NCP standardisation. We also see a tension between system and lifeworld, as dietitians emphasised the importance of the dietitian–patient relationship, stating that a patient’s complex situation does not always fit into the pre-defined NCP terms and measurements. Several approaches were identified whereby dietitians tried to reach a balance between the system and lifeworld. We argue that strategies for achieving this balance need more attention in the education and implementation of standardised care processes and terminologies.

Place, publisher, year, edition, pages
2016. Vol. 25, no 3, 240-255 p.
Keyword [en]
Nutrition Care Process; dietitian; professionalism; terminology; Habermas
National Category
Other Social Sciences not elsewhere specified Nutrition and Dietetics
Research subject
Food, Nutrition and Dietetics
Identifiers
URN: urn:nbn:se:uu:diva-263914DOI: 10.1080/14461242.2016.1197783ISI: 000384077900002OAI: oai:DiVA.org:uu-263914DiVA: diva2:858718
Available from: 2015-10-04 Created: 2015-10-04 Last updated: 2017-12-01Bibliographically approved
In thesis
1. Dietetic documentation: Content, language and the meaning of standardization in Swedish dietitians’ patient record notes
Open this publication in new window or tab >>Dietetic documentation: Content, language and the meaning of standardization in Swedish dietitians’ patient record notes
2015 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

The aim of this thesis was to explore dietetic notes in Swedish patient records regarding content, language and the meaning of standardization.

Firstly, an audit instrument for dietetic notes in patient records, Diet-NCP-Audit, was elaborated and tested. The instrument, a 14-item scoring questionnaire based on the four steps of the Nutrition Care Process (NCP), proved to have high content validity and moderate to high inter- and intra-rater reliability. The instrument was then used in an evaluation of the content, language and structure of 147 Swedish dietetic notes. Although the nutrition intervention and some information about the evaluation were well documented, the overall result showed a need for improvement in several aspects of documentation, such as nutrition prescriptions, goals and the connection between problem-etiology-symptom.

After this, 30 of the audited dietetic notes were also included in a critical linguistic study exploring how the patients and dietitians were referred to in the notes. The dietetic notes contained several linguistic devices that impersonalized and passivized both the patient and the dietitian. Thus, the grammar of the dietetic notes did not enhance or reflect the patient-centered care and the active patient-caregiver relationship that is emphasized in most health care guidelines today.

Finally, a focus group study was performed. Swedish dietitians’ experiences of the standardized Nutrition Care Process (NCP) and its connected terminology (NCPT) were explored and analyzed from the perspective of Habermas’ system and lifeworld concepts. While recognizing many advantages with the NCP and NCPT, dietitians also expressed difficulties in combining the structured and standardized process and terminology with a flexible, patient-centered approach in nutrition care.

In summary, I argue that strategies for the improvement of dietetic documentation are needed. I also suggest that the NCP and NCPT play an essential role in dietetic professionalization. At the same time, however, this standardization may entail the risk of a reductionist view and difficulties regarding how to balance the different ideals of health care. Thus, there is a need for discussions concerning how to use and develop the NCP and dietetic language in a way that ensures the best possible care for the patient.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2015. 88 p.
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Social Sciences, ISSN 1652-9030 ; 118
Keyword
Nutrition informatics, dietitians, Nutrition Care Process, patient records, professionalization
National Category
Other Social Sciences not elsewhere specified
Research subject
Food, Nutrition and Dietetics
Identifiers
urn:nbn:se:uu:diva-263915 (URN)978-91-554-9359-2 (ISBN)
Public defence
2015-11-20, BMC, sal A1: 111, Husargatan 3, Uppsala, 09:15 (English)
Opponent
Supervisors
Available from: 2015-10-30 Created: 2015-10-04 Last updated: 2015-11-10

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