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  • 1.
    Bergman, Karolin
    et al.
    Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Food, Nutrition and Dietetics.
    Elmståhl, Helena
    Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Food, Nutrition and Dietetics.
    Lövestam, Elin
    Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Food, Nutrition and Dietetics.
    Nowicka, Paulina
    Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Food, Nutrition and Dietetics.
    Eli, Karin
    University of Oxford.
    Persson Osowski, Christine
    Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Food, Nutrition and Dietetics.
    Healthy eating as conceptualized in referral responses to Sweden’s updated dietary guidelines: excluding the complexity of everyday life2017Conference paper (Other academic)
    Abstract [en]

    National Dietary Guidelines have been published in many countries to support healthier food habits among the public. In Sweden, the guidelines are produced in a process involving experts and stakeholders under the responsibility of the National Food Agency. Stakeholder perspectives on the concept of state dietary advice was explored in this study, by analyzing 40 referral responses on updated guidelines in Sweden 2015. The study focused on ideas about how state dietary advice should be framed and what it should be based on. Thematic analysis was used and resulted in two main themes. 'Securing scientifically proven advice' represented a perspective of the guidelines as to be scientifically correct and verified, and built upon an underlying assumption to present an objective and optimal composition of foods and nutrients that will fit all. Arguments based on nutritional reductionism could be seen, which gave a delimited idea of what healthy food is. 'Getting the message across' represented a perspective of the guidelines to be easily understood by and inclusive to the end user. Clarity in advice was seen to be reached by explaining difficult words, defining amounts and exact mechanisms of why something is a good choice. Also this perspective added to excluding other values of food, especially qualitative ones. The construction of a healthy diet in these remittance responses builds upon a notion of an ideal diet composed on the basis of the best scientific proof and clearly presented so as to be easily understood and practiced. It was clearly based on an individualistic behavioral view making the individual responsible to make informed and good choices for a healthy diet. This approach may be questioned, as it is too simplified to include the complex reality of everyday life.

  • 2.
    Bergman, Karolin
    et al.
    Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Food, Nutrition and Dietetics.
    Persson Osowski, Christine
    Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Food, Nutrition and Dietetics.
    Eli, Karin
    University of Oxford, Oxford, UK.
    Lövestam, Elin
    Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Food, Nutrition and Dietetics.
    Elmståhl, Helena
    Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Food, Nutrition and Dietetics.
    Nowicka, Paulina
    Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Food, Nutrition and Dietetics.
    Stakeholder responses to governmental dietary guidelines: Challenging the status quo, or reinforcing it?2018In: British Food Journal, ISSN 0007-070X, E-ISSN 1758-4108, Vol. 120, no 3, p. 613-624Article in journal (Refereed)
    Abstract [en]

    Purpose

    The purpose of this paper is to explore how stakeholders in the food and nutrition field construct and conceptualise “appropriate” national dietary advice.

    Design/methodology/approach

    In total, 40 voluntarily written stakeholder responses to updated official dietary guidelines in Sweden were analysed thematically. The analysis explored the logics and arguments employed by authorities, interest organisations, industry and private stakeholders in attempting to influence the formulation of dietary guidelines.

    Findings

    Two main themes were identified: the centrality of anchoring advice scientifically and modes of getting the message across to the public. Stakeholders expressed a view of effective health communication as that which is nutritionally and quantitatively oriented and which optimises individuals’ capacities to take action for their own health. Their responses did not offer alternative framings of how healthy eating could be practiced but rather conveyed an understanding of dietary guidelines as documents that provide simplified answers to complex questions.

    Practical implications

    Policymakers should be aware of industrial actors’ potential vested interests and actively seek out other stakeholders representing communities and citizen interests. The next step should be to question the extent to which it is ethical to publish dietary advice that represents a simplified way of conceptualising behavioural change, and thereby places responsibility for health on the individual.

    Originality/value

    This research provides a stakeholder perspective on the concept of dietary advice and is among the first to investigate referral responses to dietary guidelines.

  • 3.
    Liljeberg, Evelina
    et al.
    Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Food, Nutrition and Dietetics. Function Area Clinical Nutrition, Karolinska University Hospital, Norrbacka S1:03, SE-17176 Stockholm, Sweden.
    Andersson, Agneta
    Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Food, Nutrition and Dietetics.
    Lövestam, Elin
    Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Food, Nutrition and Dietetics.
    Nydahl, Margaretha
    Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Food, Nutrition and Dietetics.
    Incomplete descriptions of oral nutritional supplement interventions in reports of randomised controlled trials2018In: Clinical Nutrition, ISSN 0261-5614, E-ISSN 1532-1983, Vol. 37, no 1, p. 61-71Article in journal (Refereed)
    Abstract [en]

    Background & aims

    The effects of oral nutritional supplements (ONS) have been evaluated in several clinical trials and more studies have been requested. To facilitate replication, support accurate evaluations of research results and avoid research waste, high quality reporting of interventions in clinical trials is needed. The aim of this study is to assess the quality of reporting of interventions in publications describing randomised controlled trials of ONS in populations with malnutrition or at nutritional risk.

    Methods

    The PubMed database was searched for articles describing ONS trials published between January 2002 and December 2015. The quality of intervention descriptions was evaluated using the Template for Intervention Description and Replication (TIDieR) checklist and guide, which contains twelve items. Articles published before and after 2011 were compared.

    Results

    Of 76 articles identified, only 3% reported all TIDieR items in sufficient detail. The most frequently missing elements were descriptions of the intervention procedures (e.g. how the ONS were to be taken and if participants were given a choice of flavours), which were adequately presented in only 26% of the articles. Less than half of the articles included a description of the intervention provider and sufficient information about the location(s) for the intervention. Information about adherence and mode of delivery was reported in 60–65% of the articles. Most frequently reported, in >70% of the articles, were items regarding the brief name of the intervention, the rationale for the intervention and the materials used (i.e. information about the specific ONS product(s) administered). The reporting quality for two of the items (materials and provider) was higher in articles published after 2011.

    Conclusions

    The quality of reporting of ONS interventions was found to be poor. The descriptions mostly lacked information about intervention procedures, provider and location(s). A moderately higher reporting quality was observed in articles published after 2011. These findings imply that an improvement in the descriptions of ONS interventions is required in future clinical trials of malnutrition treatment.

  • 4.
    Lövestam, Elin
    Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Food, Nutrition and Dietetics.
    Dietetic documentation: Content, language and the meaning of standardization in Swedish dietitians’ patient record notes2015Doctoral 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.

    List of papers
    1. Evaluation of a Nutrition Care Process-based audit instrument, the Diet-NCP-Audit, for documentation of dietetic care in medical records
    Open this publication in new window or tab >>Evaluation of a Nutrition Care Process-based audit instrument, the Diet-NCP-Audit, for documentation of dietetic care in medical records
    Show others...
    2014 (English)In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 28, no 2, p. 390-397Article in journal (Refereed) Published
    Abstract [en]

    Adequate documentation in medical records is important for high-quality health care. Documentation quality is widely studied within nursing, but studies are lacking within dietetic care. The aim of this study was to translate, elaborate and evaluate an audit instrument, based on the four-step Nutrition Care Process model, for documentation of dietetic care in medical records. The audit instrument includes 14 items focused on essential parts of dietetic care and the documentation's clarity and structure. Each item is to be rated 0-1 or 0-2 points, with a maximum total instrument score of 26. A detailed manual was added to facilitate the interpretation and increase the reliability of the instrument. The instrument is based on a similar tool initiated 9 years ago in the United States, which in this study was translated to Swedish and further elaborated. The translated and further elaborated instrument was named Diet-NCP-Audit. Firstly, the content validity of the Diet-NCP-Audit instrument was tested by five experienced dietitians. They rated the relevance and clarity of the included items. After a first rating, minor improvements were made. After the second rating, the Content Validity Indexes were 1.0, and the Clarity Index was 0.98. Secondly, to test the reliability, four dietitians reviewed 20 systematically collected dietetic notes independently using the audit instrument. Before the review, a calibration process was performed. A comparison of the reviews was performed, which resulted in a moderate inter-rater agreement with Krippendorff's α = 0.65-0.67. Grouping the audit results in three levels: lower, medium or higher range, a Krippendorff's α of 0.74 was considered high reliability. Also, an intra-rater reliability test-retest with a 9 weeks interval, performed by one dietitian, showed strong agreement. To conclude, the evaluated audit instrument had high content validity and moderate to high reliability and can be used in auditing documentation of dietetic care.

    Keywords
    Dietetic, documentation, medical records, nutrition care process
    National Category
    Social Sciences Interdisciplinary Health Care Service and Management, Health Policy and Services and Health Economy
    Research subject
    Food, Nutrition and Dietetics
    Identifiers
    urn:nbn:se:uu:diva-200517 (URN)10.1111/scs.12049 (DOI)000334503400021 ()
    Available from: 2013-05-29 Created: 2013-05-29 Last updated: 2018-01-11Bibliographically approved
    2. Evaluation of Nutrition Care Process documentation in electronic patient records: Need of improvement
    Open this publication in new window or tab >>Evaluation of Nutrition Care Process documentation in electronic patient records: Need of improvement
    Show others...
    2015 (English)In: Nutrition & Dietetics, ISSN 1446-6368, E-ISSN 1747-0080, Vol. 72, no 1, p. 74-80Article in journal (Refereed) Published
    Abstract [en]

    Aim

    High-quality documentation in patient records is essential for patient safety and plays a prominent role in the delivery and evaluation of dietetic/nutrition care. We aimed to evaluate dietitians' documentation in patient records according to the four steps in the Nutrition Care Process: assessment, diagnosis, intervention and monitoring/evaluation.

    Methods

    A retrospective audit of 147 systematically collected outpatient dietetic notes from primary care centres and hospitals in central Sweden was performed using a validated audit instrument. The instrument was used to assess the documentation of 14 items: 10 items focusing on the Nutrition Care Process steps and four items on language clarity and structure, with a maximum total score of 26 for each dietetic note. The notes were divided into three different quality levels, A (high score), B (medium score) or C (low score). Comparisons were made between notes from primary care and hospitals.

    Results

    The audit showed that the majority of the notes were placed at level B, scoring 13.5–19.5. Only 3% of the notes scored higher than 19.5. The most frequently documented items were intervention (90%), evaluation (70%) and nutrition problem (56%), whereas the least documented items were nutrition prescription (15%), goal of intervention (9%) and connection of problem-etiology-symptom (5%). Flaws in lingual clarity were common (72%). Primary care notes received higher scores than those from hospitals.

    Conclusions

    The audit shows that Swedish dietetic documentation needs to be improved, for example, by further training and education in the Nutrition Care Process and its standardised terminology.

    National Category
    Other Social Sciences Nutrition and Dietetics
    Research subject
    Food, Nutrition and Dietetics
    Identifiers
    urn:nbn:se:uu:diva-230205 (URN)10.1111/1747-0080.12128 (DOI)000352153400012 ()
    Available from: 2014-08-20 Created: 2014-08-20 Last updated: 2017-12-05Bibliographically approved
    3. The power of language on patient‐centredness: linguistic devices in the dietetic notes of patient records
    Open this publication in new window or tab >>The power of language on patient‐centredness: linguistic devices in the dietetic notes of patient records
    2015 (English)In: International Journal of Applied Linguistics, ISSN 0802-6106, E-ISSN 1473-4192, Vol. 25, no 2, p. 225-245Article in journal (Refereed) Published
    Abstract [en]

    n this paper, 30 notes written by Swedish dietitians in patient records are analysed, inspired by Critical Linguistics and Critical Discourse Analysis. Focusing on linguistic devices such as agency sources and evidential markers, we describe how patients are constantly referred to only in terms of the institutional patient role, or not referred to at all, through different techniques such as nominalization and passive verbs. The dietitians writing the notes are even more absent from the text, as they almost never refer to themselves as persons in the dietetic notes. There is a stated ambition in health care to provide patient-centred care and a collaborative patient-clinician relationship. However, we suggest that there might be a need for more person-centred language in dietetics.

    Keywords
    Patient records, dietetics, medical discourse, patient-centered care
    National Category
    Other Social Sciences General Language Studies and Linguistics
    Research subject
    Food, Nutrition and Dietetics
    Identifiers
    urn:nbn:se:uu:diva-230206 (URN)10.1111/ijal.12064 (DOI)000368177400005 ()
    Available from: 2014-08-20 Created: 2014-08-20 Last updated: 2018-01-11Bibliographically approved
    4. The struggle to balance system and lifeworld: Swedish dietitians’ experiences of a standardised nutrition care process and terminology
    Open this publication in new window or tab >>The struggle to balance system and lifeworld: Swedish dietitians’ experiences of a standardised nutrition care process and terminology
    2016 (English)In: Health Sociology Review, ISSN 1446-1242, E-ISSN 1839-3551, Vol. 25, no 3, p. 240-255Article 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.

    Keywords
    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:nbn:se:uu:diva-263914 (URN)10.1080/14461242.2016.1197783 (DOI)000384077900002 ()
    Available from: 2015-10-04 Created: 2015-10-04 Last updated: 2017-12-01Bibliographically approved
  • 5.
    Lövestam, Elin
    et al.
    Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Food, Nutrition and Dietetics.
    Boström, Anne-Marie
    Orrevall, Ylva
    Karolinska Institutet, Institutionen för lärande, informatik, management och etik.
    Nutrition Care Process Implementation: Experiences in Various Dietetics Environments in Sweden2017In: Journal of the Academy of Nutrition and Dietetics, ISSN 2212-2672, E-ISSN 2212-2680, Vol. 117, no 11, p. 1738-1748Article in journal (Refereed)
    Abstract [en]

    Background

    The Nutrition Care Process (NCP) and Nutrition Care Process Terminology (NCPT) are currently being implemented by nutrition and dietetics practitioners all over the world. Several advantages have been related to this implementation, such as consistency and clarity of dietetics-related health care records and the possibility to collect and research patient outcomes. However, little is known about dietitians’ experiences of the implementation process.

    Objective

    The aim of this qualitative study was to explore Swedish dietitians’ experiences of the NCP implementation process in different dietetics environments.

    Method

    Thirty-seven Swedish dietitians from 13 different dietetics workplaces participated in seven focus group discussions that were audiotaped and carefully transcribed. A thematic secondary analysis was performed, after which all the discussions were re-read, following the implementation narrative from each workplace. In the analysis, The Promoting Action on Research Implementation in Health Services implementation model was used as a framework.

    Results

    Main categories identified in the thematic analysis were leadership and implementation strategy, the group and colleagues, the electronic health record, and evaluation. Three typical cases are described to illustrate the diversity of these aspects in dietetics settings: Case A represents a small hospital with an inclusive leadership style and discussion-friendly culture where dietitians had embraced the NCP/NCPT implementation. Case B represents a larger hospital with a more hierarchical structure where dietitians were more ambivalent toward NCP/NCPT implementation. Case C represents the only dietitian working at a small multiprofessional primary care center who received no dietetics-related support from management or colleagues. She had not started NCP/NCPT implementation.

    Conclusions

    The diversity of dietetics settings and their different prerequisites should be considered in the development of NCP/NCPT implementation strategies. Tailored implementation strategies should be considered in relation to context, such as increased dietetics support and facilitation where management does not lead or support the implementation process.

  • 6.
    Lövestam, Elin
    et al.
    Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Food, Nutrition and Dietetics.
    Fjellström, Christina
    Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Food, Nutrition and Dietetics.
    Koochek, Afsaneh
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Clinical Nutrition and Metabolism.
    Andersson, Agneta
    Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Food, Nutrition and Dietetics.
    The power of language on patient‐centredness: linguistic devices in the dietetic notes of patient records2015In: International Journal of Applied Linguistics, ISSN 0802-6106, E-ISSN 1473-4192, Vol. 25, no 2, p. 225-245Article in journal (Refereed)
    Abstract [en]

    n this paper, 30 notes written by Swedish dietitians in patient records are analysed, inspired by Critical Linguistics and Critical Discourse Analysis. Focusing on linguistic devices such as agency sources and evidential markers, we describe how patients are constantly referred to only in terms of the institutional patient role, or not referred to at all, through different techniques such as nominalization and passive verbs. The dietitians writing the notes are even more absent from the text, as they almost never refer to themselves as persons in the dietetic notes. There is a stated ambition in health care to provide patient-centred care and a collaborative patient-clinician relationship. However, we suggest that there might be a need for more person-centred language in dietetics.

  • 7.
    Lövestam, Elin
    et al.
    Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Food, Nutrition and Dietetics.
    Kvist, Maria
    Stockholms universitet, Karolinska institutet.
    Velupillai, Sumithra
    Stockholms universitet.
    Abbreviations in Swedish Clinical Text-use by three professions2014In: Studies in health technology and informatics, 2014, p. 720-724Conference paper (Refereed)
  • 8.
    Lövestam, Elin
    et al.
    Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Food, Nutrition and Dietetics.
    Neuman, Nicklas
    Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Food, Nutrition and Dietetics.
    Nowicka, Paulina
    Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Food, Nutrition and Dietetics.
    Kritisk dietetik: Att se mat och ätande bortom kalorier2017In: Dietistaktuellt, Vol. 26, no 3, p. 32-34Article in journal (Other (popular science, discussion, etc.))
    Abstract [sv]

    Epidemiologiska studier visar att aspekter som låg utbildning, utländsk härkomst, hög arbetslöshet och boende i områden med lägre status är kopplade till större förekomst av ohälsa, exempelvis hjärtsjukdom, diabeteskomplikationer och fetma. Även vid sjukdomsrelaterad undernäring kan patientens sociala och ekonomiska situation vara avgörande för huruvida nutritionsbehandlingen ska lyckas. Men vilken verklighet och vilken vardag döljer sig bakom dessa samband? Hur ska dietister förhålla sig till det faktum att andra faktorer förutom omtanke om egen hälsa kan ha avgörande betydelse för patientens förmåga att göra hälsobefrämjande val? Bör vi ta ställning till och diskutera dessa frågor även utanför det rent nutritionsmässiga perspektivet?  

  • 9.
    Lövestam, Elin
    et al.
    Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Food, Nutrition and Dietetics.
    Neuman, Nicklas
    Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Food, Nutrition and Dietetics.
    Nowicka, Paulina
    Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Food, Nutrition and Dietetics.
    Kritisk dietetik: självreflektion, ödmjukhet och dialog2018In: DietistAktuellt, Vol. XXVII, no 2, p. 46-48Article in journal (Other (popular science, discussion, etc.))
    Abstract [sv]

    Tack vare medel från Vetenskapsrådet och Letterstedtska föreningen anordnade vi den 25 augusti konferensen ”The 1st Scandinavian Critical Dietetics Conference”, som syftade till att introducera ämnet kritisk dietetik i Sverige. I Dietistaktuellt nr 6 2017 skriver redaktören Magnus Forslin en personlig reflektion på åtta sidor där han angriper konferensen och de diskussioner som fördes där. Tonen i texten – kombinerat med associationer till bl a förintelseförnekelse och stalinism samt hånfulla illustrationer – inbjuder tyvärr inte till dialog. Istället för att ge oss in i en debatt på de premisserna tar vi tillfället i akt att kort och koncist lyfta några punkter om kritisk dietetik som vi gärna förtydligar. Då många av de antaganden och insinuationer som görs i artikeln saknar grund vill vi också bjuda in Dietistaktuellts läsare att själva ta del av konferensens presentationer, vilka ligger öppet på Institutionen för kostvetenskap, Uppsala Universitets webbplats.

  • 10.
    Lövestam, Elin
    et al.
    Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Food, Nutrition and Dietetics.
    Orrevall, Ylva
    Karlolinska Institutet, Stockholm.
    Koocheck, Afsaneh
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences.
    Karlström, Brita
    Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Food, Nutrition and Dietetics.
    Andersson, Agneta
    Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Food, Nutrition and Dietetics.
    An NCP-based audit instrument for dietitians´documentation in medical records2012Conference paper (Other academic)
  • 11.
    Lövestam, Elin
    et al.
    Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Food, Nutrition and Dietetics.
    Orrevall, Ylva
    Karolinska Inst, Dept Learning Informat Management & Eth, Stockholm, Sweden; Karolinska Univ Hosp, Funct Area Clin Nutr, Stockholm, Sweden.
    Koochek, Afsaneh
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Clinical Nutrition and Metabolism.
    Andersson, Agneta
    Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Food, Nutrition and Dietetics.
    The struggle to balance system and lifeworld: Swedish dietitians’ experiences of a standardised nutrition care process and terminology2016In: Health Sociology Review, ISSN 1446-1242, E-ISSN 1839-3551, Vol. 25, no 3, p. 240-255Article in journal (Refereed)
    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.

  • 12.
    Lövestam, Elin
    et al.
    Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Food, Nutrition and Dietetics.
    Orrevall, Ylva
    Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Food, Nutrition and Dietetics.
    Koochek, Afsaneh
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Clinical Nutrition and Metabolism.
    Karlström, Brita
    Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Food, Nutrition and Dietetics. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Clinical Nutrition and Metabolism.
    Andersson, Agneta
    Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Food, Nutrition and Dietetics.
    Evaluating Documentation of Dietetic Care in Swedish Medical Records2013In: MEDINFO 2013: Proceedings of the 14Th World Congress On Medical and Health Informatics, Pts 1 And 2 / [ed] Lehmann, CU; Ammenwerth, E and Nohr, C, 2013, p. 1078-1078Conference paper (Refereed)
    Abstract [en]

    An adequate documentation in medical records is essential for patient safety and high quality care. The aim of this study was to evaluate documentation by dietitians in Swedish medical records. A retrospective audit of 147 dietetic notes in electronic medical records was performed. The audit focused at documentation of essential parts of the dietetic care, as well as other quality aspects such as lingual clarity and structure of the documentation. The nutrition intervention showed to be the most documented part of dietetic care. However, the audit showed that several important parts of nutrition care were poorly documented, for instance nearly half of the audited records had no clear nutrition problem documented, and in most of the records, the goal of nutrition intervention was missing. The study shows that Swedish dietitians need to improve documentation in medical records, as a suggestion by implementing a more structured documentation model.

  • 13.
    Lövestam, Elin
    et al.
    Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Food, Nutrition and Dietetics.
    Orrevall, Ylva
    Karolinska Insitutet, Stockholm.
    Koochek, Afsaneh
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Clinical Nutrition and Metabolism.
    Karlström, Brita
    Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Food, Nutrition and Dietetics.
    Andersson, Agneta
    Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Food, Nutrition and Dietetics.
    Evaluation of a Nutrition Care Process-based audit instrument, the Diet-NCP-Audit, for documentation of dietetic care in medical records2014In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 28, no 2, p. 390-397Article in journal (Refereed)
    Abstract [en]

    Adequate documentation in medical records is important for high-quality health care. Documentation quality is widely studied within nursing, but studies are lacking within dietetic care. The aim of this study was to translate, elaborate and evaluate an audit instrument, based on the four-step Nutrition Care Process model, for documentation of dietetic care in medical records. The audit instrument includes 14 items focused on essential parts of dietetic care and the documentation's clarity and structure. Each item is to be rated 0-1 or 0-2 points, with a maximum total instrument score of 26. A detailed manual was added to facilitate the interpretation and increase the reliability of the instrument. The instrument is based on a similar tool initiated 9 years ago in the United States, which in this study was translated to Swedish and further elaborated. The translated and further elaborated instrument was named Diet-NCP-Audit. Firstly, the content validity of the Diet-NCP-Audit instrument was tested by five experienced dietitians. They rated the relevance and clarity of the included items. After a first rating, minor improvements were made. After the second rating, the Content Validity Indexes were 1.0, and the Clarity Index was 0.98. Secondly, to test the reliability, four dietitians reviewed 20 systematically collected dietetic notes independently using the audit instrument. Before the review, a calibration process was performed. A comparison of the reviews was performed, which resulted in a moderate inter-rater agreement with Krippendorff's α = 0.65-0.67. Grouping the audit results in three levels: lower, medium or higher range, a Krippendorff's α of 0.74 was considered high reliability. Also, an intra-rater reliability test-retest with a 9 weeks interval, performed by one dietitian, showed strong agreement. To conclude, the evaluated audit instrument had high content validity and moderate to high reliability and can be used in auditing documentation of dietetic care.

  • 14.
    Lövestam, Elin
    et al.
    Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Food, Nutrition and Dietetics.
    Orrevall, Ylva
    Karolinska Institutet, Institutionen för lärande, informatik, management och etik.
    Koochek, Afsaneh
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Clinical Nutrition and Metabolism.
    Karlström, Brita
    Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Food, Nutrition and Dietetics.
    Andersson, Agneta
    Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Food, Nutrition and Dietetics.
    Evaluation of Nutrition Care Process documentation in electronic patient records: Need of improvement2015In: Nutrition & Dietetics, ISSN 1446-6368, E-ISSN 1747-0080, Vol. 72, no 1, p. 74-80Article in journal (Refereed)
    Abstract [en]

    Aim

    High-quality documentation in patient records is essential for patient safety and plays a prominent role in the delivery and evaluation of dietetic/nutrition care. We aimed to evaluate dietitians' documentation in patient records according to the four steps in the Nutrition Care Process: assessment, diagnosis, intervention and monitoring/evaluation.

    Methods

    A retrospective audit of 147 systematically collected outpatient dietetic notes from primary care centres and hospitals in central Sweden was performed using a validated audit instrument. The instrument was used to assess the documentation of 14 items: 10 items focusing on the Nutrition Care Process steps and four items on language clarity and structure, with a maximum total score of 26 for each dietetic note. The notes were divided into three different quality levels, A (high score), B (medium score) or C (low score). Comparisons were made between notes from primary care and hospitals.

    Results

    The audit showed that the majority of the notes were placed at level B, scoring 13.5–19.5. Only 3% of the notes scored higher than 19.5. The most frequently documented items were intervention (90%), evaluation (70%) and nutrition problem (56%), whereas the least documented items were nutrition prescription (15%), goal of intervention (9%) and connection of problem-etiology-symptom (5%). Flaws in lingual clarity were common (72%). Primary care notes received higher scores than those from hospitals.

    Conclusions

    The audit shows that Swedish dietetic documentation needs to be improved, for example, by further training and education in the Nutrition Care Process and its standardised terminology.

  • 15.
    Lövestam, Elin
    et al.
    Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Food, Nutrition and Dietetics.
    Vivanti, Angela
    Papoutsakis, Constantina
    NCP around the world: experiences from USA and other countries2017In: Journal of the Academy of Nutrition and Dietetics: The 91st Food and Nutrition Conference and Expo, Chicago, 2017Conference paper (Refereed)
  • 16.
    Neuman, Nicklas
    et al.
    Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Food, Nutrition and Dietetics.
    Lövestam, Elin
    Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Food, Nutrition and Dietetics.
    Toward a critical dietetics in the Nordic countries2018In: Journal of Critical Dietetics, ISSN 1923-1237, Vol. 4, no 1, p. 5-14Article in journal (Refereed)
    Abstract [en]

    Whereas Critical Dietetics is still primarily centered in the Anglo-American countries, the movement is expanding internationally and has recently come to develop in the Nordic countries as well. On the 25th of August 2017, the first conference for Critical Dietetics in Scandinavia was held at Uppsala University, Sweden, and, following this, a network has been established: The Nordic Network for Critical Dietetics (NNCD). This paper is yet another step in this internationalization of Critical Dietetics. We discuss why we think that the Nordic countries have great potential to develop Critical Dietetics into an influential part of the future development of this promising international movement. We then explore three areas of controversy from a Nordic context that we see as touching upon, or being relevant for, Critical Dietetics. These are thematized as 1) challenges to individualism and cognitivism in behavioral change policies, 2) working against body weight and “bad lifestyles” stigmatization, and 3) trust and recognition: challenges to the professions. Each area is illustrated by a few examples of Nordic research and current public debates and campaigns from Sweden. The main argument is that the Nordic region already has a soil in which seeds of Critical Dietetics have been sown; it is time for them to grow.

  • 17. Papoutsakis, Constantina
    et al.
    Lövestam, Elin
    Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Food, Nutrition and Dietetics.
    Orrevall, Ylva
    Karolinska Institutet, Institutionen för lärande, informatik, management och etik.
    The International NCP (Nutrition Care Process) Implementation Survey (INIS): Preliminary Data from Greek Dietitians-Nutritionists2017In: Journal of the Academy of Nutrition and Dietetics: 91st Annual Food & Nutrition Conference & Expo, Chicago, 2017Conference paper (Refereed)
1 - 17 of 17
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