A descriptive phenomenological study exploring patient experiences of parenteral nutrition in an acute healthcare setting

Abstract

Introduction: Parenteral nutrition (PN) is the intravenous administration of nutrition, required when the gastrointestinal tract is incapable of adequate nutrient absorption (NICE 2006). PN has higher levels of complications than other routes of feeding (Stewart et al. 2010) and restriction or modification of patients’ oral intake is required to control gastrointestinal symptoms (Culkin, Gabe and Madden 2009). There is a lack of research investigating the experience of patients who require parenteral nutrition (PN) in acute care. Improving patient experiences of healthcare is a national priority following the Mid-Staffordshire Public Inquiry (Francis, 2013). The aim of this study was to explore the patient experiences of receiving PN in the acute healthcare setting. Study Design: Descriptive phenomenology was the chosen methodology. Purposive sampling was used to recruit ten participants who had received PN for >7 days in an acute teaching hospital. In-depth interviews were conducted, which were audio-recorded. The interviews were transcribed verbatim and qualitatively analysed, guided by Colaizzi’s (1978) approach. Results: PN was universally considered positive by participants. It was ‘life saving’ and they felt it unlikely that they would have survived the hospital admission without it. Three core themes and seven subthemes were identified: 1) the altered relationship with food (subthemes: coping with the inability to eat ‘normally’ and loss of control over food-related decision making), 2) relationships with healthcare professionals (subthemes: competency, trust, coping with poor team working), 3) the need for patient centred care (subthemes: being heard, empowering the patient). The participants reported a profoundly altered relationship with food and eating whilst on PN due to the underlying intestinal failure. The organisation of nutritional ii services were described as fragmented due to lack of coordination and poor communication. This resulted in confusion and anxiety for the participants due to the conflicting information provided, and affected their trust and confidence in their care. In addition, healthcare professionals frequently did not operate in a patient centred manner, failing to include patients in decision making regarding their nutritional treatment. This was particularly evident when several clinical teams were involved and when enteral nutrition was introduced. The participants were clear that they wished for their nutritional care to be controlled by the nutrition support team, who they described as experts and because they operated in a more patient centred manner. Conclusion: Patient experiences of PN could be improved by nutrition support teams having greater autonomy regarding the provision of nutritional advice, better coordination and communication of nutritional care and by providing more support to patients on coping with the altered relationship with food.

Date of Award	2015
Original language	English
Awarding Institution	Coventry University
Supervisor	Alison Culkin (Supervisor), Linda Merriman (Supervisor) & Chris Carpenter (Supervisor)