Moreover, the informants also pointed out that they found it difficult to know what nutrients and fluids patients consumed when everything was mixed together in the blender and recipes were not always followed. The informants therefore wanted the content and amount of smoothies to be recorded and documented in each case so that they had control of how much energy, nutrition and fluids the individual patient received. Documentation of food and drink is in accordance with national guidelines intended to ensure that nursing homes have systems to document patients’ nutritional status and risk of undernutrition (1, 5).
Can increase fruit intake
There were differing views among the informants about whether the patients consumed as much or more fruit and berries during the pilot project as they did before it started. Some believed that the patients consumed more fruit with smoothies, while others thought that they consumed as much fruit as before the start of the pilot project. An earlier study (33) shows that 4 per cent of children who ate breakfast also ate fruit, but when the school offered smoothies, the intake of fruit increased to 45 per cent. Although the study (33) was conducted on schoolchildren, its findings may possibly have transfer value to elderly patients in nursing homes.
Another study also shows that those who have regular access to smoothies are more able to consume enough fruit in comparison to those who do not have regular access to smoothies (15). Based on earlier studies and the findings in this study, there is reason to believe that the patients had an increased intake of fruit in connection with the pilot project.
Strengths and weaknesses of the study
A strength of our study is that we chose focus group interviews. Experiences and opinions that the participants shared in the group discussions can thus promote new reflections and thoughts that they can apply in their own practice (20).
The interviewer has a first degree in nursing education and further education in nutrition. This competence is a source of knowledge and understanding when asking follow-up questions (34). A limitation may be that this prior knowledge may have resulted in biased attitudes, and curbed the interviewer’s curiosity regarding the participants’ perceptions when the questions were asked (34). The interviewer was aware of this problem and endeavoured to ensure that her own knowledge, experiences and perceptions did not influence the interview situation, so that informants could relate their experiences freely.
A weakness of the study may be that only health personnel who worked during the day and in the evening were included in the study. The reason was that it proved difficult to recruit participants who worked during the night. Two of the focus groups were homogenous, and consisted of health workers, while one was less homogenous and consisted of nurses, social educators and health workers.
Some scholars recommend that focus groups should be homogeneous, since heterogeneous groups where participants have different educational backgrounds and work experience can lead to ranking of the participants, which may hamper discussion in the group (20, 35). According to Malterud (20) on the other hand, the aim of homogeneity must be balanced against variation in the participants, both within each group and among all the participants, since diversity of experience may create nuances in the empirical data. In one of the groups, which consisted of nurses, social educators and health workers, two people withdrew. The perception of ranking may have been the reason for this.
The objective of this study was to explore the experiences of health personnel with high-energy smoothies for elderly patients in nursing homes. The findings show that some patients had problems with heartburn, nausea and constipation. Moreover, it was revealed that those who were undernourished did not gain weight because of smoothies, and that smoothies gave the patients energy and led to some of them becoming overactive. Individual adaptation of smoothies for elderly patients in nursing homes is necessary, so that the wishes and needs of the individual patient can be safeguarded. In order to control the individual patient’s intake of fluids, nutrients and energy, individual nutrition and drink lists are required.
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