Feeding the anorectic client: comfort foods and happy hour

Nostalgia evocation through seasonality-conscious purchasing behavior revealed by online survey using vegetable names

Food can be a valuable mediator of nostalgia. Japanese food culture places a great emphasis on seasons, and thus there may be a relationship between nostalgic foods and seasonality. In this study, we hypothesized that participants who emphasized seasonality at the time of vegetable purchase (seasonality-oriented; hereafter, SO) would be more likely to feel vegetable-evoked nostalgia than those who did not (non-seasonality-oriented; hereafter, non-SO). To test this hypothesis, we administered an online survey to older Japanese adults regarding 103 representative vegetables considered to be seasonal foods. After participants selected vegetables that they had eaten, they then selected those that evoked nostalgia (hereafter, nostalgic vegetables). For each nostalgic vegetable, they evaluated the degree of nostalgia and state if a past event (autobiographical memory) was recalled. If an autobiographical memory was recalled for a certain nostalgic vegetable, nostalgia for that memory was evaluated. Comparing between SO and non-SO participants, SO participants had significantly higher numbers of nostalgic vegetables with associated autobiographical memories, as well as nostalgia for those vegetables and autobiographical memories. The results supported our hypothesis, suggesting that seasonality-conscious purchasing behavior evokes nostalgia.

American Society of Parenteral and Enteral Nutrition Presidential Address: Food for Thought: It's More Than Nutrition

Three issues were highlighted in the 30(th) Presidential Address to the society: (1) A.S.P.E.N.'s unique interdisciplinary structure; (2) support of the A.S.P.E.N. Rhoads Research Foundation; and (3) the meaning of food from the perspective of the patient who is receiving life-sustaining home enteral or parenteral nutrition. A.S.P.E.N., founded as a multidisciplinary society in the 1970s has evolved into an interdisciplinary society with an expanded and diverse membership of health care professionals and scientists with overlapping interests in clinical nutrition and metabolism. A.S.P.E.N. envisions an environment in which every patient receives safe, efficacious, and high quality patient care. The society is committed to advancing the science and practice of nutrition support therapy. In support of this direction, the A.S.P.E.N. Rhoads Research Foundation exists to fund research grants, promote evidence-based practice, and foster training and mentorship in nutrition and metabolic research. The scientific advances and technologic innovations that have enabled our profession to provide enteral and parenteral nutrition to patients has caused practitioners to forget that the meaning of food extends beyond nutrient value. Some individuals receiving long term enteral nutrition or home parenteral nutrition have expressed feelings of anger, anxiety, and depression resulting from the inability to eat normally, from losses of independence, and control of body functions. The ritual of eating may be altered when the enteral or intravenous feedings provide nourishment and, for some, the loss of the eating function is a distressing experience, especially given the cultural focus on social gatherings and meals. The emotional meaning attributed to food, and changes in food preferences and eating behaviors, may become a source of conflict for individuals who have substantial dietary restrictions, or for those individuals dependent on enteral or parenteral nutrition therapy. The value of food intake on social patterns, self-esteem, pleasure, and enjoyment, may impact quality of life. While nutrition support can provide the basic need for nutrients, its impact on human needs associated with food requires further investigation.

Feeding and hydration issues for older adults with dementia

All cultures dictate the need to feed the hungry and create rituals for almost every life passage around the consumption of food and beverage. Yet, in old age and among those who cannot advocate for themselves, mealtime is medicalized and demoted to an insignificant event without dignity or regard for individualized needs. Attention must be paid to not only what people eat, but how they eat, and how they are supported in that process. Kayser-Jones summarized the extensive findings of several ethnographic studies in nursing homes by noting the multi-factorial issues involved in delivering excellent care to all residents, especially those lacking an advocate. Her findings exposed how lack of staff education, inadequate staffing and supervision, disregard for personal and cultural preferences, lack of assessment for comorbid health problems, intake of food and fluids, dysphagia, and oral health problems all contributed to malnutrition and dehydration among the residents studied. This seminal set of studies, along with Dr. Kayser-Jones' testimony in US Congressional hearings directly affected the design of federal regulatory protocols to address malnutrition and dehydration. In an attempt to increase the number of staff available to assist at meals, the Centers for Medicare and Medicaid issued a change in regulations on Sept. 26, 2003, allowing reimbursement for staff trained for a total of 8 hours to act as feeding assistants. This change is intended to, "provide more residents with help in eating and drinking and reduce the incidence of unplanned weight loss and dehydration". Although seen as answering some of the staffing ratio issues at meal times,this rule change has been criticized for not addressing the complexities of resident needs at meal times. Although offering food and fluid is time-consuming and requires special knowledge of physiological changes and empathy for persons whose behavior might be objectionable at times, it may be one of the few times during the day that the individual with dementia receives normalized social interaction. Thus, as in the care of all vulnerable persons with dementia, whether at home or in an institution, perhaps the greatest challenge and need is for nurses and other caregivers to provide a social environment that promotes individual dignity and comfort.

Nurturance. The spirit of holistic nursing

In the theory of modeling and role modeling, the concept of nurturance is connected to holistic nursing practice. As nurturance is given and received within a context of unconditional acceptance, clients' needs are fulfilled and they can move toward a healthier state. An exploration of the literature revealed several defining attributes that clarify the definition of the concept as it is used by Erickson, Tomlin, and Swain. Model, borderline, related, and contrary cases further illustrate the meaning of nurturance and its relationship to holistic care. In addition, methods of measuring nurturance are discussed. An analysis of the concept brings an increased understanding of how nurses can care for clients in a manner that respects the uniqueness and value of each individual. The result is a client who experiences growth and renewal of of strength, allowing optimal healing to occur.

Providing wholistic health care for the elderly: utilization of the Shuler Nurse Practitioner Practice Model

PURPOSE

To present an application of The Shuler Nurse Practitioner Practice Model with elderly patients through use of a gerontological wholistic assessment and the utilization of the model in developing a treatment plan and evaluating patient outcomes.

DATA SOURCES

Selected literature from nursing and medicine, including natural, alternative, and complementary (NAC) therapies, as well as the authors' personal experiences.

CONCLUSIONS

Providing health care services to the elderly involves recognition of not only physical ailments, but also an awareness of how functional status, psychological condition, social support, environmental conditions and cultural, as well as spiritual beliefs, shape the total health care needs of this vulnerable group.

IMPLICATIONS FOR PRACTICE

Nurse practitioners who work with the aged could benefit from a theoretically based, wholistic assessment guide. Treatment plans that include NAC therapies and healing strategies should be considered. Outcome evaluations should reflect adherence to the elders' preferences regarding quality and end-of-life issues.