Search results

The purpose of this paper is to investigate registered dietitians’ (RDs) experiences in consulting to adults with intellectual disabilities (ID) in Sweden.

A descriptive study using a study-specific web-based questionnaire was administered, comprising both multiple-choice questions with a space for comments and open-ended questions. The open-ended answers and comments from 53 respondents were analysed with systematic text condensation.

Four categories were identified: RDs’ experiences from the first meeting; explanations for late initial contact; the actions taken by RDs; and necessary measures for more sustainable nutrition care. Ten sub-categories described the challenges that RDs experience in more detail.

It is necessary to provide adults with ID and their supporting staff with individually tailored nutritional information. Individuals with ID must be actively involved in lifestyle changes that affect their everyday life. The RD must be included in the interdisciplinary team supporting adults with ID. If a new practice is to be implemented, it should be compatible with the existing values of adults with ID and their staff and must be feasible to implement in the everyday life of the individual.

This paper identified several barriers that should be overcome in relation to the preparation of RDs for consultation with adults with ID about nutritional health issues. A systematic structure, knowledge about nutrition and knowledge about adults with ID and their living situations are needed. An assessment instrument may meet health promotion needs and facilitate longitudinal follow-ups of nutritional problems.

Life expectancy is 15–20 years shorter for individuals with than for people without mental illness. Assuming that undiagnosed and undertreated somatic conditions are significant causes, the Central Denmark Region set out to implement joint psychiatric and somatic emergency departments (EDs) to support integrated psychiatric/somatic care as an effort to prolong the lifetime of individuals with mental illness. Through the lens of Normalization Process Theory, the authors examine healthcare frontline staff’s perceptions of and work with the implementation of integrated psychiatric/somatic care in the first joint-specialty ED in Denmark.

A single-case mixed-methods study using Normalization Process Theory (NPT) as an analytic framework to evaluate implementation of psychiatric/somatic integrated care (IC) in a joint-specialty emergency department. Data were generated from observations, qualitative interviews and questionnaires distributed to the frontline staff.

Implementation was characterized by a diffuse normalization leading to an adaption of the IC in a fuzzy alignment with existing practice. Especially, confusion among the staff regarding how somatic examination in the ED would ensure prolonged lifetime for people with mental illness was a barrier to sense-making and development of coherence among the staff. The staff questioned the accuracy of IC in the ED even though they recognized the need for better somatic care for individuals with mental illness.

This study highlights that a focus on outcomes (prolonging lifetime for people with mental illness and reducing stigmatization) can be counterproductive. Replacing the outcome focus with an output focus, in terms of how to develop and implement psychiatric/somatic IC with the patient perspective at the center, would probably be more productive.

In 2020, the Danish Health Authorities published new whole-system recommendations for emergency medicine (EM) highlighting the need for intensifying integrated intra and interorganizational care including psychiatric/somatic IC (ref). Even though this study is not conclusive, it points to subjects that can help to identify resources needed to implement psychiatric/somatic IC and to pitfalls. The authors argue that the outcome focus, prolonging the lifetime for individuals with mental illness by identifying somatic illness, was counterproductive. In accordance with the recommendations of contemporary implementation studies, the authors recommend a shift in focus from outcome to output focus; how to develop and implement psychiatric/somatic IC.