将肾脏营养指南整合到日常家庭生活
慢性肾脏疾病患者对肾脏饮食的依从性具有挑战性。饮食建议可能根据肾脏功能和药物治疗而改变。虽然患者对于这些变化向家庭成员寻求帮助，但是缺乏有关家庭成员如何提供这种帮助的文献。
2017年6月1日，英国营养师协会《人类营养与饮食杂志》在线发表华威大学考文垂医院、白金汉大学米尔顿凯恩斯医院、伯明翰大学的定性研究报告，描述并诠释了家庭成员的这种生活经历。
该研究通过电话（逐字记录）对12位成人家庭成员进行现象学（人文心理学的哲学基础之一，认为现象即本质，本质即直观）定性半结构访谈。使用框架分析和定性数据分析软件NVivo第10版。参与者对主题经历表述准确性进行评论。
结果发现4个主要问题：1、肾脏饮食带来的困扰；2、肾脏饮食推荐意见的处理；3、寻求新的身份认同；4、家庭动力学（家庭内部心理过程、行为、沟通以及家庭与外部环境之间的相互作用）转变。家庭成员感到与现有饮食相抵触的建议影响了家庭生活。孩子在家庭中导致更复杂的营养决策。继续一种饮食以避免感到来自家庭和更广泛人群的意见不是一个选择。培育家庭成为一个整体与满足肾脏疾病个人具体需求必要性之间的平衡充满挑战。转变到新的身份认同，包括家庭成员在科学引导下对营养的理解以及日常食品需求的医学化，其中包括儿童营养需求的低优先级。
因此，负责烹饪的家庭成员发现肾脏营养指南的落实具有挑战，对于儿童面临更多挑战。本研究强调需要为应对终末期肾脏衰竭和肾脏营养指南的家庭提供实践和心理帮助。
J Hum Nutr Diet. 2017 Jun 1. [Epub ahead of print]
Integrating renal nutrition guidelines into daily family life: a qualitative exploration.
Morris A, Love H, van Aar Z, Liles C, Roskell C.
University Hospital, Coventry, UK; Milton Keynes Hospital, Milton Keynes, UK; University of Birmingham, Birmingham, UK.
BACKGROUND: Renal dietary compliance is challenging for individuals with chronic renal disease. Advice may change depending on renal function and medical treatment. Although patients seek support from family members with these changes, no literature exists with respect to how family members experience the offering of this support. The present study aimed to describe and interpret this lived experience of family members.
METHODOLOGY: Phenomenological qualitative semi-structured interviews were conducted with 12 adult family members via telephone (transcribed verbatim). Framework analysis and the qualitative software nvivo, version 10 (QSR International Pty Ltd, Melbourne, VIC, Australia) were used. Participants commented on the themes for accuracy of experience representation.
RESULTS: Four major themes emerged: (i) intrusion of the renal diet; (ii) dealing with the recommendations of a renal diet; (iii) seeking a new identity; and (iv) transition of family dynamics. Perceived conflicting advice intruded into family life. Children in the family resulted in more complex nutritional decisions. Continuing a diet to avoid perceived family and wider social judgement was not an option. Balance between nurturing the family as a whole and the necessity of attending to the specific needs of one individual with renal disease was challenging. Transition to a new identity included family members being drawn to scientifically guided understandings of nutrition and a medicalisation of daily food requirements, which included low prioritisation of children's nutritional needs.
CONCLUSION: Family members who cooked found the integration of renal nutrition guidelines challenging, with children presenting further challenges. The present study highlights the need to offer practical and psychological support to families who are coping with end-stage renal failure and renal nutritional guidelines.
KEYWORDS: end-stage renal failure; family experiences; qualitative exploration; renal diet
PMID: 28568218
DOI: 10.1111/jhn.12483
