title: Nutritional rehabilitation after ICU - does it happen: a qualitative interview and observational study.
abstract: OBJECTIVE
  To compare and contrast current nutritional rehabilitation practices against recommendations from National Institute for Health and Excellence guideline Rehabilitation after critical illness (NICE) (2009, http://www.nice.org.uk/cg83).
  
  
  BACKGROUND
  Recovery from critical illness has gained increasing prominence over the last decade but there is remarkably little research relating to nutritional rehabilitation.
  
  
  METHODS
  The study is a qualitative study based on patient interviews and observations of ward practice.
  
  
  METHODS
  Seventeen patients were recruited into the study at discharge from the intensive care unit (ICU) of a large teaching hospital in central Scotland in 2011. Semi-structured interviews were conducted on transfer to the ward and weekly thereafter. Fourteen of these patients were followed up at three months post-ICU discharge, and a semi-structured interview was carried out. Observations of ward practice were carried out twice weekly for the duration of the ward stay.
  
  
  RESULTS
  Current nutritional practice for post-intensive care patients did not reflect the recommendations from the NICE guideline. A number of organisational issues were identified as influencing nutritional care. These issues were categorised as ward culture, service-centred delivery of care and disjointed discharge planning. Their influence on nutritional care was compounded by the complex problems associated with critical illness.
  
  
  CONCLUSIONS
  The NICE guideline provides few nutrition-specific recommendations for rehabilitation; however, current practice does not reflect the nutritional recommendations that are detailed in the rehabilitation care pathway.
  
  
  CONCLUSIONS
  Nutritional care of post-ICU patients is problematic and strategies to overcome these issues need to be addressed in order to improve nutritional intake.
authors.affiliation: The University of Edinburgh, The Chancellor's Building, Edinburgh, UK.
authors.forename: Judith
authors.initials: J
authors.lastname: Merriweather
authors.forename: Pam
authors.initials: P
authors.lastname: Smith
authors.forename: Timothy
authors.initials: T
authors.lastname: Walsh
mesh_terms: D004046:Dietetics; D006784:Hospitals, Teaching; D006801:Humans; D007362:Intensive Care Units; D044342:Malnutrition / Q000534:rehabilitation*; D036301:Qualitative Research; D012606:Scotland
keywords: clinical practice; grounded theory; interviews; nutrition; observation; rehabilitation