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Trinca V, Wu SA, Dakkak H, Iraniparast M, Cammer A, Lengyel C, O'rourke HM, Rowe N, Slaughter SE, Carrier N, Quiring S, Harvie R, Keller H. Characteristics Associated with Relationship-Centred and Task-Focused Mealtime Practices in Older Adult Care Settings. CAN J DIET PRACT RES 2024; 85:66-75. [PMID: 38572747 DOI: 10.3148/cjdpr-2023-023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2024]
Abstract
Purpose: To assess care home and staff characteristics associated with task-focused (TF) and relationship-centred care (RCC) mealtime practices prior to the COVID-19 pandemic.Methods: Staff working in Canadian and American care homes were invited to complete a 23-item online survey assessing their perceptions of mealtime care, with one item assessing 26 potential care practices from the Mealtime Relational Care Checklist (relationship-centred = 15; task-focused = 11) reported to occur in the home prior to the pandemic. Multivariate linear regression evaluated staff and care home characteristics associated with mealtime practices.Results: Six hundred and eighty-six respondents completed all questions used in this analysis. Mean TF and RCC mealtime practices were 4.89 ± 1.99 and 9.69 ± 2.96, respectively. Staff age was associated with TF and RCC practices with those 40-55 years reporting fewer TF and those 18-39 years reporting fewer RCC practices. Those providing direct care were more likely to report TF practices. Dissatisfaction with mealtimes was associated with more TF and fewer RCC practices. Homes that were not making changes to promote RCC pre-pandemic had more TF and fewer RCC practices. Newer care homes were associated with more RCC, while small homes (≤49 beds) had more TF practices.Conclusions: Mealtime practices are associated with staff and home factors. These factors should be considered in efforts to improve RCC practices in Canadian homes.
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Affiliation(s)
- Vanessa Trinca
- Department of Kinesiology and Health Sciences, University of Waterloo, Waterloo, ON
| | - Sarah A Wu
- School of Nursing, University of British Columbia, Vancouver, BC
| | - Hana Dakkak
- Department of Kinesiology and Health Sciences, University of Waterloo, Waterloo, ON
| | - Maryam Iraniparast
- Department of Kinesiology and Health Sciences, University of Waterloo, Waterloo, ON
| | - Allison Cammer
- College of Pharmacy and Nutrition, University of Saskatchewan, Saskatoon, SK
| | - Christina Lengyel
- Faculty of Agricultural and Food Sciences, University of Manitoba, Winnipeg, MB
| | - Hannah M O'rourke
- College of Health Sciences, Faculty of Nursing, University of Alberta, Edmonton, AB
| | - Natalie Rowe
- Faculty of Creative Industries, School of Design, Fanshawe College, London, ON
| | - Susan E Slaughter
- College of Health Sciences, Faculty of Nursing, University of Alberta, Edmonton, AB
| | - Natalie Carrier
- Faculté des sciences de la santé et des services communautaires, Université de Moncton, Moncton, NB
| | | | - Ruth Harvie
- Department of Human Nutrition, St. Francis Xavier University, Antigonish, NS
| | - Heather Keller
- Department of Kinesiology and Health Sciences, University of Waterloo, Waterloo, ON
- Schlegel-UW Research Institute for Aging, Waterloo, ON
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Nyende A, Ellis-Hill C, Mantzoukas S. A Sense of Control and Wellbeing in Older People Living with Frailty: A Scoping Review. JOURNAL OF GERONTOLOGICAL SOCIAL WORK 2023; 66:1043-1072. [PMID: 37139581 DOI: 10.1080/01634372.2023.2206438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Revised: 04/19/2023] [Accepted: 04/20/2023] [Indexed: 05/05/2023]
Abstract
A sense of control is important for supporting older people living with frailty to develop adaptive functioning to optimize wellbeing. This scoping review examined the literature on the sense of control and wellbeing in older people living with frailty within their everyday life and care service use. Nine databases were searched using the timeframe 2000 to 2021 to identify key ideas regarding control and wellbeing in older people with frailty. The review highlighted three major themes: a) Control as conveyed in bodily expressions and daily activities, b) Sense of control and influence of place of residence, and c) Control within health and social care relationships. Maintaining a sense of control is not only an internal feeling but is impacted by physical and social environments. Greater focus is needed on the nature of relationships between older people living with frailty and those who work alongside them, which support control and wellbeing.
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Affiliation(s)
- Adam Nyende
- Faculty of Health and Social Sciences, Bournemouth University, Bournemouth, UK
| | - Caroline Ellis-Hill
- Faculty of Health and Social Sciences, Bournemouth University, Bournemouth, UK
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3
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Antasouras G, Vasios GK, Kontogiorgis C, Ioannou Z, Poulios E, Deligiannidou GE, Troumbis AY, Giaginis C. How to improve food waste management in hospitals through focussing on the four most common measures for reducing plate waste. Int J Health Plann Manage 2023; 38:296-316. [PMID: 36193027 DOI: 10.1002/hpm.3586] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 09/16/2022] [Accepted: 09/26/2022] [Indexed: 11/07/2022] Open
Abstract
Hospitals have a responsibility to link human health and the environment, but food waste in hospitals has traditionally been much higher than in other areas of food supply. The cause of this situation has many negative impacts on health, economy, society, and environment. As a result, food waste has become a topic of discussion in hospital food departments. Part of this problem is plate waste, the served food that remains uneaten by patients. Given the magnitude of the food problem, this systematic review is aimed to identify the most common measures used to reduce plate waste in hospitals. PubMed, Scopus, and Google Scholar databases were comprehensively searched to identify food waste studies worldwide using related search terms. Many approaches have been recommended to increase patient food intake and minimise plate waste in hospitals. Up to date, the four most common include flexible portion sizes, increased food choices through selective menus, additional nutritional support and a better ordering and delivery system. Among them, the most used and effective are flexible portion sizes which may increase the ability of patients choosing their menus and upgrade ordering and delivery system by electronic format. In most studies, plate waste covers the most significant percentage of food waste produced in hospitals, while more than one approach is recommended to minimise it. In this aspect, further well-design, multicenter, clinical studies are strongly required to highlight and establish novel and effective approaches for improving food waste management in hospitals by reducing plate waste.
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Affiliation(s)
- Georgios Antasouras
- Department of Food Science and Nutrition, School of Environment, University of the Aegean, Lemnos, Greece
| | - Georgios K Vasios
- Department of Food Science and Nutrition, School of Environment, University of the Aegean, Lemnos, Greece
| | - Christos Kontogiorgis
- Laboratory of Hygiene and Environmental Protection, Department of Medicine, Democritus University of Thrace, Alexandroupolis, Greece
| | - Zacharias Ioannou
- Department of Food Science and Nutrition, School of Environment, University of the Aegean, Lemnos, Greece
| | - Efthymios Poulios
- Department of Food Science and Nutrition, School of Environment, University of the Aegean, Lemnos, Greece
| | - Georgia-Eirini Deligiannidou
- Laboratory of Hygiene and Environmental Protection, Department of Medicine, Democritus University of Thrace, Alexandroupolis, Greece
| | - Andreas Y Troumbis
- Department of the Environment, School of Environment, University of the Aegean, Lesvos, Greece
| | - Constantinos Giaginis
- Department of Food Science and Nutrition, School of Environment, University of the Aegean, Lemnos, Greece
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Borkent JW, Van Hout HPJ, Feskens EJM, Naumann E, de van der Schueren MAE. Diseases, Health-Related Problems, and the Incidence of Malnutrition in Long-Term Care Facilities. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:3170. [PMID: 36833865 PMCID: PMC9959926 DOI: 10.3390/ijerph20043170] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Revised: 02/06/2023] [Accepted: 02/08/2023] [Indexed: 06/18/2023]
Abstract
Certain diseases and malnutrition are known to co-occur in residents of long-term care facilities (LTCF). We assessed which diseases and health-related problems are associated with malnutrition at admission or with incident malnutrition during stays and how different definitions of malnutrition affect these associations. Data of Dutch LTCF residents were obtained from the InterRAI-LTCF instrument (2005-2020). We analyzed the association of diseases (diabetes, cancer, pressure ulcers, neurological, musculoskeletal, psychiatric, cardiac, infectious and pulmonary diseases) and health-related problems (aspiration, fever, peripheral edema, aphasia, pain, supervised/assisted eating, balance, psychiatric, GI tract, sleep, dental and locomotion problems) with malnutrition (recent weight loss (WL), low age-specific BMI (BMI), and ESPEN 2015 definition (ESPEN)) at admission (n = 3713), as well as with incident malnutrition during stay (n = 3836, median follow-up ~1 year). Malnutrition prevalence at admission ranged from 8.8% (WL) to 27.4% (BMI); incident malnutrition during stay ranged from 8.9% (ESPEN) to 13.8% (WL). At admission, most diseases (except cardiometabolic diseases) and health-related problems were associated with higher prevalence of malnutrition based on either criterion, but strongest with WL. This was also seen in the prospective analysis, but relationships were less strong compared to the cross-sectional analysis. A considerable number of diseases and health-related problems are associated with an increased prevalence of malnutrition at admission and incident malnutrition during stays in LTCFs. At admission, low BMI is a good indicator of malnutrition; during stays, we advise use of WL.
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Affiliation(s)
- Jos W. Borkent
- Department of Nutrition and Health, HAN University of Applied Sciences, Kapittelweg 33, 6525 EN Nijmegen, The Netherlands
- Division of Human Nutrition and Health, Wageningen University, Stippeneng 4, 6708 WE Wageningen, The Netherlands
| | - Hein P. J. Van Hout
- Amsterdam University Medical Center, Department of General Practice and Medicine for Older Persons, Vrije Universiteit, Van der Boechorsstraat 7, 1081 BT Amsterdam, The Netherlands
| | - Edith J. M. Feskens
- Division of Human Nutrition and Health, Wageningen University, Stippeneng 4, 6708 WE Wageningen, The Netherlands
| | - Elke Naumann
- Department of Nutrition and Health, HAN University of Applied Sciences, Kapittelweg 33, 6525 EN Nijmegen, The Netherlands
| | - Marian A. E. de van der Schueren
- Department of Nutrition and Health, HAN University of Applied Sciences, Kapittelweg 33, 6525 EN Nijmegen, The Netherlands
- Division of Human Nutrition and Health, Wageningen University, Stippeneng 4, 6708 WE Wageningen, The Netherlands
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Pankhurst M, Yaxley A, Miller M. Measuring Food Service Satisfaction amongst Residents Living in Nursing Homes-A New and Valid Person-Centered Approach. Nutrients 2023; 15:nu15030508. [PMID: 36771215 PMCID: PMC9921588 DOI: 10.3390/nu15030508] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Revised: 01/09/2023] [Accepted: 01/10/2023] [Indexed: 01/21/2023] Open
Abstract
Resident satisfaction with food services contributes to health and wellbeing. Measuring resident satisfaction is important; however, the small number of existing food service satisfaction questionnaires (FSSQs) are outdated, lack rigorous psychometric testing and do not reflect the shift to person-centered care. This study aimed to develop a valid and reliable FSSQ. Content validity was established by conducting interviews with residents, a systematic literature review and consultation with an expert panel. Data from 387 residents were used to establish construct validity (Principal Components Analysis), internal consistency (Cronbach's alpha) and temporal stability (Gwet's AC). The result was a three factor, 25-item scale with good/excellent internal consistency: Factor One (13 items-good food/service, α = 0.896), Factor Two (seven items-resident choice/food availability α = 0.648) and Factor Three (five items-resident participation/staff assistance, α = 0.729). Temporal stability was good/very good (Gwet's AC 0.6242-0.9799 (p < 0.001). This is the first FSSQ available to nursing homes that meets the COSMIN® standards for excellence and incorporates person-centered care. The questionnaire is simple to use and interpret, providing food service managers with an accurate and reliable measure of resident satisfaction and assisting them in providing a meal and dining experience that supports the health and wellbeing of residents.
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Davies M, Zúñiga F, Verbeek H, Staudacher S. Exploring resident experiences of person-centred care at mealtimes in long-term residential care: a rapid ethnography. BMC Geriatr 2022; 22:963. [PMID: 36513997 PMCID: PMC9747258 DOI: 10.1186/s12877-022-03657-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Accepted: 11/28/2022] [Indexed: 12/15/2022] Open
Abstract
INTRODUCTION Poor nutrition is a common ongoing problem in long-term residential care, often resulting in reduced quality of life. Previous research has concluded that the content of the meal, dining environment, service style and general atmosphere all add to the mealtime experience, suggesting that person-centred mealtimes are optimal. However, knowledge about which elements of person-centred care can be achieved in a mealtime setting in a given context is currently lacking. We aimed to understand the mealtime experience in long-term residential care by exploring (missed) opportunities for person-centred care in different settings. METHODS As part of the TRANS-SENIOR research network, rapid ethnographies, were conducted across multiple sites (including interviews, observations and informal conversations), in a long-term residential care home in the UK, Switzerland and the Netherlands between October 2020 and December 2021. RESULTS: Following analysis and interpretation of observations, interviews and informal conversations, the following themes were developed where either successfully achieved or missed opportunities for person-centred moments were observed: 1) considering the setting, 2) listening to and implementing resident choice, 3) enabling residents to help/care for themselves and others, 4) providing individualised care in a communal setting, and 5) knowing the person in the past and present. Residents experienced moments of participatory choice, interaction, independence and dignity, but opportunities for these were often missed due to organisational or policy constraints. CONCLUSIONS There are opportunities for person-centred moments during the mealtime, some of which are taken and some missed. This largely depended on the setting observed, which includes the overall environment (size of dining area, seating arrangements etc.) and allocation of staff resources, and the level of resident involvement in mealtimes, from preparation to the actual activity.
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Affiliation(s)
- Megan Davies
- grid.6612.30000 0004 1937 0642Nursing Science, Department of Public Health, University of Basel, Bernoullistrasse 28, 4056 Basel, Switzerland ,grid.5012.60000 0001 0481 6099Department of Health Services Research, Care and Public Health Research Institute, Maastricht University, 6229 GT Maastricht, The Netherlands ,CURAVIVA Schweiz, Zieglerstrasse 53, 3000 Bern 14, Postfach 1003 Bern, Switzerland
| | - Franziska Zúñiga
- grid.6612.30000 0004 1937 0642Nursing Science, Department of Public Health, University of Basel, Bernoullistrasse 28, 4056 Basel, Switzerland
| | - Hilde Verbeek
- grid.5012.60000 0001 0481 6099Department of Health Services Research, Care and Public Health Research Institute, Maastricht University, 6229 GT Maastricht, The Netherlands
| | - Sandra Staudacher
- grid.6612.30000 0004 1937 0642Nursing Science, Department of Public Health, University of Basel, Bernoullistrasse 28, 4056 Basel, Switzerland ,grid.5012.60000 0001 0481 6099Department of Health Services Research, Care and Public Health Research Institute, Maastricht University, 6229 GT Maastricht, The Netherlands
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Bayne DF, Shune SE. A Biopsychosocial Model of Mealtime Management in Persons with Dementia, an Asset-Based Approach to Patient-Centered Care. Geriatrics (Basel) 2022; 7:geriatrics7050112. [PMID: 36286215 PMCID: PMC9601353 DOI: 10.3390/geriatrics7050112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Revised: 09/30/2022] [Accepted: 10/02/2022] [Indexed: 01/24/2023] Open
Abstract
Considering the rapid increase in the population over the age of 65, there is increasing need to consider models of care for persons with dementia (PWD). One common deficit associated with dementia progression is difficulty with successful participation in mealtimes. Difficulty participating in mealtimes in PWD is not the result of one factor, but rather a confluence of biological, psychological, and social characteristics common in dementia. Factors leading to mealtime difficulties for PWD may include changes in cognitive status, altered sensorimotor functioning, and increased reliance on caregiver support. The complex nature of biological, psychological, and social factors leading to mealtime difficulty highlights the need for a pragmatic model that caregivers can utilize to successfully support PWD during mealtimes. Existing models of dementia and mealtime management were reviewed and collated to create a model of mealtime management that considers this complex interplay. The Biopsychosocial Model of Mealtime Management builds on past research around patient-centered care and introduces an asset-based approach to capitalize on a PWD's retained capabilities as opposed to compensating for disabilities associated with dementia. We hope this model will provide a framework for caregivers to understand what factors impact mealtime participation in PWD and provide appropriate means on intervention.
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8
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Koh RTG, Thirumanickam A, Attrill S. How are the mealtime experiences of people in residential aged care facilities informed by policy and best practice guidelines? A scoping review. BMC Geriatr 2022; 22:737. [PMID: 36085034 PMCID: PMC9463738 DOI: 10.1186/s12877-022-03340-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2021] [Accepted: 07/25/2022] [Indexed: 11/25/2022] Open
Abstract
Background Mealtimes are embedded routines of residents living in residential aged care facilities (RACFs) that directly impact their health and quality of life. Little is known about how mealtime experiences are informed and affected by structures such as government and organisational policies and processes. This scoping review used Giddens’ (The constitution of society: outline of the theory of structuration, 1984) Structuration Theory to investigate how governance structures related to mealtime practices inform residents’ mealtime experiences. Methods Using Arksey and O’Malley’s (Int J Soc Res Methodol 8:19–32, 2005) scoping review framework, a systematic database, grey literature and policy search was completed in May 2020 and updated in July 2021. From 2725 identified articles, 137 articles were included in data charting and deductive analysis, and 76 additional Australian government policy papers were used interpretatively. Results Data charting identified that the included studies were prominently situated in Western countries, with a progressive increase in publication rate over the past two decades. Qualitative findings captured structures that guide RACF mealtimes, how these relate to person-centred mealtime practices, and how these facilitate residents to enact choice and control. Conclusions Current policies lack specificity to inform the specific structures and practices of RACF mealtimes. Staff, residents, organisational and governance representatives possess different signification, legitimation and domination structures, and lack a shared understanding of policy, and how this influences processes and practices that comprise mealtimes. Supplementary Information The online version contains supplementary material available at 10.1186/s12877-022-03340-9.
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Exploring Meal Provision and Mealtime Challenges for Aged Care Residents Consuming Texture-Modified Diets: A Mixed Methods Study. Geriatrics (Basel) 2022; 7:geriatrics7030067. [PMID: 35735772 PMCID: PMC9222299 DOI: 10.3390/geriatrics7030067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Revised: 06/07/2022] [Accepted: 06/14/2022] [Indexed: 11/17/2022] Open
Abstract
Dysphagia has become more prevalent with age. Thus, the demand for texture-modified diets (TMDs) has increased. While the nutritional perspectives have been studied, the provision of TMDs and mealtime practice has received less attention. This study aimed to explore the TMD provision and mealtime challenges of residents requiring TMDs in aged care facilities. The study was conducted across five aged care facilities using a mixed methods design involving 14 TMD menu audits by a foodservice dietitian, 15 mealtime observations, and semi-structured interviews with residents and staff (n = 18). TMD menus failed to meet all nutrition requirements and foodservice and clinical standards based on the dietitian NZ foodservice and nutrition audit tool. A content analysis offered three main themes: (1) Foodservice production. Inconsistent quality and meal portions were observed. The variety, choice, and portion size of TMDs required improvement based on the residents’ preferences; (2) Serving procedures. There was a lack of standardisation of meal distribution and feeding assistance; and (3) Dining environment. The dining room set-up varied across facilities, and residents expressed different preferences towards the dining environment. There is a need to improve staff awareness of mealtime consistency and optimise feeding assistance. The dining environment should be individualised to accommodate residents’ psychosocial needs. Standardised policies and continuous training can facilitate quality mealtime implementation.
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Smith R, Bryant L, Reddacliff C, Hemsley B. A review of the impact of food design on the mealtimes of people with swallowing disability who require texture-modified food. INTERNATIONAL JOURNAL OF FOOD DESIGN 2022. [DOI: 10.1386/ijfd_00034_1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
Texture-modified foods are a common component of interventions provided to people with dysphagia (swallowing disorders) to maintain their respiratory health, nutritional health and to reduce the risk of aspiration-related illness or choking on food. However, the unsightly and unappetizing
appearance of texture-modified foods may negatively impact on the mealtime experience and acceptance of texture-modified foods of persons with dysphagia. The aim of this review was to determine what is known about the impact of specific elements of food design ‐ food structure and visual
appeal ‐ on the mealtime experiences of people with dysphagia. This review of 35 studies presents evidence on how the physical characteristics of texture-modified foods for people with dysphagia can be considered during food production, formulation or service to improve their mealtime
experience. Overall, the visual appeal, texture, taste, aroma, temperature, mealtime environment and mealtime assistance all impact upon mealtime experiences and should be considered carefully in the design of a person’s mealtime plan and food-related dysphagia interventions to improve
their mealtime-related quality of life. Further research needs to include the views of people with dysphagia, particularly those with lifelong conditions, who might require texture-modified food for an extended period over their lifespan.
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Cartwright J, Roberts K, Oliver E, Bennett M, Whitworth A. Montessori mealtimes for dementia: A pathway to person-centred care. DEMENTIA 2022; 21:1098-1119. [PMID: 35259303 DOI: 10.1177/14713012211057414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE This study examined the impact of a Montessori mealtime intervention for people living with dementia to support the mealtime experience of residents and mealtime care practices of staff in a memory support unit. The mealtime intervention was part of a broader culture change project. METHOD An observational research design was used to evaluate changes in the mealtime experience and care practices across three time points (baseline, post-implementation, maintenance), spanning 30 months. Five video recordings of the lunch time service (range: 19-32 min) were analysed. The coding protocol comprised pre-determined indicators related to accepted dimensions of person-centred care. Resident and staff behaviours were quantified across four categories: providing choice and preferences, promoting the social side of eating, supporting independence and showing respect towards residents. Staff behaviours that reflected personal enhancing actions and personal detractors were also coded during each mealtime service. RESULTS A significant increase in staff providing residents with the opportunity for choice and a subsequent significant increase in residents demonstrating choice behaviours was evident. Staff and residents both significantly increased their interactional behaviours, with greater social interaction between staff and residents. Staff further demonstrated greater support for mealtime independence that reached and maintained significance during the final two sampling points. Significant gains observed post implementation were largely maintained and, on specific measures, further increased over time. A significant increase in staff use of personal enhancing actions during mealtime care was also evident. Variability in individual staff and resident behaviour highlighted the complexity of mealtime care and culture change processes. IMPLICATIONS The study provides novel evidence to support the use of a Montessori mealtime intervention to achieve more person-centred mealtime care, and which resulted in a more respectful, enabling and social dining experience. Clinical implications and direction for future research are presented to build on these findings.
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Affiliation(s)
- Jade Cartwright
- School of Health Sciences, University of Tasmania, Launceston, Tasmania, Australia;1649 Curtin School of Allied Health, Curtin University, Perth, WA, Australia
| | - Karen Roberts
- Curtin School of Allied Health, 1649Curtin University, Perth, WA, Australia
| | - Elizabeth Oliver
- Curtin School of Allied Health, 1649Curtin University, Perth, WA, Australia
| | - Michelle Bennett
- School of Allied Health, 580091Australian Catholic University, North Sydney, Australia
| | - Anne Whitworth
- School of Health Sciences, University of Tasmania, Launceston, Tasmania, Australia; Curtin School of Allied Health, 1649Curtin University, Perth, WA, Australia
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Shune S, Barewal R. Redefining the value of snacks for nursing home residents: Bridging psychosocial and nutritional needs. Geriatr Nurs 2022; 44:39-47. [DOI: 10.1016/j.gerinurse.2021.12.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Revised: 12/29/2021] [Accepted: 12/31/2021] [Indexed: 01/11/2023]
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Faraday J. How do we provide good mealtime care for people with dementia living in care homes? A systematic review of carer-resident interactions. DEMENTIA 2021; 20:3006-3031. [PMID: 33827279 PMCID: PMC8679165 DOI: 10.1177/14713012211002041] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
People with dementia who live in care homes often depend on care home staff for help with eating and drinking. It is essential that care home staff have the skills and support they need to provide good care at mealtimes. Good mealtime care may improve quality of life for residents, and reduce hospital admissions. The aim of this systematic review was to identify good practice in mealtime care for people with dementia living in care homes, by focusing on carer-resident interactions at mealtimes. Robust systematic review methods were followed. Seven databases were searched: AgeLine, BNI, CENTRAL, CINAHL, MEDLINE, PsycINFO and Web of Science. Titles, abstracts, and full texts were screened independently by two reviewers, and study quality was assessed with Joanna Briggs Institute tools. Narrative synthesis was used to analyse quantitative and qualitative evidence in parallel. Data were interrogated to identify thematic categories of carer-resident interaction. The synthesis process was undertaken by one reviewer, and discussed throughout with other reviewers for cross-checking. After title/abstract and full-text screening, 18 studies were included. Some studies assessed mealtime care interventions, others investigated factors contributing to oral intake, whilst others explored the mealtime experience. The synthesis identified four categories of carer-resident interaction important to mealtime care: Social connection, Tailored care, Empowering the resident, and Responding to food refusal. Each of the categories has echoes in related literature, and provides promising directions for future research. They merit further consideration, as new interventions are developed to improve mealtime care for this population.
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Affiliation(s)
- James Faraday
- Population Health Sciences Institute, Newcastle University, UK;The Newcastle upon Tyne Hospitals NHS Foundation
Trust, UK
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14
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Cleland J, Hutchinson C, Khadka J, Milte R, Ratcliffe J. What defines quality of care for older people in aged care? A comprehensive literature review. Geriatr Gerontol Int 2021; 21:765-778. [PMID: 34258840 DOI: 10.1111/ggi.14231] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Revised: 06/02/2021] [Accepted: 06/17/2021] [Indexed: 01/16/2023]
Abstract
The quality of the care provided to frail older people in aged care is a concern for all Australians and for the citizens of many other countries internationally. This paper summarizes the methods and findings from an Australian study commissioned by the Royal Commission into Aged Care Quality and Safety to identify and synthesize international literature relating to the quality of care in aged care. A comprehensive literature review was undertaken to search and identify the literature (grey and peer reviewed) relating to quality of care and/or person-centered care in aged care. The review identified nine key themes as salient to the quality of care experience, which include treating the older person with respect and dignity; acknowledging and supporting their spiritual, cultural, religious and sexual identity; the skills and training of the aged care staff providing care; relationships between the older person and the aged care staff; social relationships and the community; supporting the older person to make informed choices; supporting the older person's health and well-being; ensuring the delivery of safe care in a comfortable service environment; and the ability to make complaints and provide feedback to the aged care organization. In practice, particularly in the context of residential care, quality of care has traditionally been measured using clinical indicators of care quality. These findings highlight the central importance of person-centered care and care experience as fundamental tenets of the quality of aged care service delivery in Australia and internationally. Geriatr Gerontol Int 2021; 21: 765-778.
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Affiliation(s)
- Jenny Cleland
- Health and Social Care Economics Group, Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Sturt Road, Adelaide, South Australia, 5042, Australia
| | - Claire Hutchinson
- Health and Social Care Economics Group, Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Sturt Road, Adelaide, South Australia, 5042, Australia
| | - Jyoti Khadka
- Health and Social Care Economics Group, Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Sturt Road, Adelaide, South Australia, 5042, Australia.,Healthy Aging Research Consortium, Registry of Older South Australians (ROSA), South Australian Health and Medical Research Institute (SAHMRI), North Terrace, Adelaide, South Australia, 5000, Australia
| | - Rachel Milte
- Health and Social Care Economics Group, Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Sturt Road, Adelaide, South Australia, 5042, Australia
| | - Julie Ratcliffe
- Health and Social Care Economics Group, Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Sturt Road, Adelaide, South Australia, 5042, Australia
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15
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Liu W, Williams K, Batchelor M, Perkhounkova Y, Hein M. Mealtime verbal interactions among nursing home staff and residents with dementia: A secondary behavioural analysis of videotaped observations. J Adv Nurs 2021; 77:1244-1257. [PMID: 33222218 PMCID: PMC7902310 DOI: 10.1111/jan.14647] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Revised: 09/25/2020] [Accepted: 10/27/2020] [Indexed: 12/01/2022]
Abstract
AIMS To characterize dyadic mealtime verbal interactions and examine the associations with staff and resident characteristics. DESIGN A secondary analysis of 110 videotaped mealtime observations collected from a dementia communication trial during 2011-2014. METHODS Videos involved 25 residents with dementia and 29 staff in nine nursing homes. Verbal behaviours (utterances) were coded during 2018-2019 using the Cue Utilization and Engagement in Dementia mealtime video-coding scheme, addressing eight positive behaviours and four negative behaviours. Bivariate analyses and multivariate regression models were used. RESULTS Staff spoke three times more frequently (76.5%) than residents (23.5%). Nearly all staff utterances were positive (99.2%); 85.1% of residents' utterances were positive and 14.9% negative. Staff positive utterances were correlated with their negative utterances and resident positive and negative utterances. Staff negative utterances were correlated with resident negative utterances. Resident positive and negative utterances were correlated. Resident positive utterances were significantly associated with staff care-giving length in the current nursing home (OR = 1.430, 95% CI = 1.008, 2.027). Resident negative utterances were significantly associated with resident gender (female versus male, OR = 11.892, 95% CI = 1.237, 114.289) and staff years worked as a caregiver (OR = 0.838, 95% CI = 0.710, 0.989). Staff positive and negative utterances were not associated significantly with any participant characteristics. CONCLUSIONS Staff engage residents using primarily positive verbal strategies. Staff-resident mealtime verbal interactions were dynamic, interactive, and complex and related to multiple individual characteristics. IMPACT Positive dyadic mealtime interactions are critical to engage residents in eating. Little work has characterized dyadic mealtime interactions, limiting the development of effective interventions. Findings showed staff-resident mealtime verbal interactions were primarily positive, inter-related, and associated with multiple individual characteristics. Findings inform directions to improve mealtime care practice and develop person-centred mealtime interventions targeting modifiable factors, including staff care-giving experiences.
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Affiliation(s)
- Wen Liu
- College of Nursing, The University of Iowa, Iowa City, IA, USA
| | | | - Melissa Batchelor
- School of Nursing, George Washington University, Washington, DC, USA
| | | | - Maria Hein
- College of Nursing, The University of Iowa, Iowa City, IA, USA
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16
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Baic S. Managing malnutrition in the community during the COVID-19 pandemic. Nurs Stand 2021; 36:61-66. [PMID: 33615758 DOI: 10.7748/ns.2021.e11667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/15/2020] [Indexed: 10/22/2022]
Abstract
The prevalence of risk factors for malnutrition has increased during the coronavirus disease 2019 (COVID-19) pandemic. These risk factors include various symptoms and effects of COVID-19, such as breathlessness, coughing, inflammation, sarcopenia, anorexia and loss of taste or smell, as well as the side effects of treatment. In addition, public health infection prevention and control measures can inadvertently reduce access to food and increase social isolation, thus adversely affecting people's nutritional status. This article outlines practical interventions for preventing and managing malnutrition in the community, particularly where it is exacerbated by the social restrictions in place to contain the COVID-19 pandemic.
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Affiliation(s)
- Sue Baic
- Nutrition Basics, Bristol, England
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17
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Trinca V, Chaudhury H, Slaughter SE, Lengyel C, Carrier N, Keller H. Making the Most of Mealtimes (M3): Association Between Relationship-Centered Care Practices, and Number of Staff and Residents at Mealtimes in Canadian Long-Term Care Homes. J Am Med Dir Assoc 2020; 22:1927-1932.e1. [PMID: 33338445 DOI: 10.1016/j.jamda.2020.11.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2019] [Revised: 10/07/2020] [Accepted: 11/13/2020] [Indexed: 11/18/2022]
Abstract
OBJECTIVES To determine if (1) number of staff or residents, when considering home-level factors and presence of family/volunteers, are associated with relationship-centered care practices at mealtimes in general and dementia care units in long-term care (LTC); and (2) the association between number of staff and relationship-centered care is moderated by number of residents and family/volunteers, profit status or chain affiliation. DESIGN Secondary analysis of the Making the Most of Mealtimes (M3) cross-sectional multisite study. SETTING AND PARTICIPANTS Thirty-two Canadian LTC homes (Alberta, Manitoba, Ontario, and New Brunswick) and 639 residents were recruited. Eighty-two units were included, with 58 being general and 24 being dementia care units. METHODS Trained research coordinators completed the Mealtime Scan (MTS) for LTC at 4 to 6 mealtimes in each unit to determine number of staff, residents, and family or volunteers present. Relationship-centered care was assessed using the Mealtime Relational Care Checklist. The director of care or food services manager completed a home survey describing home sector and chain affiliation. Multivariable analyses were stratified by type of unit. RESULTS In general care units, the number of residents was negatively (P = .009), and number of staff positively (P < .001) associated with relationship-centered care (F9,48 = 5.48, P < .001). For dementia care units, the associations were nonsignificant (F5,18 = 2.74, P = .05). The association between staffing and relationship-centered care was not moderated by any variables in either general or dementia care units. CONCLUSION AND IMPLICATIONS Number of staff in general care units may increase relationship-centered care at mealtimes in LTC. Number of residents or staff did not significantly affect relationship-centered care in dementia care units, suggesting that other factors such as additional training may better explain relationship-centered care in these units. Mandating minimum staffing and additional training at the federal level should be considered to ensure that staff have the capacity to deliver relationship-centered care at mealtimes, which is considered a best practice.
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Affiliation(s)
- Vanessa Trinca
- University of Waterloo Department of Kinesiology, Waterloo, Ontario, Canada
| | - Habib Chaudhury
- Simon Fraser University, Department of Gerontology, Vancouver, British Columbia, Canada
| | - Susan E Slaughter
- University of Alberta, Faculty of Nursing, Edmonton, Alberta, Canada
| | - Christina Lengyel
- University of Manitoba, Department of Food and Human Nutritional Sciences, Winnipeg, Manitoba, Canada
| | - Natalie Carrier
- Université de Moncton, Faculté des sciences de la santé et des services communautaires, Moncton, New Brunswick, Canada
| | - Heather Keller
- University of Waterloo Department of Kinesiology, Waterloo, Ontario, Canada; Schlegel-University of Waterloo Research Institute for Aging, Waterloo, Ontario, Canada.
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18
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Liu W, Batchelor M, Williams K. Ease of use, feasibility and inter-rater reliability of the refined Cue Utilization and Engagement in Dementia (CUED) mealtime video-coding scheme. J Adv Nurs 2020; 76:3609-3622. [PMID: 32996629 PMCID: PMC7655666 DOI: 10.1111/jan.14548] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2020] [Revised: 07/09/2020] [Accepted: 08/05/2020] [Indexed: 01/08/2023]
Abstract
AIMS To refine the Cue Utilization and Engagement in Dementia mealtime video-coding scheme and examine its ease of use, feasibility, and inter-rater reliability in assessing the food intake process and dyadic verbal and nonverbal interactions. DESIGN This study was a secondary analysis of 110 videotaped observations of mealtime interactions collected under usual care conditions from a dementia communication trial during 2011-2014. METHODS The videos involved 29 staff and 25 residents with dementia (42 unique staff-resident dyads) in nine nursing homes. Data coding and analysis were performed in 2018-2019. Logs of coding challenges with matched solutions and coding time were collected. Inter-rater reliability was examined through rating of randomly selected 22 videos across four trained coders. RESULTS It took a mean of 10.81 hr to code a one-hour video using the refined coding scheme. Coding challenges, including identification of key intake process characteristics and differentiation of similar verbal or nonverbal behaviours, were identified with appropriate solutions. The refined coding scheme had good inter-rater reliability (Cohen's Kappa range = 0.93 - 0.99, 95% CI = 0.92 - 0.99). CONCLUSION Findings supported preliminary evidence on feasibility, usability and inter-rater reliability of the refined coding scheme. Future psychometric testing is needed in diverse populations with dementia across different care settings. IMPACT Existing tools assessing the food intake process and dyadic interactions are few and have limited feasibility and/or reliability and fail to capture the complexity and dynamics of mealtime care. The refined coding scheme showed preliminary feasibility, usability, and inter-rater reliability. In consideration of the balance between time intensity and the richness of data obtained, the tool may be appropriate and useful in addressing certain research inquires (e.g., characterizing and clustering dyadic behaviours, temporal relationship between behaviours and intake) pertaining older adults with or without dementia and their formal or informal caregivers.
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Affiliation(s)
- Wen Liu
- The University of Iowa College of Nursing, Iowa City, IA, USA
| | - Melissa Batchelor
- School of Nursing, George Washington University, Washington, D.C., USA
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19
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Morrison-Koechl J, Wu SA, Slaughter SE, Lengyel CO, Carrier N, Keller HH. Hungry for more: Low resident social engagement is indirectly associated with poor energy intake and mealtime experience in long-term care homes. Appetite 2020; 159:105044. [PMID: 33227384 DOI: 10.1016/j.appet.2020.105044] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 10/13/2020] [Accepted: 11/12/2020] [Indexed: 10/23/2022]
Abstract
Mealtimes in long-term care (LTC) homes provide social engagement and nutritional intake to residents. Psychosocial challenges may detract from the mealtime experience, resulting in low food intake and increased risk of malnutrition. This study explores the independent effects of psychosocial factors on energy intake among LTC residents. Secondary data (Making the Most of Mealtimes [M3]) from residents in 32 Canadian LTC homes were analyzed. Data included 3-day weighed food intake, mealtime care actions taken by staff, loss of appetite, eating challenges, and other resident characteristics. Psychosocial factors (i.e., social engagement, depression, and aggressive behaviours) were measured using standardized scales. The independent effects of psychosocial factors on energy intake were tested using bivariate and linear regression analyses adjusted for loss of appetite, eating challenges, and demographic characteristics. The final sample included 604 residents (mean age = 86.8 ± 7.8 years; 31.8% male). Of the three psychosocial factors, only social engagement was associated with energy intake. Low social engagement was associated with cognitive and functional challenges, malnutrition risk, more task-focused mealtime actions by staff, and lower energy intake. Simple regression analysis revealed that individuals with low social engagement ate 59.6 kcal less per day (95% CI = -111.2, -8.0). This significant association remained when adjusting for loss of appetite, but was no longer significant when adjusting for eating challenges. Low social engagement occurs concurrently with physical and functional challenges among LTC residents, affecting both the nutritional and social aspects of mealtimes. Emphasis on socializing during mealtimes, especially for those with eating challenges (e.g., requiring assistance), may contribute to improved resident appetite and quality of life.
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Affiliation(s)
- Jill Morrison-Koechl
- Department of Kinesiology, University of Waterloo, 200 University Avenue West, Waterloo, ON, N2L 3G1, Canada.
| | - Sarah A Wu
- Department of Kinesiology, University of Waterloo, 200 University Avenue West, Waterloo, ON, N2L 3G1, Canada.
| | - Susan E Slaughter
- Faculty of Nursing, University of Alberta, 11405 87 Avenue, Edmonton, AB, T6G 1C9, Canada.
| | - Christina O Lengyel
- Department of Food and Human Nutritional Sciences, University of Manitoba, 209 Human Ecology Building, Winnipeg, MB, R3T 2N2, Canada.
| | - Natalie Carrier
- Département de Science Infirmière, Université de Moncton, Moncton, NB, Canada.
| | - Heather H Keller
- Department of Kinesiology, University of Waterloo, 200 University Avenue West, Waterloo, ON, N2L 3G1, Canada; Schlegel-UW Research Institute of Aging, 250 Laurelwood Drive, Waterloo, ON, N2J 0E2, Canada.
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20
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What kind of home is your care home? A typology of personalised care provided in residential and nursing homes. AGEING & SOCIETY 2020. [DOI: 10.1017/s0144686x20001142] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Abstract
This paper examines how care home managers in England conceptualised the approach to delivering personalised care in the homes they managed. We conducted interviews with care home managers and mapped the approaches they described on two distinct characterisations of personalised care prominent in the research and practitioner literature: the importance of close care relationships and the degree of resident choice and decision-making promoted by the care home. We derived three ‘types’ of personalised care in care homes. These conceptualise the care home as an ‘institution’, a ‘family’ and a ‘hotel’. We have added a fourth type, the ‘co-operative’, to propose a type that merges proximate care relationships with an emphasis on resident choice and decision-making. We conclude that each approach involves trade-offs and that the ‘family’ model may be more suitable for people with advanced dementia, given its emphasis on relationships. While the presence of a range of diverse approaches to personalising care in a care home market may be desirable as a matter of choice, access to care homes in England is likely to be constrained by availability and cost.
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21
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Liu W, Perkhounkova E, Williams K, Batchelor M, Hein M. Food intake is associated with verbal interactions between nursing home staff and residents with dementia: A secondary analysis of videotaped observations. Int J Nurs Stud 2020; 109:103654. [PMID: 32535342 PMCID: PMC7540727 DOI: 10.1016/j.ijnurstu.2020.103654] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Revised: 04/15/2020] [Accepted: 05/15/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Nursing home residents with dementia commonly experience low food intake, leading to negative functional and nutritional consequences. While the importance of staff-resident (dyadic) interactions during mealtime is acknowledged, little research has examined the role of dyadic verbal interactions on food intake. OBJECTIVES This study aimed to examine the relationship between food intake and dyadic verbal interactions. METHODS This study was a secondary analysis of 110 videotaped observations of mealtime care interactions among 25 residents with dementia and 29 staff (42 unique dyads) in 9 nursing homes. Staff positive utterances and resident positive and negative utterances (independent variables) and food intake (dependent variable) were coded from the videotaped observations using the Cue Utilization and Engagement in Dementia video coding scheme. A linear mixed model was fit to the data. The two-way interaction effects of food type and video duration with each independent variable as well as two-way interaction effects among the independent variables were tested. Covariates included in the model were the number of years staff worked as a caregiver, and resident age, gender, and eating function. RESULTS The model included three significant interaction effects involving verbal variables: the interaction effect of staff positive utterances with resident positive utterances (p=.030), the interaction effect of staff positive utterances with food type (p=.027), and the interaction effect of resident negative utterances with video duration (p=0.002). Increased number of intakes of liquid food per minute was associated with increased number of staff positive utterances per minute when residents did not make positive utterances. Decreased number of intakes of solid food per minute was associated with increased number of staff positive utterances per minute, especially when residents made between 0 and 3 positive utterances per minute. As the duration of the videos increased, the number of intakes per minute increased for residents who made one or more negative utterances and decreased for residents who made no negative utterances in the videos. The number of intakes per minute was associated with resident gender in that male residents had increased number of intakes per minute compared with female residents (p=.017), and was not associated with other participant characteristics. CONCLUSION Intake was associated with dyadic verbal interactions, and such relationship was complex in that it was moderated by food type and video duration. Findings support the significant role of dyadic verbal interactions on intake, and inform the development of effective, tailored mealtime care interventions to promote intake.
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Affiliation(s)
- Wen Liu
- The University of Iowa, College of Nursing, Iowa City, IA, USA.
| | | | | | - Melissa Batchelor
- George Washington University, School of Nursing, Washington, D.C., USA
| | - Maria Hein
- The University of Iowa, College of Nursing, Iowa City, IA, USA
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22
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Liu W, Batchelor M, Williams K. Development and Psychometric Testing of the Mealtime Engagement Scale in Direct Care Providers of Nursing Home Residents with Dementia. THE GERONTOLOGIST 2020; 61:e410-e420. [PMID: 32726447 DOI: 10.1093/geront/gnaa097] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Mealtime engagement is defined as verbal and nonverbal assistance provided by caregivers to guide and motivate care-recipients in eating. Quality mealtime engagement is critical to improve mealtime difficulties and intake among older adults with dementia requiring eating assistance. Few tools are feasible and valid to measure mealtime engagement. This study developed and tested the Mealtime Engagement Scale (MES). RESEARCH DESIGN AND METHODS Items were developed based on literature review and expert review and finalized based on content validity and corrected item-total correlation. A secondary analysis of 87 videotaped observations capturing 18 nursing home staff providing mealtime care to residents with dementia was conducted. Internal consistency, inter-rater reliability, and intra-rater reliability were assessed. Concurrent and convergent validity were examined through correlation (rs) with the Relational Behavior Scale (RBS) and the Mealtime Relational-Care Checklist (M-RCC), respectively. RESULTS The 18-item MES was developed with adequate content validity (Scale-CVI=1.00; Scale-CVI/Average=0.962-0.987). Each item is scored from 0 (never) to 3 (always). The total scale score ranges from 0 to 54. Higher scores indicate greater mealtime engagement. The MES had very good internal consistency (Cronbach's alpha=0.837), outstanding inter-rater reliability (Interclass Correlation=0.920), outstanding intra-rater reliability (Interclass Correlation =0.956), adequate concurrent validity based on strong correlation with the RBS (rs=0.821, p&.001), and fair convergent validity based on weak correlation with the M-RCC (rs=0.219, p=.042). DISCUSSION AND IMPLICATIONS Findings provide preliminary psychometric evidence of MES to measure mealtime engagement. Future testing is needed among more and diverse samples in different care settings to accumulate psychometric evidence.
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Affiliation(s)
- Wen Liu
- The University of Iowa College of Nursing , Iowa City, Iowa
| | - Melissa Batchelor
- George Washington University, School of Nursing, Washington, District of Columbia
| | - Kristine Williams
- University of Kansas Medical Center School of Nursing, Kansas City, Kansas
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23
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Tsai MR, Tsai HH, Tsai YF, Liao FY. "Tailoring homely meals": Family members' motivations underlying nursing home visits during residents' meals. Jpn J Nurs Sci 2020; 17:e12341. [PMID: 32347628 DOI: 10.1111/jjns.12341] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2019] [Revised: 02/15/2020] [Accepted: 03/21/2020] [Indexed: 11/28/2022]
Abstract
AIM Elderly nursing home residents are often malnourished or at risk of malnutrition. Family members often visit residents during mealtimes, which might be an ideal opportunity for interventions targeted at improving the nutritional status of older residents. Therefore, this study aimed to explore motivations behind family member visits with nursing home residents during mealtime in Taiwan. METHODS This phenomenological study was conducted with family members of residents from four nursing homes in Taiwan. Participants were purposively sampled. Data were collected with individual face-to-face interviews from 18 family members. Data from transcribed audio-recorded interviews were analyzed using the approach of van Manen. RESULTS Analysis of the interview data identified the essence of motivations underlying family members' visits to nursing home residents during mealtimes, which we termed "tailoring homely meals." This referred to providing food tailored to residents' needs, providing a comforting family atmosphere, assisting residents during mealtime, and monitoring food consumption. CONCLUSIONS The motivations of family members to visit during mealtime could guide healthcare professionals working with East Asian populations in developing interventions to reduce the possibility of malnutrition, while also improving their quality of life. We recommend providing the following for nursing home residents: a nutritious and balanced diet, supporting their independence and ability to feed themselves, and encouraging involvement of family members during mealtimes.
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Affiliation(s)
- Meng-Rung Tsai
- School of Nursing, College of Medicine, Chang Gung University, Tao-Yuan, Taiwan
| | - Hsiu-Hsin Tsai
- School of Nursing, College of Medicine, Chang Gung University, Tao-Yuan, Taiwan.,Department of Psychiatry, Chang Gung Memorial Hospital at Linkou, Tao-Yuan, Taiwan
| | - Yun-Fang Tsai
- School of Nursing, College of Medicine, Chang Gung University, Tao-Yuan, Taiwan.,Department of Nursing, Chang Gung University of Science and Technology, Tao-Yuan, Taiwan.,Department of Psychiatry, Chang Gung Memorial Hospital at Keelung, Kee-Lung, Taiwan
| | - Fang-Yu Liao
- Department of Nursing, St Joseph's Hospital at Yunlin, Huwei, Taiwan
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24
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Stakeholder Engagement in Practice Change: Enabling Person-Centred Mealtime Experiences in Residential Care Homes. Can J Aging 2020; 40:248-262. [DOI: 10.1017/s0714980820000082] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
ABSTRACTPerson-centred care is recognized as best practice in dementia care. The purpose of this study was to evaluate the effectiveness of a stakeholder engagement practice change initiative aimed at increasing the provision of person-centred mealtimes in a residential care home (RCH). A single-group, time series design was used to assess the impact of the practice change initiative on mealtime environment across four time periods (pre-intervention, 1-month, 3-month, and 6-month follow-up). Statistically significant improvements were noted in all mealtime environment scales by 6 months, including the physical environment (z = -3.06, p = 0.013), social environment (z = -3.69, p = 0.001), relationship and person-centred scale (z = -3.51, p = 0.003), and overall environment scale (z = -3.60, p = 0.002). This practice change initiative, which focused on enhancing stakeholder engagement, provided a feasible method for increasing the practice of person-centred care during mealtimes in an RCH through the application of supportive leadership, collaborative decision making, and staff engagement.
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25
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Driessen A, Ibáñez Martín R. Attending to difference: enacting individuals in food provision for residents with dementia. SOCIOLOGY OF HEALTH & ILLNESS 2020; 42:247-261. [PMID: 31705562 DOI: 10.1111/1467-9566.13004] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
In the face of warnings about total institutions and growing concern about the quality of care, healthcare professionals in Western Europe and North America have increasingly been exhorted to tailor their services to individuals in their care. In this article, we invite our readers to become more interested in the kinds of differences care is being tailored to, and with what effects. Focusing on food provision for residents with dementia, we present three repertoires through which care workers attend to, and enact different sets of differences between individuals: providing choice allows residents to express fleeting preferences; knowing residents places emphasis on care providers' familiarity with a person; and catering to identities brings to the fore the tastes which make up part of who someone is. The analysis brings attending to difference to the fore as a practical process and suggests that tailoring care requires sensitivity to the different kinds of individuals enacted when attending to difference.
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Affiliation(s)
- Annelieke Driessen
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Rebeca Ibáñez Martín
- Ethnology Department, Meertens Institute, Royal Netherlands Academy of Arts and Sciences, KNAW, Amsterdam, The Netherlands
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26
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Odencrants S, Blomberg K, Wallin A. "The meal is an activity involving at least two people"-Experiences of meals by older persons in need of elderly care. Nurs Open 2020; 7:265-273. [PMID: 31871710 PMCID: PMC6917934 DOI: 10.1002/nop2.387] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2019] [Revised: 07/16/2019] [Accepted: 09/08/2019] [Indexed: 11/19/2022] Open
Abstract
Aim A shift of focus on older persons' nutrition has occurred, from focusing on nutrition status to focusing on the whole meal. There is lack of studies on how older persons experience meals. Knowledge is needed to enhance a meal with dignity and pleasure, but also to prevent deterioration in nutrition. The aim was to describe meals from the perspective of older persons in need of elderly care. Design A descriptive qualitative study. Method Semi-structured interviews (N = 18) were conducted and analysed using thematic analyses. Result Three themes were identified: The meal is an activity which involves at least two persons, The meal relates to habits and traditions and The meal seldom gives possibilities to make individual choices. It was obvious that older persons who live in nursing homes miss the opportunity to decide what to eat, when to eat and with whom to eat. Attention must be paid to listening to older persons to enhance mealtime with dignity and autonomy.
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Affiliation(s)
- Sigrid Odencrants
- Department of NursingFaculty of Medicine and HealthSchool of Health SciencesÖrebro UniversityÖrebroSweden
| | - Karin Blomberg
- Department of NursingFaculty of Medicine and HealthSchool of Health SciencesÖrebro UniversityÖrebroSweden
| | - Anne‐Marie Wallin
- Department of NursingFaculty of Medicine and HealthSchool of Health SciencesÖrebro UniversityÖrebroSweden
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27
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Keller HH, Vucea V, Morrison-Koechl J. Reliability Testing of the Team Member Mealtime Experience Questionnaire. J Nutr Health Aging 2020; 24:570-575. [PMID: 32510108 DOI: 10.1007/s12603-020-1353-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Team members influence the mealtime experience of residents. Their perspectives on their ability to provide resident- and relationship-centred care during mealtimes is limited. The aim of this study was to describe the development and determine the factor structure and internal and test-retest reliability of the Team member Mealtime Experience Questionnaire (TMEQ). A 23-item questionnaire was developed through several steps. A Likert scale of strongly disagree (score= 1) to strongly agree (score= 5) was used. A total of 137 team members from five diverse homes participated. Time and task-focused items had lower scores (indicating more negative perceptions), whereas knowledge and capability of how to provide resident- and relationship-centred mealtime care had higher scores. Exploratory factor analysis identified three factors; four items were eliminated based on this analysis. Test-retest reliability was completed with 103 participants. Intraclass correlation (ICC) for the total score and three subscales ranged from 0.72 -0.85 while Chronbach's alpha ranged from 0.81-0.92. The 19-item TMEQ is considered reliable for use in research and practice.
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Affiliation(s)
- H H Keller
- Heather H Keller, Schlegel-University of Waterloo Research Institute for Aging, University of Waterloo, Waterloo ON, N2L 3G1, Canada,
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Iuglio S, Chaudhury H, Lengyel C, Morrison J, Boscart V, Carrier N, Keller H. Construct Validation of the Mealtime Relational Care Checklist for Individual Resident Use in Long-Term Care. J Nurs Meas 2019; 27:493-507. [DOI: 10.1891/1061-3749.27.3.493] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Background and PurposeTo determine the construct validity of the Mealtime Relational Care Checklist (M-RCC) when used with individual residents.MethodsData was collected from 639 residents from 32 long-term care homes; M-RCC was completed at three meals for each resident and averaged. Bivariate analyses determined associations between the M-RCC and other resident level and dining room level measures.ResultsResident M-RCC was positively and significantly (p < .05) associated with three of five summary scales from Dining Environment Audit Protocol and Meal Time Scan as well as resident malnutrition risk (rs = 0.23). M-RCC was negatively associated with protein intake (gram per kilogram body weight; rs = -0.13) and Cognitive Performance Score (t-value = 4.48).ConclusionsThe resident level M-RCC was significantly associated with other measures in expected directions demonstrating construct validity.
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Wang D, Everett B, Brunero S, Northall T, Villarosa AR, Salamonson Y. Perspectives of residents and staff regarding food choice in residential aged care: A qualitative study. J Clin Nurs 2019; 29:626-637. [PMID: 31769898 DOI: 10.1111/jocn.15115] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2018] [Revised: 10/17/2019] [Accepted: 11/10/2019] [Indexed: 11/29/2022]
Abstract
AIMS AND OBJECTIVES To explore the experiences of food choice and meal service in residential aged care facilities and its impact on autonomy, self-determination and quality of life from the perspectives of both residents and staff. BACKGROUND Globally, residential aged care is a principal provider of care for older people who can no longer live independently at home. Within this setting, lack of food choice has been identified as a significant factor impacting on residents' self-determination, sense of autonomy and quality of life. DESIGN This study used an exploratory descriptive qualitative approach guided by self-determination theory. METHOD A total of 14 participants (seven residents and seven staff members) from two Australian residential aged care facilities were recruited through purposive and snowball sampling with assistance from one independent contact nurse at each facility. In-depth, semi-structured interviews were conducted, digitally recorded and transcribed. The COREQ checklist was used in this qualitative study. RESULTS Three main themes were identified from the interview data provided by residents and staff, which were as follows: (a) catering for the masses; (b) organisational barriers to providing choice; and (c) food impacts well-being. CONCLUSIONS This study explored the experiences of food choice and service in residential aged care facilities, from the perspectives of both residents and staff. Results of interviews highlighted the importance of providing adequate food choice which has become an enduring issue that requires more attention and commitment to make a positive change for residents living in residential aged care facilities. RELEVANCE TO CLINICAL PRACTICE Nurses and other staff working in residential aged care facilities need to be aware of the importance of providing adequate food choice, including for residents who require modified diets. As advocates for residents, nursing staff must address the persistent lack of food choice. However, this will require a radical change in organisational culture and strong leadership.
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Affiliation(s)
- Donna Wang
- School of Nursing and Midwifery, Western Sydney University, Penrith, NSW, Australia.,Centre for Oral Health Outcomes & Research Translation (COHORT), Ingham Institute for Applied Medical Research, Liverpool, NSW, Australia
| | - Bronwyn Everett
- School of Nursing and Midwifery, Western Sydney University, Penrith, NSW, Australia.,Centre for Oral Health Outcomes & Research Translation (COHORT), Ingham Institute for Applied Medical Research, Liverpool, NSW, Australia
| | - Scott Brunero
- School of Nursing and Midwifery, Western Sydney University, Penrith, NSW, Australia.,Prince of Wales Hospital, Randwick, NSW, Australia
| | - Tiffany Northall
- School of Nursing and Midwifery, Western Sydney University, Penrith, NSW, Australia
| | - Amy R Villarosa
- School of Nursing and Midwifery, Western Sydney University, Penrith, NSW, Australia.,Centre for Oral Health Outcomes & Research Translation (COHORT), Ingham Institute for Applied Medical Research, Liverpool, NSW, Australia.,South Western Sydney Local Health District, Ingham Institute, Liverpool, NSW, Australia
| | - Yenna Salamonson
- School of Nursing and Midwifery, Western Sydney University, Penrith, NSW, Australia.,Centre for Oral Health Outcomes & Research Translation (COHORT), Ingham Institute for Applied Medical Research, Liverpool, NSW, Australia
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Dogan EIK, Raustøl A, Terragni L. Student nurses’ views of right to food of older adults in care homes. Nurs Ethics 2019; 27:754-766. [DOI: 10.1177/0969733019884614] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background: Human rights are an important part of nursing practice. Although there is increasing recognition regarding the importance of including human rights education in nursing education, few studies have focused on nursing students’ perspectives and experiences in relation to human rights in nursing, especially regarding older nursing home residents’ right to food. Objective: To explore nursing students’ perspectives and experiences in relation to the right to food. Research design: The study followed a qualitative interpretative research design. Data were collected from multistage focus groups before, during and after clinical placement in a nursing home and analysed through thematic analysis. Participants and research context: Participants were 18 first-year nursing students; the study was conducted in 2017. Ethical considerations: This study was approved by the Norwegian Centre for Research Data. Findings: Students’ understanding of older nursing home residents’ right to food was a dynamic process. Their perceptions evolved from a polarized perspective to a reality orientation and finally to retrospective reflection. Discussion: The article discusses how nursing students learn about and understand human rights within and throughout their placements. Conclusion: The study bridges human rights theory and practice. Findings suggest that the human right to food must be enacted in daily practice for students to learn in context. Human rights education, specifically pertaining to nutritional care, thus benefits from a practice-oriented approach preparing students to face ‘real life’ challenges and ethical dilemmas. Findings will help nurse educators tailor education in this field.
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Exploring food choice and flexibility practices among staff and residents at care homes in Denmark. AGEING & SOCIETY 2019. [DOI: 10.1017/s0144686x19001491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AbstractWith a growing number of people reaching older age, the need for care provided in long-term care institutions is increasing. Although the goal is to deliver person-centred care that includes choice and flexibility opportunities, pre-scheduled mealtimes and set menus are still used. The aim was to explore how food choice and flexibility practices were perceived and performed by residents and staff at three care homes in Denmark. Three food journey interviews with eight residents (aged 83–96) and three focus groups with 12 people from the care and kitchen staff were conducted. Food choice and flexibility practices were mainly performed informally and selectively by the staff, and through personal practices by the residents, implying that many residents were excluded from food choice and flexibility opportunities. However, food choice and flexibility practices were also inhibited by the staff's time pressure and unfamiliarity with choice possibilities, and by the politeness of the residents. Our findings suggest that food choice and flexibility practices must be understood and performed broadly, and include various ways of listening and responding to the residents’ needs and preferences. The study highlighted the importance of incorporating the essential embodied knowledge and emotional know-how, inherent in food choice and flexibility practices, into formal and inclusive strategies concerning how to think and act in relation to the food and meal situation.
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Buttigieg SC, Tomaselli G, Byers V, Cassar M, Tjerbo T, Rosano A. Corporate social responsibility and person-centered care: a scoping review. JOURNAL OF GLOBAL RESPONSIBILITY 2019. [DOI: 10.1108/jgr-01-2019-0006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PurposeThe aim of this paper was to explore the linkage between corporate social responsibility (CSR) and person-centered care (PCC). The scope of the review was, therefore, to identify whether – as a result of such linkage – CSR may be a potential vehicle for delivering PCC within health-care organizations.Design/methodology/approachData were retrieved by searching multiple keywords on PubMed, Medline and Scopus databases with inclusion/exclusion criteria based on years of publication from 2001 to 2018, language, no geographic restrictions, paper focus, research and document types. A total of 56 articles (N = 56) were selected and reviewed. Thematic analysis was conducted to identify and compare the main features of PCC and CSR.FindingsThe findings revealed that while CSR and PCC are interrelated, CSR features are not being exploited in their entirety in formalizing PCC as part of the CSR strategy. In particular, the two salient CSR features explicitly referred to in conjunction with explicit PCC characteristics are quality of care and health communication. Furthermore, patients’ rights and dignity were the leading implicit CSR features mentioned in conjunction with both explicit and implicit PCC characteristics.Research limitations/implicationsSubjectivity of researchers, limited number of databases and publication types included are the main limitations of this research.Originality/valueTo the best of the authors’ knowledge, this is the first paper analyzing CSR and PCC in an interrelated way.
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Namasivayam-Macdonald AM, Steele CM, Carrier N, Lengyel C, Keller HH. The Relationship between Texture-Modified Diets, Mealtime Duration, and Dysphagia Risk in Long-Term Care. CAN J DIET PRACT RES 2019; 80:122-126. [PMID: 30907128 DOI: 10.3148/cjdpr-2019-004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Many long-term care (LTC) residents have an increased risk for dysphagia and receive texture-modified diets. Dysphagia has been shown to be associated with longer mealtime duration, and the use of texture-modified diets has been associated with reduced nutritional intake. The current study aimed to determine if the degree of diet modification affected mealtime duration and to examine the correlation between texture-modified diets and dysphagia risk. Data were collected from 639 LTC residents, aged 62-102 years. Nine meal observations per resident provided measures of meal duration, consistencies consumed, coughing and choking, and assistance provided. Dysphagia risk was determined by identifying residents who coughed/choked at meals, were prescribed thickened fluids, and/or failed a formal screening protocol. Degree of texture modification was derived using the International Dysphagia Diet Standardization Initiative Functional Diet Scale. There was a significant association between degree of diet modification and dysphagia risk (P < 0.001). However, there was no association between diet modifications and mealtime duration, even when the provision of physical assistance was considered. Some residents who presented with signs of swallowing difficulties were not prescribed a texture-modified diet. Swallowing screening should be performed routinely in LTC to monitor swallowing status and appropriateness of diet prescription. Physical assistance during meals should be increased.
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Affiliation(s)
| | - Catriona M Steele
- b Toronto Rehabilitation Institute, Toronto, ON.,c University of Toronto, Toronto, ON
| | | | | | - Heather H Keller
- f University of Manitoba, Winnipeg, MB.,g Schlegel-University of Waterloo Research Institute for Aging, Waterloo, ON
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Watkins R, Goodwin VA, Abbott RA, Tarrant M. Eating well in care homes: Testing the feasibility of a staff training programme aimed at improving social interaction and choice at mealtimes. Int J Older People Nurs 2019; 14:e12247. [DOI: 10.1111/opn.12247] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2019] [Revised: 03/27/2019] [Accepted: 05/13/2019] [Indexed: 11/28/2022]
Affiliation(s)
- Ross Watkins
- University of Exeter Medical School Exeter UK
- National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care (CLAHRC) South West Peninsula Exeter UK
| | - Victoria A. Goodwin
- University of Exeter Medical School Exeter UK
- National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care (CLAHRC) South West Peninsula Exeter UK
| | - Rebecca A. Abbott
- University of Exeter Medical School Exeter UK
- National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care (CLAHRC) South West Peninsula Exeter UK
| | - Mark Tarrant
- University of Exeter Medical School Exeter UK
- National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care (CLAHRC) South West Peninsula Exeter UK
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Parker V, Engle RL, Afable MK, Tyler DA, Gormley K, Stolzmann K, Shwartz M, Sullivan JL. Staff-perceived Conflict between Resident-centered Care and Quality in the Skilled Nursing Facility: Are Both Possible? Clin Gerontol 2019; 42:267-276. [PMID: 29733754 DOI: 10.1080/07317115.2018.1467522] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
OBJECTIVES The purpose of this study was to understand if and how Veterans Affairs (VA) nursing home (CLC) staff experience difficulty in providing care that is both resident-centered (RCC) and concordant with quality standards. METHODS Twelve VA CLCs were selected for site visits, stratified based on rankings on a composite quality measure (calculated from various indicators) and resident-centered care (RCC) progress (based on a culture change tool). Staff were interviewed about efforts and barriers to achieving goals in RCC and quality, and the interview transcripts systematically analyzed for themes. RESULTS We interviewed 141 participants, including senior leaders, middle managers, and front-line staff. An emergent theme was conflict between RCC and quality, although participants varied in their perceptions of its impact. Participants perceived three conflict types: 1) between resident preferences and medically indicated actions; 2) between resident preferences and the needs or safety of others; and 3) limits of staff time or authority. CONCLUSIONS CLC staff perceive conflicts between RCC and care consistent with quality imperatives. CLINICAL IMPLICATIONS Variation in perceived RCC-quality conflicts suggests that policy clarifications and additional training may provide guidance in dealing with such dilemmas. It may be prudent to clearly communicate to what boundaries exist to RCC in the evolving CLC environment.
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Affiliation(s)
- Victoria Parker
- a Center for Healthcare Organization & Implementation Research , VA Boston Healthcare System , Boston , MA.,b Peter T. Paul College of Business and Economics , University of New Hampshire , Durham , NH
| | - Ryann L Engle
- a Center for Healthcare Organization & Implementation Research , VA Boston Healthcare System , Boston , MA
| | - Melissa K Afable
- c Department of Quality, Safety & Value , Partners HealthCare , Boston , MA
| | - Denise A Tyler
- e Program on Aging, Disability, and Long-term care, RTI , Waltham , MA
| | - Katelyn Gormley
- a Center for Healthcare Organization & Implementation Research , VA Boston Healthcare System , Boston , MA
| | - Kelly Stolzmann
- a Center for Healthcare Organization & Implementation Research , VA Boston Healthcare System , Boston , MA
| | - Michael Shwartz
- a Center for Healthcare Organization & Implementation Research , VA Boston Healthcare System , Boston , MA.,f Questrom School of Business , Boston University , Boston , MA
| | - Jennifer L Sullivan
- a Center for Healthcare Organization & Implementation Research , VA Boston Healthcare System , Boston , MA.,d Department of Health Law, Policy and Management , Boston University School of Public Health , Boston , MA
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Understanding the dining experience of individuals with dysphagia living in care facilities: A grounded theory analysis. Int J Nurs Stud 2019; 92:144-153. [DOI: 10.1016/j.ijnurstu.2019.01.017] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Revised: 01/17/2019] [Accepted: 01/30/2019] [Indexed: 12/16/2022]
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Bodenhagen L, Suvei SD, Juel WK, Brander E, Krüger N. Robot technology for future welfare: meeting upcoming societal challenges – an outlook with offset in the development in Scandinavia. HEALTH AND TECHNOLOGY 2019. [DOI: 10.1007/s12553-019-00302-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Keller HH, Chaudhury H, Pfisterer KJ, Slaughter SE. Development and Inter-Rater Reliability of the Mealtime Scan for Long-Term Care. THE GERONTOLOGIST 2019; 58:e160-e167. [PMID: 28329849 DOI: 10.1093/geront/gnw264] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Background and Objectives Poor food intake is common in long-term care (LTC). The mealtime experience has been identified as influential, yet, research has been limited by lack of quality, standardized measures. The purpose of this study was to develop and test for inter-rater reliability the Mealtime Scan (MTS), an observational measure. Research Design and Methods MTS was derived from the literature on ambiance, mealtime experience, social interactions at mealtimes, and social models of care. Three scales on person-centered care and physical and social environments are used to summarize key aspects observed with MTS. Two raters assessed MTS for reliability at 30 different meals conducted in 10 dining rooms, within three LTC residences. Intraclass correlation coefficient (ICC) was used to assess reliability. Results MTS demonstrated good to excellent reliability on the three summative scales (physical ICC = 0.73, social ICC = 0.81, person-centered care ICC = 0.83) and other scalable items had good to excellent reliability (e.g., background noise ICC = 0.65, Mealtime Relational Care checklist: negative interactions ICC = 0.85). Discussion and Implications MTS is reliable and face valid for assessing mealtime experience. Future work will explore construct validity of this measure. MTS can be used to support improving the mealtime experience for residents living in LTC.
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Affiliation(s)
- Heather H Keller
- Schlegel-University of Waterloo Research Institute for Aging, University of Waterloo
| | | | - Kaylen J Pfisterer
- Schlegel-University of Waterloo Research Institute for Aging, University of Waterloo.,Applied Health Sciences, University of Waterloo
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Greene C, Canning D, Wilson J, Bak A, Tingle A, Tsiami A, Loveday H. I-Hydrate training intervention for staff working in a care home setting: An observational study. NURSE EDUCATION TODAY 2018; 68:61-65. [PMID: 29886286 DOI: 10.1016/j.nedt.2018.05.014] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Revised: 04/10/2018] [Accepted: 05/16/2018] [Indexed: 06/08/2023]
Abstract
BACKGROUND Dehydration is a complex and well-recognised problem for older people residing in care homes. Within the social care sector support staff provide the majority of direct care for residents, and yet receive minimal training. OBJECTIVES To design, deliver and evaluate a hydration specific training session for care home staff to develop their knowledge and skills in supporting the hydration of care home residents. DESIGN An observational study comprising a pre-test post-test survey of staff knowledge following a training intervention. PARTICIPANTS AND SETTINGS Training of care home staff took place in two care homes in North West London. METHODS An interactive training session was developed and delivered, with content informed by observations of hydration care within the two homes and evaluated using CIRO model. Participant self-evaluation forms were used to collect data after the session regarding satisfaction and usefulness of the session, and pre and post levels of self-reported knowledge across six facets of hydration care. Training facilitators captured qualitative data in the form of field notes. Observations of hydration care explored the impact of training on practice. RESULTS Eighteen training sessions were delivered. A total of 161 participant evaluation forms were returned. There was a significant increase in self-reported knowledge across all six facets of hydration care (p = 0.000). The majority of participants found the training enjoyable and useful, and expressed an expected change in their practice. Participants enjoyed the interactive components of the training. A lack of reflective practice skills meant participants were unable to reflect realistically about the hydration care provided in the home. CONCLUSION Focused training on hydration in the care home environment benefits from being interactive and experiential. Although such training can be effective in increasing staff knowledge, inclusion of skills in reflective practice is required if this knowledge is to be translated into practice.
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Affiliation(s)
- Carolynn Greene
- Richard Wells Research Centre, University of West London, Paragon House, Boston Manor Road, Brentford, Middlesex TW98 9GB, United Kingdom.
| | - Deebs Canning
- College of Nursing, Midwifery and Healthcare, University of West London, United Kingdom.
| | - Jennie Wilson
- Richard Wells Research Centre, University of West London, Paragon House, Boston Manor Road, Brentford, Middlesex TW98 9GB, United Kingdom.
| | - Aggie Bak
- Richard Wells Research Centre, University of West London, Paragon House, Boston Manor Road, Brentford, Middlesex TW98 9GB, United Kingdom.
| | - Alison Tingle
- Richard Wells Research Centre, University of West London, Paragon House, Boston Manor Road, Brentford, Middlesex TW98 9GB, United Kingdom.
| | - Amalia Tsiami
- London Geller College of Hospitality and Tourism, University of West London, St Mary's Rd, London W5 5RF, United Kingdom.
| | - Heather Loveday
- Richard Wells Research Centre, University of West London, Paragon House, Boston Manor Road, Brentford, Middlesex TW98 9GB, United Kingdom.
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Lea EJ, Goldberg LR, Price AD, Tierney LT, McInerney FJ. Best intentions or best practice? A case study of the nutritional needs and outcomes of a person with dementia living in a residential aged care home. Int J Nurs Pract 2018; 25:e12692. [PMID: 30094901 DOI: 10.1111/ijn.12692] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2017] [Revised: 03/29/2018] [Accepted: 07/09/2018] [Indexed: 11/30/2022]
Abstract
AIMS To evaluate the nutritional status and needs of a person with dementia living in an aged care home, including identification of barriers to, and effective strategies for, the provision of person-centred care. BACKGROUND Nutrition and hydration care are integral to quality of life for adults with dementia, but there is little research on whether staff knowledge around effective care strategies for residents is translated into optimal care. DESIGN Focused ethnographic single-case design. METHODS The perspectives of the resident, her prime family member, and six care staff were triangulated through interviews, observation, document audit, and medical file review to investigate the resident's nutrition and hydration status and needs (October 2014-April 2015). RESULTS During 3 years in care, this resident had lost weight steadily. Staff appeared attentive but did not maintain a systematic record of body mass index. At meals, staff encouraged eating but used ineffective strategies. Food was not served in ways that facilitated active participation. Eating and drinking were structured as tasks to be completed rather than activities to be enjoyed. CONCLUSION This instrumental case study identified a task-oriented, rather than person-centred, approach to nutrition and hydration care, adversely affecting the resident's nutritional health and capability to participate actively.
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Affiliation(s)
- Emma J Lea
- Wicking Dementia Research and Education Centre, Faculty of Health, University of Tasmania, Hobart, Australia
| | - Lynette R Goldberg
- Wicking Dementia Research and Education Centre, Faculty of Health, University of Tasmania, Hobart, Australia
| | - Andrea D Price
- Wicking Dementia Research and Education Centre, Faculty of Health, University of Tasmania, Hobart, Australia
| | - Laura T Tierney
- Wicking Dementia Research and Education Centre, Faculty of Health, University of Tasmania, Hobart, Australia
| | - Fran J McInerney
- Wicking Dementia Research and Education Centre, Faculty of Health, University of Tasmania, Hobart, Australia
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Stow RE, Smith CH, Rushton AB. Care home resident and staff perceptions of the acceptability of nutrition intervention trial procedures: a qualitative study embedded within a cluster randomised feasibility trial. BMJ Open 2018; 8:e022307. [PMID: 30030321 PMCID: PMC6059282 DOI: 10.1136/bmjopen-2018-022307] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES To examine care home resident and staff perceptions of the acceptability of participating in a feasibility trial evaluating nutritional interventions in the treatment of malnutrition. DESIGN Exploratory qualitative methodology was used to gather descriptions of resident and staff perceptions of trial procedures, using semi-structured interviews with residents and focus groups with staff. The interviews were used to explore individual perceptions of the acceptability of the assigned intervention and the outcomes measured. Focus groups were used to explore staff experiences of trial participation and perspectives of nutritional support interventions. SETTING The study was embedded within a cluster randomised feasibility trial, which randomised six care homes to provide standard care (SC), food-based (FB) intervention or oral nutritional supplement (ONS) intervention to residents with, or at risk of, malnutrition. PARTICIPANTS Residents in the trial with capacity to consent (n=7) formed the sampling frame for inclusion. Four agreed to be approached by the researcher and to take part in the individual interviews. All were women, representing two arms of the trial (ONS and SC). Twelve staff participated in six focus groups, one at each care home. All participants were women, representing all three arms of the trial. RESULTS Major themes that emerged from both interviews and focus groups included the perceived acceptability of trial involvement, the value of residents completing participant-reported outcome measures and the challenges associated with outcomes measurement in this setting. Themes that emerged from the focus groups alone, included the importance of individualising an intervention, and the perceived value of FB and ONS interventions and dietetic input. CONCLUSIONS Residents and staff perceived involvement in a trial evaluating nutritional interventions to be acceptable, although the challenges associated with research in this setting were acknowledged. Resident preferences were highlighted by staff as an important consideration when implementing a nutrition support plan. TRIAL REGISTRATION NUMBER ISRCTN38047922.
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Affiliation(s)
| | - Christina H Smith
- Language and Cognition, Division of Psychology and Language Sciences, University College London, London, UK
| | - Alison B Rushton
- Centre of Precision Rehabilitation for Spinal Pain, School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK
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Iuglio S, Keller H, Chaudhury H, Slaughter SE, Lengyel C, Morrison J, Boscart V, Carrier N. Construct Validity of the Mealtime Scan: A Secondary Data Analysis of the Making Most of Mealtimes (M3) Study. J Nutr Gerontol Geriatr 2018; 37:82-104. [PMID: 29781782 DOI: 10.1080/21551197.2018.1461166] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
Long-term care (LTC) physical and psychosocial mealtime environments have been inconsistently assessed due to the lack of a standardized measure. The purpose of this study was to examine the construct validity of a new standardized observational measure, the Mealtime Scan (MTS), using the Making Most of Mealtimes data collected on 639 residents in 82 dining rooms in 32 LTC homes. The MTS includes physical, social, and person-centered care summary scales scored from 1 to 8. Mean ratings on these summary scales were moderate for physical (5.6 SD 0.9), social (5.0 SD 0.9), and person-centered care (PCC; 5.5 SD 0.8). Regression analyses determined which items within the MTS were associated with these summary scales: physical - music (B = 0.27, p = 0.04), number of staff passing food (B = -0.11, p = 0.03), number of residents (B = -0.03, p = 0.01); social - social sound (B = 0.31 p < 0.0001), number of residents requiring eating assistance (B = 0.11, p = 0.02); PCC - lighting (B = 0.01 p = 0.04), and total excess noise (B = 0.05, p < 0.0001). The Mealtime Relational Care Checklist (M-RCC) was associated positively with ratings on all three summary scales. Correlations revealed that the MTS summary scales were associated with other constructs: Dining Environment Audit Protocol functionality scale, resident and dining room level M-RCC, Mini Nutritional Assessment- Short Form, and resident Cognitive Performance Scale. These results demonstrate that the MTS summary scales exhibit construct validity, as the ratings were associated with expected observed mealtime characteristics and correlated with dining room and resident level constructs in anticipated directions.
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Affiliation(s)
| | - Heather Keller
- b University of Waterloo ; Schlegel-UW Research Institute for Aging , Waterloo , Canada
| | | | | | | | | | - Veronique Boscart
- f Conestoga College ; Schlegel-UW Research Institute for Aging , Kitchener , Canada
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Gilmore-Bykovskyi AL, Rogus-Pulia N. Temporal Associations between Caregiving Approach, Behavioral Symptoms and Observable Indicators of Aspiration in Nursing Home Residents with Dementia. J Nutr Health Aging 2018; 22:400-406. [PMID: 29484354 PMCID: PMC5830143 DOI: 10.1007/s12603-017-0943-y] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
OBJECTIVES Dysphagia, or impaired swallowing, is common in nursing home (NH) residents with dementia and contributes to malnutrition and diminished quality of life. Dysphagia also commonly leads to aspiration or passage of food or fluids into the airway, which can result in aspiration pneumonia-a leading cause of death for people with dementia. Currently available interventions for dysphagia aim to modify the risk of aspiration events primarily by modifying diet and positioning to improve the safety of an individual's swallow. However other potentially modifiable contextual factors relevant to mealtime care within NH settings that may influence the occurrence of aspiration events, such as the nature of caregiving interactions or occurrence of dementia-related behavioral symptoms, have not been examined. To address this gap, we examined the temporal associations between caregiving approach and behavioral symptoms as antecedents to observable indicators of aspiration among nursing home (NH) residents with dementia. DESIGN Secondary analysis of coded, timed-event behavioral data from 33 video-recorded observations of mealtime interactions between NH residents with dementia and caregivers. SETTING/PARTICIPANTS Residents with dementia who required assistance with mealtime care (n=12) and nursing assistants (n=8) from Memory Care Units (MCU) in 2 Midwestern NHs. RESULTS Observable indicators of aspiration were significantly more likely to occur during or following task-centered caregiver actions than person-centered actions (12% likelihood; Yule's Q 0.89; OR 95% CI 12.70-23.75) and 15-30 seconds after a behavioral symptom (5% likelihood; Yule's Q 0.65; OR 95% CI 4.18-8.57). CONCLUSIONS These findings provide compelling preliminary evidence that caregiver approach may influence the occurrence of aspiration. Provided the urgent need for more approaches to mitigate the complications associated with dysphagia in people with dementia, even a moderate reduction in aspiration events may be clinically meaningful. Further, well-designed observational studies with individuals with well-characterized dysphagia are needed to better understand and characterize these relationships, their temporal structures and their impacts on other relevant outcomes such as eating performance and malnutrition.
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Affiliation(s)
- A L Gilmore-Bykovskyi
- Andrea Gilmore-Bykovskyi, PhD, RN, UW-Madison School of Nursing, 3173 Cooper Hall, 701 Highland Avenue, Madison, WI 53705, Phone: (608) - 262-3057, E-mail:
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Prevalence and Determinants of Poor Food Intake of Residents Living in Long-Term Care. J Am Med Dir Assoc 2017; 18:941-947. [DOI: 10.1016/j.jamda.2017.05.003] [Citation(s) in RCA: 66] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2017] [Revised: 05/01/2017] [Accepted: 05/02/2017] [Indexed: 12/30/2022]
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Lea EJ, Goldberg LR, Price AD, Tierney LT, McInerney F. Staff awareness of food and fluid care needs for older people with dementia in residential care: A qualitative study. J Clin Nurs 2017; 26:5169-5178. [DOI: 10.1111/jocn.14066] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/26/2017] [Indexed: 01/11/2023]
Affiliation(s)
- Emma J Lea
- Wicking Dementia Research and Education Centre; University of Tasmania; Hobart Tas. Australia
| | - Lynette R Goldberg
- Wicking Dementia Research and Education Centre; University of Tasmania; Hobart Tas. Australia
| | - Andrea D Price
- Wicking Dementia Research and Education Centre; University of Tasmania; Hobart Tas. Australia
| | - Laura T Tierney
- Wicking Dementia Research and Education Centre; University of Tasmania; Hobart Tas. Australia
| | - Fran McInerney
- Wicking Dementia Research and Education Centre; University of Tasmania; Hobart Tas. Australia
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Watkins R, Goodwin VA, Abbott RA, Hall A, Tarrant M. Exploring residents' experiences of mealtimes in care homes: A qualitative interview study. BMC Geriatr 2017; 17:141. [PMID: 28697747 PMCID: PMC5506571 DOI: 10.1186/s12877-017-0540-2] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2017] [Accepted: 07/06/2017] [Indexed: 11/10/2022] Open
Abstract
Background Many interventions aim to alleviate well-documented problems of malnutrition in residential care homes and improve residents’ health and wellbeing. Despite some positive findings, little is known about how and why mealtime interventions might be effective, and in particular, what effects residents’ experiences of mealtimes have on health outcomes. The aim of this study was to gain an insight into these experiences and explore some of the issues that may impact on residents’ enjoyment of meals, and resulting health and wellbeing. Methods Semi-structured interviews were conducted with eleven residents from four care homes in the South West UK. Thematic analysis was used to derive content and meaning from transcribed interviews. Interviews were supplemented by researcher observations of mealtimes. Results The dining experience was a focal point for participants’ broader experiences of residing in a care home. Three themes pertaining to residents’ experiences were identified: (1) Emotional and psychological connections with other residents; (2) managing competing interests with limited resources; and (3) familiarity and routine. Conclusion Mealtimes are a mainstay of life in a care home through which residents’ experiences are characterised, exemplified and magnified. Understanding how residents interact with one another, accommodating their preferences and encouraging autonomy may enhance their mealtime experiences. It may also help to ease the transition from independent-living to life in care, which can be particularly stressful for some residents, and improve health and wellbeing over the long-term.
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Affiliation(s)
- Ross Watkins
- University of Exeter Medical School, St Luke's Campus, Heavitree Road, Exeter, EX1 2LU, UK. .,National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care (CLAHRC), South West Peninsula, UK.
| | - Victoria A Goodwin
- University of Exeter Medical School, St Luke's Campus, Heavitree Road, Exeter, EX1 2LU, UK.,National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care (CLAHRC), South West Peninsula, UK
| | - Rebecca A Abbott
- University of Exeter Medical School, St Luke's Campus, Heavitree Road, Exeter, EX1 2LU, UK.,National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care (CLAHRC), South West Peninsula, UK
| | - Abi Hall
- University of Exeter Medical School, St Luke's Campus, Heavitree Road, Exeter, EX1 2LU, UK.,National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care (CLAHRC), South West Peninsula, UK
| | - Mark Tarrant
- University of Exeter Medical School, St Luke's Campus, Heavitree Road, Exeter, EX1 2LU, UK.,National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care (CLAHRC), South West Peninsula, UK
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Song Y, Scales K, Anderson RA, Wu B, Corazzini KN. Resident challenges with daily life in Chinese long-term care facilities: A qualitative pilot study. Geriatr Nurs 2017. [PMID: 28633954 DOI: 10.1016/j.gerinurse.2017.05.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
As traditional family-based care in China declines, the demand for residential care increases. Knowledge of residents' experiences with long-term care (LTC) facilities is essential to improving quality of care. This pilot study aimed to describe residents' experiences in LTC facilities, particularly as it related to physical function. Semi-structured open-ended interviews were conducted in two facilities with residents stratified by three functional levels (n = 5). Directed content analysis was guided by the Adaptive Leadership Framework. A two-cycle coding approach was used with a first-cycle descriptive coding and second-cycle dramaturgical coding. Interviews provided examples of challenges faced by residents in meeting their daily care needs. Five themes emerged: staff care, care from family members, physical environment, other residents in the facility, and personal strategies. Findings demonstrate the significance of organizational context for care quality and reveal foci for future research.
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Affiliation(s)
| | - Kezia Scales
- Duke University School of Nursing, USA; Duke University Center for the Study of Aging and Human Development, USA
| | - Ruth A Anderson
- University of North Carolina at Chapel Hill, School of Nursing, USA
| | - Bei Wu
- New York University Rory Meyers College of Nursing, USA
| | - Kirsten N Corazzini
- Duke University School of Nursing, USA; Duke University Center for the Study of Aging and Human Development, USA
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Liu W, Jao YL, Williams K. The association of eating performance and environmental stimulation among older adults with dementia in nursing homes: A secondary analysis. Int J Nurs Stud 2017; 71:70-79. [PMID: 28340390 PMCID: PMC5495475 DOI: 10.1016/j.ijnurstu.2017.03.004] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2016] [Revised: 03/02/2017] [Accepted: 03/08/2017] [Indexed: 11/21/2022]
Abstract
BACKGROUND Nursing home residents with dementia experience increased risk for compromised eating performance due to intrapersonal, interpersonal, and environmental factors. Environmental stimulation is physical, social, and/or sensory stimulation present in the environment that can potentially trigger individuals' emotion or motivate physical reactions. Beyond the personal factors, there is a lack of evidence on how environmental stimulation influences individuals' eating performance at mealtimes. OBJECTIVES This study examined the association between environmental stimulation and eating performance among nursing home residents with dementia. DESIGN This study was a secondary analysis using baseline videos selected from a communication intervention study, where videos were recorded to capture staff-resident interactions during care activities for nursing home residents with dementia. Videos were included in this study only if residents demonstrated eating activities at mealtimes. SAMPLE AND SETTING A total of 36 videos were selected (mean length=4min). The sample included 15 residents with dementia (mean age=86), and 19 certified nursing assistants (mean age=36) in 8 nursing homes. METHODS The dependent variable was eating performance as measured by the Level of Eating Independence scale (range: 15-36, with higher scores indicating better eating performance). The independent variables were characteristics of environmental stimulation measured by the Person-Environment Apathy Rating-Environment subscale (stimulation clarity, stimulation strength, stimulation specificity, interaction involvement, physical accessibility, and environmental feedback). Each characteristic was rated on a 1-4 scale with higher scores indicating more desirable environmental stimulation. Multilevel models were used to examine the association between eating performance and environmental stimulation, adjusting for resident characteristics (i.e., age, gender, dementia stage, function, comorbidity, psychoactive medication use) and nesting effects of residents and staff. RESULTS Resident participants demonstrated moderate levels of eating performance (M=27.08, SD=5.16). Eating performance was significantly lower among older residents, those with more advanced dementia, and higher comorbidity. After controlling for resident characteristics, eating performance was significantly associated with stimulation specificity (how the stimulation is delivered and tailored to the resident), and was not associated with other environmental stimulation characteristics. For each 1 point increase in stimulation specificity, eating performance increased by 8.78 points (95% CI=0.59, 16.97). CONCLUSIONS Environmental stimulation that is personally tailored to a resident' needs and preferences and directly offered to a resident contributed to better eating performance among residents with dementia. The findings will direct future development and implementation of person-directed mealtime care programs and dining environment arrangements for residents with dementia in nursing homes.
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Affiliation(s)
- Wen Liu
- The University of Iowa, College of Nursing, 432 CNB, 50 Newton Road, Iowa City, IA, 52242, USA.
| | - Ying-Ling Jao
- Pennsylvania State University, College of Nursing, University Park, PA, USA
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Chaudhury H, Keller H, Pfisterer K, Hung L. Development of a Physical Environmental Observational Tool for Dining Environments in Long-Term Care Settings. THE GERONTOLOGIST 2017; 57:e95-e101. [DOI: 10.1093/geront/gnw261] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Smith KM, Thomas KS, Johnson S, Meng H, Hyer K. Dietary Service Staffing Impact Nutritional Quality in Nursing Homes. J Appl Gerontol 2017; 38:639-655. [DOI: 10.1177/0733464816688309] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Objective: To examine the relationship between dietary service staff and dietary deficiency citations in nursing homes (NHs). Method: 2007-2011 Online Survey and Certification and Reporting data for 14,881 freestanding NHs were used to examine the relationship between dietary service staff and the probability of receiving a dietary service–related deficiency citation. An unconditional logit model with random effects was employed. Results: Findings suggest that higher staffing levels for dietitians (odds ratio [OR] = .955; p < .01), dietary service personnel (OR = .996; p < .01), and certified nursing assistants (CNAs; OR = .981; p < .05) decrease the likelihood of receiving a dietary service deficiency citation. Conclusion: Higher levels of dietary service and CNA staffing levels have the potential to improve the quality of nutritional care in NHs. Findings help substantiate the Centers for Medicare and Medicaid Services’ proposed rules for more stringent Food and Nutrition Services in the NH setting and signify the need for further research relative to the impact of dietary service staff on nutritional and clinical outcomes.
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Affiliation(s)
| | - Kali S. Thomas
- U.S. Department of Veterans Affairs Medical Center, Providence, RI, USA
- Brown University, Providence, RI, USA
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