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Young AM, Byrnes A, Mahoney D, Power G, Cahill M, Heaton S, McRae P, Mudge A, Miller E. Exploring hospital mealtime experiences of older inpatients, caregivers and staff using photovoice methods. J Clin Nurs 2024; 33:1906-1920. [PMID: 38284486 DOI: 10.1111/jocn.17009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Revised: 12/05/2023] [Accepted: 01/07/2024] [Indexed: 01/30/2024]
Abstract
AIM To gather and understand the experience of hospital mealtimes from the perspectives of those receiving and delivering mealtime care (older inpatients, caregivers and staff) using photovoice methods to identify touchpoints and themes to inform the co-design of new mealtime interventions. METHODS This study was undertaken on acute care wards within a single metropolitan hospital in Brisbane, Australia in 2019. Photovoice methods involved a researcher accompanying 21 participants (10 older patients, 5 caregivers, 4 nurses and 2 food service officers) during a mealtime and documenting meaningful elements using photographs and field notes. Photo-elicitation interviews were then undertaken with participants to gain insight into their experience. Data were analysed using inductive thematic analysis, involving a multidisciplinary research team including a consumer. RESULTS Themes were identified across the three touchpoints: (1) preparing for the meal (the juggle, the anticipation), (2) delivering/receiving the meal (the rush, the clutter and the wait) and (3) experiencing the meal (the ideal, pulled away and acceptance). Despite a shared understanding of the importance of meals and shared vision of 'the ideal' mealtime, generally this was a time of tension, missed cares and dissatisfaction for staff, patients and caregivers. There was stark contrast in some aspects of mealtime experience, with simultaneous experiences of 'the rush' (staff) and 'the wait' (patients and caregivers). There was an overwhelming sense of acceptance and lack of control over change from all. CONCLUSIONS This study identified themes during hospital mealtimes which have largely gone unaddressed in the design of mealtime interventions to date. This research may provide a framework to inform the future co-design of mealtime interventions involving patients, caregivers and multidisciplinary staff, centred around these key touchpoints. PRACTICE IMPLICATIONS Mealtimes are experienced differently by patients, caregivers, nurses and food service officers across three key touchpoints: preparing for, delivering/receiving and experiencing the meal. Improving mealtime experiences therefore necessitates a collaborative approach, with co-designed mealtime improvement programs that include specific interventions focusing each touchpoint. Our data suggest that improvements could focus on reducing clutter, clarifying mealtime roles and workflows and supporting caregiver involvement. IMPACT What problem did the study address? Mealtimes are the central mechanism to meet patients' nutritional needs in hospital; however, research consistently shows that many patients do not eat enough to meet their nutritional requirements and that they often do not receive the mealtime assistance they require. Interventions to improve hospital mealtimes have, at best, shown only modest improvements in nutritional intake and mealtime care practices. Gaining deeper insight into the mealtime experience from multiple perspectives may identify new opportunities for improvement. What were the main findings? Patients, caregivers and staff have shared ideals of comfort, autonomy and conviviality at mealtimes, but challenges of complex teamwork and re-prioritisation of mealtimes in the face of prevailing power hierarchies make it difficult to achieve this ideal. There are three discrete touchpoints (preparing for, delivering/receiving and experiencing the meal) that require different approaches to improvement. Our data suggests a need to focus improvement on reducing clutter, clarifying mealtime roles and workflows and supporting caregivers. Where and on whom will the research have an impact? The research provides a framework for multidisciplinary teams to begin co-designing improvements to mealtime care to benefit patients, caregivers and staff, while also providing a method for researchers to understand other complex care situations in hospital. REPORTING METHOD This manuscript is written in adherence with the Standards for Reporting Qualitative Research. PATIENT OR PUBLIC CONTRIBUTION Patients and caregivers were involved in the conception and design of the study through their membership of the hospital mealtime reference group. A consumer researcher (GP) was involved in the team to advise on study conduct (i.e. recruitment methods and information), data analysis (i.e. coding transcripts), data interpretation (i.e. review and refinement of themes) and manuscript writing (i.e. review and approval of final manuscript).
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Affiliation(s)
- Adrienne M Young
- Dietetics and Food Services, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
- Centre for Health Services Research, the University of Queensland, Brisbane, Queensland, Australia
- Nutrition Research Collaborative, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
| | - Angela Byrnes
- Dietetics and Food Services, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
- Nutrition Research Collaborative, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
- Internal Medicine Research Unit, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
| | - Danielle Mahoney
- Dietetics and Food Services, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
- School of Psychology, the University of Queensland, Brisbane, Queensland, Australia
| | - Gary Power
- Consumer Representative Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
| | - Margaret Cahill
- Internal Medicine Research Unit, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
| | - Sarah Heaton
- Speech Pathology, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
| | - Prue McRae
- Internal Medicine Research Unit, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
| | - Alison Mudge
- Centre for Health Services Research, the University of Queensland, Brisbane, Queensland, Australia
- Nutrition Research Collaborative, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
- Internal Medicine Research Unit, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
| | - Evonne Miller
- School of Design, Queensland University of Technology, Brisbane, Queensland, Australia
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Treleaven E, Matthews-Rensch K, Garcia D, Mudge A, Banks M, Young AM. Mealtimes matter: Measuring the hospital mealtime environment and care practices to identify opportunities for multidisciplinary improvement. Nutr Diet 2024. [PMID: 38246600 DOI: 10.1111/1747-0080.12863] [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: 07/06/2023] [Revised: 11/08/2023] [Accepted: 12/20/2023] [Indexed: 01/23/2024]
Abstract
AIMS Hospital inpatients often eat poorly and report barriers related to mealtime care. This study aimed to measure and describe the mealtime environment and care practices across 16 acute wards in a tertiary hospital to identify opportunities for improvement. METHODS A prospective cross-sectional audit was undertaken over a two-month period in 2021. A structured audit tool was used at one breakfast, lunch and dinner on each ward to observe the mealtime environment (competing priorities, lighting, tray table clutter) and care practices (positioning, tray within reach, mealtime assistance). Data were analysed descriptively (%, count), with analyses by meal period and ward to identify variation in practices. RESULTS A total of 892 observations were completed. Competing priorities (59%), poor lighting (43%) and cluttered tray tables (41%) were common. Mealtime assistance was required by 300 patients (33.6%; 5.9% eating assistance, 27.7% set-up assistance) and was provided within 10 min for 203 (66.7%) patients. A total of 54 patients (18.0%) did not receive the required assistance. We observed 447 (50.2%) patients lying in bed at meal delivery, with 188 patients (21.1%) sitting in a chair. Competing priorities, poor lighting, poor patient positioning and delayed assistance were worse at breakfast. Mealtime environments and practices varied between wards. CONCLUSION This audit demonstrates opportunities to improve mealtimes in our hospital. Variation between wards and meal periods suggest that improvements need to be tailored to the ward-specific barriers and enablers. Dietitians are ideally placed to lead a collaborative approach alongside the wider multidisciplinary team to improve mealtime care and optimise intake.
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Affiliation(s)
- Elise Treleaven
- Dietetics and Food Services, Royal Brisbane and Women's Hospital, Brisbane, Australia
- Nutrition Research Collaborative, Royal Brisbane and Women's Hospital, Brisbane, Australia
| | - Kylie Matthews-Rensch
- Dietetics and Food Services, Royal Brisbane and Women's Hospital, Brisbane, Australia
- Nutrition Research Collaborative, Royal Brisbane and Women's Hospital, Brisbane, Australia
| | - Dwayne Garcia
- Dietetics and Food Services, Royal Brisbane and Women's Hospital, Brisbane, Australia
- Nutrition Research Collaborative, Royal Brisbane and Women's Hospital, Brisbane, Australia
| | - Alison Mudge
- Internal Medicine Research Unit, Royal Brisbane and Women's Hospital, Brisbane, Australia
- Greater Brisbane Medical School, University of Queensland, Brisbane, Australia
| | - Merrilyn Banks
- Dietetics and Food Services, Royal Brisbane and Women's Hospital, Brisbane, Australia
- Nutrition Research Collaborative, Royal Brisbane and Women's Hospital, Brisbane, Australia
| | - Adrienne M Young
- Dietetics and Food Services, Royal Brisbane and Women's Hospital, Brisbane, Australia
- Nutrition Research Collaborative, Royal Brisbane and Women's Hospital, Brisbane, Australia
- Centre for Health Services Research, University of Queensland, Brisbane, Australia
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Zhang D, Tay LBG, Lim SF, Ang JYH, Tong CCY, Tang CYL, Brennan-Cook J. Improving nutrition care and diet intake for hospitalised older people at risk of malnutrition through a nurse-driven mealtime assistance bundle. Int J Older People Nurs 2024; 19:e12590. [PMID: 37990475 DOI: 10.1111/opn.12590] [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] [Received: 06/02/2023] [Revised: 10/23/2023] [Accepted: 10/25/2023] [Indexed: 11/23/2023]
Abstract
BACKGROUND Poor dietary intake is common in hospitalised older people. A targeted mealtime intervention is needed to improve nutrition care and dietary intake, especially for those at risk of malnutrition. OBJECTIVES This quality improvement project designed, implemented and evaluated a mealtime assistance bundle consisting of care measures driven by the hospital nursing team. The aims were to improve the mealtime care process to promote dietary intake of the hospitalised older people and to improve nursing staff's knowledge, attitude and practice in malnutrition. METHODS This project adopted a pre-post design, targeting older people aged 65 years and above, who were admitted to a general medical unit in a regional hospital in Singapore. A mealtime assistance bundle consisting of seven care measures, using the acronym CANFEED, was implemented for older adults at risk of malnutrition. Outcome measures on the amount of dietary intake during meals through chart reviews and surveys of nursing staff using Malnutrition Knowledge, Attitudes and perceived Practices (M-KAP) questionnaire were performed before and after implementation. RESULTS There were fewer older adults with poor intake in the post-implementation group than the pre-implementation group. Among those at risk of malnutrition, older adults in the post-implementation group had higher average intake of all provided meals as well as the protein-dense main dish. Significant improvements were noted in the total scores rated by the nursing staff in both the Knowledge-Attitude subscale and Practice subscale of the M-KAP questionnaire. CONCLUSIONS Integrating a nurse-driven mealtime assistance bundle into usual care may have positive outcomes on nutritional intake of hospitalised older people at risk of malnutrition, and on knowledge, attitude and practice of hospital nurses in nutrition care. IMPLICATIONS FOR PRACTICE Nurses play a critical role in nutrition care for hospitalised older people. Continuing efforts to improve nutritional intake of hospitalised older people should focus on staff education, building a multidisciplinary food-promoting culture and patient, family and community empowerment. More efficient clinical processes incorporating information technology with the EMR to support better nutrition care of the hospitalised older people are needed.
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Affiliation(s)
- Di Zhang
- Nursing Division, Sengkang General Hospital, Singapore, Singapore
| | - Laura Bee Gek Tay
- Department of Geriatric Medicine, Sengkang General Hospital, Singapore, Singapore
| | - Su Fee Lim
- Nursing Division, Singapore General Hospital, Singapore, Singapore
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Young A, Kozica-Olenski S, Mallan K, McRae P, Treleaven E, Walsh Z, Mudge A. Developing and validating a novel staff questionnaire to identify barriers and enablers to nutrition and mealtime care on hospital wards. Nutr Diet 2023; 80:389-398. [PMID: 37169361 DOI: 10.1111/1747-0080.12815] [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: 11/20/2022] [Revised: 04/12/2023] [Accepted: 04/21/2023] [Indexed: 05/13/2023]
Abstract
AIMS Improving hospital nutrition and mealtime care is complex and often requires multifaceted interventions and implementation strategies to change how staff, wards and systems operate. This study aimed to develop and validate a staff questionnaire to identify multilevel barriers and enablers to optimal nutrition and mealtime care on hospital wards, to inform and evaluate local quality improvement. METHODS Literature review, multidisciplinary focus groups and end-user testing informed questionnaire development and establishment of content and face validity. To determine the construct validity, the questionnaire was administered to ward staff working in five wards across two facilities (acute hospital, rehabilitation unit). Exploratory factor analysis was used to estimate the number of factors and to guide decisions about whether to retain or reject individual items. Scale reliability was assessed using Cronbach's alpha. RESULTS The questionnaire was completed by 138 staff, with most respondents being nurses (57%) and working in the acute care facility (76%). Exploratory factor analysis supported construct validity of four of the original seven subscales. The final questionnaire consisted of 17 items and 4 sub sub-scales related to (1) Personal Staff Role; (2) Food Service; (3) Organisational Support, and (4) Family Involvement; each sub-scale demonstrated good reliability with Cronbach's alpha values all >0.70. CONCLUSION This novel and brief questionnaire shows good reliability and preliminary evidence of construct validity in this small sample. It provides a potentially useful instrument to identify barriers and enablers to nutrition and mealtime care from the staff perspective and inform where improvement efforts should be focused.
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Affiliation(s)
- Adrienne Young
- Dietetics and Food Services, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
- Centre for Health Services Research, University of Queensland, Brisbane, Queensland, Australia
| | - Samantha Kozica-Olenski
- Internal Medicine Research Unit, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
- Monash Centre for Health Research and Implementation, Monash University, Melbourne, Victoria, Australia
| | - Kimberley Mallan
- School of Behavioural and Health Sciences, Australian Catholic University, Brisbane, Queensland, Australia
| | - Prue McRae
- Internal Medicine Research Unit, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
| | - Elise Treleaven
- Dietetics and Food Services, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
- Internal Medicine Research Unit, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
| | - Zoe Walsh
- Nutrition and Dietetics, Community and Oral Health Metro North Health, Melbourne, Victoria, Australia
| | - Alison Mudge
- Internal Medicine Research Unit, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
- Greater Brisbane Medical School, University of Queensland, Brisbane, Queensland, Australia
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Furness K, Harris M, Lassemillante A, Keenan S, Smith N, Desneves KJ, King S. Patient Mealtime Experience: Capturing Patient Perceptions Using a Novel Patient Mealtime Experience Tool. Nutrients 2023; 15:2747. [PMID: 37375651 DOI: 10.3390/nu15122747] [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: 05/10/2023] [Revised: 05/23/2023] [Accepted: 06/13/2023] [Indexed: 06/29/2023] Open
Abstract
INTRODUCTION The aim of this study is to describe the mealtime experience using the qualitative components of the Austin Health Patient Mealtime Experience Tool (AHPMET) to complement the quantitative findings of this tool. METHODS A multiphase, cross-sectional study was undertaken across all sites of Austin Health (Victoria, Australia) between March 2020 and November 2021. Patient mealtime experience was measured using the AHPMET. Descriptive statistics and a deductive thematic analysis approach described the patients' mealtime experiences. RESULTS Questionnaire data were collected from 149 participants. Patients were most satisfied with staff interactions, and least satisfied with dimensions of food quality, specifically, flavour, presentation, and menu variety. Clinical symptoms, nutrition impact symptoms and the patient's position were barriers to consumption. DISCUSSION Food quality was perceived as the poorest aspect of patient satisfaction with the hospital foodservice, particularly flavour, presentation, and menu variety. Future foodservice quality improvements must prioritise improving food quality to have the greatest impact on patient satisfaction. While clinical and organisational systems have a role in improving mealtime experience and oral intake, communicating patient perceptions of the mealtime experience is critical for responding to current perceptions of hospital food quality. CONCLUSION Mealtime experience in the hospital has a significant impact on oral intake and patients' wider perception of hospital services. Questionnaires have been used to capture patient satisfaction with foodservice in the hospital; however, no comprehensive questionnaires including qualitative questions that capture the broader mealtime experience have been validated across different hospital settings. The tool developed through this study can be implemented in any acute and subacute health service to provide feedback and improve the mealtime experience of patients. This has the capacity to improve mealtime intake, mitigate malnutrition, and improve quality of life and patient outcomes.
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Affiliation(s)
- Kate Furness
- Department Sport, Exercise and Nutrition Sciences, School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, VIC 3086, Australia
- School of Health Sciences, Swinburne University of Technology, Hawthorn, VIC 3122, Australia
| | - Melina Harris
- School of Health Sciences, Swinburne University of Technology, Hawthorn, VIC 3122, Australia
| | - Annie Lassemillante
- Department Sport, Exercise and Nutrition Sciences, School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, VIC 3086, Australia
- School of Health Sciences, Swinburne University of Technology, Hawthorn, VIC 3122, Australia
| | - Stephen Keenan
- School of Health Sciences, Swinburne University of Technology, Hawthorn, VIC 3122, Australia
| | - Natasha Smith
- School of Health Sciences, Swinburne University of Technology, Hawthorn, VIC 3122, Australia
- Austin Health, Nutrition and Dietetics Department, Division of Allied Health, Heidelberg, VIC 3084, Australia
| | - Katherine J Desneves
- Austin Health, Nutrition and Dietetics Department, Division of Allied Health, Heidelberg, VIC 3084, Australia
| | - Sam King
- Austin Health, Nutrition and Dietetics Department, Division of Allied Health, Heidelberg, VIC 3084, Australia
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Bell JJ, Rushton A, Elmas K, Banks MD, Barnes R, Young AM. Are Malnourished Inpatients Treated by Dietitians Active Participants in Their Nutrition Care? Findings of an Exploratory Study of Patient-Reported Measures across Nine Australian Hospitals. Healthcare (Basel) 2023; 11:healthcare11081172. [PMID: 37108004 PMCID: PMC10138321 DOI: 10.3390/healthcare11081172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 03/27/2023] [Accepted: 04/13/2023] [Indexed: 04/29/2023] Open
Abstract
BACKGROUND Inpatient malnutrition is a key determinant of adverse patient and healthcare outcomes. The engagement of patients as active participants in nutrition care processes that support informed consent, care planning and shared decision making is recommended and has expected benefits. This study applied patient-reported measures to identify the proportion of malnourished inpatients seen by dietitians that reported engagement in key nutrition care processes. METHODS A subset analysis of a multisite malnutrition audit limited to patients with diagnosed malnutrition who had at least one dietitian chart entry and were able to respond to patient-reported measurement questions. RESULTS Data were available for 71 patients across nine Queensland hospitals. Patients were predominantly older adults (median 81 years, IQR 15) and female (n = 46) with mild/moderate (n = 50) versus severe (n = 17) or unspecified severity (n = 4) malnutrition. The median length of stay at the time of audit was 7 days (IQR 13). More than half of the patients included had two or more documented dietitian reviews. Nearly all patients (n = 68) received at least one form of nutrition support. A substantial number of patients reported not receiving a malnutrition diagnosis (n = 37), not being provided information about malnutrition (n = 30), or not having a plan for ongoing nutrition care or follow-up (n = 31). There were no clinically relevant trends between patient-reported measures and the number of dietitian reviews or severity of malnutrition. CONCLUSIONS Malnourished inpatients seen by dietitians across multiple hospitals almost always receive nutritional support. Urgent attention is required to identify why these same patients do not routinely report receiving malnutrition diagnostic advice, receiving information about being at risk of malnutrition, and having a plan for ongoing nutrition care, regardless of how many times they are seen by dietitians.
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Affiliation(s)
- Jack J Bell
- Allied Health, The Prince Charles Hospital, Brisbane, QLD 4032, Australia
- School of Human Movement and Nutrition Sciences, The University of Queensland, Brisbane, QLD 4072, Australia
| | - Alita Rushton
- Allied Health, The Prince Charles Hospital, Brisbane, QLD 4032, Australia
- School of Human Movement and Nutrition Sciences, The University of Queensland, Brisbane, QLD 4072, Australia
| | - Kai Elmas
- Allied Health, The Prince Charles Hospital, Brisbane, QLD 4032, Australia
| | - Merrilyn D Banks
- Dietetics and Food Services, Royal Brisbane and Women's Hospital, Brisbane, QLD 4029, Australia
| | - Rhiannon Barnes
- Dietetics and Food Services, Royal Brisbane and Women's Hospital, Brisbane, QLD 4029, Australia
| | - Adrienne M Young
- Dietetics and Food Services, Royal Brisbane and Women's Hospital, Brisbane, QLD 4029, Australia
- Centre for Health Services Research, The University of Queensland, Brisbane, QLD 4072, Australia
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Pashley A, Young A, Wright O. Foodservice systems and mealtime models in rehabilitation: Scoping review. J Adv Nurs 2022; 78:3559-3586. [PMID: 35880760 PMCID: PMC9796490 DOI: 10.1111/jan.15379] [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: 03/08/2022] [Revised: 05/31/2022] [Accepted: 07/05/2022] [Indexed: 01/01/2023]
Abstract
AIMS To describe current foodservice systems and mealtime care utilized in the rehabilitation setting. A secondary aim was to identify commonly used outcome measures in foodservice research in the rehabilitation setting. DESIGN A scoping review. DATA SOURCES PubMed, CINAHL, Scopus, Embase, PsycINFO and Cochrane were searched until January 2022. REVIEW METHODS The review was conducted according to Joanna Briggs Institute's methodology for scoping reviews. Included studies were conducted in the inpatient rehabilitation setting, adult population ≥18 years old and provided a description of at least one element of the foodservice system, food and menu, waste and/or eating environment. RESULTS Of 5882 articles screened, 37 articles were included, reporting 31 unique studies. Most rehabilitation units had cook-fresh production methods (50%), used decentralized bulk delivery methods (67%) had a communal dining room (67%) and had a 3-week menu cycle (71%). Mealtime care was predominantly provided by nursing staff, however few studies reported on specific activities. Nutritional intake was a key outcome measure across included studies (43%), with only six papers reporting on rehabilitation outcomes. Of the intervention studies (n = 9), all were aimed at improving nutritional intake through menu or mealtime care modifications; few (n = 3) studied changes in rehabilitation outcomes. CONCLUSION This scoping review identified a considerable lack of reporting of foodservice and mealtime care systems used in rehabilitation settings in the available literature. Further investigation is required to understand what models of mealtime care are provided to patients and to understand the impact of changes to foodservice and mealtime systems on patient outcomes. PATIENT OR PUBLIC CONTRIBUTION No patient or public contribution was necessary for this review.
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Affiliation(s)
- Alice Pashley
- School of Human Movement and Nutrition SciencesThe University of QueenslandBrisbaneAustralia
| | - Adrienne Young
- Department of Nutrition and DieteticsRoyal Brisbane and Women's HospitalHerstonAustralia,Centre for Health Services ResearchThe University of QueenslandBrisbaneAustralia
| | - Olivia Wright
- School of Human Movement and Nutrition SciencesThe University of QueenslandBrisbaneAustralia,Centre for Nutrition and Food SciencesQueensland Alliance for Agriculture and Food InnovationSt LuciaAustralia
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