Do study circles and a nutritional care policy improve nutritional care in a short- and long-term perspective in special accommodations?

The Minimal Eating Observation Form-II Danish Version: Psychometric and Metrological Aspects

BACKGROUND AND PURPOSE

The Minimal Eating Observation Form - II (MEOF-II) is a screening and research tool for eating difficulties. We assess psychometric and metrological aspects of the Danish version of the tool.

METHODS

This study includes MEOF-II data from 302 acute geriatric patients. Analyses were based on Classical Test Theory and Rasch Model Analysis.

RESULTS

51.3% of the patients had eating difficulties. The MEOFII items belonged to one higher order factor, and three lower level factors: deglutition; ingestion; and energy/appetite. The hierarchical structure of the items was revealed. The MEOF-II had a good fit with Rasch model expectations.

CONCLUSION

The study provides support for the reliability and validity of the Danish version of the MEOF-II. MEOF-II total and subscale scores are reliable and valid for use in nursing practice and research.

The Minimal Eating Observation Form-Version II Revisited: Validity and Reliability

BACKGROUND AND PURPOSE

The Minimal Eating Observation Form-Version II (MEOF-II) is a screening and research tool for eating difficulties. Here we assess the psychometric properties of the tool.

METHODS

Cross-sectional MEOF-II data, n = 5,956 persons (nursing home residents [n = 3,087]; in-hospital patients [n = 1,490]; mean age 76.9; 61% women). Data was analyzed taking account of the dichotomous nature of item-level data, that is, based on tetrachoric correlations.

RESULTS

The MEOF-II items (n = 9) belonged to one higher order unidimensional factor (61.7% explained variance, omega 0.92), and three lower level factors, with three items each (92.9% explained variance, omega 0.83-0.88): deglutition; ingestion; and energy/appetite.

CONCLUSION

The study provides support for the reliability and validity of the MEOF-II total scale and subscales, and the findings are in line with previous studies.

A registry study of nursing assessments, interventions and evaluations according to nutrition for persons living in municipal residential care homes

AIM

The aim was to explore planned nursing interventions and evaluations of such interventions, in older people at risk for malnutrition living in municipal residential care homes.

DESIGNS

A registry study.

METHODS

The study was conducted using data from the Swedish national quality registry Senior Alert. Data on all persons assessed and registered in Senior Alert living in municipal residential care homes in a mid-sized town between January and December 2014 were subjected to statistical analysis.

RESULTS

In total, 677 nutritional risk assessments were performed among the participants (N = 587), who were between 65-109 years. A larger proportion of women were estimated as being at risk for malnutrition compared with men. The three most common prescribed nursing interventions were nutritional treatment, dietary support and weight control; however, interventions were not prescribed for all participants at risk for malnutrition. Lesser than 50% of the interventions were evaluated, with dietary support, pharmaceutical review and weight control the three most likely to be evaluated. Further, planned interventions for participants at risk of malnutrition were implemented more often for men than for women.

Long-term effects of a computer-based nutritional training program for inpatient hospital care

RATIONALE

A previous short-term study showed that a computer-based training in eating and nutrition increased the probability for hospital inpatients at undernutrition (UN) risk to receive nutritional treatment and care without increasing overtreatment (providing nutritional treatment to those not at UN risk). The aim of this study was to investigate if a computer-based training in eating and nutrition influences the precision in nutritional treatment and care in a longer-term perspective.

METHOD

A preintervention and postintervention study was conducted with a cross-sectional design at each time points (baseline and 7 months postintervention). Hospital inpatients >18 years old at baseline (2013; n = 201) and follow-up (2014; n = 209) were included. A computer-based training was implemented during a period of 3 months with 297 (84%) participating registered nurses and nurse assistants. Undernutrition risk was screened for using the minimal eating observation and nutrition form-version II. Nutritional treatment and care was recorded using a standardized protocol.

RESULTS

The share of patients at UN risk that received energy-dense food (+25.2%) and dietician consultations (+22.3%) increased between baseline and follow-up, while fewer received oral nutritional supplements (-18.9%). "Overtreatment" (providing nutritional treatment to those not at UN risk) did not change between baseline and follow-up.

CONCLUSION

The computer-based training increased the provision of energy-dense food and dietician consultations to patients at UN risk without increasing overtreatment of patients without UN risk.

The effect of nutrition training for health care staff on learner and patient outcomes in adults: a systematic review and meta-analysis

Background: Nutrition training for health care staff has been prioritized internationally as a key means of tackling malnutrition; however, there is a lack of clear evidence to support its implementation. Systematic reviews in other fields of training for health care staff indicate that training strategies may have a beneficial impact on learner and patient outcomes.Objectives: We assessed whether nutrition training for health care staff caring for nutritionally vulnerable adults resulted in improved learner and patient outcomes and evaluated the effectiveness of different training strategies.Design: A systematic review of trials of nutrition training for health care staff was conducted. Six databases were searched with key terms relating to malnutrition and nutrition training. Studies were categorized according to cognitive (didactic teaching), behavioral (practical implementation of skills), and psychological (individualized or group feedback and reflection) training strategies. Where sufficient data were available, meta-analysis was performed according to study design and training strategy. All study designs were eligible. The risk of bias was evaluated in accordance with Cochrane guidance.Results: Twenty-four studies met the eligibility criteria: 1 randomized controlled trial, 4 nonrandomized controlled trials, 3 quasi-experimental trials, 13 longitudinal pre-post trials, 2 qualitative studies, and 1 cross-sectional survey. Results from a number of low-quality studies suggest that nutrition training for health care staff may have a beneficial effect on staff nutrition knowledge, practice, and attitude as well as patient nutritional intake. There were insufficient data to determine whether any particular training strategy was more effective than the others.Conclusions: In the absence of high-quality evidence, low-quality studies suggest that nutrition training for health care staff has some positive effects. However, further randomized controlled trials are required to confirm overall efficacy and to explore the impact of training strategies on learner and patient outcomes.

Quality Indicators of Nutritional Care Practice in Elderly Care

OBJECTIVES

The aim is to explore the effects of antecedent, structural and process quality indicators of nutritional care practice on meal satisfaction and screened nutritional status among older adults in residential care homes.

DESIGN

Data for this Swedish cross-sectional study regarding older adults living in residential care homes were collected by i) a national questionnaire, ii) records from the quality registry Senior Alert, iii) data from an Open Comparison survey of elderly care in 2013/2014. The data represented 1154 individuals in 117 of 290 Swedish municipalities.

MEASUREMENTS

Meal satisfaction (%) and adequate nutritional status, screened by the Mini Nutritional Assessment Short Form (MNA-SF), were the two outcome variables assessed through their association with population density of municipalities and residents' age, together with 12 quality indicators pertaining to structure and process domains in the Donabedian model of care.

RESULTS

Meal satisfaction was associated with rural and urban municipalities, with the structure quality indicators: local food policies, private meal providers, on-site cooking, availability of clinical/community dietitians, food service dietitians, and with the process quality indicators: meal choice, satisfaction surveys, and 'meal councils'. Adequate nutritional status was positively associated with availability of clinical/community dietitians, and energy and nutrient calculated menus, and negatively associated with chilled food production systems.

CONCLUSION

Municipality characteristics and structure quality indicators had the strongest associations with meal satisfaction, and quality indicators with local characteristics emerge as important for meal satisfaction. Nutritional competence appears vital for residents to be well-nourished.

Short-term effects of a computer-based nutritional nursing training program for inpatient hospital care

RATIONALE

This study aimed to explore whether a computer-based training in eating and nutrition for hospital nursing staff can influence the precision in nutritional treatment and care.

METHOD

A pre-intervention and post-intervention study was conducted with a cross-sectional design at each time point. The settings were one intervention (IH) and two control hospitals (CH1 and CH2). Hospital inpatients >18 years old at baseline (2012; n = 409) and follow-up (2014; n = 456) were included. The computer-based training was implemented during a period of 3 months in the IH with 297 (84%) participating registered nurses and nurse assistants. Nutritional risk was screened for using the Minimal Eating Observation and Nutrition Form. Nutritional treatment and care was recorded using a standardized protocol

RESULTS

In the IH, there was an increase in the share of patients at UN risk that received energy-dense food (+16.7%) and dietician consultations (+17.3%) between baseline and follow-up, while fewer received feeding assistance (-16.2%). There was an increase in the share of patients at UN risk that received energy-dense food (+19.5%), a decrease in oral nutritional supplements (-30.5%) and food-registrations (-30.6%) in CH1, whereas there were no changes in CH2. 'Overtreatment' (providing nutritional treatment to those not at UN risk) was significantly higher in CH2 (52.7%) than in CH1 (14.3%) and in the IH (25.2%) at follow-up.

CONCLUSION

The computer-based training seemed to increase the probability for patients at UN risk in the IH to receive nutritional treatment without increasing overtreatment.

A Systematic Review of Interventions to Change Staff Care Practices in Order to Improve Resident Outcomes in Nursing Homes

BACKGROUND

We systematically reviewed interventions that attempted to change staff practice to improve long-term care resident outcomes.

METHODS

Studies met criteria if they used a control group, included 6 or more nursing home units and quantitatively assessed staff behavior or resident outcomes. Intervention components were coded as including education material, training, audit and feedback, monitoring, champions, team meetings, policy or procedures and organizational restructure.

RESULTS

Sixty-three unique studies were broadly grouped according to clinical domain-oral health (3 studies), hygiene and infection control (3 studies), nutrition (2 studies), nursing home acquired pneumonia (2 studies), depression (2 studies) appropriate prescribing (7 studies), reduction of physical restraints (3 studies), management of behavioral and psychological symptoms of dementia (6 studies), falls reduction and prevention (11 studies), quality improvement (9 studies), philosophy of care (10 studies) and other (5 studies). No single intervention component, combination of, or increased number of components was associated with greater likelihood of positive outcomes. Studies with positive outcomes for residents also tended to change staff behavior, however changing staff behavior did not necessarily improve resident outcomes. Studies targeting specific care tasks (e.g. oral care, physical restraints) were more likely to produce positive outcomes than those requiring global practice changes (e.g. care philosophy). Studies using intervention theories were more likely to be successful. Program logic was rarely articulated, so it was often unclear whether there was a coherent connection between the intervention components and measured outcomes. Many studies reported barriers relating to staff (e.g. turnover, high workload, attitudes) or organizational factors (e.g. funding, resources, logistics).

CONCLUSION

Changing staff practice in nursing homes is possible but complex. Interventionists should consider barriers and feasibility of program components to impact on each intended outcome.

Action-oriented study circles facilitate efforts in nursing homes to "go from feeding to serving": conceptual perspectives on knowledge translation and workplace learning

Background. Action-oriented study circles (AOSC) have been found to improve nutrition in 24 nursing homes in Sweden. Little, however, is known about the conceptual use of knowledge (changes in staffs' knowledge and behaviours). Methods. Qualitative and quantitative methods, structured questionnaires for evaluating participants' (working in nursing homes) experiences from study circles (n = 592, 71 AOSC) and for comparisons between AOSC participants (n = 74) and nonparticipants (n = 115). Finally, a focus group interview was conducted with AOSC participants (in total n = 12). Statistical, conventional, and directed content analyses were used. Results. Participants experienced a statistically significant increase in their knowledge about eating and nutrition, when retrospectively comparing before participating and after, as well as in comparison to non-participants, and they felt that the management was engaged in and took care of ideas regarding food and mealtimes to a significantly greater extent than non-participants. The use of AOSC was successful judging from how staff members had changed their attitudes and behaviours toward feeding residents. Conclusions. AOSC facilitates professional development, better system performance, and, as shown in previous studies, better patient outcome. Based on a collaborative learning perspective, AOSC manages to integrate evidence, context, and facilitation in the efforts to achieve knowledge translation in a learning organisation. This study has implications also for other care settings implementing AOSC.

Do study circles and a nutritional care policy improve nutritional care in a short- and long-term perspective in special accommodations?

Background

Disease-related malnutrition is a major health problem in the elderly population and management issues are under-explored.

Objectives

What is the prevalence of undernutrition-risk (UN-risk), underweight, and overweight in special accommodations (SAs)? Do study circles and a nutritional care policy (NCP) improve the precision in nutritional care (NC) and decrease the prevalence of under- and overweight in a short- and/or long-term perspective?

Design

Quasi-experimental pre- and post-intervention design with three experimental groups and one control group (CG).

Setting

SAs.

Participants

In 2005 (Time 1 – T1), 1726 (90.4%) residents agreed to participate; in 2007 (Time 2 – T2), 1,526 (81.8%); and in 2009 (Time 3 – T3), 1,459 (81.3%) residents participated.

Interventions

Experimental groups: between T1 and T2 the first period of study circles was conducted in one municipality; between T2 and T3 a second period of study circles in another municipality was conducted; after T1 a NCP was implemented in one municipality. CG: residents in three municipalities.

Measurements

Under- and overweight were defined based on BMI. Risk of undernutrition was defined as involving any of: involuntary weight loss, low BMI, and/or eating difficulties. The ‘precision in NC’ describes the relationship between nutritional treatment (protein- and energy-enriched food (PE-food) and/or oral supplements) and UN-risk.

Results

The prevalence of UN-risk varied between 64 and 66%, underweight between 25 and 30%, and overweight between 30 and 33% in T1–T3. At T2 the prevalence of underweight was significantly lower in the first period study circle municipality, and at T3 in the second period study circle municipality compared to in the CG. The precision in NC was higher in a short-term perspective in the study circle municipalities and both in a short- and long-term perspective in the NCP municipality. At T3 between 54 and 70% of residents at UN-risk did not receive PE-food or oral supplements.

Conclusions

Study circles give positive short-term effects and a NCP gives positive short- and long-term effects on NC. Whether a combination of study circles and the implementation of a NCP can give even better results is an area for future studies.