Mealtime nonverbal behaviors in nursing home staff and residents with dementia: Behavioral analyses of videotaped observations

Liu, Wen; Perkhounkova, Yelena; Williams, Kristine; Batchelor, Melissa; Hein, Maria

doi:10.1016/j.gerinurse.2022.01.009

Cited by 9 publications

(10 citation statements)

References 32 publications

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“…Emerging research is needed to characterise patterns of mealtime‐specific verbal and nonverbal dyadic interactions from both positive and negative perspectives and examine the association between person‐centred and task‐centred care and resident positive, neutral and challenging behaviours. Prior research characterised mealtime verbal and nonverbal behaviours of staff and residents from positive and negative perspectives using the refined CUED and videotaped observations (Liu, Perkhounkova, Williams, et al, 2022 ; Liu, Williams, et al, 2021 ). Findings show that 99% of verbal behaviours and 91% nonverbal behaviours from staff were positive compared to 85% verbal behaviours and 21% nonverbal behaviours from residents (Liu, Perkhounkova, Williams, et al, 2022 ; Liu, Williams, et al, 2021 ).…”

Section: Introductionmentioning

confidence: 99%

“…Prior research characterised mealtime verbal and nonverbal behaviours of staff and residents from positive and negative perspectives using the refined CUED and videotaped observations (Liu, Perkhounkova, Williams, et al, 2022 ; Liu, Williams, et al, 2021 ). Findings show that 99% of verbal behaviours and 91% nonverbal behaviours from staff were positive compared to 85% verbal behaviours and 21% nonverbal behaviours from residents (Liu, Perkhounkova, Williams, et al, 2022 ; Liu, Williams, et al, 2021 ). There may be missed opportunities to better understand dyadic positive and challenging interactions.…”

Section: Introductionmentioning

confidence: 99%

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Person‐centred and task‐centred care: Impact on mealtime behaviours in nursing home residents with dementia

Liu

Perkhounkova

Hein

2022

Int J Older People Nursing

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Introduction Mealtime is a critical daily activity to ensure nutrition, hydration, function and socialisation. Interactions between staff and residents during mealtimes are complex and dynamic processes including verbal and/or nonverbal communication that can be positive/neutral or challenging. This study examined characteristics of and relationships between person‐centred and task‐centred care and positive/neutral and challenging mealtime behaviours in persons with dementia. Methods This study was a secondary behavioural analyses of videotaped mealtime observations (n = 110) involving 42 unique staff‐resident dyads (29 staff and 25 residents with dementia) in nine nursing homes. The refined Cue Utilization and Engagement in Dementia mealtime video‐coding scheme was used to code videos during 2019–2020. Dependent variables representing resident mealtime behaviours included positive verbal behaviours, positive/neutral nonverbal behaviours, functional impairments (nonverbal) and resistive behaviours (verbal and nonverbal). Independent variables were staff person‐centred and task‐centred approaches (verbal and nonverbal). Relationships between resident mealtime behaviours and staff approaches were examined using bivariate analysis and logistic regression. Results Staff person‐centred verbal approaches were associated with resident positive verbal behaviours (OR = 1.38, 95% CI = 1.09–1.76), functional impairments (OR = 0.81, 95% CI = 0.66–1.00) and resistive behaviours (OR = 1.65, 95% CI = 1.18–2.31). Staff person‐centred nonverbal approaches were associated with resident functional impairments (OR = 1.33, 95% CI = 1.02–1.74). Staff task‐centred approaches were not associated with resident positive/neutral or challenging mealtime behaviours. Conclusion This study characterised staff approaches and resident behaviours during mealtime care and provided preliminary support on associations between staff person‐centred approaches and resident positive and challenging behaviours. Person‐centred mealtime care practice is recommended by focusing on support of common, challenging behaviours and reinforcement of positive behaviours with adequate consideration of individual needs and preferences.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Person‐centred and task‐centred care: Impact on mealtime behaviours in nursing home residents with dementia

Liu

Perkhounkova

Hein

2022

Int J Older People Nursing

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“…Mealtime dyadic interactions are dynamic, complex, and fluid, involving a mixture of person-centered and task-centered care approaches by staff in responding to resident positive, neutral, and challenging behaviors, which further influences subsequent staff care approaches. Both staff person-centered and task-centered care approaches and resident positive, neutral, and challenging behaviors were frequently observed during mealtime care ( 11 , 17 , 18 ). Person-centered care (eg, orientation/giving instructions, giving choices; Supplementary Table 1 ) is defined as the individually tailored and directly delivered verbal and nonverbal assistance provided by staff that aims to engage and motivate residents in mealtime activities and address resident needs and preferences by accommodating resident remaining abilities, dyadic interactions, and the physical and social dining environments ( 19–21 ).…”

Section: Background and Objectivesmentioning

confidence: 99%

Temporal Relationships Between Nursing Home Staff Care Approaches and Behaviors of Residents With Dementia During Mealtimes: A Sequential Analysis

Liu

Perkhounkova

Hein

et al. 2023

Innovation in Aging

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Background and Objectives Optimal dyadic interactions are critical to quality mealtime care and outcomes. Prior work supports associative relationships between staff approaches and individual mealtime behaviors, yet evidence on temporal relationships is limited. This study examined temporal associations between staff approaches and resident behaviors during mealtimes. Research Design and Methods Videotaped mealtime observations (N=160) involving 36 staff and 27 residents (53 staff-resident dyads) in 9 nursing homes were analyzed. Sequential analyses using 5-, 10-, and 15-second time windows were conducted for resident positive, neutral, and challenging behaviors as antecedents as well as consequences of staff person-centered and task-centered approaches. Results Residents exhibited positive verbal (35.0%) and positive/neutral nonverbal (12.6%) behaviors, as well as challenging behaviors including functional impairments (27.7%) and resistive behaviors (24.7%). Staff primarily used person-centered approaches (54.1% verbal, 40.3% nonverbal); task-centered approaches were less frequent (5.6%). Immediately (within 5-seconds) after staff person-centered approaches, resident positive/neutral and resistive behaviors were more likely and functional impairments less likely. After staff task-centered approaches, resident positive verbal and resistive behaviors were less likely. After resident positive/neutral behaviors, staff person-centered approaches were more likely. After resident functional impairments, staff person-centered verbal approaches were less likely and task-centered approaches more likely. After resident resistive behaviors, all staff approaches were more likely. The strength of temporal relationships diminished in 10-second and 15-second time windows. Discussion and Implications Staff-resident positive interactions were associated with more subsequent positive interactions. Person-centered care was associated with fewer subsequent resident functional impairments and more subsequent resistive behaviors. Resident resistive behaviors were associated with more subsequent person-centered and task-centered care. Findings confirm the importance of facilitating positive staff-resident interactions and managing functional impairments using person-centered care. Resistive behaviors require additional awareness and attention beyond commonly used person-centered care approaches. Further investigation of temporal relationships is needed using larger diverse samples.

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“…People with dementia in residential care settings (i.e., residents) often exhibit cognitive, functional, and behavioral challenges during mealtime such as disorientation to meal time/place, swallowing difficulties, and resistance to food/care, and require varied levels of support from staff [ 1 ]. Mealtime in residential care settings inherently involves dynamic environments, including the staff-resident dyad, as well as the care contexts with multilevel stimuli including meal-related items (e.g., food, drinks, silverware, utensils), other staff and residents, and the physical and social dining environments, which can be chaotic, distracting, and overstimulating for residents with dementia [ 1 , 2 ].…”

Section: Introductionmentioning

confidence: 99%

“…Analysis of language can be at different levels, including word (expression length, word diversity), syntax/sentence (syntactic complexity of sentences), speech (speech rate or intelligibility), and discourse (coherence and cohesion of conversations) [ 18 ]. While prior work on dyadic verbal and nonverbal communication behaviors during mealtimes and other activities primarily focused on the quantity (e.g., frequency of utterances and nonverbal behaviors) and quality (staff person-centered vs. task-centered behaviors; resident positive, neutral, vs. challenging behaviors; dyadic positive, neutral, vs. negative interactions) [ 1 , 2 , 19 , 20 ], less work has examined language characteristics itself at different levels during dyadic mealtime interactions. Evidence on language characteristics at word-, sentence-, speech- and discourse-levels as well as factors associated with language characteristics during mealtime interactions is limited.…”

Section: Introductionmentioning

confidence: 99%

Mealtime interactions between nursing home staff and residents with dementia: a behavioral analysis of Language characteristics

Liu,

Jao,

Paudel

et al. 2023

BMC Geriatr

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Background Quality staff-resident communication is crucial to promote outcomes in nursing home residents with dementia requiring assistance during mealtimes. Better understanding of staff-resident language characteristics in mealtime interactions help promote effective communication, yet evidence is limited. This study aimed to examine factors associated with language characteristics in staff-resident mealtime interactions. Methods This was a secondary analysis of 160 mealtime videos involving 36 nursing staff and 27 residents with moderately severe to severe dementia in 9 nursing homes. Mixed-effects models was used to examine the relationships between factors and language characteristics in staff-resident mealtime interactions. The independent variables were speaker (resident vs. staff), utterance quality (negative vs. positive), intervention (pre- vs. post-communication intervention), and resident dementia stage and comorbidities. The dependent variables were expression length (number of words in each utterance) and addressing partner by name (whether staff or resident named their partner in each utterance). All models included staff, resident, and staff-resident dyad as random effects. Results Staff (utterance n = 2990, 99.1% positive, mean = 4.3 words per utterance) predominated conversations and had more positive, longer utterances than residents (utterance n = 890, 86.7% positive, mean = 2.6 words per utterance). As residents progressed from moderately severe to severe dementia, both residents and staff produced shorter utterances (z=-2.66, p = .009). Staff (18%) named residents more often than residents (2.0%; z = 8.14, p < .0001) and when assisting residents with more severe dementia (z = 2.65, p = .008). Conclusions Staff-resident communication was primarily positive, staff-initiated, and resident-oriented. Utterance quality and dementia stage were associated with staff-resident language characteristics. Staff play a critical role in mealtime care communication and should continue to initiate resident-oriented interactions using simple, short expressions to accommodate resident declining language abilities, particularly those with severe dementia. Staff should practice addressing residents by their names more frequently to promote individualized, targeted, person-centered mealtime care. Future work may further examine staff-resident language characteristics at other levels of language using more diverse samples.

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Mealtime nonverbal behaviors in nursing home staff and residents with dementia: Behavioral analyses of videotaped observations

Cited by 9 publications

References 32 publications

Person‐centred and task‐centred care: Impact on mealtime behaviours in nursing home residents with dementia

Person‐centred and task‐centred care: Impact on mealtime behaviours in nursing home residents with dementia

Temporal Relationships Between Nursing Home Staff Care Approaches and Behaviors of Residents With Dementia During Mealtimes: A Sequential Analysis

Mealtime interactions between nursing home staff and residents with dementia: a behavioral analysis of Language characteristics

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