Reimagining Nutrition Care and Mealtimes in Long-Term Care

Keller, Heather; Syed, Safura; Dakkak, Hana; Wu, Sarah; Volkert, Dorothee

doi:10.1016/j.jamda.2021.12.021

Cited by 12 publications

(14 citation statements)

References 47 publications

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“…The fact that the communal dining spaces for residents were smaller in the Dutch site facilitated staff to provide a more person-centred mealtime experience as they had higher staff to resident ratio and staff were able to oversee without being overstretched. This supports research by Keller, Syed [ 17 ], who noted that staffing and working environments are related to staff ability to adopt PCC. The UK site demonstrated the most restrictive dining experience, which was largely due to low staffing resources, with care staff also acting as catering staff.…”

Section: Discussionsupporting

confidence: 89%

“…Previous research shows that this rigidity in routines that adhere to more traditional care restricts the possibility to provide anything other than 'usual care' , making PCC less possible [31]. This can also lead to a more institutional feel in the mealtime setting, which research suggests can reduce resident autonomy [17]. Providing care should not overshadow independent resident choice, even though this must also be balanced with providing both care and choice in a communal environment [37].…”

Section: Discussionmentioning

confidence: 99%

“…Hunter et al (2016) found that the environment itself is important for resident choice, showing that a 'person-directed' environment is positively associated with resident autonomy [16]. Furthermore, Keller, Syed [17] stated that the overall environment is not only relational to staff ability to deliver PCC, but can also reduce resident autonomy if it is too 'institutional' [17].…”

Section: Introductionmentioning

confidence: 99%

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Exploring resident experiences of person-centred care at mealtimes in long-term residential care: a rapid ethnography

et al. 2022

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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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Section: Discussionsupporting

confidence: 89%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Exploring resident experiences of person-centred care at mealtimes in long-term residential care: a rapid ethnography

et al. 2022

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“…Researchers undertaking implementation studies focused on changing practice to improve the mealtime experience, especially during times of outbreak, should consider the impact of multi-level factors that facilitate or hinder practice change uptake. Policy makers need to accept the trade-off that exists among quality care (e.g., RCC practices and minimum staffing ratios), resident quality of life over safety, and the funding necessary to protect and support RCC mealtimes in Canada’s LTC homes (Keller et al, 2022; McGregor & Harrington, 2020).…”

Section: Discussionmentioning

confidence: 99%

“…For care staff, “the conditions of work are the conditions of care” (Baines & Armstrong, 2018, p.1), meaning that a precondition for meaningful resident care is a working environment that fosters supportive conditions for those providing the care. Thus, we recognize that micro-interactions between residents and staff are influenced by relational factors including policies, funding structures, and the marketization of the Canadian LTC sector (Baines & Armstrong, 2018; Harrington et al, 2017; Keller, Syed, Dakkak, Wu, & Volkert, 2022).…”

Section: Introductionmentioning

confidence: 99%

Multi-Level Factors Associated with Relationship-Centred and Task-Focused Mealtime Practices in Long-Term Care: A Secondary Data Analysis of the Making the Most of Mealtimes Study

Morrison‐Koechl

McAiney

et al. 2023

Can. J. Aging

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Mealtimes in long-term care (LTC) can reinforce relationships between staff and residents through relationship-centred care (RCC) practices; however, meals are often task-focused (TF). This cross-sectional study explores multi-level contextual factors that contribute to RCC and TF mealtime practices. Secondary data from residents in 32 Canadian LTC homes were analyzed (n = 634; mean age 86.7 ± 7.8; 31.1% male). Data included resident health record review, standardized mealtime observation tools, and valid questionnaires. A higher average number of RCC (9.6 ± 1.4) than TF (5.6 ± 2.1) practices per meal were observed. Multi-level regression revealed that a significant proportion of variation in the RCC and TF scores was explained at the resident- (intraclass correlation coefficient [ICC]RCC = 0.736; ICCTF = 0.482), dining room- (ICCRCC = 0.210; ICCTF = 0.162), and home- (ICCRCC = 0.054; ICCTF = 0.356) levels. For-profit status and home size modified the associations between functional dependency and practices. Addressing multi-level factors can reinforce RCC practices and reduce TF practices.

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