The nature of feeding completely dependent persons: A meta-ethnography

Abstract

Feeding completely dependent persons is a common activity in many health care settings; however, it has received relatively little attention by researchers. Recently, there has been a call for nurses to revisit some of the so-called ''basic'' tasks that have been eliminated from nurses' responsibilities and relegated to non-professional staff. This article details an analysis of the findings of ten published qualitative research reports about feeding completely dependent persons who are elderly. Drawing on procedures of meta-ethnography described by Noblit and Hare (1988, Meta-Ethnography: Synthesizing qualitative studies Newbury Park: Sage Publications) and later by Paterson, Thorne, Canam, and Jillings (2001, Meta-study of qualitative health research. A practical guide to meta-analysis and meta-synthesis Thousand Oaks: CA Sage Publications), the authors identify two central themes within the primary research; feeding as task and feeding as relationship. Based on the metaethnographic findings, two areas for future research are suggested; exploring structural and institutional influences on the feeding practices of health care providers and exploring how nurses mediate the tension between the relationship and task perspective of feeding completely dependent persons.

The meaning of assisted feeding for people living with spinal cord injury: a phenomenological study

“…In a meta-analysis, caregivers were found to have ambiguous views about feeding completely dependent people, as some regard it as an unpleasant but prescribed task, while others see it as a situation where relations are in the foreground (Martinsen et al 2007). Feeding by hand is time-consuming and labour-intensive work, and some residents in nursing homes have been found to be left to their own devices and without assistance, although their eating difficulties were well-known to staff (Kayser-Jones & Schell 1997).…”

Focus on Feeding! Evaluation of a framework for maximizing mealtime in aged care facilities

“…1). • A trusting relationship 24 • A connection, good communication processes 25 ; maximizes socialization 15 • Resident characteristics, for example, family history; needs 26 • Staff characteristics, 27 respects resident 28 ; adopts a 'nurturing and nourishing' role 29 ; good attitude 30 ; regards feeding assistance as a relationship, not as a chore 28 What-What not Procedural:…”

“…• Unpalatable diet can lead to negative health effects 31 • Nutritional 'task' 28 ; focuses on the meal 32 • Culturally appropriate, preferred food choices 33,34 ; finger foods, snacks 35,36 • Flavour enhancers when physiological changes taste and smell 8 • Dietary modifications, for example, for dysphagia-nectar-thick liquids 37 ; easy to swallow. 6 • Supplements 38 given between meals 35…”

“…• Assess, observe, monitor intake, encourage 33 ; initiate feeding tasks 39 • Remain pleasant, unhurried; respond appropriately 26 • Verbal prompts to encourage self-feeding. 40 such as 'chew', 'take another bite' or 'try some more' 26 ; clear, simple instructions; calm voice; reassurance 41 • Proper positioning, feed at slower rate, use appropriate utensils 42 • Careful hand feeding 43 ; 'Hand-Over-Hand' technique 26 • Reduce agitation and challenging behaviours 41 • Avoid bibs and cutlery that are culturally or developmentally inappropriate 28 • Open unfamiliar and difficult-to-open packaging, assist to pour, spread or cut up food 33 Where-Where not Environmental:…”

“…• Distracting, unpleasant environment can impact behaviour and weight 28,44 • Pleasant, calm, relaxing, well-lit, fewer distractions (switch-off TV); soothing music 41…”