Observations of Mealtimes in Nursing Homes

Transcription

1 ESPEN Congress Gothenburg 2011 Food and mealtimes in hospital and the community Observations of Mealtimes in Nursing Homes A. Saletti

2 Observations of Mealtimes in Nursing Homes - one part of an implementation project in Sweden ESPEN, Gothenburg 3 September 2011 A. Saletti 1 RD, PhD J. Törmä 1, T. Cederholm 1, U. Winblad 2, 1 Department of Public Health and Caring Sciences, Clinical Nutrition and Metabolism 2 Department of Public Health and Caring Sciences, Health Services Research, Uppsala University, Sweden

3 Background to the implementation project Malnutrition and inadequate nutritional routines in elderly care are common Nutritional guidelines are one way to achieve improvement In 2000 the Uppsala municipality adopted nutritional guidelines for the elderly. Revision and decision of implementation in 2006 (The Elderly Committee) Cooperation between the municipality and the University

4 Aim of the whole project To create an effective model for implementation of the nutritional guidelines in Uppsala municipality and to study the processes of implementation.

5 Guidelines Nutrition Food Mealtimes Based on the evidence up until now 24 pages Concretised with managers, members of the Senior Citizens Office and care staff

6 Overview Baseline Follow up IG Questionnaire CG Resident outcome Process outcome Team coaching 3 - hour lecture 1 year Resident outcome Process outcome Questionnaire Focus group interviews Document analyses

7 Two interventions A three hour lecture about the guidelines to a team 7 Control groups Several coaching sessions with a team at the units 7 Intervention groups Outcome? Outcome?

8 Evaluation Process indicators (the staff): Screening tool/nutritional care plan Document analyses Serving of meals/dessert/overnight fast Dietary assessment Mealtimes Observations of the mealtime Outcome indicators (the elderly): Nutritional status (MNA) Functional status (ADL Barthel Index) Cognitive status (SPMSQ) Quality of Life (EQ-5D) Blood samples

9 Observation of mealtimes No tool for mealtime observations, only for eating observations Focus on the social aspects of eating or the pleasurable dining experience How does one measure that?

10 Reflections from mealtime observations Feeding or serving of food? Seldom scent of food Seldom choices of dishes, beverages and portionsize An unawareness among staff how their actions affect the elders mealtimes Structure and logistics for the mealtime is missing

11 Resources FAMM Five Aspects Meal Model Review of the last 20 years (scoping) Norm for the mealtime Observation tool Team coaching

12 FAMM Five Aspects Meal Model ATMOSPHERE/ MEALTIMES MANAGEMENT CONTROL SYSTEM ROOM MEETING PRODUCT Gustafsson 2006, Edwards 2008

13

14

15

16

17 Scoping review MEALTIMES/ ATMOSPHERE Observations studies: 21 Interventions studies : 1 CT: 1 RCT: 2 (Mathey 2001, Nijs 2006) ROOM Observations studies : 8 Interventions studies : 6 CT: 3 MEETING Observations studies : 20 Interventions studies : 1 CT: 1 PRODUCT/FOOD Observations studies : 27 Interventions studies : 2 CT: 2

18 Norm for the mealtime Mealtime/Atmosphere (peace & quiet, disturbing activities) Room Laying of the table (spices) Furnishing Lighting Sounds Clean & tidy Shape of the room Meeting Interaction between the staff and the elderly Presentation of food and drinks Interaction between the elderly Menu Product Food service system Colours, Scent, Choice of food, drinks, seasoning, portionsize

19 Observation tool/instrument Description of the ward/unit Description of the dish, dessert, beverages Description of the room VAS-scales (not at all to very high extent)

20 1. Mealtime observations Team coaching to improve 2. Feedback to the group/team 3. Activity plan for the ward/unit Rules for the mealtime Routines Hostess Family-style mealtimes 4. Mealtime observations 5. Feedback to the group/team Mealtimes 6. Support staff to do own observations with help from a checklist

21 Thoughts.. FAMM useful for understanding that all parts are important to create mealtimes Mealtimes differ home care/elderly care/hospital Service quality - to which extent do staff need knowledge about serving meals? Structure/logistic one person who is in charge of the mealtime Is it possible to create a tool to evaluate mealtimes?

22 Thank you for your attention!