Interventions maintaining eating Independence in nursing home residents: a multicentre qualitative study

Tacit knowledge in medical consultations for patients with profound intellectual and multiple disabilities: An exploratory qualitative study

BACKGROUND

Patients with profound intellectual and multiple disabilities (PIMD) cannot clearly express themselves. Therefore, tacit knowledge (TK) is crucial in caring for individuals with PIMD, while it possibly also plays a significant role in medical consultations.

METHOD

A qualitative inductive, thematic analysis was performed of 14 audio-taped consultations with intellectual disability physicians for patients with PIMD to explore how TK is represented and considered between parents and physicians.

RESULTS

Parents conveyed their TK by sensing and perceptions of changes of their child's behaviour. Our findings demonstrate that parents of individuals with PIMD primarily shared TK concerning pain, sleeping issues, and epilepsy. Physicians recognised and incorporated parents' TK, highlighting its significance in patient care.

CONCLUSION

This study underscores the important role of TK in consultations for patients with PIMD. Parents' TK help to shape medical-decisions, urging physicians to validate parents' TK while relating this TK to other types of medical knowledge.

Healthcare professionals' experience with nutritional care beyond formal quality systems - A qualitative study

BACKGROUND

Numerous formal strategies, screening tools, and interventions have been used to prevent malnutrition in long-term care patients. Despite these efforts, the proportion of screened patients is low, and a large proportion are malnourished. Previous research has revealed that healthcare professionals use a broad approach in their nutritional care but has also emphasised the need for further investigation into these approaches.

OBJECTIVE

To explore how healthcare professionals working in long-term care experience and apply nutritional care.

DESIGN

A descriptive, exploratory, qualitative design containing 240 h of participant observation, 12 focus groups and 2 individual interviews.

SETTING(S)

Twelve nursing homes and home care units in three Norwegian municipalities.

PARTICIPANTS

Participant observation of interactions between healthcare professionals and patients. Forty-three registered nurses participated in focus group or individual interviews.

METHODS

The data were analysed using inductive thematic analysis.

RESULTS

The analysis identified three themes: The first theme, limited significance of nutritional screening, showed that healthcare professionals experienced the limited value of nutritional screening, as it often did not capture patients' nutritional challenges. They also perceived nutritional screening as unsuitable for patients at the end of their lives, those with overweight-related complications, or undergoing rehabilitation. In addition, nutritional screening was perceived as something healthcare professionals did for their managers or administrators, not because it was crucial to providing good nutritional care. The second theme, provision of individualised food, captures the healthcare professionals' efforts in adapting and preparing food according to the patient's preferences. Facilitation to enable patients to make individual food choices and the use of food cards or lists were two approaches to individualising nutrition care. The third theme, making meals more than about food, elucidated how healthcare professionals used meals to help patients cope with their situations and experience social belonging. Conversations about or around meals were used to provide patients with a sense of belonging to their past or present situation. The meals were also used as a diversion strategy for patients with unrest, as arenas for daily activity training, and for meaningful social interactions between patients around the tables.

CONCLUSIONS

Nutritional screening and prevention of malnutrition are only one part of healthcare professionals' nutritional care. Individualised food and meals that create coping, a sense of belonging, and social experiences are equally important parts of their care. Emphasising healthcare professional's person-centred approach to nutritional care would be beneficial, as it could strengthen and further develop long-term nutritional care services.

An ethnography of mealtime care for people living with dementia in care homes

Many people living with dementia have difficulties at mealtimes, which can result in serious complications for physical and mental health, leading to hospital admissions and even death. However, current training in mealtime care for staff working with this population has been found to be poorly reported, with variable effectiveness. It is essential that care home staff are able to provide good care at mealtimes. This study used ethnography to explore current practice in mealtime care for this population, identify good practice, and understand the factors influencing mealtime care. Approximately 28 h of mealtime observations were conducted in two UK care homes with diverse characteristics. Observations focused on interactions between care staff and residents living with dementia. Twenty-five semi-structured interviews were carried out with care home staff, family carers, and visiting health and social care professionals, to explore mealtime care from their perspectives. A constant comparative approach was taken, to probe emergent findings and explore topics in greater depth. Key thematic categories were identified, including: tensions in mealtime care; the symbolic nature of mealtime care; navigating tensions via a person-centred approach; contextual constraints on mealtime care; and teamwork in mealtime care. The findings indicated that a person-centred approach helps carers to find the right balance between apparently competing priorities, and teamwork is instrumental in overcoming contextual constraints. This evidence has contributed to development of a training intervention for care home staff. Future research should investigate the feasibility of mealtime care training in care homes.

Prostate cancer patients' experiences and preferences for web-based physical activity applications: A qualitative meta-synthesis

BACKGROUND

The incidence of prostate cancer increases with age. Physical activity can improve the prognosis and quality of life of patients. However, studies have observed lower levels of physical activity in men with prostate cancer, and most do not meet physical activity guidelines. Web-based physical activity is a promising form of exercise that will play an important role in prostate cancer patients.

AIMS

To synthesise the experiences and preferences of prostate cancer patients for web-based PA applications, thereby providing a basis for the construction of intervention programs tailored to the needs of patients.

METHODS

We systematically searched PubMed, Web of Science, Cochrane Library, EMBASE, CINAHL and three Chinese databases. This review includes qualitative empirical reports from the date of establishment of the respective databases until April 2023. Data extraction was performed by two independent reviewers and study quality was assessed.

RESULTS

A total of nine studies were included. The experiences and preferences of prostate cancer patients with web-based physical activity apps were synthesised into the following three analysis themes: (1) Pursuing individualised management strategies; (2) Perceiving and seeking social support and (3) Moving forwards in the struggle.

CONCLUSION

Our study found that men with prostate cancer experienced greater challenges in engaging in physical activity. Because of individual differences between patients, health care providers need to provide care that is tailored to each patient. Future studies should further explore the specific effects of web-based PA applications in promoting the physical function of prostate cancer patients to increase their flexibility.

RELEVANCE TO CLINICAL PRACTICE

This article synthesises prostate cancer patients' experiences with web-based physical activity applications, highlighting their specific information needs. The results suggest several implications for the application of individualised management strategies, the perception and search for social support, and health- literacy. The results of this study will inform future research and program design that recognises the importance of patient-centred efforts to better self-manage physical function.

PATIENT OR PUBLIC CONTRIBUTION

In the early stages of the study, objectives and subsequent findings were presented and discussed in a meeting with a reference group that represented patients, health professionals and the public.

Nutritional Care for Institutionalized Persons with Dementia: An Integrative Review

BACKGROUND

Older people are at risk of malnutrition, especially when they suffer from cognitive impairment. Guidelines that orient nursing care in this regard need to be updated. The aim of this review is to address the best available evidence on interventions that can benefit nutritional nursing care for institutionalized older adults with dementia.

METHODS

Integrative review using the Dimensions and Eureka search engines, and the PubMed, Embase, Scielo, CINAHL, and ScienceDirect databases. We searched from the year 2015 through to 2021. We employed the MMAT guidelines for mixed, qualitative, and quantitative studies, and the PRISMA, CASP, and JBI guidelines to value the reviews.

RESULTS

A total of 55 studies met the inclusion criteria. The best available evidence to support nutritional nursing care for institutionalized older adults with dementia highlights several aspects related to the assessment and caring interventions that are focused on people with dementia, their caregivers, and their context.

CONCLUSIONS

Both the assessment and nutritional care interventions for older people with dementia should consider the patient-caregiver dyad as the subject of care and understand the context as a fundamental part of it. The analysis of the context should look further than the immediate environment.

Tacit knowledge in dyads of persons with profound intellectual and multiple disabilities and their caregivers: An interpretative literature study

BACKGROUND

Caring for persons with profound intellectual and multiple disabilities (PIMD) demands specific expertise. Tacit knowledge seems to play an important role, but little is known about its nature, including what is necessary for its development and transfer.

AIM

To gain understanding of the nature and development of tacit knowledge between persons with PIMD and their caregivers.

METHOD

We conducted an interpretative synthesis of literature on tacit knowledge in caregiving dyads with persons with PIMD, persons with dementia or infants. Twelve studies were included.

RESULTS

Tacit knowledge is about caregivers and care-recipients becoming sensitive and responsive to each other's cues and together crafting care routines. Learning takes place in a constant process of action and response that transforms those involved.

CONCLUSION

Building tacit knowledge together is necessary for persons with PIMD to learn to recognise and express their needs. Suggestions are made for ways to facilitate its development and transfer.

The transition to advanced practice nursing: A systematic review of qualitative studies

BACKGROUND

Advanced practice nurses have made important contributions to the tasks of stabilising the operation of the health system and improving the quality of care. However, taking on the role of an advanced practice nurse is always challenging and can even result in the intention to leave the profession. Insights into advanced practice nursing role transitions are important to implement effective interventions to help nurses cope with the corresponding turbulence and changes.

AIM

To explore the experiences of advanced practice nurses during their role transition from registered nurses to their current role.

DESIGN

A systematic review of qualitative studies.

DATA SOURCES

Five databases were searched from inception to August 2022: PubMed, Web of Science, Cochrane, Embase and CINAHL.

REVIEW METHODS

This review was reported in accordance with the Enhancing Transparency in Reporting the Synthesis of Qualitative Research (ENTREQ) guidelines. Two reviewers independently conducted study selection and data extraction, and quality appraisal was performed using the Joanna Briggs Institute critical appraisal instrument for qualitative research. Data synthesis was conducted using thematic analysis.

FINDINGS

A total of 14 studies were included in this review. Three analytical themes emerged: (1) trudging along a narrow road, (2) driving and restraining forces in the transition, and (3) embracing the new identity. Four subthemes were graded as high confidence and the other four were moderate confidence. Establishing a new role was a priority and a significant challenge for advanced practice nurses. Beliefs regarding advanced practice, the attitudes of colleagues, and the support of mentors impacted the transition process. Advanced practice nurses expressed appreciation for their new role and developed new ambitions at the end of the transition.

CONCLUSIONS

Advanced practice nurses face a series of challenges during the process of role development, especially struggles with vague feelings and a lack of confidence in practice. These difficulties could be exacerbated without the support of team and organisational managers. The implementation of mentorship and the mediation of interprofessional conflicts are necessary to facilitate successful role transitions.

Situation Analysis of Healthcare Standards and Criteria That Contribute to the Care of Residents in Homes for Older People in Tanzania

Problems experienced in homes for older people in Tanzania highlighted the need for a situation analysis of healthcare standards to identify the baseline of care provided to residents in these homes. This study conducted a situation analysis of structure healthcare standards and associated criteria with the aim of contributing to improved quality of care for residents in homes for older people in Tanzania. Thirty-two homes for older people in Tanzania were audited using an audit instrument that included seven fields, 26 structure standards, and 262 associated criteria. The analysis showed that overall, the homes were non-compliant with healthcare structure standards and associated criteria. The Tanzanian Government should urgently introduce measures to address the missing standards and associated criteria.

How are the mealtime experiences of people in residential aged care facilities informed by policy and best practice guidelines? A scoping review

BACKGROUND

Mealtimes are embedded routines of residents living in residential aged care facilities (RACFs) that directly impact their health and quality of life. Little is known about how mealtime experiences are informed and affected by structures such as government and organisational policies and processes. This scoping review used Giddens' (The constitution of society: outline of the theory of structuration, 1984) Structuration Theory to investigate how governance structures related to mealtime practices inform residents' mealtime experiences.

METHODS

Using Arksey and O'Malley's (Int J Soc Res Methodol 8:19-32, 2005) scoping review framework, a systematic database, grey literature and policy search was completed in May 2020 and updated in July 2021. From 2725 identified articles, 137 articles were included in data charting and deductive analysis, and 76 additional Australian government policy papers were used interpretatively.

RESULTS

Data charting identified that the included studies were prominently situated in Western countries, with a progressive increase in publication rate over the past two decades. Qualitative findings captured structures that guide RACF mealtimes, how these relate to person-centred mealtime practices, and how these facilitate residents to enact choice and control.

CONCLUSIONS

Current policies lack specificity to inform the specific structures and practices of RACF mealtimes. Staff, residents, organisational and governance representatives possess different signification, legitimation and domination structures, and lack a shared understanding of policy, and how this influences processes and practices that comprise mealtimes.

Resistance to Eating in People with Dementia Living in Long-term Care Facilities: Gaps between Common and Good Practices

OBJECTIVES

The present study aims to explore the perception of common and best practices for dealing with resistance to eating of persons with dementia living in long-term care facilities.

METHODS

Forty-two staff members working in long-term care facilities were interviewed. They worked in four Spanish long-term care facilities; 21 were nursing assistants and 21 technical staff. Participants heard a vignette in which person with dementia showed resistance to eating. Participants were asked how a situation like that is commonly managed by their workmates, and how the situation should be managed. Responses were content-analyzed.

RESULTS

Strategies mentioned by participants were quite diverse and did not converge on common ground that harmonizes their responses. Less than half of the participants considered person-centered strategies as a best practice. Those strategies were lower on assistant carers, compared to technical staff.

CONCLUSIONS

Resistance to eating is a common situation faced by professionals. Nonetheless, there is not a common procedure to deal with this situation. Resistance to eating was seen more as a problem to be eradicated than a behavior to be understood.

CLINICAL IMPLICATIONS

Staff development initiatives are necessary in relation to mealtime situations. They should consider work position and competencies needed by assistant carers.

Unmet needs and health-related quality of life of dementia family caregivers transitioning from home to long-term care: A scoping review

This scoping review is to identify experiences, unmet needs, and health-related quality of life (HRQoL) of family caregivers transitioning their care recipients with dementia into long-term care (LTC). The methodological framework of Arksey and O'Malley guided the review. Themes from nineteen selected studies were organized around three categories. First, caregiver experiences during LTC placement featured challenges around placement decision-making and distress and changes in relationships and responsibilities. Second, unmet needs of caregivers were desired emotional support and information about transitions. Finally, caregivers' HRQoL varies around transition. Family caregivers experience unique challenges and can have unmet needs during the LTC placement of their care recipients with dementia. Findings suggest the need for interventions that teach skills, care planning, assistance with conflict resolution, communication training, and guidance finding services and resources.

How do we provide good mealtime care for people with dementia living in care homes? A systematic review of carer-resident interactions

People with dementia who live in care homes often depend on care home staff for help with eating and drinking. It is essential that care home staff have the skills and support they need to provide good care at mealtimes. Good mealtime care may improve quality of life for residents, and reduce hospital admissions. The aim of this systematic review was to identify good practice in mealtime care for people with dementia living in care homes, by focusing on carer-resident interactions at mealtimes. Robust systematic review methods were followed. Seven databases were searched: AgeLine, BNI, CENTRAL, CINAHL, MEDLINE, PsycINFO and Web of Science. Titles, abstracts, and full texts were screened independently by two reviewers, and study quality was assessed with Joanna Briggs Institute tools. Narrative synthesis was used to analyse quantitative and qualitative evidence in parallel. Data were interrogated to identify thematic categories of carer-resident interaction. The synthesis process was undertaken by one reviewer, and discussed throughout with other reviewers for cross-checking. After title/abstract and full-text screening, 18 studies were included. Some studies assessed mealtime care interventions, others investigated factors contributing to oral intake, whilst others explored the mealtime experience. The synthesis identified four categories of carer-resident interaction important to mealtime care: Social connection, Tailored care, Empowering the resident, and Responding to food refusal. Each of the categories has echoes in related literature, and provides promising directions for future research. They merit further consideration, as new interventions are developed to improve mealtime care for this population.

Optimizing mealtime care for people with dementia from the perspective of formal caregivers: A systematic review of qualitative research

BACKGROUND

As dementia progresses, people with dementia experience many problems during mealtimes that seriously affect their physical, psychological, and social health and quality of life. Formal caregivers play an important role in optimizing mealtime care.

OBJECTIVE

To systematically review and synthesise relevant qualitative studies exploring the experience and perceptions of formal caregivers regarding optimizing mealtime care for people with dementia.

DESIGN

A systematic review of qualitative research.

DATA SOURCES

The PubMed, Web of Science, Cochrane Library, Embase, CINAHL, CNKI, WanFang and Vip databases were systematically searched.

REVIEW METHODS

Two reviewers independently screened the titles and abstracts, extracted the data and performed critical appraisals of each included study. The data synthesis was conducted using thematic analysis.

FINDINGS

A total of 10 studies were included. The formal caregivers included nursing assistants, nurses, speech and language therapists, nursing students, dietitians, a social worker, a professional educator, physiotherapists, health care aides, kitchen staff, diversional therapy assistants and other unidentified care staff. The findings were synthesised into the following 3 analytical themes: (1) tailored rather than standardized; (2) emotional nurturance; and (3) beyond the individual level.

CONCLUSIONS

Mealtimes involve complex physiological and psychological processes. Formal caregivers should develop tailored care practices based on individual patients' preferences and needs. Emotional connection plays a key role and has a positive impact on the mealtime experience. Further research is needed to explore the specific effects of emotional connections on optimizing mealtime care.

Informal dementia caregivers' experiences and perceptions about mealtime care: A qualitative evidence synthesis

AIMS

To systematically identify, evaluate and synthesize the available qualitative evidence on the mealtime care experiences of informal caregivers of people with dementia.

DESIGN

A qualitative evidence synthesis using the Thomas and Harden method.

DATA SOURCES

All qualitative and mixed-method studies in English and Chinese were retrieved from PubMed, Web of Science, Embase, Cochrane, CINAHL, CNKI, WanFang, and Vip from the inception of each database until November 2019.

REVIEW METHODS

Two researchers independently selected the studies using qualitative assessment and review instruments for quality evaluation and thematic synthesis for the data analysis.

RESULTS

Ten studies were chosen for this review. The analytical themes identified included injecting a new element, moving forward in the challenge and external supports facilitating better coping.

CONCLUSION

Community nurses should effectively use resources to provide food-related information and services to families with dementia. Future research should combine informal caregiver experiences and clinical skills to develop high-quality interventions to improve the quality of mealtimes.

IMPACT

The findings established that informal caregivers experienced not only changes in their roles and concerns but also emotional changes. Informal caregivers develop different coping strategies to adapt to feeding issues without professional support. Although informal caregivers attach great importance to mealtimes and nutrition issues, they experience a lack of information and support services. Community nurses can provide more economical, practical, and accessible information resources based on informal caregivers' perceptions of mealtime care. Future interventions need to be more aware of the importance of dyad or family-centred support services.

Fidelity challenges while implementing an intervention aimed at increasing eating performance among nursing home residents with cognitive decline: A multicentre, qualitative descriptive study design

AIMS AND OBJECTIVES

To increase the knowledge on fidelity challenges in intervention studies promoting eating independence in residents with cognitive decline living in nursing homes (NHs).

BACKGROUND

A few studies have documented to date factors affecting fidelity in intervention studies performed in NH settings. Moreover, fidelity issues in intervention studies aimed at promoting eating independence among NH residents with cognitive decline have not been studied to date.

DESIGN

A hybrid study design was performed in 2018 and reported here according to the COnsolidated criteria for REporting Qualitative research.

METHODS

In a clustered multicentre before/after intervention study design, a nested, multicentre qualitative descriptive design was performed. Four researchers with a nursing background, who received appropriate training, implemented the designed intervention. This consisted in intentional rounds in the dining rooms during lunchtime and was based on supportive, prescriptive and informative prompts delivered to residents with cognitive decline aimed at stimulating eating independence. A momentary assessment method was used, based on daily diary filled in by participant researchers after every session of intervention delivery on the following five dimensions of fidelity: (a) adherence, (b) dose (or exposure), (c) intervention quality, (d) participant responsiveness and (e) programme differentiation. A direct content analysis of the narratives reported on the diaries was performed.

RESULTS

Factors increasing or hindering intervention fidelity during its implementation emerged at the NH, staff, family caregivers, resident, researchers and at the intervention itself levels.

CONCLUSIONS

Several factors emerged and all reported potentially both positive and negative influences on fidelity while implementing an intervention aimed at promoting eating independence among NH residents. Fidelity challenges should be considered as dynamic in NH intervention studies, where continuous adjustments of the intervention delivered are required.

RELEVANCE TO CLINICAL PRACTICE

A calm environment, with staff members showing a caring behaviour, and researchers having achieved good familiarity with the NH setting, the residents, their family carers and the staff members, can all increase intervention fidelity.

Overview of systematic reviews: Effectiveness of non-pharmacological interventions for eating difficulties in people with dementia

AIM

To evaluate the effectiveness of non-pharmacological interventions for eating difficulties in people with dementia (PWD).

BACKGROUND

Eat difficulties are common problems in PWD. Prolonged eating difficulties may lead to inadequate/excessive food and drink intake and other adverse outcomes.

DESIGN

Overview of systematic reviews.

DATA SOURCES

Cochrane Library, JBI Library, PubMed, Embase, CINAHL, PsycINFO, and Psychology and Behavioral Sciences Collection, CNKI, WANFANG, from inception up until 23 September 2019.

REVIEW METHODS

This overview was conducted in accordance with methodological recommendations of Cochrane. Two researchers independently selected studies based on inclusion criteria, extracted data, assessed eligible studies using AMSTAR 2 and GRADE system, and summarized the conclusions.

RESULTS

Eighteen systematic reviews were included. Some evidence showed that environmental modifications, education/training, and Oral nutrition supplements (ONS) were beneficial to improving eating difficulties. But the current evidence failed to support the effectiveness of other interventions.

CONCLUSION

The overall confidence of systematic reviews is relatively low. High-quality studies are needed to further validate the effectiveness of non-pharmacological interventions for eating difficulties in PWD.

IMPACT

This overview provides evidence on the effectiveness of non-pharmacological interventions for eating difficulties in PWD. It will guide caregivers to choose more effective interventions to cope with eating difficulties and reduce the risk of adverse outcomes.

Enhancing independent eating among older adults with dementia: a scoping review of the state of the conceptual and research literature

BACKGROUND

Addressing eating difficulties among older individuals with dementia living in nursing homes requires evidence-based interventions. However, to date, there is limited evidence of effective interventions designed to maintain and/or increase independent eating. In a field in which evidence is still lacking, a critical analysis of the state of research describing its main features can help identify methodological gaps that future studies should address. Hence, the aim of this study was to map the state of the research designed to maintain and/or promote independent eating in older individuals with dementia living in nursing homes.

METHODS

A scoping review was performed by following the Preferred Reporting Items for Systematic Reviews and Meta-analyses. Reviews and conceptual analyses performed with different methodological approaches, published in indexed journals, and written in English were included. Keywords Were searched for in the MEDLINE, the Cumulative Index of Nursing and Allied Health, and in the Scopus databases to identify papers published up to 31 May 2018.

RESULTS

17 reviews were included, assessing interventions' effectiveness (n = 15) and providing conceptual frameworks for eating/mealtime difficulties (n = 2). Conceptual frameworks supporting interventions' effectiveness have rarely been described in available studies. Moreover, interventions tested have been categorized according to non-homogeneous frameworks. Their effectiveness has been measured against (1) eating performance, (2) clinical outcomes, and (3) adverse event occurrence.

CONCLUSION

An increased use of conceptual frameworks in studies, as well as greater clarity in intervention categorization and outcomes, is necessary to enhance the reviews' value in providing useful cumulative knowledge in this field. Interventions delivered should embody different components that integrate individual, social, cultural, and environmental factors, while when evaluating an intervention's effectiveness, eating performance, clinical outcomes and adverse events should be considered. Together with more robust studies, involving clinicians could prove to be useful, as their knowledge of practice developed from direct experience can help develop innovative research questions.