Mealtime and patient factors associated with meal completion in hospitalised older patients: An exploratory observation study

Naughton, Corina; Simon, Rachel E.; White, Tonya; Foubert, Marguerite de; Cummins, Helen; Dahly, Darren

doi:10.1111/jocn.15800

Cited by 13 publications

(18 citation statements)

References 48 publications

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“…31 Naughton and colleagues explored the factors affecting meal completion among hospitalized older adults, including frequent interruptions ranging from nonurgent nursing tasks to medical interruptions. 31 There was also a lack of additional support required by some patients, and patients were generally not checked on during mealtimes. A lack of time and competing pressures were identified as barriers to nurses' engagement during mealtimes.…”

Section: Discussionmentioning

confidence: 99%

Original Research: Nurse-Reported Missed Care and Its Association with Staff Demographics and the Work Environment

Heng,

Rajasegeran,

See

et al. 2023

AJN, American Journal of Nursing

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Background: Nurses have primary responsibility for many of the care processes and interventions intended to improve patients' health during hospital stays. Accordingly, missed nursing care can negatively impact patient safety and lead to negative clinical outcomes. Missed nursing care is standard care that is not completed, incomplete, or seriously delayed. Purpose: There is scant literature on nurse-reported missed care (NRMC) in Singapore. Identifying the prevalence of, types of, and reasons for missed care, including staff-related factors, is imperative to understanding the implications of missed care and identifying opportunities for improvement. Methods: Ours is a correlation study of NRMC using convenience sampling. Nurses working on all inpatient units in an acute care hospital in Singapore were recruited to complete the MISSCARE survey, a quantitative tool measuring missed nursing care and the reasons for it. Descriptive statistics was applied to analyze demographics, types of NRMC, and reasons for NRMC. The Pearson χ2 test was used to analyze the correlation between demographics and satisfaction variables and NRMC. Results: A total of 314 participants out of 1,944 eligible nurses (response rate, 16%) were recruited. The most commonly reported missed care activities were setting up meals for patients who can feed themselves (87.3%), ambulation (70.1%), attending interdisciplinary conferences (64.3%), providing emotional support to patients and/or family (58%), and turning patients every two hours (56.7%). The most cited reasons for missed care were inadequate number of staff (84.4%), caregiver not in unit or unavailable (76.1%), heavy admission and discharge activity (75.5%), urgent patient situations (74.2%), and unexpected rise in patient volume and/or acuity (73.2%). Younger age, greater experience in role and current unit, inadequate staffing and teamwork, low satisfaction with current role and with being a nurse, and planning to leave the current position were factors significantly associated with greater levels of missed care. Conclusion: This study demonstrated evidence of NRMC and its associated factors within the local setting. In addition to expanding nursing resources, analyzing nursing work processes, providing support for younger nurses, and improving nursing satisfaction are possible mitigating factors in preventing missed care. Strategies targeting workforce and resource management, greater support for new and younger nurses, and job satisfaction should be considered to address missed care.

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Section: Discussionmentioning

confidence: 99%

Original Research: Nurse-Reported Missed Care and Its Association with Staff Demographics and the Work Environment

Heng,

Rajasegeran,

See

et al. 2023

AJN, American Journal of Nursing

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“…Schubert's review of interventions for missed cares also noted the lack of objective measures for missed cares (Schubert et al, 2021), and an important challenge is to make these cares visible (Feo & Kitson, 2016; Parr et al, 2018). Eat Walk Engage has contributed to the development and validation of simple, practical and patient‐centred ward‐level measures (Mudge et al, 2016; Naughton et al, 2021; Young et al, 2016) which allow teams to reflect on practices and identify opportunities for improvement, as well as harnessing the experience of individual older patients to create a compelling narrative for change. As our program continues to expand, these measures highlight variation between wards and hospitals, inform the assessment of the local context to adapt and tailor the program, and serve as measures of improvement at scale.…”

Section: Discussionmentioning

confidence: 99%

Eat Walk Engage: Enabling acute care teams to deliver consistent fundamentals of care for older people

Cahill

Neill

Treleaven

et al. 2022

Journal of Advanced Nursing

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Aims Fundamentals of care are particularly important for older people in acute inpatient settings, who are at increased risk of serious hospital‐associated complications like delirium and functional decline. These complications occur due to interactions between clinical complexity and the complex processes and context of hospital care and can be reduced by consistent attention to the fundamentals of care. This paper aims to illustrate of how multi‐level nursing leadership of fundamentals of care can be supported to emerge within complex multidisciplinary delivery systems in acute care. Design Discussion paper informed by clinical and organizational experience of a multidisciplinary leadership team and complexity leadership theory. Data sources We provide a series of vignettes as practical illustrations of a successful multidisciplinary improvement program called Eat Walk Engage which supports the delivery of better care for older inpatients, significantly reducing delirium. We argue that taking a broader complexity‐based approach including collaborative multidisciplinary engagement, iterative and integrated interventions and appropriate knowledge translation frameworks can enable emergent leadership by nurses at all levels. Implications for nursing This promising approach to improving care for older patients requires organizational support for facilitation and reflective practice, and for meaningful data to support change. Our discussion challenges nursing leaders to support the time, agency and connections their nursing staff need in order to emerge as local leaders in fundamental care. Conclusion The debate around scope and responsibilities for fundamentals of care in hospital care has important practical implications for conceptualizing leadership and accountability for improvement. Impact Our discussion illustrates how a structured multidisciplinary approach that acknowledges and navigates complexity can empower nurses to lead and improve outcomes of older patients in acute care.

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“…4 The reasons for poor nutritional intake and nutritional decline in hospitalised patients are numerous and exist at patient, ward and system level. 5 Patient factors for reduced food intake include fatigue, pain, depression, feeling too unwell to eat, dissatisfaction with hospital meals/menus, nausea and reduced appetite. 6,7 Ward-level barriers to mealtime care include competing priorities, poorly designed bedside environment, frequent interruptions and limited staff time to assist with feeding and optimise mealtime positioning.…”

Section: Introductionmentioning

confidence: 99%

“…For example, different barriers to mealtime care are reported between acute and sub-acute settings, 8 and even between wards within the same hospital. 5 This means that there is a need to understand the local barriers and enablers to inform the development of tailored interventions and implementation strategies.…”

Section: Introductionmentioning

confidence: 99%

“…System-level challenges with nutrition care delivery include foodservice barriers (e.g., insufficient menu information and difficult-to-open food packaging), poor team communication and lack of role clarity for nutrition care provision. 5,8,9 While poor nutritional intake is a problem consistently seen across different types of wards and hospitals, 2,10 barriers to nutrition and mealtime care may differ between different contexts. For example, different barriers to mealtime care are reported between acute and sub-acute settings, 8 and even between wards within the same hospital.…”

Section: Introductionmentioning

confidence: 99%

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Developing and validating a novel staff questionnaire to identify barriers and enablers to nutrition and mealtime care on hospital wards

Young,

Kozica‐Olenski,

Mallan

et al. 2023

Nutrition & Dietetics

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AimsImproving hospital nutrition and mealtime care is complex and often requires multifaceted interventions and implementation strategies to change how staff, wards and systems operate. This study aimed to develop and validate a staff questionnaire to identify multilevel barriers and enablers to optimal nutrition and mealtime care on hospital wards, to inform and evaluate local quality improvement.MethodsLiterature review, multidisciplinary focus groups and end‐user testing informed questionnaire development and establishment of content and face validity. To determine the construct validity, the questionnaire was administered to ward staff working in five wards across two facilities (acute hospital, rehabilitation unit). Exploratory factor analysis was used to estimate the number of factors and to guide decisions about whether to retain or reject individual items. Scale reliability was assessed using Cronbach's alpha.ResultsThe questionnaire was completed by 138 staff, with most respondents being nurses (57%) and working in the acute care facility (76%). Exploratory factor analysis supported construct validity of four of the original seven subscales. The final questionnaire consisted of 17 items and 4 sub sub‐scales related to (1) Personal Staff Role; (2) Food Service; (3) Organisational Support, and (4) Family Involvement; each sub‐scale demonstrated good reliability with Cronbach's alpha values all >0.70.ConclusionThis novel and brief questionnaire shows good reliability and preliminary evidence of construct validity in this small sample. It provides a potentially useful instrument to identify barriers and enablers to nutrition and mealtime care from the staff perspective and inform where improvement efforts should be focused.

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Mealtime and patient factors associated with meal completion in hospitalised older patients: An exploratory observation study

Abstract: This is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made.

Cited by 13 publications

References 48 publications

Original Research: Nurse-Reported Missed Care and Its Association with Staff Demographics and the Work Environment

Original Research: Nurse-Reported Missed Care and Its Association with Staff Demographics and the Work Environment

Eat Walk Engage: Enabling acute care teams to deliver consistent fundamentals of care for older people

Developing and validating a novel staff questionnaire to identify barriers and enablers to nutrition and mealtime care on hospital wards

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