Temporal Relationships Between Nursing Home Staff Care Approaches and Behaviors of Residents With Dementia During Mealtimes: A Sequential Analysis

Abstract

Background and Objectives Optimal dyadic interactions are critical to quality mealtime care and outcomes. Prior work supports associative relationships between staff approaches and individual mealtime behaviors, yet evidence on temporal relationships is limited. This study examined temporal associations between staff approaches and resident behaviors during mealtimes. Research Design and Methods Videotaped mealtime observations (N=160) involving 36 staff and 27 residents (53 staff-resident dyads) in 9 nursing homes were analyzed. Sequential analyses using 5-, 10-, and 15-second time windows were conducted for resident positive, neutral, and challenging behaviors as antecedents as well as consequences of staff person-centered and task-centered approaches. Results Residents exhibited positive verbal (35.0%) and positive/neutral nonverbal (12.6%) behaviors, as well as challenging behaviors including functional impairments (27.7%) and resistive behaviors (24.7%). Staff primarily used person-centered approaches (54.1% verbal, 40.3% nonverbal); task-centered approaches were less frequent (5.6%). Immediately (within 5-seconds) after staff person-centered approaches, resident positive/neutral and resistive behaviors were more likely and functional impairments less likely. After staff task-centered approaches, resident positive verbal and resistive behaviors were less likely. After resident positive/neutral behaviors, staff person-centered approaches were more likely. After resident functional impairments, staff person-centered verbal approaches were less likely and task-centered approaches more likely. After resident resistive behaviors, all staff approaches were more likely. The strength of temporal relationships diminished in 10-second and 15-second time windows. Discussion and Implications Staff-resident positive interactions were associated with more subsequent positive interactions. Person-centered care was associated with fewer subsequent resident functional impairments and more subsequent resistive behaviors. Resident resistive behaviors were associated with more subsequent person-centered and task-centered care. Findings confirm the importance of facilitating positive staff-resident interactions and managing functional impairments using person-centered care. Resistive behaviors require additional awareness and attention beyond commonly used person-centered care approaches. Further investigation of temporal relationships is needed using larger diverse samples.

Mealtime interactions between nursing home staff and residents with dementia: a behavioral analysis of Language characteristics

“…Utterance quality in the study sample had limited variations (99.1% positive and 0.9% negative in staff utterances, 86.7% positive and 13.3% negative in resident utterances). Further analysis indicated that staff positive utterances (n = 2963) were distributed across all eight codes (see Data Coding section) with varied frequencies (ranging from 927 to 52) and were primarily coded as orientation/giving instructions (n = 927, 31.3%) which may require more words, while resident positive utterances (n = 772) were primarily showing interest (n = 294, 38.1%) and approval/agreement (n = 265, 34.3%) which may only require fewer words [ 29 ]. Future work needs to examine the role of speaker and utterance quality on expression length using more diverse samples.…”