“Time’s up” – staff’s management of mealtimes on inpatient eating disorder units

Abstract

BackgroundRefeeding and normalizing eating behaviour are main treatment aims for individuals admitted to inpatient eating disorder units. Consequently, mealtime activities are specific, everyday activities, serving a clear therapeutic purpose, despite numerous challenges for both staff and patients. Few studies have specifically addressed staff involvement, interactions, and management activities to structure mealtimes. In this study, we investigated the structure of mealtime activities on inpatient eating disorder units, and identified associated staff behaviour.MethodsDescriptive and exploratory qualitative study using video observations to investigate the structure of mealtimes and staff management of mealtime activities. Forty main meals were video recorded and the observational data were analysed using interaction analysis.ResultsAn initial analysis during data screening identified three main parts of the meal: ‘pre-eating’, ‘eating’, and ‘meal completion’. For each part, a regular pattern of activities occurred which were associated with staff behaviour.ConclusionsIncreased awareness amongst staff regarding how they manage the meal and act through a clear internal structure can help staff members to further explore their behaviours and collaboration during mealtimes, and also contribute to improved interaction with patients during the various phases of the meal.

“Do you see what I mean?” staff collaboration in eating disorder units during mealtimes

“…The interviews indicated that the most important rule that influences staff collaboration, and division of labor in particular, was strategic seating. This is in line with what we found in our observations of the internal meal structure [15], where staff reserved or sought the middle seats during most of the observed meals, suggesting behavior in accordance with strong, interactive scripts. The analysis of the interviews supports the observation of scripted behavior by staff, and scripts can be a possible explanation for the seemingly implicit nature of staff collaboration during mealtimes.…”

“…The empirical findings reported in this paper is drawn from interview data, which is part of a larger data corpus of video recorded observations of mealtimes and interviews with participating staff members, focusing on teamwork and interaction during mealtimes on EDUs. Data from video-recorded observations exploring the internal structure in a meal and from interviews and video observations exploring staff behavior in staff – patient interactions have been published elsewhere [14, 15]. …”

“…Our activity “mealtimes on inpatient EDUs” involves staff members ( subjects ) working collaboratively to manage a meal ( shared object ) to realize the objective of the activity. The two main goals of this activity are 1) meal completion [4], and 2) facilitation of normalized eating behavior [15]. Mealtime activities are mediated by a set of tools , used by staff members during the meal to influence, or mediate interaction between subjects.…”

“…Staff collaboration whilst performing meal support is a shared task conducted in a shared workspace, i.e., the unit’s dining room. We have previously reported findings, based on video observations of meals, that staff’s meal management is informed by two main interactional scripts to facilitate a) normalized eating behavior and b) meal completion during the allotted time frame to perform the various activities within a meal [15]. Mealtime management is about balancing these two scripts, which is primarily learned through direct participation in meals, and on-the-job training.…”

Quality of friendships and motivation to change in adolescents with Anorexia Nervosa

“…Although a multimodal, multidisciplinary approach underpins inpatient treatment (Bakker et al, 2011;Hage, Rø, & Moen, 2015), facilitating healthy friendships on wards has received little attention. While clinicians have observed the negative impact of peers on engagement with treatment (Ramjan & Gill, 2012), young people have identified fellow patients as a key source of support (Offord, Turner, & Cooper, 2006).…”