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The effects of nutritional guideline implementation on nursing home staff performance: a controlled trial
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Clinical Nutrition and Metabolism.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health Services Research. Health Services Research, Uppsala, Sweden; School of Public Health, Brown University, Providence, RI, USA.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Clinical Nutrition and Metabolism.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Clinical Nutrition and Metabolism.ORCID iD: 0000-0003-3705-0725
2018 (English)In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 32, no 2, p. 622-633Article in journal (Refereed) Published
Abstract [en]

Rationale: Suboptimal nutritional practices in elderly caresettings may be resolved by an efficient introduction ofnutritional guidelines.Aims: To compare two different implementation strate-gies, external facilitation (EF) and educational outreachvisits (EOVs), when introducing nutritional guidelines innursing homes (NHs), and study the impact on staffperformance.Methodological design: A quasi-experimental study withbaseline and follow-up measurements.Outcome measures: The primary outcome was staff perfor-mance as a function of mealtime ambience and food ser-vice routines.Interventions/research methods: The EF strategy was a 1-year,multifaceted intervention that included support, guidance,practice audit and feedback in two NH units. The EOVstrategy comprised one-three-hour lecture about nutri-tional guidelines in two other NH units. Both strategieswere targeted to selected NH teams, which consisted of aunit manager, a nurse and 5–10 care staff. Mealtime ambi-ence was evaluated by 47 observations using a structuredmealtime instrument. Food service routines were evalu-ated by 109 food records performed by the staff.Results: Mealtime ambience was more strongly improvedin the EF group than in the EOV group after the imple-mentation. Factors improved were laying a table(p = 0.03), offering a choice of beverage (p = 0.02), theserving of the meal (p = 0.02), interactions between staffand residents (p = 0.02) and less noise from the kitchen(p = 0.01). Food service routines remained unchanged inboth groups.Conclusions: An EF strategy that included guidance, auditand feedback improved mealtime ambience when nutri-tional guidelines were introduced in a nursing home set-ting, whereas food service routines were unchanged bythe EF strategy.

Place, publisher, year, edition, pages
2018. Vol. 32, no 2, p. 622-633
National Category
Nutrition and Dietetics
Identifiers
URN: urn:nbn:se:uu:diva-312221DOI: 10.1111/scs.12487ISI: 000436254800018OAI: oai:DiVA.org:uu-312221DiVA, id: diva2:1062681
Available from: 2017-01-08 Created: 2017-01-08 Last updated: 2022-01-29Bibliographically approved
In thesis
1. Implementation strategies for nutritional guidelines in nursing homes: Effects on care staff and residents
Open this publication in new window or tab >>Implementation strategies for nutritional guidelines in nursing homes: Effects on care staff and residents
2017 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Introduction: The number of older adults (≥ 65 years) is increasing in Sweden. At the same time, the elderly care system is being restructured with an increased care burden in nursing homes (NHs). Several studies report a high prevalence of malnutrition among older adults. In recent years public awareness about malnutrition has increased and collective initiatives have been undertaken. However, we lack knowledge regarding how to implement these initiatives to achieve real improvements in practice.

Aims: The overall aims of the thesis are to update our knowledge of the nutritional situation in municipal elderly care and to evaluate different implementation strategies (external facilitation and educational outreach visits) for implementing nutritional guidelines in the NH setting.

Methods: Residents and staff of altogether eight NH units participated in the studies. The two implementation strategies were external facilitation (EF) and educational outreach visits (EOV). The EF strategy was a one-year, multifaceted intervention that included support, guidance, practice audits and feedback in four NH units. The EOV strategy comprised one three-hour lecture about the nutritional guidelines in four other NH units. Both strategies were targeted to selected NH teams, which consisted of a unit manager, a nurse and 5-10 care staff.

Results: In paper I, the prevalence of malnutrition in the NH setting remained high, i.e., 30% were malnourished and 63% at risk of malnutrition, and malnutrition was associated with deterioration in function and cognition and one-year mortality. However, possible improvements in nutritional status among NH residents over time (from 1996 to 2010) were observed. In paper II, the EF strategy improved mealtime ambience compared to the EOV strategy with respect to arranging the table, offering a choice of beverage and more to drink, serving the meal, increasing social interactions between staff and residents, decreasing social interactions among staff and reducing noise from the kitchen. In paper III, the EF strategy may have been related to a delay in cognitive deterioration in a sub-sample of communicative NH residents. In paper IV, the EF strategy improved, on average, the ability and willingness of the staff to implement the guidelines, i.e., the staff experienced a clearer assignment of responsibilities regarding nutritional procedures and that they had more time, tools and support from leadership. Moreover, the staff felt that they experienced less resistance from work colleagues, that their knowledge and experience were valued, that the guidelines worked in practice and that the implementation of guidelines was not labourious. 

Conclusions: Malnutrition is prevalent in Swedish nursing homes. Implementation of nutritional guidelines by an external facilitator, as compared to traditional methods, may be more effective on mealtime ambience, provide better preconditions for change among the staff, and may have positive effects on cognition among residents.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2017. p. 85
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 1288
Keywords
implementation, clinical guidelines, malnutrition, nursing home
National Category
Nutrition and Dietetics
Research subject
Medical Science
Identifiers
urn:nbn:se:uu:diva-312229 (URN)978-91-554-9789-7 (ISBN)
Public defence
2017-02-24, hörsal Auditorium Minus, Museum Gustavianum, Akademigatan 3, Uppsala, 09:15 (Swedish)
Opponent
Supervisors
Available from: 2017-02-02 Created: 2017-01-08 Last updated: 2017-02-02

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Törmä, JohannaWinblad, UlrikaCederholm, Tommy

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