How do organisational and social contexts influence mealtimes on wards caring for the older person aged 65 years and above?

Aim: To explore the barriers and facilitators to a positive eating experience at mealtimes in hospital and to inform the development of evidence- based strategies that enhance older people’s mealtime experience. Background: Malnutrition among older hospitalised people remains a global concern including in the National Health Service (NHS) in England. Approximately 35% (1 in every 3) of elderly patients are at risk of malnutrition at the point of admission to hospital and hospitalisation is known to increase the risk. Malnutrition poses risks such as pressure ulcers, falls, longer hospital stays, frequent readmissions, increased cost of care, increased dependency on others which can result in discharge to long term care facilities. Initiatives to tackle malnutrition such as protected mealtimes, Malnutrition Universal Screening Tool (MUST) assessments, red trays and nutrition policies have been implemented across the NHS however malnutrition remains prevalent. Research question: “How do organisational and social contexts influence mealtimes on wards caring for the older person aged 65 years and above?” Research objectives: (1) to explore individual patients’ mealtime experience, (2) to explore individual ward staff mealtime practice, (3) to observe mealtime activities, (4) to review food charts of patient participants. Methodology: Rapid ethnography to investigate the mealtime culture in hospital. Methods: Six overt non-participant mealtime observations and twelve semi-structured interviews were carried out. Interview participants included six in-patients and six staff on care of the older person ward. Six food charts of patient participants were reviewed. Field notes added to the richness of the data. Findings: Inductive thematic analysis process led to the development of six themes; Discord between nurses and healthcare assistants, inadequate assistance and interaction with patients, poor record keeping culture, indiscriminate use of red trays, infantilisation of the older person and identification and support for compromised dexterity. The six themes were further divided into two concepts of team culture and organisation culture. An overarching theme of low prioritisation of mealtimes and deviation from best practice connected all the themes. Discussion: My contributions to new knowledge which are, organisational senior nursing leadership (organisational context), working relationships and ward leadership (social context) and defunct tools and initiatives informed the discussion. The discussion argued that the lack of nursing leadership at all levels of the organisation has resulted in suboptimal mealtime practices. The discussion also argued that the current mealtime tools and initiatives are no longer serving the purpose they were intended for two decades ago. It is therefore time for nursing leadership to engage with patients and other key stakeholders and co-create what works and matters to patients. Implications: This research has implications for nursing practice, nursing education, research, and policy. Nursing practice requires nurses reclaim their responsibility and accountability for mealtimes. Nursing leadership must invest in non-technical education for the nurses on the ward to enhance teamworking and effective coordination of mealtimes. Research is required to look at new tools and initiatives that are aligned to patients’ challenges and needs at mealtimes. Policy development must be informed by engaging with patients and key stakeholders in co-creating mealtimes practices, initiatives, guidelines, and tools.

Grantor dc:publisher

Oxford Brookes University

Author dc:creator

• Buyanga, Maxmiller

Contributors dc:contributor

• Finlay, Teresa
• Stayt, Louise
• Aveyard, Helen

Statement dc:rights

• All rights reserved

Language dc:language

en

DOI dc:identifier

https://doi.org/10.24384/rtkc-q528

OAI identifier oai:identifier

tle:33c00b48-f46f-4422-8c1a-68c5c96f40c3:d6bd9758-527a-46cd-bfe2-c433766e8fca:1