Improving Nutritional Support for Nursing Home Residents: A Two-phase Project

This study will use a four-element blended Intervention, the Evidence-based Nutrition Strategy (EBNS), comprising four elements known to support improved nutritional intake-the SIP (Supportive, Informative, Prescriptive) communication protocol; family-style group dining; high ambiance table presentation; and routine Dietary-Nutrition Champion supervision. The intervention will be applied over 10 randomly allocated mealtimes per week (excluding weekends) for a total of 8 weeks. The four elements of the intervention are detailed below: - 1. Communication Protocol: Supportive, informative & prescriptive The SIP protocol consists of the systematic reinforcement of subject sitting-at-table and eating behaviours by using three dimensions of communication: a) Style, i.e. general conversation about eating (generated by the use of the Supportive, Informative and Prescriptive categories from Six-Category Intervention)(Heron, 1976); b) Form, i.e. specific elements of social behaviour (smiling, eye contact, nodding, laughing) and c) Content (focus of the conversation) on the meal and providing encouragement to eat. Systematic stopping of table-leaving behaviour should be injected into the intervention as needed. 2. Family-style group dining The preservation of homelike environments can be achieved through strategies such as: a) Preparing food close to time eaten to maximize cooking odours as a stimulant b) Keep former rituals as much as possible such as meal blessing c) If food is in a different consistency to which the PwD is familiar then cue the PwD to the item d) Eat in rooms where meals are usually served such as dining room e) Encourage caregiver involvement and engage them in eating some of the meal 3. High ambiance table presentation Physical presentation of meals and the use of very pleasant surroundings (table linen, china, flowers) has been shown to improve intake for PwD over a 6-week period 4. Dietary-nutrition champion supervision Constitutes paying particular attention to what is eaten and how it is eaten, including the following: - - Residents should be properly positioned to eat; that is, they should be sitting upright. - Residents should have their dentures, glasses, and hearing aides, if needed. - Resident requests for substitute food and fluid items should be honoured (and substitutes offered by staff if a resident doesn't seem to like the served meal). - If a resident entirely consumes a particular food or beverage, offer a second helping, even if the food is a dessert. - Residents should have access to their trays for up to 1 hour per meal (and no less than 30 minutes). Feeding assistance ends when each resident has refused all food and fluid items on his or her tray multiple times. - An oral nutritional supplement should be offered at the end of the meal only to those residents who refused all other food and fluid items on their tray, consumed less than 75% of their meal, or requested a supplement. - The nurse or nurse aide should follow a graduated prompting protocol to encourage residents to feed themselves. This standardized procedure instructs staff members to try nonverbal and verbal prompts to encourage residents to eat before offering physical guidance or assistance.