Reclaiming time for nursing practice in nutritional care: outcomes of implementing Protected Mealtimes in a residential aged care setting.

摘要

AIMS: To improve nutritional care and the mealtime experience of older people in a residential aged care setting by assisting nurses to create change to their practice and to the mealtime environment. BACKGROUND: Despite being preventable and treatable, inadequate nutrition remains a problem for many older people in residential aged care and tertiary health care settings. Nevertheless, many organisations are uniquely positioned to implement solutions that will lead to better care. DESIGN: The study used a qualitative, action research approach, grounded in the participatory worldview. METHODS: The multimethod approach of data and between-method triangulation were chosen to assist in understanding the multidimensional issues associated with resident mealtimes and the provision of nutritional care. The collection of non-participant observations was informed by aspects of the Developmental Research Sequence. Action group meetings and non-participant observations were qualitatively analysed using the Analytic Hierarchy. RESULTS: Protected Mealtimes was tailored for the residential aged care unit. The most significant change involved the transformation of system processes by creating the space in nurses' busy schedules and thus reclaiming time for nurses to reconnect with nutritional care. Fixed role boundaries were made flexible by assisting individuals to understand and extend their roles in nutritional care. Most importantly, sustainability of Protected Mealtimes was achieved and long-term changes around nutritional care continued to be resident focused. CONCLUSIONS: This study demonstrates that lasting changes to nursing practice in nutritional care can be achieved by applying the principles of a participatory worldview and action research. RELEVANCE TO CLINICAL PRACTICE: CHANGE is challenging to achieve in complex health care organisations. This study bridges the gap between theory and practice and has shown that nurses can create change by employing a participatory worldview and action research as part of their toolkit for problem solving.