"Meal realities" - An ethnographic exploration of hospital mealtime environment and practice.

AIM: To explore and understand patterns of mealtime culture, environment and social practice from the perspective of staff, volunteers and visitors on the hospital ward. BACKGROUND: Inadequate food intake is a common and complex problem in hospital and can lead to malnutrition. Mealtime interventions have been implemented to address this problem with limited success. A better understanding of mealtime environment and practice is needed to ascertain which interventions are more likely to be effective in addressing inadequate food intake in hospital. DESIGN: A qualitative, ethnographic approach was used to promote a comprehensive understanding of mealtime environment and practice. METHODS: Sixty-seven hours of fieldwork was conducted August-October 2015. More than 150 participants were observed and 61 unique participants were interviewed in 75 interviews. Data analysis followed an inductive, thematic approach, informed by systems and complexity theory. FINDINGS: Themes of "patient centredness" and "system" and their disharmonious interrelationship emerged. Staff, volunteers and visitors strive for patient centredness at mealtimes. The routine and structured nature of the meal and care systems was constantly in tension with providing patients the care they needed. CONCLUSION: The findings of this study expose the challenges associated with maintaining patient centredness at mealtimes in complex healthcare and foodservice systems. This facilitates a better understanding of why inadequate food intake is difficult to address in the hospital setting and highlights the need to support strategies that approach foodservice processes and nutritional care as complex and non-linear.

Patients recovering from abdominal surgery who walked with volunteers had improved postoperative recovery profiles during their hospitalization.

BACKGROUND: Early walking as part of a perioperative care program benefits patients who have had surgery. However, the impact of early walking by itself on the mental and physical recovery of postoperative patients has not been examined. METHODS: We established a program called walking to recovery (WTR) in which college volunteers provided walking assistance to patients recovering after abdominal surgery. Patients who participated in the program were compared with patients who did not. The postoperative recovery profile survey (PRP-17) was administered on day of discharge to 15 participants and 15 non-participants. Medical records were reviewed to obtain indication for surgery, type of surgery, length of hospital stay, and postoperative complications. At 1 month post-discharge, a short form (SF)-12v2 questionnaire was administered by telephone to assess postoperative quality of life as defined by mental and physical level of function and measured with the mental component score (MCS) and the physical component score (PCS). RESULTS: The average age of participants and non-participants was similar (48.9 ± 9.8 vs. 51.4 ± 8.7 years; p = 0.28). When the two groups were approximately matched by type and severity of surgery, participants had lower PRP-17 composite scores (9.9 vs. 12.5, p = 0.003) and higher indicator sums (9.8 vs. 8.4, p = 0.04) than non-participants, both of which indicate better postoperative recovery in participants. The mean immobilization score was significantly lower in participants (0.3 vs. 0.8, p = 0.04). Postoperative length of stay and MCS did not differ between the two groups, but in participants there was a trend for higher scores in the PCS. CONCLUSIONS: Walking with volunteers was associated with a better PRP during the hospitalization period but not at 1 month follow-up. The WTR program is a sustainable, cost-effective model program for other hospitals to emulate as part of the standard of care of postoperative patients.

The fundamentals of integrating service in a post-licensure RN to BSN program.

Integrating service in a post-licensure registered nurse to bachelor of science in nursing (RN to BSN) program provides licensed registered nurse (RN) students the opportunity to learn, develop, and experience different cultures while serving the community and populations in need (McKinnon & Fitzpatrick, 2012). Service to the community, integrated with academic learning can be applied in a wide variety of settings, including schools, universities, and community faith-based organizations. Academic service-learning (ASL) can involve a group of students, a classroom, or an entire school. In the RN to BSN program, the authors use a student-directed service learning approach that integrates service-learning throughout the curriculum. RN students are introduced to service-learning at program orientation prior to the start of classes and receive reinforcement and active engagement throughout the curriculum. The students and volunteer agencies receive and give benefits from the services provided and the life lessons gained through mentorship, education, and hands-on experiences.

A narrative literature review of the contribution of volunteers in end-of-life care services.

BACKGROUND: Volunteers are integral to the history of hospices and continue to play a vital role. However, economic, policy and demographic challenges in the twenty-first century raise questions about how best to manage this essential resource. AIM: This narrative review explores the recent literature on end-of-life care volunteering and reflects upon the issues pertinent to current organisational challenges and opportunities. DESIGN: The parameters of the review were set deliberately wide in order to capture some of the nuances of contemporary volunteer practices. Articles reporting on research or evaluation of adult end-of-life care services (excluding prison services) that use volunteers and were published in English between 2000 and 2011 were included. DATA SOURCES: Seven electronic databases, key journals and grey literature databases. RESULTS: Sixty-eight articles were included in the analysis. The articles were drawn from an international literature, while acknowledging that volunteer roles vary considerably by organisation and/or by country and over time. The majority of articles were small in scale and diverse in methodology, but the same topics repeatedly emerged from both the qualitative and quantitative data. The themes identified were individual volunteer factors (motivation, characteristics of volunteers, stress and coping, role boundaries and value) and organisational factors (recruiting for diversity, support and training and volunteers' place in the system). CONCLUSIONS: The tensions involved in negotiating the boundary spaces that volunteers inhabit, informality and regulation, diversity issues and the cultural specificity of community models, are suggested as topics that merit further research and could contribute to the continuing development of the volunteer workforce.

Medical center farmers markets: a strategic partner in the patient-centered medical home.

BACKGROUND: The number of medical center-based farmers markets has increased in the past decade, but little is known about how such organizations contribute to the preventive health goals of the patient-centered medical home. COMMUNITY CONTEXT: In 2010, we started a seasonal farmers market at Penn State Hershey Medical Center to help support the institution's commitment to the medical home. METHODS: We obtained descriptive data on the farmers market from hospital and market records and tracking information on the market's Facebook and Twitter sites. We computed summary measures to characterize how the market has begun to meet the 6 standards of the 2011 National Committee for Quality Assurance's report on the medical home. OUTCOME: During the 2010 and 2011 seasons, 146 medical center volunteers from 40 departments formed 23 interprofessional teams that spent an average of 551 volunteer hours per season at the market, providing health screenings (n = 695) and speaking to customers (n = 636) about preventive health. Fifty-five nonmedical community health partners provided 208 hours of service at the market alongside medical center staff. Market programming contributed to 5 regional preventive health partnerships and created opportunities for interprofessional mentoring, student leadership, data management, development of social media skills, and grant-writing experience. The market contributed to all 6 medical home standards outlined by the National Committee for Quality Assurance. INTERPRETATION: Medical center markets can support medical home standards. With systematic tracking of the health effects and integration with electronic medical health records, markets hold potential to contribute to comprehensive patient-centered care.

Mealtime assistance for hospitalized older adults: a report on the SPOONS volunteer program.

Mealtime assistance may be necessary to prevent declines in hospitalized older adults' nutritional well-being. This article reports the implementation of the Support for and Promotion Of Optimal Nutritional Status (SPOONS) volunteer assistance program. Patients were 65 and older, admitted to the Acute Care for Elders Unit at the University of Alabama at Birmingham Hospital, and in need of mealtime assistance. There were 236 documented patient-volunteer encounters at which social interaction (n = 217; 92%), assistance with tray set-up (n = 162; 69%), and prompting to eat (n = 161; 68%), among other activities, were performed. Mean time of interaction was 47.8 minutes, with an average estimated cost savings of $11.94 per encounter had the service been provided by a patient care technician and $26 per encounter had it been provided by an RN. This demonstration of the SPOONS program should be followed up with an evaluation of its effectiveness.

Experiences of lay counsellors who provide VCT for PMTCT of HIV and AIDS in the Capricorn District, Limpopo Province.

Human immune deficiency virus (HIV) and acquired immune-deficiency syndrome (AIDS) still carry a stigma in the community. Many people do not know their status and they are still reluctant to be tested including pregnant women despite the fact that Voluntary Counselling and Testing (VCT) is offered for free in South Africa. In South Africa VCT for HIV and AIDS is offered by lay counsellors in public hospitals and clinics. The study conducted by Mate, Bennet, Mphatswe, Barker and Rollins (2009:5483) outlined that in South Africa the prevention of mother-to-child transmission (PMTCT) of HIV guidelines have raised hope that the national goal of reducing perinatal HIV transmission rates to less than 5% can be attained. A qualitative, exploratory, descriptive and contextual study was conducted in 15 public clinics of the Polokwane Municipality in the Capricorn District, Limpopo Province. The purpose of the study was to determine the experiences of the lay counsellors who provide VCT for the PMTCT of HIV and AIDS in the Capricorn District, Limpopo Province. Data were collected through one-to-one interviews using a semi-structured guide (De Vos et al, 2006:296). The findings of the study reflected the following: the content of training and counselling skills received by lay counsellors were satisfactory, there was lack of counsellor support and in-service education. A program for in-service education and support for all lay counsellors who have had VCT training should be conceptualised and implemented.

Insuring continuity of care for chronic disease patients after a disaster: key preparedness elements.

BACKGROUND: Care for patients with chronic diseases is a challenge after a disaster. This is particularly true for individuals from health disparate populations as they are less likely to evacuate, have fewer financial resources and often depend on resource-strapped institutions for their care. The specific aim of the study presented here was to elicit challenges and solutions in the provision of health care to those with chronic diseases after Hurricane Katrina in coastal Alabama and Mississippi. METHODS: Focusing on agencies providing care to health disparate populations, a qualitative methodology was employed using in-depth interviews with health and social service providers. Participants identified key elements essential to disaster preparedness. RESULTS: Predisaster issues were patient education and preparedness, evacuation, special needs shelters, and health care provider preparedness. Postdisaster issues were communication, volunteer coordination, and donation management. CONCLUSIONS: Lessons learned from those on the ground administering health care during disasters should inform future disaster preparations. Furthermore, the methodological approach used in this study engendered collaboration between health care institutions and may enhance future interagency disaster preparedness.

Developing a Palliative Care Competency Framework for Health Professionals and Volunteers: The Nova Scotian Experience.

BACKGROUND AND OBJECTIVES: In 2014, Nova Scotia released a provincial palliative care strategy and implementation working groups were established. The Capacity Building and Practice Change Working Group, comprised of health professionals, public advisors, academics, educators, and a volunteer supervisor, was asked to select palliative care education programs for health professionals and volunteers. The first step in achieving this mandate was to establish competencies for health professionals and volunteers caring for patients with life-limiting illness and their families and those specializing in palliative care. METHODS: In 2015, a literature search for palliative care competencies and an environmental scan of related education programs were conducted. The Irish Palliative Care Competence Framework serves as the foundation of the Nova Scotia Palliative Care Competency Framework. Additional disciplines and competencies were added and any competencies not specific to palliative care were removed. To highlight interprofessional practice, the framework illustrates shared and discipline-specific competencies. Stakeholders were asked to validate the framework and map the competencies to educational programs. Numerous rounds of review refined the framework. RESULTS: The framework includes competencies for 22 disciplines, 9 nursing specialties, and 4 physician specialties. CONCLUSIONS: The framework, released in 2017, and the selection and implementation of education programs were a significant undertaking. The framework will support the implementation of the Nova Scotia Integrated Palliative Care Strategy, enhance the interprofessional nature of palliative care, and guide the further implementation of education programs. Other jurisdictions have expressed considerable interest in the framework.

The many roles of families in family-centered care--part V. Interview by Deborah Dokken.

This article, the fifth of six in a series on roles for family members in family-centered care, focuses on the role of parents as educators of clinicians in the health care system. Two interviews highlight this role. The director of family services at a pediatric hospital, a parent of a child who suffered with a chronic illness, offers suggestions for institutions wanting to further develop this key role. This includes involving patient and family advisors at the "front end" of any initiative or new project; identifying champions (clinical staff, administrators, and patients/family members) for these roles within the institution; preparing family members for the educator role; following-up with thanks and feedback; and tracking successes of projects in which patient and family advisors participate. The father interviewed in this article describes the sense of fulfillment he experiences from teaching health care providers about child and family needs and the emotional side of care. He urges all parents to recognize the important education they can offer professionals when they both ask questions and share about their own child and family.

Hospital-based rental programs to increase car seat usage.

The ability of hospital-based car seat rental programs to provide car seats inexpensively throughout an entire state and the effect of these rental programs on car seat usage by newborns were evaluated. In July 1979 individuals and groups committed to child passenger safety formed a coalition called Vermont SEAT (Seatbelts Eliminate Automobile Tragedies). During the next 3 years SEAT asked the major hospitals in the state to allow volunteers to operate car seat rental programs on their premises. The number of rental programs increased from 0 to 13; the percentage of newborns born in a hospital with a rental program increased from 0% to 99%. The estimated statewide rate of car seat usage by newborns, based on observations at discharge at five hospitals, increased from 15% to 70%. These findings suggest that a network of hospital-based car seat rental programs operated by volunteers can make car seats readily available throughout a state or region, and can significantly increase car seat usage by newborns. It is recommended that such programs be a part of comprehensive strategies to improve child passenger safety.