Best intentions or best practice? A case study of the nutritional needs and outcomes of a person with dementia living in a residential aged care home.

AIMS: To evaluate the nutritional status and needs of a person with dementia living in an aged care home, including identification of barriers to, and effective strategies for, the provision of person-centred care. BACKGROUND: Nutrition and hydration care are integral to quality of life for adults with dementia, but there is little research on whether staff knowledge around effective care strategies for residents is translated into optimal care. DESIGN: Focused ethnographic single-case design. METHODS: The perspectives of the resident, her prime family member, and six care staff were triangulated through interviews, observation, document audit, and medical file review to investigate the resident's nutrition and hydration status and needs (October 2014-April 2015). RESULTS: During 3 years in care, this resident had lost weight steadily. Staff appeared attentive but did not maintain a systematic record of body mass index. At meals, staff encouraged eating but used ineffective strategies. Food was not served in ways that facilitated active participation. Eating and drinking were structured as tasks to be completed rather than activities to be enjoyed. CONCLUSION: This instrumental case study identified a task-oriented, rather than person-centred, approach to nutrition and hydration care, adversely affecting the resident's nutritional health and capability to participate actively.

Staff awareness of food and fluid care needs for older people with dementia in residential care: A qualitative study.

AIMS AND OBJECTIVES: To examine awareness of aged care home staff regarding daily food and fluid care needs of older people with dementia. BACKGROUND: Older people in residential care frequently are malnourished, and many have dementia. Staff knowledge of the food and fluid needs of people with dementia is limited. Qualitative research on this topic is scarce but can provide insight into how nutrition and hydration care may be improved. DESIGN: Qualitative, interview-based study. METHODS: Eleven staff in a range of positions at one care home were interviewed regarding their perceptions of current and potential food/fluid care practices. Transcripts were coded and analysed thematically. RESULTS: Key food and fluid issues reported by these staff members were weight loss and malnutrition, chewing and swallowing difficulties (dysphagia), and inadequate hydration. Staff identified a number of current care practices that they felt to be effective in facilitating older people's food and fluid intake, including responsiveness to their needs. Staff suggestions to facilitate food and fluid intake centred on improved composition and timing of meals, enhanced physical and social eating environment, and increased hydration opportunities. Staff commented on factors that may prevent changes to care practices, particularly the part-time workforce, and proposed changes to overcome such barriers. CONCLUSIONS: Staff were aware of key food and fluid issues experienced by the older people in their care and of a range of beneficial care practices, but lacked knowledge of many promising care practices and/or how to implement such practices. RELEVANCE TO CLINICAL PRACTICE: Staff need to be supported to build on their existing knowledge around effective food and fluid care practices. The numerous ideas staff expressed for changing care practices can be leveraged by facilitating staff networking to work and learn together to implement evidence-based change.

"Bringing the outside world in": Enriching social connection through health student placements in a teaching aged care facility.

BACKGROUND: Older adults living in residential aged care facilities (RACFs) often experience limited opportunities for social connection despite close proximity to peers, which has implications for mental health and quality of life (QoL). The introduction of large-scale undergraduate health student placements in RACFs may enhance opportunities for meaningful engagement through social connection, although this remains unexplored. OBJECTIVE: This research explores whether interpersonal encounters between health students and RACF residents influence residents' opportunities for social connection and QoL. METHODS: A mixed methods design was employed which included questionnaire data from residents, and qualitative interview data from residents, family members and RACF staff. Data were collected during and after student placements to allow for an in-depth exploration of residents, family members and staff perspectives. RESULTS: Forty-three participants (28 residents, 10 staff and five family members) were recruited during 2014. Overall, many residents had clinical levels of depression, mild cognitive impairment and multiple morbidities, however reported moderate-to-good QoL. Thematic analysis was undertaken on interview transcripts, and three themes emerged: (i) social isolation and loneliness fostered by residents' age-related conditions, (ii) students expand socially supportive connections beyond the RACF and (iii) meaning making by sharing health experiences, which was found to help renegotiate older adults' pervasive narrative of vulnerability. CONCLUSION: Supported and structured health student placements in RACFs enable older adults to participate in meaningful encounters with younger people. These encounters focus on sharing health experiences and address long-standing issues of isolation and loneliness by providing opportunities for social connection.

Using action research to build mentor capacity to improve orientation and quality of nursing students' aged care placements: what to do when the phone rings.

AIMS AND OBJECTIVES: To describe whether an action research approach can be used to build capacity of residential aged care facility staff to support undergraduate nursing students' clinical placements in residential aged care facilities, using development of an orientation programme as an exemplar. BACKGROUND: Aged care facilities are unpopular sites for nursing students' clinical placements. A contributing factor is the limited capacity of staff to provide students with a positive placement experience. Strategies to build mentor capability to shape student placements and support learning and teaching are critical if nursing students are to have positive placements that attract them to aged care after graduation, an imperative given the increasing care needs of the ageing population worldwide. DESIGN: Action research approach employing mixed-methods data collection (primarily qualitative with a quantitative component). METHODS: Aged care facility staff (n = 32) formed a mentor group at each of two Tasmanian facilities and met regularly to support undergraduate nursing students (n = 40) during placements. Group members planned, enacted, reviewed and reflected on orientation procedures to welcome students, familiarise them with the facility and prepare them for their placement. Data comprised transcripts from these and parallel student meetings, and orientation data from student questionnaires from two successive placement periods (2011/2012). RESULTS: Problems were identified in the orientation processes for the initial student placements. Mentors implemented a revised orientation programme. Evaluation demonstrated improved programme outcomes for students regarding knowledge of facility operations, their responsibilities and emergency procedures. CONCLUSION: Action research provides an effective approach to engage aged care facility staff to build their capacity to support clinical placements. RELEVANCE TO CLINICAL PRACTICE: Building capacity in the aged care workforce is vital to provide appropriate care for residents with increasing care needs.

An investigation of nursing students' knowledge of dementia: A questionnaire study.

BACKGROUND: Globally, rising rates of dementia indicate the need for more nurses skilled in caring for people with this condition. However nursing students may not acquire the requisite knowledge from existing undergraduate curricula. OBJECTIVES: To investigate the dementia knowledge of second-year nursing students before and after a supported placement in a residential aged care facility. Assessment of the level of knowledge of dementia is important to provide evidence of the need to enhance dementia learning in the nursing curriculum. DESIGN: A pre-post control-intervention questionnaire study. SETTINGS: 16 Tasmanian residential aged care facilities (RACFs). PARTICIPANTS: 99 Tasmanian second-year nursing undergraduate students (52 intervention, 47 control). METHODS: Second year nursing students were engaged in a three week RACF clinical placement at one of the 14 control facilities or one of the 2 involved in the development of teaching aged care facilities. Pre/post data were collected using the 21-item 'Dementia Knowledge Assessment Tool 2.0' and demographic survey questions, and analysed using descriptive analyses and nonparametric significance tests. RESULTS: The data showed that these nursing students had a poor knowledge of dementia, with limited understanding of key items relevant to their clinical practice. Knowledge of dementia was significantly improved after students' participation in supported clinical placements at an intervention residential aged care facility. This knowledge improvement was significantly higher than that of students who attended clinical placements at control facilities. CONCLUSIONS: A well-supported clinical placement at a residential aged care facility can improve nursing students' knowledge of dementia, in particular in relation to aspects directly relevant to their clinical practice.

Multiple views reveal the complexity of dementia diagnosis.

OBJECTIVE: To reveal views about dementia diagnosis derived from a larger study of information needs of carers of people with dementia in Tasmania, Australia. METHODS: Over 100 participants, including family carers, health professionals and dementia service personnel, met as discrete focus groups. Data pertinent to dementia diagnosis were segregated and subjected to across-group comparative analysis. RESULTS: The term dementia held connotations of stigma and futility, despite stated benefits of having a diagnosis. General practitioners were regarded as pivotal but having inadequate diagnostic and treatment options. While most health professionals advocated a longitudinal diagnostic process, this created considerable stress for family carers who sought a speedy process. Without a diagnosis, some dementia-specific services were undeliverable. CONCLUSION: Dementia diagnosis is steeped in deep-rooted difficulties and stressful implications, compounded by carers' differing needs and interests. Better understanding between care providers of their conflicting and consistent views could contribute to better dementia care.

Shared lives-an opportunity for obesity prevention?

A longitudinal design was used to survey individual members of 22 couples about food choices, dietary intake and body weight around three months prior to cohabitation and again about three months after the moving-in date. Changes after cohabitation included an increase in shared meal occasions, increased likelihood of including alcohol at meal times and social support for dietary temptations (and restrictions). Body weight increased significantly in women (58.3+/-7.1 - 59.8+/-7.9 kg) and in men (76.7+/-12.0 - 78.4+/-12.5 kg). This life stage may be a missed opportunity for obesity prevention initiatives.