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      Do physical environmental changes make a difference? Supporting person-centered care at mealtimes in nursing homes

      1 , 2 , 3 , 1
      Dementia
      SAGE Publications

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          Abstract

          Purpose Drawing on therapeutic physical environmental design principles and Kitwood's theoretical view of person-centered care, this study examined the impact of environmental renovations in dining spaces of a long-term care facility on residents' mealtime experience and staff practice in two care units. Method The research design involved pre- and post-renovation ethnographic observations in the dining spaces of the care units and a post-renovation staff survey. The objective physical environmental features pre- and post-renovations were assessed with a newly developed tool titled Dining Environment Audit Protocol. We collected observational data from 10 residents and survey responses from 17 care aides and nurses. Findings Based on a systematic analysis of observational data and staff survey responses, five themes were identified: (a) autonomy and personal control, (b) comfort of homelike environment, (c) conducive to social interaction, (d) increased personal support, and (e) effective teamwork. Implications Although the physical environment can play an influential role in enhancing the dining experience of residents, the variability in staff practices reveals the complexity of mealtime environment and points to the necessity of a systemic approach to foster meaningful culture change.

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          Most cited references21

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          Person-centered care for nursing home residents: the culture-change movement.

          Mary Koren (2010)
          The "culture change" movement represents a fundamental shift in thinking about nursing homes. Facilities are viewed not as health care institutions, but as person-centered homes offering long-term care services. Culture-change principles and practices have been shaped by shared concerns among consumers, policy makers, and providers regarding the value and quality of care offered in traditional nursing homes. They have shown promise in improving quality of life as well as quality of care, while alleviating such problems as high staff turnover. Policy makers can encourage culture change and capitalize on its transformational power through regulation, reimbursement, public reporting, and other mechanisms.
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            The nursing home culture-change movement: recent past, present, and future directions for research.

            This article uses a retrospective approach to critique the research base underlying the nursing home culture-change movement-an effort to radically transform the nation's nursing homes by delivering resident-directed care and empowering staff. The article traces the development of the movement from its inception 10 years ago to 2005, when the Centers for Medicare and Medicaid Services implemented its own initiative to support the movement, thus giving it new momentum, to the present day. This historical overview provides context for a proposed research agenda aimed at strengthening the movement's empirical base, thereby facilitating culture-change interventions as well as helping the movement navigate the next step in its evolution.
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              Effect of family style mealtimes on quality of life, physical performance, and body weight of nursing home residents: cluster randomised controlled trial.

              To assess the effect of family style mealtimes on quality of life, physical performance, and body weight of nursing home residents without dementia. Cluster randomised trial. Five Dutch nursing homes. 178 residents (mean age 77 years). Two wards in each home were randomised to intervention (95 participants) or control groups (83). During six months the intervention group took their meals family style and the control group received the usual individual pre-plated service. Quality of life (perceived safety; autonomy; and sensory, physical, and psychosocial functioning), gross and fine motor function, and body weight. The difference in change between the groups was significant for overall quality of life (6.1 units, 95% confidence interval 2.1 to 10.3), fine motor function (1.8 units, 0.6 to 3.0), and body weight (1.5 kg, 0.6 to 2.4). Family style mealtimes maintain quality of life, physical performance, and body weight of nursing home residents without dementia. Clinical trials NCT00114582.
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                Author and article information

                Journal
                Dementia
                Dementia
                SAGE Publications
                1471-3012
                1741-2684
                December 2015
                October 2017
                January 12 2016
                October 2017
                : 16
                : 7
                : 878-896
                Affiliations
                [1 ]Simon Fraser University, Vancouver, BC, Canada
                [2 ]Vancouver Coastal Health, Vancouver, BC, Canada
                [3 ]University of Alberta, Edmonton, AB, Canada
                Article
                10.1177/1471301215622839
                26764264
                fa84aea4-249a-4753-913a-c75349ffee9c
                © 2017

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