The effects of nutritional guideline implementation on nursing home staff performance: a controlled trial

Abstract

RATIONALE: Suboptimal nutritional practices in elderly care settings may be resolved by an efficient introduction of nutritional guidelines. AIMS: To compare two different implementation strategies, external facilitation (EF) and educational outreach visits (EOVs), when introducing nutritional guidelines in nursing homes (NHs), and study the impact on staff performance. METHODOLOGICAL DESIGN: A quasi-experimental study with baseline and follow-up measurements. OUTCOME MEASURES: The primary outcome was staff performance as a function of mealtime ambience and food service routines. INTERVENTIONS/RESEARCH METHODS: The EF strategy was a 1-year, multifaceted intervention that included support, guidance, practice audit and feedback in two NH units. The EOV strategy comprised one-three-hour lecture about nutritional guidelines in two other NH units. Both strategies were targeted to selected NH teams, which consisted of a unit manager, a nurse and 5-10 care staff. Mealtime ambience was evaluated by 47 observations using a structured mealtime instrument. Food service routines were evaluated by 109 food records performed by the staff. RESULTS: Mealtime ambience was more strongly improved in the EF group than in the EOV group after the implementation. Factors improved were laying a table (p = 0.03), offering a choice of beverage (p = 0.02), the serving of the meal (p = 0.02), interactions between staff and residents (p = 0.02) and less noise from the kitchen (p = 0.01). Food service routines remained unchanged in both groups. CONCLUSIONS: An EF strategy that included guidance, audit and feedback improved mealtime ambience when nutritional guidelines were introduced in a nursing home setting, whereas food service routines were unchanged by the EF strategy.