Research evidence and clinical practice

Research evidence and clinical practice

Research Article:  Nijs, K.A., de Graaf, C., Kok, F.J. and van Staveren, W.A.  (2006).  Effect of family style mealtimes on quality of life, physical performance, and body weight of nursing home residents: Cluster randomised controlled trial.  British Medical Journal, 332,1180-1184.

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The research article authored by Nijs et al. (2006) describes the influence of family mealtimes on the well-being of residents living in nursing homes.  This randomized trial was conducted through the expression of interest of approximately 53 potential nursing centers in the Netherlands.  Each nursing home was characterized with a medium bed capacity range of 175 to 275.  Screening of the 53 nursing centers resulted in 16 particular centers that met the selection criteria for inclusion in the research study.  Unfortunately, only six of the 16 finalist centers agreed to participate in the study.  Approximately 10 resident wards were included in the study, wherein residents were positively diagnosed with chronic medical disorders.

            In order to conduct an unbiased study, a blind investigation was performed by the authors through the self-inhibition of visiting the wards while the research study was being conducted.  The authors also did not have any interactions with the staff members of the nursing homes.  In addition, the names of the participants in the study were not identified and only participants’ numbers were employed in monitoring their progress during the entire study.  Approximately 282 nursing centre residents were thus included in the study and pertinent information was collection with regards to their stay in the institution.  Information such as the length of stay, medical condition, mental state and mode of feeding were taken note of.  Participants described to be in their terminal stages of illness were excluded from the study.  The appropriate consent form was also obtained from each study participant.

            Before the actual study commenced, additional information was taken regarding each participant.  This included the motor capabilities of each participant, especially with regards to bathing and dressing themselves, as well as feeding.  The nutritional condition of each participant was also determined before the study was initiated. All these information are helpful in determining whether an effect was indeed observed after the experimentation.  The testing period was conducted for approximately six months and this was composed of variations in table dressing, as well as the service of the meals.  In addition, the staff members were also assigned specific actions during the entire six months.

            The effects of different settings for mealtimes were thus measured through the residents’ quality of life.  The information was directly collected through personal interviews with the residents after the six months of experimentation.  A scale was employed to describe the quality of life that each participant felt, such as their sensory perception, which could be easily described as their level of pain.  Their physical skills were also determined through their level of caring for themselves.  The psychosocial abilities of the residents were also assessed by asking each participant if they felt depressed or alone.  The residents’ perception of freedom to move around was also asked.  Numerical values were assigned for each question and this facilitated the quantification of the answers of the study participants.  The total score of the questionnaire amounted to 100 points and when a participant scores high, then this is an indicator that the resident thinks that his quality of life in the nursing centre was very satisfactory.

            The results of the study showed that there was a significant difference between the perceived quality of life of a resident when mealtimes were interactive with the staff members, as well as the method of presenting food to them.  Majority of the residents felt that they were not alone when the staff members of the nursing home would sit down with them as they would consume their meals.  The presentation of the food during mealtime was also influential on the quality of life the residents, wherein the participants felt more at home were the food was set before them in main plates and bowls and they had the liberty to help themselves as to what they want to eat (Keller et al., 2004).  On the other hand, the participants who were served with a set plate of food and left to dine alone expressed that they were depressed and helpless.

            The perception of a high quality of life was also reflected in the motor, social and mental conditions of the participants.  Those participants who were assigned to the interactive mealtimes were more physically and mentally active.  The exact opposite was observed among participants who were left alone to consume their meals.  The residents who were exposed to social interactions were observed to be more energetic and talkative, while the opposite group became more silent and reflective.

            Other features that supported the effect of mealtimes on the quality of life of the residents were evident in the physical attributes of the study participants.  Those individuals who were subjected to interactive settings maintained their weight, while those subjected to solitary meals lost significant weight after the study period.  The average amount of food consumed by each resident was also affected by the type of mealtime that was offered to them.  Those participants with the interactive mealtime were able to consume a bigger amount of food because they more lively and driven, while the solitary residents ate lesser as time went by.  It should be understood that the amount of food consumed by an individual directly reflects in the total energy of the body.

            This research report serves as a direct example of an evidence-based practice that is founded on actual settings that were conducted in controlled settings.  This report thus provides ample proof that the type of mealtime influences the way an individual feels towards his life.  The results observed from this study thus allow the investigators to directly analyze how such a simple event could affect an individual’s outlook with regards to himself, as well as his immediate surroundings (Haines and Jones, 1994).  Evidence-based practice could thus provide direct evidence on results that were earlier thought to be difficult to test and since this study was conducted with proper collection of consent from the study participants, then no privacy or patient rights were violated (Kitson et al. 1998).  In addition, ethical standards were maintained in this study and that no patients were seriously hurt from the investigation.

            One shortcoming of the research study was that the different mealtimes were provided as packages composed of different features such as the type of table settings, the plate arrangements, as well as the presence of social interactions while dining.  The other experimental group was presented with the entire opposite of the positive setup, wherein there were no enticing table settings and the meal plates were pre-arranged and the only thing the staff members had to do was to put the plate in front of the participating resident.  Given this packaged presentation of different mealtimes, it was thus not possible to specifically identify which part of the mealtime actually influenced the positive changes in the study participants.  It may be possible that the interaction of the staff members with the residents was the actual determining factor in the improvement in the well-being of the residents and not actually the improved presentation of the meals.

            It would thus be much more informative if more variables were implemented in the study, wherein only one difference is present in each study group.  For example, the investigators could have conducted a smaller study that would compare the effect of table settings on the well-being of the residents.  The same method of serving the food should be maintained, as well as the interaction of the staff members and the only different is one the manner of setting the table.  Another small experiment should maintain the other settings, where the interaction between the staff members and the residents should then be removed and treated as a variable.  If these settings were implemented, it would be easier to pinpoint the actual factor that influences a positive change in the perceptions of the residents.

            It would also be interesting to know how the residents felt regarding the type of mealtime that was offered to them.  Aside from asking the residents about how they feel after the study and determining their mental, physical and emotional conditions, it would also be helpful if the residents were asked about how to felt about the pretty table settings or the presentation of their meals.  It may be possible that some residents that participated in the study were used to eating their meals by themselves and thus having social interactions or special table settings actually imparted an uncomfortable feeling in them (Mathey et al., 2001).  It is thus important also to determine the previous living conditions of each of the participants before they joined the nursing home.  If the participant lived alone when he was still feeling physically stronger and not yet sickly, then it is most probable that this individual was also eating his meals alone in his home or alone in a public restaurant.

            Another shortcoming of the research study was the small population size.  Only 282 participants were included in the investigation and thus this does not represent the entire group of individuals who are currently living in nursing homes.  In addition, the research article indicated that only 28% of the study population actually continued on with the study and thus the information that they gathered could have been more comprehensive and informative if the entire study group completed the study.

            The research report also indicated that some participants were not able to complete the entire study period of six months.  It is thus possible that the input of the study was composed of both reflections of participants who stayed on for the entire experimental period and there were also some data from participants that only stayed during the initial months of the investigation.  If this is the case, then the results of the study are not reliable because some of the data do not represent the entire collection of information for the whole testing period of six months.

            The research report is still important because this is one of the first investigations that examined the effect of mealtimes on the well-being and quality of life of residents of nursing homes (Ellis et al., 1996).  It should be understood that this elderly population are often ignored with regards to their living conditions within the institution.  In addition, the family members who have brought their relative to a nursing mainly rely on the actions of the staff members of the nursing home to take care of their family member.  This report thus allows the reading population to see how even simple activities such as mealtimes can influence the well-being of a nursing home resident (Sackett et al., 1996).

            The report may thus provide information to nursing home administrators on how to manage their institutions, as well as be more vigilant with regards to how particular activities are handled within the locale (Harvey and Kitson, 1996).  As for non-nursing home administrators and physicians, this research report may be helpful in showing that a simple activity can strongly influence any individual, regardless of physical, mental or emotional condition (Morrison, 1992).  It should be noted that majority of individuals are now always rushing in doing their routine activities, and thus a simple mealtime is now considered as an activity that needs to be done several times a day, without even meaning but as a simple biological need to feel the bodies for nourishment.  This report thus shows that mealtimes are not only venues for nourishing the body, but also venues for social, emotional and intellectual improvement.

            The research report would facilitate not only the geriatric field of medicine, but also the fields of psychology, nutrition and sociology because the mental, environmental and biological effects of a simple activity such as a mealtime are described in this investigation (

(Amarantos et al., 2001).  For the field of medicine, this research article serves as an additional proof for evidence-based practices that would alleviate the conditions of elderly residents in nursing homes (Burrows, 1996).  The report is important because it describes the effect of simple activities in a nursing home that are often recognized as routine yet the positive and negative influences can be observed in the quality of life that the residents are living.

            It would be helpful if another study were conducted that carried the same principle of determining the effect of mealtimes with specific features.  In addition, the next investigation should be conducted in a bigger study population.  The backgrounds of each study participant will also be examined in more detail, so that any correlations may be identified after the current study is completed.  Evidence-based practices are important in improving the methods in healthcare services because it allows the healthcare professional to conduct activities that have already been proven to be effective and sensitive enough for implementation and improvement of the patient’s condition (Kitson et al., 1996).  The mechanism behind the adaptation of evidence-based practice should thus be critically examined in order to assure that the results that are obtained are credible, reliable and repeatable.

References

Amarantos, E., Martinez, A. and Dwyer, J.  (2001).  Nutrition and quality of life in older adults. Journal of Gerontology, A. Biological Sciences and Medical Sciences, 56,54-64.

Burrows, D.E.  (1996).  Facilitation: A concept analysis.  Journal of Advanced Nursing, 25,396–404.

Ellis, J., Mulligan, I. and Rowe, J.  (1995).  Patient general medicine is evidence based.  Lancet, 346, 407–410

Haines, A. and Jones, R.  (1994).  Implementing findings of research.  British Medical Journal, 308,1488–1492.

Harvey, G. and Kitson, A.L.  (1996).  Achieving Improvement through quality: An evaluation of key factors in the implementation process.  Journal of Advanced Nursing, 24,185–195.

Keller, H.H., Ostbye, T. and Goy, R.  (2004).  Nutritional risk predicts quality of life in elderly community-living Canadians.  Journal of Gerontology, A Biological Sciences and Medical Sciences, 59,68-74.

Kitson, A., Harvey, G. and McCormack, B.  (1998).  Enabling the implementation of evidence based practice: A conceptual framework.  Quality Health Care, 7,149-158.

Kitson, A.L., Ahmed, L.D. and Harvey, G.  (1996).  From research to practice: One organisational model for promoting research based practice.  Journal of Advanced Nursing, 23,430–440.

Mathey, M.F., Vanneste, V.G., de Graaf, C., de Groot, L.C. and van Staveren, W.A.  (2001).  Health effect of improved meal ambiance in a Dutch nursing home: A 1-year intervention study.  Preventive Medicine, 32,416-423.

Morrison, M.J.  (1992).  Promoting the motivation to change: The role of facilitative leadership in quality assurance.  Professional Nurse, 7,715–718.

Nijs, K.A., de Graaf, C., Kok, F.J. and van Staveren, W.A.  (2006).  Effect of family style mealtimes on quality of life, physical performance, and body weight of nursing home residents: Cluster randomised controlled trial.  British Medical Journal, 332,1180-1184.

Sackett, D.L., Rosenberg, W.M.C. and Gray, J.A.M.  (1996).  Evidence based medicine: What it is and what it isn’t.  British Medical Journal, 312,71–72.

 

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