Mealtime Experience Research Articles

How do we provide good mealtime care for people with dementia living in care homes? A systematic review of carer-resident interactions.

People with dementia who live in care homes often depend on care home staff for help with eating and drinking. It is essential that care home staff have the skills and support they need to provide good care at mealtimes. Good mealtime care may improve quality of life for residents, and reduce hospital admissions. The aim of this systematic review was to identify good practice in mealtime care for people with dementia living in care homes, by focusing on carer-resident interactions at mealtimes. Robust systematic review methods were followed. Seven databases were searched: AgeLine, BNI, CENTRAL, CINAHL, MEDLINE, PsycINFO and Web of Science. Titles, abstracts, and full texts were screened independently by two reviewers, and study quality was assessed with Joanna Briggs Institute tools. Narrative synthesis was used to analyse quantitative and qualitative evidence in parallel. Data were interrogated to identify thematic categories of carer-resident interaction. The synthesis process was undertaken by one reviewer, and discussed throughout with other reviewers for cross-checking. After title/abstract and full-text screening, 18 studies were included. Some studies assessed mealtime care interventions, others investigated factors contributing to oral intake, whilst others explored the mealtime experience. The synthesis identified four categories of carer-resident interaction important to mealtime care: Social connection, Tailored care, Empowering the resident, and Responding to food refusal. Each of the categories has echoes in related literature, and provides promising directions for future research. They merit further consideration, as new interventions are developed to improve mealtime care for this population.

Hand-Feeding Nursing Facility Residents with Dementia Competency Training Modules

<h3>Introduction</h3> Problem: In nursing homes around 70% of residents have some form of dementia and are at risk of malnourishment (Zimmerman et al., 2014). In this long-term care (LTC) unit, residents have varying degrees of cognitive impairment (CI) affecting their functional capabilities, including their capacity to feed themselves. The director of nursing (DON) identified that residents are vulnerable to decreased food and fluid intake, and this problem may reflect the limited feeding skills of direct care workers (DCWs). More than half of the staff in this LTC unit report that it is a challenge to assist a resident with dementia during mealtimes when they exhibit difficult feeding behaviors. The majority of staff report that one of the greatest challenges when assisting a resident with mealtimes is resistance to eating demonstrated by residents turning their head away or not opening their mouths. Only one staff member on this unit reports having additional training on feeding assistance, and only one staff member uses assistive hand-feeding techniques when assisting a resident with CI during mealtimes. Evidence supports staff training as in intervention, however no specific training has been implemented to improve DCW's feeding assistance. Purpose: The purpose of this quality improvement (QI) project is to implement and evaluate the evidence-based <i>Hand-Feeding Nursing Facility Residents with Dementia</i> training within a LTC setting, to ameliorate DCWs feeding assistance skills, enhance the mealtime experience, and improve residents' health outcomes. <h3>Methods</h3> The QI project was developed by project leaders with the help of content expert and creator of the evidence-based training program titled <i>Hand-Feeding Nursing Facility Residents with Dementia</i>. The project included nine DCWs that were chosen to participate by the DON and worked during a shift that required the provision of assisting residents with a meal. The participants completed a pre-training survey and baseline interview with project leaders to assess knowledge and use of assistive handfeeding techniques. The participants were provided online access to the training modules on topics of assessment of residents' functional and cognitive abilities, determining the most appropriate handfeeding technique, mealtime challenges associated with residents with CI, and strategies to manage feeding behaviors to promote meal intake. A train-the-trainer strategy was utilized, and the project champion was trained on the competency modules and how to perform the post-training skill checks. Participants completed the online competency modules, and the project champion completed the post-training skills checks. After the competency training modules were completed, participants completed the post-training survey and final interview with project leaders to report their utilization of learned assistive handfeeding skills and techniques, and improvement in residents' meal intake and feeding behaviors. <h3>Results</h3> Preliminary Results: Preliminary findings suggest that completion of the <i>Hand-Feeding Nursing Facility Residents with Dementia</i> competency training modules, improves DCW's utilization of assistive hand-feeding skills and techniques to better assist residents with dementia during mealtimes. <h3>Conclusions</h3> Preliminary Conclusions: The <i>Hand-Feeding Nursing Facility Residents with Dementia</i> competency training course enhanced DCWs' mealtime interactions with residents with dementia, and residents' nutritional status will be improved as a result of project implementation. <h3>Funding</h3> No funding was available.

The five aspect meal model as a conceptual framework for children with a gastrostomy tube in paediatric care.

Cancer treatments may induce side effects and cause eating problems. A gastrostomy tube may be required in order to maintain and optimise the child's nutritional needs. Despite the use of a gastrostomy tube, it is important to maintain a natural and attractive mealtime for the child. The Five Aspect Meal Model is age neutral and originally designed to improve restaurant visits. Its five aspects conceptualise what is necessary to ensure a complete meal experience. To date, there is lack of knowledge to guided model development about mealtimes adapted to children and limited knowledge regarding mealtime experiences for children with a gastrostomy tube. The aim was to investigate whether the Five Aspect Meal Model could be appropriate to be used for children with a gastrostomy tube in caring science and paediatric care. The design followed steps retrieved from Renjith and colleagues. Seven interviews were performed with the Five Aspect Meal Model as a base in the interview guide. The transcripts were analysed by using a qualitative directed content analysis with a deductive approach, which finally passed into a more inductive one. All aspects of the Five Aspect Meal Model were represented in the interviews. There were also experiences related to the gastrostomy tube and the mealtimes that did not fit into any of the five predetermined categories. As a result, the modified version was developed, an adapted prescribing practice model that includes seven aspects, whereof bodily discomfort and time for change and acceptance are specific to children with a gastrostomy tube. Based on children and their parent's experiences, the Five Aspect Meal Model has been developed and adapted into a modified version, which includes seven aspects. The modified version seems to be appropriate to use within caring science and paediatric care.

Patient-reported experiences of mealtime care and food access in acute and rehabilitation hospital settings: a cross-sectional survey.

Nutrition and mealtime interventions can improve nutritional intake amongst hospital inpatients; however, patient-reported experience is rarely considered in their development and evaluation. The present study aimed to measure patient-reported food and mealtime experience to evaluate and inform continuous quality improvement of hospital nutrition care. A cross-sectional survey with inpatients in seven acute care and rehabilitation wards was conducted. A 27-item validated questionnaire measured five domains of patient experience: food choices, organisational barriers, feeling hungry, physical barriers to eating and food quality. Responses were summarised descriptively and compared between settings (acute versus rehabilitation), patient demographics (age, gender) and time in hospital. Responses from 143 participants (mean age 67years, 57% male, 28% rehabilitation, median 6days into hospitalisation) showed that 10% or fewer respondents reported difficulties with food choices, feeling hungry or food quality. The most common difficulties were opening packets (36%), insufficient menu information provided (29%), being interrupted by staff when eating (28%), being disturbed when eating (27%), being in an uncomfortable position when eating (24%) and difficulty reaching food (21%). There were no significant differences in domain patterns by sex, age group or time in hospital. Organisational barriers were reported less frequently amongst rehabilitation participants compared to acute care (P=0.01). This survey highlights areas of positive patient-reported experience with nutrition care and suggests that local improvement efforts should focus on physical assistance needs and organisational barriers, especially in acute care wards. The questionnaire may be useful for informing and evaluating systematic nutrition care improvements.

Children's Perspectives on Mealtimes When Living with a Gastrostomy Tube: A Qualitative Study

PurposeTo explore children's experiences of mealtimes when living with a gastrostomy tube. Design and methodsThe study used a qualitative descriptive design framed within ecocultural theory. Seven children, three girls and four boys, aged 6–12 years with long-term health conditions and a gastrostomy tube participated in individual interviews. The interviews were qualitatively analysed by means of systematic text condensation. ResultsFour main categories comprised the findings of the children's mealtimes experiences: “Stable in form, open to variation,” “An individual, and a shared activity,” “An object that needs to be dealt with” and “A part of me.” A complex picture emerged, where the children experienced nutrition, whether through the gastrostomy tube or orally, as necessary for a healthy body, although this did not suffice to make the mealtime experience positive. ConclusionsRegardless of the children's amount of oral intake, everyday mealtimes were valued as opportunities for social interaction and experienced as a predictable, routine activity no different from the mealtimes of other families. The accounts illustrated that in many situations the children knew precisely what they needed and did not need, what they liked and disliked and why. Practice implicationsHealthcare professionals should take children's knowledge into consideration to a greater extent when planning follow-up and intervention. The study illuminates that children can take an active part in their healthcare when offered flexible and carefully designed communication material, even in the presence of communicative and/or intellectual disability.

Relationship-Centered Mealtime Training Program Demonstrates Efficacy to Improve the Dining Environment in Long-Term Care

ObjectivesMealtimes in residential care tend to be task-focused rather than relationship-centered, impacting resident quality of life. CHOICE+ uses participatory approaches to make mealtimes more relationship-centered. The aim of this study was to demonstrate the efficacy of the 12-month external-facilitated implementation of CHOICE+ to improve the mealtime environment. DesignModified stepped-wedge time series design. Setting and ParticipantsDining rooms in 3 homes were entered into the intervention every 4 months; total study length was 20 months. Pre- and postintervention evaluations were attained from residents (n = 27, n = 19) and staff (n = 39, n = 29) respectively. MethodsFive meals in each home were observed by a blinded trained assessor every 4 months using the Mealtime Scan+ to assess physical, social, and relationship-centered practices and overall quality of the dining environment. Repeated measures analysis determined change in mealtime environment scores. The Team member Mealtime Experience Questionnaire and 5 questions from the InterRAI Quality of Life Questionnaire for residents and family were administered at pre- and postintervention. ResultsThere were significant increases in physical and social environments, relationship-centered care practices, and overall quality of the mealtime environment during the intervention period at all sites (all P < .001) and significant site by intervention interactions for physical (P = .01) and relationship-centered care (P = .03). Statistically significant site differences were noted for relationship-centered care practices (P < .001) and overall quality of the dining environment (P < .002). There was no significant difference in staff and resident/family pre-/postintervention questionnaire results. Conclusions and ImplicationsThe external facilitated model of CHOICE+ resulted in significant improvements in the mealtime environment. Although site context impacted implementation, this study demonstrates that mealtimes can be improved even in homes that have challenges. Future work should determine impact of these improvements on other outcomes such as resident quality of life, using more specific measures.

Dysphagia assessment and intervention: evaluating inclusive approaches using video

PurposeDysphagia experienced by adults with mental health conditions and/or intellectual disabilities (IDs) has been well-reported. However, accessible and inclusive assessment measures to identify and monitor for deterioration in dysphagia are very limited. The purpose of this paper is to explore the use of video to enhance inclusion in dysphagia assessment and intervention for an inpatient setting.Design/methodology/approachThis service evaluation involved adults with IDs and mental illness living in in-patient accommodation and their multidisciplinary team. Participants were invited to film and then reflect on videos and their comments were transcribed for qualitative analysis.FindingsIn total, 42 adults gave consent to film, review and discuss mealtime video-clips. Staff feedback was invited. Thematic analysis was conducted for service-user and staff comments. A global theme of “involvement” was identified from the data analysis, with sub-themes of “enhancing participation, insight and incentive”. An additional global theme “clinical benefits” resulted from staff comments. This included sub-themes of breadth of assessment, shared working and outcome measures.Research limitations/implicationsLimitations included refusal of video by people with heightened anxiety but these were a minority. Most people showed enthusiasm and enhanced engagement. Practical issues were resolved regarding governance.Practical implicationsVideo offers a dynamic record of muscle tone, coordination, mealtime experience and individual context benefiting both service-user and staff practice. It stimulates insightful discussion of outcomes and supports the inclusion of service-user perspectives. Further research is indicated to develop a greater understanding of dysphagia in this population. Inclusion of service-users in planning and managing safer mealtimes may be enhanced through the sensitive use of video.Social implicationsThis evaluation suggests opportunities for improving inclusive approaches for service-users using video to promote insight.Originality/valueFurther research is indicated to explore the nature of dysphagia in people with mental health conditions using video as a dynamic and unique resource.

Hungry for more: Low resident social engagement is indirectly associated with poor energy intake and mealtime experience in long-term care homes

Mealtimes in long-term care (LTC) homes provide social engagement and nutritional intake to residents. Psychosocial challenges may detract from the mealtime experience, resulting in low food intake and increased risk of malnutrition. This study explores the independent effects of psychosocial factors on energy intake among LTC residents. Secondary data (Making the Most of Mealtimes [M3]) from residents in 32 Canadian LTC homes were analyzed. Data included 3-day weighed food intake, mealtime care actions taken by staff, loss of appetite, eating challenges, and other resident characteristics. Psychosocial factors (i.e., social engagement, depression, and aggressive behaviours) were measured using standardized scales. The independent effects of psychosocial factors on energy intake were tested using bivariate and linear regression analyses adjusted for loss of appetite, eating challenges, and demographic characteristics. The final sample included 604 residents (mean age = 86.8 ± 7.8 years; 31.8% male). Of the three psychosocial factors, only social engagement was associated with energy intake. Low social engagement was associated with cognitive and functional challenges, malnutrition risk, more task-focused mealtime actions by staff, and lower energy intake. Simple regression analysis revealed that individuals with low social engagement ate 59.6 kcal less per day (95% CI = −111.2, −8.0). This significant association remained when adjusting for loss of appetite, but was no longer significant when adjusting for eating challenges. Low social engagement occurs concurrently with physical and functional challenges among LTC residents, affecting both the nutritional and social aspects of mealtimes. Emphasis on socializing during mealtimes, especially for those with eating challenges (e.g., requiring assistance), may contribute to improved resident appetite and quality of life.

'A blender without the lid on': Mealtime experiences of caregivers with a child with autism spectrum disorder in South Africa.

BackgroundEvidence suggests that caregivers of children with autism spectrum disorder (ASD) and associated feeding difficulties have specific mealtime challenges in the home environment because of the limited interventions that are appropriate and responsive to the needs of the child as well as the family.ObjectivesTo describe: (1) common feeding difficulties in children with ASD, (2) mealtime challenges for the caregiver and (3) mealtime strategies used by the caregiver.MethodForty caregivers were purposively sampled to participate in the study. Participants were recruited through ASD-specific schools in Johannesburg, South Africa. Participants completed an online questionnaire focusing on their mealtime experiences with their child with ASD.ResultsFindings from the data after thematic analysis indicated the multitude of challenges caregivers have when feeding their child with ASD as well as their individualised way of dealing with these difficulties.ConclusionThe findings emphasised the importance of incorporating the family’s beliefs, values and needs into feeding management and highlight the importance of a holistic approach to intervention. The study also provided information about mealtime strategies that are being used in the home environment to support the child as well as the caregiver. This information can be used to inform management to improve therapeutic outcomes and feeding challenges in the home environment.

"If They Don't Like You, They Are Not Going to Eat for You": Individual and Interpersonal Factors Affecting Certified Nursing Assistants' Ability to Provide Mealtime Assistance to Residents With Dementia.

In long-term care facilities in the United States, certified nursing assistants (CNAs) provide mealtime assistance to residents with dementia, a task that substantially increases caregiver burden due to the time and attention required. The aim of this qualitative study was to explore the individual and interpersonal barriers and facilitators CNAs experience when providing mealtime assistance to residents with dementia. Focus group questions were developed based on the corresponding levels of the Social Ecological Model. Using purposive sampling, 9 focus groups were conducted with 53 CNAs who had at least 1 year of experience as a CNA working with older adults. Focus groups were audio-recorded and transcribed verbatim. Data were analyzed using the directed content analysis approach. CNAs reported individual skills, training, and personal characteristics that affected their ability to provide mealtime assistance. At the interpersonal level, CNAs identified their relationships with residents, residents' family members, and other health care professionals as factors that affect their ability to provide mealtime assistance. These findings provide evidence for strategies that administrators can utilize to reduce caregiver burden by improving the mealtime experience. First, CNAs need adequate training, particularly to develop communication skills. Developing verbal communication skills may improve interpersonal relationships between CNAs and residents' family members and other coworkers. Developing nonverbal communication skills may foster an improved relationship between CNAs and their residents with dementia. Future research should evaluate interventions that seek to improve these skills to determine their impact on the mealtime experience.

Family mealtime against adolescents’ drinking, drug use, and other risk behaviours. Then and now.

During adolescence, the frequency of family meals may play an important role in both counteracting risk behaviours (e.g., drugs and alcohol use, delinquency, etc.) and in promoting healthy life-styles. Objective. The aim of the present review is to chronologically order and discuss evidence supporting or disconfirming family mealtime’s effectiveness against adolescents‘ risk behaviours. Method. The present work integrated two search-strategies: scientific databanks strategies and retrospective research on sources. Inter-rater quality assessment was applied to obtain three clusters of literature; pioneering studies about nutritional habits, last decades’ evidence, and challenges for future research. Results. Effectiveness of family mealtime in preventing adolescents’ risk behaviours and in promoting healthy lifestyles and positive outcomes is discussed. Conclusions. Open theoretical and methodological questions emerged such as the lack of scientific consensus on how to measure the family mealtime frequency or the need to provide qualitative assessments about the family mealtime experience, among others.

Consistency of Family Rules and Routines as a Predictor of Food Neophobia in a Diverse Sample of Young Children

Abstract Date Presented 03/26/20 This preliminary data analysis identifies a parent-empowerment strategy that may be important for encouraging children to try new foods. Parents who reported having clear rules and routines for their family demonstrated approximately nine times greater odds that their child would willingly try new foods. Educating parents to emphasize clear rules and routines, specifically during mealtimes, may create a predictable mealtime experience and allow children to feel comfortable exploring novel foods. Primary Author and Speaker: Victoria Merritt Additional Authors and Speakers: Angela Caldwell

Dishing on dinner: a life course approach to understanding the family meal context among families with preschoolers.

Family meals promote healthful dietary intake and well-being among children. Despite these benefits, family meal participation typically declines as children age. This study utilises life course theory to explore parents' perceptions of family meals in order to understand how parents' past experiences with family meals (in childhood and earlier in adulthood) influence their current beliefs and practices regarding mealtimes with their own children. Semi-structured qualitative interviews. In-person interviews were conducted in participants' homes. Twenty families (twenty-one mothers and fifteen fathers) with a child aged between 18 months and 5 years. Thematic analysis revealed that families seemed to primarily approach mealtimes from one of three overarching orientations: meals for (1) Togetherness, (2) Nutrition Messaging or (3) Necessity. These orientations were informed by parents' own mealtime experiences and significant life transitions (e.g. parenthood). The current family meal context, including the messages parents shared with their children during mealtimes and the challenges experienced with mealtimes, characterised the orientations and families' approaches to mealtimes. Parents' own early life experiences and significant life transitions influence why families eat meals together and have important implications for the intergenerational transmission of mealtime practices. Results may help to inform the content and timing of intervention strategies to support the continuation of frequent family meals beyond the preschool years.

‘This is your golden time. You enjoy it and you’ve plenty time for crying after’: How dysphagia impacts family caregivers of people with amyotrophic lateral sclerosis – A qualitative study

Background: Dysphagia (swallowing impairments) is a well-recognised symptom of amyotrophic lateral sclerosis. Caring for a person with amyotrophic lateral sclerosis has been recognised as a complex and demanding task. No study to date investigated the impact of dysphagia on the lives of caregivers of people with amyotrophic lateral sclerosis. Aim: To investigate the experiences of dysphagia from the perspective of family caregivers of people diagnosed with amyotrophic lateral sclerosis. Design: Interpretative phenomenological analysis was employed. Individual interviews (n = 15) plus observations of mealtime preparation were conducted, where possible (seven or n). Setting/participants: Participants comprised family caregivers of people with amyotrophic lateral sclerosis and dysphagia living in the South West of Ireland (n = 10). Findings: Dysphagia transformed the mealtime experiences of the caregivers and changed their approaches to food. Frustration related to the inability to stabilise the weight of the person with amyotrophic lateral sclerosis and the fear of choking emerged strongly. The caregivers strived to ensure the safety of people with amyotrophic lateral sclerosis during meals by providing constant supervision. Despite the challenges precipitated by dysphagia and amyotrophic lateral sclerosis, the caregivers wished to maintain normality for as long as they perceived it to be possible. Conclusion: This study provides a unique contribution in advancing our understanding of the impact of dysphagia on the caregivers of people with amyotrophic lateral sclerosis. Professionals must explore and recognise the needs of the caregivers and provide them with appropriate support, especially how to manage choking.

MAMAS: Supporting Parent--Child Mealtime Interactions Using Automated Tracking and Speech Recognition

Many parents of young children find it challenging to deal with their children's eating problems, and parent--child mealtime interaction is fundamental in forming children's healthy eating habits. In this paper, we present the results of a three-week study through which we deployed a mealtime assistant application, MAMAS, for monitoring parent--child mealtime conversation and food intake with 15 parent--child pairs. Our findings indicate that the use of MAMAS helped 1) increase children's autonomy during mealtime, 2) enhance parents' self-awareness of their words and behaviors, 3) promote the parent--child relationship, and 4) positively influence the mealtime experiences of the entire family. The study also revealed some challenges in eating behavior interventions due to the complex dynamics of childhood eating problems. Based on the findings, we discuss how a mealtime assistant application can be better designed for parents and children with challenging eating behaviors.

Older patients' perspectives on mealtimes in hospitals: a scoping review of qualitative studies.

The increasing age of populations throughout the world means that healthcare services are faced with new challenges, not least regarding the provision of food during hospital stay. There is a lack of knowledge of how hospital mealtimes are experienced by older patients, and so the aim of this article was to review current knowledge regarding mealtimes in hospitals from the perspectives of older patients. A literature search was performed using seven databases: PubMed, Web of Science, Scopus, Sociological Abstracts, SweMed+, ASSIA and CINAHL with no limits regarding publication date. The inclusion criteria were peer-reviewed articles in English or Swedish that used qualitative methods to examine older patients' (>65years) mealtime experiences. The Five Aspect Meal Model (FAMM) served as a framework for understanding the complexity behind a mealtime experience. Qualitative content analysis was used as a guide when analysing the material. The search produced 415 studies, 14 of which were included in the review. The findings generated three main themes for understanding how older patients experience mealtimes while in hospital: (1) the food and the food service, (2) mealtime assistance and commensality during mealtimes and (3) the importance of retaining one's independence. The review also clearly indicated a shortage of studies that solely focus on older patients' experiences of their mealtime. More research is therefore needed to be fully able to understand the complex task of providing meals in hospitals.

Stakeholder Engagement in Practice Change: Enabling Person-Centred Mealtime Experiences in Residential Care Homes.

Person-centred care is recognized as best practice in dementia care. The purpose of this study was to evaluate the effectiveness of a stakeholder engagement practice change initiative aimed at increasing the provision of person-centred mealtimes in a residential care home (RCH). A single-group, time series design was used to assess the impact of the practice change initiative on mealtime environment across four time periods (pre-intervention, 1-month, 3-month, and 6-month follow-up). Statistically significant improvements were noted in all mealtime environment scales by 6 months, including the physical environment (z = -3.06, p = 0.013), social environment (z = -3.69, p = 0.001), relationship and person-centred scale (z = -3.51, p = 0.003), and overall environment scale (z = -3.60, p = 0.002). This practice change initiative, which focused on enhancing stakeholder engagement, provided a feasible method for increasing the practice of person-centred care during mealtimes in an RCH through the application of supportive leadership, collaborative decision making, and staff engagement.

Reliability Testing of the Team Member Mealtime Experience Questionnaire.

Team members influence the mealtime experience of residents. Their perspectives on their ability to provide resident- and relationship-centred care during mealtimes is limited. The aim of this study was to describe the development and determine the factor structure and internal and test-retest reliability of the Team member Mealtime Experience Questionnaire (TMEQ). A 23-item questionnaire was developed through several steps. A Likert scale of strongly disagree (score= 1) to strongly agree (score= 5) was used. A total of 137 team members from five diverse homes participated. Time and task-focused items had lower scores (indicating more negative perceptions), whereas knowledge and capability of how to provide resident- and relationship-centred mealtime care had higher scores. Exploratory factor analysis identified three factors; four items were eliminated based on this analysis. Test-retest reliability was completed with 103 participants. Intraclass correlation (ICC) for the total score and three subscales ranged from 0.72 -0.85 while Chronbach's alpha ranged from 0.81-0.92. The 19-item TMEQ is considered reliable for use in research and practice.

Disturbance at the dinner table: Exploring mothers' experiences of mealtimes when caring for their son or daughter with anorexia nervosa.

This study examined mothers’ (n = 9) mealtime experiences when caring for their son or daughter with anorexia nervosa through semi-structured interviews. Interpretative Phenomenological Analysis identified three themes: (1) managing mealtime combat through accommodation and acceptance; (2) feeling isolated, inauthentic and ill-equipped and (3) a need for understanding and to be understood. The overarching concepts of ‘combat’ and ‘distortion’ also underpin the analysis, uniquely outlining how mothers come to understand this daily situation. Mealtime-related interventions need to be developed which prioritise promoting skills and confidence in managing mealtimes and helping carers to address the emotional challenges of these occasions.

INDIVIDUAL AND INTERPERSONAL INFLUENCERS OF MEALTIME EXPERIENCES: PERSPECTIVES OF NURSING ASSISTANTS

In the United States, long-term care Certified Nursing Assistants (CNAs)’s central role is to provide direct care to residents, including mealtime assistance. It has been reported that employee turnover among CNAs is nearly 75% annually. High turnover rates of CNAs can increase the workload for remaining CNAs, interrupt quality of care for residents, and require extra resources for recruiting new staff. The aim of this qualitative study was to explore the individual and interpersonal barriers and facilitators CNAs experience when providing mealtime assistance to residents with dementia. Using purposive sampling, nine focus groups were conducted with a total of 53 CNAs who had at least one year of experience as a CNA working with older adults. Focus group questions were developed using the Social Ecological Model. All focus groups were audio recorded and transcribed verbatim. Data were analyzed using the directed content analysis approach. At the individual level, CNAs identified that communication skills with residents and coworkers, and the ability to accurately interpret resident behavior positively affected their ability to provide mealtime assistance. At the interpersonal level, interdisciplinary collaboration was identified as a significant facilitator. Reported barriers included negative interference from residents’ family members, unpredictable resident behaviors, and lack of support from coworkers. CNAs reported individual and interpersonal factors that may influence their ability to effectively feed residents with dementia. Our findings will inform future investigations regarding job turnover. Equally important, providing CNAs with the training and opportunity to perform their duties efficiently can ultimately benefit the residents’ mealtime experiences.