Mealtime verbal interactions among nursing home staff and residents with dementia: A secondary behavioural analysis of videotaped observations.
Wen Liu, Kristine Williams, Melissa Batchelor and 2 others
PMID 33222218WHAT IT FOUND
Staff spoke three times more often than residents with dementia during nursing home mealtimes, mostly positively.
Resident refusals were more common than staff negativity, and staff negative comments tended to co-occur with resident negative utterances.
Key findings
01Staff spoke three times more frequently (76.5%) than residents (23.5%), and 99.2% of staff utterances were positive.
02Residents' utterances were 85.1% positive and 14.9% negative, and 61.2% of their negative utterances were verbal refusal.
03Resident negative utterances were observed in 61.5% of videos with staff negative utterances and 27.8% of videos without staff negative utterances.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
The sample was small and narrow: 110 videos from 29 staff and 25 residents, all residents were White, had moderately severe to severe dementia, and had staff-reported resistiveness to care. Videos captured part of the meal rather than the whole meal and only one-on-one interactions, so they may miss mealtime patterns outside the clips. Staff negative utterances were very rare, and the analyses did not adjust for clustering of videos within staff, residents, or dyads, which limits confidence in associations. The coding scheme was based partly on routine care rather than mealtime-specific verbal behaviours, and negative behaviours such as controlling voice depend on coder judgement. Because participants knew they were being videotaped, they may have behaved more positively than usual.
The easy way to misread this
Do not conclude that positive staff speech improves intake or that female residents inherently refuse care. The study observed associations in 110 videos from 25 residents, did not test an intervention, and could not separate staff behaviour from resident characteristics.