Department of Nutrition, Dietetics and Food, Monash University, Notting Hill, VIC, Australia.
Dietetics Department, Eastern Health, Box Hill, VIC, Australia.
J Hum Nutr Diet. 2020 Aug;33(4):574-583. doi: 10.1111/jhn.12734. Epub 2020 Jan 27.
Change promotes quality in healthcare, yet adopting change can be challenging. Understanding how change in nutrition care is adopted may support better design and implementation of interventions that aim to address inadequate food intake in hospital. The present study followed the process of change in a healthcare organisation, exploring staff attitudes, beliefs and experiences of the implementation of a mealtime intervention.
In total, 103 h of fieldwork were conducted in this longitudinal ethnographic study over a 4-month period. Over 170 staff participated, with data captured using observation, interviews and focus groups. Data were analysed using an inductive, thematic approach, informed by implementation theory.
Attitudes and experiences of change in nutrition care are described by three themes: (i) staff recognised the inevitability of change; (ii) staff cooperated with the intervention, recognising potential value in the intervention to support patient care, where increased awareness of their mealtime behaviours supported adopting practice changes; and (iii) some staff were able to reflect on their practice after implementing the intervention, whereas others could not. A model illustrating the interconnectedness of factors influencing implementation emerged from the research, guiding future nutrition care intervention design and supporting change.
The requirement to address the underlying perceptions of staff about the need to change should not be underestimated. Increased efforts to market the change message to specific staff groups and physical behavioural reinforcement strategies are needed. Nutrition care in the future should focus on helping staff feel positive about making practice changes.
变革能促进医疗保健质量的提升，但变革的实施可能颇具挑战。了解营养护理的变革是如何实施的，可能有助于更好地设计和实施旨在解决医院摄入不足问题的干预措施。本研究按照医疗组织变革的过程，探索了工作人员对实施膳食干预的态度、信念和经验。
在这项为期 4 个月的纵向人种学研究中，共进行了 103 小时的实地工作。170 多名工作人员参与其中，使用观察、访谈和焦点小组收集数据。数据采用实施理论指导的归纳主题分析法进行分析。
通过三个主题描述了营养护理变革的态度和经验：（i）工作人员认识到变革的必然性；（ii）工作人员配合干预措施，认识到干预措施支持患者护理的潜在价值，因为对他们的用餐行为的认识提高有助于采取实践变革；（iii）一些工作人员在实施干预措施后能够反思自己的实践，而另一些工作人员则不能。研究中出现了一个模型，说明了影响实施的因素的相互关联性，为未来的营养护理干预措施设计和变革提供了指导。
不应低估满足工作人员对变革需求的基本看法的必要性。需要更加努力地向特定工作人员群体宣传变革信息，并采取物理行为强化策略。未来的营养护理应重点帮助工作人员对实施实践变革感到积极。
