Dietetics and Food Services, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia.
Centre for Health Services Research, the University of Queensland, Brisbane, Queensland, Australia.
J Clin Nurs. 2024 May;33(5):1906-1920. doi: 10.1111/jocn.17009. Epub 2024 Jan 29.
To gather and understand the experience of hospital mealtimes from the perspectives of those receiving and delivering mealtime care (older inpatients, caregivers and staff) using photovoice methods to identify touchpoints and themes to inform the co-design of new mealtime interventions.
This study was undertaken on acute care wards within a single metropolitan hospital in Brisbane, Australia in 2019. Photovoice methods involved a researcher accompanying 21 participants (10 older patients, 5 caregivers, 4 nurses and 2 food service officers) during a mealtime and documenting meaningful elements using photographs and field notes. Photo-elicitation interviews were then undertaken with participants to gain insight into their experience. Data were analysed using inductive thematic analysis, involving a multidisciplinary research team including a consumer.
Themes were identified across the three touchpoints: (1) preparing for the meal (the juggle, the anticipation), (2) delivering/receiving the meal (the rush, the clutter and the wait) and (3) experiencing the meal (the ideal, pulled away and acceptance). Despite a shared understanding of the importance of meals and shared vision of 'the ideal' mealtime, generally this was a time of tension, missed cares and dissatisfaction for staff, patients and caregivers. There was stark contrast in some aspects of mealtime experience, with simultaneous experiences of 'the rush' (staff) and 'the wait' (patients and caregivers). There was an overwhelming sense of acceptance and lack of control over change from all.
This study identified themes during hospital mealtimes which have largely gone unaddressed in the design of mealtime interventions to date. This research may provide a framework to inform the future co-design of mealtime interventions involving patients, caregivers and multidisciplinary staff, centred around these key touchpoints.
Mealtimes are experienced differently by patients, caregivers, nurses and food service officers across three key touchpoints: preparing for, delivering/receiving and experiencing the meal. Improving mealtime experiences therefore necessitates a collaborative approach, with co-designed mealtime improvement programs that include specific interventions focusing each touchpoint. Our data suggest that improvements could focus on reducing clutter, clarifying mealtime roles and workflows and supporting caregiver involvement.
What problem did the study address? Mealtimes are the central mechanism to meet patients' nutritional needs in hospital; however, research consistently shows that many patients do not eat enough to meet their nutritional requirements and that they often do not receive the mealtime assistance they require. Interventions to improve hospital mealtimes have, at best, shown only modest improvements in nutritional intake and mealtime care practices. Gaining deeper insight into the mealtime experience from multiple perspectives may identify new opportunities for improvement. What were the main findings? Patients, caregivers and staff have shared ideals of comfort, autonomy and conviviality at mealtimes, but challenges of complex teamwork and re-prioritisation of mealtimes in the face of prevailing power hierarchies make it difficult to achieve this ideal. There are three discrete touchpoints (preparing for, delivering/receiving and experiencing the meal) that require different approaches to improvement. Our data suggests a need to focus improvement on reducing clutter, clarifying mealtime roles and workflows and supporting caregivers. Where and on whom will the research have an impact? The research provides a framework for multidisciplinary teams to begin co-designing improvements to mealtime care to benefit patients, caregivers and staff, while also providing a method for researchers to understand other complex care situations in hospital.
This manuscript is written in adherence with the Standards for Reporting Qualitative Research.
Patients and caregivers were involved in the conception and design of the study through their membership of the hospital mealtime reference group. A consumer researcher (GP) was involved in the team to advise on study conduct (i.e. recruitment methods and information), data analysis (i.e. coding transcripts), data interpretation (i.e. review and refinement of themes) and manuscript writing (i.e. review and approval of final manuscript).
使用摄影作品的方法，从接受和提供就餐护理的人员（住院老年患者、照护者和工作人员）的角度收集和了解就餐体验，以确定接触点和主题，为新的就餐干预措施的共同设计提供信息。
本研究于 2019 年在澳大利亚布里斯班的一家综合医院的急性护理病房进行。摄影作品方法涉及研究人员在就餐期间陪同 21 名参与者（10 名老年患者、5 名照护者、4 名护士和 2 名餐饮服务人员），并使用照片和现场记录记录有意义的元素。然后对参与者进行照片启发式访谈，以深入了解他们的体验。使用多学科研究团队（包括消费者）进行归纳主题分析，对数据进行分析。
在三个接触点中确定了主题：（1）准备用餐（忙碌、期待），（2）提供/接收用餐（匆忙、混乱和等待），（3）用餐体验（理想、被打断和接受）。尽管对用餐的重要性和“理想”用餐时间有共同的理解，以及对“理想”用餐时间的共同愿景，但通常情况下，这是工作人员、患者和照护者紧张、护理失误和不满的时候。在一些用餐体验方面存在明显的对比，同时存在“匆忙”（工作人员）和“等待”（患者和照护者）的情况。所有人都感到无法接受，对改变缺乏控制。
本研究确定了迄今为止在设计就餐干预措施时尚未解决的就餐时间主题。这项研究可能为未来患者、照护者和多学科工作人员共同设计就餐干预措施提供框架，以这些关键接触点为中心。
患者、照护者、护士和餐饮服务人员在准备、提供/接收和体验用餐三个关键接触点有不同的就餐体验。因此，改善就餐体验需要采取协作的方法，共同设计改善就餐的方案，包括每个接触点的具体干预措施。我们的数据表明，改进可以集中在减少混乱、明确就餐时间的角色和工作流程以及支持照护者的参与。
该研究解决了什么问题？就餐时间是医院满足患者营养需求的核心机制；然而，研究一致表明，许多患者没有摄入足够的营养，而且他们通常没有得到所需的就餐帮助。改善医院就餐时间的干预措施最多只能在营养摄入和就餐护理实践方面取得适度的改善。从多个角度深入了解就餐体验可能会为改善提供新的机会。主要发现是什么？患者、照护者和工作人员对就餐时间的舒适度、自主性和融洽性有共同的理想，但在复杂的团队合作和重新优先考虑就餐时间以应对普遍的权力等级制度方面存在挑战，这使得难以实现这一理想。有三个离散的接触点（准备、提供/接收和体验用餐）需要不同的改进方法。我们的数据表明，需要集中精力减少混乱，明确就餐时间的角色和工作流程，并支持照护者。这项研究将对哪些人和哪些地方产生影响？该研究为多学科团队提供了一个框架，开始共同设计改善就餐护理，以造福患者、照护者和工作人员，同时为研究人员提供了一种方法，了解医院中其他复杂的护理情况。
本文按照定性研究报告标准撰写。
患者和照护者通过他们在医院就餐时间参考小组中的成员身份，参与了研究的构思和设计。一名消费者研究人员（全科医生）参与了团队，就研究的开展（即招募方法和信息）、数据分析（即转录编码）、数据解释（即主题的审查和完善）和手稿撰写（即审查和批准最终手稿）提供建议。
