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A systematic review of the use of volunteers to improve mealtime care of adult patients or residents in institutional settings
Abstract and Figures
The objective of this review was to locate and assess the evidence obtained from articles reporting empirical research that volunteers improve mealtime care of adults in institutional settings.
Malnutrition in adult patients or residents in institutional care settings is common. Poor standards of mealtime care have been suggested to contribute to the development of malnutrition.
A systematic review of the literature was undertaken.
Key words were identified and used separately and in combination to search the electronic databases MEDLINE, CINHAL, BNI and EMBASE and the internet for relevant articles. Searches were undertaken in August 2008, April 2009 and July 1010.
Ten studies fulfilled the criteria for inclusion. The methodologies of five of the 10 studies were unclear due to the brevity of the reports. The validity of the design of the other five studies varied. Generally the results suggested the use of volunteers in mealtime care increased satisfaction of patients, relatives, volunteers and staff concerning meal-time assistance (assessed using methods such as questionnaires and focus groups) and three studies found increased nutritional intake in groups assisted by volunteers. However, few well designed and reported studies were identified.
There is some evidence that volunteers can improve mealtime care of adult patients or residents in institutional settings, however few well designed studies are reported. Relevance to clinical practice. This review demonstrates that there is limited evidence that the use of volunteers improves mealtime care of adult patients or relatives in institutional settings.
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... 53,54 Moreover, additional feeding assistance to patients could help to reduce the plate waste resulting from malnutrition ( Figure 2). 54,55 Initially, a pilot clinical study in a community hospital evaluated whether feeding assistance could affect dietary intake for elderly patients. 53 This study conducted in a convenience sample of nine elderly inpatients (3 males and 6 females) from an aged care ward. ...
... 54 In a systematic review which including 10 studies of the literature to locate and assess whether volunteers could improve the nutritional intake of patients or residents in institutional care settings has been performed. 55 The publication date of reviewing articles ranged from 1990 to 2009, suggesting that may not be a new concept to use volunteers to facilitate patient mealtime care. This review revealed some evidence that volunteers could improve the care of adult patients or inpatients during meals to avoid malnutrition by parallelly increasing FW. ...
... However, the evidence to support the stated benefits was generally limited and needed further research to evaluate the effectiveness of using volunteers in daily clinical practice. 55 In a survey of 99 nursing assistants and 44 nurses from five nursing homes, 73% of nursing assistants and 93% of nurses agreed that when the nursing home was short-staffed, residents did not get enough assistance to eat, and this situation linked to increased mortality among residents. 56 Experienced nursing assistants did not see the nurse as an active participant during meals. ...
Hospitals have a responsibility to link human health and the environment, but food waste in hospitals has traditionally been much higher than in other areas of food supply. The cause of this situation has many negative impacts on health, economy, society, and environment. As a result, food waste has become a topic of discussion in hospital food departments. Part of this problem is plate waste, the served food that remains uneaten by patients. Given the magnitude of the food problem, this systematic review is aimed to identify the most common measures used to reduce plate waste in hospitals. PubMed, Scopus, and Google Scholar databases were comprehensively searched to identify food waste studies worldwide using related search terms. Many approaches have been recommended to increase patient food intake and minimise plate waste in hospitals. Up to date, the four most common include flexible portion sizes, increased food choices through selective menus, additional nutritional support and a better ordering and delivery system. Among them, the most used and effective are flexible portion sizes which may increase the ability of patients choosing their menus and upgrade ordering and delivery system by electronic format. In most studies, plate waste covers the most significant percentage of food waste produced in hospitals, while more than one approach is recommended to minimise it. In this aspect, further well-design, multicenter, clinical studies are strongly required to highlight and establish novel and effective approaches for improving food waste management in hospitals by reducing plate waste.
... Hospital volunteers have been shown to help in meeting patients' nutritional needs by assisting patients at mealtimes (Green et al, 2011;Tassone et al, 2015;Howson et al, 2017). Studies have shown volunteers to be helpful in providing dietary intake for patients; some in relation to protein and energy intake (Walton et al, 2008, Wong et al, 2008Wright et al, 2008;Manning et al, 2012;Roberts et al, 2014;Huang et al, 2015) and others in relation to amount of food consumed (Robinson et al, 2002;Gilbert et al, 2013). ...
... Moreover, patients were primarily comforted by nurses or healthcare assistants and doctors as opposed to hospital volunteers. In common with existing research, which is mainly based in inpatient wards, this study found that volunteers provide a valuable contribution in meeting the nutritional needs of patients (Green et al, 2011;Tassone et al, 2015;Howson et al, 2017). The role of the volunteers in existing studies was primarily as 'meal-time assistants', supporting patients with their nutritional intake by helping cut up food or feed patients. ...
Background
Fundamental aspects of patient experience have been reported as substandard in emergency departments. Hospital volunteers can improve the patient experience in inpatient settings. However, evidence is limited on their impact in emergency departments.
Aims
To determine whether emergency department volunteers could enhance patient experience through assisting with the psychological aspect of patient care and patients' nutritional needs.
Methods
Patients attending an emergency department responded to a questionnaire as part of a cross-sectional study. Comparisons were made between when the volunteer scheme was running and when there were no volunteers. Outcomes included patient experience of emotional support from staff and access to food and drink.
Results
Patients present when the volunteer scheme was running reported obtaining food and drink more often (96/124 vs 20/39, % rate difference 26, 95% CI 10–42, P=0.002) and that a member of staff offered them something to eat and drink more frequently (96/146 vs 19/52, % rate difference 29, 95% CI 14–45, P<0.001). There was no difference between patient responses when the volunteer scheme was running and not for emotional support from staff (49/68 vs 14/21, % rate difference 5, 95% CI-17-28, P=0.63).
Conclusions
Hospital volunteers made a substantial contribution to providing food and drink to patients in the emergency department. Emotional support from volunteers was limited.
... Some reports cautiously interpret the improvement in nutritional status as a result of implementing a nutrition plan, suggesting that a beneficial effect on nutritional status can be demonstrated at a follow-up time of at least 3 months. There are still factors, such as inflammation, pain, acute illness, and depression, that may interfere with the results regarding the demonstration of a difference in nutritional status caused by nutritional interventions (Abbott et al., 2013;Green et al., 2011). It is expected that it takes a few weeks for weight gain, followed by an increase in BMI (Schultz et al., 2014). ...
Malnutrition is a significant issue among elderly individuals in 24-hour care facilities, leading to increased morbidity. The aim of the study was to compare the nutritional status before and after nutritional intervention based on selected indicators of nutritional status among residents of a 24-hour care institution. The study included a group of 104 people aged 65 to 97 years. Nutritional status was assessed before and after the nutritional intervention based on indicators: levels of prealbumin, albumin, transferrin, total lymphocyte count, BMI, and MNA scale. The nutritional intervention consisted of administering oral nutritional supplements (ONS) to patients, regardless of nutritional status. The method of retrospective analysis of patients' medical records was used. Statistical analysis was performed using IBM SPSS Statistics 24 for Windows. Improvements in nutritional status occurred among patients with malnutrition based on MNA and prealbumin indices, and in groups of patients with moderate or mild malnutrition as determined by transferrin, prealbumin and albumin. The mean levels of nutritional indices significantly increased: MNA ( p = .001), BMI ( p = .001), prealbumin ( p = .001), and albumin ( p < .001). The use of ONS resulted in better nutritional status parameters based on MNA, albumin and prealbumin. These indices may be predictors of reducing the risk of various disorders among the elderly.
... Furthermore, another study demonstrated that mealtime volunteers can improve mealtime treatment for adult patients or residents in institutional settings [67]. However, little well-designed research is available on mealtime volunteers or feeding assistance. ...
This review aims to identify hospital food service strategies to improve food consumption among hospitalized patients. A systematic search that met the inclusion and exclusion criteria was manually conducted through Web of Science and Scopus by an author, and the ambiguities were clarified by two senior authors. The quality assessment was separately conducted by two authors, and the ambiguities were clarified with all the involved authors. Qualitative synthesis was used to analyze and summarized the findings. A total of 2432 articles were identified by searching the databases, and 36 studies were included. The majority of the studies applied menu modifications and meal composition interventions (n = 12, 33.3%), or included the implementation of the new food service system (n = 8, 22.2%), protected mealtimes, mealtime assistance and environmental intervention (n = 7, 19.4%), and attractive meal presentation (n = 3, 8.3%). Previous studies that used multidisciplinary approaches reported a significant improvement in food intake, nutritional status, patient satisfaction and quality of life (n = 6, 16.7%). In conclusion, it is suggested that healthcare institutions consider applying one or more of the listed intervention strategies to enhance their foodservice operation in the future.
Background
The intensive care unit (ICU) is an emotionally taxing environment. Patients and family members are at an increased risk of long-term physical and psychological consequences of critical illness, known collectively as post-intensive care syndrome (PICS). These environmental strains can lead to a high incidence of staff turnover and burnout.
Aim
The ICU Bridge Program (ICUBP) is a student-led organization that attempts to mitigate these stressors on patients, family, and staff, by assigning university volunteers to ICUs across Montreal.
Setting
ICU.
Participants
ICU volunteers, staff, patients, and families.
Program description
The ICUBP volunteers support staff by orienting patients and families, while using effective communication strategies to provide comfort and promote a calm environment. The presence of volunteer visitors is helpful to patients who do not have the support of family members and/or friends. The program provides students with profound learning experiences by allowing them to shadow multidisciplinary teams, gaining a privileged and varied exposure to an acute medical environment, while developing their communications skills.
Program evaluation
The program reassesses its methods and impact via internal student-designed surveys distributed on a yearly basis to staff and volunteers.
Discussion
Research is warranted to assess the impact of the program on ICU patients, visitors, staff, and volunteers.
Podłużne badanie jakościowe doświadczenia wolontariuszy opiekujących się pacjentami oddziału geriatrycznego szpitala chorób wewnętrznych zostało przeprowadzone w ramach Projektu Zdrowy Kontakt. Jest to pierwszy w Polsce i Europie Środkowo-Wschodniej program niefarmakologicznego zapobiegania majaczeniu szpitalnemu, które jest częstym powikłaniem hospitalizacji osób starszych. Wolontariuszami programu są studenci psychologii, pielęgniarstwa i medycyny, którzy odwiedzają chorych w szpitalu i realizują złożoną interwencję profilaktyczną. Badanie przeprowadzono, korzystając z podejścia idiograficznego, w formie cyklu interpretatywnych studiów przypadku. Z ośmiorgiem uczestników badania przeprowadzono po dwa częściowo ustrukturyzowane wywiady – przed rozpoczęciem wolontariatu i po jego zakończeniu. Celem powtórzonych rozmów było opisanie zmian, jakie mogły zajść w doświadczeniu, motywacji, przekonaniach i rozumieniu siebie przez studentów pod wpływem udziału w wolontariacie na oddziale geriatrycznym. W badaniu skorzystano z metody interpretatywnej analizy fenomenologicznej, analizę danych jakościowych przeprowadzono z pomocą oprogramowania Atlas.ti. W wyniku badania uzyskano złożone opisy indywidualnego doświadczenia badanych związanego z ich pracą na oddziale. Ujawniły się również motywy wspólne dla większości z nich. Do najpoważniejszych należy zetknięcie się z myślą o śmierci i próby nawiązania relacji z pacjentami, z którymi kontakt jest utrudniony z powodu zmian otępiennych, skutków udaru lub zaburzeń poznawczych i percepcyjnych występujących w majaczeniu szpitalnym. Związana z kontekstem geriatrycznym i wynikająca z profilaktycznego oraz behawioralnego charakteru interwencji trudność w dostrzeżeniu przez wolontariuszy efektów swojej pracy okazała się w największym stopniu zniechęcać ich do odwiedzin na oddziale. Najważniejszym wyodrębnionym w badaniu tematem jest relacja sfery osobistej i profesjonalnej w opiece nad pacjentami. Uzyskany opis i próba zrozumienia doświadczenia studentów kierunków medycznych działających jako wolontariusze na oddziale geriatrycznym może posłużyć jako punkt wyjścia do refleksji nad perspektywą personelu medycznego i możliwymi formami wsparcia chroniącymi go przed nadmiernym obciążeniem, stresem i wypaleniem zawodowym. Może być także źródłem inspiracji dla kształcenia przyszłych kadr medycznych.
Background
Malnutrition is estimated to affect over three million people in the UK resulting in serious consequences on both the individuals’ health and healthcare system. While dietitians are uniquely qualified to provide nutritional interventions, they have one of the lowest workforce numbers in the NHS making it difficult to tackle the malnutrition burden alone. Thus, innovative ways of working are needed. Non-dietetic health care professionals are often involved in the identification, assessment and treatment of malnutrition and research has shown benefits of their involvement in identification and management of nutritional issues, however their role in delivering nutritional interventions has not yet been evaluated. The aim of this systematic review is to collate evidence on the potential roles and effectiveness of non-dietetic healthcare professionals in providing nutritional interventions and their impact on patient-centred outcomes in malnourished or at-risk individuals.
Methods
Three electronic databases were searched on 10th October 2019. Titles and abstracts were initially screened, followed by full texts, against inclusion criteria and included/excluded studies by two authors independently. Data were extracted and tabulated where possible and grouped according to type of intervention and outcomes. Risk of bias and quality of evidence was assessed using the GRADE approach. Data were combined in the form of a narrative synthesis.
Results
Eighteen eligible studies were included; five involved feeding assistance, 10 involved implementing individualised nutrition monitoring or care plans and three were multi-factorial interventions. Interventions took place in a range of settings including hospital and long term care facilities. Very low and low quality evidence suggests that non-dietetic HCP interventions may improve weight, percent of patients reaching estimated energy requirements, quality of life, falls and frailty rate and patient satisfaction. Very low quality evidence suggests that non-dietetic HCP interventions may not improve mid-arm circumference, energy or protein intake, activities of daily living, handgrip strength or length of hospital stay. Low quality evidence suggests that non-dietetic HCP interventions have no effect on mortality.
Conclusions
A lack of good quality evidence on the effectiveness of non-dietetic HCP delivered interventions on the management of malnutrition in adults makes it difficult to draw conclusions. However, this review has highlighted the types of interventions and potential roles of non-dietetic HCPs, providing a groundwork for further high-quality research such as feasibility studies in this area, for the effective management of malnutrition within clinical and community practice.
Context
Malnutrition in institutionalized patients is associated with adverse outcomes and increased costs. Nurses have a crucial role in the recognition and treatment of malnutrition and empowering patients in nutritional care.
Objective
This systematic review provides an overview of the effectiveness of nursing nutritional interventions to counteract malnutrition.
Data Sources
Data were obtained through a systematic search in MEDLINE/PubMed, Cochrane, CINAHL, EMBASE and ISI Web of Science databases from inception to February 15th 2018.
Data extraction
Studies were eligible for inclusion when published in English, Spanish or German. Primary outcome parameters were nutritional status and dietary intake.
Data analysis
The Evidence analysis checklist from the American Dietetic Association and GRADE were used to evaluate the methodological quality of the studies.
Results
Out of 8162 studies, fifteen studies were included in the study, representing nine hospitals and six long-term care facilities. Two main categories of nursing nutrition interventions were identified; the implementation of 1) a nursing nutrition plan focusing on nursing actions in nutritional care or 2) nursing assistance in feeding support, mostly during mealtimes. Studies were heterogeneous and of most of them of low quality. This hampered drawing conclusions on effectiveness of nursing nutrition interventions on malnutrition related outcomes in clinical care. Nevertheless, six out of 15 studies reported a slightly improved nutritional status and/or clinical outcomes as a result of the interventions.
Conclusion
This review identified two categories of nursing nutrition interventions to counteract malnutrition. Their effectiveness needs to be further evaluated in future studies.
Tweetable abstract: Systematic review of effective Nursing Nutrition Interventions in the management of malnutrition in hospital and nursing home care.
The objective of this systematic review is to assess whether old people should be actively involved in activities related to meals to support quality of life, nutritional status and functional abilities related to meals. Two electronic databases Cochrane Database of Systematic Reviews and the Database of Abstracts of Reviews of Effectiveness were searched, supported by PubMed citation, snowball searches. Eleven primary studies were included. The quality was low. No studies assessed the effect on health-related quality of life. Three types of interventions to support activities related to meals were identified: Meal-related activities to facilitate improved autonomy seemed to overall improve nutritional intake, physical and social function related to meals, plus mealtime coping. Interventions of encouragement and reinforcement by staff to facilitate independence in eating seemed to have beneficial effect on nutritional intake and physical function related to meals. Interventions using food preparation and cooking to support participation seemed to have beneficial effects on social function related to meals and mealtime coping. There is an urgent need for good quality, adequately powered studies in this area and among old people in all health care settings.
Aims:
This study is aimed at exploring experiences of, and practices related to, mealtime challenges in patients with COPD.
Background:
Nutritional status is a significant indicator of prognosis and outcome in patients with COPD. Preventing unintended weight loss and helping patients regain weight are important nursing tasks. Dietary supplements have been effective in treating underweight in cases of stable COPD. However, compliance with long-term interventions is quite low. Improving nutritional intake through knowledge of meal-related challenges is the key to making further progress in preventing unintended weight loss.
Design:
This study employed an ethnographic design using the go-along method.
Methods:
From September 2018 to June 2019, 34 hours of meal-related observations and informal conversations with purposefully selected patients (n=15) were completed at a Danish respiratory medicine ward and in patients' homes. We analysed the empirical data using a Ricoeur-inspired method. Reporting adheres to the COREQ Checklist.
Findings:
In this study, we identified the absence of professional responsibility as a main challenge. Mealtimes appeared to be relegated to a matter of nutrition, and common practices surrounding mealtimes were no longer observed. Patients became dependent individuals who had to settle for the food available. In addition, physiological challenges often resulted in patients re-evaluating the benefits of eating, concluding that it was not worth the effort and therefore not eating. Furthermore, patients were hesitant to communicate their needs, which left a number of non-verbalised challenges unattended.
Conclusions:
Overall, meal-related challenges pose a risk of unintended weight loss, and the health professionals' work with mealtimes lacks a coordinated, systematic approach. Further research is needed to develop or implement interventions that can accommodate mealtimes.
Systematic reviews and meta-analyses have become increasingly important in health care. Clinicians read them to keep up to date with their field [1],[2], and they are often used as a starting point for developing clinical practice guidelines. Granting agencies may require a systematic review to ensure there is justification for further research [3], and some health care journals are moving in this direction [4]. As with all research, the value of a systematic review depends on what was done, what was found, and the clarity of reporting. As with other publications, the reporting quality of systematic reviews varies, limiting readers' ability to assess the strengths and weaknesses of those reviews.
Several early studies evaluated the quality of review reports. In 1987, Mulrow examined 50 review articles published in four leading medical journals in 1985 and 1986 and found that none met all eight explicit scientific criteria, such as a quality assessment of included studies [5]. In 1987, Sacks and colleagues [6] evaluated the adequacy of reporting of 83 meta-analyses on 23 characteristics in six domains. Reporting was generally poor; between one and 14 characteristics were adequately reported (mean = 7.7; standard deviation = 2.7). A 1996 update of this study found little improvement [7].
In 1996, to address the suboptimal reporting of meta-analyses, an international group developed a guidance called the QUOROM Statement (QUality Of Reporting Of Meta-analyses), which focused on the reporting of meta-analyses of randomized controlled trials [8]. In this article, we summarize a revision of these guidelines, renamed PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses), which have been updated to address several conceptual and practical advances in the science of systematic reviews (Box 1).
Box 1: Conceptual Issues in the Evolution from QUOROM to PRISMA
Completing a Systematic Review Is an Iterative Process
The conduct of a systematic review depends heavily on the scope and quality of included studies: thus systematic reviewers may need to modify their original review protocol during its conduct. Any systematic review reporting guideline should recommend that such changes can be reported and explained without suggesting that they are inappropriate. The PRISMA Statement (Items 5, 11, 16, and 23) acknowledges this iterative process. Aside from Cochrane reviews, all of which should have a protocol, only about 10% of systematic reviewers report working from a protocol [22]. Without a protocol that is publicly accessible, it is difficult to judge between appropriate and inappropriate modifications.
Focus groups were conducted with staff in a geriatric care facility who provided mealtime assistance during a quarantine that prevented family members from entering the facility. The volunteers' accounts reflected 3 primary themes that influenced their experience as mealtime assistants. First, the role of volunteer-recipient relationships emerged as paramount in facilitating optimal mealtime care. Strong reinforcement was derived from small signs of gratitude and awareness in the residents' nonverbal behaviors. This fostered the volunteers' sense of fiduciary responsibility toward the resident, thereby facilitating a meaningful and successful mealtime experience. Second, it was clear that the experience of being a mealtime assistant evolved over time, with changes in volunteer attitude mediated directly by the relationships that developed between volunteers and recipients. Lastly, the data reflect a strong awareness among volunteers of the challenges faced by nursing staff on a daily basis with respect to meeting the mealtime needs of residents in long-term care institutions, and a concern that nursing staff have insufficient time to develop intimate relationships with residents at the mealtime. These data strongly suggest that volunteer-assisted mealtime programs that focus primarily on social relationships can enhance the mealtime experience for residents in long-term care institutions.
Scope: malnutrition among older people in care settings is common and associated with adverse outcomes. Poor standards of mealtime care are reported, with one in five patients not receiving help with eating when required. We assessed the evidence for volunteers improving mealtime care. Search Methods: the literature was searched in August 2008 using databases; MEDLINE®, CINHAL®, BNI and EMBASE. This identified 21 potentially relevant studies. Studies were selected if they described the use of volunteers to assist adults at mealtimes in institutions and the effect this had on outcomes including nutritional intake and satisfaction. Appraisal: seven studies fulfilled the criteria for inclusion. The methodology of 5 of the 7 studies was unclear due to the brevity of the report bringing into question the validity. Results: generally the review suggested the use of volunteers in mealtime care increased satisfaction of patients, relatives, volunteers, and staff concerning meal-time assistance (assessed using methods such as questionnaires and focus groups). One study found that the mean meal intake of 34 patients assisted to eat by a volunteer was increased by 26% in comparison to a matched group assisted by nursing staff. Conclusions: there is some evidence that volunteers can improve mealtime care of patients, however few well designed studies are reported. A detailed evaluation of the use of volunteers to improve the mealtime care in institutions, and any impact on patient health is required.
The effect of an individualized occupational therapy programme designed to improve independence in meal management and to enhance the physical and social mealtime environment was examined using a single subject multiple baseline design across four subjects A baseline phase was followed by an intervention phase in which occupational therapy assessment and treatment were introduced. Four subjects of 65 years or older who required verbal guidance and/or physical assistance during mealtimes were assigned to the study group. Mealtime behaviours were videotaped and analyzed by two independent raters. Throughout the project subjects' behaviour in the areas of social interaction, self-feeding responses, verbal prompting and physical assistance required, inappropriate mealtime responses weight change, and caloric intake were monitored using videotape recordings. Data for each subject on each mealtime behaviour were plotted on graphs and analyzed visually for changes in level, trend and variability. The results suggested that an individualized occupational therapy treatment programme promoted greater caloric intake, increased correct self-feeding responses, and decreased inappropriate mealtime behaviour, incorrect self-feeding responses, number of verbal prompts and physical assists, and appropriate weight change. While these results are encouraging, they should be applied cautiously in elderly people in similar situations due to a small sample population and a relatively short intervention period.
Nursing home residents nationwide are at nutritional risk as the result of physical, social and environmental factors. The Dining with Dignity program integrates long-term care residents, staff, community volunteers and occupational therapy students to improve residents nutritional intake. Volunteers are trained to provide one-on-one assistance during meals and to promote a positive dining experience as organized by the theory of Social Support. Resident satisfaction with meals and improved nutritional status are important outcomes as is volunteer commitment to the program.
Focus groups were conducted with staff in a geriatric care facility who provided mealtime assistance during a quarantine that prevented family members from entering the facility. The volunteers' accounts reflected 3 primary themes that influenced their experience as mealtime assistants. First, the role of volunteer-recipient relationships emerged as paramount in facilitating optimal mealtime care. Strong reinforcement was derived from small signs of gratitude and awareness in the residents' nonverbal behaviors. This fostered the volunteers' sense of fiduciary responsibility toward the resident, thereby facilitating a meaningful and successful mealtime experience. Second, it was clear that the experience of being a mealtime assistant evolved over time, with changes in volunteer attitude mediated directly by the relationships that developed between volunteers and recipients. Lastly, the data reflect a strong awareness among volunteers of the challenges faced by nursing staff on a daily basis with respect to meeting the mealtime needs of residents in long-term care institutions, and a concern that nursing staff have insufficient time to develop intimate relationships with residents at the mealtime. These data strongly suggest that volunteer-assisted mealtime programs that focus primarily on social relationships can enhance the mealtime experience for residents in long-term care institutions.