The effects of nutritional guideline implementation on nursing home staff performance: a controlled trial

Rationale Suboptimal nutritional practices in elderly care settings may be resolved by an efficient introduction of nutritional guidelines. Aims To compare two different implementation strategies, external facilitation ( EF ) and educational outreach visits ( EOV s), when introducing nutritional guidelines in nursing homes ( NH s), and study the impact on staff performance. Methodological design A quasi‐experimental study with baseline and follow‐up measurements. Outcome measures The primary outcome was staff performance as a function of mealtime ambience and food service routines. Interventions/research methods The EF strategy was a 1‐year, multifaceted intervention that included support, guidance, practice audit and feedback in two NH units. The EOV strategy comprised one‐three‐hour lecture about nutritional guidelines in two other NH units. Both strategies were targeted to selected NH teams, which consisted of a unit manager, a nurse and 5–10 care staff. Mealtime ambience was evaluated by 47 observations using a structured mealtime instrument. Food service routines were evaluated by 109 food records performed by the staff. Results Mealtime ambience was more strongly improved in the EF group than in the EOV group after the implementation. Factors improved were laying a table (p = 0.03), offering a choice of beverage (p = 0.02), the serving of the meal (p = 0.02), interactions between staff and residents (p = 0.02) and less noise from the kitchen (p = 0.01). Food service routines remained unchanged in both groups. Conclusions An EF strategy that included guidance, audit and feedback improved mealtime ambience when nutritional guidelines were introduced in a nursing home setting, whereas food service routines were unchanged by the EF strategy.