Melissa Batchelor

The growing population of aging Korean American nursing home residents underscores the need for culturally tailored care. This study developed and evaluated a clinical decision-support system (CDSS) based on the North American Nursing Diagnosis Association-International, Nursing Intervention Classification (NIC), and Nursing Outcome Classification (NOC) for US Korean American nursing home nurses. We used GPT-4.0 (OpenAI, San Francisco, CA) to generate 130 customized nursing care scenarios incorporating the relevant NANDA-I, NIC, and NOC elements. Subsequently, the RN Korean version CDSS’ was developed using a large language model. System usability was evaluated using the Korean System Usability Scale; Korean Usefulness, Satisfaction, and Ease-of-Use questionnaire; and Korean Nielsen heuristic evaluation. The SUS results indicated favorable scores, while USE was rated positively. Ease of learning was rated the highest. Expert evaluations of heuristic principles revealed diverse ratings, with particularly favorable ratings for user control and freedom. However, principles such as flexibility and efficiency of use, and the match between the system and real-world contexts scored lower, highlighting areas of improvement. The proposed NNN CDSS can improve communication and care delivery, thereby enhancing care quality for diverse populations and supporting health equity among US nursing homes.

This study examined how nursing home staff adapt to challenging mealtime behaviors in residents with dementia, such as turning away or refusing food. Ten focus groups were conducted with 52 clinical and administrative staff from three southeastern U.S. nursing homes. Transcripts were analyzed using four key codes: feeding behaviors, interventions, training, and communication. Staff described a range of mealtime challenges, including cognitive and functional decline, dysphagia, and elopement. Feeding-related behaviors like refusing to eat reflect the complexity of care required. Staff reported adapting interventions based on residents’ abilities, their own interactions, or environmental factors. Most strategies aligned with evidence-based practices, though one novel tactic involved “sprinkling sugar” to stimulate appetite. Findings suggest that reframing feeding behaviors as communication may improve care and reinforces the need for tailored interventions. Differences in staff perspectives emphasize the value of cross-role collaboration in managing mealtime challenges and improving outcomes for residents with dementia.

Background: People with dementia face numerous challenges during mealtimes, including difficulties with food intake, cutlery use, and maintaining attention. These can lead to severe consequences such as malnutrition and aspiration pneumonia, affecting the well-being of these individuals. Aim: To determine the effectiveness of an educational intervention in improving mealtime support needs and enhancing the well-being of both individuals with dementia and direct care workers. Methods: A cluster-randomized controlled trial was conducted in four residential care facilities. The study involved direct care workers and residents with dementia, with facilities randomly assigned to either an intervention or control group. The intervention comprised three weekly 2-hour training sessions, focusing on dementia-related mealtime challenges and practical support strategies. Data were collected at baseline and one-week post-intervention using questionnaires and observational tools to assess caregivers’ skills, burnout levels, and job satisfaction, as well as residents’ mealtime behavior and food intake. Results: Direct care workers from the intervention group showed significant improvements in knowledge ( p < .001; d = 0.728) and skills ( p < .001; d = 0.842) compared to the control group. Additionally, there were notable reductions in burnout levels ( p = .001; d = 0.466) and higher job satisfaction ( p = .003; d = 0.410). People with dementia in the intervention group demonstrated better performance at mealtimes. Conclusion: The educational intervention effectively enhanced direct care workers’ abilities to support people with dementia during mealtimes, leading to better outcomes for both caregivers and residents. Implementing such training programs can improve care quality and alleviate challenges in dementia care.

Objectives: Little is known about how nursing home staff use resident characteristics to individualize care delivery or whether care is affected by implicit bias. Design: Randomized factorial clinical vignette survey. Setting: Sixteen nursing homes in North Carolina. Participants: Nursing, rehabilitation, and social services staff (n = 433). Measurements: Vignettes describing hypothetical residents were generated from a matrix of clinical and demographic characteristics. Resident age, race and gender were suggested by a photo. Participants completed up to four randomly assigned vignettes (n = 1615), rating the likelihood that 12 fall prevention activities would be used for the resident. Fixed and random effects mixed model analysis examined the impact of vignette resident characteristics and staff characteristics on four intervention categories. Results: Staff reported a higher likelihood of fall prevention activities in all four categories for residents with a prior fall (0.2–0.5 points higher, 10 point scale, P < 0.05), but other risk factors did not affect scores. There was little evidence of individualization; only dementia increased the reported likelihood of environmental modification (0.3, P < 0.001, 95% CI 0.2–0.5). Individualization did not vary with staff licensure category or clinical experience. Registered nurses consistently reported higher likelihoods of all fall prevention activities than did licensed practical nurses, unlicensed staff and other professional staff (1.0–2.7 points, P < 0.001 to 0.005). There was a small degree of implicit racial bias; staff indicated that environmental modification would be less likely to occur in otherwise identical vignettes including a photo of a black rather than a white resident (−0.2 points, 95% CI −0.3 to −0.1). Conclusion: Nursing home staff report a standardized approach to fall prevention without individualization. We found a small impact from implicit racial bias that should be further explored.

Background: Nursing home ( NH ) residents who require assistance during mealtimes are at risk for malnutrition. Supportive handfeeding is recommended, yet there is limited evidence supporting use of a specific handfeeding technique to increase meal intake. Objectives: To compare efficacy of three handfeeding techniques for assisting NH residents with dementia with meals: Direct Hand ( DH ), Over Hand ( OH ), and Under Hand ( UH ). Design: A prospective pilot study using a within‐subjects experimental Latin square design with randomization to one of three handfeeding technique sequences. Setting and Participants: 30 residents living with advanced dementia in 11 U.S. NH s. Measurements: Time required for assistance; meal intake (% eaten); and feeding behaviors, measured by the Edinburgh Feeding Evaluation in Dementia (EdFED) scale. Intervention: Research Assistants provided feeding assistance for 18 video‐recorded meals per resident (N = 540 meals). Residents were assisted with one designated technique for 6 consecutive meals, changing technique every 2 days. Results: Mean time spent providing meal assistance did not differ significantly between techniques. Mean meal intake was greater for DH (67 ± 15.2%) and UH (65 ± 15.0%) with both significantly greater than OH (60 ± 15.1%). Feeding behaviors were more frequent with OH (8.3 ± 1.8%), relative to DH (8.0 ± 1.8) and UH (7.7 ± 1.8). Conclusion: All three techniques are time neutral. UH and DH are viable options to increase meal intake among NH residents with advanced dementia and reduce feeding behaviors relative to OH feeding.

Little is known about the sustainability of behavioral change interventions in long-term care (LTC). Following a cluster randomized trial of an intervention to improve staff communication (CONNECT), we conducted focus groups of direct care staff and managers to elicit their perceptions of factors that enhance or reduce sustainability in the LTC setting. The overall aim was to generate hypotheses about how to sustain complex interventions in LTC. In eight facilities, we conducted 15 focus groups with 83 staff who had participated in at least one intervention session. Where possible, separate groups were conducted with direct care staff and managers. An interview guide probed for staff perceptions of intervention salience and sustainability. Framework analysis of coded transcripts was used to distill insights about sustainability related to intervention features, organizational context, and external supports. Staff described important factors for intervention sustainability that are particularly challenging in LTC. Because of the tremendous diversity in staff roles and education level, interventions should balance complexity and simplicity, use a variety of delivery methods and venues (e.g., group and individual sessions, role-play/storytelling), and be inclusive of many work positions. Intervention customizability and flexibility was particularly prized in this unpredictable and resource-strapped environment. Contextual features noted to be important include addressing the frequent lack of trust between direct care staff and managers and ensuring that direct care staff directly observe manager participation and support for the program. External supports suggested to be useful for sustainability include formalization of changes into facility routines, using “train the trainer” approaches and refresher sessions. High staff turnover is common in LTC, and providing materials for new staff orientation was reported to be important for sustainability. When designing or implementing complex behavior change interventions in LTC, consideration of these particularly salient intervention features, contextual factors, and external supports identified by staff may enhance sustainability. ClinicalTrial.gov, NCT00636675