title: Can trained volunteers make a difference at mealtimes for older people in hospital? A qualitative study of the views and experience of nurses, patients, relatives and volunteers in the Southampton Mealtime Assistance Study.
abstract: BACKGROUND
  Malnutrition is common amongst hospitalised older patients and associated with increased morbidity and mortality. Poor dietary intake results from factors including acute illness and cognitive impairment but additionally patients may have difficulty managing at mealtimes. Use of volunteers to help at mealtimes is rarely evaluated.
  
  
  OBJECTIVE
  To obtain multiple perspectives on nutritional care of older inpatients, acceptability of trained volunteers and identify important elements of their assistance.
  
  
  METHODS
  A qualitative study 1 year before and after introduction of volunteer mealtime assistants on one ward and parallel comparison with a control ward in a Medicine for Older People department at a UK university hospital.
  
  
  METHODS
  Semi-structured interviews and focus groups, in baseline and intervention years, with purposively sampled nursing staff at different levels of seniority; patients or close relatives; and volunteers.
  
  
  RESULTS
  At baseline staff felt under pressure with insufficient people assisting at mealtimes. Introducing trained volunteers was perceived by staff and patients to improve quality of mealtime care by preparing patients for mealtimes, assisting patients who needed help, and releasing nursing time to assist dysphagic or drowsy patients. There was synergy with other initiatives, notably protected mealtimes. Interviews highlighted the perceived contribution of chronic poor appetite and changes in eating patterns to risk of malnutrition.
  
  
  CONCLUSIONS
  Improved quality of mealtime care attributed to volunteers' input has potential to enhance staff morale and patients'/relatives' confidence. A volunteer mealtime assistance scheme may work best when introduced in context of other changes reflecting commitment to improving nutrition.
  
  
  CONCLUSIONS
  (i) A mealtime assistance scheme should incorporate training, supervision and support for volunteers; (ii) Good relationships and a sense of teamwork can develop between wards staff and volunteers; (iii) Impact may be maximised in the context of 'protected mealtimes'.
authors.affiliation: National Institute for Health Research Southampton Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust and University of Southampton, Southampton, UK.
authors.forename: Judy
authors.initials: J
authors.lastname: Robison
authors.forename: Anna L
authors.initials: AL
authors.lastname: Pilgrim
authors.forename: Gemma
authors.initials: G
authors.lastname: Rood
authors.forename: Norma
authors.initials: N
authors.lastname: Diaper
authors.forename: Marinos
authors.initials: M
authors.lastname: Elia
authors.forename: Alan A
authors.initials: AA
authors.lastname: Jackson
authors.forename: Cyrus
authors.initials: C
authors.lastname: Cooper
authors.forename: Avan
authors.initials: A
authors.lastname: Aihie Sayer
authors.forename: Sian
authors.initials: S
authors.lastname: Robinson
authors.forename: Helen C
authors.initials: HC
authors.lastname: Roberts
mesh_terms: D000369:Aged, 80 and over; D001291:Attitude of Health Personnel; D016022:Case-Control Studies; D002755:Choice Behavior; D004739:England; D005190:Family; D017144:Focus Groups; D005518:Food Preferences; D006785:Hospitals, University; D006801:Humans; D007407:Interviews as Topic; D044342:Malnutrition / Q000517:prevention & control*; D062407:Meals; D009728:Nursing Assistants; D009741:Nursing Staff, Hospital; D014838:Volunteers; D016526:Workload
keywords: acute care system; nutrition; older people nursing; qualitative methods; voluntary sector