To Örebro University

In order to understand the provision of meals to older patients in hospitals, the notion of hospitality is interesting. Previous research has found that even if adequate nutrition is provided the food served to the patients is not always consumed (Agarwal et al. 2013). Therefore, it is essential to also highlight aspects related to how and where the meals areserved, as well as the interaction between the staff and the patients.

The overall aim of this study was to explore how nursing staff and meal-hosts approached the mealtime for older patients and what aspects impacted on how the meals were served to the patients.

Method: Twenty mealtimes was observed across four wards within two hospitals in Sweden that had nursing staff serving meals on wards with a dayroom (2 wards) and meal-host serving meals on the wards with a dining room (2 wards). The objectives of the observations was to observe how the staff served the meals to the patients with as special focus on the hospitality approaches provided and the overall dining area. The Five Aspect Meal Model (Gustafsson, Öström, Johansson & Mossberg, 2006; Edwards & Gustafsson, 2008) and the notion of hospitality (Lashley, 2000; Telfer, 2000) serves as main frameworks. Moreover, Goffman’s dramaturgical theory (Goffman, 2014) is used to understand the scenery observed during the mealtimes.

Preliminary findings: Two overall themes were identified in the initial analyses, 1) atmosphere in the dining area; 2) and serving style and hospitality approaches.

The overall atmosphere differed between the two dining areas which impacted on how the patients were approached during mealtimes. The observations disclosed several encounters were the atmosphere in the dining area in the wards with meal-hosts serving were perceived as a regular restaurant with patients approached and asked what they would like to eat and drink in relation to the menu that was available. It was also observed in several occasions that the meal-host sat down next to the patients and helped the patients to choose a dish from the menu, asking if they were satisfied with the meal or if they needed anything else. The meal-host constant presence in the dining room contributed to a positive atmosphere as well as opportunities for the patients to get direct assistance. In the wards with nursing staff serving the food in the dayroom the patients were not as frequently out for lunch or dinner and several observations disclosed that no patients were taken to dine outside the own room. However, when the patients were out the hospitality approaches differed. Most often the patients were nicely talked and attended to in the moment of providing the meal tray and when the tray was taken away. However, the time between service and closing of the meal the patients was most often left unattended for. The atmosphere was most often sensed as “heavy” and silent. It was observed that the nursing staff not always thought of turning the lights on in the dayroom contributing to a less positive atmosphere. The staff was observed to just passing by the dayroom without visiting the dayroom to ask if the meal was of satisfaction or overall seeing the patients.

The serving style and hospitality approaches differed in some aspects between meal-hosts and nursing staff at the observed wards. The nursing staff was observed on all wards, including the wards with meal-host serving the meals, to be more hands-on and talking closer with the patients, which also disclosed different caring roles during mealtimes. If patients wanted anything else, a hand was often seen to be touched upon the patient or confirmed the wish by talking near and close to the patient. The meal-host was observed to both display a near service style with taking orders by sitting next to the patient or squatting to be on the same level as the patient, and, in some occasions, take orders as in restaurants with the help of a note pad standing next to the table.

Conclusion: The preliminary findings of this study indicate that a constant presence of a meal-host or nursing staff would be beneficial for both the overall atmosphere in the dining area as well as for patients getting timely assistance. However, further analyses are needed to fully understand and report the findings of this study.