Original Article
European Journal of Clinical Nutrition (2007) 61, 664–672. doi:10.1038/sj.ejcn.1602559; published online 29 November 2006
Nutritional implications of patient–provider interactions in hospital settings: evidence from a within-subject assessment of mealtime exchanges and food intake in elderly patients
Guarantors: L Dubé and C Paquet.
Contributors: LD, CP, DSM, MJK and GF were responsible for the study concept and research design. CP and ZM performed data analysis. LD and CP drafted and edited the manuscript. All authors critically revised the article for important intellectual content.
L Dubé1,2,3, C Paquet1,2, Z Ma1, D St-Arnaud McKenzie2,4, M-J Kergoat2,5 and G Ferland2,4
- 1Desautels Faculty of Management, McGill University, Québec, Canada
- 2Research Center, Institut universitaire de gériatrie de Montréal, Québec, Canada
- 3Canadian Institute of Health Research/Social Sciences and Humanities Research Council of Canada, Career Scientist, Québec, Canada
- 4Nutrition Department, Université de Montréal, Québec, Canada
- 5Faculty of Medicine, Université de Montréal, Québec, Canada
Correspondence: Dr L Dubé, Desautels Faculty of Management, McGill University, 1001 Sherbrooke Street West, Montreal, Québec, H3A 1G5, Canada. E-mail: laurette.dube@mcgill.ca
Received 31 January 2006; Revised 28 July 2006; Accepted 12 September 2006; Published online 29 November 2006.
Abstract
Objective:
To examine the nutritional implications of the interactions taking place between patients and care providers during mealtimes in hospital settings. Specifically, we tested research propositions that the amount and nature of interpersonal behaviours exchanged between patients and providers impact patients' food intake. These propositions were derived from prior evidence of social influences on eating behaviour and a well-established framework that identifies two fundamental modalities of human interaction: striving for mastery and power (agency) and efforts to promote union with others (communion).
Design:
In a within-subject naturalistic study, participants were observed on multiple meals (n=1477, 46.2 meals/participant on average), during which participants' and providers' agency- and communion-related behaviours and patients' protein and energy intake were recorded. Meal-level frequency and complementarity of patients' and providers' behaviours were computed to test research propositions.
Setting:
Dining room of a geriatric rehabilitation unit.
Subjects:
Thirty-two elderly patients (21 females, mean age:78.8, 95% CI: 76.4, 81.1).
Results:
Meal-level frequency of patient–provider exchanges (P=0.016) and patients' agency-related behaviours (P=0.029), as well as mutual reciprocation of patients' and providers' communion-related behaviours (P=0.015) on a given meal were positively linked to protein intake. Higher energy intake was found during meals where patients expressed more agency-related behaviours (P=0.029).
Conclusion:
Results present evidence that the amount and nature of patient–provider interpersonal exchanges on a given meal influence the nutritional quality of food intake in hospitalized elderly. They provide insights into how to improve the design and delivery of routine care to this malnutrition-prone population.
Sponsorship:
This study was supported by the Canadian Institutes of Health Research (Operating grant to Laurette Dubé, Doctoral Fellowship to Catherine Paquet) the Fonds de la Recherche en santé du Québec and by the Danone Institute (Doctoral fellowship to Danielle St-Arnaud McKenzie).
Keywords:
food intake, care provider, interpersonal behaviour, elderly patients, social facilitation, malnutrition
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