多面向進食環境修正對機構住民進食量及進食滿意度之成效

Abstract

目的： 本研究主要探討多面向進食環境修正對機構住民進食量及進食滿意度之成效，次要目的為探討機構工作人員於多面向進食環境修正後對協助住民進食之工作滿意度之差異。 背景： 由於機構住民營養不良與生活功能、認知及死亡率密切相關，會衍伸出許多醫療問題，其中，飲食攝取量差為營養不良的高風險因子之一，現今機構住民之用餐環境雜亂，用餐過程受到許多與用餐非相關照護措施的干擾，如：同室住民的給藥、尿布更換等活動，導致住民無法專心進食，由於工作人力有限，無法在分散進食的環境中，同時提供進食輔助給所有住民，機構護理師如何用進食環境修正，藉以改善住民營養狀況以預防健康不良結果為現今重要課題。 方法： 採前實驗性單組前後測研究設計，於臺灣某長照機構進行，每位參與者於介入前1週的隨機3日晚餐中，以非參與式觀察法，了解住民進食時間、進食量、進食環境、接受進食輔助次數。介入措施包括告知進食物理性環境修正內容及進食輔助策略之判斷及運用，於介入兩星期後，每位參與者再次於1週內的隨機3日晚餐中，以非參與式觀察法，了解住民進食時間、進食量、進食環境、接受進食輔助次數，觀察結束後，詢問住民滿意度及工作人員對協助住民進食之滿意度。統計分析方式使用SPSS for Mac 29中文版電腦統計套裝軟體進行資料整理及統計分析，資料顯著水準定為 α<.05，描述性統計包括百分比、平均數、標準差，以了解機構住民的人口學特性。進食環境改善成效採推論性統計Paired-t test以了解介入前後1週隨機3日平均進食量及滿意度的差異，並使用獨立樣本t檢定及相關性檢定了解介入前後進食量改變的因素。 結果： 研究期間從民國113年12月01日至114年03月20日，共計37位住民及9位照服員執行進食輔助活動參與納入本研究結果做最後分析，本研究結果顯示，多面向的進食環境調整可有效提升機構住民的進食量，此外，住民的共病數與進食量變化呈正相關，同時，此策略亦提升了住民對用餐環境的整體滿意度，而照服員在多面向進食環境修正後的整體工作滿意度無顯著改變，其中「協助進食之工作內容滿意度」及「協助進食之工作時間的滿意度」呈現負值的差異，雖然沒有統計上的意義，卻也表示了住民用餐的改變對照服員來說是有負擔的。 結論與應用： 本研究結果顯示多面向進食環境修正可以提升機構住民進食量及滿意度，建議未來此策略可廣泛應用於所有可由口進食的機構住民，同時，在給予照服員進食輔助指導過程，需加強教育不要以任務為導向的方式照護住民，讓照服員重視住民用餐活動，願意花時間精力投入於住民的用餐過程。

Purpose: This study primarily explores the effectiveness of multi-aspects dining environment modifications on the food intake and eating satisfaction of institutionalized residents. A secondary aim is to examine the differences in job satisfaction among institutional staff assisting with meals after implementing such environmental changes. Background: Malnutrition among institutionalized residents is closely linked to functional decline, cognitive impairment, and increased mortality, resulting in various medical issues. Poor food intake is one of the high-risk factors for malnutrition. Currently, the dining environments in institutions are often chaotic, with residents’ mealtimes disrupted by unrelated caregiving activities such as medication administration and diaper changes. These interruptions prevent residents from focusing on eating. Due to limited staffing, it is difficult to provide consistent eating assistance to all residents simultaneously in a dispersed dining environment. How institutional nurses can modify the dining environment to improve residents’ nutritional status and prevent adverse health outcomes has become a critical issue. Methods: A pre-experimental research with single group pre-post test design was employed in a long-term care institution in Taiwan. Each participant was observed using a non-participatory method during three randomly selected dinners in the week before the intervention to assess meal duration, food intake, dining environment, and the frequency of receiving eating assistance. The intervention included environmental modifications and staff preparation, such as informing them about the physical changes to the dining environment and training on strategies for determining and providing meal assistance. Two weeks post-intervention, participants were again observed during three randomly selected dinners within one week using the same method. After the observations, residents were surveyed for satisfaction and staff were asked about their satisfaction with assisting residents during meals. Data were analyzed using SPSS for Mac version 29. Descriptive statistics (percentages, means, standard deviations) were used to understand residents' demographic characteristics. Paired-t tests were used to assess changes in average food intake and satisfaction before and after the intervention. Independent sample t-tests and correlation tests were used to identify factors affecting the changes. Results: From December 1, 2024, to March 20, 2025, a total of 37 residents and 9 caregivers participated in the study. The results showed that multi-aspects modifications to the dining environment effectively increased residents’ food intake. Additionally, the number of comorbidities were positively correlated with changes in food intake. The strategy also enhanced residents’ overall satisfaction with the dining environment. However, while there was no significant improvement in caregivers’ overall job satisfaction after the intervention, satisfaction with the content and time spent assisting during meals showed negative differences. Though not statistically significant, this indicates that changes in residents’ dining behavior may increase caregivers’ workload. Conclusion and Application: The results suggest that multi-aspects dining environment modifications can improve both food intake and satisfaction among institutionalized residents. It is recommended that this strategy be widely applied to all residents capable of oral intake. Furthermore, during caregiver training, it is important to emphasize a resident-centered approach rather than a task-oriented one to encourage caregivers to value and invest more time and effort into the residents’ dining experience.