Interprofessional practice in nutrition and mealtime care: An ethnographic exploration across rehabilitation units
Hannah Olufson1,2,3, Ella Ottrey4, Adrienne Young1,5, Theresa Green1,31University Of Queensland , QLD, Australia2Surgical, Treatment & Rehabilitation Service (STARS), Herston, QLD, Australia3STARS Education and Research Alliance, Herston, QLD, Australia4Monash University , VIC, Australia5Royal Brisbane & Women’s Hospital , Herston , QLD , Australia
Abstract
Background: Nutrition and mealtime care has traditionally been considered the responsibility of nurses and dietitians. However, evidence has demonstrated the potential for delegated or interprofessional approaches to optimise care. Our study aimed to explore interprofessional practice (IPP) in the delivery of nutrition and mealtime care, by identifying collaborative staff activities and understanding what influences these activities.
Methods: Our ethnographic study was completed through an interpretivist paradigm. Field work was undertaken on three rehabilitation units, including 28hrs of observations with 125 participants (95 staff), and 30hrs of interviews with 77 participants (49 staff). We used reflexive thematic analysis to analyse the data, informed by IPP theory.
Results: We generated three themes: (1) mealtimes as an opportunity for IPP, exploring communication, teamwork, role clarity and reciprocity in mealtime care initiatives; (2) hierarchy of nutrition roles and tasks impedes IPP, where nutrition is perceived to be of lower importance than other clinical activities and roles which hinders staff involvement in nutrition and mealtime care; and (3) “we don’t even know what they [nutrition staff] do”, highlighting lack of staff awareness concerning nutrition care roles/systems, impeding IPP.
Discussion/Implications: Opportunities exist for rehabilitation managers and staff to create and embed models of care that enable IPP. Additionally, strengthening staff training/education processes may enhance understanding and awareness of nutrition care systems and staff roles. Our findings suggest that supporting IPP in nutrition care is complex and it may be beneficial to consider complexity, systems or behaviour change theories in future research on this topic.
Biography
Hannah is a PhD candidate at the University of Queensland and a dietitian from the Surgical, Treatment & Rehabilitation Service, both in Brisbane. With interprofessional practice increasingly cited as a necessary component in the delivery of high-quality nutrition and rehabilitation services, Hannah’s PhD research focuses on creating a conceptual model to inform person-centred, interprofessional nutrition and mealtime care in this setting. As a clinically-embedded researcher, Hannah also leads and builds the capacity of other staff to undertake improvement initiatives to enhance subacute healthcare services and meet the diverse nutritional needs of consumers.