What Characterizes

The purpose of this study was to characterize the quality of less tangible, psychosocial care during mealtimes in nursing homes. The Therapeutic Communication Study has provided communication training targeting certified nursing assistants (CNAs) in skilled nursing facilities to improve their emotional connection with residents having some cognitive impairment. Eighteen CNAs received the four-hour intervention. Data were collected via pre- and post-video tapings during mealtimes. From 72 videotapes (4 per CNA), those for the CNA with the most quantitative improvement in five targeted communication behaviors (i.e., greeting, eye contact, wait for a response, sit in front, and direct/redirect) were examined in-depth using qualitative methods. Analytic procedures included selecting and labeling video clips into “quotations” with “codes,” respectively, that were further categorized into groups or “families” using Atlas.ti software. The research team examined these families and their most exemplary quotes and codes and then compared and contrasted them both within and between the four pre- and post-videos by writing about their observations in “memos.” Three themes capture the most variation from these systematic comparisons and represent the most compelling characterizations of quality psychosocial care during mealtimes using subtle verbal and non-verbal communication behaviors. They include 1) responsive, engaging but cooperative caregiving; 2) genuinely being present and calm; and 3) comfortable proximity with a gentle touch. These less tangible characterizations of psychosocial care during mealtime may be incorporated into future training for CNAs on how to emotionally connect with residents who have cognitive impairment and may contribute to improving consumer satisfaction with care.