Ethnomethodologic analysis of accounts of feeding demented residents in long-term care.

Purpose: To describe the self-organizing activities and the unspoken knowledge that nursing assistants employ in performing the work of feeding as a routine part of their activities. In U.S. long-term care facilities, activities related to medical and nursing care are frequently based on the ability of nursing assistants to successfully accomplish the work of feeding. Nurses are not always aware of the difficulties involved in feeding nor the means by which food is offered and intake calculated.

Design: Qualitative phenomenologic.

Methods: Observations were conducted during 12 weekday mealtimes, October and November 1994. Data were collected using participant observation of mealtimes in the congregate dining room of one licensed long-term care facility. Data were analyzed using the framework of ethnomethodology to indicate the methods nursing assistants used to make sense of their interactions with demented residents.

Findings: Nursing assistants used several common behaviors: grouping the "difficult feeders" together; "marking the borders" by maintaining a tidy tray; and "loading the spoon" to maximize the amount of food given at one time. Estimations of the quantity of intake varied according to ideas about the nutritional content of various foods.

Conclusions: Unsuccessful feeding interactions have implications for the quality of life for the demented. When inadequate intake leads to significant weight loss, medical and nursing interventions should be implemented.