Understanding the dining experience of individuals with dysphagia living in care facilities: A grounded theory analysis.

BACKGROUND AND OBJECTIVES: Person-directed care in nursing homes, also known as the 'culture-change movement', aims to enhance dining-related quality of life. However, for residents with dysphagia, it is unclear how to best support this enhancement while balancing eating-related safety/risks. Thus, the purpose of this study was to explore the experience of and to define successful, person-centered dining for residents with dysphagia. RESEARCH DESIGN AND METHODS: Grounded theory methodology guided twenty-one 60-90 minute semi-structured interviews with participants across 7 stakeholder groups including residents, family members, and nursing, dietary, and therapy staff. We used a systematic and iterative approach for all data collection, analysis, and generation of theory. RESULTS, DISCUSSION, AND IMPLICATIONS: A theory emerged from the data that highlighted how individualization and socialization are the central tenants for improving residents' dining experiences and success, or 'focusing on the person: individualization and socialization during mealtimes'. We identified multiple facilitators and barriers to successful dining for residents with dysphagia such as the importance of positive social connections and invested, knowledgeable, and aware care team members. The focus of care was a salient theme suggesting that individualization of care that promotes residents' quality of life is a key facilitator of successful dining experiences. A social-ecological model for successful dining with dysphagia is ultimately proposed: optimizing health and well-being for these residents through successful dining experiences requires collaborative and coordinated care to address a variety of interrelated individual-, interpersonal-, and organizational-level facilitators and barriers.