Employee reactions to the introduction of a bulk food distribution system in a nursing home

Decentralized bulk food distribution was implemented in a nursing home. Employees working with elderly residents with dementia were asked their opinion of the impact of the new system on residents and workload. A convenience sample of 24 employees (57% of the staff) completed a 31-item, self-administered Likert-scale questionnaire that allowed open-ended comments. Responses were subjected to descriptive quantitative analysis, and a qualitative approach was used to explore themes that emerged in comments. Qualitative analysis indicated that 52% of responses were negative in tone, 30% were positive, and 18% were neutral. Initially, three categories of comments emerged, with specific multiple themes related to the residents (41%), the employees (37%), or the food-service system (22%). Most comments in the employee category were negative, and suggested that the decentralized food-service system caused hardship for the staff. This problem was resolved by adding one staff-hour at the midday meal. One year later, an abbreviated repeat survey of 29 employees revealed adaptation and general acceptance of the system. Because a motivated patient care staff is essential to the successful feeding of nursing home residents with dementia, employees' concerns must be considered when operational changes are planned.