Issues in conducting intervention research in long-term care settings

Originally we proposed a straightforward experimental design using quantitative data to test a series of hypotheses about how changes in the mealtime context and mealtime interactions would influence self-feeding behaviors and imposed disability. The design was clean and the interventions carefully delineated. We used a number of strategies for reducing threats to internal validity, some of which worked and some of which did not. Many of the problems we encountered in operationalizing this clinical experiment arose, not from the particular environment in which we worked, but from the nature of long-term care settings and the staffing patterns within those settings. To some degree, the problems we encountered are inherent to field experimentation in nursing in general. Often field experiments are reported as if no problems arose in implementation, yet no study is problem free. We believe acknowledging and understanding some of the sources of field noise in field experiments are almost as important as understanding the results of the study itself. The field noise is an indispensable part of the results.