152 pubs · 2,067 cites · h-index 27
AIMS: To examine temporal relationships of resident food intake with resident mealtime behaviors and staff mealtime care approaches. METHODS: This study was a secondary analysis of 160 videos capturing dyadic mealtime interactions among 27 residents with dementia and 36 care staff in 9 nursing homes. Videos were coded using the refined Cue Utilization and Engagement in Dementia Mealtime Video-Coding Scheme to characterize resident mealtime behaviors, staff mealtime care approaches, and resident food intake process. Sequential analysis was conducted with resident mealtime behaviors and staff mealtime care approaches conceptualized as antecedents of resident successful food intake. RESULTS: Decreased pace of resident-initiated food intake was correlated with preceding resident mealtime functional impairments and resistive behaviors. Increased pace of staff-initiated food intake was correlated with preceding staff mealtime person-oriented verbal approaches. Decreased pace of staff-initiated food intake was correlated with preceding resident mealtime positive/neutral nonverbal behaviors and functional impairments, and staff mealtime task-oriented care approaches. CONCLUSION: Findings suggest resident mealtime behaviors and staff care approaches may serve as temporal indicators of pace of food intake. Higher rates of food intake co-occurred with resident-oriented positive communication, support addressing functional impairments, responses to resistive behaviors, greater use of person-centered care, and less use of task-centered care. Findings highlight potential targets for mealtime care practices aimed at supporting food intake, particularly resident-initiated intake, which reflects resident functional independence and active engagement in mealtime activities with or without staff assistance. Future investigation of full-meal dyadic interactions capturing diverse meal types and accounting for clustering effects is needed.
PURPOSE AML is a highly aggressive hematologic cancer. During induction chemotherapy, up to 40% of patients experience complications resulting in unplanned readmissions or early death. This study aimed to identify the reasons for postinduction unplanned readmissions and to develop predictive models for unplanned readmissions or early death using structured and unstructured electronic health record (EHR) data to identify patients at highest risk. METHODS We retrospectively analyzed 1,111 inpatient encounters from 305 adult patients with AML treated at a Midwestern university hospital between 2006 and 2021. Inclusion criterion was adults with AML undergoing induction chemotherapy; exclusion criteria included acute promyelocytic leukemia, stem cell transplant recipients, and confirmed chronic myeloid leukemia. Adverse events—unplanned readmissions or mortality within 30 days of discharge from the initial induction hospitalization—were identified through chart review using predefined rules. Multiple logistic regression was used to identify risk factors. Variable selection was performed using the least absolute shrinkage and selection operator. RESULTS Within 30 days postdischarge, 22% of patients experienced an unplanned readmission. The most frequent reasons were fever/infection (53.5%), metabolic/GI/renal complications (16.2%), and pain/discomfort (14.1%). Mortality within 30 days was 22%. Predictive performance improved when comorbidities and symptom frequency from clinical notes were added (AUC increased from 0.67 to 0.74). Statistically significant predictors of increased adverse event risk included solid neoplasm (odds ratio [OR], 2.34), higher cardiopulmonary symptom burden per day (OR, 1.16), and a chemotherapy intensity moderated by age (OR, 0.90). CONCLUSION Unplanned readmissions or early mortality occurred in 39.7% of patients with AML within 30 days postdischarge. Integrated risk stratification tools leveraging structured and unstructured EHR data may inform timely interventions to improve survival and reduce avoidable hospitalizations.
Quantitative factorial survey evaluates how patients' security perceptions influence nurses' reporting of safety events, indicating potential interventions.
BACKGROUND: Hospitalized patients continue to experience preventable harm and safety threats. The purpose of this study was to evaluate the extent to which nurse judgments of credibility and concern (perceived importance) mediated the relationships between patient demographic characteristics and nurse intent to report a patient-reported safety event while adjusting for nurse and event characteristics. METHODS: A cross-sectional, quantitative study using a factorial survey experiment was conducted. Hospital nurses working in United States practice settings (N = 240) participated in an online survey. Path analysis was used to test the study model. RESULTS: Our findings indicate that increased nurse concern regarding a patient-reported safety event increased the likelihood of reporting the event to organizational incident reporting systems. Nurse concern also mediated the relationship between patient socioeconomic status and race/ethnicity (Black vs. non-Hispanic White) and nurses' intent to report. Other variables directly affecting intent to report were patient ethnicity (Hispanic White versus Non-Hispanic White), and event type (medication versus miscommunication). The degree of credibility judged by participants had no effect on intent to report. CONCLUSIONS: These results suggest key motivations for nurse reporting are (a) the degree of concern (perceived importance) of the event and (b) the type of event, with medication errors associated with both greater nurse concern and intent to report. While literature suggests that patient characteristics are directly and indirectly associated with intent to report, our study suggests credibility is not a mitigating factor in that relationship. Overall, our study suggests interventions focusing on nurse judgments of importance may be more effective than those focused on judgments of credibility.
PURPOSE OF STUDY: The purpose is to describe sepsis survivors' functional recovery and symptom experience following Intensive Care Unit (ICU) hospitalization. PRIMARY PRACTICE SETTINGS: Academic Medical Center, Community Living. METHODOLOGY AND SAMPLE: This longitudinal observational study recruited participants during hospitalization at two adult ICUs in a single Midwestern academic medical center. Participants completed surveys to assess function and symptom experience at baseline (discharge), 1-month, 3-months, and 6-months post-discharge. RESULTS: Participants were non-Hispanic Whites with mean age 55.4 years (SD = 17.0). The majority were discharged to home (78.6%), with 3 (21.4%) discharged to a skilled nursing facility or acute rehabilitation unit. Participants had notable improvements in mobility, self-rated health, and fatigue from discharge to 6-months post-discharge. Increases in mobility from discharge to 1 month, 3 months, and 6 months were statistically significant (α < .05). Decreases in fatigue from discharge to 1 month and 6 months were statistically significant (α < .05). Cognitive and social engagement and other symptom experience measures did not differ significantly during the study period. IMPLICATIONS FOR CASE MANAGEMENT PRACTICE: Findings reveal trends in mobility recovery and symptom experience post-hospitalization, which are important considerations post-ICU sepsis hospitalization. This study reinforces the need to promote early mobilization of patients during hospitalization and work with patients to develop strategies for mobility recovery post-hospitalization, as part of a comprehensive plan which integrates a client's medical, behavioral, social, psychological, functional, and other needs. The authors encourage assessment of common symptoms, including pain, fatigue, anxiety, and sleep disturbance, experienced by sepsis survivors during and post-hospitalization. As a result, case managers will be better positioned to implement evidence-based interventions to promote recovery and reduce symptom burden and improve outcomes. Evidence-based interventions should include those that are centered on client's functional and symptom-related needs, preferences, safe mobility, and facilitate awareness of and connections with community supports and resources.
OBJECTIVES: We sought to (1) validate the Patient-Reported Outcomes Measurement Information System (PROMIS) Pain Intensity Short Form 3a measure and Brief Pain Inventory (BPI) for assessing pain during pregnancy and (2) evaluate pain in a sample of pregnant individuals. METHODS: Pregnant individuals (N = 196) were prospectively surveyed: n = 171 up to 22 weeks gestational age, n = 123 during their third trimester of pregnancy, and n = 98 both times. Additional measures included SPRINT Post-Traumatic Stress Disorder Tool, Neurological Quality of Life, Edinburgh Postnatal Depression Scale and anxiety subscale, and Adverse Childhood Experiences Questionnaire. Validity evidence examined included content validity, reliability, convergent and discriminant validity, and relevant criterion relationships. RESULTS: Content validity analysis suggests that the PROMIS pain measure was easy to use and interpret while the BPI provided more detail. However, BPI questions regarding medication usage and relief were unclear to some pregnant individuals. In addition, the relationships among pain ratings were stronger than relationships between pain ratings and measures intended to assess other constructs suggesting convergent and discriminant validity. Relationships with relevant criterions were presented for both the PROMIS and BPI by comparing ratings of pain intensity and severity for pregnant individuals with and without areas of pain reported on BPI. CONCLUSION: Results indicate that PROMIS and BPI provided valid information on pain intensity or severity for our perinatal sample. Depending on the research question, the PROMIS pain or BPI may be more appropriate to an individual study. Either measure could also be included in an electronic health record for accurate pain assessment in clinical settings.
BACKGROUND AND OBJECTIVES: Pain management is often suboptimal in individuals with dementia, and their family caregivers are tasked with supporting pain management despite limited preparation. The web-based PACE-app (PAin Control Enhancement) was designed to assist caregivers in managing pain for individuals with dementia. This study aimed to evaluate the usability of the PACE-app. RESEARCH DESIGN AND METHODS: A convergent parallel mixed-methods design was used to evaluate the PACE-app's usability with 16 family caregivers and 6 healthcare professionals. Quantitative data were collected using the Post-Study System Usability Questionnaire (PSSUQ), and qualitative data were gathered through guided-app reviews and semistructured interviews. Quantitative data were analyzed descriptively, and qualitative data were thematically coded. RESULTS: The PSSUQ results indicated that both family caregivers and healthcare professionals had a highly positive experience with the PACE-app: overall scores (2.01 vs 1.68), system usefulness (1.76 vs 1.68), information quality (1.98 vs 1.80), interface quality (2.30 vs 1.60), and satisfaction (2.00 vs 1.60) were rated on a 1-7 scale (with lower scores indicating better usability). Qualitative findings supported these results, with participants endorsing the PACE-app's usefulness, ease of use, learnability, effective information presentation, aesthetics, clear layout, and overall satisfaction. Participants also provided valuable feedback for improving information quality (enhancing clarity) and interface quality (real-time coaching on pain management). DISCUSSION AND IMPLICATIONS: The study demonstrated favorable usability and strong satisfaction among family caregivers and healthcare professionals using the PACE-app. Incorporating participants' suggestions will guide enhancements to the app's information and interface, ensuring it better meets users' needs.
Aim To test the influences of patient, safety event and nurse characteristics on nurse judgements of credibility, importance and intent to report patients' safety concerns. Design Factorial survey experiment. Methods A total of 240 nurses were recruited and completed an online survey including demographic information and responses to eight factorial vignettes consisting of unique combinations of eight patient and event factors. Hierarchical multivariate analysis was used to test influences of vignette factors and nurse characteristics on nurse judgements. Results The intraclass coefficients for nurse judgements suggest that the variation among nurses exceeded the influence of contextual vignette factors. Several significant sources of nurse variation were identified, including race/ethnicity, suggesting a complex relationship between nurses' characteristics and their potential biases, and the influence of personal and patient factors on nurses' judgements, including the decision to report safety concerns. Conclusion Nurses are key players in the system to manage patient safety concerns. Variation among nurses and how they respond to scenarios of patient safety concerns highlight the need for nurse‐level intervention. Implications for the Profession and Patient Care Complex factors influence nurses' judgement, interpretation and reporting of patients' safety concerns. Impact Understanding nurse judgement regarding patient‐expressed safety concerns is critical for designing processes and systems that promote reporting. Multiple event and patient characteristics (type of event and apparent harm, and patient gender, race/ethnicity, socioeconomic status, and communication approach) as well as participant characteristics (race/ethnicity, gender, years of experience and primary hospital area) impacted participants' judgements of credibility, degree of concern and intent to report. These findings will help guide patient safety nurse education and training. Reporting Method STROBE guidelines. Patient or Public Contribution Members of the public, including patient advocates, were involved in content validation of the vignette scenarios, norming photographs used in the factorial survey and testing the survey functionality.
Validation study demonstrates structural and relational dimensions of healthcare innovation in academic-practice partnerships, highlighting a diagnostic tool for collaborative nursing progress.
Nurse management occupies a demanding position between frontline staff needs and administrative requirements, profoundly impacted by COVID-19. Health care researchers, administration, and policymakers must learn how to support, retain, and sustain nursing management in a post-pandemic world.
Summary Hippocampal atrophy is a prominent neurodegenerative feature of Alzheimer's disease and related dementias. Alterations in circadian rhythms can exacerbate cognitive aging and neurodegeneration. This study aimed to examine how dim light melatonin onset and melatonin levels are associated with hippocampal volume in cognitively healthy individuals. We studied data from 52 later‐life adults (mean age ± SD = 70.0 ± 6.3 years). T1‐weighted anatomical images from 3.0 T magnetic resonance imaging data were collected and processed using the BRAINSTools toolbox. Dim light melatonin onset was used to assess circadian timing. The area under the curve was calculated to quantify melatonin concentration levels 6 hr before bedtime, and 14‐day wrist actigraphy data were used to assess habitual bedtime. Multiple linear regression modelling with hippocampal volume as the dependent variable was used to analyse the data adjusting for age and sex. The average dim light melatonin onset was 19:45 hours (SD = 84 min), and area under the curve of melatonin levels 6 hr before habitual bedtime was 38.4 pg ml −1 × hr (SD = 29.3). We found that later dim light melatonin onset time ( b = 0.16, p = 0.005) and greater area under the curve of melatonin levels 6 hr before habitual bedtime ( b = 0.05, p = 0.046) were associated with greater adjusted hippocampal volume. The time between dim light melatonin onset and the midpoint of sleep timing was not associated with hippocampal volume. The findings suggest that earlier circadian timing (dim light melatonin onset) and reduced melatonin may be associated with reduced hippocampal volume in older adults. Future research will help researchers utilize circadian rhythm information to delay brain aging.
Background and Objectives Optimal dyadic interactions are critical to quality mealtime care and outcomes. Prior work supports associative relationships between staff approaches and individual mealtime behaviors, yet evidence on temporal relationships is limited. This study examined temporal associations between staff approaches and resident behaviors during mealtimes. Research Design and Methods Videotaped mealtime observations (N = 160) involving 36 staff and 27 residents (53 staff–resident dyads) in 9 nursing homes were analyzed. Sequential analyses using 5-, 10-, and 15-second time windows were conducted for resident positive, neutral, and challenging behaviors as antecedents as well as consequences of staff person-centered and task-centered approaches. Results Residents exhibited positive verbal (35.0%) and positive/neutral nonverbal (12.6%) behaviors, as well as challenging behaviors including functional impairments (27.7%) and resistive behaviors (24.7%). Staff primarily used person-centered approaches (54.1% verbal, 40.3% nonverbal); task-centered approaches were less frequent (5.6%). Immediately (within 5 seconds) after staff person-centered approaches, resident positive/neutral and resistive behaviors were more likely, and functional impairments less likely. After staff task-centered approaches, resident positive verbal and resistive behaviors were less likely. After resident positive/neutral behaviors, staff person-centered approaches were more likely. After resident functional impairments, staff person-centered verbal approaches were less likely, and task-centered approaches more likely. After resident resistive behaviors, all staff approaches were more likely. The strength of temporal relationships diminished in 10-second and 15-second time windows. Discussion and Implications Staff–resident positive interactions were associated with more subsequent positive interactions. Person-centered care was associated with fewer subsequent resident functional impairments and more subsequent resistive behaviors. Resident resistive behaviors were associated with more subsequent person-centered and task-centered care. Findings confirm the importance of facilitating positive staff–resident interactions and managing functional impairments using person-centered care. Resistive behaviors require additional awareness and attention beyond commonly used person-centered care approaches. Further investigation of temporal relationships is needed using larger diverse samples.
In primary and urgent care, headache and facial pain are common and challenging to diagnose and manage, especially with using opioids appropriately. We therefore developed the Decision Support Tool for Responsible Pain Management (DS-RPM) to assist healthcare providers in diagnosis (including multiple simultaneous diagnoses), workup (including triage), and opioid-risk-informed treatment. A primary goal was to supply sufficient explanations of DS-RPM's functions allowing critique. We describe the process of iteratively designing DS-RPM adding clinical content and testing/defect discovery. We tested DS-RPM remotely with 21 clinician-participants using three vignettes-cluster headache, migraine, and temporal arteritis-after first training to use DS-RPM with a trigeminal-neuralgia vignette. Their evaluation was both quantitative (usability/acceptability) and qualitative using semi-structured interviews. The quantitative evaluation used 12 Likert-type questions on a 1-5 scale, where 5 represented the highest rating. The mean ratings ranged from 4.48 to 4.95 (SDs ranging 0.22-1.03). Participants initially found structured data entry intimidating but adapted and appreciated its comprehensiveness and speed of data capture. They perceived DS-RPM as useful for teaching and clinical practice, making several enhancement suggestions. The DS-RPM was designed, created, and tested to facilitate best practice in management of patients with headaches and facial pain. Testing the DS-RPM with vignettes showed strong functionality and high usability/acceptability ratings from healthcare providers. Risk stratifying for opioid use disorder to develop a treatment plan for headache and facial pain is possible using vignettes. During testing, we considered the need to adapt usability/acceptability evaluation tools for clinical decision support, and future directions.
INTRODUCTION: Mealtime is a critical daily activity to ensure nutrition, hydration, function and socialisation. Interactions between staff and residents during mealtimes are complex and dynamic processes including verbal and/or nonverbal communication that can be positive/neutral or challenging. This study examined characteristics of and relationships between person-centred and task-centred care and positive/neutral and challenging mealtime behaviours in persons with dementia. METHODS: This study was a secondary behavioural analyses of videotaped mealtime observations (n = 110) involving 42 unique staff-resident dyads (29 staff and 25 residents with dementia) in nine nursing homes. The refined Cue Utilization and Engagement in Dementia mealtime video-coding scheme was used to code videos during 2019-2020. Dependent variables representing resident mealtime behaviours included positive verbal behaviours, positive/neutral nonverbal behaviours, functional impairments (nonverbal) and resistive behaviours (verbal and nonverbal). Independent variables were staff person-centred and task-centred approaches (verbal and nonverbal). Relationships between resident mealtime behaviours and staff approaches were examined using bivariate analysis and logistic regression. RESULTS: Staff person-centred verbal approaches were associated with resident positive verbal behaviours (OR = 1.38, 95% CI = 1.09-1.76), functional impairments (OR = 0.81, 95% CI = 0.66-1.00) and resistive behaviours (OR = 1.65, 95% CI = 1.18-2.31). Staff person-centred nonverbal approaches were associated with resident functional impairments (OR = 1.33, 95% CI = 1.02-1.74). Staff task-centred approaches were not associated with resident positive/neutral or challenging mealtime behaviours. CONCLUSION: This study characterised staff approaches and resident behaviours during mealtime care and provided preliminary support on associations between staff person-centred approaches and resident positive and challenging behaviours. Person-centred mealtime care practice is recommended by focusing on support of common, challenging behaviours and reinforcement of positive behaviours with adequate consideration of individual needs and preferences.
Food intake was associated with staff person-centered approaches and resident positive/neutral and challenging behaviors. Findings emphasize the importance of facilitating positive dyadic interactions using individualized, context-based, multifaceted, person-centered care. Future research on temporal and causal relationships is warranted in larger diverse samples.
Background and Objectives The Changing Talk (CHAT) communication training effectively reduces elderspeak and subsequent behavioral challenges in residents with dementia in nursing homes (NHs). As part of the pilot pragmatic clinical trial testing Changing Talk: Online Training (CHATO), a new online version, a remote implementation design, and process evaluation were developed to capture contextual factors, ensure fidelity, and determine effective implementation strategies. Research Design and Methods The Expert Recommendation for Implementing Change compilation informed this 2-phase approach to develop and test remote implementation. An Advisory Board guided the developmental phase while pilot testing used a cluster-randomized design. Data were analyzed to evaluate NH characteristics; implementation strategies used; CHATO participation, completion, and passing rates; and leadership evaluation. Results Five out of 7 NHs were nonprofit with above average quality ratings (M = 4.3 of 5). Staff participants (N = 237) were mostly female (90%), non-Hispanic White (91%), and nursing assistants (46%). Implementation time ranged from 54 to 86 days (M = 70.3, standard deviation [SD] = 9.3), with planning phase ranging from 11 to 29 days (M = 20.1, SD = 6.7), and training phase ranging from 35 to 58 days (M = 50.0, SD = 7.6). A range from 3 to 11 implementation strategies were used by each NH. Assigning champions, including the social worker on the implementation team, utilizing multiple mediums for reminders, giving rewards or public recognition, supporting onsite discussions, and other tailoring strategies were associated with improved outcomes. Participation ranged from 20% to 76%. Over 63% of participants completed training (N = 150) and 87% passed the posttest (N = 130). Leadership evaluations noted staff used CHATO concepts in practice and improved communication culture. Discussion and Implications Leadership who took an active role, engaged multiple team members, and varied strategies had better outcomes. Effectiveness of the strategies will be evaluated in a national pragmatic clinical trial testing CHATO’s effects on reducing behavioral and psychological symptoms in dementia care.
BACKGROUND: People with cancer who also have multiple chronic conditions (MCCs) experience co-occurring symptoms known as symptom clusters. OBJECTIVE: To describe MCC and symptom clusters in people with cancer and to evaluate the relationships between MCCs and symptom severity, symptom interference with daily life, and quality of life (QoL). METHODS: Weekly over a 3-week chemotherapy cycle, 182 adults with solid tumor cancer receiving chemotherapy completed measures of symptom severity, symptom interference with daily life, and QoL. Medical records reviewed to count number of MCCs in addition to cancer. Exploratory factor analysis was performed to identify symptom clusters. The relationships between the number of MCCs and the outcomes (symptom severity and symptom interference with daily life and QoL) at each time point were examined using the χ2 test. Longitudinal changes in outcomes were examined graphically. RESULTS: The number of MCCs ranged from 0 to 9, but most participants (62.1%) had 2 or fewer MCCs. Obesity was the most prevalent chronic condition. Four symptom clusters were identified: nutrition, neurocognitive, abdominal discomfort, and respiratory clusters. At each time point, no significant differences were found for MCCs and any outcome. However, symptom severity in all the symptom clusters, symptom interference with daily life, and QoL demonstrated a worsening in the week following chemotherapy. CONCLUSION: A majority of our sample had 2 or fewer MCCs, and MCCs did contribute to patient outcomes. Rather, timing of chemotherapy cycle had the greatest influence of patient outcomes. IMPLICATIONS FOR PRACTICE: Additional support on day 7 of chemotherapy treatment is needed for people with MCCs.
AIMS AND OBJECTIVES: To understand how pain affects physical and mental health-related quality of life during the third trimester of pregnancy. BACKGROUND: Poor health-related quality of life during pregnancy is associated with adverse maternal foetal health outcomes such as increased risk of low-birth-weight neonates. Poor health-related quality of life is linked to pain, pain interference and anxiety in the general adult population. However, we do not know how pain, pain interference (i.e., interference of pain with patient function), and anxiety are interrelated during the third trimester of pregnancy. METHODS: This exploratory cross-sectional study followed STROBE guidelines. A mobile educational and tracking pregnancy application was used to obtain a racially/ethnically diverse convenience sample of 141 third trimester pregnant women from the U. S. In this sample, 58.2% of women had commercial health insurance, 68.8% were Caucasian, 86.5% were younger than 35 years, and 85.1% had a partner. Women completed demographics, Edinburgh Postnatal Depression Scale and the Brief Pain Inventory on REDCap. Path analysis was used to investigate a model for the relationships among pain intensity, pain interference, anxiety and physical and mental health-related quality of life. RESULTS: Pain intensity affected health-related quality of life indirectly by increasing pain interference, which in turn, decreased both physical and mental health-related quality of life. In addition, pain interference also increased anxiety, which in turn worsened mental health-related quality of life, but not physical health-related quality of life. CONCLUSIONS: Treating perinatal pain may improve health-related quality of life by decreasing pain interference and anxiety. RELEVANCE TO CLINICAL PRACTICE: Nurses should assess for pain interference and anxiety in women experiencing moderate to severe pain during the third trimester of pregnancy. With this knowledge, nurses may advocate for women in receiving effective treatment for their conditions and improvements in their physical and mental health-related quality of life.
AIMS: To characterize dyadic mealtime verbal interactions and examine the associations with staff and resident characteristics. DESIGN: A secondary analysis of 110 videotaped mealtime observations collected from a dementia communication trial during 2011-2014. METHODS: Videos involved 25 residents with dementia and 29 staff in nine nursing homes. Verbal behaviours (utterances) were coded during 2018-2019 using the Cue Utilization and Engagement in Dementia mealtime video-coding scheme, addressing eight positive behaviours and four negative behaviours. Bivariate analyses and multivariate regression models were used. RESULTS: Staff spoke three times more frequently (76.5%) than residents (23.5%). Nearly all staff utterances were positive (99.2%); 85.1% of residents' utterances were positive and 14.9% negative. Staff positive utterances were correlated with their negative utterances and resident positive and negative utterances. Staff negative utterances were correlated with resident negative utterances. Resident positive and negative utterances were correlated. Resident positive utterances were significantly associated with staff care-giving length in the current nursing home (OR = 1.430, 95% CI = 1.008, 2.027). Resident negative utterances were significantly associated with resident gender (female versus male, OR = 11.892, 95% CI = 1.237, 114.289) and staff years worked as a caregiver (OR = 0.838, 95% CI = 0.710, 0.989). Staff positive and negative utterances were not associated significantly with any participant characteristics. CONCLUSIONS: Staff engage residents using primarily positive verbal strategies. Staff-resident mealtime verbal interactions were dynamic, interactive, and complex and related to multiple individual characteristics. IMPACT: Positive dyadic mealtime interactions are critical to engage residents in eating. Little work has characterized dyadic mealtime interactions, limiting the development of effective interventions. Findings showed staff-resident mealtime verbal interactions were primarily positive, inter-related, and associated with multiple individual characteristics. Findings inform directions to improve mealtime care practice and develop person-centred mealtime interventions targeting modifiable factors, including staff care-giving experiences.