Element of Reasoning 1-3 sentences describing your thoughts on the

issue related to that element

1. Purpose (all reasoning has a purpose) All 39 residents of the rehab and nursing
facility share the same mealtimes and dining
area.
Alert and oriented individuals rehabilitating
joint replacements are eating meals near
dementia patients with pureed food being
spooned into their mouths.
The purpose is to determine how to make
mealtimes satisfying and therapeutic for
different kinds of patients.
2. Questions at issue or central problem (all
reasoning is an attempt to figure something out, to
settle some question, solve some problem)
Should rehab patients be separated from long
term residents for meals?
Does the location in which a patient eats his
meals make a difference in terms of therapeutic
advantage?
How can staff ensure that all 39 residents are
gaining the full benefit of each meal? How do
we give attention to feeding a dependent
person while also satisfying requests from alert
and oriented individuals?
3. Point of view (all reasoning is done from some
point of view; think about the stakeholders)
It is not therapeutically ideal for patients to eat
meals in their assigned rooms.
Rehab patients take more enjoyment in
mealtimes in an environment that differs from
that of nursing home, therefore increasing
dietary intake and improving outcomes.
Staff members are unable to accommodate
separate mealtimes and locations for different
types of patients.
4. Information (all information is based on data,
information, evidence, experience, research)
Aspiration while eating may lead to pneumonia
and death.
Immobility while in the hospital is a leading
cause of complications and can lead to death.
Hospitalized persons and those with dementia
often require both physical and verbal cues to
promote adequate intake of food and liquids.
Adequate nutrition is an important element of
rehabilitation.
5. Concepts and ideas (all reasoning is expressed
through, and shaped by, concepts and ideas)
The eating environment should be designed to
be pleasing to the alert and oriented patient to
encourage adequate intake and satisfy social
needs.
Feedback from alert and oriented patients and
residents family members is useful to
determining what changes are desired for
mealtimes.
Separate mealtimes may be feasible to provide
a therapeutic environment for the rehab patient,
while also providing time later for direct
assistance with meals for dementia patients.
6. Assumptions (all reasoning is based on
assumptions-beliefs we take for granted)
We assume that a primary need for all
hospitalized patients is adequate nutrition.
We assume that it certain aspects of long term
care are disturbing to the appetite of the alert
and oriented individual.
7. Implications and consequences (all reasoning
leads somewhere. It has implications and when
acted upon, has consequences)
Inadequate nutrition can lead to lengthier
hospital stay.
Deciding to eat in ones room decreases
opportunities for ambulation. Immobility can
lead to complications and increased hospital
stay.
8. Inference and interpretation (all reasoning
contains inferences from which we draw
conclusions and give meaning to data and
situations
Nurses must be aware to each patients needs
and preferences with regard to meals.
Whether or not separate mealtimes or locations
are offered, each person is different; the plan of
care should be adjusted accordingly.


Gorzoni, M. and Pires, S. (2011, May-June). Deaths in nursing homes. Revista da Associacao
Medica Brasileira, 57, 327-331.
This article discusses the leading causes of death in long term care facilities. It details a study
conducted at a 508-bed nursing home in Sao Paulo, Brazil. The authors of the article, Milton
Gorzoni and Sueli Pires, are respectively an adjunct professor at Faculdade de Ciencias Medicas
in Sao Paulo and the director of the hospital at which the study was conducted. The article is
written at a level appropriate for healthcare professionals, but he or she should also be familiar
with the vocabulary of statistics. No conflict of interest is readily apparent within the article or
study. Conclusions have been reached based on a review of the patients medical records. It was
found that together with infection, immobility is a leading cause of death in nursing homes.


Nicholson, J., Dowrick, A., and Liew, S. (2012, December 20). Nutritional status and short-term
outcome of hip arthroplasty. Journal of Orthopaedic Surgery, 20, 331-335.
This article discusses the relationship between healing after hip arthroplasty and the patients
nutritional status. A study was conducted with both males and females who underwent hip
arthroplasty. All three of the contributors to the article are employed within the Department of
Orthopaedic Surgery in Victoria, Australia. An appropriate audience for this article would be a
healthcare professional with an exceptional understanding of statistics. At times the writing
becomes choppy as the data is conveyed. A negative factor with this article is the variance
among the individuals included in the study. The ages ranged from 26 to 96 and some surgeries
were from trauma while others were elective. The conclusion reached by the study indicates that
compromised nutrition poses a risk for lengthier hospital stays.
Simmons, E. et al (2008, July 15). Prevention of unintentional weight loss in nursing home
residents: a controlled trial of feeding assistance. Journal of the American Geriatrics
Society, 56, 1466-1473. doi: 10.1111/j.1532-5415.2008.01801.x
The purpose of this article is a description of a study to determine the need for feeding assistance
in nursing homes to prevent unintentional weight loss. Among the six contributors to the
writing, four have their doctorate degree, one has a masters degree, and one has a bachelors
degree. All of the authors shared in aspects of conducting the study. No conflict of interest was
found with the article or study, and the limitations of the study are included in the journal. The
article is written in language that is readily understood by any healthcare professional. The
import of the article is the findings that feeding assistance greatly improved intake of food and
fluids and that unintentional weight loss is associated with higher rates of morbidity and
mortality.


Sura, L. et al (2012, July 30). Dysphagia in the elderly: management and nutritional
considerations. Clinical Interventions in Aging, 7, 287-298. doi: 10.2147/cia.s23404
This article discusses the complications associated with dysphagia and ideas for maintaining
health and nutritional statues in clients affected with it. This is not a description of a scientific
study but is an explanation of the physiology of swallowing difficulties and treatment options.
Scientific data included in the journal was obtained from US Department of Health and Human
Services. The authors of the journal are experts in the fields of public health and speech
pathology and report no conflict of interest. The writing is such that an entry level healthcare
worker should be able to understand the material. Statistical information is included in the
article but the purpose of the writing is to explain dysphagia and its management.
Julie Walker

How did the planning process, where you thought about what you wanted to change,
prepare you for the EBPP?

Frankly, I did not fully understand the requirements of the assignment at the outset, so my
planning stage was lacking. There is so much that I would like to change about my practice that
I feel is currently out of my control. This lead me to become frustrated with deciding upon a
problem to tackle. Thankfully, changing the dining room atmosphere has recently become a
project for a committee on which I serve.

How did the peer evaluation process prepare you for the EBPP?

I did not find the peer evaluation helpful with regard to feedback I received. However, I did
benefit from reviewing my peers EBPP grids. I feel that the feedback may not have been helpful
due to the fact that many of us work in such different environments and find it difficult to
understand a persons purpose for their article in such short sentences.

Do you feel you are prepared to elicit change in your practice with your proposal?
How does it fit into quality health care?

I do not feel fully prepared but feel that I have a start. I intend to use the information I have here
discovered in my committee meetings with regard to mealtimes. Unfortunately, I am not yet
able to see how this information will be sufficient to make the changes necessary at our facility.
That being said, I do intend to evaluate the needs of each patient individually to determine what
mealtime and location would suit him/her best in therapeutic terms. Additionally, I will be
education my colleagues on the information I have researched to encourage them to make such
considerations. I feel that my example and positive attitude will be contagious and get us on the
path toward a more satisfying and therapeutic mealtime experience. This all fits together to
create an environment of providing high quality health care.

What could you have done better?

The single most important thing I could have done better with this project is obtain a better
understanding of the requirements earlier in the semester. Unfortunately, I did not know what I
did not know, which caused me to fail to ask the right questions. This caused unneeded stress on
my part, which in my experience leads me to develop tunnel vision and overlook things.

How well do you think you are using the EOR? Do they make sense to you (why or
why not?
I am not using the EOR with any comfort or ease at all. I find it cumbersome and feel that a
couple of the elements are redundant. I have not given up on the idea by any means, but am
willing to try to become more familiar with the ideas and elements. I do see that the process is a
framework for how problems are solved and feel that there is some value to having the steps laid
out to follow. Perhaps this is uncomfortable for me as it is another facet of thinking about
thinking which has literally caused me physical discomfort. I am not giving up on the idea of
metacognition; I simply find it quite difficult to follow and explain it due to its intangible nature.