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Table 6 Reflexive monitoring—real and ideal conditions for appraising nutrition guidelines

From: Implementing nutrition guidelines for older people in residential care homes: a qualitative study using Normalization Process Theory

Real conditions Ideal conditions Strategies to promote reflexive monitoring
Emphasis on adverse events and lack of systematic feedback on impacts of nutrition guidelines Access to information on a wide range of outcomes (e.g., waste, falls) See strategies for improving coherence and cognitive participation (see Table 3 and 4)
Feedback from clients to cooks mediated by care staff (and potentially contaminated by their own views of the nutrition guidelines and modified menus) Direct feedback from clients to cooks Provide “taster” sessions as a way of involving clients and obtaining feedback
   Encourage care staff to separate their own views from those of clients
Lack of information on nutrition profile of modified menus Comparative information on nutrition profile of baseline and modified menus available Provide feedback comparing nutrition profile of baseline and modified menus
Cooks lack confidence in adapting menus and recipes (particularly in ways that are acceptable to clients) Cooks have skills and confidence to update menus and dishes in ways that are consistent with principles underlying the nutrition guidelines and acceptable to clients Provide training in principles underlying the nutrition guidelines
   Provide taster sessions for clients