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Table 1 Variables measured, metrics and validity of the measure, and source(s) of data collection

From: A path analysis on the direct and indirect effects of the unit environment on eating dependence among cognitively impaired nursing home residents

Outcome Measure metrics and validity evidence documented in available studies [in brackets] and as emerged in this study Source(s) of data
Edinburgh Feeding Evaluation in Dementia scale (EdFED) From 0 total independent, to 20 totally dependent [19, 20]
Reliability Cronbach alpha = 0.909
Direct observation during lunch time
Appropriate level of care required by the resident (only supportive/educative; partly or wholly compensatory) (EdFED) From 0 to 2 [19, 20]
Individual level
 Age, Sex Data was extracted from the NH and regional database
 Functional dependence using the Barthel Index (10 items) From 0 total dependent, to 100 total independent [21]
Reliability Cronbach alpha = 0.945
 Cognitive Performance Scale (6 items) From 0 intact, to 6 severe impairment; scores ≥4 indicate moderate/severe impairment [22]
Reliability Cronbach alpha = 0.937
 Depression Rating Scale (14 items) From 0 to 14; scores ≥3 indicate minor or major depressive disorders [23]
Reliability Cronbach alpha = 0.834
 Pain Intensity Scale (1 item) From 0 no pain, to 3 severe pain [24]
 Night restlessness (1 item) Each scored from 0 absent, to 4 always present [25]
 Verbal aggressiveness (1 item)
 Physical aggressiveness (1 item)
 Clinical Instability Score (1 item) From 0 clinically stable, to 4 high instability [25]
 Close/intimate relationships with family relatives (1 item) Yes/no [25]
 Where the resident habitually eats
 -in his/her bedroom, alone
 -in the dining room, near one resident (on left or right side)
 -near two residents (on left and right)
 -near two residents (on left/right and in front)
 -surrounded by other residents (on left, right and in front)
From 0 eating alone, to 4 surrounded by other residents
Nursing care level
 (a) environmental interventions: starting the mealtime ritual by stimulating hearing and sight memory (1. ringing a bell, 2. opening the dining room), promoting the desire to eat by stimulating smell and visual memory (3. setting the tables in advance as in a restaurant, 4. entering the dining room with a meal trolley); creating and maintaining a peaceful environment allowing residents’ concentration (5. lowering distracting stimuli; 6. balancing the presence of the family) (a) From 0 none, to 6 all interventions are daily performed [18] Nursing Staff observation via checklist
 (b) resident interventions: knowing the resident (1. collecting and sharing their stories and habits; 2. understanding their daily variances and adapting routines; 3. establishing residual self-feeding abilities), escalating feeding care (4. verbal, 5. behavioural, 6. motivational prompts; 7. respecting refusals and waiting; 8. balancing insistence and resistance; 9. deciding the best position), de-escalating difficulties due to meals/utensils (10. by adapting the consistency of food, and utensils) (b) From 0 none, to 10 all interventions are daily performed [18]
NH level
 Units composing each NH
 Beds of the NH unit where each resident was living
Number
Number
Data was extracted from the regional database
 Therapeutic Environment Screening Survey for Nursing Home (TESS-NH) (84 items categorised in 13 domains [26, 27] Higher scores in each domain indicates high environment quality [26, 28] Reliability resulted in all evaluable dimensions in Cronbach alpha = > 0.600 Direct observation
  - ‘Unit autonomy’: nursing station presence/type; nursing station for paperwork; desk for paperwork; combined work area for paper work; enclosed workroom, not a nursing station; unit use as pathway between other units; residents eat on/off units; formal activities on/off unit; residents bathe on/off unit (9 items) - Scores 0, 1, 2 or 3 according to the item
  - ‘Outdoor access’: enclosed courtyard; attractiveness of courtyard; courtyard is functional (3 items) - Scores 0, 1, 2 or 3 according to the item
  - ‘Privacy’: privacy curtain provides only separation between beds in semiprivate rooms (1 item) - Score 0 or 1
  - ‘Exit control’: doors of rest of facility distinguished; doors to outside distinguished; number of exits off of the unit; number of elevators off of the unit; doors are looked; locking device triggered by approach; look disengaged by keypad/switch; looked at night/during bed weather; doors are alarmed; alarm triggered by device worn by resident; alarm disengaged using keypad, card or switch (12 items) - Scores 0, 1 or 2 or Not applicable according to the item
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  - ‘Maintenance’: maintenance of social space; of halls; of residents’ rooms; of resident bathrooms (4 items) - Scores 0, 1 or 2
  - ‘Cleanliness’: cleanliness of social spaces; of halls; resident rooms; resident bathrooms; bodily excretion odour in public area; in resident rooms (6 items) - Scores 0, 1 or 2
  - ‘Safety’: floor surfaces in social spaces; in halls; in resident rooms; in resident bathrooms; handrails in hallways; in bathrooms (6 items) - Scores 0, 1 or 2
  - ‘Lighting’: intensity in hallways; in activity areas; in resident rooms; glare in hallways; in activity areas; in resident rooms; lighting evenness in hallways; in activity areas; in resident rooms (9 items) - Scores 0, 1, 2 or 3 according to the item
  - ‘Visual/tactile stimulation’: bedrooms with a view of the courtyard; public areas with a view of the courtyard; tactile stimulation opportunities; visual stimulation opportunities (4 items) - Scores 0, 1 or 3
  - ‘Noise’: status of the television in main activity areas; resident screaming/calling out; staff screaming/calling out; T/radio noise; loud speakers/intercom noise; alarm/call bell noise; other machine noise (7 items) - Scores 0, 1, 2 or 6
  - ‘Space/seating’: % of rooms with a chair per person; public room inventory; path leads to dead ends; path with places to sit; configuration of rooms on unit (5 items) - From 0 to 1, 2 or 3 or Not applicable according to the item
  - ‘Familiarity/home likeness’: public areas homelike; kitchen of the unit; pictures/mementos in resident room; non-institutional furniture in resident rooms; residents’ appearance (5 items) - Scores 0, 1, 2 or 3 according to the item
  - ‘Orientation/cueing’: doors left open; resident’s name on/near door; current picture of the resident; old picture of the resident; object of personal significance; room numbers; colour coding; bathroom door left open, toilet visible from the bed; bathroom door left open; toilet non visible from the bed; bathroom door closed, picture or graphic; activity areas visible from the 50% of resident rooms; visual indicator of activity areas visible from 50% of resident rooms; direction, identification sign visible from 50% of resident room (13 items) - Scores 0 or 1
 Therapeutic Environment Screening Survey for Nursing Home (TESS-NH) global single item (1 item) From 1 low, distinctly unpleasant, negative, non-functional, to 10 high, quite pleasant, positive, and functional environment [26] Direct observation
  1. ADL Activity of Daily Living, NH Nursing Home, RN Registered Nurse, TESS-NH Therapeutic Environment Screening Survey for Nursing Home