Table 2.

Codes of Staff Nonverbal behaviors in Part III of CUED

Codes		Definitions
Staff Person-centered Behaviors
A.	Modifications of Resident Abilities
1.	Positioning resident appropriately	Staff helps the resident to sit in an appropriate position or re-positions the resident to facilitate eating. For example, staff positions residents upright in the chair, wheelchair, or from the bed (i.e., sitting upright is when the resident’s mouth is higher than the swallowing system).
2.	Adjusting to resident’s pace	Staff adjusts to the resident’s pace physically prior to next intake attempt, rather than hurrying the resident along (e.g., staff loaded the spoon with next bite, and sits and waits for resident to get ready).
3.	Offering a different type of food	When the resident has refused to eat one food/drink item being offered or eaten up one type of item, staff offers another food/drink to encourage intake (e.g., offering a vegetable once the resident refuses to eat the meat or eats up all the meat on the plate).
4.	Offering beverage	Drinks is offered by staff to promote swallowing or moving meal forward (especially when resident was not swallowing food or had prolonged chewing), or if a food item was refused.
5.	Offering finger food	Staff offers food that can be picked up by hand by the resident (e.g., peanut butter and jelly sandwich, chicken strips, french fries, hamburger, bacon, toast, fruit, cookie).
6.	Offering condiments	Staff offers the resident condiments (e.g., mustard, ketchup, sugar, pepper, salt, jelly).
7.	Putting item in container/utensil resident can manage	Staff puts item in container or utensil that resident can manage (e.g., preloading utensil with food)
8.	Giving a bite of appropriate size	Staff provides portions of food in appropriate bite size to ease the process of chewing and/or swallowing (e.g., 1/3 to 1/2 of spoon). Size should not be too big that part of the portion of food cannot get into the mouth and/or falls out of mouth.
9.	Guiding resident’s hand to pick up food	Staff holds resident’s hand to pick up food, or empty utensil to preload food, or preloaded utensil/container with food/drinks.
10.	Putting food/utensil into resident hand	Staff puts food, empty utensil (for the resident to preload food), or preloaded utensil/container with food/drink into resident’s hand. Following that, resident starts to eat with or without assistance.
11.	Holding resident’s hand to get food into the mouth	Staff holds resident’s hand to move food/drinks in the mouth in the following scenarios: ∘ When the resident is holding the food/drinks/utensils but cannot move food/drinks/utensils to mouth. ∘ When staff is holding the food/drinks/utensils and wants to involve resident in the intake attempt.
12.	Wiping away oral spillage or drool	Staff cleans any oral spillage or drool from the resident’s mouth, face, hand, body, or clothes.
B.	Modifications of (social/interpersonal) Care Approaches
1.	Adjusting proximity	Staff understands and respects the resident’s needs related to proximity by moving closer to or further from the resident or moves into a different position to better face and help resident (e.g., moves to other side of bed; moves from resident’s non-dominant side to dominant side; Staff stands up or sits down to better assist resident who is in bed). An appropriate distance between staff and resident during mealtime care is about an-arm length away from the food and the resident, so that caregiver does not lean over the resident or food.
2.	Attempting to gain attention	Resident is not engaged in the meal, in response, a non-verbal behavior is initiated and used by the staff to redirect/gain resident’s attention to the meal (e.g., tactile cue – touches resident’s arms, shoulder, eye contact with resident)
3.	Positive gestures/facial expressions	Staff uses positive gestures and facial expressions (e.g., laughter, waving, blowing a kiss, smiling).
4.	Appropriate use of affectionate touch	This is physical touch that is not necessary for the completion of a task (e.g., a pat on the back, a hug).
5.	Assessing comfort	When staff notices that the resident is experiencing discomfort and, without verbally telling the resident, takes steps to make the resident more comfortable. These tasks are not necessary for the safety of the resident. ∘ Physical comfort - Staff shows awareness of the resident’s physical needs, condition, and/or discomfort (e.g., resident’s facial expression, pain, cold, comfort in position) by observing the resident. ∘ Emotional comfort - Staff shows awareness of the resident’s or social/emotional needs by observing the resident (e.g., staff observes a change in social interaction or emotional expression, such as crying or long silence).
6.	Affirmative nodding	Staff nods head as a sign of approval, encouragement, or interest in the resident.
7.	Resident-directed eye gaze	This includes any attempts made to make eye contact with the resident through kneeling down, leaning over, or sitting next to a resident to be at the eye level.
C.	Modifications of Dining Environment
1.	Modifying traffic	Staff indicates other people who are walking in and out of the room or walking through/around the resident/dining table to stop.
2.	Modifying noise level	Staff intervenes to reduce background noise in the dining room (e.g., turning down the TV/radio to reduce the noise level. Asking other resident, staff, families) to talk more quietly.
3.	Reducing clutter	This could be staff removing food or drinks leftover, uneaten items, and/or other items that resident has not engaged in from the immediate meal environment (e.g., resident’s tray table or dining area).
4.	Limiting distractions	staff removes objects that resident is paying attention to or playing with but that interferes with meal intake.
5.	Arranging/mixing edible items for easy access	Staff moves food/drinks or other meal-related items (utensils or napkins) around in a way that’s easy for the resident to reach or puts the preferred food/dink item in front of resident, or mix some food (e.g., potato and cheese) or drinks (e.g., water and juice) that is regularly mixed up in a container for resident easy access of different drinks.
6.	Cutting food into manageable size	Staff cuts big chunk of food items into smaller pieces, so they are easier to pick up and eat.
7.	Adjusting, providing, or taking away assistive devices/items	Staff offers the use of assistive devices (e.g., hearing aid, glasses), meal-related items (e.g., bib, napkins), or other resident personal items (e.g., coat, protection), or adjust or take off/away the devices/items based on resident needs. The purpose is to facilitate the process of the mealtime.
Staff Task-centered Behaviors
1.	Ignoring/lack of interactions	Staff disregards/declines a request or question from the resident without response. This could also include statements/requests the resident makes and the FA does not acknowledge/respond. For example, staff is silent, or turns back to the resident, or leaves the resident alone, or talks to other residents or staff when the resident still needs staff’s attention (e.g., resident asks if he/she can return to his/her room and the care provider does not respond).
2.	Physically controlling	Staff physically forces the resident to do something, or performs care in a controlling manner (e.g., staff manages the eating pace and does not allow the resident some control in eating process, or force/order the resident to eat specific food/drinks items, or food/drinks in general).
3.	Inappropriate touch	Staff continues touching the resident in a manner that clearly makes the resident appear uneasy (e.g., staff continuously pats the resident’s shoulder or rubs the resident’s leg while the resident recoils or pulls away).
4.	Outpacing	Staff provides information or choices to the resident in a rushed manner that is too fast for the resident to understand, tolerate, or follow.
5.	Discouraging/taking over resident’s self-eating attempt	Staff discourages the resident’s attempt to eat by self and tries to provide complete assistance to the resident instead of trying to engage resident and encourage independence (e.g., takes utensil away from the resident and starts feeding the resident regardless of resident eating ability).
6.	Mixing ALL food up	Staff mixes all or most of the food items up without asking the resident’s preference to prepare the food for the resident. This applies to mixing different items that were served in separate containers or packages for the purpose of easily serving the resident everything in one spoon (e.g., mix up bacon, eggs, and/or oatmeal). This does not apply to food that is regularly mixed up (e.g., potato and cheese) does not count.
7.	Leaving the table/resident	Staff stands up and leaves the resident. This applies to different scenarios: staff has other duties/tasks, leaves to throw away some items, or get some items for the resident.
8.	Non-affirmative nodding	Staff nods head from side to side to non-verbally indicate “No”.