Aim: The overall aim of the thesis was to increase knowledge about caring mealtime environments, from a holistic perspective, by exploring different aspects of mealtime environments in nursing homes.

Methods: The thesis is based on four studies. In study I, an observation instrument for mealtime observations in nursing homes was further developed and validated. Method for validation was the Content Validity Index. The structure and content of the observation instrument followed the Five Aspects Meal Model framework. Study II was a descriptive observational study using a deductive approach. Observations of the mealtime environment were conducted at 23 meals. Five Aspects Mealtime Environment – Observation Instrument and dining map were used to collect data during the observations. The data were analysed using descriptive statistics and a deductive content analysis. Study III was a qualitative study where 20 residents in a nursing home were interviewed. Thematic analysis with an inductive approach was used. Study IV was also a qualitative study using thematic analysis with an inductive approach to analyse data collected from 19 interviews. The persons interviewed in this study were healthcare staff in a nursing home.

Results: In study I, the development of structure, content and wording resulted in the observation instrument FAME-OI. FAME-OI showed high validity after calculating I-CVI, S-CVI and modified Kappa. Studies II, III and IV strengthened the perception of the mealtime environment as an event intertwined with multiple perspectives. Different parts of the mealtime environment had different significance depending on whose perspective was considered. When mealtime environments in dementia care units and non-specialised units in a nursing home were explored in study II, the results were presented based on the theoretical framework FAMM. Varying needs were identified among the mealtime participants as well as different strategies and aids to meet these needs. The residents’ experiences of mealtime environments in nursing homes were explained by four themes in study III; the significance of food, security through routines, variability in staff influence, and limited social interactions. Two main themes related to the creation of a well-functioning mealtime environment were identified in study IV; significance of a calm environment and importance of organisational structure.

Conclusions: The results show that, for the mealtime environment in special nursing homes to become caring mealtime environments, a holistic perspective needs to be applied. All aspects of FAMM were significant, which means that all involved in the mealtime environment needs to work in collaboration. To create a caring mealtime environment, more is needed than optimizing the aspects of FAMM. The results showed that concepts such as participation, independence and care relationship need to be included when creating caring mealtime environments. A caring mealtime environment therefore needs to be developed based on a caring science perspective and implemented in accordance with the framework of person-centered care.