JCPSLP
Volume 16, Number 3 2014
135
and attending to individual needs and respecting
preferences and choice. Seven of the twelve informants
provided suggestions for improvements to their mealtime
experience. Suggestions included: being assisted first,
going out for lunch more often, having a quiet mealtime
environment and ensuring support staff are seated, and do
not rush meal assistance.
Tension between individual preferences and
organisational constraints was evident. One adult with
dysphagia indicated they did not like having dinner at an
early and set time each night. Two indicated they preferred
a quiet mealtime environment and acknowledged that
this was not always possible. Two adults with dysphagia
expressed a dislike for having to wait while DSWs attended
to other tasks and one informant indicated they did not like
being assisted by casual staff.
Family perspectives
Sixteen questionnaires from family members were received,
representing a 22% response rate. Two key themes
emerged: the need for training for DSWs and the
importance of understanding and meeting individual needs.
The three items rated
extremely important
at greatest
frequency were that “training be provided for DSWs in
mealtime assistance” (14/16), “training be provided for
DSWs in the preparation of thickened drinks and texture
across the three focus groups and was identified as an
important area for continuous improvement.
DSWs indicated they valued mealtime guidelines. A
suggestion was made to document effective tips and ideas
from DSWs. DSWs also identified the need for improved
handover processes, particularly when new clients enter a
service.
Training emerged as a key theme, with consensus among
DSWs that training be provided on a regular basis. Some
informants suggested annual updates with a focus on
client-specific information and information sharing among
team members. This theme was corroborated by
questionnaire results (see Table 4) in which one of the top
three items rated by DSWs as
extremely important
was that
“training be provided for DSWs in mealtime assistance”
(16/17).
The other two questionnaire items rated most frequently
as
extremely important
by DSWs were that ‘there be
greater emphasis on a multidisciplinary team approach
to supporting people with disabilities with eating and
swallowing difficulties’ (16/17), and “people with disabilities
are consulted as much as possible when their mealtime
guidelines are being developed” (14/17).
Client perspectives
The overwhelming theme that emerged from interviews with
adults with dysphagia was the importance of understanding
Table 3. Thematic categorisation of focus group data
Major themes
Subthemes
Examples
Peer support
Sharing tips and ideas
Information and training
Dysphagia and meal assistance
Induction workshop is valued
Need for regular training and updates, e.g., at annual staff
training days
Client-specific information
Need for regular information sessions to take into account
changing client circumstances
Collaboration
Speech pathology
Access to responsive and on-site speech pathology
Support workers observe changes in swallowing and refer to
speech pathologist
Others
Effective collaboration with all who support the client is important
Staffing
Supervision of students, casual and new staff
Unsafe practices put clients at risk
Responsibility for client safety
Importance of compliance
Permanent DSWs
Leadership role
Documentation
Mealtime guidelines
Value of clear, accessible guidelines
Documentation of DSW’s ideas
Handover
Need for information when new clients enter service
Informed choice
Contracts assist clients to learn about risks and empower DSWs
Complexities
Acknowledging complexities
Range of complex needs
Choice versus risk
Communication barriers
Understanding individual preferences
Making adjustments
Allocating sufficient time to assist
Accommodating individual preferences
Equipment
Need for equipment that meets individual needs
Attitudes
Need to foster affirming attitudes towards adults with dysphagia
