ACQ Vol 11 no 2 2009

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ACQ Volume 11, Number 2 2009 93
Natasha Matheson and Crystal Ensell
nursing staff, as they were unable to participate in formal
education.
For consolidation of learning, the information presented
during the education session correlated with that on
the reference poster. As a further point of reference, the
information sheet for inclusion in the nursing care plan
summarised the 16 behaviours and associated strategies.
Only those nursing staff who participated in formal education
completed a post education questionnaire to assess
improvement in knowledge. All 25 questionnaires were
returned.
Results
When examining the results of the pre education
questionnaires, it was apparent that nursing staff understood
the definition and symptoms of dysphagia, but were not as
well informed about mealtime challenges, feeding issues or
template that outlined behaviours and appropriate
management strategies, which was then adapted for
individual patients’ post speech pathology assessment
and kept in the nursing care plan. This idea was expanded
upon and modified for an acute care facility. Improved
management of mealtime behaviours in the dementia
population at the hospital was targeted, with a view to
improving quality of care for people with dementia, as well
as service provision and allocation of speech pathology
resources.
Method
Initially, standard management of dementia mealtime
behaviours was identified through a literature review. A pre
education questionnaire with general dysphagia and
dementia questions was designed (see Table 1), covering the
prevalence of mealtime behaviours in the dementia
population, management strategies for several dementia
behaviours seen frequently in the hospital, and
appropriateness of speech pathology referral. The
questionnaire was completed by nursing staff on a general
medical and geriatric ward, with 100% return rate (37/37). A
variety of question formats was used including true/false,
multiple choice and one open-ended question.
A nursing education package was then compiled based
on management strategies cited in the literature and on the
questionnaire results, with the information tailored to suit
staff and patients at an acute care facility. The sole focus
of the package was management of dementia mealtime
behaviours, in the absence of dysphagia. McGillivray and
Marland (1999) emphasised the importance of nursing staff
education in the area of interpretation and management of
challenging feeding behaviours. Multiple studies have con­
cluded that nursing staff are inadequately trained to assist
patients and residents during mealtimes, and consequently
have difficulty coping appropriately with complex mealtime
behaviours (Sidenval & Ek, 1993; Watson, 1990).
Nursing education was provided in multiple formats to
accommodate different learning styles, and included A1-
sized reference posters, education sessions and A4-sized
summary sheets for nursing care plans (Appendix 1 provides
a list of behaviours and strategies covered in the education
package).The reference poster gave a brief explanation
of dementia and mealtime challenges, and outlined
16 mealtime issues. A variety of practical and relevant
management strategies were provided for each of these 16
issues. Referral to other disciplines such as dietetics and
occupational therapy were suggested where appropriate.
Education sessions of 45-minutes duration were
completed during regular working hours on the pilot ward
over a month-long period, with 67% attendance (25/37
nurses). The content of the session included the purpose of
the education program, an overview of Australian dementia
statistics, feeding behaviours in the dementia population and
their prevalence, and management strategies for feeding
behaviours relevant to the acute care setting. The same
session was presented on four occasions in an attempt to
educate nursing staff from a range of shifts. The education
session was practical and interactive to encourage
participation and learning. Chang and Lin (2005) emphasised
the importance of using a practical, hands-on, interactive
approach during nursing education, to enhance participation,
skill development and consolidation of knowledge. All
permanent morning and afternoon nursing staff on the ward
attended an education session. A copy of the PowerPoint
presentation from the package was made available to night
associated management strategies for the dementia
population. Table 1 provides an overview of the pre and post
education questionnaire results. Nursing staff were able to
identify when a speech pathology referral was warranted (i.e.,
coughing or voice changes present during a meal), however
could not distinguish when a speech pathology referral was
not warranted (e.g., 44% of respondents indicated that a
referral to the speech pathologist was necessary when a
patient’s dentures have been left at home).
The education session was tailored to meet this identified
knowledge gap. Post education questionnaire results in
Table 1 show an improvement in knowledge. A repeated
measures t-test was completed to determine progress.
Participants who did not complete education, and hence did
not complete a post education questionnaire, were removed
for the purpose of this statistical data analysis. The mean
number of questions correctly answered by participants prior
to education was 8/15. This improved to a mean of 13/15
which was found to be statistically significant (using a paired
samples t-test: t(1,24) = 9.35, p < 0.001).
Thirty-four referrals to speech pathology for management
of mealtime behaviours, in the absence of dysphagia were
received in 2007 from the ward in question. The education
package was implemented in early 2008, following which
only six referrals for management of mealtime behaviours
alone were received for the remainder of the year.
Additionally, spontaneous, subjective reports from the clinical