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ACQ
Volume 11, Number 2 2009
ACQ
uiring knowledge in speech, language and hearing
nurse manager on the pilot ward indicated that staff were
displaying a more positive attitude towards people with
dementia since implementation of the education package,
however no objective data was attained.
Discussion
The findings from this study correlate to those discussed in
previous studies. For example, Nailon, Scott and Benjamin
(2007), after implementation of a similar project, found
increased knowledge and confidence of nursing staff
regarding managing people with dementia during mealtime.
Similarly, Chang and Lin (2005) reported improved nursing
knowledge and a positive shift in attitude towards people with
dementia after introducing a comprehensive feeding skills
training program. Improved empathy towards this population
post nursing education was a common finding, as discussed
by Astrom, Nilsson, Norberg and Winblad (1990), Chang and
Lin (2005), and McGillivray and Marland (1999).
After participating in the education package nursing staff
appeared to display a more positive attitude toward people
with dementia. It is felt this shift in viewpoint is due to a more
holistic understanding of dementia and related mealtime
issues. Further investigation into the attitude of nursing
staff toward people with dementia after implementation of
the education package would have been useful and will be
considered when education is completed on other wards.
The education package will be implemented on other wards
that care for patients with dementia (i.e., geriatric rehabilitation
unit, orthopaedic ward and other general medical wards), as
the need for education on these wards is becoming
apparent. The reduced number of referrals for management
of dementia-related mealtime behaviours on the pilot ward
has motivated speech pathology staff to discuss the
package with nurses on other wards. Nursing staff are keen
for such education to take place and have indicated that
management of challenging mealtime behaviours is a topic
rarely addressed. Sidenval and Ek (1993) and Watson (1990)
reiterate that nursing staff are inadequately trained to assist
patients or residents during mealtimes, and support the
initiative of nursing education to address this.
Numerous studies consider weight maintenance and
nutritional status, and monitor these both before and after
nursing education (Beattie, Algase & Song, 2004; Nailon,
Scott & Benjamin, 2007). Nutritional status and weight
maintenance were not measured in this study, however will
be considered for potential projects. In the future, ways to
disseminate the education package to speech pathologists
in the community will be considered, for implementation in
community hospitals, hostels and nursing homes.
Limitations
This study did not control for speech pathology attention,
making it difficult to attribute the results to the education
package alone. It would be beneficial in future to compare
multiple groups – a group that receives education, a group
that does not, and a group that receives speech pathology
attention (unrelated education) – in attempt to further
scrutinise how the education package improves nursing
knowledge and referral appropriateness. Chang and Lin
(2005) compared a control and treatment group, with
nursing staff in the treatment group receiving comprehensive
feeding skills training. They found a considerable difference
between the groups in knowledge and attitude towards
people with dementia, and were able to attribute these
results to their program.
Table 1. Results of pre and post education
questionnaires
% correct % correct
pre in-
post in-
service service
Q:
What is dysphagia?
87% 100%
A:
Difficulty swallowing food, fluid or saliva
(32.5/37)
(25/25)
Q:
What percentage of people with
13% 84%
dementia experience feeding difficulties? (5/37)
(21/25)
(multiple choice)
A:
80%
Q:
What complications might arise if feeding 86% 92%
difficulties are not managed
(32/37)
(23/25)
appropriately? (multiple choice)
A:
Dehydration, weight loss & malnutrition
Q:
Do you need to refer a patient if they eat 59% 88%
non-food items?
(22/37)
(22/25)
A:
No
Q:
Do you need to refer a patient if they
91% 92%
cough while eating and drinking?
(34/37)
(23/25)
A:
Yes
Q:
Do you need to refer a patient if their
56% 100%
dentures have been left at home?
(21/37)
(25/25)
A:
No
Q:
Do you need to refer a patient if they
40% 88%
eat /drink very slowly?
(15/37)
(22/25)
A:
No
Q:
Do you need to refer a patient if they
89% 100%
have voice changes during meals?
(33/37)
(25/25)
A:
Yes
Q:
Do you need to refer a patient if they have 8% 100%
been transferred from a nursing home on (3/37)
(25/25)
modified diet and thickened fluids?
A:
No, unless not managing pre admission
diet and fluids
Q:
Encouraging exercise prior to meals can 73% 84%
stimulate appetite (T/F)
(27/37)
(21/25)
A:
True
Q:
Offering fruit juice prior to meals does
46% 80%
not stimulate appetite (T/F)
(17/37)
(20/25)
A:
False
Q:
If a person is spitting out food during
73% 88%
meals, offering intake in liquid form can
(27/37)
(22/25)
help (T/F)
A:
True
Q:
If a person has left neglect, you should
65% 96%
assist from their right (T/F)
(24/37)
(24/25)
A:
True
Q:
ALL people without teeth should be
40% 60%
offered a minced/moist diet (T/F)
(15/37)
(15/25)
A:
False
Q:
What percentage of people with dementia 30% 76%
are unable to feed themselves?
(11/37)
(19/25)
(multiple choice)
A:
50%
Note.
Number of correct responses out of the total number of responses
are reported in brackets.