ACQ Vol 11 no 2 2009

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 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 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.

Natasha Matheson and Crystal Ensell

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

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ACQ Volume 11, Number 2 2009

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