ACQ Vol 11 no 2 2009

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.

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ACQ Volume 11, Number 2 2009

ACQ uiring knowledge in speech, language and hearing