Development and effectiveness of dementia-specific careful hand feeding training workshop for Community Nurses in NTWC

Abstract Description

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Authors (including presenting author) :

Wong SYI (1), Kwan CY(1),TMH Department of Speech Therapy (1), NTWC Community Geriatric Assessment Service (2)

Affiliation :

(1)TMH Speech Therapy Department, (2) NTWC Community Geriatric Assessment Service

Introduction :

Hong Kong is facing challenges of rapid population growth and aging. By 2039, it is projected that 11% of persons aged 60 and above would be suffering from dementia. Feeding and swallowing problem are common in dementia which may result in a substantial risk of malnutrition and dehydration (Yu et al., 2012). Aversive feeding behaviors in moderate to late stage of dementia also make mealtime management challenging for frontline staff. In view of many pitfalls with tube feeding, careful hand feeding has been proposed as an alternative feeding option for advanced dementia adults. Education and training of health care team members are crucial in managing feeding issues in dementia (American Geriatrics Society Ethics Committee and Clinical Practice and Models of Care Committee, 2014). Recent study showed that staff education program facilitated care delivery and improved the execution of activities of daily living including feeding for dementia patients in community (Bauer et al., 2018). Therefore, training program for community nurse, including CGAS & CNS nurses who play an important role in guiding and supporting to caregivers, bridges the gap of delivering feeding care plan from hospital to community.

Objectives :

This study aims to evaluate the effectiveness of dementia-specific careful hand feeding skills training program for CGAS and CNS nurses on their knowledge and skills of feeding in dementia population.

Methodology :

In 2017 & 2018, dementia-specific careful hand feeding skills training workshops were held for CGAS & CNS nurses in New Territories West Cluster (NTWC). The training program was run by speech therapists of NTWC. The workshop consisted of didactic lecture on the overview and update on swallowing and feeding management of dementia population; in conjunction with practicum of careful hand feeding skills and hand feeding skills targeting behavioural feeding problem. A knowledge-based written quiz was used to evaluate the effectiveness of the program. The quiz focused on: 1. knowledge on swallowing and feeding management of dementia population; and 2. techniques for handling dementia-related feeding problem and careful hand feeding cases. Furthermore, satisfaction survey was used to collect participants’ opinion on the workshop.

Result & Outcome :

A total of 66 CGAT nurses & CNS nurses from NTWC joined the careful hand feeding skills training program in 2017 & 2018. A comparison of the participants’ pre and post-workshop knowledge based written quiz were performed. The score of post-feeding workshop test (Mean = 9.7) was significantly higher than pre-test score (Mean = 7.26) and Wilcoxon Signed-Ranks Test indicated the improvement was statistically significant (Z= -6.454, p< 0.05). Workshop satisfaction survey’s response rate was 98.5%. Analogue scale was used for the survey. More than 90% respondents reported that the workshop can enhance their understanding on swallowing and feeding disorders in dementia and awareness on careful hand feeding skills for this population. The careful hand feeding skills training program for community nurses was found to be effective in improving participants’ knowledge and skills in handling careful hand feeding patients. In future, this type of program can extend to frontline staff to facilitate the corresponding management in hospital setting.