Hand-Feeding Nursing Facility Residents with Dementia Competency Training Modules

Abstract

<h3>Introduction</h3> Problem: In nursing homes around 70% of residents have some form of dementia and are at risk of malnourishment (Zimmerman et al., 2014). In this long-term care (LTC) unit, residents have varying degrees of cognitive impairment (CI) affecting their functional capabilities, including their capacity to feed themselves. The director of nursing (DON) identified that residents are vulnerable to decreased food and fluid intake, and this problem may reflect the limited feeding skills of direct care workers (DCWs). More than half of the staff in this LTC unit report that it is a challenge to assist a resident with dementia during mealtimes when they exhibit difficult feeding behaviors. The majority of staff report that one of the greatest challenges when assisting a resident with mealtimes is resistance to eating demonstrated by residents turning their head away or not opening their mouths. Only one staff member on this unit reports having additional training on feeding assistance, and only one staff member uses assistive hand-feeding techniques when assisting a resident with CI during mealtimes. Evidence supports staff training as in intervention, however no specific training has been implemented to improve DCW's feeding assistance. Purpose: The purpose of this quality improvement (QI) project is to implement and evaluate the evidence-based <i>Hand-Feeding Nursing Facility Residents with Dementia</i> training within a LTC setting, to ameliorate DCWs feeding assistance skills, enhance the mealtime experience, and improve residents' health outcomes. <h3>Methods</h3> The QI project was developed by project leaders with the help of content expert and creator of the evidence-based training program titled <i>Hand-Feeding Nursing Facility Residents with Dementia</i>. The project included nine DCWs that were chosen to participate by the DON and worked during a shift that required the provision of assisting residents with a meal. The participants completed a pre-training survey and baseline interview with project leaders to assess knowledge and use of assistive handfeeding techniques. The participants were provided online access to the training modules on topics of assessment of residents' functional and cognitive abilities, determining the most appropriate handfeeding technique, mealtime challenges associated with residents with CI, and strategies to manage feeding behaviors to promote meal intake. A train-the-trainer strategy was utilized, and the project champion was trained on the competency modules and how to perform the post-training skill checks. Participants completed the online competency modules, and the project champion completed the post-training skills checks. After the competency training modules were completed, participants completed the post-training survey and final interview with project leaders to report their utilization of learned assistive handfeeding skills and techniques, and improvement in residents' meal intake and feeding behaviors. <h3>Results</h3> Preliminary Results: Preliminary findings suggest that completion of the <i>Hand-Feeding Nursing Facility Residents with Dementia</i> competency training modules, improves DCW's utilization of assistive hand-feeding skills and techniques to better assist residents with dementia during mealtimes. <h3>Conclusions</h3> Preliminary Conclusions: The <i>Hand-Feeding Nursing Facility Residents with Dementia</i> competency training course enhanced DCWs' mealtime interactions with residents with dementia, and residents' nutritional status will be improved as a result of project implementation. <h3>Funding</h3> No funding was available.