Taking dysphagia management out of the classroom: A ward-based feeding and swallowing training project.

Abstract

INTRODUCTION The recent Care Quality Commission (2011) report into dignity and nutrition 2011 suggested that only 51% of hospital trusts were fully compliant with Outcome 5: Meeting nutritional needs. The Northamptonshire Healthcare Foundation NHS Trust (NHFT) Adult Speech and Language Therapy Department provides several levels of high quality dysphagia and feeding training to Northampton General Hospital (NGH) staff. They provide dysphagia training (Magnus, 2001) that is designed to increase the swallowing identification, management skills and knowledge base within hospitals. This approach is supported by interprofessional guidelines such as the framework proposed by Boaden, Davies, Storey & Watkins in 2006. It is suggested that this traditional approach to training reduces the likelihood of clients presenting with dehydration, malnutrition, choking and aspiration pneumonia. The Northampton ward based swallowing and feeding training initiative was introduced to provide a sustainable training package that would overcome the two problems that become apparent when training packages are provided within acute trusts. The Northampton package overcame the need for employees to be released from their primary and immediate role of providing patient care and it also accommodated the need to provide training comprehensively enough to reach the majority of NHS employees involved in direct patient care. RESEARCH METHOD This research was conducted in four phases on an acute/rehabilitation stroke unit in Northampton General Hospital: Baseline 1(B1), Teaching 1(T1), Baseline 2(B2) and Baseline 3(B3). NGH and De Montfort University gave ethical approval for the study. In the first baseline phase (B1) four members of nursing staff were asked to answer a feeding and swallowing knowledge questionnaire. In the second phase of this project ward based teaching was provided on eight consecutive working days. Training lasted up to one hour and was delivered by two therapists from the hospital SLT team. The feeding and swallowing awareness training was client centered and was offered to all ward staff. On the tenth day (B2) four members of staff were asked to answer the same questionnaire that had been answered in B1. Two weeks after the completion of the teaching phase, a further four members of staff were asked to complete the questionnaire for the B3 measure. The research design allowed the feeding and swallowing knowledge questionnaires to be completed by different participants. This overcame the problem of unpredictable ward staffing and was intended to capture the widespread increase in knowledge that should result from this type of generic intensive ward based training. SUMMARY OF RESULTS & CONCLUSIONS All twelve questionnaires were analysed independently without reference to the phase in which they had been produced. After the questionnaires had been scored they were sorted back into the phase in which they had been produced and the results from each phase were compared. Initial quantitative and qualitative analysis suggested that the training had significantly improved the feeding and swallowing knowledge of ward staff in this busy general hospital. It also suggested that this improvement was maintained two weeks after the training programme had been completed. As the training package proved successful the scheme is being extended to more hospital wards to see if the success of the pilot study can be replicated hospital wide. REFERENCES Bixley, M., Blagdon, B., Dean, M., Langley, J. & Stanton, D. (2011) In search of consensus on aphasia management. Royal College of Speech and Language Therapists Bulletin, October, 18-20. Boaden, E. & Davies, S., Storey, L., & Watkins, C. (2006) Interprofessional Dysphagia Framework. www.uclan.aca.uk/facs/health/nursing/research/groups/stroke Care Quality Commission (2011) Dignity and Nutrition Inspection Programme. Newcastle upon Tyne: Care Quality Commission. Magnus, V. (2001) Dysphagia training for nurses in an acute hospital setting – a pragmatic approach. International Journal of Language and Communication Disorders, 36, 375-378