Hand-Feeding Nursing Facility Residents with Dementia Competency Training Modules

Abstract

Problem: Residents with dementia are at a greater risk for developing dehydration and malnutrition due to a decline in cognitive and physical function. The Director of Nursing (DON) at the facility expressed concern for the lack of staff skill to adequately provide hand-feeding assistance to residents with dementia. The DON discussed concern for residents’ risk for malnutrition due to a lack of staff skill. Purpose: The purpose of this quality improvement (QI) project was to implement and evaluate the use of the evidence-based Hand-Feeding Nursing Facility Residents with Dementia competency training modules on assistive hand-feeding techniques within a long-term care setting, to change direct care workers’ (DCW) feeding-assistance behavior. Methods: The methodology included providing DCWs (n=9) with the virtual Hand-Feeding Nursing Facility Residents with Dementia competency training modules, a program codeveloped by Dr. Melissa Batchelor-Murphy with the Texas Health and Human Services Commission and the Texas Health and Human Services Quality Monitoring Program, based on current evidence-based hand-feeding techniques and recommendations. A train-the-trainer strategy was utilized, and a registered nurse project champion was trained on the competency modules and how to perform the post-training skills-check using a competency checklist. Preand post-training surveys as well as baseline and post-training final interviews of the DCWs were completed to evaluate their utilization of skills and perceived benefits of the training. Results: Pre-training, 55.6% of the DCWs reported via a survey that it was a challenge to assist a resident with dementia during mealtimes when they exhibited difficult feeding behaviors. Posttraining, eight (89%) participants reported utilization of the information and skills learned from the training, which they felt improved managing residents’ challenging mealtime behaviors. During a final interview, all the staff reported that the competency training modules were very helpful and beneficial to the residents and their mealtime experience or their nutritional state. Conclusions: Online competency training modules improved DCWs knowledge and skill to provide hand-feeding assistance to residents with dementia. Sustainability of the project was achieved through a train-the-trainer strategy and the DCWs holding each other accountable to continue the practice change.