• Hand-Feeding Nursing Facility Residents with Dementia Competency Training Modules

      Naugler, Ashley M.; Windemuth, Brenda (2021-12)
      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.
    • Implementation of a Mealtime Assistance Training Program for Long Term Care Staff

      Griffin, Joshua W.; Windemuth, Brenda (2021-05)
      Problem: In nursing homes approximately 70% of residents have a form of dementia and are at risk of malnourishment. Long-term care (LTC) facility residents have varying degrees of cognitive impairment affecting their capacity to feed themselves. The director of nursing at the project site identified that residents are vulnerable to decreased food and fluid intake, which may be reflective of limited feeding skills of the nursing staff. Purpose: The purpose of this quality improvement project was to implement an online staff training program for handfeeding of residents with cognitive impairment (CI) in a LTC facility to optimize the mealtime interaction and improve resident health outcomes. Methods: The project was implemented at a LTC facility in rural Maryland with nine staff participants (2 nurses and 7 geriatric nursing assistants), who worked shifts while meals were served. Data collection occurred through pre- and post-training surveys as well as baseline and final (end-of-project) interviews to evaluate the staff’s perception of improvements in the mealtime interaction and enhanced outcomes for residents. Results: Prior to the training, only 11.1% of the staff reported ever having any formal training/education on feeding assistance beyond their basic nursing educational program. All the staff completed the training program and corresponding skill competency checklists. While 100% of the staff reported via the surveys the training as being helpful, only 87% had the opportunity to use any of the skills or techniques from the training. The primary qualitative finding from the final interviews was 100% of staff said the training has or would improve the mealtime experience and nutritional state of residents. Conclusion: The data collected from surveys and interviews confirms that staff participants found the training program for handfeeding of residents with CI to be valuable in improving feeding interactions as well as the nutritional state of residents.
    • Screening for Depressive Symptoms Using the Cornell Scale for Depression in Dementia

      Jono, Yumi; Windemuth, Brenda (2019-05)
      Background: Dementia and depression are two of the most common mental illnesses among the older adults. Some older adults have both diagnoses. The prevalence of depression among those over 65 years of age ranges between 1-5% in the community, 13.5% in those who require homehealth care, and 25% in those residing in long-term and assisted living facilities. Prevalence of depression among older adults residing in long-term facilities or assisted living facilities is a significant issue because the number of these facilities in the United States is increasing. However, it is difficult to assess depressive symptoms in patients with dementia in long-term and assisted living facilities as those patients are often unable to accurately articulate their feelings and thoughts. Local Problem: The provider for residents at an assisted living facility on the east coast currently has the Patient Health Questionnaire-9 as a screening tool for depressive symptoms. The screening for depressive symptoms is not being conducted because most residents have moderate to severe dementia and are unable to answer the questions on PHQ-9. Therefore, there is a need for another screening tool that could be used for those with dementia. Interventions: The purpose of this DNP project was to screen residents at the assisted living facility using the Cornell Scale for Depression in Dementia (CSDD) to identify those who may need intervention and to educate and involve the staff in screening. The CSDD is a screening tool for depressive symptoms that can be used for those with and without dementia. The CSDD is useful because the questions can be answered by those around individuals with dementia. The possible score for CSDD ranges between 0 and 38. The score of 8 is considered a person is presenting with depressive symptoms. Score of 12 and above is considered significant depressive symptoms. Results: Fifty residents were screened using the Cornell Scale for Depression in Dementia. Among those screened, the lowest score was 0 and the highest was 13. The mean score was 5.36 (SD 2.66). Eleven out of 50 residents had CSDD score of 8 or above. All residents with a diagnosis of depression were already receiving a pharmacological intervention. A significant number of residents without diagnosis of were also on pharmacological interventions for other medical diagnoses such as anxiety, insomnia, and Parkinson’s disease Conclusion: The screening for depressive symptoms using CSDD provided a structure to screen residents with dementia. It also provided an objective measurement of residents’ level of depressive symptoms. Having an objective number allows the provider to assess the improvement or progression of depressive symptoms in residents in the future. This assisted living facility had a small number of residents with frequent access to their provider, which may explain a low mean CSDD score and their existing treatments. This screening can be implemented in other facilities that do not have a screen tool or have large volume of patients with dementia, especially in underserved areas. However, the need for screening for depressive symptoms must be assessed prior to the actual screening.