Mealtime Symptoms in Dementia: Adaptive Leadership Approaches
试验速览
- 阶段
- 不适用
- 状态
- 已完成
- 入组人数
- 132
- 主要终点
- Change in Feeding Skills Knowledge Test
研究概览
简要总结
The purpose of this study is to combine current evidence-based guidelines with adaptive leadership (AL) training to assist nursing staff to navigate the delicate balance of necessary technical and adaptive work to improve problematic dementia-related mealtime symptoms.
详细描述
Currently, basic training programs do not adequately teach nursing home (NH) staff to handle behavioral symptoms at mealtime that typically accompany dementia. When persons with dementia (PWD) exhibit mealtime symptoms (e.g. turning away of the head, pushing food away), these symptoms may be interpreted as lack of interest in eating, and feeding attempts ceased. This misinterpretation poses serious health risks to PWD including under-nutrition and increased risk for more aggressive medical treatment (e.g. feeding tube). The Aims of this study are to: 1) Identify the adaptive leadership challenges of NH staff for alleviating mealtime symptoms for PWD; 2) Determine NH staff evaluation of a dementia feeding skills training program that combines adaptive leadership approaches with technical approaches to mealtime symptoms; and 3) Conduct a 12-week feasibility study implementing this dementia feeding skills training program with NH staff, linking training to resident outcomes. Focus groups will be conducted in four NHs during which NH staff will describe adaptive challenges around: mealtime symptom recognition, communication patterns, typical responses to mealtime symptoms, and feelings when interventions are met with success or failure. Focus group interviews will be transcribed and content analysis conducted. Findings from the focus group interviews will be used to revise a dementia feeding skills program. The revised training program will be evaluated by NH staff to determine how NH staff perceives the coaching intervention, and if case scenarios are realistic and compatible with current workplace practices. The training program will be implemented in two skilled NHs over a five week period. NH staff outcomes include mealtime knowledge and self-efficacy. Through meal observations, NH staff will be assessed for time spent assisting with feeding and feeding skill behaviors; and PWD outcomes assessed by quantifying meal intake and aversive feeding behaviors. Findings from this study will describe adaptive leadership challenges for NH staff, revise and implement a training program teaching NH staff adaptive and technical interventions for alleviating mealtime symptoms for PWD in the NH setting.
研究设计
- 研究类型
- Interventional
- 分配方式
- Randomized
- 干预模型
- Parallel
- 主要目的
- Supportive Care
- 盲法
- None
入排标准
- 年龄范围
- 18 Years 至 —（Adult, Older Adult）
- 性别
- All
- 接受健康志愿者
- 否
入选标准
- •Nursing Home staff participants must be:
- •18 years of age or older,
- •able to read and write English,
- •willing to sign informed consent,
- •employed as a Registered Nurse, Licensed Practical Nurse, Certified Nursing Assistant, part of the Nursing Home Administration team, or part of the therapy team.
- •Persons With Dementia participants must be:
- •a resident (> 6 wks) of NH,
- •60+ years of age,
- •able to speak English in order to give assent,
- •have a positive Minimum Data Set 3.0 for: Active disease diagnosis of Alzheimer's Disease or dementia,
- •require extensive assistance to total dependence for eating,
- •have a Brief Interview for Mental Status (BIMS) score ranging from 0-12 (lower score indicates greater cognitive impairment)37, and
- •have a legally authorized representative (LAR) able to read English in order to provide informed consent for the PWD.
排除标准
- •Minimum Data Set 3.0 positive for: Human Immunodeficiency Virus (HIV) Infection, Parkinson's Disease, and/or Traumatic Brain Injury,
- •any swallowing disorder,
- •parental/ IV feedings, or presence of a feeding-tube;
- •any significant auditory or visual impairment that would prevent the PWD from hearing/seeing verbal/visual cues.
结局指标
主要结局
Change in Feeding Skills Knowledge Test
时间窗: Baseline (before training program), Week 6 (after training program), and Week 12
10 item multiple choice test administered in paper/ pencil format to nursing staff assisting with feeding persons with dementia (Scores range from 0-10)
Change in Feeding Skills Self-Efficacy Test
时间窗: Baseline (before training program), Week 6 (after training program), and Week 12
10 items with likert scale response administered to nursing home staff
次要结局
- Brief Inventory of Mental Status(12 weeks)
- Functional Rating Scale for Symptoms in Dementia(12 weeks)
- C3P Feeding Skills Checklist(12 weeks)
- Food Intake Record(Collected for 3 meals over 2 days at Baseline, Week 6 and Week 12)
- Edinburgh Feeding in Dementia (EdFED) scale(Collected for 3 meals over 2 days at Baseline, Week 6 and Week 12)
- Time Spent Feeding(Collected for 3 meals over 2 days at Baseline, Week 6 and Week 12)