| Summary: | This project evaluates the effectiveness and impact of a feeding assistance programme ‘Making Meal Times Better for those with a Dementia’ (MMB) supported by five sixty minute health professional led support forums as compared to a three hour MMB standalone version and control conditions for health care assistants (HCAs) working with residents with a dementia and oral feeding difficulties. Outcomes were evaluated for 90 participating health care assistants and 451 observed meal times across three nursing homes. Measures of staff knowledge, competency, attitudes and daily care practices were measured using self completion questionnaires alongside observations of the quality of and adequacy of mealtime feeding assistance pre- and five months post intervention, using purposive sampling. HCAs who participated in support forums maintained significantly better knowledge and competency scores five months following training compared to those who received the stand-alone three hour MMB training programme and control conditions. Observations of mealtimes revealed that the nursing home exposed to greatest duration of training demonstrated most improvement in the provision of quality feeding assistance: actively identifying and providing targeted feeding assistance to those residents deemed at risk of malnutrition and relocating more residents into the communal dining room. Beneficial changes were accompanied by a significant reduction in social stimulation. Control conditions demonstrated several changes in feeding behaviours which may be attributed to attempts to increase oral intake without sufficient training. Training increased the food consumption of those residents at risk of malnutrition but did not increase food consumption overall or the high levels of stress and guilt experienced by HCAs. Lack of social cueing and less than five minutes of feeding assistance were correlated with increased risk of malnutrition across nursing homes. A paucity of HCA documentation of oral intake in medical records suggests an organisational barrier to the translation of HCA knowledge to the wider healthcare team.
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