Austbø Holteng Lise Birgitte, Frøiland Christina Tølbøl, Corbett Anne, Testad Ingelin
Centre for Age-Related Medicine, SESAM, Stavanger University Hospital, Stavanger, Norway.
University of Exeter Medical School, St Luke's Campus, University of Exeter, Exeter, UK.
Ann Palliat Med. 2017 Oct;6(4):310-318. doi: 10.21037/apm.2017.06.24.
Dysphagia and dementia are conditions, which combined, can lead to complications for the person and require good nutritional care. There is very little evidence-based literature regarding nutritional care for people with dysphagia and dementia. It is clear that care staff plays a vital role, and that communication and informed decision-making are critical to the process, yet little is known regarding the use of available interventions such as texture modified food (TMF), and their acceptability and feasibility for care staff and residents. Therefore the aim of this study was to investigate the experiences of care staff when providing nutritional care for people with dysphagia and dementia, and their impressions and experience of using TMF as a new intervention for nutrition.
This was a qualitative study with an inductive approach, which aimed to explore the experience of care staff using TMF in a care home setting. Data were collected using focus group interviews, an approach which is validated as a means of supporting and developing the understanding of a phenomenon, through interactions and discussions in the group. Participants were care staff working in a care home setting in Norway.
Twelve participants were recruited to this study across two focus groups. The cohort included four nurses, six practical nurses, one nurse assistants and one student nurse. Four main categories emerged from the focus group discussions regarding the use of TMF. These were: (I) emotional strain; (II) deficient nutritional care; (III) increased self-efficacy with use of TMF; (IV) better nutritional care with TMF.
Use of TMF to improve nutritional care for people with dysphagia appears to have merit for both residents and care staff, and should be considered as a means of improving nutritional care for people with dementia in care homes. Minimizing feeding difficulties and increasing nutritional intake is an important goal when caring for this vulnerable group of people, and there is a need to provide better training and support for care staff to ensure they feel confident and empowered to provide high quality nutritional care. The existing Norwegian Directorate of Health checklist for nutritional care may provide a helpful basis for improvements to guidance that accounts for the needs of staff and institutions. Further research and evaluation of an intervention for tailored nutritional care is warranted to improve this critical aspect of dementia care.
吞咽困难和痴呆症这两种病症若同时出现，会给患者带来并发症，因此需要良好的营养护理。关于吞咽困难和痴呆症患者营养护理的循证文献非常少。很明显，护理人员起着至关重要的作用，沟通和明智的决策对这一过程至关重要，但对于质地改良食品（TMF）等现有干预措施的使用情况，以及它们对护理人员和居民的可接受性和可行性，人们却知之甚少。因此，本研究的目的是调查护理人员在为吞咽困难和痴呆症患者提供营养护理时的经历，以及他们对使用TMF作为一种新的营养干预措施的印象和体验。
这是一项采用归纳法的定性研究，旨在探索护理人员在养老院环境中使用TMF的体验。通过焦点小组访谈收集数据，这种方法通过小组内的互动和讨论，被验证为一种支持和加深对某一现象理解的手段。参与者是挪威一家养老院的护理人员。
通过两个焦点小组招募了12名参与者。该队列包括4名护士、6名实习护士、1名护士助理和1名实习护士。焦点小组讨论中出现了关于使用TMF的四个主要类别。它们是：（I）情感压力；（II）营养护理不足；（III）使用TMF后自我效能感增强；（IV）使用TMF后营养护理改善。
使用TMF改善吞咽困难患者的营养护理，对居民和护理人员似乎都有好处，应被视为改善养老院痴呆症患者营养护理的一种手段。在照顾这一弱势群体时，尽量减少喂食困难并增加营养摄入是一个重要目标，需要为护理人员提供更好的培训和支持，以确保他们有信心并有能力提供高质量的营养护理。挪威卫生局现有的营养护理检查表可能为改进考虑到工作人员和机构需求的指南提供有益的基础。有必要对量身定制的营养护理干预措施进行进一步的研究和评估，以改善痴呆症护理的这一关键方面。
