Prof Jennie Wilson1, Prof. Heather Loveday1, Ms Alison Tingle1, Ms Hannah Griffin1
1University Of West London, Ealing, United Kingdom
Introduction: Dysphagia affects up to 70% of nursing home residents and incorrect management can result in choking and aspiration pneumonia.
Methods: A qualitative descriptive and developmental design was used in two large care homes in London. The Theoretical Domains Framework (TDF)and COM-B frameworks were used to guide observations, key informant interviews and develop a safety behaviour survey (SBS). A sample of 250-300 completed survey responses was required for confirmatory factor analysis (CFA). Qualitative interview data were analysed using framework analysis.
Results: Interviews were conducted with 21 key informants. The following themes were developed from these interviews:
- Knowledge, skills, and beliefs about capabilities
- Professional role identity and decision making
- Environmental context and resources
- Emotional Impact of Caring
- The concept of a DLP
Descriptive analysis of 93 responses used TDF domains. Missing data ranged from 2-11 missing responses per item. A skew towards strongly or agree or agree responses suggested confirmation bias and CFA was discarded. Staff reported being confident in their knowledge/skills in helping residents with dysphagia but less confident about managing coughing/choking. Education on dysphagia was limited and staff were unaware of safe swallowing (SS) strategies; coughing during eating/drinking were not always recognised. Assisting residents to eat/drink is time consuming, adding pressure to limited workforce resources.
Conclusion: Safer swallowing care for residents with dysphagia is essential to prevent aspiration and reduce the risk of pneumonia. Staff have limited knowledge and training on how to manage SS and workforce and system issues are barriers to improvement.
Biography: Professor of Evidence-based Healthcare, Director of Research at the Richard Wells Research Centre, and Director of the JBI Centre for Evidence-based Healthcare at the University of West London.
A national and international leader in the field of infection prevention and control and patient safety, Heather has been at the forefront of translational research and evaluation of implementation, and lead author of national evidence-based guidelines for the prevention of HCAI in England. She is widely published in the field of infection prevention and control practice and is a past president of the Infection Prevention Society