The Development and Operationalization of a Mealtime Enhancement Training Video for Long-Term-Care Homes


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  • Didactic experience –(5 minutes) Sabrina?
    Background to the project (5 minutes) Sabrina ?
    Video presentation (13 minutes)
    Study & Results (10 minutes) Roseann ?
    Future Plans (5 minutes) Allison?
    Questions (10 minutes) all three
    (putting a couple small marshmallows under the tongue and holding them in place, try to eat a soda cracker to mimic the inability to full use their tongue fully).
  • (Mention that those who are allergic to marshmallows and the crackers can’t take part)
    Dysphagia (impaired swallowing) is a common problem for residents in LTC, and this really impacts a resident’s ability to eat and participate in a healthy mealtime experience.
  • I decided to rename this the smores exercise (minus chocolate). Because, its just so much more appealing this way. We unfortunately, don’t have chocolate for you but we all have great imaginations so we can pretend.
    This is one of several exercises that I will use with staff in LTC so they experience what it feels like to have a difficult time eating. They type of inservices are nice as they’re hands on and can help care-staff better relate to residents needs at meal-times. It also leads to a lot of laughing and bonding amongst colleagues. You are not obliged to do this exercise if you feel uncomfortable but I assure you its a lot of fun.
    (Doing this myself- so place one or two marshmallows under your tongue. No chewing or biting them. Just keeping them held under your tongue. This is to mimic
  • Today we’re going to describe a mealtime management training video that was developed within RQHR, the rationale for development of this tool, the process of creating the video, and responses from the initial evaluation of this video as a training tool
    The video is an educational- training intervention that focuses on 3 key areas of mealtime assistance: creating the proper physical and social environment for mealtimes, ensuring proper positioning of residents during mealtimes, and the key role of trusting, respectful relationships in the mealtime experience in LTC.
  • Lack of standardized mealtime education in SK long-term care homes.b) Residents eating in an unsafe manner, with a less dignity and respect than warranted, and unnecessary risk for malnutrition and dysphagia.c) One dietitian responsible for mealtime education to over 1100 staff at 8 different care-homes, in addition to resident care responsibilities. Lack of time to educate all staff and re-educate or achieve a ‘culture change’ to enable person-centered mealtime care, combined with the same questions/concerns being asked or observed inspired the solution for a more efficient method to reach everyone
    a) Dissemination of this free person-centered mealtime education resource across Canada within the next year. b) Improved safety and atmosphere in dining rooms at meals resulting in lower rates of malnutrition (cost savings) and improved quality of life for elders. Also, reduced wastage from food un-eaten due to factors such as temperature, improper texture, lack of assistance etc. All of this could be positive to not only residents but also to families and staff as many complaints in LTC are related to food or meal-times
  • Healthy Resident Focused care-home =
    Healthy work Culture for staff
    Staff Feel valued
    And empowered
    (really high warmth survey results)
    Me- CNS, strong team where my manager was supportive of my visiion, more of an upstream approach in a clinical position.
    Medical Media- RQHR – videographer who was flexible and very open minded and worked closely with me. Make me the “director” even though at the time I knew what I thought was nothing about directing.
    Leaders within the teams at all levels – care-staff to CEO’s
  • Thorughout the process we took an interdisciplinary approach: experts included other RDs, OT, social work, care aides, nurses, SLP, food service supervisors, dif department managers --- wanted a holistic, inclusive approach of all of those involved in the LTC health team
    The end product is a 12 minute video BUT,
    The process to get to that end product is substantially MORE than 12 minutes!
    Before we could even begin the video production we had to attend to all the logistic details like agreements within the region, consents from staff and residents at the LTC, and scheduling. The script development process took a number of months and the content was reviewed by several LTC experts within and external to the region, including RDs and a number of other health care providers.
    Then filming and video editing, again with feedback from experts and non-experts (non-healthcare affiliated people), then voiceover work and the final product.
    All tolled, it took about a year to develop.
  • So, now we’re going to play a short clip from the video. The twelve minutes in length so unfortunately we don’t have enough time to show it in its entirety, but this will give you a taste of the video’s quality and content (no pun intended!).
  • We invited all residents, volunteers, families, staff, and anyone else involved in the project for an evening where we presented the project and previewed the video. Mostly, an evening of celebrating together… . Such an important method to thank everyone and leave them with the desire to do a future project should one arise. ……
    ****Mention the sense of pride that the whole LTC home had, excitement, residents dressed up etc
  • We received a great deal of feedback about the video from family members, from LTC staff within RQHR and also from the LTC RDs who were involved in the development, as well as from other stakeholder agencies who are interested in using the video.
    We’ve had a high amount of demand for the video from across Canada a few places in the US – solely based on word of mouth, sight-unseen. To us, this really demonstrates the strong need for this type of educational tool in LTC.
    We’d like to briefly share some of the responses we’ve had to the video.
  • Sara Brunner is a LTC RD from Ontario
  • Four dietetic interns completed a study to examine knowledge acquisition as a result of viewing this video
  • The last section of questionnaire had a series of open-ended questions. The questions are listed on this slide.
    The questions focused on how staff can help residents, how to help maintain independence, and why it is important to be seated when assisting residents.
    Because this section used open-ended questions, we identified the main themes from the participant responses. So let’s get into those themes.
    Some of the participant answers are listed here on the slide.
    The themes that were apparent to us were: paying close attention to changes in food consumption and swallowing ability, helping to prevent choking and assisting at mealtimes.
  • After watching the video, we saw several apparent themes in addition to the original answers.
    These themes included communication, relationship building, allowing adequate time for residents to enjoy their meals, and showing respect and dignity for residents. These themes were all highlighted in the video.
    Some examples of responses in addition to those listed here include:
    Giving the resident you full attention at mealtimes
    Treating residents with respect
    Creating a welcoming atmosphere
    This section showed that most staff believe they can improve mealtimes in their facility.
  • Our next step is a national evaluation project. We have just received our ethical approval and are about to begin recruitment
    We will advertise for participant LTC homes through the DC gerontology network, aiming for 40 LTC homes with at least 25 staff participating per home so a min of 1000 participants viewing the video and then completing a validated evaluation scale.
    As well, we will be doing an in-depth examination of the video’s content as it pertains to dementia care. Many residents in LTC have a form of cognitive impairment (estimations between 60-80% of LTC), making this an important aspect to consider. The video is general to LTC, and through this study we hope to better understand how it can help with dementia care, or what additional training/information is needed to better care for residents with dementia.
    As soon as that is underway the video will be made available widespread --- RQHR is committed to this being a non-proprietary tool available for widespread use.
  • The QI process can be a long road, and we are only partway through the journey. The next steps are key and will ……
  • The Development and Operationalization of a Mealtime Enhancement Training Video for Long-Term-Care Homes

    1. 1. Initial Findings from the Development & Operationalization of a Mealtime Enhancement Training Video for LTC Staff Sabrina Bovee, RD; Allison Cammer, MSc, RD; Roseann Nasser, MSc, RD Regina Qu’Appelle Health Region and University of Saskatchewan #QS14
    2. 2. Faculty/Presenter Disclosure Faculty: Sabrina Bovee, Allison Cammer, Roseann Nasser Relationships with commercial interest: •No relationships to disclose
    3. 3. Disclosure of Commercial Support • This program has received financial support from RQHR to produce the video • This program has received in-kind support from RQHR and University of Saskatchewan in the form of employee time Potential for Conflict(s) of Interest: •No potential conflicts of interest to disclose
    4. 4. Outline • Background • Hands-on Exercise • Video Development • Video Clip • Initial Feedback • Initial Research • Future Plans • Discussion
    5. 5. Nutrition and Eating in Long-term Care • LTC residents are at an increased risk for malnutrition • Mealtimes serve multiple roles • Food and eating are integral to quality of life
    6. 6. Dysphagia Simulator What might it feel like to have a difficult time eating?
    7. 7. “Smores” Exercise!! 1) Hold 1-2 marshmallows under your tongue 2) Eat 1-2 crackers 3) Think about the sensory experience of eating
    8. 8. Mealtime Enhancement Training Video
    9. 9. Inspiration for this video -No standard for mealtime education -Residents eating without dignity, high rates of malnutrition, dysphagia… -Can’t be in 8 places at once!
    10. 10. Background Budget: $0.00 Passion + creativity + partners = Video ?
    11. 11. Strong Teams in the Region
    12. 12. Outside Partnerships: Edge Acting Agency Local Makeup studio Wintergreene Friends and Family
    13. 13. Making the Video • Content research • Logistics (consents, scheduling, etc) • Draft Script, expert review, revise script, review, revise, review, revise… • Filming • Draft Video, expert review, revise, review, revise, review, revise… • More filming, revising, voice-overs, polishing • Final video Having fun!
    14. 14. Video Clip
    15. 15. Film Premiere
    16. 16. Initial Responses •Family members •LTC Staff: care-staff, recreation, nursing, RDs, house-keeping, home- care, FSS, F&N staff, client rep, nurse educators, admin/leadership •Other: Alzheimer's society, SIAST, CEO’s of LTC homes outside RQHR •High amount of demand…
    17. 17. Maintenance worker, Extendicare LTC “ This video provides a thorough overview of the key aspects of dining in long term care, a very important moment in time for our residents. Dining, when delivered as this video represents, provides the opportunity for our residents to make choices and socialize with dignity and respect - what better way to enhance the quality of life of our elders?” “ I learned a lot! Helpful for ALL staff to watch” Cheryl George , Education Leader
    18. 18. Lani Antoine, R.N Home Care “Nutrition is the base for a foundation of health. This video is a reminder for caregivers and support staff how to provide a safe and enjoyable meal time experience to our clients. The empathy we display directly impacts the client's quality of care and healthcare experience as a whole. By using a multidisciplinary approach and encouraging independence; we can make a difference! Thank you for the education and insightful tips to assist us in providing care that we can feel proud of!” “Relevant, concise, and informative; a great tool for those already working in and starting in LTC” “Relevant, concise, and informative; a great tool for those already working in and starting in LTC” Sara Brunner, LTC RD
    19. 19. Family member “Very comprehensive! I think new and existing staff should all watch this video. I have seen staff “shovel” food into my mother. Staff should re-watch this regularly, even every 3 months. I worked on a safety team and just like CPR you forget things over time. This could be a great refresher. This video could work with peer assessments too. Where staff are paired up, maybe with a mentor, and ask themselves: are my colleagues doing things like in the video? Could give them positive feedback!” “What we love about the video is that it is not just about nutrition but stresses the importance of mealtimes being person directed. Eating is one of the great pleasures of life, an important part of a full and abundant life.” Suellen Beatty, CEO Sherbrooke Community Center, Saskatoon
    20. 20. Initial Evaluation Pre-test QuestionnaireQuestion: What is the knowledge of staff working in LTC regarding mealtime management principles and practices before and after watching the educational video? 7 Demographic 5 True/False 5 True/False 1 Multiple Choice 1 Multiple Choice 4 Open-Ended 4 Open-Ended
    21. 21. Initial Evaluation  Female  Over 50 years old  In their current role for 5+ years  CCAs Participants (n=30)
    22. 22. Results
    23. 23. Open-Ended Questions •How can staff help residents maintain their independence and dignity at mealtimes? •What are the reasons staff should sit when helping residents eat at mealtimes? •What can you do to help residents at mealtimes? •Pre-test - What are some things you would like to learn from the Mealtime Management video? •Post-test - After watching the video, if you knew it was easy to change, what would you do differently in your care home? “It’s our responsibility to take care and watch them any time, especially if they’re in the mealtime, because they might choke” “It’s our responsibility to take care and watch them any time, especially if they’re in the mealtime, because they might choke” Pre-test
    24. 24. Post-test themes showed an increase in awareness of the importance of: Communication Building relationships Allowing adequate time for residents to enjoy their meals Showing respect and dignity for residents “All staff is responsible for assisting in any way they can” “Mealtimes are EVERYONE’s job ” “Engage residents in the experience” Results Themes Post-test
    25. 25. Future Plans • National Evaluation • 40 LTC homes recruited through Dietitians of Canada Gerontology network • Validated evaluation scale • In-depth examination of the video in relation to dementia care • Widespread use
    26. 26. Key components • Critical area of need • Expertise available and motivated • Supportive leadership • Teamwork and partnerships • Investment in evaluation • Passion project
    27. 27. Questions? Contact Me: Sabrina Bovee, RD RQHR #QS14