An interventional study of 12 week feasibility study in Dementia, sponsored by Duke University. Completed. Open to participants aged 18 Years and older. Per ClinicalTrials.gov, last updated 2017-04-04.
Sponsored by Duke University · Not applicable, Interventional, and Supportive care
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.
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.
2,172 studies on the registry are indexed under Dementia; 540 are open to participants now.
This study's planned enrollment of 132 is above the median of 83 across 1,629 interventional studies indexed under Dementia.
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Nursing Home staff participants must be:
Persons With Dementia participants must be:
Exclusion Criteria:
PWD:
The 2 NH's not used in the focus groups will receive the intervention, a 12-week feasibility study. At baseline, weeks 6 and 12, dementia feeding skills knowledge and self-efficacy tests will be administered, meal observations of nursing staff assisting PWD with meals will be video recorded for 3 meals over 2 days at baseline and again at week 6 and 12, and a medical record review will be conducted. After baseline data is collected, the training program will be delivered in 5 weekly modules with group coaching sessions completed the same week.
Behavioral: 12 week feasibility study
Year 1 focus groups will aim to identify how nursing staff feel about usual interventions for feeding behaviors of PWD and staff responses when a PWD displays difficult eating behaviors. Year 2 focus groups will evaluate the revised dementia feeding skills training program, the coaching interventions, and case scenarios, and indicate how realistic and compatible the intervention is with their work environment.
: At baseline, weeks 6 and 12, dementia feeding skills knowledge and self-efficacy tests will be administered, meal observations of nursing staff assisting PWD with meals will be video recorded for three meals over two days, and a medical record review will be conducted to ascertain technical and adaptive interventions also in place for the PWD (e. g., high density protein supplements, appetite stimulant medications, weighing, diet texture modifications). After baseline data is collected, the training program will delivered in five weekly modules with group coaching sessions completed the same week
Change in Feeding Skills Knowledge Test
10 item multiple choice test administered in paper/ pencil format to nursing staff assisting with feeding persons with dementia (Scores range from 0-10)
Time frame: Baseline (before training program), Week 6 (after training program), and Week 12
Change in Feeding Skills Self-Efficacy Test
10 items with likert scale response administered to nursing home staff
Time frame: Baseline (before training program), Week 6 (after training program), and Week 12
Functional Rating Scale for Symptoms in Dementia
14 categories related to functional ability of PWD (e. g., eating and dressing ability, emotionality, memory). Each category scores 0-3. Totals range from 0-42; higher score indicative of greater impairment
Time frame: 12 weeks
Brief Inventory of Mental Status
Part of Minimum Data Set (MDS) 3.0. 5 sections of cognitive ability questions scored 0-2; scores of 0-12 considered moderate to severe cognitive impairment.
Time frame: 12 weeks
C3P Feeding Skills Checklist
Multi-item checklist of feeding skill behaviors grouped around changing the person, place or people. Each section is given numerical value.
Time frame: 12 weeks
Food Intake Record
Meal intake documented by pre-post meal tray weight as well as documentation of hand feeding techniques used during the meal.
Time frame: Collected for 3 meals over 2 days at Baseline, Week 6 and Week 12
Edinburgh Feeding in Dementia (EdFED) scale
Scale measuring aversive feeding behaviors on a 0-20 scale of 10 items. Higher scores equal more aversive feeding behaviors.
Time frame: Collected for 3 meals over 2 days at Baseline, Week 6 and Week 12
Time Spent Feeding
Time spent feeding was measured in hours and minutes via stopwatch.
Time frame: Collected for 3 meals over 2 days at Baseline, Week 6 and Week 12
No study locations are listed for this record.
This study is completed, as verified in Mar 2017. You cannot join it, but the record below documents what was studied.
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