养老护理员吞咽障碍管理知识与技能的调查研究
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摘要
目的 :从理论知识和实践行为两个角度调查养老护理员吞咽障碍管理能力现状,为我国养老机构进行吞咽障碍管理提供参考。方法 :采用吞咽障碍管理知识问卷调查湖南省30所养老机构358名养老护理员的知识水平;采用结构性喂食观察表,观察记录87名养老护理员对老年人的喂食行为。结果 :吞咽障碍管理知识得分为(15.84±3.69)分,正确率最低的条目为"进食水样液体最安全";喂食行为中,养老护理员完全做到"给老年人选择进食顺序机会"的例数最少,为3例(4.4%)。结论:应针对性地开展知识技能培训,完善饮食服务流程和管理标准,以规范养老护理员服务行为,提升养老服务质量。
Objective: To investigate the knowledge and practical behavior of dysphagia management of geriatric nursing assistants, and to provide references for dysphagia management in nursing home in China. Methods: Totally358 geriatric nursing assistants from 30 nursing homes in Hunan province was investigated by Dysphagia Management Knowledge Questionnaire, and the feeding behavior of 87 geriatric nursing assistants were observed and recorded based on the Structural Feeding Observation Table. Results: The score of dysphagia management knowledge was 15.84±3.69, and the item "Watery liquids are the safest substances to drink" got the lowest correct rate. In the feeding behavior, only 3 geriatric nursing assistants(4.4%) completely "offers choice in what sequence food and beverage is fed". Conclusion: It is necessary to strength targeted knowledge and skills training, and improve food service processes and management standards, to regulate the service behavior of geriatric nursing assistants, and improve the quality of aged care service.
Objective: To investigate the knowledge and practical behavior of dysphagia management of geriatric nursing assistants, and to provide references for dysphagia management in nursing home in China. Methods: Totally358 geriatric nursing assistants from 30 nursing homes in Hunan province was investigated by Dysphagia Management Knowledge Questionnaire, and the feeding behavior of 87 geriatric nursing assistants were observed and recorded based on the Structural Feeding Observation Table. Results: The score of dysphagia management knowledge was 15.84±3.69, and the item "Watery liquids are the safest substances to drink" got the lowest correct rate. In the feeding behavior, only 3 geriatric nursing assistants(4.4%) completely "offers choice in what sequence food and beverage is fed". Conclusion: It is necessary to strength targeted knowledge and skills training, and improve food service processes and management standards, to regulate the service behavior of geriatric nursing assistants, and improve the quality of aged care service.
引文
[1]韩维嘉,孙建琴,谢华,等.老年吞咽障碍者营养与生活质量的现状.中国老年学,2014,6(34):3438-3440.Han WJ,Sun JQ,Xie H,et al.Life quality and nutrition situation in of dysphagia in elders.Chin JGerontol,2014,6(34):3438-3440.
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[3]宁璞,杨菁菁,孙铁英,等.住院老年人吸入性肺炎患病率及其危险因素分析.中华老年医学杂志,2017,36(4):428-432.Ning P,Yang JJ,Sun TY,et al.Analysis of prevalence rate and risk factors for aspiration pneumonia in elderly inpatients.Chin J Geriatr,2017,36(4):428-432.
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[14]Nakashima T,Maeda K,Tahira K,et al.Silent aspiration predicts mortality in older adults with aspiration pneumonia admitted to acute hospitals.Geriatr Gerontol Int,2018,18(6):828-832.
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[16]窦祖林,郭铁成.回眸2013吞咽障碍康复,期待学科快速发展.中华物理医学与康复杂志,2013,35(12):913-915.Dou ZL,Guo TC.Review of the dysphagia rehabilitation in 2013 and expect it to rapidly develop.Chin J Phys Med Rehabil,2013,35(12):913-915.
[17]王如蜜,张亮,张长杰.如何在综合医院开展摄食-吞咽障碍康复工作.中华物理医学与康复杂志,2013,35(12):988-992.Wang R M,Zhang L,Zhang CJ.How to develop the work of aliment-swallowing barrier rehabilitation.Chin J Phys Med Rehabil,2013,35(12):988-992.
[18]Watkins R,Goodwin VA,Abbott RA,et al.Attitudes,perceptions and experiences of mealtimes among residents and staff in care homes for older adults:a systematic review of the qualitative literature.Geriatr Nurs,2017,38(4):325-333.
[19]Bennett MK,Ward EC,Scarinci NA.Mealtime management in Australian residential aged care:comparison of documented,reported and observed care.Int J Speech Lang Pathol,2015,17(5):451-459.
[20]Bennett MK,Ward E,Scarinci N,et al.Perspectives on mealtime management in residential aged care:insights from a crossdisciplinary investigation.J Nutr Gerontol Geriatr,2014,33(4):325-339.
[21]Steele CM,Alsanei WA,Ayanikalath S,et al.The influence of food texture and liquid consistency modification on swallowing physiology and function:a systematic review.Dysphagia,2015,30(1):2-26.
[22]王如蜜,陈建设,郝建萍,等.国际吞咽障碍食物标准.北京:北京科学技术出版社,2018.Wang RM,Chen JS,Hao JP,et al.International dysphagia diet standardization.Beijing:Beijing Science and Technology Press,2018.
[23]Batchelor-Murphy M,Amella EJ,Zapka J,et al.Feasibility of a web-based dementia feeding skills training program for nursing home staff.Geriatr Nurs,2015,36(3):212-218.
[24]沈志云,陈利群.培训者培训模式在健康教育中的应用现状.中华护理杂志,2015,50(10):1250-1253.Shen ZY,Chen LQ.Rewiew of the application of train-the-trainer model in health education.Chin JNurs,2015,50(10):1250-1253.
[2]窦祖林.吞咽障碍评估与治疗.2版.北京:人民卫生出版社,2017.Dou ZL.Assessment and treatment of dysphagia.2nd ed.Beijing:People's Medical Publishing House,2017.
[3]宁璞,杨菁菁,孙铁英,等.住院老年人吸入性肺炎患病率及其危险因素分析.中华老年医学杂志,2017,36(4):428-432.Ning P,Yang JJ,Sun TY,et al.Analysis of prevalence rate and risk factors for aspiration pneumonia in elderly inpatients.Chin J Geriatr,2017,36(4):428-432.
[4]Lanspa MJ,Jones BE,Brown SM,et al.Mortality,morbidity,and disease severity of patients with aspiration pneumonia.J Hosp Med,2013,8(2):83-90.
[5]Sura L,Madhavan A,Carnaby G,et al.Dysphagia in the elderly:management and nutritional considerations.Clin Interv Aging,2012(7):287-298.
[6]Chang E,Brownhill S,Bidewell J,et al.Focus on feeding!Evaluation of a framework for maximizing mealtime in aged care facilities.Int JNurs Pract,2015,21(3):269-277.
[7]湖南老龄办.2015年度湖南省老龄事业发展统计公报.(2016-10-12)[2018-09-01].http://www.cncaprc.gov.cn/contents/37/177178.html.Department of Civil Affairs of Hunan Province.The 2015 of statistical bulletin on aging development.(2016-10-12)[2018-09-01].http://www.cncaprc.gov.cn/contents/37/177178.html.
[8]Rhoda A,Pickel-Voight A.Knowledge of nurses regarding dysphagia in patients post stroke in Namibia.Curationis,2015,38(2):1564.
[9]Pelletier CA.What do certified nurse assistants actually know about dysphagia and feeding nursing home residents.Am J Speech Lang Pathol,2004,13(2):99-113.
[10]Lok YW.Nursing home care workers'knowledge in dysphagia management:effectiveness of a training programme.Hong Kong:University of Hong Kong,2012.
[11]Chan HK.Dysphagia management of elderly in nursing home:skills and knowledge of frontline staff.Hong Kong:University of Hong Kong,2013.
[12]Baijens LW,Clave P,Cras P,et al.European society for swallowing disorders-European Union Geriatric Medicine Society white paper:oropharyngeal dysphagia as a geriatric syndrome.Clin Interv Aging,2016(11):1403-1428.
[13]Ortega O,Sakwinska O,Combremont S,et al.High prevalence of colonization of oral cavity by respiratory pathogens in frail older patients with oropharyngeal dysphagia.Neurogastroenterol Motil,2015,27(12):1804-1816.
[14]Nakashima T,Maeda K,Tahira K,et al.Silent aspiration predicts mortality in older adults with aspiration pneumonia admitted to acute hospitals.Geriatr Gerontol Int,2018,18(6):828-832.
[15]长沙市民政局.长沙市养老机构服务基本规范.CSCR-2015-09004.(2015-05-09)[2018-09-01].https://www.changsha.gov.cn/xxgk/gfxwj/smzj/201505/t20150522_727900.html.Ministry of Civil Affairs of Changsha.Basic service specification of nursing homes in Changsha.CSCR-2015-09004.(2015-05-09)[2018-09-01].https://www.changsha.gov.cn/xxgk/gfxwj/smzj/201505/t20150522_727900.html.
[16]窦祖林,郭铁成.回眸2013吞咽障碍康复,期待学科快速发展.中华物理医学与康复杂志,2013,35(12):913-915.Dou ZL,Guo TC.Review of the dysphagia rehabilitation in 2013 and expect it to rapidly develop.Chin J Phys Med Rehabil,2013,35(12):913-915.
[17]王如蜜,张亮,张长杰.如何在综合医院开展摄食-吞咽障碍康复工作.中华物理医学与康复杂志,2013,35(12):988-992.Wang R M,Zhang L,Zhang CJ.How to develop the work of aliment-swallowing barrier rehabilitation.Chin J Phys Med Rehabil,2013,35(12):988-992.
[18]Watkins R,Goodwin VA,Abbott RA,et al.Attitudes,perceptions and experiences of mealtimes among residents and staff in care homes for older adults:a systematic review of the qualitative literature.Geriatr Nurs,2017,38(4):325-333.
[19]Bennett MK,Ward EC,Scarinci NA.Mealtime management in Australian residential aged care:comparison of documented,reported and observed care.Int J Speech Lang Pathol,2015,17(5):451-459.
[20]Bennett MK,Ward E,Scarinci N,et al.Perspectives on mealtime management in residential aged care:insights from a crossdisciplinary investigation.J Nutr Gerontol Geriatr,2014,33(4):325-339.
[21]Steele CM,Alsanei WA,Ayanikalath S,et al.The influence of food texture and liquid consistency modification on swallowing physiology and function:a systematic review.Dysphagia,2015,30(1):2-26.
[22]王如蜜,陈建设,郝建萍,等.国际吞咽障碍食物标准.北京:北京科学技术出版社,2018.Wang RM,Chen JS,Hao JP,et al.International dysphagia diet standardization.Beijing:Beijing Science and Technology Press,2018.
[23]Batchelor-Murphy M,Amella EJ,Zapka J,et al.Feasibility of a web-based dementia feeding skills training program for nursing home staff.Geriatr Nurs,2015,36(3):212-218.
[24]沈志云,陈利群.培训者培训模式在健康教育中的应用现状.中华护理杂志,2015,50(10):1250-1253.Shen ZY,Chen LQ.Rewiew of the application of train-the-trainer model in health education.Chin JNurs,2015,50(10):1250-1253.