What knowledge do CNA’s have of feeding techniques in nursing homes?
In a study conducted in the AJSLP, it was found that CNA’s overall had poor knowledge of technical skills, safety, and communication across all facilities studied.
Feeding Techniques:
Most CNA’s did demonstrate use of verbal/physical prompts for feeding, wiping the face, and removing food from clothing.
They were also aware of choking or coughing and difficulties with chewing food. A wet or gurgly voice was only mentioned by one CNA in the study.
Overall they demonstrated adequate knowledge.
Communication Skills:
CNA’s had limited knowledge of how to communicate with the residents while they were feeding them.
The CNA’s spoke mainly only to residents who spoke back, but were quiet with the ones who didn’t speak.
Overall:
CNA’s had limited information on knowledge of dysphagia and how to feed the residents.
The researcher noted that although the professional can be educated on proper feeding techniques and communication, research has shown that this will not necessarily improve their techniques. It is known in the literature that asking a health care worker to change his/her practice techniques is difficult.
She suggests improving feeding skill techniques with a combination of education and supervision.
For more information on this article, please see the journal as noted below.
Thanks for reading.
Kim
Pelletier, C.A. (2004). What do Certified Nurse Assistants Actually Know about Dysphagia and Feeding Nursing Home Residents? American Journal of Speech-Language Pathology, 13, 99-192.
Kudos to you, Cujo. You are very right. CNAs do most of the patient care in most nsg home settings. They are also the least paid, least equipped and least respected. Perhaps this is why turn over is so high.
Nevertheless, some basic anatomy and physiology provided on the job can really help CNAs understand and prevent dysphagia. CNAs aren’t stupid, as you well point out. Because of the nature of their work they are called on to implement the recommendations of physicians, RNs, PTs, OTs, Speech Pathologists, registered dieticians and who knows who else. That’s a lot of specialities. Few of those making recommendations actually see the patient on a daily basis. That’s why it is so important to listen to, train and equip CNAs to do their very demanding jobs.
A study like the one discussed above is not intended to point out the deficiencies of CNAs, but to point out that what some people think is common knowledge and common practice is not necessarily obvious to those doing direct care. In that case, improved education is the key.
Best,
David White, SLP
I am a 58 yr old CNA – I have found through experience that most CNA’s know how to feed, however, I do know of a patient of mine that I do have diffuculty feeding – my recourse is chit-chat and stroking the throat to get the natural responses working – also to do chin tucks and in one particular case to keep the patients head up and straighjt to allow the passage to accept and be able to swallow the food – and by the way, this is with a alert and oriented person times 3, the pt did not realize what she was doing, weeble wobble, the head falls down, and you can end up with a case of aspiration. We are not all stupid – and I usually talk my patients to death, and they do not have a clue that they are actually eating everything I present to them – whatever works is acceptable, nutrition and hydration are the most important aspects of feeding – All CNA’s are not stupid and your comments are leading towards that direction – I have personally witnessed LPN’s and RN’s that do not have a clue how to feed, they open mouth insert food – the ability to know how to feed a patient and how to get the patient to swallow comes from knowlege, one on one with the pt, and the willingness to be able to encourage the pt to eat, not pocket and swallow. Unforttutelly the LPN and Rn are paperwork monitors and pill pushers – they have lost the ability to be nurses and that is not there fault it is the trail of paperwork – the CNA’s have to to the ADL’s and charting to an extent – and in my nursing home it is becomming mind boggling – The unfortunate aspect of this whole blog thing is that CNA’s are the minds and the ears of the nurses – nurses pass pills, CNA’s know the patients/residents – we hear the aspiration, we know when a pt is drowning in their own fluids, I can suction a pt in distress and have done so when I could not find my nurse, but immediately reported to the nurse my actions , and this is only because we are there, we are not in a total paperwork jungle. I love my work and I do believe that CNA’s need a minimum of LPn training to do their job – inservice hours are a joke – there is no training there. However, CNA’s do not make the money that nurses make – some of can not afford to support a household and go to school, there are only so many hours in a day – If the Nurses would Lobby and encourage the lawmakers to provide additional nursing training to CNA’s it would help immensly, let the licensed staff push pills – we can do the rest,up to and including the crash cart, cpr, heimlich manuever – I tell my nurse when my pt is in respiratory distress – when they are ready to code – and of course the answerfrom administration is always GO TO SCHOOL< BECOME A NURSE< but some on us do not want to go there, being a nurse means you loose the ability to provide direct patient care – in most facilities, and patient care is where you learn the patient on a daily basis. Yes, we change diapers, we wipe up poopy, that is not the good aspect of the job, but nurses beware – we do tell the nurse when a patient has a UTI or CDIF, SCABIES, DVT's and TIA's only because we provide direct one on one care, that the nurse does not have the time to do,. We do not always have the time but one on one makes you know the diffence, Don't put the CNA's down – Most CNA's know the ropes, (The bad CNA's are ultimately forced out by the other CNA's – we do believe in sticking together) and jump through more hoops than you do. But I would encourage all nurses to lobby for additional OJT training for CNA's – that would make everyones job easier and provide better patient care and hopefully less liability issues for CNA's Nurses, DONS, administration , owners etc. Just my Opinion. Cujo