What do certified nurse assistants actually know about dysphagia and feeding nursing home residents?

The purpose of this study was to examine certified nurse assistants' (CNAs') knowledge of dysphagia and how to feed nursing home residents using nonparticipatory structured feeding observation, critique of staged feeding behaviors on film, and semistructured interview in a triangulation methods design. Content analysis of the data confirmed previous studies that suggested CNAs lack knowledge about dysphagia and how to feed residents. A surprising result was the lack of accurate, comprehensive information in CNA texts and classrooms about dysphagia and how to manage challenging feeding behaviors. Speech-language pathologists are uniquely trained to improve CNA communication skills and provide accurate information to nursing colleagues. Specific recommendations of how to improve CNA feeding training programs are provided.

Observations on the prevalence of protein-calorie undernutrition in VA nursing homes

OBJECTIVE

To determine the prevalence of underweight and hypoalbuminemia in Veterans Affairs nursing home residents and the frequency with which physicians, nurses, and dietitians documented their awareness of the presence of underweight and hypoalbuminemia.

DESIGN

Retrospective survey of medical records.

SETTING

Twenty-six Department of Veterans Affairs nursing homes located in the Department's Central Region.

PATIENTS

2811 residents.

MAIN OUTCOME MEASURES

(1) Prevalence of underweight (defined as body weight less than 80% of standard) and hypoalbuminemia (defined as serum albumin less than 3.5 g/dl); (2) frequency with which physicians, nurses, and dietitians documented the prevalence of underweight and hypoalbuminemia in the records.

RESULTS

Three hundred thirty-two (11.8%) of the patients were underweight and 772 (27.5%) were hypoalbuminemic. The prevalence of the two conditions varied widely across nursing homes. The prevalence of low serum albumin ranged from 5% to 58% in the 26 institutions, and the prevalence of body weight less than 80% of standard ranged from 2% to 20%. In the Region as a whole, the dietician's notes in the medical charts mentioned underweight in an average of 95% of affected cases but mentioned the suboptimal albumin level in only 82% of the hypoalbuminemic individuals. In the nurses's notes, these figures were only 80% and 45%, respectively, and in the physician's notes, only 62% and 46%, respectively. The frequency of documented awareness of underweight and hypoalbuminemia by nurses and physicians varied tremendously across the 26 facilities (as few as 7% of the undernourished cases in one nursing home, 100% of the affected individuals in another).

CONCLUSIONS

This study showed a high prevalence of calorie and protein undernutrition in the nursing home residents of VA nursing homes, wide variation in the prevalence across nursing homes, and frequent lack of documentation of these nutritional deficiencies by physicians and nurses.