Evaluating a novel approach to enhancing dysphagia management: workplace-based, blended e-learning.

AIMS AND OBJECTIVES: To evaluate the learning effect and resource use cost of workplace-based, blended e-learning about dysphagia for stroke rehabilitation nurses. BACKGROUND: Dysphagia is a potentially life-threatening problem that compromises quality of life. In many countries, nurses play a crucial role in supporting the management of patients with swallowing problems, yet the literature reports a need for training. DESIGN: A single-group, pre- and post-study with mixed methods. METHODS: Each blended e-learning session comprised a needs analysis, e-learning programmes, practical skills about modifying fluids and action planning to transfer learning into practice. Participants were the population of registered nurses (n = 22) and healthcare assistants (n = 10) on a stroke rehabilitation ward in a large, teaching hospital in England between August 2010-March 2011. Data collection comprised observation (34 hours), questionnaires administered at four time points to examine change in attitude, knowledge and practice, and estimating the resource use cost for the service. Nonparametric tests and content analysis were used to analyse the data. RESULTS: All participants achieved a nationally recognised level of competence. The learning effect was evident on the post- and follow-up measures, with some items of dysphagia knowledge and attitude achieving significance at the p ≤ 0·05 level. The most common self-reported changes in practice related to medicines management, thickening fluids and oral hygiene. The resource use cost was estimated at £2688 for 108 hours training. CONCLUSIONS: Workplace-based, blended e-learning was an acceptable, cost effective way of delivering essential clinical knowledge and skills about dysphagia. RELEVANCE TO CLINICAL PRACTICE: Dysphagia should be viewed as a patient safety issue because of the risks of malnutrition, dehydration and aspiration pneumonia. As such, it is pertinent to many members of the interdisciplinary team. Consideration should be given to including dysphagia management in initial education and continuing professional development programmes.

Medication management in patients with dysphagia: a service evaluation.

The administration of medicines to patients with dysphagia presents substantial challenges to patient safety. Within stroke services, where up to half of patients may experience dysphagia, ensuring safe medication management is particularly challenging. This article describes how best practice within one stroke unit is being achieved by means of a knowledge-to-action service improvement project, ongoing education and training, and the input of a specialist dysphagia practitioner.

Embedding nursing and therapy consultantship: the case of stroke consultants.

AIMS AND OBJECTIVES: As the basis for the design of career development opportunities for current and aspiring nursing and therapy consultants, we aimed to explore the factors that shape how these roles have embedded in UK stroke services. BACKGROUND: The non-medical consultant role has been introduced into UK health care services to provide opportunities for experienced practitioners to progress their careers in clinical practice. Whilst there have been evaluations of the impact of the role on service delivery, little attention has been paid to the pathways towards consultantship. DESIGN: An exploratory design, incorporating focus group discussions, was used to address the research questions. Participating consultants, both nurses and allied health professionals, worked in stroke services, although it is anticipated that the results will have wider application. METHODS: Two focus groups were held with non-medical consultants in stroke from across the UK. Participants had the opportunity to comment on an interim paper prior to publication of the results. Thirteen consultants took part in the study. RESULTS: A lack of consensus about the nature of clinical expertise and a diverse range of pathways towards consultantship were identified. Health care policy had presented the opportunity for consultants to be entrepreneurial in the development of stroke services, although this had limited the scope for the development of professional knowledge. Inflexible programmes to support aspiring consultants may limit the opportunities to develop these entrepreneurial skills. CONCLUSIONS: This study challenges health care organizations and the education and research departments that support them to think creatively in the way that the non-medical consultant role is embedded, and that this should draw on the commitment of existing consultants to support succession planning. RELEVANCE TO CLINICAL PRACTICE: The identification of those aspects of career pathways that current consultants have found to be helpful will be useful in designing opportunities for aspiring consultants.