An exploration of the "feeding partnership" between patients with late stage dementia and nursing staff
This study explores the nature of feeding partnerships between patients with late stage dementia and nursing staff. Twelve video dyads, consisting of four female patients and three members of their nursing team, were recorded during feeding. All twelve videos were made during the midday meal, within the normal nursing environment of the continuing care ward of a psychogeriatric unit. The videos were transcribed using an adapted conversation analysis technique. A number of small scale studies were carried out on the data. A correlation was found between the amount and type of speech used by the members of staff and the amount of food successfully fed to the patients. Demarcation of feeding was lost when there were high levels of speech, suggesting that staff members' communication should be task related so as to enable feeding cues to be detected. The findings were interpreted against a summary model which was then reconfigured into three stages. The roles of the members of nursing staff and the speech and language therapist were conceptualised and three key components of intervention during feeding portrayed. The model emphasises the staff-patient partnership and the direct and indirect influence the speech and language therapist exerts on this. Suggestions are made for further exploration and future research including communication and feeding profiles, analysis of different demarcation processes and the development of a demarcation hierarchy. Such an intervention would relate equally to other clinical areas such as neurology and learning disabilities. A number of factors were identified which challenge current speech and language therapy practice, including the link between interaction and successful feeding. It is advocated that dysphagia and communication therapies should be placed on opposing ends of a continuum rather than being viewed as separate constituents to speech and language therapy intervention. By proposing such a continuum it is possible to see how therapy can be targeted at the specific, task related interaction that is necessary for successful feeding.
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