Vol.36 (Education 2013, pp.67-72 http://dx.doi.org/10.14257/astl.2013 Educational Needs and Provision of Preventive care for Dysphagia by the caregivers in Elderly Medical Welfare Facilities 1 Kim, Mi-Ran, 2 Han, Su-Jeong 1 Konyang University, mrkim@konyang.ac.kr *2 Konyang University, sjhan@konyang.ac.kr * Corresponding Author: Han, Su-Jeong Department of Nursing, College of Medicine, Konyang University 158 Kwanjeodong-ro, Seogu, Daejeon-si, Rep. of Korea 302-718 Tel: +82-42-600-6344 Fax: +82-42-600-6314 E-mail: sjhan@konyang.ac.kr Abstract. The purpose of this study was to identify the degree of educational needs and provision of preventive care for dysphagia by the caregivers in elderly medical welfare facilities. Participants were 131 caregivers working at the elderly medical welfare facilities in Daejeon. Data collection was done from September 9, 2013 to September 23, 2013. Descriptive statistics ANOVA with Scheffe's test with the SPSS for Windows 15.0 program was used to analyze the data. The mean score of caregivers nursing education needs for dysphagia was 4.07 with a possible range of 1 to 5. Practice of preventive nursing was 3.81 out of a total score of 5. According to the above results, the caregivers educational needs were high, and the practice of preventive care was high. The results of this study suggest that a need for formal guidelines on preventive care for dysphagia in elderly medical welfare facilities. Therefore, it should be considered in developing continuing education program to increase caregivers practice. Key words: Aged, Facility, Education, Dysphagia 1 Introduction Elderly people over 65 years old in Korea account for 12.2%, which indicates Korea has already entered into an aging society, and problems derived from old population chronically increasing has long been a major issue to solve(statistics Korea,2013. Dysphagia (swallowing difficulty is a growing health concern in our aging population. Age-related changes in swallowing physiology as well as age-related diseases are predisposing factors for dysphagia in the elderly (Sura, et al., 2012. ISSN: 2287-1233 ASTL Copyright 2013 SERSC
Vol.36 (Education 2013 Dysphagia contributes to a variety of negative health status changes; greater mortality, malnutrition, dehydration, poorer risk of complications such as aspiration pneumonia (Guyomard et al., 2009; Kim et al., 2011; Sura, et al., 2012. Dysphagia ranges from 12% amongst hospitalized patients to 68% amongst older people in institutions. It is becoming a major problem in medicine adherence because of the increase in the older population; for example, they account for over one-third of prescribing volume in the United Kingdom (Kelly, D Cruz & Wright, 2009. In the US, dysphagia affects 300,000-600,000 persons yearly. Although the exact prevalence of dysphagia across different settings is unclear, conservative estimates suggest that 15% of the elderly population is affected by dysphagia (Sura et al., 2011. In the Korea, dysphagia ranges from 19.1% to 43.5% amongst older people in facilities (Park, J. A., 2011. Dysphagia increases with age, mainly owing to the presence of concomitant disease processes (Kim et al., 2011; Morris, 2012; Sura, et al., 2012. These figures indicate that dysphagia is a common problem and many caregivers are likely to have a degree of dysphagia which needs to be identified and managed effectively (Morris, 2012. This study examined the degree of educational needs and provision of preventive care for dysphagia by the caregivers in elderly medical welfare facilities. 2. Method 2.1. Study design This study assesses the educational needs and provision of preventive care for dysphagia by the caregivers in elderly medical welfare facilities. 2.2. Sampling and Data collection Data of the subjects for this study are the data of 131 participants from random sampling. The total participants in this study were 131 caregivers work in 3 facilities which were Daejeon City in South Korea from October 9 to October 23, 2013. Data were collected using face to face interview with a structured questionnaire. The participant in this study, who consented to participate in this study, understood the purpose of this study, and had the complete capacity to verbally communicate in Korean. It took 20-25 minutes to complete the questionnaire. 2.3. Instruments Provision of preventive care for dysphagia: In order to determine the provision of preventive care for dysphagia, a tool of the 20 questions was used which was developed by Han (2013. 5-point Likert scale was used. Higher score means good provision of preventive care for dysphagia. Cronbach's α was.82 in this survey. 68 Copyright 2013 SERSC
Vol.36 (Education 2013 Educational needs: The modified the tool of Kim et al. (2011 and Bang & Park (2013 was used. It consists of 11 questions with the 5-point Likert scale. Higher score means higher needs in the education. In this survey, the Cronbach's α coefficient was.92. 2.4. Data Analysis The data were analyzed using the SPSS Win 15.0 program. Descriptive statistics was determined for all demographic variables. Cronbach s alpha reliability coefficients were used to estimate internal consistency and reliability of the tools. Provision of preventive care for dysphagia and educational needs were analyzed using means and standard deviations. The differences in degree of provision of preventive care for dysphagia and educational needs were analyzed using ANOVA and Scheffe s test for post-hoc test. 2.5. Ethical consideration Standard ethical and legal points were followed regarding the use of reporting subjects in research; salient, relative points were explained to all subjects. These guidelines included: participants right to withdraw from the project, anonymity, limitations on the use of resulting data, use for research and or academic purposes only, and the possible destruction of sensitive materials. 3. Result 3.1. Demographic characteristics of participants Of the 131 respondents, 100% were female and 54.3% had received less than high school education. Their mean age was 50.61 years (SD = 8.43. As for the question on needs of preventive care for dysphagia, Very need was 71.5%, and Need was 26.3%. As for importance, Very importance was 72.3%, Importance was 25.5, indicating most of the respondents replied they important to preventive care for dysphagia. 3.2. Provision of preventive care for dysphagia Table 1 displays descriptive statistics for the provision of preventive care for dysphagia. The provision of preventive care for dysphagia was significantly related to the respondent s position (F=6.021, p=.003. Scheffe s test showed that the nurses have a higher level of provision of preventive care for dysphagia than home care aids. Copyright 2013 SERSC 69
Vol.36 (Education 2013 Table 1. Provision of preventive care for dysphagia Nurse a (n=36 Nurse Aid b (n=37 Home care aid c (n=58 Variables Mean(SD Mean(SD Mean(SD Practice preventive nursing dysphagia Assessment Intervention Education of for 4.00(0.42 3.84(0.35 3.68(0.46 3.79(0.45 3.70(0.38 3.76(0.43 3.91(0.48 3.79(0.34 3.54(0.37 4.29(0.48 4.02(0.56 3.75(0.94 F(p 6.021(.00 3 0.457(.63 4 10.463(<. 001 6.052(.00 3 (N=131 Schef fe test a,b> c 3.3. Educational needs of preventive care for dysphagia Table 2 displays descriptive statistics for the educational needs of preventive care for dysphagia. The educational needs of preventive care for dysphagia was not significantly related to the respondent s position (F=1.501, p=.227. But in the subcategories, assessment, side effects, treatment, oral care, posture, exercise, feeding care, and medication care were significantly related to the respondents position. These items showed that the nurses have a higher level of educational need for dysphagia than home care aids. Table 2. Educational needs of preventive care for dysphagia Nurse a (n=36 Nurse Aid b (n=37 Home care aid c (n=58 Variables Mean(SD Mean(SD Mean(SD Educational Needs for dysphagia 4.16(0.65 4.32(1.61 3.84(1.54 Definition 3.83(0.89 3.72(1.03 3.48(1.19 (N=131 F(p 1.501(.227 1.341(.265 Scheff e test 70 Copyright 2013 SERSC
Vol.36 (Education 2013 Risk factors 4.13(0.71 4.00(0.89 3.73(1.10 2.179(.117 Sing & 1.962(.145 4.13(0.71 4.02(0.84 3.76(1.07 symptoms Assessment 4.24(0.72 3.83(0.77 3.60(1.13 5.119(.007 Side effects 4.18(0.70 4.11(0.70 3.64(1.18 5.014(.008 Treatment 4.29(0.66 4.16(0.65 3.62(1.10 7.739(.001 Oral care 4.18(0.73 4.13(0.76 3.71(0.96 4.457(.013 Posture 4.18(0.70 4.27(0.70 3.75(1.00 4.519(.013 Exercise 4.21(0.71 4.16(0.73 3.57(1.15 6.948(.001 Feeding care 4.24(0.72 4.25(0.69 3.83(0.84 3.802(.025 Medication 4.042(.020 4.18(0.73 4.25(0.69 3.78(1.02 care a,b>c a,b>c 4. Discussion According to the results of this study, indicating most of the respondents replied it is important to preventive care for dysphagia and need to learn about the preventive care for dysphagia. This is the same as previous studies (Park, 2010. The mean score for provision of preventive care for dysphagia was on 3.81 within the range of 1 to 5. This is the same as Han (2013 and Park et al. (2006 studies. The nurses have a higher level of provision of preventive care for dysphagia than home care aids. The mean score for educational needs score was 4.07 within the range of 1 to 5. In the subcategories, assessment, side effects, treatment, oral care, posture, exercise, feeding care, and medication care were significantly related to the respondents position. These items showed that the nurses have a higher level of educational need for dysphagia than home care aids. The respondents wanted education on preventive care for dysphagia. The results of the study indicate a need for formal guidelines on preventive care for dysphagia in elderly medical welfare facilities, education on caregivers, and the development of education programs for caregiver on the high priority of educational need to preventive care for dysphagia. Copyright 2013 SERSC 71
Vol.36 (Education 2013 5. Conclusion This results show that participants educational needs score was 4.07 within the range of 1 to 5. The mean score for provision of preventive care for dysphagia was on 3.81 within the range of 1 to 5. In conclusion, this results show that the participants educational needs of dysphagia and the provision of preventive care were high. This study suggests that a need for formal guidelines on preventive care for dysphagia in elderly medical welfare facilities. Therefore, it should be considered in developing continuing education program to increase caregivers practice. References 1 Statistics Korea, from http:// www.kostat.go.kr, 2013. 2 Morris, H., How to recognize dysphagia and provide support Nursing & Residential Care, 14,10, pp. 522-525, 2012. 3 Kim, N. H., Kwon, Y. S., Lee, M. A., Lee, K. H., & Kwak, H. W., A study on the nutritional status, symptoms, and information needs in stroke patients with dysphagia Journal of Korean Biological Nursing Science, 13, 1, pp. 72-80, 2011. 4 Sura, L., Madhaban, A., Carnaby, G., & Crary, M. A., Dysphagia in the elderly: management and nutritional considerations Clinical Interventions in Aging, 7, pp. 287-298, 2012. 5 Kelly, J., D Cruz, G., & Wright, D., Patients with dysphagia: experiences of taking medication Journal of Advanced Nursing, 17, ppl 82-91, 2009. 6 Guyomard, V., Fulcher, R. A., Redmayne, O., Metcalf, A. K., Potter, J. F., & Myint, P. K., Effect of dysphasia and dysphagia on inpatient mortality and hospital length of stay: a database study Journal of the American Geriatrics Society, 57, 11, pp.2101-2106, 2009. 7 Bang, H. L. & Park, Y. H., Development of evidence-based dysphagia nursing care protocol for nursing home residents Journal of Muscle Joint Health, 20, 1, pp.31-42, 2013. 8 Park, J. A., The prevalence and related factors of dysphagia at a long-term care facility Master's Thesis, Seoul National University, Seoul, 2011. 9 Park, Y. H., Dysphagia care Journal of Korean Dysphagia Society, 1, 1, pp.50-53, 2011. 10 Han, J. H., The influence of geriatric hospital nurses knowledge, and preventive attitude on practice of preventive nursing for dysphagia Master's Thesis, Korea National University of Transportation, 2013. 11 Park, H. T., Kim, Y. A., & Hwang, H. Y., The importance and performance of nursing interventions perceived by nurses in long-term care facilities for elderly Journal of Korean Academy Nursing Administration, 12, 2, pp. 189-195, 2006. 12 Park, M. S., Educational needs in the provision of oral care by nursing staff in long-term care facility for elderly people Journal of Korean Gerontology Nursing, 12, 1, pp.72-80, 2010. 72 Copyright 2013 SERSC