1. Icap Research proposal
Rebecca rose

2. Experiences and perceptions of care home staff looking after older adults with dysphagia who are eating and drinking at risk

3. background
Swallowing difficulties ‘dysphagia’ = prevalent in the elderly population (O'Rourke, 2014)
Some possible consequences: chest infections, choking, coughing, distress, reduced oral intake
Some people with dysphagia (PWD) will not be fully safe with any oral intake and are at risk if they continue to eat and drink, but are not appropriate for non-oral feeding via tube to the stomach
Currently described as “feeding at risk”, “risk feeding” (Hansjee, ), or “comfort feeding” (Palecek, 2010)

4. Literature review
No studies identified with the aim of addressing perceptions or experiences of paid carers/nursing staff about what it is like to manage PWD eating and drinking at risk in care homes
4 studies found = investigated perceptions and experiences of people caring in some capacity for PWD
2 focus on nursing staff, 1 looks at partners of PWD, 1 includes family and staff members (in an acute hospital)
All studies took place outside of the UK

5. My aims
SLTs assess PWD who are eating and drinking at risk, make recommendations, and discharge
We have limited understanding of what it is like for care home staff to provide ongoing daily care for those eating and drinking at risk
Research proposal aims to address this gap and explore the experiences and perceptions of care home staff in this situation
Use the results to:
- inform local SLTs about training needs in care homes
- inform the development of a questionnaire to be used in a further study to gather data from a larger sample

6. Research design Research design: Sampling: Qualitative approach↓
Paradigm / philosophy / theoretical perspective:
Constructivist / interpretive
Participants construct meaning (Creswell, 2009).
Strategies of inquiry / research methodologies:
Qualitative descriptive
Describes the participants' experience in a language similar to their own (Neergaard et al., 2009).
Sampling:
Purposeful
Maximum variation sampling ↓
Research methods:
Open-ended questions
Focus groups
Practices:
Bringing personal values:
- from my perspective as an SLT and visiting care homes as part of my clinical work
- wanting to use data to inform training and support for care home staff
Research design

7. Data collection
2 focus groups, one for care staff and one for nursing staff
Staff from across different care homes
Nursing and care staff grouped separately due to differences in roles and responsibilities and potential power imbalance
Semi-structured interview guide with questions initially generated by researcher then refined through expert review (experienced SLTs).
Focus groups carried out in a neutral setting

8. Data analysis
Inductive content analysis using coding systems that are closely linked to the data
Aim to present situation from the point of view of the participants as far as possible
Coding carried out with the aid of a software package such as NVivo
Data categorised using a transparent protocol
Descriptive statistics used where appropriate to summarise

9. Summary
Nursing and care staff in care homes provide oral intake to people with dysphagia who are eating and drinking at risk
There are no studies which directly investigate this experience
An exploratory study is proposed using qualitative descriptive methodology to learn more about this experience for staff in local care homes
This would start to fill the gap in knowledge, improve training and support for care staff, and develop an appropriate questionnaire for a further study

10. references
Creswell, J.W. (2009) Research design: qualitative, quantitative, and mixed methods approaches. Thousand Oaks, California: Sage.
Hansjee, D. (2015) 'Risk feeding: The story continues', RCSLT Bulletin, September 2015, 761, pp
Neergaard, M., Olesen, F., Andersen, R. and Sondergaard, J. (2009). ‘Qualitative description – the poor cousin of health research?’ BMC Medical Research Methodology, 9 (1). DOI: /
O'Rourke, F., Vickers, K., Upton, C. and Chan, D. (2014) ‘Swallowing and oropharyngeal dysphagia’, Clinical Medicine, 14(2), pp
Palecek, E.J., Teno, J.M., Casarett, D.J., Hanson, L.C., Rhodes, R.L., and Mitchell, S.L. (2010) ‘Comfort feeding only: a proposal to bring clarity to decision-making regarding difficulty with eating for persons with advanced dementia’, The American Geriatrics Society, 58(3), pp. 580– 584.