JCPSLP Vol 16 no 3 2014_FINAL_WEB

Table 3. Thematic categorisation of focus group data

Major themes

Subthemes

Examples

Peer support

Sharing tips and ideas

Information and training

Dysphagia and meal assistance

Induction workshop is valued Need for regular training and updates, e.g., at annual staff training days Need for regular information sessions to take into account changing client circumstances Access to responsive and on-site speech pathology Support workers observe changes in swallowing and refer to speech pathologist

Client-specific information

Collaboration

Speech pathology

Others

Effective collaboration with all who support the client is important

Staffing

Supervision of students, casual and new staff

Unsafe practices put clients at risk Responsibility for client safety Importance of compliance

Permanent DSWs

Leadership role

Documentation

Mealtime guidelines

Value of clear, accessible guidelines Documentation of DSW’s ideas

Handover

Need for information when new clients enter service

Informed choice

Contracts assist clients to learn about risks and empower DSWs

Complexities

Acknowledging complexities

Range of complex needs Choice versus risk

Communication barriers

Understanding individual preferences

Making adjustments

Allocating sufficient time to assist Accommodating individual preferences

Equipment

Need for equipment that meets individual needs

Attitudes

Need to foster affirming attitudes towards adults with dysphagia

across the three focus groups and was identified as an important area for continuous improvement. DSWs indicated they valued mealtime guidelines. A suggestion was made to document effective tips and ideas from DSWs. DSWs also identified the need for improved handover processes, particularly when new clients enter a service. Training emerged as a key theme, with consensus among DSWs that training be provided on a regular basis. Some informants suggested annual updates with a focus on client-specific information and information sharing among team members. This theme was corroborated by questionnaire results (see Table 4) in which one of the top three items rated by DSWs as extremely important was that “training be provided for DSWs in mealtime assistance” (16/17). The other two questionnaire items rated most frequently as extremely important by DSWs were that ‘there be greater emphasis on a multidisciplinary team approach to supporting people with disabilities with eating and swallowing difficulties’ (16/17), and “people with disabilities are consulted as much as possible when their mealtime guidelines are being developed” (14/17). Client perspectives The overwhelming theme that emerged from interviews with adults with dysphagia was the importance of understanding

and attending to individual needs and respecting preferences and choice. Seven of the twelve informants provided suggestions for improvements to their mealtime experience. Suggestions included: being assisted first, going out for lunch more often, having a quiet mealtime environment and ensuring support staff are seated, and do not rush meal assistance. Tension between individual preferences and organisational constraints was evident. One adult with dysphagia indicated they did not like having dinner at an early and set time each night. Two indicated they preferred a quiet mealtime environment and acknowledged that this was not always possible. Two adults with dysphagia expressed a dislike for having to wait while DSWs attended to other tasks and one informant indicated they did not like being assisted by casual staff. Family perspectives Sixteen questionnaires from family members were received, representing a 22% response rate. Two key themes emerged: the need for training for DSWs and the importance of understanding and meeting individual needs. The three items rated extremely important at greatest frequency were that “training be provided for DSWs in mealtime assistance” (14/16), “training be provided for DSWs in the preparation of thickened drinks and texture

135

JCPSLP Volume 16, Number 3 2014

www.speechpathologyaustralia.org.au