[Dysphagia] training CNA's

[joanneaton at charter.net (JoAnn Eaton)]

Get yourself scheduled for a mandatory in-service. Sometimes the facility 
will videotape it for those who can't attend. You develop a handout related 
to dysphagia and they can get credit for a one-hour in-service for their 
licensing if they take a post-test of a few basic questions. I also promise 
treats. . . little do they know.

Experienced, long-empoyed CNAs in the facilities have learned not to sit 
close to where I do the in-service because I usually pick someone close to 
be my "resident" during the interactive part of the in-service.
We cover positioning, bite size, etc. in the lecture portion with me using 
examples of real residents and explain the "why" of certain recommendations. 
Then the fun begins. I've already passed out the juice and cookies or rolls, 
etc. Whatever the treat is to be. As I discuss positioning, there will be 
one close at hand who is slouched as she listens. So, I bring a clean glass 
of water over as I'm moving around the front of the room and say, "This is 
why positioning is so important" and grab my "victim" and start giving her 
the drink. While I do this, I may talk to the CNA next to her and don't look 
directly. If I notice a problem with this in the dining room, I'll even 
start talking to the CNA about someone (made up name NOT on staff) getting 
wasted over the weekend or complaining about how someone wasn't helping like 
they should. (They get the picture about appropriate communication.) Usually 
there is a startle reaction from the person getting the drink. Then I ask 
her to describe how she felt about being served in that way. It's a great 
opportunity to talk about positioning, mental prepping the resident for 
what's coming, etc. Then I have her sit upright and model the "perfect" 
feeding assistance. After that, all the attendees pair off and practice 
giving food and drink to their partners in good positioning and bad. With 
large bites or small.  Did I mention that I often use thickener packets and 
have them try to thicken the juice?
This workshop often gets lots of discussion going. I usually run out of 
time. We cover mental set, how to offer choices, ways to reduce combative 
behavior by giving choices or letting someone know before they start moving 
them what they are doing.