STROKE SERVICES FEATURE
To facilitate conversation patients were given some magazine articles , poems and a newspaper . They proved useful to start new topics of conversation when needed .
As the patients were positioned a distance from each other communication was a little ‘ clunky ’; with masks on , it was even more difficult for people to hear each other . There were several distracting noises from the kitchen , which was located nearby . Usually this would not have been problematic , but the distancing and use of PPE amplified communication difficulties .
Once the patients were about to start eating and drinking they were able to remove their masks and conversation between themselves and the healthcare professionals became much easier . Staff remained in full PPE , with face masks and aprons .
The activity co-ordinators were delighted that four patients had attended , as this was the greatest number of patients expressing an interest in group activities since groups were re-commenced .
Patients said they were keen to have the opportunity to practise eating and drinking skills and have social interaction with other patients . Reflections after the group concluded that for future groups the room needed to be better organised so that equipment and resources were on-hand on mobile trolleys .
The speech and language therapist was pleased that she was able to see four patients in one hour and conduct joint assessments with other healthcare professionals . Two patients had assessments , resulting in changes to their recommended diet and fluid intake .
Healthcare professionals reflected on the challenge of observing one patient while treating another with the two meter distancing . Staff were unable to move swiftly between patients , compounded by the need to change PPE for each patient , so more staff were needed for this session than usual non-COVID-19 groups .
Healthcare professionals also commented on how positive it was to see patients engaging in ‘ normal everyday conversations ’ with each other , giving those with speech difficulties an opportunity to practise .
After the breakfast group , patients were asked for feedback on their experiences . Two patients said that they liked being able to socialise with other patients . One lady attended who had previously declined other groups when offered . She expressed a desire to work on feeding herself using her affected arm and said that the social aspect of the group was her motivation for agreeing to attend .
The session lasted for one hour , plus 20 minutes for set-up and cleaning afterwards . The opportunity to treat and assess several patients in one hour was a major benefit highlighted by the speech and language therapist .
After the group a de-brief was held with the healthcare professionals involved , which included a SWOT analysis ( strengths , weaknesses , opportunities , and threats ).
They all reflected that testing out a mealtime group in pandemic conditions had provided a rich learning experience . They compiled a list of ‘ top tips ’ that could be used to improve the experience of running groups , and specifically mealtime groups for other healthcare professionals ( see box above ).
Top 10 tips
• Develop a protocol for groups that includes a standard operating procedure or ‘ how to ’ guide for preparing and delivering the group .
• Develop an aphasia-friendly leaflet to support conversations about attending groups with pandemic restrictions .
• Develop an aphasia-friendly leaflet about the benefits of mealtime groups .
• All equipment and PPE required should be positioned on a portable trolley in the dining room .
• All food and utensils required should be set up in advance on a potable trolley in the room .
• Create job cards ( all healthcare professionals have a specific role in the group ), instructions and tips on making a successful group .
• Training is required for all staff participating ; on setting up and preparation , running the group and skills required .
• Produce a training needs analysis for healthcare professionals running mealtime groups .
• Have information on patients ’ diet and fluid requirements in large print visibly displayed for all healthcare professionals , this could also include strategies and a personalise treatment plan .
• Allow extra time to prepare patients in PPE and clean afterwards .
• Create conversational props for supporting socialisation .
In summary , extra effort was required to deliver a mealtime group under COVID-19 restrictions , however , the healthcare professionals involved thought that despite identified challenges the benefits and opportunities afforded to patients were positive to balance the investment of time and resources .
Patient feedback was encouraging , and this was also reflected by the level of engagement . All patients involved said that the social aspect of the intervention is as important as the physical aspects .
References
Jones N and Nasr N ( 2018 ) The experiences of stroke survivors with managing eating six months post-stroke . British Journal of Occupational Therapy , 81 ( 2 ): 106-115 . DOI : https :// doi . org / 10.1177 / 0308022617738487
Poels BJJ , Brinkman-Zijlker HG , Dijkstra PU and Postema K ( 2006 ) Malnutrition , eating difficulties and feeding dependence in a stroke rehabilitation centre . Disability and Rehabilitation , 28 ( 10 ): 637-643 . DOI : https :// doi . org / 10.1080 / 09638280500276612
Westergren A , Ohlsson O and Rahm Hallberg I ( 2002 ) Eating difficulties in relation to gender , length of stay , and discharge to institutional care , among patients in stroke rehabilitation . Disability and Rehabilitation , 24 ( 10 ): 523- 533 . DOI : https :// doi . org / https :// doi . org / 10.1080 / 09638280110113430
Natalie Jones , clinical academic occupational therapist , Sheffield Teaching Hospitals NHS Foundation Trust and University of Sheffield , email : Natalie . jones56 @ nhs . net , and Audrey Delaney , senior speech and language therapist , and Mags Kelly , stroke activity co-ordinator , Sheffield Teaching Hospitals NHS FT
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