Hospital transport: Reflection

Reflective Log

1. Think of a recent therapy session or event.

- I booked ENT appointment for a patient with locked in syndrome who’s only communication method was speech.

- Ambulance crew called to say he needed to be ready 2 hours before they picked him up, which was an hour before his appointment.

- The patient told the crew and his wife he didn’t want to go because of pain from sitting but they took him anyway.

-the patient refused to have FEES done and was upset at his family and wife for bringing him.

- I apologised and explained to the patient that the ambulance crew had needed to come early. He was very agitated but this calmed him.

3. What did this session make you feel?

- I felt guilty and upset that I had not researched hospital transport further.

-I thought that I had prepared well since I had spoken to the lead LST in the ENT clinic to handover communication guidelines and I had talked to the aptient extensively about the procedure. This made me feel disappointed since my plans did not work out.

-I felt that I had broken the trust I had developed with my patient.

4. What would you want to change, and why?

- I would request the ENT appointment information so that I could attend the session with the patient

- I would explain the full procedures for the hospital appointment to the patient i.e. when he would get out, waiting times etc.

- I would consult OT/PT regarding how long the patient could sit out for.

- I would consider alternative forms of transport e.g. family members/ dial-a-ride…

Nursing Home Working - Reflection

Think of a recent therapy session or event.

Nursing home staff frequently did not position a patient upright enough for oral intake and did not adhere to guidelines I had set when feeding the patient. The patient’s family also frequently fed them inappropriate foods/drinks, resulting in the patient being re-referred due to having frequent chest infections. The patient also had cognitive impairments affecting her dysphagia and making her ability to swallow variable.

What did this session make you feel?

I felt that I was not being productive when I assessed the patient time after time. I also felt frustrated that I could not prevent the patient having chest infections and frustrated at the communications between the nursing home and the patient’s family.

What would you want to change and why?

I would want to communicate more clearly with the patient’s nursing home and family from the off. I would explain how the patient’s cognitive impairments meant that their ability to swallow was variable and would put plans in place to deal with their variability.

What has this session taught you?

This experience really tought me that I need to educate other health professionals more on dysphagia (causes, strategies to reduce the risk of aspiration, hypothesis for dysphagia….) and facilitate staff to be able to use their own judgements when working with patient's who have variable swallowing abilities.

What will you do next time?

·   Liaise closely with patient’s family regarding their mealtime recommendations, goals and therapy input.

·   Take a picture of the patient when they are positioned optimally and put this on their bedside wall.

·   Explain to nursing home staff/ the patient’s family why the person has dysphagia and why some foods/drinks are more difficult for them to swallow.

·   Create a plan for patient’s whose swallowing is variable e.g. downgrade to puree if they appear fatigued/ have an infection.

·   Request skilled carers/ contact the manager of the nursing home to handover recommendations.