Monday, 17 March 2014

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.

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