INTRODUCTION: The main goal of this assignment is to reflect back on nursing practice area which needs improvement in my country i.e. swallowing assessment. Reflective practice has the broad meaning of being able to look at your own professional behaviour and practice with the intention of improving and developing ( & 1998). I was caring for a patient in who I shall be referring as Tina (80year) to protect her identity and therefore adhere to protecting her confidentiality as laid in (Reference of ) medicine department during my three year training. She was admitted for investigations of weight and difficulty in swallowing (dysphagia).Swallowing is a complex neuromuscular disorder described as having four stages: oral preparatory, oral, pharyngeal and esophageal. Dysphagia disorder results from neurogenic, myogenic, psychogenic or mechanical causes. Swallowing impairment increases with the advancing age and is a major health care problem, especially in nursing homes. I was asked by the registered nurse (RN) of the shift to assist Tina to eat dessert from the general menu. I questioned the nurse’s instruction, but she insisted Tina could swallow and was in fact, had only attention seeking behaviour. I wanted to clarify the patient’s condition and went to the doctor. By the time I came back, the nurse took the dessert from the trolley herself and forcefully spoon-fed the patient and immediately left the place. The patient tried to resist and subsequently started to choke. Tina became cyanosed and needed esophageal suction, the attention of doctor and the administration of oxygen. I suctioned her immediately and administered oxygen.
BODY: , , and (1995) found that nurses can perform bedside swallowing assessments Feeding often becomes one of the first tasks nurses delegate to less-skilled personnel (, , , & , 1998). CNAs’ disagreements may result from their belief that they are the feeding experts. Although dysphagia is diagnosed and treated by a multidisciplinary team including a radiologist, speech therapist, dietician and nurse ( 1983) but according to (1999), nurses are the professionals who most often are present at the bedside, particularly at mealtime, and are the first members of the healthcare team to observe signs and symptoms of dysphagia. By recognizing dysphagia early, nurses can help to prevent complications and decrease the number of deaths associated with dysphagia in those who have had a stroke (, 1999). It is duty of RN according to NATIONAL COMPETENCY STANDARDS that nurse should do a comprehensive and systematic nursing assessment by using her skills. She should discuss whole information with the other members of team as dysphagia is diagnosed and treated by a multidisciplinary team including a radiologist, speech therapist, dietician and nurse ( 1983). A nurse’s complete swallowing assessment should include testing of the four phases of swallowing: the oral preparatory phase, the oral phase, the pharyngeal phase, and the esophageal phase ( & , 1990). Assessment should begins by communicating with the patient or their families if they have had any difficulty in swallowing food and liquids then ask questions such as Do you chock when eating or drinking?, Do you have any problem controlling your saliva?. I will communicate with resident and explain her that I am going to help with the feed. After asking for her choice of food. I will held the spoon up, coaxing her, but she wouldn’t open her mouth and at that time then I will rubb the spoon against her lips, putting a little an applesauce on them. Using these technique nurses can prevent futher complications in elderly patients The nurse is the person who performed a complete swallowing assessment described assessment of the oral stage in a variety of ways and gathered a data by observation, interview, physical examination and measurement in obtaining a nursing history. It is one liability of the nurse to provide prior information related to treatment options so that elderly patient takes decision (1998 & 1990). Although nurses have an important advocacy role in promoting the autonomy of elderly patient ( 2001). It is well documented in code of professional conduct. That all registered nurses should respect the patient as an individual; and promote and protect the interests and dignity of patients. The nurse’s bedside assessment of swallowing ability should occur before initiation of feed ( & 1990)
In the end after all my research I came to the conclusion that simple nursing interventions of nurses can effectively prevent dysphagia’s most serious complications. After reflecting on the whole scenario I am able to analyse that nurses are primary carer and who performs a complete swallowing assessment and described Now after analyzing the whole situation my action plan is that now I would like give prior information to elderly patient as it is vital that older people receive consistently high standards of care. By improving professional and practical skills I will make an active contribution to slow down the rate of swallowing and provide high standard care to elderly and other patiens and I will also encourage my coworker to follow the same Having awareness and current knowledge of the procedure of feeding being undertaken was invaluable in being able to see that the colleague was making mistake.
Reference:
Credit:ivythesis.typepad.com
0 comments:
Post a Comment