Explore this Free Case Study on person-centred dysphagia management to understand caregiver challenges, shared decision-making strategies, and evidence-based nursing interventions. Get online Assignment Help Australia for Nursing, Disability Care, and Healthcare coursework from experienced academic writers.
Person Centred Nursing Strategies for Dysphagia Management
Challenges Faced By Tanisha And Her Mother
As per the case video, Tanisha Flemming is facing a multifaceted challenge as she already has Oral Motor Dysphagia which is also called swallowing disorder and she is also suffering from a rare genetic disorder which is caused by duplication chromosome 5q and deletion of chromosome 18p. Due to this health condition, a constant care is required for her. As a result of this condition, she chokes during her meals and this is a big concern for her mother. This situation is arising difficulties for her mother Bronwyn too as she is a single parent and she has to manage the caregiving duties for Tanisha. This caregiving process included both physical and mental aspects to ensure that Tanisha is safe. Her mother said that when Tanisha is tired she becomes more stressed and she chokes after. Bronwyn remains attentive and fearful whenever Tanisha is attacking any meal as the chances of choking is higher. This situation is unpredictable and this is increasing obstacles in their daily lives.
Apart from that, they are facing some societal challenges as well. It has been mentioned that, there are health inequalities in case of patients with intellectual disabilities. As opined by Sanagapalli et al. (2023), patients with developmental and intellectual disabilities are more frequent to face barriers in case of accessing the healthcare system. NDIS or National Disability Insurance Scheme does not provide proper support to these people and they also have lack of specialised care. In this case, Tanisha initially got funding for speech therapy but that was cut unannounced in 2018. As stated by Howells et al. (2021), this is quite common for the people with disabilities to get their allowance cut and there are no such government programs to support them for their health issues.
Hence, it can be seen here that in case of Tanisha and her mother, they are facing both emotional and physical burden for this situation.The burden of caregivers is too high in such cases and this becomes more difficult to handle for the single parents.
Person Centred Care
Person centred care is a process of healthcare system where focus of the treatment remains on the patient and their family. This is an effective healthcare model for the patients like Tanisha who are suffering from chronic conditions like physical disabilities. In such cases, the needs, values, and preferences of the patients are taken into account before designing any treatment for them. There will be several approaches to be followed in the case of Tanisha. Multidisciplinary healthcare approach will be followed by the caregivers where she will be provided with speech therapy by consulting with a therapist (McCoy, 2021). Apart from that, dieticians will be consulted for her food intake issue and also there will be an expert who will guide the mother and daughter to design a specific care plan to meet their specific needs. Proper evaluation and monitoring is required in such cases and based on that the condition of the patient will be checked properly. In case of any issue or lack of improvement, the treatment process will be altered. In case of Tanisha having swallowed food, one of the major things to look after is the food consistency and the feeding process. These should be adopted properly to avoid the risks of choking.
Apart from these, autonomy and dignity of the patient should be considered while providing a person-centred care. This is a very crucial matter in the case of the people who have physical and intellectual disabilities. In this case, the caregivers must ensure that the needs and requirements of Tanisha are being fulfilled properly (based on the discussion of Rogus-Pulia & Plowman, 2020). Ensuring the quality of life of the patient is also important in such cases. Evidence based practice is important in this case. The treatment of care that Tanisha gets must be followed by the latest clinical guidelines and also those should be specific to dysphagia. Proper evaluation of the health condition is important before tailoring any treatment for the patient (Wilkinson, Codipilly & Wilfahrt, 2021). Also, the family and living condition of the patient should be taken into account while developing any treatment or care plan. In this case, the situation of Tanisha’s mother will be taken into account as well to ensure that she is able to manage the treatment or care plan since she is the primary caregiver of Tanisha.
Strategies To Promote Shared Decision Making
Shared decision making is a process where healthcare decisions are taken collaboratively between the healthcare professionals and the patients and their families. In this case, the needs and demands of the patient party is prioritised the most and also, the decision making process is kept transparent so that the patient and their family can be aware about the situation and the outcomes (Bulmer et al. 2021). This approach becomes more vital when the patient has intellectual disabilities. In this case personalised care plans are made considering the needs and preferences of the patients. In this case, the share decision making will be included with regular consultation with Tanisha and her mother for the care plan they have made and they will make necessary judgements on that. The condition of the patient will be clearly portrayed to Browyn and all the information regarding her treatment will be accessible to her (Weaver & Geppert, 2023). She will be provided with all the available treatment options and they will be elaborated by the healthcare professionals so that she can take the informed decision for her daughter. In this case, decision aids will be used by the healthcare professionals to meet the need and requirement of the patient. This can help the patient and family to understand all the available treatment options and their potential outcomes before taking the decision. In this process, the knowledge of the patient is increased regarding the treatment process and their involvement can help them gaining trust on the treatment
Another major element in this case is to maintain regular communication with the patient and their family. As opined by Atkinson (2022), the communication should be clear and in simple language so that the patient party can understand the process. In the case of Tanisha the treatment process will be complex as she is suffering from a complex situation. In such conditions Tanisha and her mother must be provided with a simple explanation of the situation and the treatment plans. This is the duty of the caregivers to maintain that decorum to proceed with the shared decision making. While making the decisions, the social and cultural aspects of the patient should be considered as this can have a huge impact on the outcomes. In this case Bronwyn is a single parent and she is the primary caregiver of Tanisha. Hence, she has different living conditions and priorities. These should be taken into consideration while choosing a treatment plan for Tanisha (based on the discussion of Donohue, Perry & Garand, 2024). The treatment plan should be developed in a way so that Bronwyn can easily manage the caregiving process of her daughter. Moreover, it should be looked after that all the healthcare professionals and the caregivers are collaboratively working on this care plan of Tanisha. In this regard, regular communication should be maintained and the condition and progress of the patient should be conveyed to keep the process going. In terms of ethical aspects, the patient details and care plan should be confidential and in case of any disclosure of the information required, it should be consulted with the patient and the family.
References
Atkinson, K. (2022). Shared decision making in dysphagia. British Journal of Nursing, 31(13), S21-S24.
Bulmer, J. M., Ewers, C., Drinnan, M. J., & Ewan, V. C. (2021). Evaluation of spontaneous swallow frequency in healthy people and those with, or at risk of developing, dysphagia: A review. Gerontology and Geriatric Medicine, 7, 23337214211041801.
Howells, S. R., Cornwell, P. L., Ward, E. C., & Kuipers, P. (2021). Client perspectives on living with dysphagia in the community. International Journal of Speech-Language Pathology, 23(2), 201-212.
McCoy, Y. M. (2021). Retraction: Servicing the Senior Swallow: A Family-Centered Private Practice Model of Service Delivery. Perspectives of the ASHA Special Interest Groups, 6(1), 171-174.
Rogus-Pulia, N. M., & Plowman, E. K. (2020). Shifting tides toward a proactive patient-centered approach in dysphagia management of neurodegenerative disease. American Journal of Speech-Language Pathology, 29(2S), 1094-1109.
Sanagapalli, S., Plumb, A., Lord, R. V., & Sweis, R. (2023). How to effectively use and interpret the barium swallow: current role in esophageal dysphagia. Neurogastroenterology & Motility, 35(10), e14605.
Weaver, M. S., & Geppert, C. M. (2023). Sometimes a difficult decision to swallow: Ethical dilemmas when patients with dysphagia who lack capacity want to eat. Journal of Pain and Symptom Management, 65(1), e97-e102.
Wilkinson, J. M., Codipilly, D. C., & Wilfahrt, R. P. (2021). Dysphagia: evaluation and collaborative management. American Family Physician, 103(2), 97-106.
Donohue, C., Perry, B., & Garand, K. L. (2024). A Clinical Focus on Shared Decision Making in Clinical Practice When Providing Dysarthria and Dysphagia Services to Individuals With Amyotrophic Lateral Sclerosis. Perspectives of the ASHA Special Interest Groups, 1-13.
