Vloga logopeda pri ozaveščenosti medicinskih sester o motnjah požiranja

Komel, Tinkara (author), Hočevar Boltežar, Irena (mentor)

V teoretičnem delu magistrskega dela smo predstavili faze normalnega poteka požiranja in nevrološko kontrolo požiranja. V nadaljevanju obravnavamo pojav disfagije – pogostost, možne vzroke, simptome in zaplete pri motnjah požiranja ter dejavnike, ki lahko vplivajo na uspešno požiranje. Dotaknili smo se področja diagnostike motenj požiranja s poudarkom na identifikaciji rizičnih pacientov, rehabilitacije in timskega pristopa k obravnavi pacientov z motnjami požiranja. Posebno smo izpostavili vlogo medicinskih sester in logopeda pri obravnavi motenj požiranja ter poudarili vrednost sodelovanja med njimi. Izpostavili smo tuje in domače raziskave, ki so že obravnavale ozaveščenost medicinskih sester o motnjah požiranja ter predstavili ovire, s katerimi se srečujejo medicinske sestre pri obravnavi pacientov z motnjami požiranja. V empiričnem delu smo raziskovali ozaveščenost medicinskih sester o simptomih, zapletih in ustrezni obravnavi pacientov z motnjami požiranja. Ker so medicinske sestre s pacienti največ v stiku, poleg tega so tudi prisotne ob hranjenju pacientov, je njihovo poznavanje motenj požiranja ključnega pomena. Osredotočili smo se na iskanje statistično pomembnih razlik v poznavanju motenj požiranja med medicinskimi sestrami, ki pogosto sodelujejo z logopedom, in medicinskimi sestrami, ki z logopedom sodelujejo redkeje oziroma nikoli. Prav tako nas je zanimalo, ali obstajajo razlike med medicinskimi sestrami, ki obravnavajo paciente z motnjami požiranja vsaj enkrat mesečno in medicinskimi sestrami, ki se s to patologijo srečujejo redkeje. Kot zadnje smo preverili razliko v ozaveščenosti o simptomih motenj požiranja med medicinskimi sestrami, ki so zaposlene na oddelkih, kjer pogosto zdravijo paciente z motnjami požiranja, in medicinskimi sestrami, zaposlenimi na oddelkih, kjer disfagija pri pacientih ni prisotna v tolikšni meri. Uporabili smo anonimni vprašalnik, ki je bil sestavljen na podlagi strokovne literature. Zajemal je vprašanja, preko katerih smo dobili informacije o mestu zaposlitve medicinske sestre, pogostosti obravnave pacientov z motnjami požiranja, udeležbe na dodatnem izobraževanju glede disfagije, možnosti in pogostosti sodelovanja z logopedom ter morebitno željo po dodatnem izobraževanju v obliki seminarjev ali delavnic. Drugi del vprašalnika je preverjal ozaveščenost o simptomih, pravilni obravnavi (položaji med hranjenjem, prilagoditve diete in procesa hranjenja) in zapletih pri motnjah požiranja, kjer so udeleženci raziskave morali izbirati med ''da'', ''ne'' in ''ne vem''. Rezultati so pokazali statistično pomembne razlike v poznavanju obravnave pacientov z motnjami požiranja v prid medicinskim sestram, ki z logopedom redno sodelujejo (P = 0,000). Prav tako se je statistično pomembna razlika (P = 0,028) pokazala pri subjektivni oceni suverenosti pri obravnavi pacientov z motnjami požiranja. Primerjava prepoznavanja zapletov in simptomov motenj požiranja je pokazala določene statistične razlike pri dveh postavkah, vendar to ni predstavljajo pomembne razlike glede skupne vsote pravilno prepoznanih simptomov in zapletov motenj požiranja. Medicinske sestre, ki se s pacienti z motnjami požiranja srečujejo vsaj enkrat mesečno, niso pokazale pomembno večjega poznavanja motenj požiranja in njegove obravnave, kot medicinske sestre, ki redkeje negujejo paciente z disfagijo. Prav tako ne obstaja statistično pomembna razlika v poznavanju simptomov med medicinskimi sestrami, zaposlenimi na oddelkih, kjer se s pacienti z motnjami požiranja pogosteje srečujejo, in oddelki, kjer se z motnjami požiranja srečujejo redko ali nikoli. Se je pa med skupinama pokazalo precej razlik, ki bi jih bilo vredno podrobneje raziskati na večjem vzorcu. Pridobljeni rezultati nakazujejo na pomembno vlogo logopeda pri ozaveščenosti medicinskih sester o motnjah požiranja. Ugotovili smo, da pogostost obravnave pacientov z motnjami požiranja ne vpliva na samo ozaveščenost medicinskih sester toliko kot sodelovanje z logopedom. Poleg tega smo potrdili hipotezo, da medicinske sestre, ki nimajo možnosti sodelovanja z logopedom, menijo, da bi jim sodelovanje z logopedom pomagalo pri obravnavi pacientov z motnjami požiranja. Oba profila sta ključna v obravnavi pacientov z motnjami požiranja, zato je njuno sodelovanje še toliko bolj pomembno.

• Language: Slovenian
• Keywords: motnje požiranja
• Work type: Master's thesis/paper
• Typology: 2.09 - Master's Thesis
• Organization: PEF - Faculty of Education
• Year: 2020
• PID: 20.500.12556/RUL-122436
• COBISS.SI-ID: 41817859
• Publication date in RUL: 15.12.2020

Secondary language

• Language: English
• Title: Role of the speech and language therapist in raising nurses' awarenessof swallowing disorders

Abstract

In the theoretical part of the master's thesis, we presented the phases of the normal swallowing process and the neurological control of swallowing. We explained the phenomenon of dysphagia – prevalence, possible causes, symptoms and complications that occur in swallowing disorders as well as factors which can influence successful swallowing. We touched on the diagnostic process of swallowing disorders, focusing on the identification of patients at risk of acquiring dysphagia, the rehabilitation and a team approach in treatment of patients with dysphagia. We brought special attention to the role of nurses and speech and language pathologists in treatment of dysphagia and highlighted the importance of cooperation between these two profiles in treatment. We presented foreign and Slovene studies that explored nurses' awareness of swallowing disorders and exhibited obstacles they face in treatment of patients with dysphagia. In the empirical part of the master's thesis, we studied nurses' awareness of symptoms, complications and appropriate treatment of patients with dysphagia. As nurses have the most direct contact with patients and are present at the feeding process, their knowledge of swallowing disorders is of crucial importance. We focused on finding statistically significant differences in the awareness of swallowing disorders between those nurses who often cooperate with a speech and language pathologist and those who do so only rarely or never. We were also interested in potential differences between nurses who treat patients with dysphagia at least once per month and nurses whose encounter with dysphagia is rarer. Lastly, we explored the difference in awareness of dysphagia symptoms between those nurses who work in hospital departments where dysphagia patients are treated often and those who work in departments where dysphagia is less common. An anonymous questionnaire was used, developed on the basis of scientific writings and encompassing questions which gave information on the department of nurses' employment, frequency of treating dysphagic patients, participation in additional education in dysphagia treatment, the possibility and frequency of cooperation with a speech and language pathologist and the willingness or desire of additional education in form od seminars or workshops. The second part of the questionnaire examined awareness of dysphagia symptoms, correct treatment (body position while feeding, adjustment of diet and feeding process) and possible complications in swallowing disorders. Participants were given the choice to answer with »yes«, »no« and »maybe«. Statistically significant differences in knowledge of dysphagia treatment were found in favor of nurses who regularly cooperate with a speech and language pathologist (P=0,000). A statistically significant difference (P=0,028) was also found in the subjective judgement of the ability and confidence in treatment of dysphagia patients. The comparison of dysphagia symptoms and complications recognition showed certain statistical differences in two items, which did not present an important difference in the sum of correctly identified dysphagia symptoms and complications. Nurses who encounter dysphagia patients at least once per month, in comparison with nurses who rarely treat dysphagia patients, did not show significantly greater knowledge of swallowing disorders and their treatment. We did not find a statistically important difference in knowledge of dysphagia symptoms among nurses employed in hospital departments that are more likely to treat swallowing disorders and that of nurses employed in departments that rarely treat dysphagic patients. However, some differences between the two groups did become apparent – exploring those further on a larger sample would be of value. Results point to the important role of a speech and language pathologist in nurses' awareness of swallowing disorders. We have found that cooperation with a speech and language pathologist affects nurses' awareness of swallowing disorders more than frequency of dysphagia treatment. Additionally, we confirmed the hypothesis stating that nurses not having the possibility of cooperation with a speech and language pathologist believe such cooperation would aid them in treatment of dysphagic patients. Both profiles are of key importance in treatment of dysphagic patients, which makes the cooperation between them all the more important.

• Keywords: swallowing disorders