Massey Documents by Type
Permanent URI for this communityhttps://mro.massey.ac.nz/handle/10179/294
Browse
Search Results
Item Contextualising clinical reasoning within the clinical swallow evaluation: A scoping review and expert consultation(AOSIS, 2021-07-29) Pillay T; Pillay MBackground: This study explored the available literature on the phenomenon of clinical reasoning and described its influence on the clinical swallow evaluation. By exploring the relationship between clinical reasoning and the clinical swallow evaluation, it is possible to modernise the approach to dysphagia assessment. Objectives: This study aimed to contextualise the available literature on clinical reasoning and the CSE to low-middle income contexts through the use of a scoping review and expert consultation. Method: A scoping review was performed based on the PRISMA-ScR framework. The data was analysed using thematic analysis. Articles were considered if they discussed the clinical swallow evaluation and clinical reasoning, and were published in the last 49 years. Results: Through rigorous electronic and manual searching, 12 articles were identified. This review made an argument for the value of clinical reasoning within the clinical swallow evaluation. The results of the study revealed three core themes related to the acquisition, variability and positive impact of clinical reasoning in the clinical swallow evaluation. Conclusion: The results of this review showed that the clinical swallow evaluation is a complex process with significant levels of variability usually linked to the impact of context. This demonstrates that in order to deliver effective and relevant services, despite challenging conditions, healthcare practitioners must depend on clinical reasoning to make appropriate modifications to the assessment process that considers these salient factors.Item Decision making and the bedside assessment: The Speech Language Therapists’ thinking when making a diagnosis at the bed(AOSIS, 2021-06-30) Coutts K; Pillay MBackground: The bedside assessment is often seen as a screener because of its high variability in sensitivity and specificity, whilst the instrumental measures are viewed as gold standards because of the ability of speech-language therapist (SLT) to visualise the swallow more objectively. Objectives: This research article explores how the value needs to be placed on the decision-making abilities of the SLT rather than on the assessment measure itself. Method: A mixed methodology concurrent triangulation design was employed to collect data in two phases: the first phase included observing seven SLTs conducting assessments using a standardised bedside measure together with pulse oximetry and cervical auscultation. The second phase was a focus group discussion based on the findings from the first phase. Data were analysed thematically using a bottom-up approach. Results: The following factors were found to influence the decision-making process at the bedside: bedside assessment data sets, patient, multidisciplinary team, context and then SLT. The availability of more data from the assessment from different data sets improved the confidence of the SLT at the bedside when needing to make clinical decisions. Clinical instincts are developed through experience and observation of those more experienced. These skills need to be developed from junior years. Conclusion: This research study showed that a bedside assessment can provide valuable information that will allow for diagnostic decisions to be made at the bedside. This study also highlighted the importance of critical thinking using clinical instincts, and that these are the factors that need to be valued and emphasised rather than the assessment measures themselves.