The nursing model of Roper, Logan and Tierney Essay Example

will indicate the suprasternal notch or behind the sternum as part of obstruction.

There are a number of causes for oesophageal dysphasia these can be divided in to mechanical and functional courses.

Functional causes include:

1. Achalasia

2. Myasthenia Gravis

3. Pschdobulhar Palsy

Mechanical causes can include:

1. Peptic esophagitis

2. Gastric cure

3. External compression of the esophagus, such as obstruction by lymph node and left atrial dilatation in mitral stenosis

4. Candida esophagitis

5. Pharyngeal pouch

6. Esophagel web

Swallowing disorders can occur in all age ranges from the very young to the old, resulting from congenital abnormalities, striatal damage and/or medical conditions, including dysphagia; this is the most comment medical condition within the elderly.

Dysphagia (from the Greek word "dys" meaning difficulty and "phagia" meaning to eat) is a condition in swallowing, an impairment of the ability to safely chew and swallow food. This gives rise to the possibility of not being able to sustain life due to lack of nutritional intake (Logemann 1998).

Physical.

Some of the main symptoms of dysphagia are, chocking, aspiration, pneumonia and malnutrition.

The national clinical guidelines for stroke (royal college of physicians, 2004) point out that any patient that suffers from a stroke should have their swallowing assessed as soon as possible by a trained medical professional, using a validated bedside testing system, the most comment testing system is for the patient to drink 30 ml of water, while sitting in the upright position, once this has taken place, nursing observations look for the following:

1. Delayed swallowing

2. The presence of drooling

3. Coughing during or within 1 minute of swallowing

4. Dysphonia

Based on this testing system the patient would have to only meet one of the above to be diagnosed by a doctor with dysphasia.

Along with the above testing, x-rays and further investigations will be carried out. If a trained professional isn’t available to carry out these tests, the patient, in their best interest should be kept “nil-by-mouth” however should be kept hydrated by drip, until a review can take place.

Groups such as the multiple sclerosis website (www.mossociet.org.uk), state that there are practical measures to manage patients that find it hard to swallow. These are management from Speech and Language team, and/or dieticians, sure interventions from these 2 specialists alone can assist the patient with finding solutions and with assistance from nursing staff these interventions can be put into play. Weekly communications between, Nursing staff with such professionals as Dieticians and Speech and Language teams means that the patient will find the best solutions while remaining safe.

With the involvement of different professionals a patient with dysphagia in connection with the RLT nursing model, in relation to the assessment and reassessment to help give indications of the condition progress and interventions needed.

Another major part of the multidisciplinary team (MDT) involved in the care of a patient with dysphagia would be a dietician (NICE 2006). A dietician will advise a patient on different types and texture of food that will best suit an individual patient, this will greatly contribute to safer swallowing for the patient, with this advice it will again assistance lessoning the chance of food becoming secreted within the tooth or cheek cavity. Following the advice from the Dietician, nursing staff will assist the patient to follow these activities through, helping the patient with their food and fluids.

Once a patient has finished a meal if in hospital this should

be recorded on a food and fluid chart, this is the duty of a nurse to enter this in a correct fashion however; the nursing staff may wish to ask the patient to record this information on to the food and fluid chat. This gives the patient chance to become involved in their own care and gives the patient a sense of independence; this would have to be check on a regular basis to make sure that this is being done correctly by nursing staff, another method is for 2 charts to be in place, one for the patient to fill in another for nursing staff to fill in again this gives the patient a sense of being involved in their own care.

Social and Psychological

The ways families eat will vary, where some families will make a point of sitting down at a table together at meal times, other families may never sit down together to eat at all. Some families will only ever sit down at a dinner table on occasions such as Christmas where different kinds of foods are eaten, during such occasions patient with the said condition may find it difficult to join in with such activities, this is where while in hospital, the patient along with the nursing staff can sit down and talk to members of the patient’s family, and explain the patients fears and anxieties about eating when going home along with answering any questions that the family members may have.

The patient along with assistance from nursing staff, can explain that there may be times while eating, when a patient will be sick, or choke, and that during meal times

the patient may need to stand up while at the table, one way of coping with this is a family member that does not suffer which such a condition could stand up either at the same time or at different time, to take attention away from the patient, like wise should the family be taking the patient out for a meal, this can sometimes be a very tense time for someone with this condition, talking to the family before you leave to have the meal can sometimes clam the patient down, informing them that should the move away from the table quickly this could be that they are going to be sick, and ask one family member to come with them, or again should they need to stand up, as a family member to stand with them. Doing this will help the patient remain calm and hopefully enjoy the meal with their family.

One theory that has been look at and tried within a hospital setting is the second meal time this was addressed by Musson et al (1990), where a patient with dysphagia is given an independent meal time in a dining room setting rather than eating their meals in their rooms, where most patients decide to eat, as this can course embarrassment if eating with able bodied patients.

The setting should be given a lot of thought in preparation, as these are factors that impinge on the activities of daily living (Roper et al 2003). This means making sure the table is free of distraction, making sure the patient is comfortable and ready to eat, if they need to use the toilet, each patient will

be assess by their own needs, thus meaning that nursing staff can assist a number of patients at one time, the only down side to this is it takes away 1-2-1 nursing care for said patient, however it then gives the patient the independence of eating within a dining room setting, together with giving them a change of environment along with some social stimulation being with other patients with the same condition.

Each patient will have their own individual experiences and each will find their own way of coping. Each patient will have certain factors that will become triggers this could be anxiety about eating while people are watching, or what is going to happen when they do eat, this may make things more difficult for the patient to swallow, input from a mental health team may help avoid these triggers, the mental health nursing team will assist the patient to find ways to cope with situations like eating in public, to lessen anxieties it is shown that talking about these situations helps and patients with the same conditions spending time together, talking to one another also helps patients deal with social settings, knowing that they are not alone within the world.

In conclusion Dysphagia is without doubt a most common difficulty, there are a number of different types of this condition and is more of a complaint within older persons, and is very comment within stroke victims this can provoke a number of feelings within a patient that has this complaint, it can also be life threatening. It is therefore important that it is detected early, and appropriate nursing care is given, to give the patient

a better standard of living.

It is important that a bedside test is carried out as soon as possible to detect this condition, and appropriate support is given to the patient. It is also important to make the patient and their family feel included in the patients care.

The nursing model by Roper, Logan and Tierney shows a framework, to give assessment and reassessment in nursing care, all this is shown around activates of daily living. By using this model affectively a nurse can give the patient the best care possible, whilst maintaining and promoting the best level of dignity and independence possible.