3. Electronic Theses and Dissertations (ETDs) - All submissions
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Item Knowledge translation in dysphagia : a South African study.(2014-01-10) Seedat, JaishikaBackground: Knowledge translation models to address existing knowledge gaps in different areas of speech-language pathology practice are providing researchers and clinicians the opportunity to improve efficiency and effectiveness of service delivery. As a developing context, public health care in South Africa can scarce afford the luxury of wasting resources and finances on interventions that are inefficient or without proven benefit given the increasing prevalence of chronic burden of disease such as stroke and traumatic related injury, both of which has dysphagia as a symptom. The outcome of the manner, efficiency and consistency of traditional models of dysphagia management currently being implemented in this context were compared to a pre-existing theoretically proven free water protocol for dysphagia management. Method: The primary aim of the current study was to enable knowledge-to-action translation in dysphagia management by determining the feasibility of using a free water protocol for stroke or traumatic brain injured patients presenting with dysphagia in an acute government hospital setting in Gauteng, South Africa. A mouth care training protocol was developed for nurses as a component of the free water protocol. Nurse perceptions on the training and implementation of mouth care were explored. The quantitative aims investigated if there was a difference between traditional and free water management in terms of a) the occurrence of aspiration pneumonia, b) amount of water intake and c) length of hospitalisation. 139 Nurses and 46 patients with dysphagia were participants. A mixed method design was used. The study was conducted in two phases, phase one comprised the ethnography and the nurse training component. Phase two was quantitative and comprised implementation of the free water protocol by the researcher. Thematic content analysis was used for the qualitative data. Quantitative data was analysed using inferential statistics. Results: The mouth care training protocol for nurses was efficient and effective for the current context. Nurses engaged positively with the study by implementing mouth care successfully when necessary for the dysphagic patients. This combined with consistent daily management of dysphagia with patient involvement, facilitated patient compliance, adequate levels of water intake, with no cases of dehydration, and no incidence of aspiration pneumonia at the end of the intervention period. The comparison group in contrast who received the traditional model of dysphagia management showed longer period of hospitalisation and higher consumption of liquids despite recommendations for liquid restricted diets. There were seven cases of aspiration pneumonia at the end of the intervention period in the comparison group. Conclusions & Implications: Despite no statistically significant differences between the study and comparison groups on the specified outcome measures, clinically significant differences were noted. The method employed in the study seemed to facilitate knowledge translation of the free water protocol to a public hospital context in South Africa. The findings of the study suggested that a collaborative partnership between the speech-language pathologist and nurse was attainable and this seemed to have multifaceted mutual benefits to the patient, institution and the respective professions. Improved monitoring of service provision, implementation of protocols based on contextual evidence, importance of knowledge translation in a developing context and an expanded role of the speech-language pathologist responsive to the needs of the context and patient population were some of the implications that arose from the study.Item Bridging the gap : establishing the need for a dysphagia training programme for nurses and speech-language therapists working with tracheostomised patients in critical care in government hospitals in Gauteng.(2012-08-28) Hoosen, AzraThe primary objective of the current study was to attempt to establish whether there is a need for a dysphagia training programme for nurses and speech-language therapists working with acute tracheostomised patients in critical care units in South Africa. The research design that was adopted for this project was within a mixed methods approach framework. An exploratory descriptive survey design using semi-structured face-to-face interviews was used. The final sample consisted of interviews with 20 speech-language therapists from eight different hospitals with critical care facilities and 12 nurses from four different hospitals with such facilities. Data from the close ended questions were analysed using descriptive statistics, while remaining data from open ended questions were thematically analysed and the constant comparison method was applied. The data demonstrated that all speech-language therapists and 10 out of the 12 nurses were in agreement that there was a need for a dysphagia training programme for nurses in critical care for tracheostomised patients presenting with dysphagia. An important and unexpected result of this study was that speech-language therapists themselves required additional training in this area. The data demonstrated that the majority of speech-language therapists and nurses were of the view that they had received minimal theoretical and practical hours on tracheostomy screening, assessment and management at an undergraduate level. Overall, the results of the current study suggested varied practices in the screening, assessment and management of tracheostomy and dysphagia, particularly with regard to blue dye testing, suctioning protocols and cuff inflation and deflation protocols. The research significance and implications of the study included the need to improve undergraduate training for speech-language therapists and nurses in the area of dysphagia and tracheostomy, to alert professional training bodies regarding institution of additional licensing and qualifications for speech-language therapists and nurses in the area of dysphagia and tracheostomy, and to thereby improve the situation of clinicians practising in dysphagia and tracheostomy management through the development of guidelines, protocols and position papers. An important implication of this research is that it established the need for a dysphagia training programme for both speech-language therapists and nurses in critical care in dysphagia and tracheostomy, and thereby monitoring the efficacy of this programme and measuring/monitoring the outcomes of multidisciplinary teamwork in the assessment and management of dysphagia and tracheostomy in critical care.Item Dysphagia in a group of adult in-patients living with HIV/AIDS in Gauteng, South Africa.(2012-07-03) Alborough, KimAims: The aims of this research were to describe the signs and symptoms of dysphagia in people who are living with HIV/AIDS and to see what participant variables such as CD4 count, age and diagnosis affect dysphagia. Methods: This study was a descriptive, cross-sectional, quasi non-experimental design. The sampling method that was used for this research was non-probability and convenient. These patients were referred to the speech therapy and audiology department from various multidisciplinary team members for dysphagia assessments. There were 106 participants in total. Eighty participants underwent only a clinical bedside assessment and 26 underwent a bedside assessment as well as a modified barium swallow. The Mann Assessment of Swallowing Ability (MASA) was used to conduct the clinical bedside assessments and a modified barium swallow (MBS) was used as an objective measure. The data was analysed using both descriptive and inferential statistics. These tests included the Wilcoxon signed rank test, Spearman Rho test, Kruskal-Wallis and Mann Whitney U-test. Results: Descriptively, the results revealed that participants with neurological conditions appeared to present with more severe signs and symptoms of dysphagia. The results from the Wilcoxon signed rank test showed that participants with a neurological disorder experienced more severe signs and symptoms of dysphagia, except with laryngeal elevation. The Wilcoxon signed rank test also showed that older participants experienced more dysarthria and oral transit difficulties. The results from the Kruskal-Wallis test highlighted that participants with a lower CD4 count had more significant respiration and voice difficulties. The results from the Mann-Whitney U test showed that participants who were on a HAART regimen experienced increased difficulty in the pharyngeal phase and aspirated more frequently. The Spearman-Rho test results showed that the MASA was seen as a valid bedside assessment tool for assessing adult dysphagia in an acute hospital setting. Discussions: Dysphagia does occur in the HIV/AIDS population in South Africa in participants who have neurological conditions as well as opportunistic infections. The SLP needs to play a key role in the assessment and management of these patients. The MASA is a good assessment tool to use in settings where objective measures are not available.