11.8 A Day in the Life of a Speech and Language Therapist

Presented by: Iain Wilkinson, Stephen Collins, Georgina Gill

Guests: Lydia McKay, Emily Stacey, Natalia Bomanji and Claudia Kate Au-Yeung.


Broadcast Date: 19th April 2022

Recording Date: 13th April 2022

Show notes PDF

Main Points: 

 

1) SLT’s facilitate patient communication and expression of language and act as advocates for patient opportunities to participate in their care.

2) Mouth care can impact patients swallowing and communication abilities.

3) SLT’s can help with capacity assessments especially for patients who might have complex communication problems.

4) Not all patients with swallowing problems need thickeners.

5) Considering the cultural influences in a person’s life can aid us to understand their choices and beliefs and enable us to personalise their care. . 

Download PDF here

Social Media

Stephen shared a twitter conversation from a few OT’s about whether its okay to send a patients family a card when the patient dies.

Georgie:

We recently have seen this clip from a documentary called Nothing like a Dame which follows famous theatre actresses discussing their careers. It features Dame Maggie Smith, Eileen Attkins, Joan Plowright and Judi Dench. 


See the documentary here: https://www.youtube.com/watch?v=1xXHgxCIAB0

The section that caught our eye is Judi Dench speaking out her experience of ageism when a health professional asked her ‘whats our name? and do we have a carer?’


We discuss the importance of balance when changing assessment styles to suit the needs of an older person whilst remaining respectful of their abilities.


Dan Thomas shared the tweet and generated an excellent discussion with this tweet: 

#MDTeaser and solution

There are many reasons to refer to this person but communication is key!

 

 

You might refer to a Speech and Language Therapist for speech, communication or swallowing difficulties, communication is key refers to both communicating across the MDT with referals and findings, and also their facilitation of patient communication. 

Learning Outcomes

Knowledge:

  • To know what speech and language therapists might consider when assessing patients communication, speech and swallowing. 

 

Skills:

  • To be able to identify patients who may or may not benefit from speech and language therapist review. 
  • To consider how we as MDT members can support SLT’s work by implementing good mouth care practice and implementing communication strategies

Attitudes:

  • To have an understanding of the ways SLT’s can support and work with both patients and the multidisciplinary team to enhance patient care.  

 

Main Discussion

Mouthcare

Kate and Lydia explained how mouthcare is important for all patients but especially those requing SLT input during their admission. Mouth care is something the whole MDT can contribute to supporting patients with. 

The bacteria in the mouth if mouth care is not carried out can be harmful, and increase patients risk of complications such as aspiration pneumonia. 

You don’t have to use a big glass of water. Wards have small green mouth care wands with green rubber tips which can be used to clean the front of the mouth removing food particles and secretions. 

 

Mouthcare matters is a Health Education England programme setting out to improve oral health. Research has sown oral care is lacking in hospital and community settings especially for patients who cannot undertake their own personal care. 

Hospitals may have mouth care matters teams who can assist with difficult or complex mouthcare via referrals.

Health Education England Mouthcare Matters Programme

We Spoke about Mouth Care in Series 3, Episode 5.

Wilson, 2011. How to provide effective oral care

Tips for communicating with someone with a communication problem

 

Emily and Lydia gave us some useful tips for enhancing our communication with patients who might have more difficulty. They are: 

 

  1. 1) Speak slowly and keep sentences simple and short
  2.  
  3. 2) Point to objects as sentence prompts. 
  4.  
  5. 3) Providing choices might support someone who has difficulty          generating a response to longer complex questions. 
  6.  
  7. For patients with expressive communication problems: 
  1.  
  2. 1) don’t pretend to understand when you haven’t- it’ll only cause frustration for all
  3.  
  4. 2) be honest and try to problem solve with them.
  5.  
  6. 3) be willing to pause and revisit conversations at a later point
  7.  
  8. 4) acknowledge that on top of acute illness and communication problems the person is in a distracting environment and they’re probably feeling quite anxious which affects peoples ability to follow what we are saying.

Advocacy and Facilitating Communication: 

 

Natalia and Emily talked about how Speech and Language colleagues can help ensure patients are involved in decision making around their care, and support assessment of mental capacity. 

 

Communication difficulties can make it more difficult for people to understand, think and talk about decisions. SLT’s have a role in supporting people to mak decisions, demonstrate their mental capacity or express wishes and preferences about different decision options. 

 

Natalia spoke about how she was supporting a phone call for a patient with another hospital to help ensure their understanding and act as an advocate. 

Royal College of Speech and Language Therapists- Supported decision-making and mental capacity.

Royal College of Speech and Language Therapists- position statement: the unique and essential contribution of speech and language therapists to supported decision making and mental capacity assessment

Awareness of patient culture and diversity 

 

 

Natalia explained the importance of professionals developing their own cultural knowledge and awareness and how our own views and beliefs can impact care. Natalia points out how for an older person they have years of culture influencing their outlook, beliefs, how they talk and behave, and this might impact the choices patients make. 

 

 

Natalia gave the example of how some south asian communities might not always perceive cognitive and communication disorders as purely medical. 

 

 

We’ve talked about cultural and religious practices round death and dying before in episode 10.9. But its worth having a think about how culture might influence patients outside of these examples. 

 

 Think about the diversity of the population with which you work. Are there any minority groups that you work with more often? What might their specific population needs be?

The relationship between cognition and communication

 

 

Our SLT’s explained the need to differentiate the cause of a persons communication difficulty. Is it a cognition problem? If so is it acute such as delirium, or progressive such as dementia? Is it long or short term? 

 

 

Identifying patients who may benefit from SLT input early can help us support them

 

We spoke about communicating with people with a cognitive impairment in episode 1.4, and also discuss a bit in episodes 4.10 and 5.05

Team Working

Like many of the professionals we’ve spoken to before in this series,  between them the SLts’ mentioned nurses, doctors, physios, OT’s, pharmacists, psychologists,


Patients are complex and within the hospital we all play  part in the team caring for patients.

Our SLT’s explained how older adults can present more challenges, especially when assessing a persons likely targets for recovery, due to the lower physiological reserve of older people.

Swallowing is more than adding thickener


Our SLT’s explained why thickener is not always suitable for everyone.


They explained how the staff perception that thickener isn’t very nice is not always helpful when we are gibing it to patients. 


Lydia explained how thickener doesn’t change the temperature, taste or hydration of the drink. 


Our SLT’s also suggested some alternatives to thickened fluids such as smoothies. Straws might not always be the best option either. There are lots of steps involved is drinking through a straw- first you have to create a seal and pressure in the mouth in order to sip up through the straw, next you have to hold the fluid in our mouth, next engage the swallow, finally complete the swallow. 

How to make a Hot drink with Thickener: 


1) Make the drink as normal in a cup. Thickener can be used with water, squash, fizzy and hot drinks.

2) In a new cup measure out the advised quantity of thickener

3) Add drink to the thickening powder and stir with a fork. This helps stop the drink thickening lumpy and uneven.

4) your drink is ready

Where is Jean?

Jean may be referred to Speech and Language teams following the pharmacy and nursing teams noting some dysphagia when she is taking her medications.


Together they might identify alternative ways for Jean to take her medications, or positions that can assist her with swallowing more easily. 

A patient like Jean with Parkinson’s and a CAP could be referred for a number of reasons. 

 

Parkinson’s patients often present with dysphagia which can then be further exacerbated when they are acutely unwell. SLT’s might get involved if the patient is struggling with their baseline diet or if there are suspicions that the CAP might actually be an aspiration pneumonia. 

 

They would also get involved to support with a patient’s communication. Parkinson’s patients often present with dysarthria – a referral to the SLT’s could be considered if a patient’s dysarthria is limiting their ability to participate in important conversations regarding care, treatment or discharge.

Additional Bits:

One of the SLT’s Kate who we spoke to this episode is involved with a project called Speech Therapist Links. Set up by Kate and Serena its a network of other Newly Qualified SLT’s working in practice to support newly qualified and student SLT’s. 


They’re on a mission to nurture evidence-based and reflective practice for fledgling and experienced speech therapists by creating a non-judgemental and inspirational multi-lingual community.

 

They work to provide advocacy, mentorship, and networking opportunities, in order to deliver the best client-centred therapy.

#MDTeaser

This person MUST be a supplement to your MDT

 

Can you solve this clue? Contact us via twitter @MDTea_Podcast, Facebook- MDTea Podcast, Instagram @MDTeaPodcast or via our email or contact us on the website.

NHS Key Skills Framework

Core: 

Communicate with a range of people on a range of matters

Contribute to own personal development

Maintain the quality of own work

 

Health and Wellbeing: 

Enable people to meet ongoing health and wellbeing needs. 

 

Plan , deliver and evaluate care to meet peoples health and wellbeing needs

Foundation Y1

Section 2.6 Interface with HCPs

Section 2.7 Interaction with Colleagues

Section 4:20 Healthcare resource management

Describes the structure and importance of the wider healthcare team

Works effectively within the healthcare team for the benefit of patient care

Makes clear, concise and timely written and oral referrals to other healthcare professionals within the hospital



Acts as a member of the multidisciplinary professional team by supporting, respecting and being receptive to the views of other healthcare professionals

Works effectively with others towards a common goal e.g. accepts instructions and allocation of tasks from seniors at handovers and multidisciplinary team meetings


Demonstrates understanding of the organisational structure of the NHS and independent sector and their role in the wider health and social care landscape

 

Describes hospital and departmental management structure

Foundation Y2

Section 2.6 Interface with other healthcare professionals

Section 2.7 Interaction with Colleagues

Demonstrates ability to make referrals across boundaries / through networks of care (primary, secondary, tertiary)

Demonstrates initiative e.g. by recognising work pressures on others, providing support and organising / allocating work to optimise effectiveness within the clinical team

GP training Curriculum

Clinical Management: 

Contribute to an organisational and professional approach that facilitates continuity of care (e.g. through adequate record keeping and building long term patient relationships)

 

Organise follow up of your patients after referral through multiprofessional, team bases and structured approaches including monitoring, reviewing and regular care planning.

Managing complex and long term care

Demonstrate the ability to effectively ‘navigate’ patients with multiple problems along and between care pathways, enabling them to access appropriate team members and services in a timely and cost-effective manner.

Working with colleagues and in teams

 

Enhance working relationships by demonstrating understanding, giving effective feedback and maintaining trust. 

 

Appropriately seek advice from other professionals and team members according to their roles and expertise. 

 

Working well in organisations and systems of care

Show commitment to a process of continuing professional development through critical reflection and addressing of learning needs.

 

Organisation, management and leadership

Recognise the importance of distributed leadership within health organisations, which

places responsibility on every team member and values the contribution of the whole team

 

Community orientation

Describe the current structure of your local healthcare system, including various role, responsibilities and organisations within it, applying this understanding to improve the quality and safety of care you provide.

Core medical training curriculum

Managing long term conditions and promoting patient self care:

Define the role of rehabilitation services and the multi-disciplinary team to facilitate long-term care

Recognise importance of multi-disciplinary assessment

Contribute to effective multi-disciplinary discharge planning

Internal medicine training curriculum

Communicates effectively with clinical and other professional colleagues 

 

Applies management and team working skills appropriately, including influencing, negotiating, re- assessing priorities and effectively managing complex, dynamic situations

Geriatrics and higher specialty training curriculum

Define the role of rehabilitation services and the multi-disciplinary team to facilitate long-term care

Roles and expertise of different members of interdisciplinary team 

 

Physical therapies which improve muscle strength and function 

 

Therapeutic techniques/training to improve balance and gait 

 

Aids and appliances which reduce disability.

 

Understand the structure, roles and responsibilities of the multi-disciplinary team including the importance of outside agencies, and the way in which individual behaviours can impact on a group 

 

Role of the geriatrician and the multidisciplinary team in discharge planning