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A Protocol for A Systematic Review and Meta-Analysis
Goal of Rehabilitation
The three-goal of rehabilitation that patient wants to achieve is back to the active lifestyle he had in his past, improving the speech and language and last is the improvement in the nutrition intake to help the body metabolism. The nursing interventions are identified to address the patient goal to directly help the patient to improve the health status. The first intervention that is used is a multifaceted impairment-based walking exercise to achieve his first goal by improving his movement. The second intervention includes Compensatory approaches approach that will address the third goal of the patient and improve his dietary difficulties. The last goal is speech and language therapy that directly focus on improving the speech of the individual so that he can have a normal lifestyle.
The first intervention that is applied to increase the physical movement of the patient because he was not able to move and always requires assistance. The multifaceted impairment-based walking exercise is one of the good methods to decrease the impairment in the patient. The article proposed by Sherrington and Tiedemann (2015), discussed the exercise intervention that can be used to improve the walking and explained that impairment occurs due to decreased muscle strength or poor postural control. The article discussed that multiple-component exercise will help the individual to improve the movement and it includes a different aspect that will be targeted which include gait, strength, flexibility, endurance and functionality of the individual. The researcher discussed the different exercise which includes graded reaching standing, walking practise, sit to stand, steps forward and lateral, heel raise and stepping in a different direction. The article also discussed some major point that should be considered when planning the exercise intervention that includes the moderate challenge to balance, sufficient dose to affect, should be personalized; the environment should be comfortable and should be done in the group. The walking exercise slowly improves the movement of the individual that eventually increase the physical activity of the individual.
This intervention will help the patient to reach his goal to improve the physical movement of the individual that has got impaired. The intervention in teamwork will help the patient to get assistance at every step and it also improves the patient analysis concerning the intervention. The therapist helps the patient to slowly increase the exercise according to his condition that will eventually increase his endurance and physical movement. During the exercise, a therapist will be there to analyse the correct exercise posture and a general practitioner so that he/she can help in emergency and nursing staff to assist the patient.
The second intervention was prescribed to improve the Dysphagia condition of the individual that directly impacted the body of the individual. The difficulty in intake of food can be improved by Compensatory approaches to improve the food passage that directly helps the individual to get proper nutrient. According to Ducan et al. (2019) described that that main aim of the intervention is to alter the flow of food and liquid by modifying the consistency of the food. The other method that was discussed by the researcher include repositioning the head, neck and body before swallowing that is considered to be the safe eating and drinking method. The article also described the swallowing exercise that basically on resistant training, tongue and respiratory muscle training and swallowing manoeuvres. The researcher also discussed other technique that can be used to improve intakes like peripheral sensory stimulation, thermal tactile, electrotherapies and non-invasive brain stimulation. The proper food intake procedure help to increase the food intake of the individual that directly help to maintain the energy metabolism in the body.
The intervention will help the patient to improve the food and liquid intake by improving muscle strength. The specialist of the therapy can help the individual to do accurate exercise that eventually improves the intake and working in teamwork improves the patient analysis. The team will help the patient to incorporate exercise in daily routine to improve the intake.
Speech and language therapy is prescribed to help the individual because he was facing difficulty while delivering the speech. The speech and language therapy include a different set of activity that includes language activates, articulation therapy and swallowing therapy. The article presented by Law, Dennis and Charlton (2017), the main of the intervention is to improve the speech of the individual that includes activities that focus over speech sound, vocabulary, sentence framing and word formation. The article discussed that restoring speech and language is one of the difficult tasks that are required keen attention and time to help the patient to recover. The researcher discussed that speech and language therapy includes different aspect like behavioural technique, imitation, repetition, modelling and extension to improve speech. The time duration should be set according to the individual preference and family involvement increase the chances of the patient to respond. The article also discussed that involvement of the patient with the therapist is important and trying to indulge in the activity decrease the recovery time.
The speech and language therapy will help the individual to restore the speech that is the main aim of the patient. The speech and language specialist will assist the patient that increases the chances of positive result because the specialist can understand the issue more accurately. The teamwork will help in the overall growth of the patient that directly decreases the stay of the individual in the hospital.
Discharge Planning
The discharge process is considered to be one the cruel step inpatient care because it the risk of complication as an individual is going to be free from all care process and monitoring. The most important step during the discharge process of the individual is the information exchange and collaboration with the health care professional. The discharge process is and complex process because the staff of the hospital has to tell the patient and his/her family regarding all the necessary information that should be considered during patient care. The proper documentation should be done during the discharge process to help the patient to take reference if he/she forgot any point that is important concerning the health status. The proper information transfer between the care provider and patient with his/her family is required for the appropriate care at the home (Nordmark, Zingmark and Lindberg, 2016). The article proposed by Tseng et al. (2016) discussed the toll that is required in comprehensive discharge planning to completely understand and help the patient in need. The first step in the discharge includes patient requested for the discharge and after that ward, the nurse is going to inform the case manager about the current situation of the patient and his wish for discharge. The next step in the study includes post-discharge care requirement to the individual will be assessed to understand the care process that is used during care and current condition of the patient. The case manager will provide multiple services and resources referral to the patient and then the entire health care associates who are involved with the patient will be involved in the decision making. After analysing everything patient will be discharged and then follow-up will be done to ensure the good health status of the patient.
The direct interaction of the nurse increases the role in the discharge plan of the patient because they have been doing the follow-up to understand the patient health status. The discharge planning of the patient has a key role of the ward nurse because they are in the frontline during patient care and they are more aware of the risk-factor that is associated with individual’s health status. There are different role that is done by the nurse during the patient discharge process to decrease his/her dependency over other individuals. The first sector where they play a key role is teaching the patient about the home-care skill that is required to maintain the mood health status. The next step is to the identification of the client need that should be remembered after the discharge process that will help the health status. The introduction of the patient toward social resources is one of the key roles played by the nurse that helps the patient to increase understanding of the different sources. The direct relation of the nurse with the patient family also increases her responsibility to increase their awareness regarding the care process that is required for the patient at home. They help the patient and his/her family to understand the procedure of medical treatment by simplifying the procedure so that it can easily be performed at home (Sakai et al. 2015).
The interventions that are prescribed to the patient are according to the patient current condition and they are prescribed to improve the health status of the individual. The current situation of the patient was first analysed and according to the symptoms, each intervention is suggested. After the patient assessment proper researched has been done to understand the link between symptoms and disease and then proper intervention according to disease is suggested using the evidence-based method.
References for Interventions for Oropharyngeal Dysphagia
Cera, M. L., Romeiro, T. P. P., Mandrá, P. P., & Fukuda, M. T. H. (2019). Variables associated with speech and language therapy time for aphasia, apraxia of speech and dysarthria. Dementia & Neuropsychologia, 13(1), 72–77. doi:10.1590/1980-57642018dn13-010007
Duncan, S., Gaughey, J. M., Fallis, R., McAuley, D. F., Walshe, M., & Blackwood, B. (2019). Interventions for oropharyngeal dysphagia in acute and critical care: a protocol for a systematic review and meta-analysis. Systematic Reviews, 8(1), 1-8. doi:10.1186/s13643-019-1196-0
Law, J., Dennis, J. A., & Charlton, J. (2017). Speech and language therapy interventions for children with primary speech and/or language disorders. The Cochrane Database of Systematic Reviews, 2017(1), 1-21. https://doi.org/10.1002/14651858.CD012490
Nordmark, S., Zingmark, K., & Lindberg, I. (2016). Process evaluation of discharge planning implementation in healthcare using normalization process theory. BMC medical informatics and decision making, 16, 48. https://doi.org/10.1186/s12911-016-0285-4
Sakai, S., Yamamoto-Mitani, N., Takai, Y., Fukahori, H., & Ogata, Y. (2015). Developing an instrument to self-evaluate the Discharge Planning of Ward Nurses. Nursing open, 3(1), 30–40. https://doi.org/10.1002/nop2.31
Sherrington, C., & Tiedemann, A. (2015). Physiotherapy in the prevention of falls in older people. Journal of Physiotherapy, 61(2), 54–60. doi:10.1016/j.jphys.2015.02.011
Tseng, J.-H., Lin, H.-S., Chen, S.-M., & Chen, C.-H. (2016). A comparison study between two discharge planning tools. Applied Nursing Research, 32, 52–60. doi:10.1016/j.apnr.2016.04.007
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