Co-Treatment at the Bedside

Case Study: Co-Treatment at the Bedside

Mrs. Denise Watkins is hospitalized after a stroke that has impaired her swallowing ability. She demonstrates right-sided weakness. A speech–language pathologist (SLP) is addressing her swallowing dysfunction, and an occupational therapist (OT) is helping her learn to use her left hand to perform self-care activities. The OT and SLP on this unit work together frequently, maximizing their complementary abilities to provide optimal patient outcomes. Today the OT and SLP are meeting for a planned cotreatment session with Mrs. Watkins and her family, at her bedside. The goal of the session is to develop strategies to support Mrs. Watkins in self-feeding while avoiding choking. The SLP plans to evaluate Mrs. Watkins’ ability to swallow and assess readiness for progression of her modified diet to pureed food consistencies. They enter Mrs. Watkins’ room and explain their goal and their roles for the session. The SLP focuses on the alignment of Mrs. Watkins’ head and neck that will facilitate her ability to swallow small amounts at a time. The OT focuses on optimal positioning of Mrs. Watkins’ trunk and upper limbs to facilitate self-care activities. The OT instructs Mrs. Watkins in the use of an adaptive spoon to provide better control in bringing food toward her mouth. They alternate activities throughout the session. At the end of the session, they acknowledge the progress that Mrs. Watkins has made and determine that Mrs. Watkins needs more practice before she can attempt self-feeding. They share this with the patient and the family. The OT agrees to communicate their plan to the nurse caring for Mrs. Watkins.

Discussion Questions

1. Imagine that you are the SLP caring for Mrs. Watkins. How would you communicate your role and responsibilities for Mrs. Watkins to the patient and to the family? Repeat this exercise assuming you are the OT caring for Mrs. Watkins.
2. Explain how engaging another team member in a co-treatment session was more effective than providing discipline-specific care.
3. Explain how the roles and responsibilities of the patient, family members, OT, SLP, dietary, and nursing staff members are interrelated in providing nutrition to Mrs. Watkins.

1. As the Speech-Language Pathologist (SLP): To communicate my role and responsibilities to Mrs. Watkins and her family, I would start by introducing myself and explaining the purpose of my involvement in her care. I would say something like:
   • “Hello, I’m [Your Name], the Speech-Language Pathologist. My primary focus is on helping Mrs. Watkins with her swallowing difficulties and ensuring that she can eat safely without choking. I will be assessing her ability to swallow and providing strategies to make eating safer and more comfortable for her. My goal is to ensure that Mrs. Watkins can enjoy her meals without any harm.”

   I would then go on to explain the specifics of what I will do during the session:

   • “During our session today, I’ll be paying close attention to the alignment of Mrs. Watkins’ head and neck, which is crucial for her ability to swallow. I will guide her through exercises and techniques that will help her swallow small amounts of food at a time without any issues. If necessary, I may recommend changes to her diet consistency to ensure her safety while eating.”

   Additionally, I would encourage questions and provide an opportunity for Mrs. Watkins and her family to share their concerns or ask for clarification about my role.

   As the Occupational Therapist (OT): When communicating my role and responsibilities, I would approach it this way:

   • “Hello, I’m [Your Name], the Occupational Therapist. My main focus is to assist Mrs. Watkins in regaining her independence in performing self-care activities, particularly with her left hand due to the right-sided weakness caused by her stroke. I will be working on positioning her trunk and upper limbs optimally to make self-feeding and other self-care tasks easier for her.”

   I would then elaborate on what I plan to do during the co-treatment session:

   • “During our session today, I will be demonstrating and instructing Mrs. Watkins on how to use adaptive tools, like the adaptive spoon, to enhance her control when bringing food to her mouth. My goal is to empower her to regain her self-feeding abilities and maintain her independence in daily activities.”

   Just like the SLP, I would also encourage questions and create an open dialogue with Mrs. Watkins and her family to address any concerns or queries they may have about my role.

2. Engaging another team member in a co-treatment session was more effective than providing discipline-specific care for several reasons:
   • Holistic Care: Co-treatment allows for a more holistic approach to patient care. In this case, the SLP and OT brought their expertise together to address both swallowing difficulties and self-care activities simultaneously. This comprehensive approach considers the patient’s overall well-being and functional needs.
   • Synergy: The combined efforts of the SLP and OT maximize their complementary abilities. They can identify and address potential issues more effectively and collaboratively. For instance, the SLP can ensure that Mrs. Watkins’ head and neck alignment during feeding align with the OT’s positioning of her upper body for self-feeding.
   • Patient Engagement: Co-treatment can be more engaging for the patient. Mrs. Watkins benefits from the shared attention of two experts, each focusing on her specific needs. This can motivate her and provide a more positive experience during therapy.
   • Efficiency: Co-treatment can save time and resources. Rather than having separate therapy sessions, the SLP and OT can work together, making the most of their time and reducing any potential duplication of efforts.
3. The roles and responsibilities of various team members in providing nutrition to Mrs. Watkins are interrelated as follows:
   • Patient: Mrs. Watkins plays a central role in her own nutrition. She needs to follow the recommendations and instructions provided by the SLP and OT for safe and effective self-feeding. Her active participation and practice are crucial for her progress.
   • Family Members: Family members are essential in providing support and encouragement to Mrs. Watkins. They can help facilitate her therapy exercises and ensure that she follows dietary recommendations and restrictions at home.
   • Occupational Therapist (OT): The OT focuses on Mrs. Watkins’ physical abilities and positioning during self-feeding. They provide guidance on adaptive tools and techniques to enhance her independence in meal preparation and eating.
   • Speech-Language Pathologist (SLP): The SLP is responsible for assessing and addressing Mrs. Watkins’ swallowing difficulties. They recommend modifications to her diet consistency to ensure safe swallowing. Their expertise is critical in preventing choking and aspiration.
   • Dietary Staff: Dietary staff members are responsible for preparing meals that align with the patient’s recommended diet consistency, as advised by the SLP. They must ensure that Mrs. Watkins receives appropriate and safe food options.
   • Nursing Staff: Nurses play a vital role in monitoring Mrs. Watkins’ overall health and well-being, including any changes related to her nutritional status or swallowing abilities. They communicate with the OT, SLP, and dietary staff to ensure a coordinated approach to her care.

   In this collaborative effort, effective communication and coordination among all team members are essential to provide Mrs. Watkins with the best possible care and support her in her recovery.