Thematic analysis elicited individual service user characteristics, and social and contextual factors implicated in choking. The findings will facilitate risk assessment for service-users and inform mealtime practice. Staff familiarity is a key factor. Further research involving service-users is indicated to complement these findings. This study widens the focus of recent studies which have considered physical more than socio-environmental aspects of mealtime difficulties.
Purpose Dysphagia experienced by adults with mental health conditions and/or intellectual disabilities (IDs) has been well-reported. However, accessible and inclusive assessment measures to identify and monitor for deterioration in dysphagia are very limited. The purpose of this paper is to explore the use of video to enhance inclusion in dysphagia assessment and intervention for an inpatient setting. Design/methodology/approach This service evaluation involved adults with IDs and mental illness living in in-patient accommodation and their multidisciplinary team. Participants were invited to film and then reflect on videos and their comments were transcribed for qualitative analysis. Findings In total, 42 adults gave consent to film, review and discuss mealtime video-clips. Staff feedback was invited. Thematic analysis was conducted for service-user and staff comments. A global theme of “involvement” was identified from the data analysis, with sub-themes of “enhancing participation, insight and incentive”. An additional global theme “clinical benefits” resulted from staff comments. This included sub-themes of breadth of assessment, shared working and outcome measures. Research limitations/implications Limitations included refusal of video by people with heightened anxiety but these were a minority. Most people showed enthusiasm and enhanced engagement. Practical issues were resolved regarding governance. Practical implications Video offers a dynamic record of muscle tone, coordination, mealtime experience and individual context benefiting both service-user and staff practice. It stimulates insightful discussion of outcomes and supports the inclusion of service-user perspectives. Further research is indicated to develop a greater understanding of dysphagia in this population. Inclusion of service-users in planning and managing safer mealtimes may be enhanced through the sensitive use of video. Social implications This evaluation suggests opportunities for improving inclusive approaches for service-users using video to promote insight. Originality/value Further research is indicated to explore the nature of dysphagia in people with mental health conditions using video as a dynamic and unique resource.
This study demonstrates paucity of detail in reporting in systems without additional question prompts. Adding these questions requires staff to include greater detail which enables learning and risk mitigation to take place.
Purpose -This paper aims to present the distinctive roles and perspectives of the members of a multidisciplinary team supporting a man with multiple diagnoses who was under Section by the Mental Health Act.Design/methodology/approach -The management of risk for this man with intellectual disability, mental illness and a degenerative neurological condition was particularly complex due to his self-harming and impulsivity. Each specialist clinician (nurse, speech and language therapist, psychiatrist) reflects on their role as a member of a team approach. The perspective of the man himself is represented, although he was unable to give a consistent descriptive self report.Findings -For people with mental illness and intellectual disability the capacity to understand and retain information about their condition may be limited and variable. The paper discusses the multiple ethical issues in attempting to preserve a modified autonomy and in decision making around best interests.Practical implications -Supporting someone with dysphagia presents specific challenges to staff teams due to the everyday and familiar nature of mealtimes. When the person is unable to understand and refuses to comply with guidelines outlining restrictions to mealtime choices, the staff's role in safeguarding is particularly complex. The paper considers how to mitigate against risks to mental and physical health.Originality/value -In cases of self harm the care team is challenged to respect autonomy and maintain quality of life whilst ensuring safety of the individual. The paper discusses maintaining professional integrity when considering compromise.
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