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Our Family Is Crazy
Reflecting on Our

Care
By: Angie Quesnell
Date: September 23, 2021

Reflecting on Our Care
By Angie Quesnell

If you feel anything like I do, this last year and a half has prompted me to reflect on my role and skill as a clinician and reaffirmed I didn’t and couldn’t learn everything in school. Our education is important. It builds the foundation for our path forward professionally, but it also becomes about our experiences and our investment into information, knowledge, and who we are professionally that allows us to adapt to the reality of the real world. We then maintain and build upon our knowledge, our skill, and adjust to the environment in which we choose to work. If there was ever a time, it is now that we are acclimating to so many changes, challenges, and new information. It seems a bit like a rollercoaster. Just when we begin to relax and loosen our grip, here comes another incline. To get through this ride, it has helped to focus on something constant. For me, it has been the quality care we provide within our communities, for our patients, and the commitment to our teams.

I decided to step into that feeling of constant and learn more about the quality care we can provide while riding this rollercoaster. I took a couple days off and participated in a virtual conference with ASHA called Maximizing Outcomes for Medically Complex Patients of All Ages. In participating, I learned new information and refreshed past knowledge.

Key take-aways:

• Medicine should be proactive not reactive (Coyle, 2021).
• For SLPs, it matters why we call ourselves speech-language pathologists. A pathologist “analyzes not only the impaired area, but integrates the effects of existing comorbidities, age, self-care attitudes and motivation, and formulates a plan to lower the risk of the effects of the disease on the patient’s well-being and health…” This is especially important with chronic conditions, as well as patients at end of life (Coyle, 2021).
• Disorders are disruptions of function caused by the disease. To understand the disorder, the clinician must understand the disease (Coyle, 2021).
• Identify the impaired physiologic mechanisms resulting in dysphagia (Knigge & Namasivayam-MacDonald, 2021). For example, do we assess for and consider impaired respiration a contributing factor in our dysphagia patients (frequently enough) and treat accordingly?
• Look at the WHOLE patient (Knigge, 2021). This concept is currently expressed in our maintenance and prevention pillar of “doing what matters.”
• Actively develop our cultural competence (Knigge & Riegler, 2021).
• All patients are entitled to communication strategies and support (Altschuler, 2021).
• Compassion and empathy are important qualities. This was a common theme.
• Be an expert in (swallowing) function, not every single diagnosis (Knigge, 2021).
• “Treatment Follows Function” (Knigge, 2021). When documenting include:

o Diagnostic statement: “The patient exhibits…”
o Physiologic features = “characterized by…”
o Prognosis statement
o Health risk/consequence
o If reassessment, comparison to prior evaluation
o Finally, list general needs uncovered in evaluation such as strategies, diet modifications, evidence-based treatments, referrals, or need for further evaluation

• SLPs should not feel like we shoulder the burden in making tough decisions related to dysphagia care. Incorporate your interprofessional teams (Mohr, 2021).
• Maximize life experiences to leverage therapeutic gains (Riegler, 2021).
• Empower and prepare patients to manage their health (Riegler, 2021). This concept is currently expressed in our self-management pillar encouraging patient’s involvement in his/her care.
• Promote clinical care that is consistent with scientific evidence and patient preferred goals (Riegler, 2021).
• One course focused on understanding long-term complications after critical illness and factors impacting recovery. This included the importance of PT and OT quality care including use of the 6-Minute Walk Test and Grip Strength and how these quality outcomes were determining factors in the patients’ recovery (Parker, 2021). We are already implementing these measures.
• Create a culture, organization, and mechanisms that promote safe, high-quality care (Riegler, 2021).

I’m hoping some of the above points will serve as areas to reflect upon for you, as it did me.

Additionally, while it wasn’t surprising, it was encouraging to see Infinity Rehab has been proactive in their initiatives and clinical model to ensure clinicians are prepared to provide quality care regardless of where we at on this rollercoaster, already implementing many of the areas discussed in the conference. Therefore, I was reminded why I have worked at Infinity Rehab for nearly 13 years. We are prepared and have the tools to provide the best standards of care to keep us advancing even in unexpected times.

As we move forward on this rollercoaster of a ride, and we are unable to see what’s around the next turn, don’t lose sight of our role as clinicians and how and why we got here. Ultimately, we must hold on tight, and if we can, lean into the ride and continue to lead the charge in providing quality care for our patients while recognizing the value of care we bring together as a team.

Altschuler, T. (2021). AAC for Patients in Critical and Acute Care Settings. [PowerPoint slides]. ASHA. https://www.asha.org/

Coyle, J. (2021). Realistic, Functional Interventions and Collaborative Services for Medically Complex Patients. [PowerPoint slides]. ASHA. https://www.asha.org/

Knigge, M.A. (2021). Dysphagia Management for Medically Complex Patients in Acute Care
Approaching Unfamiliar Diagnoses in Acute Care. [PowerPoint slides]. ASHA. https://www.asha.org/

Mohr, T. (2021). The Role of the SLP in Palliative Care. [PowerPoint slides]. ASHA. https://www.asha.org/

Namasivayam-MacDonald, A. (2021). Managing Dysphagia in Patients with COVID-19 in Acute Care and Beyond. [PowerPoint slides]. ASHA. https://www.asha.org/

Parker, A.M. (2021). Post-Intensive Care Syndrome (PICS): Understanding long-term complications after critical illness (Adults). [PowerPoint Slides]. ASHA. https://www.asha.org/

Riegler, L.R. (2021). Approaches to Lifelong Care for Adults with Complex Medical Conditions.
[PowerPoint slides]. ASHA. https://www.asha.org/ASLPO


Reflecting on Our Care

By: Angie Quesnell
Date: September 23, 2021


Reflecting on Our Care
By Angie Quesnell

If you feel anything like I do, this last year and a half has prompted me to reflect on my role and skill as a clinician and reaffirmed I didn’t and couldn’t learn everything in school. Our education is important. It builds the foundation for our path forward professionally, but it also becomes about our experiences and our investment into information, knowledge, and who we are professionally that allows us to adapt to the reality of the real world. We then maintain and build upon our knowledge, our skill, and adjust to the environment in which we choose to work. If there was ever a time, it is now that we are acclimating to so many changes, challenges, and new information. It seems a bit like a rollercoaster. Just when we begin to relax and loosen our grip, here comes another incline. To get through this ride, it has helped to focus on something constant. For me, it has been the quality care we provide within our communities, for our patients, and the commitment to our teams.

I decided to step into that feeling of constant and learn more about the quality care we can provide while riding this rollercoaster. I took a couple days off and participated in a virtual conference with ASHA called Maximizing Outcomes for Medically Complex Patients of All Ages. In participating, I learned new information and refreshed past knowledge.

Key take-aways:

• Medicine should be proactive not reactive (Coyle, 2021).
• For SLPs, it matters why we call ourselves speech-language pathologists. A pathologist “analyzes not only the impaired area, but integrates the effects of existing comorbidities, age, self-care attitudes and motivation, and formulates a plan to lower the risk of the effects of the disease on the patient’s well-being and health…” This is especially important with chronic conditions, as well as patients at end of life (Coyle, 2021).
• Disorders are disruptions of function caused by the disease. To understand the disorder, the clinician must understand the disease (Coyle, 2021).
• Identify the impaired physiologic mechanisms resulting in dysphagia (Knigge & Namasivayam-MacDonald, 2021). For example, do we assess for and consider impaired respiration a contributing factor in our dysphagia patients (frequently enough) and treat accordingly?
• Look at the WHOLE patient (Knigge, 2021). This concept is currently expressed in our maintenance and prevention pillar of “doing what matters.”
• Actively develop our cultural competence (Knigge & Riegler, 2021).
• All patients are entitled to communication strategies and support (Altschuler, 2021).
• Compassion and empathy are important qualities. This was a common theme.
• Be an expert in (swallowing) function, not every single diagnosis (Knigge, 2021).
• “Treatment Follows Function” (Knigge, 2021). When documenting include:

o Diagnostic statement: “The patient exhibits…”
o Physiologic features = “characterized by…”
o Prognosis statement
o Health risk/consequence
o If reassessment, comparison to prior evaluation
o Finally, list general needs uncovered in evaluation such as strategies, diet modifications, evidence-based treatments, referrals, or need for further evaluation

• SLPs should not feel like we shoulder the burden in making tough decisions related to dysphagia care. Incorporate your interprofessional teams (Mohr, 2021).
• Maximize life experiences to leverage therapeutic gains (Riegler, 2021).
• Empower and prepare patients to manage their health (Riegler, 2021). This concept is currently expressed in our self-management pillar encouraging patient’s involvement in his/her care.
• Promote clinical care that is consistent with scientific evidence and patient preferred goals (Riegler, 2021).
• One course focused on understanding long-term complications after critical illness and factors impacting recovery. This included the importance of PT and OT quality care including use of the 6-Minute Walk Test and Grip Strength and how these quality outcomes were determining factors in the patients’ recovery (Parker, 2021). We are already implementing these measures.
• Create a culture, organization, and mechanisms that promote safe, high-quality care (Riegler, 2021).

I’m hoping some of the above points will serve as areas to reflect upon for you, as it did me.

Additionally, while it wasn’t surprising, it was encouraging to see Infinity Rehab has been proactive in their initiatives and clinical model to ensure clinicians are prepared to provide quality care regardless of where we at on this rollercoaster, already implementing many of the areas discussed in the conference. Therefore, I was reminded why I have worked at Infinity Rehab for nearly 13 years. We are prepared and have the tools to provide the best standards of care to keep us advancing even in unexpected times.

As we move forward on this rollercoaster of a ride, and we are unable to see what’s around the next turn, don’t lose sight of our role as clinicians and how and why we got here. Ultimately, we must hold on tight, and if we can, lean into the ride and continue to lead the charge in providing quality care for our patients while recognizing the value of care we bring together as a team.

Altschuler, T. (2021). AAC for Patients in Critical and Acute Care Settings. [PowerPoint slides]. ASHA. https://www.asha.org/

Coyle, J. (2021). Realistic, Functional Interventions and Collaborative Services for Medically Complex Patients. [PowerPoint slides]. ASHA. https://www.asha.org/

Knigge, M.A. (2021). Dysphagia Management for Medically Complex Patients in Acute Care
Approaching Unfamiliar Diagnoses in Acute Care. [PowerPoint slides]. ASHA. https://www.asha.org/

Mohr, T. (2021). The Role of the SLP in Palliative Care. [PowerPoint slides]. ASHA. https://www.asha.org/

Namasivayam-MacDonald, A. (2021). Managing Dysphagia in Patients with COVID-19 in Acute Care and Beyond. [PowerPoint slides]. ASHA. https://www.asha.org/

Parker, A.M. (2021). Post-Intensive Care Syndrome (PICS): Understanding long-term complications after critical illness (Adults). [PowerPoint Slides]. ASHA. https://www.asha.org/

Riegler, L.R. (2021). Approaches to Lifelong Care for Adults with Complex Medical Conditions.
[PowerPoint slides]. ASHA. https://www.asha.org/ASLPO

© 2019 Avamere Family of Companies
© 2019 Avamere Family of Companies
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© 2019 Avamere Family of Companies