SOUTH AFRICAN JOURNAL OF COMMUNICATION DISORDERS最新文献

Background:  A multidisciplinary team approach is crucial for effectively assessing and managing dysphagia. With nurses as key players in healthcare, there is limited knowledge about nursing students' experiences and exposure to dysphagia as part of their undergraduate training.

Objectives:  To explore the experiences of final-year nursing students at a university in the Eastern Cape regarding dysphagia management.

Method:  A qualitative descriptive phenomenological approach was employed. Semi-structured interviews were conducted with 12 final-year nursing students who had prior exposure to dysphagia management. Thematic analysis was used to analyse and identify key themes in the data.

Results:  Four main themes emerged: (1) confidence and knowledge, (2) clinical exposure, (3) current dysphagia management practices and (4) development of clinical skills. The participants expressed varying levels of theoretical knowledge and clinical exposure regarding dysphagia management, with the majority reporting that the focus in their lectures was on the insertion of a nasogastric tube as part of dysphagia management. Exposure to dysphagia depended on which ward the students were placed in during the clinical training. There was notably limited knowledge among participants on the role of speech therapists in dysphagia management.

Conclusion:  The expressed knowledge gaps and limited clinical exposure hindered nursing students' confidence and competence in dysphagia management.Contribution: This study highlights the importance of reevaluating the way dysphagia is taught to nursing students. By providing more theoretical and practical exposure and integrating interprofessional education, nursing students' knowledge, confidence and practice in dysphagia can be improved.

Background:  Functional voice disorders (FVDs) result from inefficient vocal use without an organic cause and have an underreported incidence.

Objectives:  This study aimed to investigate the incidence and nature of FVDs among treatment-seeking patients at a private interdisciplinary voice clinic in Pretoria, South Africa.

Method:  A retrospective quantitative design was used to analyse data from 86 patients diagnosed with FVDs between January 2017 and July 2022. Descriptive and inferential statistics were applied.

Results:  The incidence rate of FVDs was 16.67% among 516 patients with voice disorders. The primary diagnosis was muscle tension dysphonia (MTD), affecting 80.2% of cases. The most common secondary diagnosis was laryngeal pharyngeal reflux (LPR) at 39.5%. Hoarseness was the most reported symptom. No significant differences were found between occupational and non-occupational voice users.

Conclusion:  The findings clarify the incidence and nature of FVDs in the South African context.Contribution: It underscores the need for greater awareness of FVDs in low- and middle-income countries (LMICs) as well as future research on prevention and management strategies.

Background:  Premature birth is associated with many medical conditions including feeding and swallowing difficulties. Despite the existing knowledge on caregivers' experiences, there is a dearth of literature that has explored experiences of caregivers whose infants have feeding difficulties in the neonatal intensive care unit (NICU) in South Africa.

Objectives:  This study explored experiences of caregivers of premature infants diagnosed with feeding difficulties in the NICU within the South African context.

Method:  This study was conducted using an explorative qualitative design. Data were collected using an anonymous qualitative survey distributed through caregiver social media support groups. Purposive sampling was used to recruit 9 participants. Data were analysed using inductive thematic analysis.

Results:  Three main themes emerged, namely: (1) Emotional distress associated with infants' feeding and swallowing difficulties and prematurity, (2) infants' inability to feed orally and NICU restrictions: barriers to caregiver-infant attachment and bonding, and (3) caregiver informational needs regarding oral feeding and general child care.

Conclusion:  This study indicates the need for holistic family-centred healthcare practices within the NICU. Therefore, in addition to providing oral-sensorimotor intervention to infants with feeding and/or swallowing difficulties, speech-language therapists (SLTs) need to ensure that caregiver needs and concerns related to their child are addressed. Moreover, SLT interventions need to consider caregiver-infant attachment and bonding strategies in the absence of oral feeding.Contribution: This study highlights the need for family-centred care practices within the NICU, which considers informational needs, inclusion in oral-sensorimotor intervention, and the psychosocial needs of caregivers.

Background:  A significant gap in literature exists regarding speech-language therapists' (SLTs') guidelines for swallowing management in patients with head and neck cancer (HNC), particularly in low- and middle-income countries like South Africa.

Objectives:  This study explored a sample of South African SLTs' views of swallowing management in patients with HNC.

Method:  A custom-designed online questionnaire was shared on social media platforms and completed by 14 South African SLTs with experience in swallowing management of patients with HNC. Quantitative data were analysed using descriptive statistics and structured tabular thematic analysis for qualitative data.

Results:  Participants (n = 14) believed they have a key role in the swallowing management of patients with HNC. Yet, they often face obstacles, such as late inclusion as a team member, cultural and linguistic barriers and/or limited access to resources and standard operating protocols. Most SLTs in this sample (n = 8) include instrumental assessments during initial evaluation. Treatment varied for each patient (e.g., type of surgical procedure [n = 14], anatomical and physiological changes [n = 14]). Speech-language therapists highlighted the importance of multidisciplinary collaboration, cultural and linguistic considerations and professional development.

Conclusion:  This population requires increased SLT involvement in multidisciplinary teams to ensure timely and appropriate evidence-based swallowing intervention.Contribution: This study provides a description of SLTs' views on swallowing management of patients with HNC. Continued professional development is needed for South African SLTs to enhance evidence-based decision-making in HNC management, thus enhancing quality of care.

Background:  Communication between speech-language therapists (SLTs) and nursing personnel is essential for safe dysphagia management, as unclear exchanges can compromise patient outcomes and care continuity. In South Africa, high patient loads, limited dysphagia training, and linguistic diversity create additional challenges, making effective interprofessional communication crucial.

Objectives:  This study aimed to identify communication practices related to dysphagia in exchanges between SLTs and nursing personnel, focusing on mutual understanding, openness in interactions and frustration experienced during communication. It also explored nursing personnel's preferred communication modes when discussing feeding and swallowing management.

Method:  A quantitative, cross-sectional design was used. Data were collected from 18 nurses by means of an adapted Nurse-Physician Communication Scale. The survey was distributed electronically across South Africa via multiple channels. Purposive sampling targeted nursing personnel with at least 6 months' experience in managing patients with dysphagia.

Results:  Findings showed that while some mutual understanding exists, nursing personnel often felt misunderstood during interactions with SLTs. Reduced mutual understanding and openness correlated with dissatisfaction in communication. Nursing personnel frequently perceived much of the dysphagia-related information as irrelevant, which increased frustration. Nurses expressed a preference for face-to-face verbal and written communication over electronic modes.

Conclusion:  The study highlights the need to improve communication practices employed in dysphagia management to support successful interactions and optimal patient management. Strengthening interdisciplinary communication between SLTs and nursing personnel can enhance patient outcomes, increase nursing satisfaction, and promote better teamwork.

Background:  Feeding and swallowing difficulties usually demand specialised knowledge and skills for effective assessment and management. In South Africa, community service speech-language therapists (SLTs) play an integral role in delivering care within the public healthcare system, where the ratio of patients to medical professionals is notably disproportionate. However, the extent to which they feel prepared when managing these conditions remains relatively underexplored.

Objectives:  To explore the extent to which community service SLTs feel prepared when managing paediatric feeding and swallowing difficulties, the challenges they experience, and the resources and support systems available to them.

Method:  An explorative descriptive qualitative design was used in this study. Data were collected using online surveys and analysed using inductive thematic analysis. Twelve clinicians participated in this study, all of whom worked in different public healthcare institutions throughout South Africa.

Results:  Three themes emerged: (1) lack of confidence and self-doubt in their clinical skills; (2) systemic factors within the public health sector that impede service delivery; and (3) difficulty in navigating caregiver health beliefs and the duty of care.

Conclusion:  This study provides a nuanced understanding of the lack of preparedness community service SLTs feel when managing children with complex feeding and swallowing difficulties. The findings further underscore the need for additional mentorship support for these therapists, especially in facilities where there are no established speech therapy services.Contribution: The study has implications for improved service delivery initiatives and curriculum reform at institutions of higher learning.

Background:  Children with cerebral palsy (CP) often experience feeding and/or swallowing difficulties (FSD), which are lifelong, necessitating long-term care by caregivers, particularly in resource-constrained contexts like South Africa. This ongoing responsibility can lead to burden and reduced quality of life (QoL) for the caregiver and child. Exploring caregivers' experiences is required for planning and implementation of effective support services.

Objectives:  The study aimed to explore the experiences of caregivers of children with CP who have FSD, regarding the burden, QoL and support needs.

Method:  A qualitative case study design was used, involving eight mothers of children aged 2-8 years, recruited from a hospital-based CP clinic. Participants (aged 25-42 years) engaged in semi-structured telephonic interviews conducted in English and isiXhosa. Thematic analysis was conducted to generate themes and sub-themes.

Results:  Thematic analysis yielded seven main themes: Worry; Feeding is everything; Identified support needs; What helps me cope?; Cost of caregiving; Hopeful caregiving and Shortfalls of healthcare system and society, reflecting emotional strain, the centrality of feeding, specific support requirements, caregiver resilience, multifaceted burden and hope.

Conclusion:  Caregiver burden and QoL are closely linked and shaped by the emotional, physical, social and financial demands of caregiving. While caregivers described their unmet support needs, they also identified positive aspects of caregiving, including a sense of purpose and connection with their child.Contribution: The findings offer insight into caregiver experiences in South Africa and underscore the need for tailored, contextually relevant interventions to improve caregiver well-being and child outcomes.

Background:  Intrapartum-related complications, including intrapartum hypoxia and subsequent hypoxic ischemic encephalopathy (HIE), are the second leading cause of neonatal deaths in South Africa. Complications may be associated with a substantial burden of impairment, including dysphagia.

Objectives:  To describe the feeding and swallowing profile of neonates with HIE in a neonatal unit in Cape Town, South Africa.

Method:  A descriptive, exploratory, longitudinal study of 52 participants with varying severities of HIE is presented. Clinical feeding and swallowing assessments were conducted with 13 prospective participants using the Neonatal Feeding Assessment Scale, and medical folder reviews were conducted for 39 retrospective participants. Data were analysed using descriptive and inferential statistics.

Results:  A median of 4 days (p = 0.036) to oral feeding readiness and 5 days (p = 0.016) to full oral feeds was observed. Participants with a severely abnormal initial amplitude-integrated electroencephalography who did not receive hypothermia treatment demonstrated significantly longer times for both outcomes. Participants across all severities presented with feeding and swallowing difficulties, primarily in the oral phase. Most participants (96.2%) were discharged on full oral feeds, while the remaining 3.8% were discharged on nasogastric tube feeds while awaiting gastrostomy placement.

Conclusion:  Regardless of severity, neonates with HIE are at increased risk of feeding and swallowing difficulties. Thus, early identification and management before discharge from the neonatal unit, and long-term follow-up of infants with HIE, are recommended.Contribution: This study contributes to the small body of research on feeding and swallowing difficulties in neonates with HIE and may guide future research.

Background:  Dysphagia in tracheostomised patients is highly prevalent but often underdiagnosed, especially in resource-constrained settings such as South Africa. Delays in referral and limited access to instrumental assessments further compromise the quality of care. There is limited data regarding the incidence and severity of dysphagia in patients with tracheostomies within this context.

Objectives:  This study aimed to evaluate the incidence of dysphagia in tracheostomised patients at a South African private intensive care unit (ICU) in order to understand and explore the need for context-appropriate, standardised practices of care in this population.

Method:  A retrospective file review was conducted on 68 adult patients who underwent fibreoptic endoscopic evaluation of swallowing (FEES) between July 2022 and January 2024. Data were extracted for 42 patients who had a tracheostomy at the time of assessment. Dysphagia severity was rated using the Penetration-Aspiration Scale (PAS). Descriptive statistics were used to analyse incidence, severity, referral timing and ICU stay duration.

Results:  A total of 66.6% of tracheostomised patients assessed using FEES presented with dysphagia. Penetration-aspiration scores showed a polarised distribution, with 33.3% scoring 1 (normal) and 28.6% scoring 8 (silent aspiration). The average time to referral was 25.7 days, with FEES completed after 32.4 days. These delays suggest missed opportunities for early identification.

Conclusion:  The findings highlight a high incidence of dysphagia and delays in referral, underscoring the need for standardised practices of care to support earlier identification and management.Contribution: Implementing context-appropriate protocols may improve referral efficiency, optimise resource use and enhance patient outcomes in South African ICUs.

Background:  In the context of Africa and other resource-limited settings, there is a necessity to address the unique challenges faced by dysphagic patients and to better understand how healthcare professionals, including speech language pathologists (SLPs), can provide contextually and culturally responsive care given our unique healthcare context.

Objectives:  Therefore, this scoping review aims to map and synthesise evidence relating to dysphagia research in Africa to understand trends as well as research and clinical gaps.

Method:  An electronic search of CINAHL, Medline, Academic Search Premier, Global Health, PubMed was conducted in May 2024. Peer-reviewed, English-language articles published between 2015 and 2024 were retrieved. A total of 627 articles were screened, and 61 were included in the final review.

Results:  Broadly, 60.7% of the articles stemmed from SA with 62.3% being conducted by SLPs. The articles predominantly focused on practice (n = 39, 63.9%) but also looked at aspects around prevalence, screening, assessment and teaching and learning. Research on dysphagia in Africa highlights the diverse patient populations affected by the condition and the need for interdisciplinary work.

Conclusion:  There is a strong trend towards patient descriptions and the need for describing local data and developing tools that are appropriate for our contexts, but the gaps strongly highlight the need for multidisciplinary involvement in dysphagia, which is not being conducted.Contribution: This study provides some insight into research being conducted in the African continent, including current trends and areas of future research.