What is the decision-making. process for speech-language. therapists in deciding to feed. infants on high flow nasal. cannula oxygen therapy?
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1 What is the decision-making process for speech-language therapists in deciding to feed infants on high flow nasal cannula oxygen therapy? Rebecca Murphy Highly Specialist Speech & Language Therapist 27 th September 2017
2 Aims & Objectives To develop an understanding of the literature To consider how YOU might carry out a piece of research To reflect on your own practice
3 Motivation Non-invasive respiratory support has gained increased acceptance and popularity with infants In many neonatal units High Flow Nasal Cannula (HFNC) oxygen therapy is being used as an alternative to nasal continuous positive airway pressure (ncpap) Benefits of HFNC oxygen therapy are multifactorial The decision to feed an infant on HFNC oxygen therapy does not have a specific, set protocol
4 Purpose To identify how speech-language therapists (SLTs) perceive their role in relation to implementing early feeding intervention when treating an infant on HFNC oxygen therapy To identify what factors lead an SLT to initiate feeding trials for an infant on HFNC oxygen therapy
5 Background Extremely-Low-Birth-Weight infants Respiratory support Impacts of respiratory support Pre-feeding interventions Feeding on HFNC Oxygen Therapy Clinical decision-making
6 Method An explorative, qualitative study design Qualitative interviews with open-ended questions
7 Participants
8 Participants Inclusion criteria: Qualified SLTs presently working with a neonatal caseload Actively and recently involved in the decision making of feeding infants on HFNC oxygen therapy Not currently participating in another project about dysphagia
9 Data collection The data was thematically analysed using a Framework approach (Richie & Spencer, 1994) Nvivo software was used to manage the data
10 Results
11 Summary HFNC oxygen therapy has multiple benefits SLTs considered a range of clinical and other factors These factors are usually discussed within a multidisciplinary team The SLTs role in communication was not discussed surprising!? The work place has an effect of the decision-making process of SLTs
12 Future research Asking about clinical decision-making is an important and necessary part of the research process, as such it needs to be done on a broader scale by considering: Practice of SLTs across the United Kingdom Practice across disciplines
13 Workshop Group A: Ferrara, L., Bidiwala, A., Sher, I., Pirzada, M., Barlev, D., Islam, S.,... & Hanna, N. (2017). Effect of nasal continuous positive airway pressure on the pharyngeal swallow in neonates. Journal of Perinatology, 37(4), Group B: Leder, S. B., Siner, J. M., Bizzarro, M. J., McGinley, B. M., & Lefton-Greif, M. A. (2016). Oral alimentation in neonatal and adult populations requiring high-flow oxygen via nasal cannula. Dysphagia, 31(2),
14 Workshop Consider the following: 1. How do the papers relate to the presentation? 2. How relevant are the papers to clinical practice? 3. Look at each group of neonatal participants, give feedback on any thoughts related to gestational age, post menstrual age, etc. 4. What do you find challenging about the papers (this can be practice, or design, or both)? 5. How would you re-design this study so that it is relevant for a SLT caseload? 6. What else should we be doing in research to develop clearer protocols for introducing oral feeding with premature infants?
15 Questions
16 Key references Ferrara, L., Bidiwala, A., Sher, I., Pirzada, M., Barlev, D., Islam, S.,... & Hanna, N. (2017). Effect of nasal continuous positive airway pressure on the pharyngeal swallow in neonates. Journal of Perinatology, 37(4), Hanin, M., Nuthakki, S., Malkar, M. B., & Jadcherla, S. R. (2015). Safety and efficacy of oral feeding in infants with BPD on nasal CPAP. Dysphagia, 30(2), Hoogewerf, M., Ter Horst, H. J., Groen, H., Nieuwenhuis, T., Bos, A. F., & van Dijk, M. W. G. (2017). The prevalence of feeding problems in children formerly treated in a neonatal intensive care unit. Journal of Perinatology. Leder, S. B., Siner, J. M., Bizzarro, M. J., McGinley, B. M., & Lefton-Greif, M. A. (2016). Oral alimentation in neonatal and adult populations requiring high-flow oxygen via nasal cannula. Dysphagia, 31(2), Reynolds, P., & Soliman, M. (2013). Using nasal high flow instead of nasal continuous positive airway pressure on the NICU. Infant, 9(2). Ritchie, J., & Spencer, L. (2002). Qualitative data analysis for applied policy research. The qualitative researcher s companion, 573(2002), Testa, G., Iodice, F., Ricci, Z., Vitale, V., De Razza, F., Haiberger, R.,... & Cogo, P. (2014). Comparative evaluation of high-flow nasal cannula and conventional oxygen therapy in paediatric cardiac surgical patients: a randomized controlled trial. Interactive cardiovascular and thoracic surgery, 19(3), Yoder, B. A., Albertine, K. H., & Null, D. M. (2016, June). High-frequency ventilation for non-invasive respiratory support of neonates. In Seminars in Fetal and Neonatal Medicine (Vol. 21, No. 3, pp ). WB Saunders.
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Skilled skin care should be provided by an agency licensed to provide home health
8.5.D. LIMITATIONS OF PERSONAL CARE In order to delineate the types of services that can be provided by a personal care worker, the following are examples of limitations where skilled home healthcare would