Health Science and Medicine Plan - Case Study Example

Health Science and Medicine Case Plan al Affiliation Case scenarios Recently on a speech pathology clinical placement I meta middle aged man with dysphagia (swallowing difficulties) and dysphonia (voice dysfunction) following a farming accident. The dysphonia was characterized by a high pitched voice due to nerve damage causing his vocal folds to become inflexible. The dysphagia was reasonably serious as the man was aspirating food and drink into his lungs causing him to experience repeated chest infections. This can also lead to a potentially fatal ‘aspiration pneumonia’. Interestingly, despite the severity of the dysphagia, this man seemed much more concerned with his high pitched voice and the prospect of sounding ‘like a girl’ for the rest of his life. Voice is a powerful communication tool, and it was clear this man felt that his manliness/masculinity was threatened by the change in his voice. Identify the likely environmental, practitioner skill, and procedure/policy factors that contribute to the problem. Dysphagia and dysphonia are the two frequent ACDF surgical complications (Groher, 1997). Although they are often temporary, they can be long-standing or even permanent conditions. A substantial number of patients usually improve with eventual total resolution after post-operative treatment, however, some patients carry on with the condition for a life time (Groher, 1997). The dysphagia practitioner should exhibit basic skills that assist in the care, management and treatment of patients suffering from dysphagia. The practitioners through their skills should subsidize to the execution of dysphagia management and care plans prepared by care team mates and report to Dysphagia Foundation, more competent specialist or dysphagia consultant practitioners to aid information sharing in managing the condition (Goroll, & Mulley, 2009). Dysphagia practitioners should organize oral intake for the patients with the condition and contribute to feeding and providing fluids. The oral intakes include; food or drink, and medication drugs that are given by practitioners according to their location and designation. The practitioners require training in developing the skills and knowledge. Their proficiency should be evaluated by a more experienced and skilled practitioner. During assessment, they should demonstrate adequate knowledge of relevant policies, procedures and guidelines in management and care of the condition (Goroll, & Mulley, 2009). The practitioners should identify and present signs and symptoms that appear in patients, and undertake a protocol-guided examination of dysphagia. They often work on pre-defined criteria, which include; the use of liquids, semi-solids and solids, with relation to the patient’s age and needs. The practitioners initiate and implement actions which are dictated by the protocol and distribute this information to the patient, the caregivers and the whole team managing the condition. They establish the knowledge, skills and understanding of the relevant policies, procedures, and guidelines regarding dysphagia (Goroll, & Mulley, 2009). Speech language pathologists examining the patient population with dysphagia should, therefore, understand the right surgical process in addition to the relevant physiological and anatomical conditions before and after ACDF surgery. With the relevant knowledge and skills practitioners can make thorough clinical decisions concerning the evaluation process, treatment of the condition, counseling of the patients and making appropriate referrals of clients after anterior cervical surgery to prevent dysphagia (Groher, 1997). The policy procedure contributing to the management of Dysphagia provides for appreciation of relevant information detailed in the dysphagia supervision (Goroll, & Mulley, 2009). The relevant information provided in the policy and procedure in management of the condition includes; medical state and diagnosis, examination of chest status, psychological state and mood of the patient, the cognitive state, perceptual issues and sensory integration difficulties in patients (Goroll, & Mulley, 2009). Environmental factors have a serious impact in the management and care of Dysphagia condition. Polluted irritating environment is a major setback in management of the condition. General health diagnosis and prognosis, communication with relevant practitioners, physical, emotional and psychological support are thus important in managing the condition (Goroll, & Mulley, 2009). Other environmental factors include, variability, sociocultural needs, functional capacity like perception and cognition, behavioral issues of the affected, the current levels of alertness and response in the community, ability to co-operate and influence of endurance in individuals, perceptions, beliefs and compliance and available equipment in managing the condition (Goroll, & Mulley, 2009). Describe some SPECIFIC desired outcomes for this type of client /patient /user. Dysphagia and dysphonia conditions have got their own specific management, treatment and outcomes, the treatment to each individual is also specific. The general techniques of management and outcomes are described below. Conservative therapy: Under this therapy, causative factors such as stress, smoking, and alcohol use are identified eliminated before the symptoms persist. Drinking of plenty clear fluids is encouraged to avoid a dry throat. The voice should be completely rested for two to three days and during the resting period, neither talking nor whispering is allowed and the patient can only communicate to others through writing on a note pad (Boysen, Ford, Fleming, United States., & Johns Hopkins Medical Institutions, 1990). Speech therapy: Speech therapist role is to assess and treat patients with voice ailments, like vocal cord nodules problem and voice misuse condition. Speech therapy takes may take considerable number of weeks or even months before any improvement is realized and so the patient should be highly motivated and be patient to notice the changes (Boysen, Ford, Fleming, United States., & Johns Hopkins Medical Institutions, 1990). Medical therapy: Medical research has found that, upper respiratory tract infections, like dysphonia, are often caused by viral infections. Enough bed rest, regular aspirin and saline gargles are commonly used to manage the condition. The antibiotics should only be administered when there is a bacterial infection (Boysen, Ford, Fleming, United States., & Johns Hopkins Medical Institutions, 1990). Nasal sprays can also be used to treat patients suffering from chronic inflammation of the sinuses and nasal lining and those who get irritation down the back of the throat. When the chronic inflammation of the sinuses is not handled at early stages, the condition can lead to dysphonia. Endolayngeal microsurgery is only recommended when all other measures have failed to manage the condition (Boysen, Ford, Fleming, United States., & Johns Hopkins Medical Institutions, 1990). It may involve removal of tumor and laser surgery. Any individual who has experienced hoarse voice for a period of four weeks or more should seek medical advice from competent and skilled medical practitioner in the relevant field. They can seek medical attention from a nose and throat specialist for further assessment like inspection of the larynx (Boysen, Ford, Fleming, United States., & Johns Hopkins Medical Institutions, 1990). Specify and justify a variety of individual and service level strategies /actions /techniques 
based on male strengths approach relevant to the desired outcomes. Patient-centered approach should be applied in primary care, thus demanding the primary care giver to be watchful of and reactive to patients’ capabilities and understandings of health and illness. This requires effective communication strategies of the key dimensions of patient-centeredness which include; the adoption of bio psychosocial perspective where men are identified with dignity; sharing power and responsibility and perceiving the doctor as person (James, Annette, Gary, & Megan, 2008). The approach is premised on a solid, trusting and long lasting relationship that is insightful of mutual involvement between the doctors and patient. The approach grows the patient’s satisfaction during and after consultations services and improves the health outcomes (James, Annette, Gary, & Megan, 2008). Research has shown that, men tend to delay seeking medical attention, and there is a general belief that men are reluctant users of health care facilities and, therefore, become victims of their own character. The social construction theory of masculinity explains this occurrence in men. However, recent Australian data, indicated that almost 90% of men over the age of 40 who were interviewed visited their general practitioners in the previous one year (James, Annette, Gary, & Megan, 2008). The male gender favors a concise, direct approach and matter of fact style of communication when it comes to seeking health care in managing dysphagia and dysphonia illnesses. This approach is consistent with male communication patterns, which encompasses direct, result-oriented and conclusive communication (James, Annette, Gary, & Megan, 2008). Although a patient-centered approach in men’s health care integrates a non-directive communication style, leading to achievement a therapeutic alliance, for some men individuals, there is an inclination towards a directive and a direct approach in achieving the desired outcome in managing dysphagia and dysphonia health complications (James, Annette, Gary, & Megan, 2008). The general perception is that men often under-utilize health services both in terms of access and the way they use the services accessed to them. There is inadequate knowledge on the processes of making appointments and negotiating with mainly female receptionists especially if the man is suffering from dysphonia (Keith, David & Peter, 2008). They may think that the female receptionist will discriminate them as a mistake them as ladies. This makes the men feel like losing their masculinity (Keith, David & Peter, 2008). Other factors include; health facility opening hours that coincide with work commitments, unwillingness to wait for appointments and long lines, the feeling that the service is primarily meant for women and children. A dysphasic patients have a lot of difficulty in talking and would fear the negative response they may get when presenting with problems that are not quickly solved hence, making the desired outcomes hard to achieve (Keith, David & Peter, 2008). Most men suffering from dysphonia and dysphagia do not trust the confidentiality of health care system. The condition may make a man behave like a woman and therefore the condition should be treated with confidentiality, especially among the adolescents and adults. They fears relating to shame when the problem is judged to be of little consequence, or admitting to another person that they suffer from the condition that betrays the masculine nature (Keith, David & Peter, 2008). Due to poor vocal pitch, they may lack to words that can explain the condition in a simple and non-embarrassing manner to the health care practitioner, hence may affected individual find it hard to seek medication attention to achieve the specific treatment outcomes. When men make early contact with a program, the condition of the immediate environment and staff openness and reaction towards them often influence the level of trust that men build (Andrew, Steve, & Ross, 2004). Men usually enter new situations with distrust anything that may be expected of them and often rely on visual cues to relax (Andrew, Steve, & Ross, 2004). These causes major setbacks in the management and care of dysphagia and dysphonia conditions. They investigate if other men are present in the health care facilities or if men are shown in positive images on posters in the health facility. Certain environmental factors can increase commitment of men to seeking medical care, these include; using positive images of men on the health care posters, providing relevant reading material in the waiting rooms that may be related to infections that attack men, and employing male medical staffs to work with male patients suffering from dysphagia (Andrew, Steve, & Ross, 2004).
 Describe changes in your knowledge or attitudes towards working with men and boys. 
 Due to the fact that, men do not find it necessary to visit health care facilities, it is, therefore, important locate health care premises that are easy without many frustrations. The facility should also employ male medical staff who can engage the man on the problem to handle during initial telephone contact (Andrew, Steve, & Ross, 2004). Male adolescents usually associate mental health counselling with mental illness rather than mental health promotion and they no do not have formal experience with mental health counselling and identifies action oriented strategy as improving the chances of successful outcome of counselling (Smith, 2004). The adolescents, therefore, needs public awareness campaign to educate on the importance of counselling and public education because it assists in preventing some illnesses. Most men associate themselves by their work and often feel more comfortable in their workplace than in health facility settings like community health centers, maternal and child care health centers, hospitals and general practices. Several men usually view the health care delivery system as a powerful and threatening complex that they cannot trust. (Greg, 2009). Men, therefore, need sensitization on the importance of visiting health care centers to assist in detecting illness that can be handled while they are still in their early stages. Diseases like dysphagia and dysphonia are easily treatable at early stages. Reference Andrew K, Steve S, & Ross F. (2004). Checklist for Organizations Working with Men. Developing Practice 2004. Boysen, A. E., Ford, R. W., Fleming, S., United States. & Johns Hopkins Medical Institutions. (1990). Dysphagia: Evaluation and management. Washington, D.C.: Dept. of Veterans Affairs. Goroll, A. H., & Mulley, A. G. (2009). Primary care medicine: Office evaluation and management of the adult patient. Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins. Groher, M. E. (1997). Dysphagia: Diagnosis and management. Boston: Butterworth-Heinemann. James A. S., Annette J. B., Gary, A W., & Megan. J. W. (December 15, 2008). Qualities men value when communicating with general practitioners: implications for primary care settings. Doctor and Patient 2008. Keith C, David C, Peter B. (2008). The Bradford & Airedale Health of Men Initiative: A study of its effectiveness in engaging with men. Centre for Men’s Health. Faculty of Health: Leeds Metropolitan University. Smith, J. M. (2004). Adolescent males view on the use of mental health counseling service. Adolescence; Spring 2004; 39, 153; ProQuest. Greg, M. (2009). Engaging men in health care. Australian Family Physician Vol. 38, No. 3, March 2009 Read More