Valuing Interprofessional Work

Throughout the dietetic internship, one thing that I have significantly observed is how important interprofessional work is within the clinical field. The hospital is a place of healing with constant working parts from different systems and specialties. Being consulted and referred by other medical professionals is such a great and connective concept. To properly heal a patient, there are several people who must do their best to try to aid the healing process.

During my clinical rotation, I really wanted to see a Modified Barium Swallow, but never got the chance. Little did I know that I would get that chance during my FSSM rotation at Baptist Health Madisonville (BHM)! I was thrilled when I heard we were going to see one; I think speech-language pathology is a fantastic field to go into. Beth, the speech pathologist we had the opportunity to follow, was wonderfully helpful and described the process before and the results afterwards.

An image from radiology

A Modified Barium Swallow (MBS) is a fluoroscopic procedure designed to see whether a liquid or food is entering a person's lungs, which is known as aspiration. According to the UM Baltimore Washington Medical Center, the swallow allows the speech pathologist and physician to determine if the anatomical structures in the mouth and throat are properly functioning when drinking, chewing and swallowing. The particular patient we observed was first administered water, then pudding, and finally one cracker, which all had consistencies of Barium in order to visualize the swallowing process through the fluoroscopy (a type of X-ray).

This is the fluoroscopic room we were in for the procedure.

The pathologist and physician ruled out aspiration, as the patient did decently well with the swallow. There was still some food getting stuck near the epiglottis, so they decided to start the patient out on thin liquids and see how they will progress. The pathologist then told us about how patients can be educated on "swallowing exercises" to better their swallowing and decrease the risk of aspiration. Overall, that experience was extremely interesting.

Fluoroscopic image from a Modified Barium Swallow

This general video shows fluoroscopic images of a BMS that are similar to the ones we were able to observe, if you are interested in taking a look!

This week I was also able to shadow the renowned wound nurse at BHM. From the second I met Betty I knew that she was extremely intelligent and well-respected by everyone in the hospital. The first in-patient we went to visit had a doozy of a first wound to see, if I do say so myself. The patient had 13 wounds in total, with several of them being unstageable.

Eschar in an unstageable wound

The pressure ulcer on the patient's right hip

was unlike anything I had ever seen in person. According to Elizabeth Ayello, unstageable wounds are unable to determine the depth of the wound's damaged soft tissue. Since the bed of the wound was completely covered with eschar, Betty said that it had to be classified as unstageable. Eschar is black-looking dead or devitalized tissue that is firmly adherent to the base and sides of the wound.

I can only appreciate the work of a wound nurse, as I could simply never do that myself. I was a bit uneasy in the patient's room while seeing the severity of those wounds for the first time ever.

The Centering Booklet

A bit more lighthearted and laid-back specialty that I was able to attend at BHM was a Centering Class for the local community of pregnant women. It is fantastic that this hospital offers the Centering Healthcare Institute, as it is a great way to empower and educate women during pregnancy. The class that I got to sit in on was focused on methods of contraception and pre-term labor. The women in the group got a chance to connect and relate to one another's pregnancy journey.

The class portrayed real support for current and future mothers; the women seemed to feel understood and accepted. I have always wanted to help pregnant women with their nutrition, so it felt great to sit with them and have their voices felt heard, understood, and safe.

These past two weeks were filled with immense learning opportunities. A competency I feel that I fulfilled was: CRDN 2.4 Function as a member of interprofessional teams. Each group of professionals from each field asked how nutrition and dietetics could be related to all the specialties I was shadowing. It was nice to feel respected within the field of dietetics. Once you're fully submerged into the clinical setting, it is important to appreciate the value of interprofessional work.

References:

Ayello, E. A. (2014, May 12). Pressure Ulcer Staging. www.cms.gov. https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/IRF-Quality-Reporting/Downloads/IRF-QRP-Training-%E2%80%93-PrU-Staging-May-12-2014-.pdf.

Improving health by transforming care through Centering groups. Centering Healthcare Institute. (2021, April 12). https://www.centeringhealthcare.org/.

Modified Barium Swallow. UM Baltimore Washington Medical Center. (n.d.). https://www.umms.org/bwmc/health-services/rehabilitation/speech-language-pathology/modified-barium-swallow.