Department of Speech Pathology, University of the Witwatersrand, Johannesburg, South Africa; and, Department of Speech-Language Pathology, University of KwaZulu-Natal, Durban, South Africa.
S Afr J Commun Disord. 2021 Jun 30;68(1):e1-e8. doi: 10.4102/sajcd.v68i1.790.
The bedside assessment is often seen as a screener because of its high variability in sensitivity and specificity, whilst the instrumental measures are viewed as gold standards because of the ability of speech-language therapist (SLT) to visualise the swallow more objectively.
This research article explores how the value needs to be placed on the decision-making abilities of the SLT rather than on the assessment measure itself.
A mixed methodology concurrent triangulation design was employed to collect data in two phases: the first phase included observing seven SLTs conducting assessments using a standardised bedside measure together with pulse oximetry and cervical auscultation. The second phase was a focus group discussion based on the findings from the first phase. Data were analysed thematically using a bottom-up approach.
The following factors were found to influence the decision-making process at the bedside: bedside assessment data sets, patient, multidisciplinary team, context and then SLT. The availability of more data from the assessment from different data sets improved the confidence of the SLT at the bedside when needing to make clinical decisions. Clinical instincts are developed through experience and observation of those more experienced. These skills need to be developed from junior years.
This research study showed that a bedside assessment can provide valuable information that will allow for diagnostic decisions to be made at the bedside. This study also highlighted the importance of critical thinking using clinical instincts, and that these are the factors that need to be valued and emphasised rather than the assessment measures themselves.
由于床边评估的灵敏度和特异性变化较大，通常被视为一种筛选工具，而仪器测量则被视为金标准，因为言语治疗师 (SLT) 能够更客观地观察吞咽情况。
本文探讨了如何重视 SLT 的决策能力，而不是评估方法本身。
采用混合方法同时三角设计，分两个阶段收集数据：第一阶段包括观察七名 SLT 使用标准化床边评估工具与脉搏血氧饱和度和颈部听诊一起进行评估。第二阶段是基于第一阶段的发现进行焦点小组讨论。使用自下而上的方法对数据进行主题分析。
发现以下因素会影响床边的决策过程：床边评估数据集、患者、多学科团队、背景和 SLT。从不同数据集获得更多评估数据可提高 SLT 在床边进行临床决策时的信心。临床直觉是通过经验和观察更有经验的人发展起来的。这些技能需要从初级阶段开始发展。
本研究表明，床边评估可以提供有价值的信息，从而可以在床边做出诊断决策。本研究还强调了使用临床直觉进行批判性思维的重要性，而这些是需要重视和强调的因素，而不是评估方法本身。
