SLP in a Skilled Nursing Facility

4 weeks in and LOVING it!

I have been participating in my current clinical practicum experience, at a skilled nursing facility, for 4 weeks now and can honestly say that I did not expect to gain as much as I have in this short time. I have gained a passion for this population, I have gained skill level and competency in evaluation and treatment, and I have gained confidence in myself with this setting. I have never aspired to work in a SNF, it actually was the complete opposite. I had negative feelings about working in this setting, there are so many ill perceptions of nursing homes, and it persuaded me to steer away from this career path. 

The thought of being responsible for ordering one's least restrictive diet (LRE), was absolutely terrifying as I began this semester. What if I don't make the right decision? Multiple aspects are involved in my clinical decision-making skill including a resident's safety, functional outcomes, and quality of life. My supervisor has been more than amazing, and has guided me, encouraged me, and helped me gain the confidence I need to provide quality care to this population. I can definitely see myself in this type of setting in the future, which is a complete 360 degrees from what I thought when beginning my graduate education journey. 

Evaluation & Assessment

I am learning a lot during this medical practicum experience, that I didn't even realize I needed to know such as all the abbreviations used in documentation and using the appropriate wording when document to prove that my services are skilled and appropriate for a resident. I am also getting experience with evaluation, an aspect of this setting that I wanted to get a lot of experience with.  I have not had any experience with this population in assessment before now. Unfortunately, at this setting they do not conduct MBSS, which I was really hoping to get experience with (in addition to the MBSImP  we used in our dysphagia course). Swallowing evaluations at this SNF consist of a patient chart review, informal assessment (e.g., observation, interview with patient/family, impact on quality of life (QoL), etc.), Bedside Swallowing Evaluation using multiple textures and consistencies. We always trial different consistencies during our swallowing evaluation via rim of cup and straw to find if signs and symptoms of aspiration present with one greater than the other.

Here is a video by Theresa Richard, a medical speech pathologist that is board-certified in swallowing and swallowing disorders. She is the Founder and CEO of the MedSLP Collective and MedSLP education, she also reaches an audience through her podcast 'Swallow Your Pride'. In this video, she shares what should be included in a Bedside Swallow Evaluation, very useful information for new clinicians!

I have also conducted comprehensive evaluation for cognitive-communication disorder with patients during this placement. My supervisor has completed training in the Brief Cognitive Assessment Tool (BCAT) system, so I have actively assisted in administering this assessment tool. We also review patient charts, using informal tools (e.g., screening tools, observation, family/patient interview, impact on ADL's and QoL), and other formal assessment (SLUMS), to diagnose cognitive-communication disorders. There are many similarities between the comprehensive evaluation process for the pediatric population that I have had much more experience with, which made the transition to this setting manageable. 

I have really enjoyed my placement thus far and look forward to where it takes me on this journey, what I continue to learn and relationships I am able to prosper with the residents and staff at this facility. I'll be back soon with another update, stay tuned! ❤

Blogroll

Darla Gardner's blog provides helpful information for speech-language pathologists in various settings.

Rebecca Reinking's blog shares information specific to speech sound disorders (SSD).

The Gift of Gab is a blog by Jessica, where she gives tips, tricks, and strategies to focus on teaching.

The Traveling Traveler is Julia a traveling SLP visit her blog to learn tips on therapy and travel therapy.

Sweet Southern Speech is an adorable blog by Ashley Rossi, an SLP that has worked with all populations and settings and provides great literacy tips.