專業間協力合作在長期照顧之吞嚥訓練

Interprofessional Collaborative Practice in Long-Term Care: Swallow Training

吞嚥障礙常見於長期照顧機構的長輩，當出現較嚴重的吞嚥障礙影響由口進食攝取時，多數會使用鼻胃管以替代正常進食的方式。吞嚥訓練一般是由語言治療師來執行，依其障礙程度與進展， 每階段需使用不同的食物質地作為訓練食材，食物量及質地的調製則由營養師依照長輩進食能力作配置。現行的照顧模式，專業間各自執行， 缺乏完整的討論與計畫，導致訓練成效無法達到預期。本文論述對於長照機構無法執行安全吞嚥的長者，如何執行營養師與語言治療師的專業間整合，設訂增進個案營養狀況及安全由口進食為目標，共同制定每一階段的吞嚥訓練及飲食質地調整，設計並指導照顧者製備定量飲食，藉以提升個案吞嚥訓練的成效。期望本文的全人照護模式，能提升個案生活品質，符合個案及家屬的照護期待，實踐「以個案為中心」的專業核心價值。

"Oropharyngeal dysphagia is common in elders living in long-term care facilities. Nasogastric tubes are used in place of normal eating when severe swallowing disorders affect oral intake. Swallowing training is usually delivered by a speech therapist who uses different food textures for training at different stages, depending on the severity and progression of the disorder. The amount and texture of foods are adjusted by the dietitian based on an elder’s ability to eat. The current care model allows the specific preferences and experiences of the implementing specialist to guide delivery of swallowing training and thus lacks comprehensive discussion and planning, which may result in interventions failing to achieve their expected effect. In this study, we discuss how to implement the professional integration of dietitians and speech therapists, set goals for nutrition improvement and safe oral eating for the elderly with swallowing disorders in long-term care facilities. Swallowing training protocols and diet for each stage, texture adjustment, design, and caregiver guidance to prepare quantitative diets are provided to enhance the effectiveness of swallowing training. It is expected that implementation of the holistic care model presented in this study will improve quality of life in patients with oropharyngeal dysphagia, meet the expectations of both patients and family members, and help realize the professional core value of 'case-centered'."