Swallowing Awareness Day by Linda Prevett

Are you reading this while sipping a cup of coffee, enjoying a biscuit or two? These seemingly basic, everyday pleasures are not to be taken for granted.

Welcome to Swallowing Awareness Day held on Wednesday 16^th March 2022, midway through NHS Nutrition and Hydration Week (14 – 20 March 2022). This is a blog that began two years ago, before Covid-19 suspended 2020’s Swallowing Awareness events. That year Dumfries & Galloway’s Speech and Language Therapy team (Adult Service) had marked the week with personal challenges, which are still relevant to share with you today.

A large part of the role of speech and language therapy (SLT) is to help people living with eating, drinking and swallowing difficulties. The medical term for swallowing difficulties is dysphagia. People may present with symptoms including:

• Difficulty chewing or moving the food or drink around in the mouth
• Food getting stuck in the throat
• Changes in eating habits, eating or drinking slowly or avoiding certain foods
• Coughing or choking when they eat or drink
• Recurrent chest infections or pneumonia (termed an aspiration pneumonia if due to food or drink entering the lungs and becoming infected) 

These difficulties may be due to muscle weakness, altered sensation or coordination of the swallow.  This can happen in medical conditions such as stroke, brain injury, head and neck cancer, Parkinson’s Disease, Multiple Sclerosis, Motor neurone disease, frailty and dementia.

People, and their carers, may report fear of choking, how much they miss their favourite food and drink or how it’s changed their enjoyment of eating and drinking. It can also impact socially; less likely to go out for meals or eat and drink with others.

SLT aims to enable people to continue eating and drinking as near normal a diet of their choice as they can, balancing risk factors and quality of life. To help manage dysphagia and to reduce the risks of choking or aspiration pneumonia, speech and language therapists may recommend long term use of:

• swallowing strategies (including changing pace or size of mouthfuls)
• altering head position when swallowing
• modifying the texture of food and drinks (including adding sauce, chopping, mincing or pureeing food and thickening drinks)
• using different utensils (alternative cup, special straw)

The challenge : to Practise what we Preach

In the week leading up to Swallowing Awareness Day in March 2020, each member of the SLT (Adult Service) team chose to follow some of the advice we would give to people with a swallowing difficulty. We decided there was nothing better than practising what we preach to have a better appreciation of the recommendations we regularly give to our patients. Here are some of our honest reflections:

• Thickened Fluids

• Equipment

Our reflection

Each one of us found our own recommendations challenging to follow! It was a hugely powerful reminder that what we so easily advise, is definitely not so easy to do in practice. We must be aware of the implications of our recommendations. It has reinforced to us the importance of that good conversation with people, when deciding how best to help them manage their daily challenge in eating, drinking and swallowing.

IDDSI (International Dysphagia Diet Standardisation Initiative), for more information on the international classification of food & drink texture modification used in Dumfries & Galloway, please refer to https://www.iddsi.org

I’d like to acknowledge and thank Fiona Murchie and Anna Faughey, Speech & Language Therapists for their contributions and work on this blog.

Linda Prevett, Highly Specialist Speech & Language Therapist, Dumfries & Galloway Royal Infirmary Tel : 01387-241422.   E-mail : linda.prevett@nhs.scot      MSTeams : linda.prevett@dg.nhs.scot

The Pressure to be Perfect by Kim Black

In preparation for International Women’s Day on the 8^th March and as part of our continuing efforts to eradicate violence against women and girls, a question I often ask myself is how we can move from a culture of protection to one of prevention? How can we create a world in where our children and future generations can live both equally and safely?

Gender inequality has a strong relationship with a range of different types of violence, specifically sexual violence and domestic family violence. These forms of violence are generally considered inherently gendered due to the overwhelming perpetration of the violence by men towards women and children throughout the world. 1 in 3 women experience domestic abuse in a lifetime.

So how do we address the unconscious human bias that is innate in all us that allows for these inequalities to unknowingly shape our own thinking and behaviour within society?

A good example of when my own human bias was on full (albeit unconscious) alert was only week ago when my almost 1 year old and almost 10 year old were both unwell with a tummy bug. After only recently returning to work from being on maternity leave and the pressures of juggling all that comes with being a working mum…my immediate thought was, I need to take time off ; but I have so much to do; followed by feelings of guilt and shame around the mere consideration of not being at home to care for my sick children. What would people think if I were to leave them at home with their Dad? Does that make me a terrible Mother? All the while, I am telling myself, that I am indeed, a terrible Mother for working full time and dare I say it, actually enjoying coming to work. So Mum guilt took over, followed closely by self doubt and a general feeling of inadequacy washed over me like a tidal wave.

I was fearful of what others including my own family would think of me as a mother and entered into an unhealthy dialogue with myself, weighing up what options were available to me and why I was feeling so guilty about not staying at home to care for my family.  Research tells us that guilt and shame are the two most common emotions associated with motherhood. Self discrepancy theory suggests that guilt and shame result from ‘perceived discrepancies between one’s actual and ideal selves’ and the fear of negative opinion or judgment by others can exacerbate these feelings.   So how can we better understand the drivers for all the guilt, shame, self discrepancy, pressure to be the perfect Mum, perfect partner, have the perfect figure and conform to behave in a way that’s expected of a ‘lady’? A good place to start is by understanding how women’s gender socialisation provides the basis of ‘intensive mothering’ expectations. ‘Intensive mothering’ norms prescribe women to be perfect mothers and recent research tells us that women’s experiences of pressure to be a perfect parent are related to higher levels of guilt, stress and worst of all shame.  A common cultural message that women receive is that our greatest priority should be having children and caring for family over our own personal goals, aspirations and careers.

From birth, we are all immersed in a social and cultural environment that produces and perpetuates gender stereotypes- clothing, toys, TV shows, books, friends and extended family members all communicate messages either explicitly or implicitly about what is considered ‘appropriate’ for girls and boys. While the wider context has a significant influence on children’s developing understanding of gender, research confirms that families, and in particular parents, are young children’s first and primary source of information and learning about gender.

No pressure, right?

Gender stereotypes influence the way that children develop and engage with the world. From a very young age, children begin to learn about the attitudes, values, skills and behaviours that are seen as ‘normal’ or ‘acceptable’ for their social context and begin to shape or express their identity and preferences accordingly, so that they can ‘fit in’ and be part of a social network. For example, some cultural gender stereotypes associated with masculinity suggest boys may learn that it is ‘not okay’ to cry (or that they can only cry in rare circumstances or in private.

Parents should role-model respectful relationships and gender equality when we make decisions about who does what parenting, school runs, household tasks, and of course, who looks after the children when they are sick. When we show how these tasks and roles are valued in the family, and when they demonstrate shared decision-making we shape and pave the way to adapt to new equal societal norms whilst breaking historical stereotypes.

We all have the ability to effect change against restrictive gender stereotypes, roles and identities for children and the generations to follow.  Upholding or supporting rigid gender stereotypes can potentially impact on both girls’ and boys’ development and inadvertently shape their later career prospects, ability to process and manage their emotions in healthy ways and potentially adversely affect their capacity to engage in equal and respectful relationships. 

By adhering to and reinforcing gender stereotypes perpetuates a historical system of gender inequality that creates specific issues for both women, girls, men and boys, results in women and girls typically facing greater disadvantage.

We can change the current trajectory and story that sees one woman murdered every week by a current or former partner. The message is clear – Violence against women and girls IS preventable. While the drivers of violence against women and girls are complex, international and national evidence shows that factors related to gender inequality are the most significant and consistent predictors of violence against women. One of these factors is rigid gender stereotypes.

Be the change you want to see that breaks the bias. Engender change and imagine a world free from inequalities and stereotypes not just for ourselves today but for a sustainable tomorrow.

#Internationswomensday #IDW #bethechange #breakthebias #eradicateVAWG #equallysafe

Kim Black is Nurse Consultant for Public Protection (Child & Adult & Lead for Violence Against Women and Girls)

References

Aarnten et al, (2020) How individual gender role beliefs, organisational gender norms and national gender norms predict parents work- Family guilt in Europe. ResearchGate

URL{https://www.researchgate.net/publication/344978080_How_individual_gender_role_beliefs_organizational_gender_norms_and_national_gender_norms_predict_parents’_work-Family_guilt_in_Europe}Accessed 3^rd March 2022

Ferrante, M. (2018) How Intensive Mothering is Hurting Working Parents. Available URL {https://www.forbes.com/sites/marybethferrante/2018/08/30/how-intensive-mothering-is-hurting-working-parents/?sh=2c6bc8ea7ea6} Accessed 3^rd March 2022

Forbes, et al (2019). Differences in Intensive Parenting Attitudes and Gender Norms Among U.S. Mothers URL{https://journals.sagepub.com/doi/full/10.1177/1066480719893964} SAGE journals Accessed 3^rd March 2022

Liss et al, (2012) Maternal Guilt and shame: The role of self discrepancy and fear of negative evaluation. College of Arts and Sciences. Psychological Science.

Available URL{http://scholar.umw.edu/pscyhlogical_science}

Hassain, M et al, (2015) Gender stereotyping in family: An institutionalised and mormative mechanism in Pakhtun society of Pakistan. SAGE. Vol 1 (11).